Sutureless Aortic Valve Replacement – the First Experience in Trakya University

DergiPark: 378995tmsjIntroduction: We present the first experience of sutureless aortic bioprosthesis valve replacement in Trakya University Cardiovascular Surgery Clinic. Case report:A 71 year-old female patient with shortness of breath admitted to the cardiology clinic. In physical examination, there was a 3/6 systolic murmur on aortic area spreading to the neck. In the echocardiography, severe aortic stenosis and mild aortic insufficiency was found. In coronary angiography, 90% stenosis was found on proximal portion of left anterior descending coronary artery. Aortic valve replacement and coronary artery by-pass operation was planned. Results: The first sutureless aortic valve replacement in Trakya University Hospital was performed successfully and the patient was discharged from the hospital without any complication

A Rare Etiology of Heart Failure: Traumatic Arteriovenous Fistula Due to Stab Injury 17 Years Ago

Background: Although traumatic fistula is frequently encountered, high-output heart failure due to fistula is a very rare condition. Despite an indefinitive history of trauma, arteriovenous (AV) fistula may develop insidiously, and therefore identification of a shunt is highly important for treatment. Case Report: Here we report a 46-year-old male patient with heart failure due to traumatic femoral arterio- venous fistula developed following a penetrating stab injury 17 years ago. Conclusion: Traumatic AV fistula is a curable cause of heart failure. Also, careful examination of the patient is as significant as radiological imaging methods

The evaluation of arterial and venous grafts with intraoperative flowmeter techniques in coronary artery bypass grafting operations

Amaç: Çalışmada, koroner arter cerrahisinde kullanılan greftlerin intraoperatif Transit Time Akım Ölçüm (TTFM) Cihazı ile değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Koroner arter bypass greft (CABG) operasyonu uygulanan 59 hasta çalışmaya alındı. Sol internal mammaryan arter (LİMA) ve safen ven greft olarak çıkartılarak koroner bypass anastomozları gerçekleştirildi. Kardiyopulmoner bypasstan çıkıldıktan sonra Transit Time Flow Meter cihazı ile her bir greften geçen akım miktarı mililitre/dakika olarak, akım eğrisi eş zamanlı olarak ve greftin pulsatilite indeksi (PI) ve diyastolik doluş yüzdesi (%DF) otomatik olarak ölçüldü. Bulgular: Hastaların ortalama greft sayısı 3.25±0.8 idi. Toplam 187 greftte Transit Time Flow Ölçümü yapıldı. En yüksek ortalama akım 55.5 ml/dk ile aorta-RCA sistemde saptanırken en düşük ortalama akım ise 37.6 ml/dk ile aorta-diagonal sistemde ölçüldü. İki hastada toplam 2 greftte (%3.38) akımda yetersizlik saptandı. Sonuç: Transit Time Flow Ölçümü (TTFM), cerrahi esnasındaki teknik yetersizliklerin saptanmasında önemli katkıları olan bir yöntemdir. Perioperatif olarak greft yetersizliğinin saptanması ile küçük girişimlerle, genellikle hatanın düzeltilmesi ve yeterli greft akımının sağlanması mümkün olabilmektedir.Objective: The purpose of this study was to evaluate the coronary artery bypass grafts with Transit Time Flowmeter (TTFM). Material and Methods: Fifty-nine patients who were scheduled for coronary artery bypass graft (CABG) surgery were included in the study. Coronary artery bypass anastomoses were performed using the left internal mammary artery (LIMA) and saphenous vein. At the end of the cardiopulmonary bypass, graft flow (ml/min), pulsatility index (PI), flow curve and diastolic filling percentage (DF%) of each graft were assessed with TTFM. Results: Mean graft number of the patients was 3.25±0.8. We assessed the patency of a total of 187 grafts using TTFM. Highest mean flow was 55.5 ml/min in aorta-RCA grafts and lowest mean flow was 37.6 ml/min in aorta-diagonal grafts. Revision was required for two grafts (3.38%) in two patients based on inadequate TTFM findings. Conclusion: Transit time flowmeter is an important technique that provides the detection of technical errors during surgery. With the detection of graft failure intraoperatively, revision of the graft and restoration of blood flow could be performed

