US-accelerated catheter-directed thrombolysis for the treatment of deep venous thrombosis

PURPOSEWe aimed to evaluate the efficacy and feasibility of ultrasonography (US)-accelerated catheter-directed thrombolysis for the treatment of deep venous thrombosis. MATERIALS AND METHODSA total of 26 patients with deep venous thrombosis were prospectively selected for thrombolysis. Overall, 80.8% of the occlusions were in the lower extremities, and 19.2% were in the upper extremities. US-accelerated catheter-directed thrombolysis was performed using a recombinant human tissue plasminogen activator (alteplase), which was delivered using the EKOS EkoSonic® Endovascular System (EKOS Corporation, Bothell, Washington, USA). Postprocedure venography was repeated after the treatment, which included angioplasty and stenting if stenosis was present. RESULTSThrombolysis was successful in 92.3% (24/26) of the patients, with complete clot lysis in 14 patients and partial clot lysis in nine patients. The mean symptom duration was 54.9±51 days (range, 6–183 days), and the mean thrombolysis infusion time was 25.3±5.3 hours (range, 16–39 hours). Pulmonary embolism was not observed; however, there were three cases of bleeding at the catheter insertion site. In three patients, the underlying lesions were successfully treated with balloon angioplasty and stent insertion. Two patients developed early recurrent thrombosis due to residual venous obstruction. CONCLUSIONUS-accelerated thrombolysis was demonstrated to be a safe and efficacious treatment for deep venous thrombosis in this study. The addition of US reduces the total infusion time and increases the incidence of complete lysis with a reduction in bleeding rates. Residual venous obstruction should be treated by angioplasty and stent insertion to prevent early rethrombosis

Reoperations after total correction of fallot

İstanbul Göğüs Kalp ve Damar Cerrahisi Merkezi'nde 1963-1989 yılları arasında fallot tetralojisi nedeniyle total korreksiyon yapılan ve hastane mortalitesi dışında kalan olgu sayısı 273'tür. Bu olgulardan 5 tanesi reopere edilmiştir (% 1.83 ). Reoperasyon nedeni 3 olguda rezidüel ventriküler septal defect, bir olguda rezidüel VSD ve transannuler perikard yama anevrizması, bir olguda ise triküspid kapak endokarditine bağlı triküspid yetmezliği olmuştur. Reoperasyonlarda 2 olguda VSD yama ile tamir edilmiş, bir olguda ilave olarak triküspide Dewega annuloplasti yapılmış, bir olguda VSD kapatılması ve anevrizmektomi uygulanmış, bir olguda ise triküspid kapak replasmanı yapılmıştır. Ameliyat sonu dönemde bir olguda uzamış mekanik ventilasyon, bir olguda A-V tam blok nedeniyle kalıcı pacemaker implantasyonu gerekmiştir. Hasta mortalitesi yoktur.In İstanbul thoracic and cardiovascular surgery centre, between the years of 1963-1989, 273 case had total correction because of fallot tetralogy and these were exceptional according to the mortality ranges of the hospital 5 out of these operation were reoperated (% 1.83). The reasons of the reoperations were: residual VSD in three cases, residual VSD and transannular pericardial patch aneurysm together in one case and tricuspid failure due to tricuspid valve endocarditis in one case. In repeating operations, VSD was repaired by a patch in two of them and in one of them tricuspid devega annuloplasty was perfomıed additionally and one of them tricuspid valve replacement was achieved. In the postoperative stage, prolonged mechanical ventilation in one of them and permanent pacemaker implantation due to AV complete block in arıother were reeded. There was not mortality

Transatriosptal approach to mitral valve

1980-1990 yılları arasında İstanbul Göğüs Kalp ve Damar Cerrahisi Merkezi'nde 83 olguya transatrial septal yolla mitral kapaga cerrahi girişimde bulunulmuştur. Olguların 49 tanesi kadın (% 59), 34 tanesi erkek (% 41), yaş dağılımı kadınlarda ortalama 30 ( 19-40), erkeklerde 36 (21- 50), olguların cerrahi anatomik dağılımı 29 olgu daha önce mitral commissurotomy geçmiş (% 34), 23 olguda mitral yetmezligi (% 27. 7), 34 olguda mitral darlığı, mitral yetmezligi mevcuttu. İlave lezyon olarak( 7 glguda atrial septal defekt (% 8.4), 43 olguda triküspid yetmezliği vardı (% 51.8). Cerrahi girişim olarak 75 olguya mitrale mekanik yapay kapak (% 90.3), 4 olguya bioprotez (% 4.8), 3 olguya açık commissurotomy, 1 olguya carlos duran ring annuloplasty uygulanmış, 7 olguda ASD yama ile tamir edilmiş, 43 olguda aynı anda triküspit kapağa müdahale edilmiş (2 olguya mekanik kapak, 28 olguya dewege annuloplasti, 3 olguya puig massana annuloplasty, 1 olguya bioprotez takılmıştır). Postop dönemde 2 olguda A-V tam blok oluşarak kalıcı pacemaker implantasyonu gerektirmiştir. Tüm olgularda mortalite % 6.02'dir.In istanbul thoracic and cardiovascular surgery center, in the years of 1980-1990, 83 mitral valve procedures were performed by transatrial septal way. 49 of the cases were female (% 59) and 34 were male (% 41), mean age were 30 (19-40) in females and 36 (23-50) in males, surgical anatomical findings of the cases were: 29 had mitral commissurotomy (% 34), 23 had mitral failure (% 27.7), 34 had mitral stenosis and mitral failure both, additional to these, there were 7 ASD cases (% 8.4) and 43 tricuspid failure (% 51.8). As a surgical procedure 75 cases had mechanical valve (% 90.3).4 cases had bioprosthesis (% 4.8), 3 had commissurotomy, one had carlos duran ring annuloplasty, in 7 cases ASD was repaired by a patch and in 43 on intervention to tricuspid va/ve was achieved at the same time. At the end of the procedure in two of them, a pemıanent pacemaker was required as a result of AV complet block, mortality was % 6.02 in all of cases

