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Preoperative autologous blood donation is widely used in cardiac surgery. However, some patients are unable to store adequate amounts of blood before surgery, and some develop anemia after the operation. We attempted to clarify the limitations of blood donation alone and its influence on erythropoiesis in comparison with those associated with adding recombinant human erythropoietin (rEPO). Subjects were twenty-five patients who were scheduled to undergo elective cardiac surgery. A unit of autologous blood (200 ml) was to be donated every 3 or 4 days for 2 weeks. 200mg of ferrous sulfate was given orally every day in 10 patients (the simple donation group), while 200 U/kg of rEPO was given intravenously 3 times a week in combination with oral ferrous sulfate supplementation in 15 patients (the rEPO-treatment group). After donation, reticulocyte counts increased significantly in both groups. In the simple donation group, hematocrit levels decreased significantly (p0.02), while serum iron levels did not change significantly. In the rEPO-treatment group, hematocrit levels remained unchanged and serum ferritin levels decreased significantly (p0.02) after the donation; in addition, serum iron levels in the rEPO-treatment group decreased significantly (p0.05) than those in the simple donation group during donation. The erythroid/nucleated cell ratio remained almost normal in the simple donation group. This ratio was significantly higher in the rEPO-treatment group than in the simple donation group (36.4 +/- 8.3% versus 26.2 +/- 6.8%, p0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

A 69-year-old woman, who developed acute respiratory distress syndrome (ARDS) after coronary artery bypass grafting, underwent venovenous extracorporeal membrane oxygenation (V-V ECMO) because conventional ventilatory support was ineffective. We used a covalently bonded heparin surface ECMO system, including an artificial lung, a centrifugal pump, cannulas, tubing and connectors, that was maintained with low-dose systemic heparinization, the patient was weaned from ECMO after 186 hours. During ECMO, her platelet count was about half of the initial level and markedly elevated thrombin-antithrombin complex (TAT), plasmin-alpha 2 plasmin inhibitor complex (PIC) and D-dimer were decreased by the use of heparin and protease inhibitors. V-V ECMO seems to be useful even in patients with severe adult respiratory failure and can be performed safely if a heparin covalent circuit is applied.

A 5-year-old boy who had typical tetralogy of Fallot (TOF) with mild cyanosis was referred to us. Preoperative echocardiogram revealed that in addition to the TOF morphology, an abnormal piece of tissue attached to the right side of the ventricular septum was floating and obstructing flow through the ventricular septal defect (VSD) in systole. Preoperative cardiac catheterization showed suprasystemic right ventricular pressure with a gradient of 60 mmHg between the right ventricle and the aorta, and a right ventriculogram demonstrated a narrow radiolucent structure beneath the aortic valve in the right ventricle. During surgery a fibrous membranous tissue, with no relation to the tricuspid valve, was found to extend from the edge of the VSD to the aortic valve and to partially occlude the defect. This tissue was used as a suture anchorage for patch closure of the defect. Preoperative echocardiography is useful to detect such flaps and early surgical correction should be done to prevent right ventricular failure resulting from right ventricular pressure overload.