Surgical treatment of cardiogenic shock due to huge right atrial thromboembolus.

An unusual case is reported of thromboembolus in the right atrium associated with cardiogenic shock and multiple pulmonary micro-embolisms. Two-dimensional echocardiograpy demonstrated a large irregular mass in the right atrium floating freely, prolapsing through the tricuspid valve into the right ventricle during diastole, and leading to inflow and outflow obstruction. An emergency operation was performed and the thromboembolic material was successfully extracted from the right atrium without using cardiopulmonary bypass. This exemplary case highlights the benefit of surgical intervention rather than more conservative approaches such as anticoagulation and/or thrombolysis

Aortobifemoral bypass via paramedian incision and retroperitoneal approach for aortoiliac occlusive disease

Introduction : Aorto-bifemoral graft bypass operation is performed in the surgical treatment of aortoiliac occlusive occlusive disease. The conventional standard technique used is the median laparotomy and transperitoneal approach. In this study we evaluated the outcome of aortobifemoral bypass operation via paramedian and retroperitoneal approach. Methods : 17 patients were operated upon for aortobiiliac occlusive disease from January 2008 through December 2011. Mean age of the patients was 61.8 ± 8.9 (47-78 years). All patients except for one were operated via left paramedian vertical 8 to 10 cm incision approximately 6 cm to the left or right of midline, extending from a few centimeters above the umbilicus to just above the symphysis pubis. The aortas were reached retroperitoneally through this incision. Results : There was one postoperative death secondary to pulmonary complications. No intraoperative or postoperative surgical complication had occured. All patients were discharged from the hospital on antiplatelet therapy. Graft patency was evaluated by means of physical examination on discharge. Upon the patients' hospital discharge, primary graft patency was 100%. The ankle-brachial indices measured from both the right and left sides were 0.51 ± 0.10 preoperatively and 0.99 ± 0.14 postoperatively (p < 0.001). Discussion : A lot of complications can be observed due to median laparotomy such as evisceration, incisional hernia, peritonitis, bride ileus. We believe that retroperitoneal approach for aorto-bifemoral graft bypass operation in the patients with bilateral iliac arterial occlusive disease is a well tolerated minimally invasive operation when compared to the conventional median laparotomy approach. © Acta Chirurgica Belgica 2013

Spiral saphenous vein grafts in the femoral artery and vein reconstruction

Autogenous vein grafts have become the first choice with their positive outcomes in vascular injuries and are quite widely used today. Particularly in the case of size mismatch, spiral saphenous vein grafts prepared from the saphenous veins have had encouraging results. Two cases in which the patients had vascular reconstructions with spiral saphenous vein grafts for a stab wound and gunshot injury are presented in this paper

Anti-tumor effects of bemiparin in HepG2 and MIA PaCa-2 cells.

Recent researches have demonstrated improved survival in oncologic patients treated with low molecular weight heparins (LMWHs) which are anticoagulant drugs. We evaluated "second generation" LMWH bemiparin and its in vitro anti-tumor effects on HepG2 hepatocellular carcinoma and MIA PaCa-2 cancer cells. The aim of the study is to investigate anti-cancer mechanism of bemiparin in HepG2 and Mia-Paca-2 cancer cells. Cytotoxic effects of bemiparin were determined by XTT assay. IC50 dose of bemiparin was found to be 200 IU/mL in the 48th hour in the MiaPaCa-2 cell line and 50 IU/mL in the 48th hour in the HepG2 cell line. CCND1 (cyclin D1), CDK4, CDK6, p21, p16, p53, caspase-3, caspase-9, caspase-8, Bcl-2, BID, DR4, DR5, FADD, TRADD, Bax, gene mRNA expressions were evaluated by Real-time PCR. Real-time PCR analysis showed that CCND1 expression was reduced in HepG2 dose the group cells when compared with the control group cells and p53, caspase-3, caspase p21, caspase-8 and expressions were increased in the dose group cells when compared with the control group cells. CCND1, CDK4 and CDK6 expressions were reduced in MIA PaCa-2 dose group cells when compared with the control group cells and p53 expression was increased in the dose group cells when compared with the control group cells. Other expressions of genes were found statistically insignificant both of cell lines. It was found that bemiparin in HepG2 and MIA PaCa-2 cells suppressed invasion, migration, and colony formation by using matrigel invasion chamber, and colony formation assay, respectively. In conclusion, it is thought that bemiparin indicates anti-tumor activity by affecting cell cycle arrest, apoptosis, invasion, migration, and colony formation on cancer cells

The value of gamma glutamyl transpeptidase in atrial fibrillation following coronary artery bypass grafting