Tetrology of fallot with absent pulmonary valve

Pulmoner kapak yokluğu ile birlikte fallot tetralojisi sendromu ventriküler septal defekt, overriding aorta, sağ ventriküler hipertrofi ve kapakların yokluğu ya da nudimentarlığı ile birlikte giden pulmoner annuler stenozla karakterizedir. Belirtiler yenidoğanın yaşamını tehdit edecek ölçüde respiratuar obstrüksiyon ve kalp yetmezliğinden yıllarca hiç kısıtlanmadan yaşayabilen semptomsuz şahıslara kadar değişebilir.The syndrome of tetralogy of fallot with absent pulmonary valve is characterized by ventricular septal defekt, overriding of the aorta, right ventricular hypertrophy and pulmonary annular stenosis is associated with absent or rudimentary valve. Symptoms vary from life-threatening respiratory obstruction or cardiac failure in neonates to absence of symptoms in patients who may live unrestricted lives for many years

The factors influencing the selection of palliative or corrective surgery in patients with tetralogy of fallot

Günümüzün modem kardiak cerrahi merkezlerinde total korreksiyon uygulanması öncelik kazanmıştır. İstanbul Göğüs Kalp Damar Cerrahisi Merkezi'nde de aynı görüş benimsenmekle birlikte hasta için en iyi tedavi yolunu seçmek korrektif cerrahiyi takiben prognozu değerlendirebilmek için önemli bazı parametreler üzerinde durulmaktadır. Bu parametreler ise şunlardır. 1) Pulmoner arter dallarının ve pulmoner vasküler yatağın gelişme derecesini gösteren oranlar:2) Sol ventrikül kavitesinin durumu, 3) Hastanın hematokriti 4) Preoperatif sineanjiogramlar yardımıyla hesaplanabilir postrepair olması muhtemel P RV/LV basınç oranı. Formüller için dosyaya bakınız.Total correction is the chosen treatment in tetralogy of fallot in modern cardiac surgery centers. Even though this concept has been fully accepted in İstanbul Thoracic and Cardiovascular Surgery Center, some important parameters are used to evaluate the prognosis after the corrective surgery. These parameters are: I) The ratios which show status of pulmonary artery branches and vascular bed. 2) The condition of the left ventricular cavity, 3) Hematocrit level, 4) Preoperative prediction from cineangiograms the ratio of postrepair P RV/ LV Pressure. Please open the file for the formulas

Ventilator Associated Pneumonia Cases in the Postoperative Intensive Care Unit of a Cardiothoracic Surgery Center

Ventilator associated pneumonia (VAP) cases were investigated in a cardiothoracic surgery postoperative intensive care unit between 1 January 1999 and 1 January 2000. A total of 1716 patients who undergone cardiothoracic operations and followed in intensive care unit (ICU) were included in the study. Patient and laboratory based prospective surveillance study of VAP was done along with other hospital acquired infections. During the study period, a total of 26585 patient days with 2708 ventilator days were determined. 46 cases of VAP were founded in 36 of 1716 patients who undergone cardiothoracic operations (2.09%, 1.3 pneumonia/patient). Ventilator utilization rate at our institution was found to be 0.10. There were 16.4 VAP’s per 1000 ventilation days. 38% of VAP were caused by gram-negative enteric rods (27% Enterobacter spp., 8% Klebsiella spp., 3% Serratia spp.), 34% by Pseudomonas aeruginosa, 17% by Staphylococcus aureus. VAP was polymicrobial in 9% of cases. No causative microorganism was identified in 2% of cases. Same bacteria were isolated both in blood and endotracheal aspirate cultures in 10 of 46 pneumonia cases (22%). Crude mortality rate of VAP was calculated as 30%