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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

Immanuels Taivans, Gunta Strazda, Nora Porīte, Indulis Vanags, Juris Lejnieks, Romāns Lācis and Eva Strīķe

Regional Lung Blood Perfusion Measured With Laser Doppler Method During Body Position Change, Valsalva Manoeuvre and Cardiopulmonary Bypass

Methodological approaches to investigate local regulatory mechanisms of lung blood supply in humans are restricted. We tried a new approach using laser Doppler technique. During bronchoscopy, an angled laser Doppler flow probe was introduced through a biopsy channel and wedged into small bronchus. Laser light penetrated the wall of small bronchus and was reflected from blood cells running through neighbouring capillaries. Regional blood perfusion changes were recorded during body position change from vertical to supine and back to vertical, while performing Valsalva maneuver and during cardiac bypass surgery. Body position change and Valsalva maneuver markedly influenced the blood perfusion signal. During cardiac bypass when lungs were supplied with blood only through bronchial arteries regional blood perfusion dropped substantially on average from 93 ± 42 to 7.3 ± 4.3 perfusion units. We conclude that blood perfusion measured with this method reflect mainly the pulmonary vascular bed and may be used for investigation of its local regulatory mechanisms.

Open access

Janis Vilmanis, Arturs Ozolins, Kaspars Kisis, Sergejs Kovalovs, Andris Veiss, Janis Savlovskis, Eva Strike and Janis Gardovskis

First Liver Transplantation in Latvia for Patient with Primary Sclerosing Cholangitis

This is the case of first orthotopic liver transplantation (LT) in Latvia. LT was done due to liver cirrhosis caused by primary sclerosing cholangitis (PSC). After LT patient had two complications - stenosis of portal anastamosis and necrosis of common bile duct (CBD), which were successfully solved with stenting of v.porta and reconstructive operation of CBD.

Open access

Nora Porīte, Eva Striķe, Mihails Bekers-Ančipolovskis, Larisa Semčenko, Inguna Krustiņa and Pēteris Stradiņš

Assessment of Tissue Perfusion During Cardiopulmonary Bypass

Cardiopulmonary bypass (CPB) remains essential for all valvular operations and the vast majority of coronary bypass surgeries. Inadequate CPB results in tissue underperfusion, activation of anaerobic metabolism and increased lactate production. The goal of the study was to determine the factors influencing oxygen delivery to and consumption in tissue. Fifty-six patients (41 male and 14 female patients of 27 to 84 years of age) scheduled to undergo cardiac surgery with CPB were enrolled in this prospective study. No operation-based selection was applied. The following data have been collected and analysed: demographics, preoperative cardiovascular profile. Arterial and venous blood gas tests, including blood glucose and lactate concentrations were obtained. We have assessed DO2 (mL/min/m2) and VO2 (mL/min/m2), venous oxygen content (CvO2) (mL/dL), arterial oxygen content (CaO2) (mL/dL) calculated according to standard equations based on haemoglobin concentration and saturation in arterial blood, cardiac output or pump flow. The main factors of organ dysoxia during CPB are the haemodilution degree and low peripheral oxygen delivery (DO2). Our study confirmed that hematocrit on pump and systemic flow rate determine the amount of oxygen delivery to the body, i.e. DO2 decrease is correlated with decrease of both hematocrit (Ht) and pump flow.

Open access

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

Abstract

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

Sigita Kazūne, Andris Grabovskis, Eva Strīķe and Indulis Vanags

Abstract

Sepsis is characterised by massive inflammatory response, which can affect vascular function. This study was designed to assess the impact of early severe sepsis and septic shock on arterial stiffness and the relationship of this impact to outcome. Twelve patients with severe sepsis and 22 with septic shock were included in the study. We measured carotid to femoral and carotid to radial pulse wave velocity (PWV), an index of aortic and brachial arterial stiffness, in patients with early severe sepsis and septic shock within 24 hours of admission to intensive care unit and repeatedly after 48 hours. No difference was observed between patients with severe sepsis and septic shock regarding carotid to femoral PWV (11.7 ± 2.2 vs. 11.3 ± 3.6 m/s) and carotid to radial PWV (12.0 ± 3.8 vs. 9.5 ± 2.2 m/s). On 48 hour follow-up, PWV did not significantly differ between survivors and non-survivors. A positive, similar correlation occurred between PWV and pulse pressure in all patients (r = 0.35, p = 0.05), and there was a negative correlation between PWV and C-reactive protein levels (r = -0.43, p = 0.04). In conclusion, PWV is not affected by disease severity or prognosis.

Open access

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

Abstract

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.