Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehovah's Witness: a case report.

Cardiac surgery on Jehovah's Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to +/-50 ml. Bypass time was 63 min with an average blood flow of 5300+/-114 ml/min and postmembrane pressures of 180+/-45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55+/-12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.

[Endovascular treatment of 2 patients with an aneurysm of the descending thoracic aorta]. / Endovasculaire behandeling van 2 patiënten met een aneurysma van de thoracale aorta.

Two men, aged 71 and 70, who had previously experienced an abdominal aneurysm were found to have thoracic aortal aneurysms of respectively 8 cm and 7.5 cm in length. For the first patient an endovascular operation was carried out due to a high operative risk: with the help of a radiograph, four endoprostheses were inserted into the thoracic descending aorta via the femoral artery, after which the aorta diameter became more normal. A month later, the patient died from persistent renal failure, which had developed as a result of the previously ruptured abdominal aneurysm. In the second patient with an aneurysm of the proximal descending aorta, a left decompensation arose following aortal clamping during open surgical repair. Ten weeks later an endoprosthesis was inserted via the femoral artery. A year later the aortal diameter had decreased to 6.5 cm; the patient functioned well. The insertion of an endoprosthesis in the thoracic aorta is a minimally invasive procedure in which the patient experiences little perioperative inconvenience.

Acquired aorto-pulmonary fistula in acute dissection.

We describe a 41-year-old man with an acute dissection of the ascending aorta with fistulation into the pulmonary artery. The diagnosis was made pre-operatively by 2-D and Doppler echocardiography. Surgery was successfully performed.