Reduction of post-surgical pericardial adhesions using a pig model.

BACKGROUND: Post-surgical pericardial adhesions pose an increased risk of complications during redo sternotomies. Adhesive tissue formation is a normal response to tissue injury and involves complex patho-physiological processes including the actions of prostaglandins to cause plasma leakage and fibrin formation. The purpose of this study was to assess the ability of two non-steroidal anti-inflammatory agents (Indomethacin and Rofecoxib) and a barrier (Coseal, a polyethylene glycol) to limit adhesion formation following cardiac surgery in a pig model. METHODS: Forty-four piglets were allocated equally to four treatment groups: Group 1: Control, Group 2: intramuscular Indomethacin, Group 3: oral Rofecoxib and Group 4: Coseal sprayed on the heart. A full median sternotomy was performed on each animal and the heart exposed. Adhesions were induced by rubbing tissues with gauze, applying sutures and leaving blood in the pericardial sac before chest closure. Plasma inflammatory markers including prostaglandin E(2) and thromboxane B(2) were measured preoperatively and on Days 2, 5 and 10 after surgery. Eight animals from each group were slaughtered after 12 weeks and 3 after 25 weeks. Adhesions were assessed macroscopically and microscopically. RESULTS: Compared to the Control group, the extent of adhesions was significantly less in all other groups whilst adhesion density was least in the Indomethacin and Coseal groups. Indomethacin and less so Rofecoxib, inhibited the synthesis of prostaglandin E(2) and thromboxane B(2) but there were no significant changes in other inflammatory markers. CONCLUSIONS: We conclude that systemic Indomethacin, and locally applied Coseal are suitable methods to markedly reduce pericardial and retrosternal adhesions.

Conservative management of a large oesophageal haematoma as a complication of systemic thrombolysis.

An acute coronary syndrome patient was treated with tissue plasminogen activator to produce thrombolysis. Six hours post-lysis, haematemesis occurred. Computed tomography (CT) revealed a large haematoma around the lower oesophagus and endoscopy showed a tear in the lower end of the oesophagus. This case represents an unusual complication of anticoagulation and thrombolysis associated with the management of acute coronary syndrome. Conservative management was successful.

Platelet function after off pump coronary surgery.

BACKGROUND: Little is known about the impact of off pump coronary artery bypass (OPCAB) on platelet function. Although improved platelet function may decrease bleeding and reduce cerebral and pulmonary damage, there is a concern that changes in platelet function may also accentuate bypass graft occlusion or other thrombotic processes. In this pilot study we used a point-of-care test--Hemostatus (Medtronic, Minneapolis, MN, USA)--to assess changes in platelet function after OPCAB. METHODS: We analyzed data from 11 adult patients undergoing CAB surgery whose platelet function was assessed before and after OPCAB. A Hemostatus test was conducted prior to heparin administration and after protamine reversal. RESULTS: There was a significant improvement in platelet function as measured in both channels 5 and 6 of the Hemostatus test. Blood loss was 598 +/- 244 mL in the first 24 hours. One patient received blood products. CONCLUSION: This pilot study suggests that platelet function is not diminished but instead is improved after OPCAB. This improvement may be due to the release of newer, larger platelets from the bone marrow into the circulation. This finding has important implications for the use of antiplatelet agents perioperatively. Furthermore, more detailed studies in this field are needed.

Angiosarcoma of the right ventricle: a rare encounter.

We report a case of angiosarcoma involving the right ventricle. The patient was seen in our Cardiology Department and subsequently referred to our unit for surgery. He gave a 1-week history of lethargy, chest pain, breathlessness on exertion, fevers, and night sweats. Echocardiography and computed tomography of the chest showed a large pericardial effusion with multiple densities, raising suspicions of a hemorrhagic effusion. Surgical exploration showed an epicardial mass. Histopathology revealed angiosarcoma.