Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study.

The study was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application during heart valve surgery in the post-aprotinin era. One-hundred patients were enrolled in the study and all the patients were given tranexamic acid intravenously. The participants were randomized into two groups (A, n = 49; B, n = 51), and before commencing the sternal suturing, the study solution (group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group B: 250 ml of normal saline) was poured into the pericardial cavity. The cumulative blood loss (geometric means [95% confidence intervals]) 4 h after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3, 194.4] in group B, test for equality of geometric means P = 0.107, test for equality of variances P = 0.059. Eight hours after the surgery, the blood loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in group B, P = 0.130 and P = 0.050, respectively. Twenty-four hours postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A, 569.7 [476.0, 681.7] ml in group B, P = 0.293 and P = 0.014, respectively. The proportion of patients transfused postoperatively by fresh frozen plasma differed significantly between the two study groups (group A: n = 21, group B: n = 36, P = 0.008). Our hypothesis is supported by a significant difference in the inter-group variance of blood loss and the proportion of patients requiring fresh frozen plasma; however evident differences in mean postoperative blood loss were not statistically significant.

Infective endocarditis of the tricuspid valve caused by Staphylococcus aureus after ear piercing.

Right-sided endocarditis usually involves the tricuspid valve, predominantly in intravenous drug abusers, in patients with anti-arrhythmic devices or central venous lines, and in patients with skin or genitourinary infection and with congenital heart disease 1. We describe a case of a 15-y-old patient, who had tricuspid valve endocarditis in a morphologically normal valve after having his ear pierced, without history of parenteral drug addiction and vascular catheter use. Progression of vegetation size and development of tricuspid valve regurgitation in spite of the intensive antibiotic treatment eventually required surgical intervention.