The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe

Introduction: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. Aim of the study: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. Material and methods: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. Results: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 +/- 4.47%, 98.52 +/- 3.95%, 93.78 +/- 3.64%, and 30.87 +/- 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. Conclusion: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency

Open heart surgery in dialysis-dependent patients with end stage renal failure

Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75%) and nine women(25%) totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76) years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3): 335-338Key words: Cardiac surgery, chronic renal failure, mortalit

The role of the abdominopelvic ultrasonography in detecting the occult malignances in patients with lower limb venous thrombosis

Amaç: Derin ven trombozu (DVT) tanısı alan hastalarda rutin abdominopelvik ultrasonografi (APUSG) yapılmasının önemi araştırıldı. Hastalar ve Yöntemler: Ocak 1999 - 2004 tarihleri arasında DVT tanısıyla kliniğimize yatırılan 212 olgu (105 erkek, 107 kadın; ort. yaş 55.2±16; dağılım 7-75) çalışmaya alındı. Derin ven trombozu tedavisi gören hastalarda tanı aşamasında abdominopelvik ultrasonografi yapıldı. Bulgular: Derin ven trombozu tanısı konan olgular arasında malignite %9.9 sıklıkta görülürken, en sık jinekolojik (%33.3) ve akciğer (%28.5) maligniteleri saptandı. Bunları gastrointestinal sistem (%14.3), ürolojik sistem, intrakraniyal ve meme (%4.8) kanserleri takip ediyordu. On beş hastada (%7) yatış sırasında malignite tanısı vardı. Altı hastada (%3) ise yatış sırasında APUSG ile yeni jinekolojik malinite tanısı kondu. Malignite saptanan olguların yaş ortalaması 57±10 (35- 72 yıl) ve erkek/kadın oranı 10/11 olarak bulundu. Jinekolojik maligniteler uterus (n=4), over (n=2) ve vulva (n=1) yerleşimliydi. Gastrointestinal sistem malignitelerinin tümü kalın bağırsak yerleşimliydi. Ürolojik malignitelerin ikisi renal (hipernefroma) ve biri prostat kaynaklıydı. Akciğer maligniteleri ise küçük hücreli (n=4) ve epidermoid hücreli kanser (n=2) olarak saptandı. Genç bir kadın hastada ise APUSG’de endometrial kavitede altı haftalık canlı fetus saptandı. Sonuç: Derin ven trombozu tanısı konulan hastalarda APUSG ile kitle saptanması durumunda tedavi planı değişebilmekte, daha önemlisi patoloji erken fark edilebilmekte ve buna yönelik tedaviye de erkenden başlanabilmektedir.Objectives: We assessed the role of routine abdominopelvic ultrasonography (APUSG) in patients with deep vein thrombosis (DVT). Patients and Methods: The study included 212 patients (105 men, 107 women; mean age 55.2±16 years; range 7 to 75 years) who were treated for DVT between January 1999 and 2004 in Cardiovascular Surgery Department of Medical Faculty of Trakya University. Results: In our study, the incidence of malignancies in these patients was 9.9%, the most common being gynecologic (33.3%) and lung (28.5%) malignancies. Gastrointestinal (14.3%), urological, intracranial, and breast malignancies (4.8%) were less common. Fifteen patients had a malignancy before hospitalization. On admission, a gynecological malignancy was diagnosed in six patients (3%) with APUSG. The mean age of patients with a malignancy was 57±10 (35-72 years), with a male to female ratio of 10/11. Gynecological malignancies involved the uterus (n=4), ovary (n=2), and vulva (n=1). All gastrointestinal system malignancies were in the colon. Of urological malignancies, two were of renal localization (hypernephroma) and one was in the prostate gland. Lung malignancies included small cell lung cancer (n=4) and epidermoid cell cancer (n=2). In one young female patient, APUSG showed a six-week fetus in the endometrial cavity. Conclusion: In patients with DVT, detection of a mass with APUSG may alter the treatment plan. More importantly, APUSG may enable early detection of the pathology, and thus, early initiation of the treatment

The Role of Chlamydia pneumoniae in the Atherosclerotic Process of Patients under 50 Years of Age Who Underwent Coronary Artery Bypass Graft Surgery

