Mitral and tricuspid valve surgery in homozygous sickle cell disease: perioperative considerations for a successful outcome.
Homozygous sickle cell disease (SCD) presents a multitude of challenges in patients undergoing cardiac surgery with cardiopulmonary bypass. Special consideration must be made in such patients and routine practice modified to prevent hypoxia, hypothermia, acidaemia and low-flow states which may potentially trigger a fatal sickling crisis perioperatively. We discuss several perioperative management strategies including a preoperative exchange transfusion, high flow normothermic bypass and warm blood cardioplegia that was utilized in a woman with homozygous SCD who underwent a successful double valve procedure.
Sachithanandan
Anand
A
Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK.
Nanjaiah
Prakash
P
Wright
Christine J
CJ
Rooney
Stephen J
SJ
D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006720:Homozygote; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*