Evaluations of topical application of tranexamic acid on post-operative blood loss in off-pump coronary artery bypass surgery

One of the major complications of cardiac surgery is the presence of post-operative bleeding. The aim of the present study was to investigate the topical application of tranexamic acid in the pericardial cavity on post-operative bleeding in off-pump coronary artery bypass graft [CABG] surgery. This study was on 71 patients who underwent off-pump CABG. The anesthesia and surgery methods were the same for all patients. Patients were assigned to two equal groups. In the first group, 1 g of tranexamic acid in 100 mL of normal saline solution [NSS] was applied to pericardium and mediastinal cavity at the end of surgery. In the second group, only 100 mL of NSS was applied. Chest drainage of the patients after 24 h and the amounts of blood and blood products transfusion were also recorded during this time. Patients were the same regarding demographic information and surgery. The average volume of blood loss after 24 h was 366 mL for the first group and 788 mL for the control group. There was a statistically significant difference between the two groups [P < 0.001]. The amount of packed red blood cells transfusion in the first group was less than that of the control group, which was not statistically significant. There was no statistically significant difference between the amount of hemoglobin, hematocrit, platelets, prothrombin time and partial thromboplastin time in the postoperative stage in the two groups. The topical application of tranexamic acid in off-pump CABG patients leads to a decreased post-operative blood loss.

Simultaneous transcatheter closure of ventricular septal defect and pulmonary valvuloplasty

Transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis [PS] in children. Transcatheter closure of perimembranous ventricular septal defect [VSD] with Amplatzer VSD occluder is an alternative to surgical repair. A 12 year old boy presented with history of exertional dyspnea and atypical chest pain. Physical findings were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvar pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after balloon pulmonary valvuplasty. We demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session

[Tracheo-innominate artery fistula as a late onset tracheotomy complication: a case report]

Tracheo-innominate artery fistula [TIF] is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The Incidence Rate of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a patient 50 days post tracheotomy, based on our research, it appears that our case is the first finding with the latest onset of TIF after tracheotomy, which now has been improved by early diagnosis and surgical treatment