We present two cases of carnitine deficiency in pregnancy. In our first case, systematic screening revealed L-carnitine deficiency in the first born of an asymptomatic mother. In the course of her second pregnancy, maternal carnitine levels showed a deficiency as well. In a second case, a mother known with carnitine deficiency under supplementation was followed throughout her pregnancy. Both pregnancies had an uneventful outcome. Because carnitine deficiency can have serious complications, supplementation with carnitine is advised. This supplementation should be continued throughout pregnancy according to plasma concentrations.
Background: Blood cardioplegia is a technique with many variations in its use. Intermittent cross clamping with Lidoflazine has proven to deliver good cardioprotection in our center. Question: Is tepid (32˚C) antegrade intermittent blood cardioplegia an efficient, safe and easy-to-use alternative to intermittent crossclamping with Lidoflazine in elective isolated CABG in low-risk patients? Primary outcomes are heart enzymes (cTnI, CK-MB). Secondary outcomes are operation times, length of hospital stay, major complications and in-hospital mortality. Methods: From January 2012 until November 2012, 40 patients with LVEF ≥50%, EuroSCORE II <3.5% and no severe systemic disease underwent elective CABG and were consecutively randomized to intermittent cross-clamping (ICC; n = 20) or blood cardioplegia (BCP; n = 20). All were operated on by the same surgeon. Results: There were no significant differences in age (BCP 65.34 ± 9.76; ICC 65.25 ± 8.42) and EuroSCORE II (BCP 1.25 ± 0.72; ICC 1.04 ± 0.71). There was a significant difference in cross clamp time (BCP 61.10 ± 23.07; ICC 41.30 ± 13.10). No significant differences in ECC-time (BCP 95.85 ± 27.04; ICC 113.80 ± 34.47) and number of distal anastomoses (BCP 2.70 ± 0.73; ICC 2.90 ± 0.72) were found. Values of cTnI 1-day postoperative (BCP 1.50 ± 0.76; ICC 4.50 ± 3.90), maximum cTnI (BCP 2.85 ± 1.73; ICC 6.40 ± 4.30) and maximum CK-MB (BCP 21.10 ± 22.30; ICC 31.35 ± 24.39) differed significantly. No significant differences in postoperative parameters were found: length of hospital stay (BCP 7.95 ± 1.40; ICC 8.25 ± 1.71), atrial fibrillation (BCP 0.20 ± 0.41; ICC 0.45 ± 0.51), major complications (BCP 0.35 ± 0.49; ICC 0.30 ± 0.47). There was no in-hospital mortality. Conclusion: Primary outcomes defined by the cardiac enzymes (cTnI, CK-MB) favour the use of tepid antegrade intermittent blood cardioplegia in low-risk patients undergoing elective CABG-operations. Regarding secondary outcomes, ICC showed shorter cross clamp times.
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