losartan-potassium and Aortic-Valve-Insufficiency

Topics: Acetylcysteine; Aged; Aortic Valve; Aortic Valve Insufficiency; Aspartate Aminotransferases; Bilirubin; Cardiac Catheterization; Drug Administration Schedule; Erythropoietin; Ferrous Compounds; Folic Acid; Glucose; Heart Valve Prosthesis; Hematinics; Hemoglobinuria; Hemolysis; Humans; Infusions, Intravenous; L-Lactate Dehydrogenase; Male; Mitral Valve; Mitral Valve Insufficiency; Renal Insufficiency; Treatment Outcome; Ultrasonography

A 50-year-old man was admitted to our hospital for possible surgery. Echocardiogram showed severe calcification of the aortic valve, and cardiac catheter examination recorded a gradient greater than 150 mmHg across the valve. These results determined aortic valve replacement (AVR) to relieve the pressure-overloaded ventricle. Preoperative evaluations however, demonstrated anemia derived from hereditary spherocytosis (HS), an inherited hemolytic disorder. In order to avoid homologous blood transfusion, the following strategies were tried; 1) an iron supplement and an injection of recombinant human erythropoietin (rHuEPO); 2) pre- and perioperative autologous blood transfusion; and 3) an aggressive iron supplement just after the surgery. These raised the blood hemoglobin concentration to the criterion where autologous blood donation was started, and maintained the hemoglobin level stable, up to his discharge. In conclusion, bloodless cardiac surgery is possible for cases with anemia, and some strategies should be tried to raise and maintain the blood hemoglobin concentration well.

Topics: Aortic Valve; Aortic Valve Insufficiency; Blood Transfusion, Autologous; Drug Administration Routes; Drug Therapy, Combination; Echocardiography; Erythropoietin; Follow-Up Studies; Heart Valve Prosthesis Implantation; Hemoglobins; Humans; Intraoperative Period; Iron Compounds; Male; Middle Aged; Recombinant Proteins; Spherocytosis, Hereditary

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

In view of the transfusional risks of viral transmission (notably HIV), autologous transfusion is increasingly used; it is often the only possible type of transfusion. A 42-year-old woman with lupus erythematosus, chronic renal failure and triple cardiac valve disease demanding surgery was admitted for multifactorial severe anaemia. Treatment with erythropoietin (8000 units/day) iron replenishment, corticosteroids and polyvalent immunoglobulins was initiated. The patient was operated upon in April 1990. A preoperative cell-saver autotransfusion was performed during surgery. The postoperative period was uneventful. Homologous transfusion was not necessary. In this case where homologous transfusion was ruled out, erythropoiesis stimulated by erythropoietin enabled autotransfusion and cardiac surgery to be performed.

Topics: Adult; Anemia; Aortic Valve Insufficiency; Blood Transfusion, Autologous; Erythropoietin; Female; Humans; Immunotherapy; Kidney Failure, Chronic; Lupus Erythematosus, Systemic; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency

Topics: Adult; Aged; Aged, 80 and over; Aortic Valve Insufficiency; Aortic Valve Stenosis; Cardiac Surgical Procedures; Christianity; Coronary Artery Bypass; Erythropoietin; Female; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Middle Aged; Mitral Valve Insufficiency; Myocardial Infarction; Pulmonary Valve Stenosis; Religion and Medicine; Rheumatic Heart Disease; Tricuspid Valve Insufficiency