RESUMEN
BACKGROUND: Due to the distinctive nature of cardiac surgery, patients suffering from hereditary spherocytosis (HS) are potentially at a high risk of perioperative complications resulting from hemolysis. Despite being the most prevalent cause of hereditary chronic hemolysis, the standards of surgical management are based solely on expert opinion. OBJECTIVE: We analyze the risk of hemolysis in HS patients after cardiac surgery based on a systematic review of the literature. We also describe a case of a patient with hereditary spherocytosis who underwent aortic valve repair. METHODS: This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42023417666) and included records from Embase, MEDLINE, Web of Science, and Google Scholar databases. The case study investigates a 38-year-old patient who underwent surgery for an aortic valve defect in mid-2022. RESULTS: Of the 787 search results, 21 studies describing 23 cases of HS undergoing cardiac surgery were included in the final analysis. Hemolysis was diagnosed in five patients (one coronary artery bypass graft surgery, two aortic valve bioprosthesis, one ventricular septal defect closure, and one mitral valve plasty). None of the patients died in the perioperative period. Also, no significant clinical hemolysis was observed in our patient during the perioperative period. CONCLUSIONS: The literature data show that hemolysis is not common in patients with HS undergoing various cardiac surgery techniques. The typical management of a patient with mild/moderate HS does not appear to increase the risk of significant clinical hemolysis. Commonly accepted beliefs about factors inducing hemolysis during cardiac surgery may not be fully justified and require further investigation.
RESUMEN
A 27-year-old woman sustained a blunt chest trauma after a car accident. Computed tomography revealed tension pneumopericardium, bilateral pneumothorax, and a suspected rupture of the left main bronchus. Emergent pericardial needle aspiration was successfully performed. Bronchial amputation was confirmed by bronchofiberoscopy. Despite total detachment of the distal part of the bronchial tree, the ventilation of the left lung was maintained without air leakage by use of pleural drains. Bronchial obturation resulted from the injury, and was effectively treated by bronchoscopic sputum suction at the distal end of the bronchus. Finally, the patient underwent a left thoracotomy with an end-to-end bronchial anastomosis. The patient was discharged home on the 32nd day after the trauma, and no complications were recorded during a 3-month follow-up period.