Outcome of aortocoronary bypass in a patient with a history of hemophilia.

Guseinov, Zaur; Topcu, Sebil Merve; bayraktar, fatih avni; Aydin, Ebuzer

Outcome of aortocoronary bypass in a patient with a history of hemophilia. [Haydarpasa Numune Med J]

Haydarpasa Numune Med J. Ahead of Print: HNHJ-70707

Outcome of aortocoronary bypass in a patient with a history of hemophilia.

Zaur Guseinov, Sebil Merve Topcu, fatih avni bayraktar, Ebuzer Aydin
Department Of Cardiovascular Surgery, Medeniyet �niversity Medical Faculty, Istanbul, Turkey

Hemophilia is a congenital disorder of the blood coagulation system linked to the X chromosome and manifested by a deficiency of blood coagulation factor VIII (hemophilia type A) or factor IX (hemophilia type B). We present our own clinical case involving the combination of MI and hemophilia type A. A 42-year-old young man with a known history of haemophilia A was admitted to the emergency department of an external centre with the complaint of pressing chest pain radiating to the left arm. He was treated with 300 mg ecopyrine and 300 mg plavix and a significant increase in troponin value was detected. The patient was transferred to the emergency department of our hospital. In the emergency department, the patient was evaluated by cardiology. The control troponin 72 was detected and the patient was interned to the coronary intensive care unit with a preliminary diagnosis of NON ST myocardial infarction (MI). Coronary angiography was planned (Figure 1,2,3). Internal medicine and haematology clinics were consulted to adjust anticoagulant treatment for angiography and the patient was treated with 2 antiplatelet therapies (ecopirin + plavix). After coronary angiography, the patient was evaluated by cardiovascular surgery and cardiology council. Coronary bypass was recommended. The patient was transferred to the cardiovascular surgery service for preoperative preparations. During preoperative preparations, the patient was evaluated by the haematology clinic in terms of haemophilia A history and surgery. With the recommendation of the haemophilia clinic, preop and postop specific factor FVIII treatment and daily aPTT monitoring were performed. No problems were experienced during the operation. Cardiopulmonary bypass was performed when ACT (activated clotting time) was above 450. No bleeding complications occurred in the postoperative period. The patient was successfully discharged.

Keywords: Hemophilia A, bypass, FVIII, coronary angiography.

Hemofili �yk�s� olan bir hastada aortokoroner baypas sonucu.

Zaur Guseinov, Sebil Merve Topcu, fatih avni bayraktar, Ebuzer Aydin
Medeniyet T�p Fak�ltesi Kalp Ve Damar Cerrahisi Anabilim Dal�, �stanbul

Hemofili, X kromozomuna ba�l� kan p�ht�la�ma sisteminin konjenital bir bozuklu�udur ve kan p�ht�la�ma fakt�r� VIII (hemofili tip A) veya fakt�r IX (hemofili tip B) eksikli�i ile kendini g�sterir. MI ve hemofili tip A kombinasyonunu i�eren kendi klinik olgumuzu sunuyoruz. Hemofili A �yk�s� olan 42 ya��nda gen� bir erkek, sol kola yay�lan bask�lay�c� g��s a�r�s� �ikayetiyle d�� merkez acil servisine ba�vurdu. 300 mg ekopirin ve 300 mg plavix ile tedavi edildi ve troponin de�erinde �nemli bir art�� tespit edildi. Hasta hastanemizin acil servisine transfer edildi. Acil serviste hasta kardiyoloji taraf�ndan de�erlendirildi. Kontrol troponin 72 tespit edildi ve hasta NON ST miyokard enfarkt�s� (MI) �n tan�s�yla koroner yo�un bak�m �nitesine yat�r�ld�. Koroner anjiyografi planland� (�ekil 1,2,3). Anjiyografi i�in antikoag�lan tedavisinin ayarlanmas� amac�yla i� hastal�klar� ve hematoloji kliniklerine dan��ld� ve hastaya 2 antiplatelet tedavi (ekopirin + plavix) uyguland�. Koroner anjiyografi sonras� hasta kalp damar cerrahisi ve kardiyoloji konseyince de�erlendirildi. Koroner bypass �nerildi. Hasta preoperatif haz�rl�klar i�in kalp damar cerrahisi servisine transfer edildi. Preoperatif haz�rl�klar s�ras�nda hasta hematoloji klini�i taraf�ndan hemofili A �yk�s� ve ameliyat� a��s�ndan de�erlendirildi. Hemofili klini�inin �nerisiyle preop ve postop spesifik fakt�r FVIII tedavisi ve g�nl�k aPTT takibi yap�ld�. Operasyon s�ras�nda herhangi bir sorun ya�anmad�. ACT (aktif p�ht�la�ma zaman�) 450'nin �zerinde oldu�unda kardiyopulmoner bypass yap�ld�. Postoperatif d�nemde herhangi bir kanama komplikasyonu ya�anmad�. Hasta ba�ar�yla taburcu edildi.

Anahtar Kelimeler: Hemofili A, bypass, FVIII, koroner anjio.

Corresponding Author: Zaur Guseinov, T�rkiye
Manuscript Language: English

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