Carotid artery stenosis in asymptomatic patients undergoing coronary artery bypass grafting: who and when should be screened?

Background: Carotid artery stenosis (CAS) is one of the major causes of stroke in coronary artery bypass grafting (CABG). Aims: The aim of this study was to determine which age groups require screening for CAS using carotid duplex ultrasound in asymptomatic patients undergoing CABG. Methods: We included 644 neurologically asymptomatic consecutive patients (mean [SD] age, 63.9 [8.8] years; men, 453 [70.3%]) who underwent elective isolated CABG between June 2015 and June 2020. Clinical, demographic, and radiological data as well as coronary angiography results were retrospectively reviewed. Patients were classified into 4 age groups: 40 to 50, 51 to 60, 61 to 70, and > 70 years, as well as 3 groups depending on the CAS degree: 50% or less, 50% to 70%, and 70% or greater. Regression analysis was applied across the selected parameters to identify risk factors for significant CAS, and receiver operating characteristic analysis, to determine cutoff age and SYNTAX score of patients who had to be screened before CABG. Results: Overall, 8 (1.1%) patients included in the present study had stroke following CABG. Cutoff values of the SYNTAX score and CAS of 70% or greater were found to be 27 and 64 years, respectively. The sensitivity and specificity of the cutoff value were 98.4% to 98.3% and 74.3% to 55.1%, respectively. The area under the curve was 0.98 and 0.73, respectively. Conclusion: Based on the receiver operating characteristic analysis, we recommended to perform screening for CAS in patients older than 64 years and with a SYNTAX score of 27 or higher, even if they are asymptomatic

Hemangioma of the tricuspid valve

Oldukça nadir görülen lezyonlar olan kalp kapak tümörleri kalbin primer neoplastik oluşumlarının %10 kadarını oluşturmaktadırlar. Literatürde triküspid kapakta yer alan hemanjioma oldukça nadir rastlanmaktadır. Olgumuz olan 17 yaşında erkek hasta perimembranöz ventriküler septal defekt nedeniyle opere edilirken triküspid kapağın anterior leafletinde 7 x 5 mm boyutlarında bir lezyon saptanarak eksize edilmiş ve patolojisi benign vasküler proliferasyon; hemanjiom olarak rapor edilmiştir. Bu olguyu literatürde nadir rastlanması ve özellikle konjenital operasyonlarda eşlik edebilecek patolojiler açısından inspeksiyonun önemini vurgulamak amacıyla sunmaktayız.Cardiac valve tumors are rare, accounting for less than 10% of all primary cardiac tumors. Hemangiomas of the tricuspid valve are rarely documented in the literature. A 7 x 5 mm lesion was determined and resected during the operation of a 17-year-old male who underwent surgery for perimembranous ventricular septal defect and documented as benign vascular proliferation; hemangioma in the pathology report. We report this case because of it’s rarity and to demostrate the importance of inspection for the lesions which can especially accompany to congenital cardiac diseases

Hemangioma of the tricuspid valve

Oldukça nadir görülen lezyonlar olan kalp kapak tümörleri kalbin primer neoplastik oluşumlarının %10 kadarını oluşturmaktadırlar. Literatürde triküspid kapakta yer alan hemanjioma oldukça nadir rastlanmaktadır. Olgumuz olan 17 yaşında erkek hasta perimembranöz ventriküler septal defekt nedeniyle opere edilirken triküspid kapağın anterior leafletinde 7 x 5 mm boyutlarında bir lezyon saptanarak eksize edilmiş ve patolojisi benign vasküler proliferasyon; hemanjiom olarak rapor edilmiştir. Bu olguyu literatürde nadir rastlanması ve özellikle konjenital operasyonlarda eşlik edebilecek patolojiler açısından inspeksiyonun önemini vurgulamak amacıyla sunmaktayız.Cardiac valve tumors are rare, accounting for less than 10% of all primary cardiac tumors. Hemangiomas of the tricuspid valve are rarely documented in the literature. A 7 x 5 mm lesion was determined and resected during the operation of a 17-year-old male who underwent surgery for perimembranous ventricular septal defect and documented as benign vascular proliferation; hemangioma in the pathology report. We report this case because of it’s rarity and to demostrate the importance of inspection for the lesions which can especially accompany to congenital cardiac diseases

