losartan-potassium and Mitral-Valve-Insufficiency

Brisk hemolysis due to perivalvular leak is usually an indication for valve re-replacement. Repeated surgery after multiple previous valve operations is associated with high mortality, morbidity and failure rates. The present study evaluated the role of erythropoietin (EPO) administration in deferring or obviating the need for repeated surgery.. Three patients (two men, one woman; age range 62-76 years) with two mechanical valves each and two to four previous heart valve operations, who suffered from severe mechanical hemolytic anemia, were given subcutaneous EPO for 15-17 months.. A marked reduction in red blood cell consumption was achieved with a weekly EPO dose of 18,000 U in two patients, both of whom also had mild or moderate kidney malfunction. A third patient with normal renal function and extreme hemolysis showed a transient, partial response to 30,000 U of EPO per week, and eventually needed a fifth operation.. EPO may defer or even obviate the need for repeated valve surgery in patients with severe hemolysis due to perivalvular leak, especially those with inadequate EPO response, such as those with renal malfunction.

Topics: Aged; Aged, 80 and over; Anemia, Hemolytic; Erythropoietin; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Reoperation; Risk Assessment; Severity of Illness Index

The effects of erythropoietin administration on mitral regurgitation in patients with congestive heart failure have not yet been examined. After 2 months, erythropoietin treatment results in a significant reduction in left ventricular volumes and mitral regurgitation severity and improves hemodynamics.

Topics: Erythropoietin; Heart Failure; Humans; Mitral Valve Insufficiency; Prospective Studies; Therapeutics; Ventricular Function, Left; Ventricular Remodeling

Haemolytic anaemia is a well-recognised but rare complication of heart-valve prostheses. The authors report a case of an 80-year-old woman with severe haemolytic anaemia previously treated with valvuloplasty and annuloplasty without rings. To our knowledge, no cases of haemolysis have been described with this type of surgery.

Topics: Aged, 80 and over; Anemia, Hemolytic; Atrial Fibrillation; Diagnosis, Differential; Echocardiography; Echocardiography, Transesophageal; Erythrocyte Indices; Erythrocyte Transfusion; Erythropoietin; Female; Hematocrit; Hemoglobinometry; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Postoperative Complications; Psychotic Disorders; Recombinant Proteins; Respiratory Insufficiency; Suture Techniques; Ultrasonography, Doppler, Color

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

Topics: Adult; Anemia; Antibody Specificity; Blood Grouping and Crossmatching; Erythroblastosis, Fetal; Erythrocytes; Erythropoietin; Female; Humans; Immunoglobulin G; Infant; Infant, Newborn; Isoantibodies; Mitral Valve Insufficiency; Phenotype; Pregnancy; Pregnancy Complications, Hematologic; Rh-Hr Blood-Group System; Risk Factors

The case of a patient with Osteogenesis imperfecta is reported who underwent surgery for mitral valve replacement. Osteogenesis imperfecta is a hereditary disease of the connective tissue, associated with bone fragility, bluish colouring of the sclerae, loss of hearing and dental anomalies. Osteogenesis imperfecta is included in a group of hereditary pathologies with Ehlers-Danlos syndrome, Hurler syndrome, pseudoxanthoma elasticum and Marfan syndrome. In the literature there are few cases of patients with osteogenesis imperfecta operated for mitral valve disease secondary to such disease. The patient also has a positive family history and a severe anaemia: this was treated with epoetin-alpha and ferrous sulphate during the three weeks before surgery. The response to epoietin treatment was good while clinical outcome was poor due to rupture of the posterior ventricular wall in the 12th postoperative hour. The use of epoietin-alpha is discussed.

Topics: Anemia; Erythropoietin; Fatal Outcome; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Osteogenesis Imperfecta; Postoperative Hemorrhage

An 11-year-old castrated male Dachshund was determined to have pancytopenia on the basis of results of CBC and bone marrow cytologic examination. Pancytopenia was believed to have resulted from administration of captopril, which had been administered for treatment of chronic mitral insufficiency, because other causes of pancytopenia were not found. Treatment consisted of discontinuing captopril and stimulating the bone marrow with recombinant human erythropoietin and granulocyte colony-stimulating factor. Although neutralizing antibodies will develop against the heterologous human protein, recombinant human granulocyte colony-stimulating factor should be considered for short-term treatment of neutropenias associated with adverse drug reactions, canine parvovirus infections, and bone marrow suppression from primary bone marrow disease, cancer chemotherapy, or total body irradiation before bone marrow transplantation.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Biopsy, Needle; Blood Cell Count; Bone Marrow; Captopril; Chronic Disease; Dog Diseases; Dogs; Erythropoietin; Granulocyte Colony-Stimulating Factor; Hematocrit; Male; Mitral Valve Insufficiency; Pancytopenia; Recombinant Proteins

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

Open heart surgery with non-blood transfusion was performed in 2 cases of severe mitral valve disease with cardiac cachexia by administering recombinant human erythropoietin (EPO). Case 1 was a 72-year-old and case 2 was a 66-year-old woman whose % usual body weight was 71-79% and Ht value on admission was 28.5-30%. Both patients were administered 9000-18000 U/week of EPO and ferrous sulfate pre- and postoperatively. In each case 800-1200 ml of autologous blood was drawn within 3 weeks preoperatively without hemodynamic change or decrease of Ht value. Both patients were received mitral valve replacement with non-blood transfusion. Preoperative administration of EPO and autologous blood preservation allowed open heart surgery with non-blood transfusion even in such a serious case as cardiac cachexia.

Topics: Aged; Blood Transfusion, Autologous; Cachexia; Erythropoietin; Female; Heart Valve Prosthesis; Hematocrit; Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Preoperative Care; Recombinant Proteins; Tricuspid Valve Insufficiency