ABSTRACT Background: To evaluate the presence of C. pneumoniae DNA in the tissues and C. pneumoniae DNA antibodies in the blood samples of patients who underwent CABG surgery. Material and Methods: Fifty-one patients <50 years of age were included in the study, and analyzed in two groups according to the intimal thickness of aorta. C. pneumoniae DNA was evaluated in the tissues collected from the atrium, left internal thoracic artery and ascending aorta of patients. Results: Although, C. pneumoniae DNA was negative in the atrial and left internal thoracic artery tissues of all patients, it was positive in the tissues obtained from the ascending aortas of twelve patients. C. pneumoniae DNA positivity was significantly higher in patients with increased aortic intimal thickness compared to those without increased aortic thickness. Conclusion: The question whether C. pneumoniae is triggering atherosclerosis or is involved as a superinfection could not be clarified

Off-pump coronary artery bypass grafting: Edirne experience

Amaç: Çalışan kalpte koroner baypas (off-pump) tekniğiyle ameliyat edilen olguların orta dönem sonuçları değerlendirildi. Çalışma Planı: Bu retrospektif çalışmaya 1999-2003 yılları arasında off-pump baypas yapılan 60 olgu (45 erkek, 15 kadın; ort. yaş 62±9.1; dağılım 42-78) alındı. Ameliyatlar aynı cerrah tarafından gerçekleştirildi. Hasta verileri ameliyat ve yoğun bakım kayıtları taranarak elde edildi. Dosyalardaki adres veya telefon numaralarından hastalara ulaşılarak son durumları öğrenildi. Ortalama takip süresi 23.3±14.9 ay (dağılım 1.1-59.4 ay) idi. Bulgular: Hiçbir hastada ameliyat anında miyokard infarktüsü görülmedi. Ameliyat sonrası erken dönemde hiçbir hasta kaybedilmedi, geç dönem mortalite dört hastada (%6.7) görüldü. Beş yıllık sağkalım Kaplan-Meier yaşam analizine göre %66 bulundu. Sonuç: Bulgularımız, çalışan kalpte koroner baypas ameliyatının güvenli ve rahat uygulanabilir bir teknik olduğu yönündedir.Objectives: The aim of this study was to evaluate the mid-term results of off-pump coronary artery bypass surgery. Study Design: The study included 60 patients (45 males 15 females; mean age 62±9.1 years; range 42 to 78 years) who underwent off-pump coronary artery bypass operation in our clinic between 1999 and 2003. All operations were performed by the same surgeon. Data were collected by review of operation and intensive care unit records. Final status of the patients were inquired by telephone calls. The mean follow-up period was 23.3±14.9 months (range 1.1 to 59.4 months). Results: Perioperative myocardial infarction was not detected in any patient. No postoperative mortality occurred in the early period. Late mortality was found in four patients (6.7%). Five-year survival was 66% using the Kaplan-Meier survival analysis. Conclusion: Our results show that off-pump coronary artery bypass can be performed with safety and comfort

The long outcome in patients with carotico-subclavian bypass surgery for subclavian steal syndrome

OBJECTIVE: In our study we aimed to evaluate long term outcome of carotico-subclavian bypass surgery in patients with subclavian steal syndrome. MATERIALS and METHODS: We evaluated the patients who underwent caroticosubclavian bypass surgery between the years 1999 and 2011 in our clinic. Total number of patients was 6 (5 female and 1 male). The mean age of the patients was 60.8±2.1 (48- 78). The patients presented with claducatio of upper extremities, headache, dizziness, and differences in arterial pressure between two arms. RESULTS: There were no complications after the carotico-subclavian bypass surgery. The differences in arterial pressure between the two arms disappeared together with the symptoms after the surgery. CONCLUSION: Carotico-subclavian bypass surgery is a procedure with low mortality and morbidity rates and good long term outcomes in patients with subclavian steal syndrome

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

BACKGROUND: According to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting. METHODS: Electrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG) and heart valve replacement with moderate hypothermic (mean 28°C) cardiopulmonary bypass (CPB) were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia. RESULTS: In all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement). No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB) or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms) and amplitude (mV) did not differ statistically before and after surgery in either group (p > 0.05). CONCLUSIONS: Our results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery)