Low-dose aprotinin in heart valve reoperations

BACKGROUND AND AIM OF THE STUDY

Aprotinin is effective in promoting hemostasis, notably in cardiac surgery with cardiopulmonary bypass. Its efficacy has been shown in coronary bypass graft operations. However, few reports exist of aprotinin use in valve operations, and in those studies only the full dose was used. Thus, our aim was to evaluate the effects of low-dose aprotinin in patients undergoing heart valve reoperation.

METHODS

Eighteen patients having reoperative valve surgery received 10(6) KIU aprotinin after induction of anesthesia, and a further 10(6) KIU in the pump prime. A group of 18 similar patients who were operated on but did not receive aprotinin were used as controls.

RESULTS

A significant reduction in postoperative blood loss (approximately 470 ml) occurred in patients receiving aprotinin. These patients also presented less postoperative bleeding than untreated patients in 70.4% of cases. No adverse effects of the drug were noted, except for one case of allergic reaction.

CONCLUSION

The systematic use of low-dose aprotinin should be considered in valve reoperation, except in cases of re-exposure to the drug, or allergic reaction.

Hemodynamic performance evaluation of small aortic ATS Medical valves by Doppler echocardiography

BACKGROUND AND AIMS OF THE STUDY

The ATS Medical valve was first implanted in 1992. The purpose of this report was to establish the normal range of each hemodynamic parameter, measured by Doppler echocardiography, in small aortic ATS Medical valves.

METHODS

Twenty-five patients with small aortic ATS Medical valves, operated on over six months, and with no cardiac or prosthetic dysfunction, in sinus rhythm, on adequate oral anticoagulant therapy, and no other valve prosthesis or significant valvulopathy, were reviewed on the basis of physical examination and transthoracic Doppler echocardiography.

RESULTS

For the aortic 21 Standard ATS Medical valve (n = 10), the following values were registered: peak velocity 2.40 +/- 0.39 m/s; peak gradient 23.7 +/- 6.8 mmHg; mean gradient 12.6 +/- 4.0 mmHg; valve effective orifice area 1.73 +/- 0.41 cm2; Doppler velocity index 0.47 +/- 0.11. For the aortic 19 Standard ATS Medical valve (n = 9), these values were: 3.41 +/- 0.43 m/s; 47.0 +/- 12.6 mmHg; 26.2 +/- 7.9 mmHg; 0.96 +/- 0.18 cm2; and 0.32 +/- 0.06, respectively. For the aortic 16 AP ATS Medical valve (n = 6), these parameters were 3.44 +/- 0.47 m/s; 47.7 +/- 12.0 mmHg; 27.0 +/- 7.3 mmHg; 0.61 +/- 0.09 cm2; and 0.30 +/- 0.04, respectively.

CONCLUSIONS

Using Doppler echocardiography, the present study establishes the normal range of parameters which define the hemodynamic performance of the aortic 21 and 19 Standard and 16 AP ATS Medical valves, and demonstrates satisfactory hemodynamic performance of the aortic 21 and 19 Standard ATS Medical valves. It should be noted that the valve effective orifice area determined for the aortic 16 AP ATS Medical valve was smaller than that for the aortic 19 Standard ATS Medical valve, though these two prostheses have the same physical orifice area.

[Doppler echocardiography evaluation of the hemodynamic performance of the Lillehei-Kaster and Medtronic Hall valves in aortic position]

PURPOSE

To establish the range of normal values by Doppler echocardiography of the parameters inherent to the hemodynamic performance of the Lillehei-Kaster (LK) and Medtronic Hall (MH) prosthetic valves (V), in the 23 mm (LKV-16, MHV-23) and 25 mm (LKV-18, MHV-25) outer diameter valves, in the aortic position.

METHODS

Doppler echocardiography was performed in 32 asymptomatic patients, with normally functioning prosthetic aortic valves (8 of each type).

RESULTS

The peak velocity of aortic jet was 3.13 +/- 0.46 m/sec for the LKV-16, 2.76 +/- 0.31 m/sec for the MHV-23, 2.82 +/- 0.48 m/sec for the LKV-18 and 2.43 +/- 0.36 m/sec for the MHV-25. The maximal pressure gradient was 39.84 +/- 12.05 mmHg for the LKV-16, 30.70 +/- 6.80 mmHg for the MHV-23, 32.60 +/- 10.75 mmHg for the LKV-18 and 24.11 +/- 6.70 mmHg for the MHV-25. The mean pressure gradient was 24.25 +/- 7.09 mmHg for the LKV-16, 18.50 +/- 4.41 mmHg for the MHV-23, 18.21 +/- 6.95 mmHg for the LKV-18 and 13.57 +/- 4.17 mmHg for the MHV-25. The valve effective orifice area, considering the left ventricle outflow area determined by two-dimensional echocardiography in the continuity equation, was 0.62 +/- 0.13 cm2 for the LKV-16, 1.05 +/- 0.21 cm2 for the MHV-23, 0.98 +/- 0.22 cm2 for the LKV-18 and 1.36 +/- 0.36 cm2 for the MHV-25. Considering the left ventricle outflow area equivalent to the valve sewing ring area, the valve effective orifice area was 1.40 +/- 0.23 cm2 for the LKV-16, 1.65 +/- 0.19 cm2 for the MHV-23, 1.91 +/- 0.43 cm2 for the LKV-18 and 2.37 +/- 0.56 cm2 for the MHV-25. The Doppler velocity index was 0.34 +/- 0.05 for the LKV-16, 0.40 +/- 0.04 for the MHV-23, 0.39 +/- 0.09 for the LKV-18 and 0.49 +/- 0.11 for the MHV-25.

CONCLUSION

Significant hemodynamic performance superiority of the MHV over the LKV was registered, indicating that the small LKV (LKV-16 or smaller) should be avoided.

[Multiple causes of death in diabetics in the municipality of Recife, 1987]

In 1987, diabetes mellitus was mentioned in 492 death certificates of the population of the city of Recife, Brazil, 202 of them for males and 290 for females. Diabetes mellitus was the underlying cause of death according to 80 certificates for men and 290 for women, as a result of which premature death occurred in 16.2% of men and 11.1% of women. Multiple cause of death analysis showed that cardiovascular diseases were the most frequent underlying cause of death in individuals over 50 years of age and acute complications of diabetes mellitus in individuals under 50. Cerebrovascular diseases were the most frequent in the cardiovascular group, particularly in females. Arterial hypertension was the most frequent associated cause of death appearing in death certificates mentioning diabetes mellitus (not as the underlying cause of death), also more often in females. The acute complications of diabetes mellitus (keto-acidosis and coma) and peripheral circulatory disorders peculiar to this disease caused 23% and 30% of the deaths, respectively, in cases where diabetes mellitus was the underlying cause. Infectious and parasitic diseases were the most frequent associated causes of death according to those certificates which gave diabetes mellitus as the underlying cause.