ABSTRACT
Objective This study was designed to evaluate the change in coagulation and platelet function during cardiac surgery using SONOCLOT(SCT), a new coagulation and platelet function analyser which can analyse the whole process of coagulation including platelet function , fibrin formation and fibrinolysis with only 0 4ml of whole blood Methods Thirty ASA Ⅱ Ⅲpatients scheduled for cardiac surgery were studied 15 patients underwent valve replacement (group V) and another 15 patients coronary artery bypass graft (CABG, groupC) under combined intravenous and inhalation anesthesia Anesthesia was induced with midazolam 0 05mg?kg -1 ,fentanyl 5 10?g kg -1 or propofol 1 1 5mg?kg -1 and vecuronium 0 1 0 2mg?kg -1 and maintained with isoflurane(0 8 1 5MAC) supplemented with intermittent boluses of propofol and fentanyl ECG,SpO 2, P ET CO 2, BP, CVP, PAP, HCT and T were monitored during operation And dopamine, adrenaline, nitroglycerin, milrinone and other vasoactive drugs were used to maintain hemodynamic stability Blood samples were taken before anesthesia (T 1), after induction (T 2), after heparinization 3mg? kg -1 ( T 3) and 5min after protamine administration (T 4) for determination of ACT, clot rate and platelet function using SONOCLOT analysis Platelet counts were checked at T 1 and T 4 Results CPB time was less than 2h in all 30 patients Clot rate was significantly faster at T 2 than at T 1(P
ABSTRACT
This paper is to analyze the clinical features of infective endocarditis (IE) and summarize the experience of surgical treatment. The retrospective review was based on 65 consecutive patients, who fulfilled the Duck criteria of the diagnosis of endocarditis, admitted from Jan 1997 to Jun 2002. There were 44 males and 21 females, with age ranged from 9 to 68 years. Pre operative blood cultures were positive in 20 out of 55 patients(45%), with Streptococcus in 8 (45%). Staphylococcus in 9 (40%), and other bacteria in 3 (15%). Echo cardiography revealed vegetations in 62 cases, involving the mitral valve in 19 cases, aortic valve in 31 case, pulmonary valve in 5 cases, tricuspid valve in 5 cases, and valsalva sinus in 2 cases. Among 65 patients, aortic valve replacement was performed in 22, mitral valve replacement in 13, combined aortic and mitral valve replacements in 5, mitral valve plasty in 3, repair of atrial septal defect in 2, ventricular septal defects in 14, rupture of Valsalva sinus in 3, correction of tetralogy of Fallot in 1, patent ductus arteriosus in 2. Four patients died in hospital. 56 patients (91%) were followed up for 6 months to 69 months. Two patients with replacement of aortic valve died 1 and 3 years later due to congestive heart failure and sepsis. In the other 54 patient, no recurrent infection was found. One year, 3 year, and 5 year survival rates were 96 6%, 90 1%,90 1%, respectively. The results suggest that urgent early diagnosis and optimal surgical intervention play key role in successful treatment of infective endocarditis.