हृदय रोग एवं निदान

The Impact of Short Term Vs. Extended Venesection in Symptomatic Patients with Congenital Cyanotic Heart Diseases: A Single Center Comparative Study

Abstract

Nour A, Kamel H and Roshdy A

Background: Secondary polycythemia in patients with Congenital Cyanotic Heart Diseases (CCHD) is associated with many complications starting from iron deficiency anemia up to extensive cerebrovascular stroke. It is noteworthy to say that there is a lot of debate about the agreed protocol for the optimal management of this particular group of patients to obtain the best outcome with less incidence of complications.

Methods: This is a prospective study comparing two different exchange transfusion protocols used for the management of secondary erythrocytosis in CCHD patients. The study included 20 CCHD patients who came to our congenital heart disease unit for elective exchange transfusion over the past 12 months. A custom-made sheet was made including age, diagnoses, number of times for venesection, all hematological parameters before and after the procedure, oxygen saturation and 6-minute walk test.

Results: A total number of 20 patients with CCHD were recruited with mean age of 20.84 years ± 7.4 years with average weight 60 kg. Tetralogy of Fallot was the most common CCHD in the recruited patients (n=5). The average oxygen saturation before the procedure was 75% which improved to 81% after the procedure. Mean hematocrit before the procedure was 70.45% which decreased to a value of 59% after the phlebotomy. A number of 12 out of 20 patients under went venesection of the recommended amount (followed by equivalent isotonic saline replacement) divided equally over an extended period of time of 3 weeks. The remaining 8 patients under went phlebotomy divided over two successive days. There was no significant difference between the 2 groups as regard hemoglobin level and 6-minute walk test, However Among the first arm only one patient developed Iron deficiency anemia versus 7 patients of the second arm.

Conclusion: The extended gradual venesection with adequate volume replacement in patients with CCHD is associated with better outcome as regards iron deficiency anemia.