RESUMO
Acute normovolemic hemodilution [ANH] and preoperative autologous blood donation [PABD] have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances. In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery [35 in ANH, 35 in PABD] in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the infl uence of two transfusion methods on homeostatic function and hemodynamic balance. We compared 70 patients [38 male [54.3%] and 32 female [45.7%]] with mean age 54.8 years undergoing open heart surgery [CABG and valvular]. In ANH group, significant decrease was detected in Na [28.5%] K [2.5%], prothrombin time [PT] [88.57%], partial thromboplastin time [PTT] [94.28%], creatine phosphokinase [CPK] [11.4%], lactic dehydrogenase [LDH] [11.43%], albumin [Alb] [17.14%], globulin [91.43%] and total protein [80%]. Mean initial and post-operative hemoglobin was 14.12 +/- 1.06 versus 11.97 +/- 0.98, hematocrit 42.22 +/- 3.45 versus 35.40 +/- 2.88, systolic blood pressure 124.1 +/- 14.4 versus 110.88 +/- 15.6 [reduction 22.86%] diastolic blood pressure 76.02 +/- 10 versus 69.26 +/- 11 [reduction 3%] and pulse rate was 75.45 +/- 10 versus 84.45 +/- 12 [12%] in this case difference between two groups was strongly significant [P = 0.001]. In PABD group, significant decrease was detected in Na [20%], K [2.5%], PT [91.43%] PTT [80%], CPK [8.57%], LDH [5.72%], Alb [57.15%], globulin [71.43%] and total-protein [62.85%], the value of hemodynamic changes were in normal range. Though aut ologous blood transfusion [ANH and PABD] was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance
RESUMO
To report calcified aortic stenosis due to hyper-cholesterolemia in two siblings. Case Presentation and Intervention: A 13-year-old boy with a history of dyspnea on exertion and a systolic murmur of aortic stenosis was referred to our center. Echocardiography showed combined valvular and supravalvular aortic stenoses with a good left ventricle systolic function and severe left ventricular hypertrophy. Two years later his 17-year-old sister was referred to the clinic with similar symptoms. Severe valvular aortic stenosis was detected by echocardiography. Selective coronary angiography showed significant involvement. The father had a history of hypercholesterolemia and confirmed coronary artery disease involving 3 vessels. Angiography showed anterioapical and inferiobasal hypokinesis with preserved left ventricle systolic function. The mother and the other two siblings did not have hyperlipidemia, thereby indicating heterozygous familial hypercholesterolemia in the two affected siblings. The siblings were managed with atrovastatin and nicotinic acid and cholestyramine was added stepwise. The father was treated with lovostatin. This report shows that severe hyperlipidemia in very young patients may be a risk factor for valvulopathy