**5.2 Planned surgical intervention in correctly diagnosed cardiac amyloidosis**

In contradiction to the abovementioned, very few reports describe intentional reconstructive cardiac surgery in patients with diagnosed cardiac amyloidosis. In 1983, Goffin coined a term dystrophic valvular amyloidosis for isolated amyloid deposits in cardiac valves (Goffin 1980). Successful aortic valve replacement was described by Iqbal (Iqbal, Reehana et al. 2006). In two cases, severe mitral regurgitation from papillary muscle or chordae rupture was successfully treated by valve repair and valve replacement (Coisne, Corbi et al. 2003; Nishi, Mitsuno et al. 2008). Obstructive intramural coronary amyloidosis was the speculative explanation for ischemic papillary muscle rupture in the latter case (Coisne, Corbi et al. 2003). Namai replaced successfully both mitral and aortic valve for endocarditis in a 62-year-old patient with multiple myeloma combined with renal amyloidosis (Namai, Sakurai et al. 2010). Uneventful postoperative course in these rare cases indicates that degree and distribution of morphological derangement, and moreover, the resulting functional deficit may vary considerably and therefore cannot be easily estimated prospectively.

Fig. 2. Obstructive amyloid deposits in the wall of small intramyocardial artery

**5.2 Planned surgical intervention in correctly diagnosed cardiac amyloidosis** 

percutaneous coronary intervention even in a difficult topography, instead of a surgery. Severe valve disease in a known cardiac amyloidosis would most probably lead to decision

In contradiction to the abovementioned, very few reports describe intentional reconstructive cardiac surgery in patients with diagnosed cardiac amyloidosis. In 1983, Goffin coined a term dystrophic valvular amyloidosis for isolated amyloid deposits in cardiac valves (Goffin 1980). Successful aortic valve replacement was described by Iqbal (Iqbal, Reehana et al. 2006). In two cases, severe mitral regurgitation from papillary muscle or chordae rupture was successfully treated by valve repair and valve replacement (Coisne, Corbi et al. 2003; Nishi, Mitsuno et al. 2008). Obstructive intramural coronary amyloidosis was the speculative explanation for ischemic papillary muscle rupture in the latter case (Coisne, Corbi et al. 2003). Namai replaced successfully both mitral and aortic valve for endocarditis in a 62-year-old patient with multiple myeloma combined with renal amyloidosis (Namai, Sakurai et al. 2010). Uneventful postoperative course in these rare cases indicates that degree and distribution of morphological derangement, and moreover, the resulting functional deficit may vary considerably and therefore cannot be

(hematoxyllin-eosin, 400x)

for conservative treatment.

easily estimated prospectively.
