ABSTRACT
BACKGROUND: Plasminogen activator inhibitor 1 (PAI-1) attenuates the conversion of plasminogen to plasmin. Polymorphisms of the PAI-1 gene are associated with varying PAI-1 levels and risk of prothrombotic events in nonsurgical patients. The purpose of this study, a secondary analysis of a clinical trial, was to investigate whether PAI-1 genotype affects the efficacy of tranexamic acid (TA) in reducing postoperative chest tube blood loss of patients undergoing cardiopulmonary bypass. METHODS: Fifty patients were classified according to PAI-1 genotype (4G/4G, 4G/5G, or 5G/5G). Twenty-four received 2 g TA before and after cardiopulmonary bypass, whereas 26 received placebo. The authors recorded data related to coagulation, fibrinolysis, and bleeding before surgery, at admission to the intensive care unit (0 h), and 4 and 24 h later. RESULTS: In patients not receiving TA, those with the 5G/5G genotype had significantly higher chest tube blood loss and transfusion requirements compared with patients with the other genotypes at all time points. Patients with the 5G/5G genotype receiving TA showed significantly lower blood loss compared with the placebo group. There were no significant differences in blood loss or transfusion requirements between patients with the 4G/4G genotype when TA was used. CONCLUSIONS: Plasminogen activator inhibitor-1 5G/5G homozygotes who did not receive TA showed significantly greater postoperative bleeding than patients with other PAI-1 genotypes. 5G/5G homozygotes who received TA showed the greatest blood-sparing benefit.
Subject(s)
Cardiopulmonary Bypass/adverse effects , Homozygote , Plasminogen Activator Inhibitor 1/genetics , Polymorphism, Genetic/genetics , Postoperative Hemorrhage/genetics , Tranexamic Acid/therapeutic use , Aged , Female , Humans , Male , Middle Aged , Polymorphism, Genetic/drug effects , Postoperative Hemorrhage/prevention & control , Randomized Controlled Trials as Topic/methods , Tranexamic Acid/pharmacologySubject(s)
Coronary Artery Bypass/methods , Diabetic Angiopathies/surgery , Graft Occlusion, Vascular/prevention & control , Mammary Arteries/transplantation , Coronary Artery Bypass/adverse effects , Diabetes Mellitus, Type 1/complications , Graft Survival , Humans , Prognosis , Risk Assessment , Treatment OutcomeABSTRACT
An aortic neck with a nonconstant diameter represents a challenge for endovascular treatment. We report our experience in a patient with right aortic arch, aneurysmatic aberrant subclavian artery, aortic coarctation, and a precoarctation aneurysm that was treated with surgery and endoprothestic procedures in two stages.
Subject(s)
Aneurysm/therapy , Aorta, Thoracic , Aortic Aneurysm/therapy , Aortic Coarctation/therapy , Blood Vessel Prosthesis Implantation , Blood Vessel Prosthesis , Subclavian Artery/abnormalities , Aged , Anastomosis, Surgical , Carotid Arteries/surgery , Equipment Design , Female , Humans , Subclavian Artery/surgery , Treatment OutcomeSubject(s)
Heart Neoplasms/diagnosis , Pheochromocytoma/diagnosis , Adult , Female , Heart Atria , HumansSubject(s)
Aneurysm, False/surgery , Aortic Coarctation/surgery , Aortic Diseases/surgery , Blood Vessel Prosthesis , Adult , Aorta, Thoracic , Humans , Male , Time FactorsABSTRACT
Endocarditis produced by Erysipelothrix rhusiopathiae is an uncommon disease in humans. This bacterial species is found worldwide as a commensal or a pathogen in many animals. Infection in humans is usually due to occupational exposure. The case is reported of a 43-year-old male parrot breeder with native aortic and mitral valve endocarditis and NYHA class II heart failure at six months after wound infection. The patient was discharged after six weeks' treatment with intravenous penicillin G and replacement of the mitral and aortic valves due to severe regurgitation. At one year after surgery the patient was asymptomatic and infection-free.
