Rajani Sundar

Efficacy of tranexamic acid as compared to aprotinin in open heart surgery in children.

Background: Coagulopathy is a major issue in children undergoing high-risk pediatric cardiac surgery. Use of anti-fibrinolytics is well documented in adults, but recently there are questions raised about safety and effectiveness of their use on routine use. Tranexamic acid is a potent anti-fibrinolytic, but its role is not fully understood in children. This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients. Methods and Results: Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin (Group A; n = 24) or tranexamic acid (Group B; n = 26) from September 2009 to February 2010 were studied. Primary end points were early mortality, postoperative drainage, reoperation for bleeding and complications. Mean age and body weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75 vs. 14.80 kg) respectively. Group A had more cyanotic heart disease than Group B (87.5% vs. 76.92%). Mean cardiopulmonary bypass time (144.33 vs. 84.34 min) and aortic cross-clamp time (78.5 vs. 41.46 min) were significantly higher in group A. While the blood and products usage was significantly higher in Group A, there was no difference in indexed postoperative drainage in first 4, 8 and 12 h and postoperative coagulation parameters. Mean C-reactive protein was less in Group A than B and renal dysfunction was seen more in Group A (25% vs. 7.6%). Mortality in Group A was 16.66% and 7.6% in Group B. Conclusion: Anti-fibrinolytics have a definitive role in high-risk children who undergo open-heart surgery. Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality. Ultramini Abstract: Coagulopathy has been a major issue in pediatric cardiac surgery, and anti-fibrinolytics have been used fairly regularly in various settings. This study aims to evaluate the efficacy of tranexamic acid as compared against that of aprotinin in a randomized model. Tranexamic acid proves to be equally effective with less toxicity with no added mortality.

Single patch closure of multiple VSDs through right atrial approach

Multiple ventricular septal defects (VSD) are traditionally considered as surgical challenges and often ventriculotomy is needed. We report our experience with single patch closure of multiple VSDs in 4 children with a median weight was 5.6 kg. VSDs were closed via right atrium with a single Goretex patch with no operative death and short mean intensive care stay. To conclude, surgical approach to multiple VSDs is still a challenge, but a select approach to septate through right atrium adds to the surgical armamentarium to handle this difficult problem.

Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occlusion technique.

Large Tracheal Cast: An Unusual Cause of Acute Airway Obstruction

Acute airway obstruction developed after overnight ventilation in a patient who had undergone a closed mitral valvotomy for mitral stenosis. This was due to a large tracheal cast that had formed probably as a result of fibrinous or plastic tracheobronchitis. The cast was expelled by coughing, after which the postoperative course was uneventful.