Suppressed fibrinolysis after administration of low-dose aprotinin: reduced level of plasmin-alpha2-plasmin inhibitor complexes and postoperative blood loss

Various clinical investigation have shown that aprotinin therapy reduces bleeding after open-heart operations. In this study low-dose aprotinin, 30,000 KIU/kg in the cardiopulmonary bypass (CPB) priming volume and 7,500 KIU/kg intravenously each hour during CPB, was used in ten patients undergoing primary myocardial revascularization or surgery for valvular diseases. Another ten patients served as controls. Blood loss, platelet count and plasma levels of hemoglobin, antithrombin III, fibrinogen, fibrinogen degradation products (FDP), total plasmin inhibitor and alpha2-plasmin inhibitor-plasmin complexes were evaluated at nine preoperative, intraoperative and postoperative points. Intraoperative and postoperative blood loss was significantly reduced in the aprotinin group. There was no significant difference between the two groups in platelet count and levels of hemoglobin and antithrombin III. A significant increase in FDP during CPB in the control group indicated hyperfibrinolysis. The levels of plasmin inhibitor were significantly reduced during CPB in the control group. The alpha 2-plasmin inhibitor-plasma complex levels, indicating the plasmin activity, were significantly reduced in the aprotinin group. These results confirmed that low-dose aprotinin reduced blood loss with the prevention of hyperfibrinolysis during CPB and demonstrated improved hemostasis.

Combined mitral valve prolapse and atrial septal aneurysm. A cause for embolic events

The "association" atrial septal aneurysm and mitral valve prolapse is often asymptomatic with an incidence of about 1% in autopsied adults. Occasionally, however, embolic phenomena can occur. The two-dimensional echocardiography allows an accurate diagnosis of these two cardiac lesions when present. In this paper the Authors report on three patients affected by mitral valve prolapse associated with atrial septal aneurysm, one of whom complicated by a cerebral embolism. Owing to the significant incidence of peripheral or cerebral vascular embolic events in this group of patients, the Authors conclude that long-term anticoagulation therapy is mandatory in all cases, whereas a surgical repair could be advisable when a previous embolism or interatrial shunting is demonstrated.

Protection by coenzyme Q10 from myocardial reperfusion injury during coronary artery bypass grafting

To evaluate the effect of coenzyme Q10 in reducing postoperative cardiac complications after ischemia and reperfusion, we randomly divided 40 patients undergoing elective coronary artery bypass into two groups: patients in group 1 received coenzyme Q10 (150 mg/day) for 7 days before operation, and those in group 2 were the control group. Concentrations of thiobarbituric acid-reactive substances (malondialdehyde), conjugated dienes, and cardiac isoenzymes of creatine kinase were measured in samples from both arterial and coronary sinus sites. Serial sampling was performed 5 minutes after heparin administration, at 10 and 30 minutes during cardiopulmonary bypass, 15 and 30 minutes after aortic cross-clamp removal, and 5 minutes after protamine administration. The concentrations of malondialdehyde, conjugated dienes, and creatine kinase in group 1 were significantly lower than those in group 2. The decrease in plasma malondialdehyde concentrations correlated positively with the decrease in creatine kinase levels in the coronary sinus. The treatment group showed a significantly lower incidence of ventricular arrhythmias during the recovery period than did the control group (p < 0.05). Although the percentage of patients requiring inotropic agents was not significantly different between the two groups, the mean dosage of dopamine required to maintain stable hemodynamics was significantly lower in patients of group 1 than in those of group 2 (p < 0.01). Our findings suggest that pretreatment with coenzyme Q10 may play a protective role during routine bypass grafting by attenuating the degree of peroxidative damage.

Primary malignant melanoma of the oesophagus with a left atrial metastasis

A 75 year old man with an eight month history of dysphagia and weight loss underwent pericardiocentesis for a massive pericardial effusion. The echocardiogram showed a mass in the left atrium, and computed tomography also showed distal oesophageal narrowing, which was found to be due to a malignant melanoma. The left atrial mass, investigated by immunoscintigraphy with technetium-99m labelled monoclonal antibody, was diagnosed as metastatic melanoma. This represents a rare case of primary oesophageal melanoma with left atrial metastasis.

[Isolated traumatic rupture of the ascending aorta. Clinical case and review of the literature]

Rupture of the descending aorta after severe blunt chest trauma is a well recognised injury. Instead, isolated traumatic rupture of the ascending aorta is rarely diagnosed, with only five cases reported in the literature. A case of isolated traumatic rupture of the ascending aorta is here reported and the role of medical treatment is described.