[Show abstract][Hide abstract] ABSTRACT: A 44-year-old woman was admitted with the diagnosis of peripheral arterial emboli. Peripheral angiography demonstrated total occlusion of the popliteal artery. The obstruction was successfully resolved with a Fogarty arterial embolectomy catheter. Both transthoracic and transesophageal echocardiography showed a mobile, round thrombus in the noncoronary sinus of Valsalva. The patient did not accept surgery, and anticoagulation with warfarin was initiated. One month after treatment, transthoracic echocardiography demonstrated disappearance of the thrombus in the noncoronary sinus of Valsalva. The patient did not experience any recurrent episode of systemic embolization. This is a rare case of peripheral embolism caused by a thrombus in the noncoronary sinus of Valsalva without aneurysm.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2011; 39(1):52-4.
[Show abstract][Hide abstract] ABSTRACT: Mycotic pseudoaneurysm of the aorta is an uncommon disease, especially in childhood but has a high mortality due to spontaneous rupture. It is caused by endarteritis following bacteraemia or fungaemia. Due to spontaneous rupture, early diagnosis is very important.
Cardiovascular journal of Africa 01/2011; 22(3):143-4. · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study was designed to evaluate the long-term efficacy and safety of once-daily enoxaparin plus warfarin for the outpatient ambulatory treatment of lower-limb deep venous thrombosis (DVT).
A total of 246 patients, comprising 128 men (mean age, 54.28±16.48 years) and 118 women (mean age, 50.11±16.47 years) with symptomatic lower extremity DVT, were included in this open-label, single-arm, multicenter, phase IV clinical trial conducted at 14 centers in Turkey. All patients were administered subcutaneous enoxaparin (1.5 mg/kg, once-daily) until international normalized ratio (INR) levels reached to 2 to 3, followed by oral warfarin (5 mg/d) for at least 3 months and elastic compression stockings (30-40 mm Hg). Clinical signs (leg circumference), symptoms (edema, pain, tenderness), recanalization rates upon duplex ultrasound examination, laboratory findings (D-dimer and INR levels), and postthrombotic syndrome status with CEAP classification were the efficacy parameters evaluated every 3 months during 18 months of follow-up. Safety end points included minor and major bleeding as well as serious adverse events.
Ambulatory treatment with enoxaparin plus warfarin significantly reduced physical symptoms, including tenderness, edema, pain (P<.001), and the circumference of the affected leg (P<.001). The leg circumference difference in almost all patients was <1.5 cm at the end of 18 months (P<.001). Recanalization rates for occluded iliofemoral vein were 76.1% at 3 months and 86.5% at 18 months (P<.001). An early and significant decrease obtained in D-dimer levels on day 10 continued to decline significantly until month 6 and remained unchanged afterwards (P<.001). Of four patients diagnosed with major bleeding during oral anticoagulant use, three recovered with conservative treatment (reduction in hemoglobin levels in 2 developed at visit 2 [day 10] and intracranial bleeding in 1 developed at visit 3 [day 30]), and one patient required a hysterectomy after menorrhagia developed at visit 7 (month 18). Two of the 65 (9.9%) adverse events documented were serious adverse events, but none of the serious adverse events leading to death were related to the study medications.
Ambulatory treatment with enoxaparin plus warfarin seems to be effective in symptomatic healing and in clinical improvement by reducing thrombus formation and organization at all levels of lower extremity venous system with DVT, without a significant major bleeding risk. Therefore, the results of our conventional conservative treatment are in line with 1A level evidence reported in the recent American College of Chest Physicians guideline.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2010; 52(5):1262-70. · 3.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: One of the most important adverse drug reactions that physicians encounter is the life-threatening prothrombotic syndrome
known as heparin-induced thrombocytopenia (HIT). In patients with a history of heparin-induced thrombocytopenia and coronary
arterial disease, alternative anticoagulatory regimens are needed during cardiac surgery for prevention of thrombosis. Treatment
options for such patients now generally include the use of alternative anticoagulants such as lepirudin, bivalirudin, argatroban
or danaparoid. In this article, we present a case where heparin-induced thrombocytopenia was properly performed coronary arterial
bypass grafting by using lepirudin. (This sentence is confusing)
KeywordsLepirudin-Heparin-induced thrombocytopenia-Coronary arterial bypss surgery-Heparin-Anticoagulation
Central European Journal of Medicine 01/2010; 5(2):150-153. · 0.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early postoperative arrhythmias are a known complication of cardiac surgery. It is unusual, however, to encounter postoperative junctional and ectopic atrial tachycardias in the same patient. We describe our experience with a 2-year-old girl who suffered both these tachycardias after repair of a ventricular septal defect, the abnormal rhythms being controlled solely with intravenous administration of amiodarone.
