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Lin PS, Yao YT. Perioperative Management of Hemophilia A Patients Undergoing Cardiac Surgery: A Literature Review of Published Cases. J Cardiothorac Vasc Anesth 2020; 35:1341-1350. [PMID: 32723585 DOI: 10.1053/j.jvca.2020.06.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the perioperative management of patients with hemophilia A (HA) who undergo cardiac surgery. DESIGN Retrospective analysis of the published literature. SETTING University hospital. PARTICIPANTS HA patients undergoing cardiac surgery. INTERVENTIONS The PubMed, Embase, Web of Science Core Collection, CNKI, VIP, and WANFANG databases were searched with the terms "hemophilia A," "cardiac surgery," "cardiopulmonary bypass," "coronary artery bypass graft," "valve disease," and "congenital heart disease" to identify relevant articles. Data regarding patient characteristics, perioperative management protocols, and clinical outcomes were extracted and analyzed. MEASUREMENTS AND MAIN RESULTS Fifty articles, with 72 patients aging from 12 days to 80 years, were included. The analyzed population consisted of 36 (50%) mild HA, 10 (14%) moderate HA, and 25 (35%) severe HA patients. Factor VIII inhibitors were detected in 7 cases. Surgical procedures included 27 coronary artery bypass grafting procedures, 15 valve surgeries, 8 combined coronary artery bypass grafting with valve surgery procedures (1 with left ventricular assist device), 1 ventricular aneurysm resection with valve surgery, 11 corrections of congenital heart disease, 7 adult aortic surgeries, 3 heart transplantations, and 1 repair of heart injury. Factor VIII concentrates were used as a substitution therapy to ensure normalization of perioperative coagulation function. Although an uneventful clinical outcome was achieved in the majority of cases, 20% of patients developed complications with different severities. CONCLUSIONS Execution of a perioperative management strategy with a multidisciplinary approach, a thorough factor replacement protocol, and careful monitoring of factor levels facilitate an optimal outcome for HA patients undergoing cardiac surgery.
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Affiliation(s)
- Pei-Shuang Lin
- Department of Anesthesiology, Fujian Medical University Affiliated First Quanzhou Hospital, Fujian, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Rupert E, Muralidhar K, Shetty DP. Tetralogy of Fallot and Hemophilia A: Successful Management of Intracardiac Repair. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239900700214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 4-year-old boy with moderately severe factor VIII deficiency underwent successful intracardiac repair of tetralogy of Fallot under cardiopulmonary bypass with the aid of factor VIII concentrates and aprotinin.
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Affiliation(s)
- Emmanuel Rupert
- Department of Cardiac Anaesthesiology Manipal Heart Foundation Bangalore, India
| | - Kanchi Muralidhar
- Department of Cardiac Anaesthesiology Manipal Heart Foundation Bangalore, India
| | - Devi Prasad Shetty
- Department of Cardiac Anaesthesiology Manipal Heart Foundation Bangalore, India
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Thankachen R, George B, Shukla V, Korula RJ. Aortic and Mitral Valve Replacement in a Patient with Hemophilia B. Asian Cardiovasc Thorac Ann 2016; 15:526-7. [DOI: 10.1177/021849230701500618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 25-year-old man with factor IX deficiency had an aortic and mitral valve replacement using a 2M Starr Edwards valve in the mitral position and a 22 Medtronic valve in the aortic position under cover of factor IX concentrate. The surgical procedure and the immediate postoperative period were uneventful except for a pericardial effusion which required a pericardiostomy. He was anticoagulated with heparin in the immediate postoperative period while the factor IX concentrate was being administered. Oral anticoagulation with acenocoumarol (Acitrom®) was started, maintaining the international normalized ratio between 1.5 and 2. He was doing well at follow-up 9 months later.
