Kapak tanımı/Aort darlığında takılan kapak ölçülerinin ventrikül hipertrofisi üzerine etkileri

[No abstract available

Patient prosthesis mismatch effect on survival/The effects of implanted valve sizes on ventricular hypertrophy in aortic stenosis

WOS: 000308575800020

Can Cervical Blockage Routinly Application at Carotis Artery Surgery?

Amaç; İnme, kardiyovasküler ölümler için en sık ikinci, nörolojik ölümcül olaylar için de en sık nedendir. Karotis endarterektomi (KEA) ameliyatlarında değişen teknikler, erken ve uzun dönem takiplerde tekrar müdahale ihtiyacını da belirlemektedir. Bu çalışmada derin servikal blokaj ile yapılan KEA ameliyatlarının erken ve orta dönem sonuçları değerlendirildi. Çalışma planı: Çalışmada lokorejyonel anestezi altında longitudinal arteriotomi ile KEA uygulanan 12 hasta (4 kadın, 8 erkek; ort. yaş 67.5; dağılım 52-78) retrospektif olarak incelendi. Hastaların ameliyat öncesi özellikleri ile perioperatif olaylar; birinci hafta, birinci ay, altıncı ay ve 12. ay kontrolleri kaydedildi. Üçüncü ve 6.ay takipleri ile hastalarda rezidüel darlık, yeniden darlık oluşumu, tıkanma ve yalancı anevrizma gibi bulgular araştırıldı. Ortalama izlem süresi 4.3 ay (dağılım 3-12 ay) idi. Bulgular: Hastalarda en sık görülen tablo geçici iskemik atak ve tek taraflı %70den fazla darlık idi. 6 hastada (%50) koroner arter hastalığı saptandı; ayrıca, 3 hastada (%25) da periferik arteryel obstrüktif hastalık bulundu. bir hastada (%8.3) şant kullanıldı. Karotis arteri klempleme süresi ortalama 9.41.9 dakika idi. Perioperatif olarak bir olguda sol üst ekstremitede geçici güç kaybı görüldü. Hiçbir hastada ölüm görülmedi. İzlem süresi içinde olumsuz nörolojik olay, rezidüel darlık, yeniden darlık oluşumu, tıkanma veya yalancı anevrizma saptanmadı. Sonuç: Karotis endarterektomi, lokorejyonel anestezi eşliğinde kolay, etkili ve çabuk bir tekniktir. Çoğu olguda yeterli cerrahi alan sağlandığı gibi, erken ve orta dönem sonuçlar kabul edilebilir sınırlardadır. Özellikle bilateral ciddi stenozu olan hastalarda kros klemp esnasında serebral perfüzyon takibinde hasta ile konuşarak bilinç ve motor durum takibi açısından lokal anestezinin daha konforlu olduğunu düşünmekteyizAim: Stroke is most second reason in cardiovascular deaths and most common reason of deaths in neurologic accidents. Changing techniques in carotis endarterectomy operations defines operation necessities early and mid term fallow up. We evaluated the early and mid term results of carotis endarterectomy under deep cervical blockage in our study. Study plan: We examine the 12 patients (4 female, 8 male; mean age 67,5(52-78)) whom carotis endarterectomy was performed with longitudinal arteriotomy under locoregional anesthesia. Patients perioperative properties and postoperative accident was noted as fist week, first month, 6th month and one year control. We searched residual and new stenosis, occlusion and false aneurysms at 3rd and 6th month Doppler ultrasonography follow up. Mean fallow up time was 4.3 months (3-12) Findings: The most clinical findings at patients were transient ischemic attack and unilateral stenosis more than 70%. 6 patients (50%) had coronary artery stenosis and 3 patients (25%) had peripheric arterial obstruction disease. Shunt was used for one patient. Mean carotid artery clamping time was 9.4±1.9 minutes. Perioperative transient left upper extremity paralyse seen at one patient. There was no death. During the fallowing time new neurologic accident, residual or new stenosis, occlusion and false aneurysm were not discovered. Results: Carotis endarterectomy is an easy, fast and effective technique under locoregional anesthesia. In most cases enough surgical area was supplied and early and mid term results of the surgery is in acceptable limits. Especially, during clamping carotid artery with bilateral severe carotis stenosis local anesthesia is comfortable for fallowing up cerebral perfusion by conscious and motor activity speaking with the patient

Graft selection for the peripheral vascular by-pass surgery and its contribution to patency

Amaç: Bu çalışmada, periferik bypass cerrahisinde seçilen greftlerle ilgili klinik sonuçlarımızı sunmayı amaçladık. Gereç ve yöntem: Çalışmaya Ağustos 2007- Ocak 2009 tarihleri arasında Kalp ve Damar Cerrahisi kliniğinde periferik arter bypass cerrahisi uygulanan 68 hasta alınmıştır. Hastaların % 81’i erkek (n55), %19’u kadındı (n13) ve yaşları ortalama 5710 idi. Hastalardan 16 tanesine aorto-bifemoral bypass, 36 hastaya femoro-popliteal bypass, 7’sine femoro-femoral kros over bypass, 4’üne iliofemoro- popliteal bypass, 4’üne axillo-bifemoral bypass ve 1 hastaya aorto- femoral bypass yapıldı. Aterosklerotik alana ve yapılacak cerrahi tekniğe göre Safen ven, ringli politetrafloroetilen (PTFE) ve Dacron, ringsiz PTFE ve Dacron veya kompozit greft kullanıldı ve bir yıllık açıklık oranları karşılaştırıldı. Bulgular: Hastalar bir yıl boyunca klinik olarak ve doppler ultrasonografi ile değerlendirmeye alındı. Ringli PTFE ile axillo-femoral yapılan 1 hastada 3. ayda, femoro-popliteal bypass yapılan 1 hastada 6. ayda total oklüzyon görüldü. Ringli PTFE femoro-femorol cross over yapılan bir vakada, ringsiz PTFE kullanılan dört femoro-popliteal vakasında ve otojen safenven kullanılan bir femoropopliteal vakasında asemptomatik %20-50 stenoza yol açan daralmalar tespit edildi. Hastaların 31’ine diz üstü, 37’sine de diz ve diz altı bölgelere cerrahi girişim uygulandı. Diz üstü bölgede kullanılan sentetik greftler arasında ve sentetik greftlerle safen ven greftleri arasında açıklık oranı bakımından önemli bir fark görülmezken, diz ve diz altı bölgesinde safen ven greftinin diğer sentetik greftlere gör daha üstün olduğu görülmüştür.Objectives: In this study, we aimed to present clinical results associated with graft selection in peripheral bypass surgery. Materials and methods: Between August 2007 and January 2009, 68 patients who underwent peripheral arterial bypass surgery in our cardiovascular department were included in this study. Eighty-one percent (n55) of them were male and 19 % (n13) of them were female, patients’ mean age was 57±10 years. We have performed aorto-bifemoral bypass to 16 patients, femoro-politeal bypass to 36 patients, femoro-femoral cross over bypass to 7 patients, ilio-femoro-politeal bypass to 4 patients, aorto- femoral bypass to1 patient and axillo-bifemoral bypass in 4 patients, respectively. Saphenous vein, stented or stentless polytetrafluoroethylene (PTFE) and Dacron grafts and composite grafts were used according to atherosclerotic area and surgical technique. Results: Above knee bypass procedure was performed in 31 patients and the remaining 7 patients required knee level or below knee bypass procedure. Comparing synthetic grafts and composit vein grafts above knee and below knee regions, revealed that there was no difference in above knee region, but in the below knee region autogenous saphenous vein graft was superior to synthetic grafts in patency rate. Conclusions: In this study, according to patency rate, there was no difference in above knee bypass procedures; but in the below knee bypass procedures, autogenous saphenous vein graft was found superior to synthetic grafts

Evaluations Of Open Hearth Surgeries In Cardiovascular Surgery Department Of Kırıkkale Yuksek İhtisas Hospital

Amaç: Yazımızda yeni kurulan açık kalp cerrahisi merkezindeki ilk bir yıllık sonuçları sunmayı amaçladık Çalışma planı: Kliniğimizde açık kalp cerrahisi için tüm hazırlıklar 7 ay gibi kısa bir sürede tamamlandıktan sonra Mayıs 2008 ile mayıs 2009 tarihleri arasında toplam 106 hastaya açık kalp cerrahisi uygulandı. Bu hastaların 57si erkek, 49u kadın olup ortalama yaş 54.75 20 olarak hesaplandı. Koroner arter bypass uygulanan 93 hastanın 19unda atan kalpte bypass yapıldı. Mitral kapak replasmanı 5, aort kapak replasmanı 4, aort kapak ve mitral kapak replasmanı birlikte 1 hastaya uygulandı. Asendan aort replasmanı, anevrizma nedeniyle 2 hastada uygulandı. Yetişkin konjenital cerrahi ise 1 hastada sekundum atriyal septal defekt nedeniyle uygulandı. Hastalarda major komorbiditeler Kronik obstrüktrif akciğer hastalığı (KOAH, n42), diyabetes mellitus (DM II, n35), sol ventrikül disfonksiyonu (LV EF% :30- 50 n19), periferik arter hastalığı (PAH, n8) morbid obesite (BMI40 n5), ve kronik böbrek yetmezliği (KBY, n2), şeklindeydi. Bulgular: Hastane mortalitesi dört hasta ile %3,7 oranında gerçekleşti. Mortalitelerin 4ü de koroner cerrahi mortalitesi olup yalnızca koroner cerrahi mortalite oranı %4,3 olarak hesaplandı. Kaybedilen hastalardan birincisi koroner arter hastalığı ve abdominal aort anevrizması mevcuttu. Hastaya koroner cerrahi sonrası 3. ayında anevrizmaya yönelik operasyon planlanıyordu. Koroner bypass sonrası postoperatif 8. saatinde ekstübasyon sonrası anevrizma rüptürü nedeniyle acil operasyona alınan hastaya aortobiiliak bypass uygulandı düşük kardiyak output gelişen hasta kaybedildi. İkinci mortalitemiz ise koroner cerrahi risk skoru yüksek olan (euro skorlaması 9) anstabil anjina pektorisli koroner arter hastası olup postoperatif 5. gününde servis takiplerinde ani gelişen aspirasyon nedeniyle solunum ve kardiyak arrest sonrası kaybedildi. Üçüncü mortalite postoperatif 3. gününde servis takiplerinde serebrovasküler inme nedeniyle tekrar yoğun bakıma alındı. Erken dönemde başlayan tedaviye rağmen hasta postoperatif 44. gününde yoğun bakım takibinde pnomoni ve sonrasında gelişen sepsis nedeniyle kaybedildi. Dördüncü mortalite ise bilateral büllöz akciğeri ve morbid obezitesi olan hasta postoperatif 5. gününde bilateral spontan pnomotoraks gelişmesi üzerine kaybedildi. Morbidite olarak 7 (%6.6) hastada drenaj nedeniyle re-explorasyon gerekti. Hiçbir hastada yüzeyel cilt infeksiyonu dahil infeksiyon görülmedi. Sonuç: Ciddi mortalite ve morbiditeye sahip açık kalp cerrahisi operasyonları özellikle yeni kurulan merkezlerde rutin işleyiş yerine oturuncaya kadar gelişebilecek aksaklıklar açısından daha fazla dikkat gerektirmektedir. Henüz yeni kurulmasına karşın kliniğimizde morbidite ve mortalitenin ülkemiz ve dünya standartları ile karşılaştırıldığında başarılı olduğunu düşünmekteyiz.Aim: In this article, our aim is to present the first year results of newly founded cardiovascular surgery clinic. Study Plan: Cardiovascular surgery has been carried out on 106 patients from May 2008 to May 2009 after the completion of all preparations within seven months. The number of Male patients were 57 while the womens were 49 and their average age was calculated as 54,75 years. 19 individuals of total 93 patients who took coronary arterial by-pass were operated by off pump surgery. Of 10 patients who were operated by valve surgery, 5 of them were AVR, 4 patients were MVR and one was operated by both AVR and MVR. 2 patients were treated by ascending aorta due to aneurysm. Adult congenital surgery was applied to one patient due to secundum type atrial septal defect. The major comorbidities in all patients were cronic obstructive lung disease (n42), type-II diabetes mellitus (n35), left ventricul disfonction (LV EF%:30-50 n19), peripherial arterial disease (PAD n8) morbid obesity (BMI≥40 n5), and cronic renal failor (n2). Findings: The mortality rate of the hospital is about 3.7% due to the death of four patients who took coronary arterial bypass surgery. And the coronary surgery mortality ratio was calculated as 3.7 %. One of lost patients had both coroner artery disease and abdominal aort aneurysm. Due to aneurysm, operation to patient was planned in 3 rd month after coronary surgery. Aneurysm rupture was formed after extubation in 8th hour of post operation.Aorto-biiliac by pass surgery was immediately applied to the patient. After the development of low cardiac output, the patient was lost. In second mortality, the risk scor of coronery surgery was very high (Euro scoration 9). In 5 th day of post operative monitoring in service, The coronary arter patient, having preoperative unstable angina pectoris, was lost due to fast developing pulmoner aspiration after respiratuar and cardiac arrest. In third mortality, the patient was retransferred to intensive care due to cerebrovascular stroke in 5. day of postoperation. Despite the early care, the patient was lost at intensive care by pneumonia and sepsis in 44 th day of postoperation. The fourth mortality was occured in 5 th day of bilateral spontaneous pneumothorax development. The morbiditiy ratio was calculated as 6.6 % since 7 patient were re-explorated due to bleeding. No infection including superficial skin infection was experienced. Result: It is inevitable to experience some defections up to the formation of routine sequence in newly founded open hearth surgery centers. In this context, more careful attempts should be considered to prevent the increase in mortality and morbidity. We consider our clinic adequately successful with respect to local and international standarts, in terms of mortality and morbidity, although it is newly set up

Evaluations of open hearth surgeries in cardiovascular surgery department of kırıkkale yuksek İhtisas hospital [Yeni kurulan açık kalp cerrahisi merkezindeki açık kalp operasyonlarının de?erlendirilmesi]

Aim: In this article, our aim is to present the first year results of newly founded cardiovascular surgery clinic. Study Plan: Cardiovascular surgery has been carried out on 106 patients from May 2008 to May 2009 after the completion of all preparations within seven months. The number of Male patients were 57 while the womens were 49 and their average age was calculated as 54,75 years. 19 individuals of total 93 patients who took coronary arterial by-pass were operated by off pump surgery. Of 10 patients who were operated by valve surgery, 5 of them were AVR, 4 patients were MVR and one was operated by both AVR and MVR. 2 patients were treated by ascending aorta due to aneurysm. Adult congenital surgery was applied to one patient due to secundum type atrial septal defect. The major comorbidities in all patients were cronic obstructive lung disease (n=42), type-II diabetes mellitus (n=35), left ventricul disfonction (LV EF%:30-50 n=19), peripherial arterial disease (PAD n=8) morbid obesity (BMI?40 n=5), and cronic renal failor (n=2). Findings: The mortality rate of the hospital is about 3.7% due to the death of four patients who took coronary arterial bypass surgery. And the coronary surgery mortality ratio was calculated as 3.7 %. One of lost patients had both coroner artery disease and abdominal aort aneurysm. Due to aneurysm, operation to patient was planned in 3 rd month after coronary surgery. Aneurysm rupture was formed after extubation in 8th hour of post operation.Aorto-biiliac by pass surgery was immediately applied to the patient. After the development of low cardiac output, the patient was lost. In second mortality, the risk scor of coronery surgery was very high (Euro scoration= 9). In 5 th day of post operative monitoring in service, The coronary arter patient, having preoperative unstable angina pectoris, was lost due to fast developing pulmoner aspiration after respiratuar and cardiac arrest. In third mortality, the patient was retransferred to intensive care due to cerebrovascular stroke in 5. day of postoperation. Despite the early care, the patient was lost at intensive care by pneumonia and sepsis in 44 th day of postoperation. The fourth mortality was occured in 5 th day of bilateral spontaneous pneumothorax development. The morbiditiy ratio was calculated as 6.6 % since 7 patient were re-explorated due to bleeding. No infection including superficial skin infection was experienced. Result: It is inevitable to experience some defections up to the formation of routine sequence in newly founded open hearth surgery centers. In this context, more careful attempts should be considered to prevent the increase in mortality and morbidity. We consider our clinic adequately successful with respect to local and international standarts, in terms of mortality and morbidity, although it is newly set up. © 2012 Düzce Medical Journal

The effects of implanted valve sizes on ventricular hypertrophy in aortic stenosis

WOS: 000300797800013PubMed: 22306570Amaç: İzole aort darlığına bağlı aort kapak replasmanı yapılan vakalarda, vücut yüzey alanına göre kapak ölçülerinin, aortik gradiyent ve sol ventrikül hipertrofisi üzerindeki etkilerini sunmayı amaçladık. Yöntemler: Ciddi aort stenozu nedeniyle Ocak 2006- Nisan 2007 tarihleri arasında aort kapak replasmanı yapılan hastalar (12’ si erkek,15’i kadın; toplam 27 ), post-operatif 4. ve 6. aylarda ekokardiyografileri yapılarak prospektif olarak takip edildi. Hastalar operasyon sırasında replase edilen mekanik aort kapak ölçülerine göre iki gruba (19-21 mm ve 23-25 mm) ayrıldı. İki gruba ait primer sonlanım noktası değişkenleri olan renkli ve sürekli dalga Doppler ekokardiyografi ile ölçülen aort kaçak varlığı, sol ventrikül kitle indeksi (SVKİ) ve ortalama transaortik gradiyentleri karşılaştırıldı. Gruplararası karşılaştırmalarda Fischer tam testi ve Mann-Whitney U testi, grup içi analizde Freidman testi kullanıldı. Bulgular: Aort kapaktaki ortalama sistolik gradiyent (OSG) ve SVKİ'de preoperatif ve postoperatif değerler kıyas edildiğinde, 23 mm ve 25 mm kapaklarda, istatistiksel olarak anlamlı gerilemeler bulundu (p<0.01). Preoperatif ve postoperatif ekokardiyografik verilerle, özellikle sol ventrikül kitlesi, SVKİ, pik sistolik gradiyent ve OSG değerlerinde gerilemelerin belirgin olduğu bulundu. Bu gerilemeyle ilişkili değerler, 4. ayda da tespit edilebilir seviyedeyken, asıl anlamlı gerilemenin postoperatif 6.ayda olduğu gözlendi. Diğer taraftan 19 mm ve 21 mm kapaklar için elde edilen değerler istatistiksel olarak diğerlerinden (23 mm ve 25 mm) daha az anlamlı bulundu (p<0.05’e karşı p<0.01). Sonuç: Aort kapak replasmanında uygun kapak ölçülerinin seçiminde yaş, cinsiyet ve aktivite, gibi faktörler önemlidir. Ancak hastanın vücut yüzey alanına göre kapak ölçüsü daha önemli olan kriterdir. (Anadolu Kardiyol Derg 2012; 12: 165-70)Objective: We aimed to study the effects of the valve sizes according to body surface area on aortic gradient and ventricular hypertrophy in the cases of aortic valve replacement due to isolated aortic stenosis. Methods: Between January 2006 and April 2007, patients (12 men, 15 women; totally 27) followed up prospectively with echocardiography fourth and sixth month postoperatively. The patients were divided into two groups according to the prosthetic aortic valve diameters (19-21 mm vs 23-25 mm). The primary endpoints between the two groups (aortic regurgitation, left ventricular mass index and transvalvular gradient measured by color and continuous wave Doppler) were compared. Fischer exact test and Mann-Whitney U test were used for intergroup comparison whereas intragroup analysis was done with Freidman test. Results: Mean systolic gradient and left ventricular mass index were significantly reduced in 23 mm and 25 mm valves (p<0.01) in the postoperative follow-up. In addition, especially, decline in the values of left ventricular mass, left ventricular mass index, peak systolic gradient and the mean systolic gradient were found to be significant. These values associated with regression were detectable at the postoperative 4th month, but actual significant regression was observed at the postoperative 6th month (p<0.01). On the other hand, the values obtained for 19 mm and 21 mm valves also showed significant progress (p<0.05). Conclusion: Factors such as age, gender and activity are important in the selection of appropriate valve sizes in aortic valve replacement. However, the patient's body surface is the most important prognostic factor compared to others. (Anadolu Kardiyol Derg 2012; 12: 165-70

Protective effect of heparin in the end organ ischemia/reperfusion injury of the lungs and heart

Ankarali, Handan Camdeviren/0000-0002-3613-0523WOS: 000315283500001PubMed: 23151309Background: Ischemia/reperfusion (I/R) injury is harmful to the cardiovascular system and is responsible for the inflammatory response and multiple organ dysfunctions. In this study we investigated the effect of activated clotting time level on the aortic cross-clamping triggers a systemic inflammatory response and it effects to lungs and heart. Methods: End organ concentrations of interleukin-6 (IL-6), myeloperoxidase (MPO) and heat shock protein 70 (HSP-70) were determined in four groups of Spraque Dawley rats: ischemic control (operation with cross clamping received IP of 0.9% saline at 2 ml/kg n=7) Sham (operation without cross clamping, n=7), heparin (ACT level about 200), High dose heparin (ACT level up to 600) The infrarenal aorta was clamped for 45 minutes by a mini cross clamp approximately 1cm below the renal artery and 1cm iliac bifurcation in all groups without sham group. Heparin was given intraperitoneal (IP) before the procedure. All rats were sacrificed 48 h later. In a second experiment, the effects of I/R on remote organs (lungs and heart) were harvested for analysis. We evaluated tissue levels of myeloperoxidase, interleukin-6, and heat shock protein (HSP-70) were analyzed as markers oxidative stress and inflammation. Histological analyses of the organs were performed. Results: The lungs paranchymal MPO and HSP-70 levels significantly decreased (p0.05) in heparinized and high dose heparinized groups when compared to ischemic control group. Histopathological evaluation as edema, cell degeneration, inflammation statistically significantly decreased in both group heparinized and high dose heparinized compared with ischemic control group (p<0.05). The heart paranchymal MPO levels significantly decreased in heparinized and high dose heparinized groups when compared to ischemic control group (p=0.023). IL-6, HSP-70 levels were not significant heparinized and high dose heparinized groups when compared to ischemic control group (p=0.0489, p=0.0143). Histopathological evaluation as degeneration statistically significantly decreased in both group heparinized and High dose heparinized compared with ischemic control group (p=0.005). Conclusion: Heparin decreased remote organs injury on the lung and heart after ischemia/reperfusion of infra-renal section of the body in the rat model. So, we should be balance to act level for avoid to I/R injury per operative and early post operative period as providing ACT level nearly 200

Coil Embolization of Splenic Artery Aneurysm: Case Report

Aort diseksiyonunun eşlik ettiği splenik arter anevrizması, nadir görülen bir klinik tablodur. Her iki patolojinin de cerrahi tedavisinde mortalite ve morbidite oranları yüksektir. Bu hastalarda daha az invaziv olan, kolay uygulanabilen ve oldukça başarılı sonuçlar elde edilen endovasküler yöntemler tercih edilen ve güncel tedavi yöntemi haline gelmiştir. Bu makalede splenik arter anevrizması ve beraberinde tip-B aort diseksiyonu tespit edilen, ve her iki patoloji için de endovasküler tedavi uygulanan bir olgu sunuldu.Splenic artery aneurysm accompanied with aortic dissection is a rarely seen clinical condition. Mortality and morbidity rates are high in the surgical treatment of both pathologies. In these patients, endovascular methods that are less invasive, easily performed and achieve rather successful results and they become preferred and current treatment methods. In this article, a patient with splenic artery aneurysm accompanied with type-b aortic dissection and underwent endovascular treatment for both pathologies was presented