Cardiac troponin T (cTnT) is derived from the troponin regulatory complex on the thin filament of the myocardial contractile apparatus. Because the cardiac isoform is distinct from the skeletal muscle isoform9 cTnT specifically identifies myocardial damage in a variety of clinical settings. "0'4 Its cardiac specificity makes it a particularly useful marker for assessing myocardial damage during cardiac surgery'4 by contrast with myoglobin and the MB isoenzyme of creatine kinase that may also be derived from skeletal muscle after cardiac operations."5 A serum cTnT concentration >0 2 ,ug/l detects myocardial injury whereas a value <2-5 jug/l excludes "significant" myocardial injury."3To compare the effects of cold crystalloid cardioplegia and intermittent ischaemic arrest on myocardial preservation 20 patients undergoing coronary artery surgery were randomised to either technique. Efficacy of myocardial protection was assessed by clinical course, electrocardiographic changes, and serial measurements of cTnT.
Patients and methods
PATIENTSWe studied 20 patients undergoing elective coronary surgery.
Traumatic tricuspid regurgitation (TR) is a rare cause of acute right ventricular dysfunction. The surgical technique could be complex and the reparative gesture has a lower success rate when compared with functional TR. We present the case of a 26‐year‐old male patient with traumatic TR who underwent tricuspid valve repair, with an initial satisfactory result. Later, the onset of acute severe residual TR was observed and the valve needed to be replaced. Surgery is the mainstay of treatment for traumatic TR, either in the form of repair or replacement. It requires an early diagnosis and concomitant treatment of injuries.
Aim: Post-operative bleeding remains a significant risk after
cardiac surgery. Despite adequate protamine reversal of heparin
intraoperatively, protein-bound heparin causes anticoagulant effect,
leading to bleeding in the post-operative period. The aim of this study
is to whether the use of a four-hour, low dose protamine infusion in
intensive care would reduce post-operative bleeding and hence, blood
transfusion requirements. Methods: A retrospective cohort study
of seven hundred and two patients, who underwent elective or urgent
coronary artery bypass grafting from April 2014 and January 2017, were
divided into two groups based on who received post-operative protamine
infusion (Group A, 472 patients) versus those who did not (Group B, 230
patients). They were assessed for amount of post-operative mediastinal
and pleural drainage for the first 24 hours, use of post-operative
transfusion of blood products, postoperative hospital stay, and
re-exploration. Results: We found no significant difference
between the rate of bleeding in either of the groups. No significant
difference was observed in blood product requirements as well. In the
sub-group consisting of patients with high BMI (BMI ≥30), who received
protamine infusion, post-operative platelets transfusion was found to be
significantly less. Conclusions: Our results suggest that a low
dose protamine infusion given in the immediate postoperative period does
not lead to any significant clinical benefits. Both patients receiving
and not receiving the infusion had similar postoperative drainage,
transfusion requirements, haemorrhagic morbidity, mortality and length
of hospital stay.
Introduction: Patients with central lung tumours often undergo surgery, offering them a chance of cure. With central lung tumours, there is always the dreaded risk of injury to the left main pulmonary artery (PA) and rupture of the anterior segmental artery, known as the artery of sorrow. Case Presentation: A 75-year-old lady with a background of breast cancer presented to our cardiothoracic centre because computed tomography (CT) of the chest revealed a left lung lesion of 5 x 4 x 3.7 cm, in contact with oblique fissure, radiological staging T3 N2 M0, which was later shown to be highly avid on positron emission tomography (PET-CT). Resection via thoracotomy was done, due to dense attachment to PA, Left PA defect was noted after resection which was repaired with a pericardial patch with no post-operative complication. Discussion: In the event of tumours invading the PA, it is safe to divide the tumours completely and repair the PA using a patch if there are any complications. Conclusion: We performed a repair of the PA using a pericardial patch and reconstruction of the PA using a pericardial patch, and evidence shows that there is excellent long-term survival associated with this.
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