Wpływ zmian tandemowych na parametry hemodynamiczne: badanie eksperymentalne

Background: The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesions has a direct impact on endovascular treatment (PTCA/stent); however, the arrangement of the lesions is underestimated and not well studied. Aim: We sought to evaluate the haemodynamic effects of different stenotic lesion models and arrangements in vitro. Methods: Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate, sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long, and critical short lesion combinations were performed and haemodynamic parameters were recorded. Results: Tandem lesions were more likely to result in critical stenosis comparing single lesions with the same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions also resulted in more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result in more flow restriction with reference to single lesions with the same stenotic ratio. Contrary to expectations, tandem short lesions were found to be more stenotic compared with the same degree long individual lesions. Conclusions: It is effortless to give the decision for simple, discrete and individual lesions, while the ideal decision for long and complicated lesions may remain unclear. Even if these “grey zone” lesions are considered non-critical while investigating them one by one, it must be kept in mind that the overall stenotic effect of these lesions may lead to more haemodynamic impairment.Wstęp: Morfologia i długość zwężeń tętnic mają równie istotne znaczenie, jak stopień zwężenia. Powszechnie wiadomo, że złożoność zmian w tętnicach ma bezpośredni wpływ na leczenie wewnątrznaczyniowe (przezskórna wewnątrznaczyniowa angioplastyka wieńcowa/stent), jednak znaczenie konfiguracji zmian nie jest doceniane ani nie zostało wystarczająco zbadane. Cel: Celem niniejszej pracy była ocena efektu hemodynamicznego różnych rodzajów zwężeń tętnic i ich konfiguracji w wa¬runkach in vitro. Metody: Wykonano model do symulacji układu naczyniowego w warunkach in vitro. Wykorzystano do tego oksygenator, zestaw drenów, syntetyczną protezę naczyniową z politetrahydroflouroetylenu oraz czujniki ciśnienia i przepływu. Przeprowa¬dzono pomiary przy różnych konfiguracjach zmian (izolowane krótkie zwężenie, izolowane długie zwężenie, dwa identyczne krótkie zwężenia w układzie tandemowym, dwa identyczne długie zwężenia w układzie tandemowym, kombinacja długiego zwężenia podkrytycznego i krótkiego zwężenia krytycznego) i zarejestrowano parametry hemodynamiczne. Wyniki: Zmiany tandemowe wiązały się z większym ryzykiem krytycznego zwężenia niż pojedyncze zmiany o takim samym stopniu zwężenia światła naczynia. Różnica była tym większa, im większy był stopień zwężenia. Długie zwężenia tandemo¬we również powodowały więcej krytycznych zwężeń niż krótkie zwężenia w układzie tandemowym. Można stwierdzić, że zmiany tandemowe powodują większe ograniczenie przepływu niż pojedyncze zwężenia o takim samym stopniu zwężenia światła naczynia. Przeciwnie niż oczekiwano, okazało się, że krótkie zwężenia tandemowe powodują większe zaburzenia niż pojedyncze długie zwężenia o tej samej średnicy. Wnioski: Decyzje dotyczące leczenia nieskomplikowanych, ograniczonych i izolowanych zmian naczyniowych nie są trudne, natomiast w przypadku długoodcinkowych i złożonych zmian optymalna decyzja może być nieoczywista. Nawet jeśli te zmiany „szarej strefy” są uważane za niekrytyczne, w przypadku gdy ocenia się je niezależnie od siebie (każdą osobno), należy pa¬miętać, że sumaryczny efekt zwężenia łożyska naczyniowego może spowodować poważniejsze zaburzenia hemodynamiczne

Effect of tandem lesions on hemodynamic parameters: an experimental study

WOS: 000424153600005PubMed ID: 28832097Background and aim: The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesion has direct impact on endovascular treatment (PTCA/stent), however; different arrangement of the lesions is underestimated and not well studied. We sought to evaluate the hemodynamic effects of different stenotic lesion models and arrangements in vitro Methods: Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long and critical short lesion combination were performed and hemodynamic parameters were recorded. Results: Tandem lesions were more likely to result critical stenosis comparing single lesions with same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions were also resulted more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result more flow restriction with reference to single lesions with same stenotic ratio. Contrary to expectations, tandem short lesions were found more stenotic compared with the same degree long individual lesions. Conclusions: It is effortless to give decision for simple, discrete and individual lesions while ideal decision for long and complicated lesions may remain unclear. Even if these "gray zone" lesions considered non-critical while investigating them one by one, it must be kept in mind overall stenotic effect of these lesions may lead to a more hemodynamic impairment.Hitit University Faculty of Medicine Scientific Research Projects [TIP19002.14.002]The study was funded with the project number of TIP19002.14.002 under the coverage of Hitit University Faculty of Medicine Scientific Research Projects