Gelatin, ringer or modern hydroxyethyl starch solutions: which is better after coronary artery bypass graft?

Hemodynamic stability in patients after coronary artery bypass graft surgery [CABG] with the cardiopulmonary bypass pump [CPB], especially during transfer to ICU ward and the early hours of ICU admission is very important. Adequate fluid therapy and intravascular volume maintenance as a matter of principle is essential using various intravenous fluids, but there is always the question of what is the ideal intravenous fluid?. The aim of this study is to compare the effects of gelatin, hydroxyethyl starch [HES 6%, Voluven], and Ringer's solution to maintain hemodynamic status after cardiopulmonary bypass in patients undergoing coronary artery bypass surgery. In this randomized double blind clinical trial, 92 patients who were candidates for onpump CABG were studied. After discontinuation of CPB, all patients were transferred to the ICU and were put randomly into three groups. The first group received Ringer's solution, the second group gelatin 4%, and the third group HES 6% [Voluven]. Hemodynamic parameters like heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented. The volume that was needed for maintaining normal blood pressure and central venous pressure [CVP] in the range of 10 to 14 mmHg was less in the HES group than the other groups, but was similar in the gelatin 4% and Ringer's groups in the first 24-hours after surgery. Urinary output in the first four hours and 24 hours after surgery were significantly higher in the HES group than the other two groups, and mean creatinine levels were significantly lower in the HES group. HES 6% has better volume-expanding effects than gelatin 4% and Ringer's solution and its short-term effects on renal function are also better

12-year experience with primary cardiac tumors

We report our experience with 117 patients with primary cardiac tumors who underwent surgery at our institute [a referral center] between March 1995 and February 2006.The patients comprised 47 men and 70 women with a mean age of 44.97 years [range: 2.5- 81 years]. The predominant symptom was dyspnea on exertion and palpitation. In all the patients, echocardiography was the main diagnostic tool, but magnetic resonance imaging [MRI] and CT scan and coronary angiography were also performed if indicated. Most of the tumors were found in the left atrium [LA] [77.77%], but the other chambers were also involved with lesser prevalence [right atrium: 7.5%, left ventricle: 5.1%, and right ventricle: 2.5%]. Involvement of multiple chambers was found in 8 [6.8%] patients.All the patients survived the surgical procedure and were discharged from hospital. Follow-up ranged from 1-10 years [mean: 2.4 years]. The most prevalent tumor was myxoma [104 cases], followed by sarcoma [4 cases] and fibroma [2 cases]. Four patients had secondary [metastatic] cardiac tumors [two Hodgkin lymphoma, one renal cell carcinoma, and one osteosarcoma] and were consequently excluded from the study

Unusual intraoperative fracture of a 21mm Regentr St. Jude Medical [SJM] Valve

A case of aortic valve replacement [AVR] with St. Jude Medical [SJM] Regent_ valve no 21, that was fractured intraoperatively and replaced with a SJM Regent_ valve no 19, is reported here.The fracture point was ring part of the valve that has not been reported yet

Coronary artery bypass graft in porcelain aorta

A 48 years old male, with porcelain ascending aorta, and diffuse and severe stenosis of great vessels who underwent coronary artery bypass graft [CABG], and the challenges surgeons may encounter in relation to these patients are discussed along with the review of corresponding literature on this challenging entity in cardiac surgery