Post-cardiac surgery outcomes following COVID-19 infection in unvaccinated patients.

The provision of cardiac surgery services nationwide has been affected by the COVID-19 pandemic. We noticed a high COVID-19 mortality rate in unvaccinated patients who were diagnosed with COVID-19 after recent cardiac surgery. All the patients were tested negative for COVID-19 before surgery. We conducted a review of our hospital data and reported our findings. We identified 15 patients and reported 7 deaths (46.7%). All the patients died from COVID-19 or its complications. We recommend that cardiac centres actively promote vaccination before cardiac surgery and also enhance infection control measures to prevent nosocomial infections.

A successful pregnancy outcome of homozygous familial hypercholesterolaemia patient on statin therapy.

Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disorder of lipoprotein metabolism mainly due to mutation of the low-density lipoprotein (LDL)-receptor gene (LDLR). It is a life-threatening disease that causes accelerated, multi-vessel atherosclerosis presented in early childhood. Pregnancy in HoFH may pose early coronary morbidity and mortality to both the foetus and mother. The combination of HoFH and pregnancy can be a fatal condition. While statins are very effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, they are generally contraindicated during pregnancy, thus their use during pregnancy is uncommon. On the other hand, lipid apheresis (LA) has turned into an effective treatment to control cholesterol level amid pregnancy. However, the procedure is not widely available in our region. To date, there are scarcely documented case reports of HoFH in pregnancy in which the majority of them underwent LA to keep LDL-C at a low level. We report a rare case of successful pregnancy outcome of HoFH patient treated with lipid-lowering drugs including statin without LA therapy. Apart from that, we also discussed the genetic findings of the proband and all screened family members in which to the best of our knowledge, the first study using the whole-exome sequencing technique to identify the causative gene mutations for familial hypercholesterolaemia among the Malaysian population.