INTRODUCTION Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvular, great vessels and CABG surgery. In several large studies TEE has been shown to have higer sensitivity than TTE for native valve (94-100% vs. 44-63%) and prosthetic valves (75% vs 25%) both have high specificity (91-98%). TEE has got its value, particularly when surgeon intends to repair diseased valves, which are favorable operations due to its better survival rate, better ventricular function and fewer tromboembolic events. Most commonly valve repairs performed in patients with mitral and tricuspid valve diseases although reparative procedures have been described for all valve positions. AIM Our aim is to define how important is TEE during mitral valve repairing operations. PATIENTS AND METHODS At our institution, during five years period (between may 1999. and may 2004.) 29 patients have been operated with mitral valve repairing and monitored by TEE intraoperatively. They all went through preoperative preparations at the Clinic for Heart diseases and rheumatism, as well as Cardiology dept. of Cardiac surgery clinic KCU Sarajevo. We were following ASE/SCE guidelines for intraoperative examination during four different intraoperative mitral valve surgery stages, using Siemens ultrasound machine Sonoline Versa Plus with TEE multiplane probe type MPT-4. RESULTS For 20 pts. (71%) mitral valve repairing has been performed solely, in 9 (29%) pts. combined mitral and tricuspide valves repairing. In two cases (6,9%) after not satisfied repairing cardiac surgeon had to replaced native (previously repaired) mitral valve with mechanical prosthesis. 7 pts. (24%) got Carpantier rings and others 22 (76%) have been operated with pericardium patch. CONCLUSIONS IOP TEE proved to be very useful in determination of the nature, severity and egzact anatomic location (scaloping) of the mitral and other valves disorders, in assessment of the urgency and feasibility of valves reparation and in plaining of the surgical procedures. In the case of poor surgical valve reparations, intraoperative TEE is the first method of choice in monitoring the process of valve reparation and in estimating the time for valve replacement.

ASA is commonly used for many years as pain relief drug, anti-inflammatory and against temperature, as well as antiaggregatory agent in coronary disease therapy. Aprotinin (Trasylol) has antifibrinolytic properties, among other actions, inhibits intrinsic coagulation cascade, and it has been demonstrated to reduce blood loss. Can be given in different doses and by different protocols. It is frequently used in cardiosurgery to reduce postoperative bleeding in the cases when ASA is not stopped at the right time before surgery. We evaluated the effects of therapeutic ASA doses on postoperative bleeding in patients undergoing coronary bypass grafting (CABG) compared with usage of Trasylol in CABG, bleeding and blood and fresh frozen plasma (FFP) requirements. This is a retrospective study, period October 1998-March 2002. Out of total CABG patients 75 fulfilled criteria (elective surgery, first CABG)--they were divided into following groups: ASA group of 25 patients (ASA withdrawn 1-3 days before surgery), Non ASA group of 25 patients (ASA withdrawn 10 or more days before surgery) and Trasylol group of 25 patients (ASA till surgery plus Trasylol intraoperatively). Average bleeding in ASA group 24 hours postoperatively was 1600 ml, Non ASA group had average bleeding 900 ml, while Trasylol group had average drainage of 700 ml after 24 hours. ASA average blood requirement was 1800 ml, 250 ml FFP and 250 ml 5% albumin, Non ASA group has less need for blood and FFP--250 ml blood, 50 ml FFP and 30 ml 5% albumin. Our Trasylol group had quite profound bleeding and high requirements for blood and FFP--average 850 ml blood, 200 ml FFP and 150 ml 5% albumin. We recommend discontinuation of ASA therapy sufficiently early for all elective CABG, because in our case Trasylol did not give satisfactory decrease in postoperative bleeding and blood and FFP requirements. That all increase possibility of postoperative complication occurrence and increase CABG costs.