Atrial fibrillation (AF) seen following open heart surgery is one of the complications with important conseqences in the short and long term. The exact cause is unknown, however oxidative stress has been postulated. In this study, the significance of serum gamma glutamyl transferase (GGT) as a predictor of oxidative stress was evaluated in cases who developed AF after coronary artery bypass grafting (CABG).One hundred patients undergoing CABG in the department of cardiovascular surgery at our hospital, were included in the study. Patients with chronic liver disease, atrial fibrillation prior to surgery, large left atrium (greater than 45 mm), the need for emergency surgery, thyroid dysfunction, were excluded from the study. Before operation all patients had echocardiographic examination, electrocardiograms taken, and blood samples drawn for routine biochemistry including GGT. Group 1 consisted of 36 patients, who developed AF; group 2 consisted of 64 patients who did not develop AF. Patients were seen at one month after surgery. Medical treatment was given to the group with AF. Beta blocker therapy was contiunued the same as prior to surgery. The groups were similar with respect to sex, cardiovascular risk factors, the extent of coronary artery disease (p>0.05). Age differed significantly between the groups (Table 1). Patients who developed AF within 48 hours after surgery had a tendency to have a higher level of GGT. The group with AF had a significantly higher level of AST (p=0.027) (Table 2). In this study, we found that patients undergoing coronary bypass surgery, who developed AF after surgery, had a tendency to have a higher level of GGT. Our finding suggests a need for larger prospective studies looking at the relationship of plasma GGT level as a predictor of oxidative stres and the development of AF after CABG

Coronary arterial revascularization in an adult with congenitally corrected transposition of great arteries and dextrocardia.

OBJECTIVES: Congenitally corrected transposition of great arteries with dextrocardia is an extremely rare lesion in adulthood. This group of patients does not live long enough for atherosclerotic coronary artery disease processes, because of existing comorbid anomalies. METHODS: We report a 47-year-old man with isolated congenitally corrected transposition of great arteries, dextrocardia, and athersclerotic coronary artery disease. The patient underwent coronary artery revascularization with cardiopulmonary bypass. The free left internal mammary artery (LIMA) was grafted to the tiny left anterior descending artery (LAD), and the reversed saphenous vein Y graft was anastomosed to the posterior descending and posterolateral branches of the morphologic right coronary artery. RESULTS: The patient recovered uneventfully. He is alive and well 24 months after the surgery. CONCLUSIONS: To our knowledge, the present case is the first congenitally corrected transposition of great arteries with dextrocardia treated with grafted coronary artery bypass. Early and full revascularization is very important for the systemic right ventricle exposed to a systemic workload. The vessel pathologies and technical details of this unusual case are discussed in this paper

Protective effects of trimetazidine in transient spinal cord ischemia.

The neuroprotective effect of trimetazidine (TMZ) was tested prospectively in a rabbit spinal cord ischemia model. Ischemia was induced by clamping the aorta just distal to the left renal artery and proximal aortic bifurcation for 20 min. Twenty-five male New Zealand white rabbits were randomized as follows: TMZ group (n=100) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta; control group undergoing occlusion but receiving no pharmacologic intervention (n=10); sham-operation group (n=5) subjected to operative dissections without aortic occlusion. Physiological parameters and somatosensory evoked potentials (SEP) were monitored in animals before the ischemia, during the ischemia and in the 1st, 15th and 60th min of reperfusion. Neurologic status was assessed 24 and 48 h after the operation. The spinal cord, abdominal aorta, and its branches were processed for histopathologic examinations 48 h after the operation. At the end of the ischemic period, the average N1-P1 amplitude was reduced to 22% of the baseline in all ischemic animals. This was followed by a gradual return to 90+/-2% of the initial amplitude in the TMZ group and 81+/-2% in the control group (P<0.05) after 60 min of reperfusion. The average motor function score was significantly higher in the TMZ group than the control group (3.7+/-0.5 vs 3.1+/-0.6 at 24 and 3.5+/-0.7 vs 2.9+/-0.6 at 48 h; P<0.05). Histologic observations were clearly correlated with the neurologic findings. The results suggest that trimetazidine reduces spinal cord injury during thoracoabdominal aortic operations and may have therapeutic utility during high risk operations

"Right atrial-jugular vein graft bypass" for treatment of superior vena cava syndrome caused by protein S deficiency

Superior vena cava syndrome from protein S deficiency was diagnosed in a 32 year-old female. A three month period of medical treatment did not relieve her symptoms. We performed a " right atrial-jugular vein graft bypass" which relieved her symptoms within 10 days. The patient did not develop any complications in the 18 month postoperative period. We present this case with a review of the relevant literature