Prevention of thromboembolism with ticlopidine shortly after valve repair or replacement with a bioprosthesis.

BACKGROUND AND AIMS OF THE STUDY: This study investigated the efficacy of postoperative ticlopidine as antiplatelet therapy in patients shortly after heart valve repair or replacement. METHODS: Between 1990 and 1995, 235 consecutive patients underwent either valve repair (n = 67) or replacement with a bioprosthesis (n = 168). The bioprostheses used were Carpentier-Edwards porcine or pericardial (n = 158) valves, Prima stentless valves (n = 3) and cryopreserved homografts (n = 7). Types of repair were aortic (one), mitral annuloplasty with Carpentier ring (65) and tricuspid repair (one). Mean patient age was 67 (range: 16 to 83) years for valve replacement and 57 (range: 32 to 74) years for repair (p < 0.01). Atrial fibrillation occurred in 34% of patients. The hospital mortality rate was 11% (26 patients). Of the 209 survivors, 137 were assigned to antiplatelet treatment with ticlopidine for the first three months of follow up. The other 72 received either oral anticoagulation (coumadin; n = 40), aspirin (n = 14) or no medication (n = 18). In 15 patients, ticlopidine treatment was interrupted due to diarrhea (13 cases), mild allergic reaction (one) or anemia (one). The mean follow up was 3.2 years (range: 1 month to 6 years); cumulative follow up was 684 patient-years (pt-yr) and was complete in 96% of cases. RESULTS: There were two episodes of thromboembolism in the ticlopidine group at 1 month and 6 months respectively, with a linearized incidence of 0.5% pt-yr. In the coumadin group there were four episodes of thromboembolism, three within the first three months of follow up. The linearized incidence was 3% pt-yr (p < 0.01). There were three episodes of hemorrhage in the ticlopidine group in the first three months of follow up and one in the coumadin group. The linearized incidence was 0.75% pt-yr. CONCLUSIONS: Following heart valve repair or replacement with a bioprosthesis, the first three months is a high-risk period for thromboembolism. Ticlopidine seems to prevent this complication better than conventional therapy with oral anticoagulants. Nevertheless, hemorrhage continues to be a problem with ticlopidine therapy.

[Minimally invasive coronary surgery. Thoracostomy-assisted thoracotomy. Apropos a case]. / Cirugía coronaria mínimamente invasiva. Toracotomía asistida por toracoscopia. A propósito de un caso.

UNLABELLED: CLINICAL CASE PRESENTATION: Male, 62 years old with progressive angina. Positive stress test. At catheterization a proximal 90% stenosis of the LAD was found. Not suitable for PTCA. SURGICAL TECHNIQUE: Double lumen endotracheal tube was inserted. Position was 30 degrees right lateral decubitus. The thoracoscope was introduced through the 7th intercostal space and a minithoracotomy was done. The internal mammary artery (IMA) was dissected partially through direct vision and partially with the help of the thoracoscope. The IMA graft was implanted to the LAD without cardiopulmonary bypass with a segmentary occlusion of the vessel with tourniquets. EVOLUTION: Thoracic drainage 575 cc, CK/MB 311/5, final hematocrit 37%. No blood transfusion. Dismissed on the 5th postoperative day.

[Congenital stenosis of pulmonary veins in the adult]. / Estenosis congénita de venas pulmonares en el adulto.

We report a case of congenital bilateral pulmonary vein stenosis associated with a double-chambered right ventricle, ventricular septal defect and persistence of the ductus arteriosus in a 29 year-old female. The angiographic, echocardiographic and surgical findings are discussed. A precise diagnosis, the utility of the echocardiography and the surgical correction of this type of ostial stenosis is also reported.