<i>Objective:</i> The aims of this study were to determine the rate of blood product transfusion, associated perioperative factors and cost of such blood product transfusion in primary coronary artery bypass surgery (CABG). <i>Subjects and Methods:</i>The medical records of 159 consecutive primary CABG patients (142 male, 17 female) from January 1, 2003 to June 30, 2003 at Chest Diseases Hospital, Kuwait, were reviewed. Urgent and emergency cases were included. <i>Results:</i> The mean age of the patients was 57.2 (range 36–77 years). Overall, 128 (80.5%) patients received blood product transfusion during primary CABG: 113 (70.5%) packed red blood cells (RBC), 54 (33.9%) fresh frozen plasma, and 13 (8%) platelets. Overall, 23 patients (12.6%) received more than two RBC transfusions intraoperatively. Significant factors for intraoperative RBC transfusion were: age >60 years, female gender, preoperative hemoglobin <12 g/dl, and 3 or more coronary bypass grafts constructed. One hundred and fifty-nine patients consumed 342 units of RBC at an average of 2.1 RBC units per patient. The cost per patient was 80 Kuwaiti dinar (KD; USD 240). <i>Conclusion:</i>The findings indicate a high rate of blood component transfusion in primary CABG patients in Kuwait that could expose the patients to the possible adverse effects, and such transfusions have high economic impact.
Coronary artery bypass surgery for coronary artery thrombosis in patients with polycythaemia rubra vera has been rarely described. The main issue with such patients is their risk of both bleeding and thrombosis and as such the ideal postoperative management of such cases is unknown. Hereby, we describe a case of a 62-year-old man with polycythaemia rubra vera who underwent coronary artery bypass surgery. Although his initial postoperative course was complicated, his long-term outcome was good.
IntroductionProsthetic valve thrombosis is a rare but life-threatening condition that requires careful evaluation and prompt treatment. While surgical intervention remains the gold standard, thrombolytic therapy is now emerging as a potential substitute. Various thrombolytic treatments including streptokinase, urokinase and recombinant tissue plasminogen activators have been reported with variable success rates. However, the data on the use of tenecteplase (a synthetic tissue plasminogen activator) is limited.Case presentationA 44-year-old Middle Eastern man with a previously implanted prosthetic mitral valve presented with exertional dyspnea and orthopnea. Investigations revealed a thrombosed prosthetic mitral valve. Successful thrombolysis was achieved using tenecteplase which lead to the complete restoration of valve function with no risk to the patient.ConclusionProsthetic valve thrombosis is a rare but life threatening condition, the diagnosis of which requires a high index of suspicion. Tenecteplase can be used successfully in the management of such cases. It has proved to be useful with no extra risk to the patient.
Atrial myxomas are rare tumors that require surgical excision. However, in the presence of a severely calcified ascending aorta, such excision becomes rather challenging and difficult. Here we report a case of a left atrial myxoma in a 64-year-old woman with an extensively calcified aorta that was successfully excised using cardiopulmonary bypass beating-heart technique without the need for cardioplegic cardiac arrest and aortic cross-clamping. The use of this technique proved useful with no increased risk incurred to the patient.
Dextrocardia with situs inversus is a rare condition. Few previously published cases have addressed the observation of isolated coronary artery disease or isolated mitral valve disease in these patients. However, the occurrence of ischemic mitral regurgitation in such cases has never been previously reported. Here, we report such a case with emphasis on both surgical and echocardiographic features.
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