Cardiology in the Young 07/2009; 19(4):407-9. · 0.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectif
Les tumeurs du corpuscule carotide (TCCs), en particulier les paragangliomes familiaux, sont de rares tumeurs bénignes représentant moins de 0,5% de toutes les tumeurs. Ils sont les plus fréquents des paragangliomes extra surrénaliens.
Dans cette étude, les TCCs étaient suspectés cliniquement chez 31 patients mais diagnostiqués en histopathologie chez 28 d'entre eux entre 1977 et 2007 dans notre institution. Tous sauf un ont été opérés. L'âge des 30 patients traités chirurgicalement variait de 17 à 73 ans. Une masse cervicale était le symptôme commun à tous les patients. Deux parmi 28 patients ayant une TCC avaient un antécédent familial de TCC.
28 des 30 patients opérés ont eu confirmation du diagnostic de TCC par l'histopathologie. Les diagnostics chez les deux autres patients étaient un neurofibrome pour l'un et une adénopathie tuberculeuse pour l'autre. Ces deux patients ont été exclus de l'étude. Les TCCs ont été réséqués sans mise en place de shunt. L'UltraCision a été utilisée pour la résection tumorale chez cinq patients ; les résultats chirurgicaux de ces patients étaient excellents (dissection facile, hémorragie et durée d'intervention minimes). Vingt patients ont eu une résection totale, 6 ont eu une résection avec greffe veineuse saphène, un a eu une résection partielle et un a eu une ligature de l'artère carotide sans séquelle neurologique. Un cas de paralysie de l'hypoglosse et une récidive bénigne ont été observés. Il n'y a eu aucun décès ni transformation tumorale.
Les TCCs sont de rares tumeurs ; leur traitement chirurgical dépend considérablement des capacités et de l'expérience du chirurgien. La discussion diagnostique et thérapeutique réside en l'établissement d'un diagnostic assez rapide pour proposer un traitement chirurgical visant à prévenir les complications et les séquelles neurologiques. La résection chirurgicale est habituellement curatrice pour ces lésions.
Annales De Chirurgie Vasculaire. 01/2009; 23(5):667-672.
[Show abstract][Hide abstract] ABSTRACT: Antecedentes
Los tumores del cuerpo carotídeo (TCC), especialmente los paragangliomas familiares, son neoplasias benignas poco frecuentes, que representan <0,5% de todos los tumores, y son los paragangliomas extraadrenales más frecuentes.
En este estudio, se sospechó clínicamente de la existencia de TCC en 31 pacientes, pero se realizó el diagnóstico histopatológico en 28 de ellos entre 1977 y 2007 en nuestro departamento. Todos los pacientes fueron intervenidos excepto uno. La edad de los 30 pacientes tratados quirúrgicamente osciló entre los 17 y los 73 años. El síntoma común a todos los pacientes fue una masa en el cuello. Dos de los 28 pacientes con TCC tenían antecedentes de paragangliomas familiares.
El TCC se confirmó mediante histopatología en 28 de estos 30 pacientes tratados quirúrgicamente; el diagnóstico de los otros 2 fue neurofibroma en uno y linfadenitis tuberculosa en el otro. Estos 2 pacientes fueron excluidos del estudio. Los TCC se resecaron sin colocar ninguna derivación temporal. Se utilizó un bisturí UltraCision en 5 pacientes para la resección tumoral; los resultados quirúrgicos fueron excelentes (fácil disección, mínima hemorragia y tiempo de intervención). Veinte pacientes fueron sometidos a resección total, en 6 se realizó la resección junto con la interposición de vena safena, en uno se realizó la resección parcial, y en uno la ligadura de la arteria carótida sin déficit neurológico resultante. Se detectó un caso de parálisis hipoglosa y una recurrencia benigna. No se observó mortalidad ni malignización.
