losartan-potassium and Mitral-Valve-Stenosis

Topics: Anemia; Epoetin Alfa; Erythropoietin; Female; Heart Valve Prosthesis Implantation; Hematinics; Humans; Middle Aged; Mitral Valve Stenosis; Postoperative Complications; Preoperative Care; Recombinant Proteins; Risk Factors; Treatment Outcome

Topics: Erythropoietin; Female; Heart Valve Prosthesis; Hemolysis; Humans; Middle Aged; Mitral Valve Stenosis; Uremia

The patient was a sixty five-year-old woman and Jehovah's Witness who refused either homologous or autologous blood transfusion on the ground of her faith. At the age of 47, she had closed commissurotomy for mitral valve stenosis. This time, because mitral valve restenosis and tricuspid valve regurgitation were found, double valve replacement, mitral and tricuspid, was performed on her, with an excellent result. It is expected that, in the near future, the indication for open heart surgery without blood transfusion will be increased by means of the following considerations as to blood loss preservation; 1. to shorten the time necessitating for an operation and reduce preoperative blood loss, 2. to improve cardio-pulmonary bypass system (Heparin coating etc), and 3. to augment the erythropoiesis (administration of EPO at the patient's own expense, etc.) and so on.

Topics: Aged; Bioprosthesis; Christianity; Erythropoietin; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Stenosis; Reoperation; Tricuspid Valve; 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