Timshina Anuj, Parajuli Santosh S, Adhikary Sumnima
Anesthesiology, Shahid Gangalal National Heart Centre, Kathmandu, NPL.
Cureus. 2024 Sep 7;16(9):e68875. doi: 10.7759/cureus.68875. eCollection 2024 Sep.
In Nepal, rheumatic heart disease (RHD) is alarmingly prevalent, marked by presentations like migratory joint arthritis, carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea. This condition can progress to instigate valvular defects. Although these patients are first approached medically, they may require surgery for severe cases. Refusal for blood transfusion might not be a major issue for other general surgeries; however, in cardiac surgery, where there is massive blood loss, it's quite a challenge. This challenge becomes even more pronounced in a developing country that lacks advanced facilities like a cell saver for autotransfusion. Herein, we report a case of a 22-year-old female, a Jehovah's Witness, suffering from RHD, severe mitral regurgitation, severe tricuspid regurgitation, and severe pulmonary artery hypertension. She underwent mitral valve replacement and tricuspid repair surgery (modified DeVega) by avoiding any form of blood product transfusion.
在尼泊尔，风湿性心脏病（RHD）的患病率高得惊人，其症状表现为游走性关节关节炎、心脏炎、皮下结节、边缘性红斑和 Sydenham 舞蹈病等。这种疾病可能会发展并引发瓣膜缺陷。虽然这些患者最初会接受药物治疗，但严重病例可能需要手术。拒绝输血对于其他普通外科手术可能不是一个大问题；然而，在心脏手术中，由于会有大量失血，这是一个相当大的挑战。在一个缺乏如自体输血细胞保存器等先进设备的发展中国家，这一挑战变得更加突出。在此，我们报告一例 22 岁女性耶和华见证会教徒的病例，她患有风湿性心脏病、严重二尖瓣反流、严重三尖瓣反流和严重肺动脉高压。她在避免任何形式的血液制品输血的情况下接受了二尖瓣置换和三尖瓣修复手术（改良 DeVega 手术）。
