Surgical management of a coronary arteriovenous fistula between diagonal coronary artery to pulmonary artery: a case report

Koroner arteriovenöz fistül %0.1-0.2 insidans ile nadir bir anomalidir. Bu anomali bir koroner arter ile kardiyak boşluklardan biri, koroner sinüs, süperior vena kava, pulmoner arter ya da pulmoner venler arasında kapiller sistemi olmayan direkt bağlantılar olarak tanımlanır. Arteriovenöz fistüllerin birçoğu sağ koroner arter ya da sol ön inen koroner arterden köken alır. Bu arteriovenöz fistüller kıvrıntılı, anevrizmatik yapıda ve birden fazla sayıda olabilir. Bununla birlikte, birden fazla olan fistüller tüm koroner arteriovenöz fistüllerin %10.7-16' sını oluşturur. Bu olgu sunumunda, koroner arter bypass operasyonu ile es zamanlı diagonal arter - pulmoner arter arasında koroner arteriovenöz fistül kapatma operasyonu uygulanan bir olguyu sunuyoruz.Coronary arteriovenous fistula is a rare anomaly with an incidence between 0.1- 0.2 %. This anomaly is defined as a direct connection between a coronary artery and one of the cardiac chambers, coronary sinus, superior vena cava, pulmonary artery or pulmonary veins without intervening with capillary system. The majority of arteriovenous fistulas arise from the right coronary artery or left anterior descending artery. These arteriovenous fistulas may be tortuous, aneurysmal and multiple. However, multiple fistulas occur in 10.7% to 16% of all coronary arteriovenous fistulas. In this case report, we present a patient who underwent closure of a coronary arteriovenous fistula between diagonal coronary artery and pulmonary artery concomitant with coronary artery bypass operation

Central venous catheterization in open heart surgery: Internal jugular vein or supraclavicular subclavian vein approach?

Amaç: Bu çalışmada santral venöz kateter (SVK) takılan hastalarda komplikasyon gelişimine etki eden faktörler araştırıldı. Çalışma planı: Kasım 2007 - Ocak 2009 tarihleri arasında kliniğimizde SVK uygulanan 94 hasta (69 erkek, 25 kadın; ort. yaş 60.3±13.2 yıl; dağılım 4-84 yıl) ileriye yönelik olarak incelendi. Hastalar rastgele iki gruba ayrıldı. Santral venöz kateter grup 1’de (n=49), sağ internal juguler ven (İJV) yoluyla, grup 2’de (n=45) ise sağ supraklaviküler subklaviyen ven (SpSV) yoluyla uygulandı. Tüm SVK’ler aynı hekim tarafından Seldinger tekniği ile takıldı. Bulgular: Demografik özellikler açısından iki grup arasında anlamlı fark yoktu. Ameliyat sırası ve sonrası dönemde, iki grup arasında pnömotoraks, hemotoraks, malpozisyon, hematom gelişimi, nörolojik hasar, infeksiyon ve kateter kalış süresi açısından anlamlı fark bulunmadı. Dokuz hastada arter ponksiyonu [grup 1 (n=8) ve grup 2 (n=1); p=0.020], yedi hastada pinch-off fenomeni [grup 1 (n=0) ve grup 2 (n=7); p=0.004] ve 19 hastada iki veya daha fazla girişim [grup 1 (n=16) ve grup 2 (n=3); p=0.002] gerçekleşti. Çokdeğişkenli analizde; arter ponksiyonu için vücut kütle indeksi (VKİ) (p=0.028), pinch-off fenomeni için VKİ (p=0.040) ve SpSV yaklaşım (p=0.022); iki veya daha fazla girişim için ise İJV yaklaşım (p=0.007) güçlü öngörücü faktörler olarak saptandı. Sonuç: Başarılı bir girişim için hasta anatomisi, VKİ ve hekimin deneyimi göz önünde bulundurulmalı ve bu seçenekler arasında SpSV kateterizasyonunun da olabileceği düşünülmelidir.Background: In this study we investigated the factors that affect the development of complications in patients who had central venous catheter (CVC) insertion. Methods: Ninety-four patients (69 males, 25 females; mean age 60.3±13.2 years; range 4 to 84 years) who had CVC between November 2007 - January 2009 in our clinic were investigated prospectively. Patients were randomized to two groups; in group 1 (n=49), CVC was performed through right internal jugular vein (IJV), and in group 2 (n=45), CVC was performed through right supraclavicular subclavian vein (SpSV). All of the CVC's were performed by means of Seldinger's technique by the same operator. Results: There were no significant differences in the demographic features between the two groups. There were no significant differences between the groups with regard to pneumothorax, hemothorax, malposition, hematoma development, neurological damage, infection and catheter stay in the intra- and postoperative periods. Nine cases had arterial puncture [group 1 (n=8) and group 2 (n=1); p=0.020], seven cases had pinch-off phenomenon [group 1 (n=0) and group 2 (n=7); p=0.004], and 19 cases had two or more interventions [group 1 (n=16) and group 2 (n=3); p=0.002]. In the multivariate analysis, the powerful predictive factor for arterial puncture was the body mass index (BMI) (p=0.028), for the pinch-off phenomenon BMI (p=0.040) and the SpSV approach (p=0.022); the predictive factor for two or more insertional attempts was IJV approach (p=0.007). Conclusion: The patient's anatomy, BMI and the physician's experience should be considered for a successful attempt. We think that SpSV catheterization may be among the preferences

Investigating the effect of electrolyte types with various ionic liquids on the electrochromic performance of PEDOT:PSS based LbL multilayers

The objective of the study is to investigate the electrochromic performances of layer-by-layer (LbL) multilayered thin film electrode prepared from linear polyethylene imine (LPEI) and poly(3,4-ethylenediox-ythiophene):polystyrene sulfonate (PEDOT:PSS) on PET-ITO substrate in the presence of different types of electrolytes. For this purpose, the electrochromic behaviors of (LPEI/PEDOT:PSS) 10 is performed in LiClO4/propylene carbonate (PC) and two different ionic liquids (IL) namely N-methylimidazolium tetrafluoroborate (Melm-BF4) and 2-hydroxy ethyl ammonium formate (2-HEAF), as a function of IL content and scanning rate. The optical contrast value of (LPEI/PEDOT:PSS) 10 film is determined as 58.4% in the existence of 10 wt% of 2-HEAF as the electrolyte. The coloration efficiency of this film is determined as 606.7 cm(2)/C, which this value was greater approximately four times than 1 M LiClO4/PC. According to the obtained results, 2-HEAF has been evaluated as a suitable electrolyte alternative for (LPEI/PEDOT:PSS) 10 film due to its better optical contrast and coloration efficiency compared to other electrolytes