**1. Introduction**

368 Perioperative Considerations in Cardiac Surgery

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> Cardiac amyloidosis is a rare and complex pathology resulting in infiltrative restrictive cardiomyopathy and there are only very few clinical pathways through which the diseased amyloidotic heart may be a subject of cardiosurgical intervention. Cardiac surgery may rarely be warranted in very selected cases, and, on the other hand, may be performed mistakenly in misdiagnosed patients with cardiac amyloidosis. In clinical terms, the accumulation of expertise is hampered by the scarcity of its occurrence, heterogeneity of etiological subgroups, late clinical manifestation and polymorphous nature of symptoms.

> The term amylon was first coined by Matthias Schleiden, German botanist, in 1838, for waxy starch in plants. In 1842 Karl Rokitansky described amyloidosis in connection with hepatosplenomegaly and Rudolf Virchow used in 1854 iodine for staining of amyloid. Today, more than one and half century later, we recognize amyloidosis as a heterogeneous infiltrative disease in which insoluble protein deposits are accumulated in various organs with deleterious effects on their functional integrity. Kidney, heart, blood vessels, central and peripheral nervous systems, liver, intestines, lungs, eyes, skin or bones may be affected (Cohen 1967).
