Measurement of primary hemostasis potential with platelet function analyzer to investigate the predictive effect on post-operative blood loss in cyanotic and acyanotic pediatric patients

Aim: To investigate hemostatic parameters, including primary hemostasis potential in twenty pediatric patients with or without cyanosis undergoing cardio-pulmonary bypass (CPB) and cardiac surgery to repair congenital defects. Methods: The platelet function analyzer is an instrument that provides a rapid, in vitro, quantitative measurement of platelet adhesion and aggregation in whole blood flowing through a small aperture under high shear conditions. Other parameters monitored included blood loss, prothrombin time, anti-thrombin 3 activity, and fibrinogen and D-dimer levels. Additionally, hematocrit and albumin levels were monitored to assess the level of hemodilution during CPB. Results: Both, cyanotic and acyanotic pediatric patients had evidence of supranormal primary hemostasis potential. Although, measurements in cyanotic patients exhibited a higher percentage ratio, this was found to be statistically insignificant between cyanotic and acyanotic patients (collagen-epinephrine p=0.07 and, collagen and adenosine diphosphate (ADP) p=0.248). While, in preoperative period, measurements of primary hemostasis potential, coagulation and fibrinolytic system parameters demonstrated no statistically significant difference between cyanotic and acyanotic patients, measurement of prothrombin time, international normalized ratio and thrombin time levels significantly changed in cyanotic patients, after the operation (p<0,05). Longer cardio-pulmonary bypass time in cyanotic patients could be responsible for this indifference. Conclusion: The results of our study suggest that the platelet function analyzer system may be an indicator that it can predict bleeding in the postoperative period

Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

<p>Abstract</p> <p>Purpose</p> <p>Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study.</p> <p>Patients and Methods</p> <p>In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months.</p> <p>Results</p> <p>Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%).</p> <p>Conclusion</p> <p>We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.</p

Saccular Aneurysm Formation of the Descending Aorta Associated with Aortic Coarctation in an Infant

Aneurysm of the descending aorta associated with CoA is an extremely rare congenital abnormality. In this report, we present a 16 months old female patient in whom cardiac catheterization had been performed which had revealed a segment of coarctation and saccular aneurysm in the descending aorta. The patient was operated and a 3x2 centimeters aneurysm which embraces the coarcted segment in descending aorta was resected. In summary, we present a case of saccular aortic aneurysm distal to aortic coarctation in an infant without any history of intervention or vascular inflammatory disease. Our case report seems to be the youngest patient in literature with this pathology

Saccular aneurysm formation of the descending aorta associated with aortic coarctation in an infant

Aneurysm of the descending aorta associated with CoA is an extremely rare congenital abnormality. In this report, we present a 16 months old female patient in whom cardiac catheterization had been performed which had revealed a segment of coarctation and saccular aneurysm in the descending aorta. The patient was operated and a 3x2 centimeters aneurysm which embraces the coarcted segment in descending aorta was resected. In summary, we present a case of saccular aortic aneurysm distal to aortic coarctation in an infant without any history of intervention or vascular inflammatory disease. Our case report seems to be the youngest patient in literature with this pathology

Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass

6th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion -- MAY 06-08, 2010 -- Boston, MAWOS: 000284588300004PubMed ID: 21092030The objectives of this study were: (i) to evaluate the effects of perfusion modes (pulsatile vs. nonpulsatile) on vital organs recovery and (ii) to investigate the influences of two different perfusion modes on the homeostasis of thyroid hormones in pediatric patients undergoing cardiopulmonary bypass (CPB) procedures. Two hundred and eighty-nine consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and were randomly assigned to two groups: the pulsatile perfusion group (Group P, n = 208) and the nonpulsatile perfusion group (Group NP, n = 81). All patients received identical surgical, perfusional, and postoperative care. Study parameters included total drainage, mean urine output in the intensive care unit (ICU), intubation time, duration of ICU and hospital stay, the need for inotropic support, pre- and postoperative enzyme levels (ALT [ alanine aminotransaminase] and AST [ aspartate aminotransaminase]), c-reactive protein, lactate, albumin, blood count (leukocytes, hematocrit, platelets), creatinine levels, and thyroid hormones (thyroid stimulating hormone [ TSH], FT3 [ free triiodothyronine], FT4 [ free thyroxine]). All patients survived the perioperative and postoperative periods. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Group P, compared to Group NP, required significantly less inotropic support, had a shorter intubation period, higher urine output in ICU, and shorter duration of ICU and hospital stay. Lower lactate levels and higher albumin levels were observed in Group P and there were no significant differences in creatinine, enzyme levels, blood counts, or drainage amounts between two groups. TSH, Total T-3, Total T-4, and FT3, FT4 levels were markedly reduced versus their preoperative values in both groups. FT3 and FT4 levels were reduced significantly further in the nonpulsatile group both during CPB and at 72 h postoperation. The results of this study confirm our opinion that pulsatile perfusion leads to better vital organ recovery and clinical outcomes in the early postoperative period as compared to nonpulsatile perfusion in pediatric patients undergoing CPB cardiac surgery. The plasma concentrations of thyroid hormones are dramatically reduced during and after CPB, but pulsatile perfusion seems to have a protective effect of thyroid hormone homeostasis compared to nonpulsatile perfusion

Recurrent Thrombotic RCA Occlusions Due to Exaggerated Stent Protrusion into the Aorta

P>We report a case with exaggerated stent protrusion from the right coronary ostium into the aorta leading to recurrent inferoposterior and right ventricular myocardial infarctions due to stent thrombosis, which were treated successfully with fibrinolysis. The stent was removed via transverse aortotomy and two bypass grafts were performed. Stents protruding from the aorta may not only cause technical difficulties but also carry a high risk of thrombosis

Perfusion Practices and Education of Perfusionists for Open Heart Surgery in Turkey-Current Practices and Future Suggestions

Our objective is to compare our current findings with the findings of our former study in 2004 and to make new suggestions for the development of cardiovascular perfusion in Turkey according to the results of the survey in 2011