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Affiliation(s)
| | - Biju George
- Department of Hematology, Christian Medical College and Hospital, Vellore, India
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Barbara DW, McKenzie KM, Parikh SA, Ashrani AA, Pruthi RK, Burkhart HM, Suri RM, Mauermann WJ. Successful Perioperative Management of Severe Bleeding From Undiagnosed Acquired Factor VIII Inhibitors. J Cardiothorac Vasc Anesth 2014; 29:731-4. [PMID: 24462516 DOI: 10.1053/j.jvca.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Indexed: 11/11/2022]
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Ventricular assist device as a bridge to transplant, and extracorporeal membrane oxygenation for primary graft failure in a child with hemophilia A. Pediatr Crit Care Med 2011; 12:e432-5. [PMID: 21926657 DOI: 10.1097/pcc.0b013e31822f1b63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To report the management of hemophilia in a patient with dilated cardiomyopathy during application of the Berlin-Heart biventricular assist. DESIGN Case report. INTERVENTIONS AND RESULTS The Berlin-Heart biventricular assist was successfully used as a bridge to heart transplantation (178 days) in a child with hemophilia A; post-transplant extracorporeal membrane oxygenation was implanted until the patient recovered from primary graft failure. Anticoagulant therapy varied as a function of patient status: 1) postoperative bleeding was treated by partial replacement of deficient factors (VII and VIII) and hemoderivatives in order to maintain factor VIII at 50% of normal levels; 2) once the bleeding had stopped, the effect of the hemophilia itself maintained the degree of anticoagulation required by the ventricular assist device; and 3) transplant surgery was followed by complete replacement of factor VIII and intravenous heparinization (a simple way of preventing clot formation in the device and to ensure proper scarring of surgical wounds). CONCLUSIONS Selection of anticoagulant therapy as a function of patient status in terms of bleeding and surgical-wound scarring progress is vital for the proper functioning of support techniques (Berlin-Heart biventricular assist and extracorporeal membrane oxygenation) in hemophiliac patients. Collagen dressings placed on surgical wounds achieved good functional and aesthetic results, as well as mechanically isolating the scars from the exterior.
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Successful cryoablation of atrioventricular nodal reentrant tachycardia in a child with hemophilia A. J Pediatr Hematol Oncol 2010; 32:404-6. [PMID: 20505535 DOI: 10.1097/mph.0b013e3181e0040d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the hematologic and invasive electrophysiologic management of a 12-year-old boy with mild hemophilia A (factor VIII deficiency) and atrioventricular nodal reentrant tachycardia. Thoughtful preparation with detailed input from the patient's comprehensive hemophilia center combined with vigilant pericatheterization hematologic management allowed for safe and successful cryoablation of this arrhythmia. Strategies for the management of patients with bleeding disorders who require invasive cardiac catheterization or surgery are reviewed.
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7
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Acquired factor VIII hemophilia in a trauma patient: case report and literature review. ACTA ACUST UNITED AC 2010; 68:E35-8. [PMID: 20154529 DOI: 10.1097/ta.0b013e318156869b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Murugan SJ, Viswanathan S, Thomson J, Parsons JM, Richards M. Heart Surgery in Infants With Hemophilia. Ann Thorac Surg 2006; 81:336-9. [PMID: 16368397 DOI: 10.1016/j.athoracsur.2004.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 08/30/2004] [Accepted: 09/01/2004] [Indexed: 10/25/2022]
Abstract
We describe 2 infants with hemophilia A who had heart surgery under cardiopulmonary bypass with factor VIII replacement therapy, and we recommend a guideline for factor VIII support for cardiac surgery. One child had repair of total anomalous pulmonary venous connection. The second had cardiac catheterization followed by repair of ventricular septal defect and total anomalous pulmonary venous connection. Close collaboration between hematologist, laboratory, cardiologist, and cardiac surgeon is crucial in successful management of coagulation abnormalities during and after surgery.
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Thiagarajan RR, Roth SJ, Margossian S, Mackie AS, Neufeld EJ, Laussen PC, Forbess JM, Blume ED. Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in a patient with cardiomyopathy and hemophilia A. Intensive Care Med 2003; 29:985-988. [PMID: 12719805 DOI: 10.1007/s00134-003-1748-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Accepted: 03/13/2003] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To report the use of extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation in a patient with hemophilia A and dilated cardiomyopathy. DESIGN Case report. INTERVENTIONS AND RESULTS During ECMO factor VIII concentrate was administered to maintain a factor VIII level close to 50% of normal control both to decrease the risk of bleeding and to allow standard anticoagulation with heparin. The patient developed an inhibitor to exogenous factor VIII during hospitalization, which was successfully managed with a high-dose continuous infusion of factor VIII during ECMO, the transplant operation, and the postoperative period. CONCLUSIONS We report the successful use of ECMO as a bridge to cardiac transplantation in a patient with hemophilia A and low-level factor VIII inhibitors.
