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Open access

Agnese Ozolina, Eva Strike and Indulis Vanags

The Predictive Value of Thrombelastography and Routine Coagulation Tests for Postoperative Blood Loss in Open Heart Surgery

Introduction. Hemorrhage after cardiopulmonary bypass remains a clinical problem.

Aim of the Study. Study was performed to compare efficacy of trombelastography (TEG) and routine coagulation tests in relation for postoperative bleeding after cardiac surgery in CPB.

Materials and methods. Forty-seven adult cardiac surgical patients were enrolled in prospective study at Pauls Stradins Clinical University Hospital in 2010. Blood samples for prothrombin time, international normalized ratio, activated partial thromboplastin time (APTT), fibrinogen level, platelet count were collected before surgery, at admission in intensive care unit (ICU) and 6, 12 hours after operation.

Before induction of general anesthesia blood sample was collected to perform kaolin activated TEG (kTEG) and at admission in ICU - kTEG and heparinase- modified kTEG.

Results. Correlation postoperatively was between kTEG reaction time (R) and APTT, as well as heparinase-modified kTEG maximum amplitude (MA) and platelet count. Significant correlation with postoperative bleeding showed heparinase-modified kTEG MA on admission to the ICU.

The highest predictive value preoperatively showed kTEG alpha angle (A), APTT, platelet count and postoperatively kTEG MA, APTT on admission to ICU.

Conclusions. Associated with bleeding are following TEG variables: preoperatively kTEG A, postoperatively kTEG MA and heparinase-modified kTEG MA. APTT and platelet count are also related to postoperative bleeding but to a lesser degree.

Open access

Agnese Ozolina, Eva Strike, Vladimirs Harlamovs and Nora Porite

Excessive Bleeding After Cardiac Surgery in Adults: Reasons and Management

Postoperative bleeding is a concern for all patients undergoing cardiac surgery. In patients exposed to cardiopulmonary bypass, bleeding following surgery is excessive in up to twelve percent of patients in whom subsequent re-exploration is required. Several studies have evaluated main reasons, prevention of excessive postoperative bleeding and impact of patients outcomes. This article contains a literature review on excessive bleeding and re-exploration following cardiac surgery, main surgical and medical sources, prevention and management of bleeding.

Open access

Marina Sarkele, Olegs Sabelnikovs, Indulis Vanags, Agnese Ozolina, Andrejs Skesters and Alise Silova


Introduction. Patients in the intensive care unit (ICU) are likely to suffer from acute respiratory failure (ARF) with a risk of developing acute lung injury (ALI) and its more severe condition, acute respiratory distress syndrome (ARDS) with 30 - 50% mortality. Evidence shows, that important role in ARDS pathophysiology may play an imbalance between oxidant and antioxidant species. Oxidative stress is well established in adult critical illnesses characterized by systemic inflammatory response.

Aim of the study was to investigate the influence of oxidative stress species on developing of acute respiratory distress syndrome in patients at risk.

Materials and methods. The study was conducted in Pauls Stradins Clinical University Hospital ICU during 6 months in 2013 and approved by ethics committee. There were included 15 ARDS risk patients over 18 years of age with mechanical lung ventilation (MLV) over 24 hours and massive blood component transfusions, acute severe pancreatitis, pneumonia or sepsis. Blood samples were taken three times during observational period- first sample were taken just exactly after inclusion, second sample- on 4th and the last sample- on 7th day after inclusion. The developing of ARDS were diagnosed using revised diagnostic criteria according to the Berlin definition. Reactive oxygen species were measured in plasma using manual or automatic spectrophotometry.

Results. Among included patients 82.4 % were males with the mean age 49.3 years, for female 67 years. The most popular diagnosis was acute severe pneumonia (n= 5; 33.3 %), followed by patients with sepsis (n= 4; 26.7%) and acute severe pancreatitis (n= 4; 26.7%). The most informative marker of oxidative stress among all ARDS risk patients is GPx, which correlates with PaO2/ FiO2 and oxidation index (R= -0.52; p= 0.045 and R= 0.57; p= 0.027) at the 1st day of observation. At the 4th day of observation GPx shows statistically significant relation with the level of PEEP (R= 0.57; p= 0.033). Among ARDS patients we have found correlation between PaO2/FiO2 ratio and MDA+ HNE plasma levels (R= 0.69; p= 0.026) at the 1st day of observation.

Conclusion. Reactive oxygen substances causing oxidative stress shows a dynamic changes in ARDS patients. The changes of some oxidative markers are related to the increased level of hypoxemia and PEEP used in treatment of ARDS patients.

Open access

Jevgeņijs Stepanovs, Agnese Ozoliņa, Vita Rovīte, Biruta Mamaja and Indulis Vanags


Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005–2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.

Open access

Marina Šarkele, Agnese Ozoliņa, Olegs Sabeļnikovs, Andrejs Šķesters, Alise Silova and Indulis Vanags


Acute respiratory distress syndrome is a common complication characterised by severe hypoxemia, which leads to high mortality rates in ICU patients. Imbalance between oxidative stress markers like oxidants and antioxidants may play an important role in pathophysiology of the syndrome. We observed 17 ARDS patients during seven days after inclusion, with the main goal to describe dynamic changes in the level of oxidative stress markers in patients with acute respiratory distress syndrome. We found that there are dynamic differences in the level of malondialdechyde (MDA) and nitric oxide (NO) in patients with acute respiratory distress syndrome. There were also different levels of oxidative stress markers in non-survivor compared with survivor groups. Increased level of an oxidant like a thiobarbituric acid substance with malondialdechyde (TBS_MDA) and antioxidant glutathionperoxidase (GPx) at the first day after inclusion was related with poor outcome in patients with acute respiratory distress syndrome.

Open access

Roberts Leibuss, Mārtiēņš Kalējs, Andris Skride, Mihails Bekkers, Agnese Ozoliņa, Pēteris Stradiņš, Eva Strīķe and Romāns Lācis


Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in 1 to 4% after acute pulmonary embolism. CTEPH can be cured by pulmonary endarterectomy (PEA), which is approved golden standard in chronic condition. There were performed three cases of PEA in Latvian Cardiology Centre during 2013-2014. General anaesthesia under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests was provided. The core issue is correct patient selection (in terms of central PA obstruction by thrombus) as well as pulmonary circulation recovery capacity. Neuroprotection was provided by deep hypothermia, topical cooling of the head, Trendelenburg position, mild hypocapnia, Hb 9-10 g/L and pharmacological agents. For screening postoperative cognitive function the mini mental state examination (MMSE) was used before and after the surgery. Postoperative pulmonary vascular resistance index decreased by 56.3% (right ventricular systolic pressure decreased from 93.3 ± 25.7 to 44.5 ± 11.2 mmHg). Before the surgery three patients had NYHA functional class III or IV, at the time of discharge - I or II. In one case moderate (MMSE 18) cognitive disorders was observed at discharge from the ICU. No one died neither in the hospital nor within 30 days of discharge. The surgery improved RV function and pulmonary perfusion with no considerable organ failure, except mild cognitive disorders.

Open access

Roberts Leibuss, Martins Kalejs, Agnese Ozolina, Andris Skride, Peteris Stradins, Eva Strike and Romans Lacis


Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in a minority of patients after acute embolism and belongs to Orphan diseases. There is no specific medical treatment currently approved. Pulmonary thromboendarterectomy (PTEAE) remains as the main and curative treatment for the CTEPH. Case presentation in a patient with acquired CTEPH is a rare condition that can be treated successfully with PTEAE under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests.