Tag Archives: surgery

Introduction Bleeding post cardiac surgery carries significant patient mortality and morbidity including resternotomy, increased hospital stays, and blood product transfusion.1,2 Bleeding is more severe in patients who are taking pre-operative antiplatelet or anticoagulation medications that have not been stopped sufficiently in advance to minimise such risks. Current guidelines across Europe recommend stopping such agents at least two to five days prior to surgery; they also recommend delaying urgent surgery so that the risk of perioperative bleeding is minimised.3 However, this is not always possible in the setting of urgent and emergency c

Introduction Open-heart surgery is gradually gaining recognition in Nigeria following the first open-heart surgery carried out at the University of Nigeria Teaching Hospital (UNTH), Enugu in 1974.1 For a long time, UNTH remained the only centre in Nigeria carrying out open-heart surgery.2 However, more patients requiring these surgeries are now being operated on with the emergence of new cardiac centres.3 Open-heart surgery is a major surgical procedure that requires intensive monitoring pre-operatively, intra-operatively and postoperatively. It, thus, requires team work with various professionals. Laboratory personnel form an essential arm

Case A 63-year-old woman presented with breathlessness for a week. She had had a right mastectomy and axillary node clearance three weeks previously for breast cancer. She was known to have rheumatic heart disease and mitral stenosis with history of balloon mitral valvuloplasty 12 years ago. An echocardiogram, which was performed four months before, showed moderate mitral stenosis with valve area of 1.2 cm2, moderate aortic stenosis with peak gradient across aortic valve of 42 mmHg and mean of 22 mmHg and mild tricuspid regurgitation with normal pulmonary artery pressure. She was also known to have permanent atrial fibrillation and was on w

The study, published in Circulation on June 14 (Circulation 2012; 126:343–8.  http://dx.doi.org/10.1161/CIRCULATIONAHA.111.090464), reported bleeding rates in RE-LY from seven days before until 30 days following invasive procedures in a total of 4,591 patients. Procedures included pacemaker/defibrillator insertion, dental procedures, diagnostic procedures, cataract removal, colonoscopy, and joint replacement. Among patients assigned to dabigatran, the last dose of study drug was given an average of 49 hours prior to the procedure, compared with 114 hours in patients receiving warfarin. Bridging anticoagulation with heparin was given in 28%

Inspiring the next generation of cardiac specialists: learning from the British Association of Plastic, Reconstructive and Aesthetic Surgeons undergraduate course Dear Sirs, Medical and surgical cardiology are among the most competitive specialties to enter. In 2010, there were 6.0 applicants for every specialty training (ST3) post for cardiothoracic surgery1 and 5.7 for cardiology.2 Bearing in mind that these competition ratios represent the competitiveness after the longlisting and shortlisting stages, they represent intense competition for admission into these specialty programmes. The changes brought in by the modernising medical careers

Table 1: Emerging issues in pulmonary arterial hypertension (PAH) A likely first step might be to understand new targets. Evidence to guide clinical decision-making in how to measure success is coming from RCTs, but sometimes it can be difficult to translate this evidence into clinical experience. Professor Vachiéry discussed some of these new targets and investigational therapies, including vasoactive intestinal peptide (VIP)8 and antiproliferative agents.9 As cancer and PAH may share similar pathophysiology of aberrant cell proliferation, growth factor inhibition could play a role in the treatment of PAH, said Professor Vachiéry. But thes

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