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Affiliation(s)
- Ravi R Thiagarajan
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
| | - Stephen J Roth
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven Margossian
- Division of Hematology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew S Mackie
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Ellis J Neufeld
- Division of Hematology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Peter C Laussen
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Joseph M Forbess
- Department of Cardiovascular Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Elizabeth D Blume
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA
- Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
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Kaminishi Y, Aizawa K, Saito T, Misawa Y, Madoiwa S, Sakata Y. Modified Bentall operation in a patient with hemophilia A. Gen Thorac Cardiovasc Surg 2003; 51:68-70. [PMID: 12692936 DOI: 10.1007/bf02719171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We detail a successful modified Bentall operation in a patient with hemophilia A. A 53-year-old man with mild hemophilia A and a history of few bleeding episodes was diagnosed with annuloaortic ectasia. Surgical repair was planned. Simple bolus infusions of factor VIII concentrate were given before and after cardiopulmonary bypass to achieve 100% blood levels and postoperatively every 12 hours for 7 days to maintain 50% levels. The patient received no transfusion other than 10 units of platelet concentrate. We used routine operative and cardiopulmonary bypass techniques. The patient recovered well postoperatively with no excessive bleeding despite warfarin therapy.
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Affiliation(s)
- Yuichiro Kaminishi
- Division of Cardiovascular Surgery, Jichi Medical School, 3311-1 Yakushiji, Minami-kawachi, Tochigi 329-0498, Japan
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Sheth S, Dimichele D, Lee M, Lamour J, Quaegebeur J, Hsu D, Addonizio L, Piomelli S. Heart transplant in a factor VIII-deficient patient with a high-titre inhibitor: perioperative management using high-dose continuous infusion factor VIII and recombinant factor VIIa. Haemophilia 2001; 7:227-32. [PMID: 11260285 DOI: 10.1046/j.1365-2516.2001.00483.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Four years prior to transplantation, a 14-year-old boy with severe haemophilia A and a high-responding factor VIII (FVIII) inhibitor developed an anteroseptal myocardial infarct while receiving high doses of an activated prothrombin complex concentrate (PCC). Cardiac transplantation was required for survival because of the ensuing cardiomyopathy. At surgery, the patient's inhibitor titre was 1.8 Bethesda units (BU). High-dose bolus therapy, followed by a continuous infusion of FVIII provided excellent operative and initial postoperative haemostasis without additional blood-product support. Once anamnaesis developed on day 6 postoperatively, recombinant factor VIIa (rFVIIa) therapy was initiated. Haemostasis remained excellent, except for the transient increase in chest-tube bleeding that was noted on day 7. epsilon-Aminocaproic acid was added and haemostasis was re-established. On day 15, rFVIIa was replaced with alternate day infusions of prothrombin complex concentrates (PCCs). On day 21 following the transplant, the patient was discharged, remaining on daily FVIII immune tolerance and thrice-weekly PCC prophylaxis. He remains well 24 months after transplant with an inhibitor titre of 39 BU. This paper describes the second case of cardiac transplantation complicated by haemophilia and an inhibitor, and discusses preoperative planning and operative and postsurgical haemostasis management.
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Affiliation(s)
- S Sheth
- Division of Paediatric Hematology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Shobeiri SA, West EC, Kahn MJ, Nolan TE. Postpartum acquired hemophilia (factor VIII inhibitors): a case report and review of the literature. Obstet Gynecol Surv 2000; 55:729-37. [PMID: 11128909 DOI: 10.1097/00006254-200012000-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pathologic inhibitors of blood coagulation as a cause of postpartum acquired hemostatic failure are rare. Since 1937, 96 cases of postpartum factor VIII (FVIII) inhibitors, including the current case, have been reported. Suspicion for the diagnosis of this condition is often low. We report a case of postpartum FVIII inhibitor formation in a 24-year-old woman who developed intermittent postpartum bleeding that resulted from the inhibitors she formed to FVIII. A unique form of therapy was used in treatment of her disorder. She did not respond to conventional surgical or medical management of her bleeding until Autoplex T (Baxter Healthcare, Glendale, CA), an activated prothrombin complex concentrate (aPCC) was used. The literature concerning acquired hemophilia is reviewed, and new therapeutic medical advances are emphasized.
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Affiliation(s)
- S A Shobeiri
- Louisiana State University Health Sciences Center, Department of Obstetrics and Gynecology, New Orleans 70112, USA.
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MacKinlay N, Taper J, Renisson F, Rickard K. Cardiac surgery and catheterization in patients with haemophilia. Haemophilia 2000; 6:84-8. [PMID: 10781193 DOI: 10.1046/j.1365-2516.2000.00384.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study summarizes the results of 12 cardiac surgical procedures performed in a carrier of Haemophilia B and in six patients with Haemophilia A at a single centre from 1979 to 1998. The median age of the patients at the time of intervention was 56 years ranging from 18 years to 73 years. The six patients with Haemophilia A ranged in severity from moderately to mildly affected. Three patients were hepatitis C antibody positive. No patients were HIV antibody or hepatitis B surface antigen positive. The cardiac procedures included cardiac catheterization (n=4), coronary artery bypass surgery (n=2), percutaneous transluminal coronary angioplasty (n=1), cardiac valve replacement (AVR n=1 and AVR/MVR n=2), and closure of an atrial septal defect and subsequent drainage of a pericardial effusion (n=1). No patients had demonstrable inhibitors at the time of surgery. Haemostasis was achieved with AHF in 10/11 procedures and high purity factor IX (Immunine) in one procedure. The initial procedures involved intermittent bolus factor therapy while more recently, AHF was administered by continuous intravenous infusion. All patients demonstrated excellent intra- and post-operative haemostasis. These results, although from a small and varied group of patients, demonstrate that cardiac surgical procedures can be performed safely in patients with Haemophilia.
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Affiliation(s)
- N MacKinlay
- Haemophilia Centre, Institute of Haematology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown NSW 2050, Australia
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Abstract
The application of coagulation factor therapy by continuous infusion (CI) was first suggested by Brinkhous in the early 1950s. The recent introduction of this mode of therapy to everyday practice was made possible after the demonstration of a good stability of most factor concentrates which were also found safe regarding potential bacterial contamination. Other developments included a better understanding of the pharmacokinetics of factors concentrates as well as the availability of a new delivery system. Continuous infusion was shown to be superior to bolus injection (BI) in achieving a stabile haemostatic effect, in the prevention of post-operative bleeding and was found to save between 20-50% in the required factor. This mode of therapy was found effective in haemophilia A and B as well as among patients with inhibitors to FVIII and with von Willebrand disease (vWD).
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Affiliation(s)
- D Varon
- National Haemophilia Center, Sheba Medical Center, Tel Hashomer, Israel.
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Halfman-Franey M, Berg DE. Recognition and Management of Bleeding Following Cardiac Surgery. Crit Care Nurs Clin North Am 1991. [DOI: 10.1016/s0899-5885(18)30695-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jedele KB, Michels VV, Gordon H, Gilchrist GS. Frequency of congenital heart defects in patients with hemophilia. AMERICAN JOURNAL OF MEDICAL GENETICS 1990; 36:333-5. [PMID: 2363433 DOI: 10.1002/ajmg.1320360318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Most structural congenital heart defects (CHD) are thought to be multifactorially determined, but the precise causal factors usually are unknown. One may postulate that vascular events, such as hemorrhage in the developing embryo, could influence morphogenesis of the heart. One method of studying this hypothesis is to determine the frequency of CHD in persons with heritable bleeding diatheses and their families. We reviewed retrospectively medical and family histories of 120 hemophilia A and 14 hemophilia B patients seen in our Genetics Department. The family histories included 1,126 maternal relatives of hemophiliac patients. We also reviewed the family histories of 138 patients with X-linked disorders who did not have bleeding diatheses or syndromes associated with CHD; these histories included 960 maternal relatives. There was one confirmed case of a CHD in 134 hemophilia patients, giving a frequency of 0.75% compared to 0.8% in the general population at birth. There was no apparent difference in the frequency of CHD in hemophilia A and B patients compared to the general population or in the relatives of hemophilia patients as compared to control individuals.
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Affiliation(s)
- K B Jedele
- Department of Medical Genetics, Mayo Clinic, Rochester, MN 55905
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Czer LS. Mediastinal bleeding after cardiac surgery: etiologies, diagnostic considerations, and blood conservation methods. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1989; 3:760-75. [PMID: 2521037 DOI: 10.1016/s0888-6296(89)95267-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- L S Czer
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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Mazzucco A, Stellin G, Cantele P, Boschello M, Traldi A, Gallucci V. Repair of ventricular septal defect and aortic regurgitation associated with severe hemophilia B. Ann Thorac Surg 1986; 42:97-9. [PMID: 3729624 DOI: 10.1016/s0003-4975(10)61846-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A child with severe factor IX deficiency who underwent an open-heart operation using extracorporeal circulation is described. The factor IX level was normalized immediately before operation and at the end of cardiopulmonary bypass by infusing prothrombin complex concentrate and fresh frozen plasma. Partial thromboplastin time and factor IX serum levels were monitored for 20 days postoperatively and showed factor IX activity higher than 50%.
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