warfarin and Marfan-Syndrome

A 55-year-old man with Marfan syndrome taking warfarin for anticoagulant therapy after aortic valve replacement developed acute kidney injury (serum creatinine level of 9.01 mg/dL) and gross macrohematuria. Renal biopsy showed red cell casts in the renal tubules, glomerular crescent formation in the glomeruli with immunoglobulin A deposition, and global sclerosis. Based on these findings, the patient was diagnosed with warfarin-related nephropathy with acute kidney injury characterized by immunoglobulin A nephropathy with crescents. The warfarin was withdrawn, and his hematuria and renal function improved without immunosuppressive agents.

Topics: Acute Kidney Injury; Anticoagulants; Aortic Valve Insufficiency; Glomerulonephritis, IGA; Hematuria; Humans; Kidney; Kidney Glomerulus; Kidney Tubules; Male; Marfan Syndrome; Middle Aged; Treatment Outcome; Warfarin

A 78-year-old man presented with abdominal pain, high International Normalised Ratio and rapidly falling haemoglobin. He had a background of Marfan syndrome and was on warfarin following mechanical aortic valve replacement. Abdominal CT imaging showed haemoperitoneum with a leaking aneurysm of the left gastric artery measuring 10 mm in diameter. The decision whether to reverse his anticoagulation provided a difficult clinical scenario given the risk of thrombosis associated with the mechanical aortic valve. The patient went on to have a successful percutaneous embolisation of the aneurysm using a metallic coil and Onyx. Left gastric artery aneurysms are rare and have a reported mortality of up to 70%. This is the first case of gastric artery aneurysm described in a patient with Marfan syndrome.

Topics: Abdominal Pain; Aged; Anticoagulants; Aortic Aneurysm, Abdominal; Aortic Dissection; Blood Vessel Prosthesis Implantation; Celiac Artery; Embolization, Therapeutic; Heart Valve Prosthesis; Humans; Male; Marfan Syndrome; Risk; Warfarin

Topics: Aged; Anticoagulants; Aortic Valve; Blood Coagulation Factors; Cardiac Tamponade; Heart; Heart Valve Prosthesis Implantation; Humans; International Normalized Ratio; Male; Marfan Syndrome; Pericardial Effusion; Pericardiectomy; Pericardium; Postoperative Complications; Postoperative Hemorrhage; Thrombosis; Warfarin

A case of central retinal artery occlusion in a patient with Marfan's syndrome secondary to possible thromboembolism from a prolapsed mitral valve is presented. Clinical investigations and treatment of this condition are discussed. The world literature on retinal occlusive events secondary to mitral valve prolapse is briefly summarised. To the best of our knowledge, this is the first case report in the literature of central retinal artery occlusion in a patient with Marfan's syndrome.

Topics: Adult; Female; Fluorescein Angiography; Fundus Oculi; Humans; Marfan Syndrome; Mitral Valve Prolapse; Retinal Artery Occlusion; Thromboembolism; Warfarin