losartan-potassium and Aortic-Aneurysm

Blood-sparing surgical technique and perioperative medical management allows complex surgery in Jehovah's Witnesses. The authors review four cases of urgent cardiothoracic surgery performed on Jehovah's Witnesses. No lasting sequelae associated with either bleeding or end-organ ischemia were noted. Cardiopulmonary bypass management, meticulous hemostatic operative technique, and pharmacologic support of hemostasis and erythropoiesis permit this complex surgery.

Topics: Adult; Aged; Anti-Bacterial Agents; Aortic Aneurysm; Aortic Dissection; Aprotinin; Blood Transfusion, Autologous; Blood Vessel Prosthesis Implantation; Cardiac Surgical Procedures; Cardiac Tamponade; Combined Modality Therapy; Comorbidity; Endocarditis, Bacterial; Erythropoietin; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Hematocrit; Hemodilution; Humans; Iron; Jehovah's Witnesses; Male; Patient Acceptance of Health Care; Preoperative Care; Streptococcal Infections; Treatment Refusal; Viridans Streptococci

Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee. There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/dl. Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively. We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.

Topics: Aortic Aneurysm; Aortic Valve Insufficiency; Cardiac Surgical Procedures; Child; Christianity; Endocarditis, Bacterial; Erythropoietin; Heart Valve Prosthesis Implantation; Humans; Male; Sinus of Valsalva

The risks of homologous blood transfusion are well known. Herein, we describe the successful preoperative use of human recombinant erythropoietin to correct severe anemia in a patient refusing transfusion. This case report emphasizes the important perioperative role human recombinant erythropoietin may play in the future.

Topics: Anemia; Aorta, Thoracic; Aortic Aneurysm; Erythropoietin; Female; Humans; Middle Aged; Premedication; Preoperative Care; Recombinant Proteins; Religion and Medicine