Los TCC son neoplasias muy poco frecuentes; su tratamiento quirúrgico depende en gran medida de la habilidad y experiencia del cirujano. La importancia diagnóstica y terapéutica reside en realizar un diagnóstico precoz para proponer un tratamiento quirúrgico destinado a prevenir complicaciones y lesiones neurológicas. La resección quirúrgica suele ser el tratamiento definitivo para estas lesiones.
[Show abstract][Hide abstract] ABSTRACT: Carotid body tumors (CBTs), especially familial paragangliomas, are rare benign neoplasms, accounting for <0.5% of all tumors; and they are the most common extra-adrenal paraganglioma.
In this study, CBTs were clinically suspected in 31 patients but diagnosed by histopathology in 28 between 1977 and 2007 at our department. All but one was operated upon. The ages of the 30 surgically treated patients ranged 17-73 years. A mass in the neck was the common symptom in all patients. Two of the 28 patients with CBTs had a familial paraganglioma history of CBT.
Twenty-eight of these 30 surgically treated patients had confirmed CBT by histopathology; the diagnoses of other two patients were neurofibroma in one and tuberculosis lymphadenitis in one. These two patients were excluded from the study. CBTs were resected without a shunt procedure. UltraCision was used in five patients for tumor resection; the surgical results of these patients were excellent (easy dissection, minimal hemorrhage and time operation). Twenty patients underwent total resection, six had resection and saphenous vein interposition, one had partial resection, and one had carotid artery ligation with no resultant neurological deficit. One case of hypoglossal paralysis and one benign recurrence were detected. No mortality or malignant course was observed.
CBTs are infrequent neoplasms; their surgical treatment is highly dependent on the ability and experience of the surgeon. The diagnostic and therapeutic relevance reside in making a timely diagnosis to propose a surgical treatment aimed at preventing complications and neurological damage. Surgical resection is usually definitive therapy for these lesions.
Annals of Vascular Surgery 01/2009; 23(5):616-20. · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the effects of the radial artery on the functional outcomes and endothelium when the harvest was made either by harmonic scalpel or by high-frequency electrocautery.
Between 2002 and 2007, 982 patients with coronary artery diseases were operated for coronary artery revascularization. The radial arteries were harvested for 101 of these patients and divided into two groups depending on the use of the harmonic scalpel (Group A; N=51) and the high-frequency electrocautery (Group B; N=50). Harvesting time, use of hemostatic clips, frequency of spasm, in situ free flow, and endothelial damage were compared between the two groups.
Conventional high-frequency electrocautery technique used 8.7+/-3.9 hemostatic clips versus 1.5+/-1 clips (P<0.001). In situ free blood flow was 85+/-5.5 mL/min for Group B versus 114+/-21.7 mL/min for Group A (P<0.006). The endothelial damage of the radial arteries taken down with the harmonic scalpel was significantly less than when taken down with the high-frequency electrocautery (P<0.05). There was no statistically significant difference in terms of harvesting time and spasm between the two groups (P>0.05).
Ultrasonic dissection with harmonic scalpel of the radial artery is associated with a decreased use of hemostatic clips. Moreover, the harmonic scalpel has a positive effect on endothelial preservation and it was associated with increased free blood flow of the radial artery.
The Journal of cardiovascular surgery 07/2008; 49(3):371-9. · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chest X-rays can detect aortic aneurysms or other silently developing aortic or cardiac diseases. In the present study, an ascending aortic aneurysm was detected in a 20-year-old woman with a persistent cough presenting to our emergency department. A Bentall procedure was carried out under deep hypothermic circulatory arrest.
The Thoracic and Cardiovascular Surgeon 04/2008; 56(2):112-3. · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We designed an experimental study to show the effects of some agents in order to prevent reperfusion injury of the spinal cord.
Twenty rabbits were used and were divided into two groups in our study. Infrarenal abdominal aortic occlusion, between renal arteries and iliac bifurcations, was applied to the subjects in group 1 for only 30 min; in the group 2 subjects, on the other hand, intra-aortic diltiazem, N-acetylcysteine, and catalase combinations were applied after infrarenal abdominal aortic occlusion. The spinal cord functions of the subjects were assessed at the 48th hour after the operation according to Tarlov scoring, then cord tissue samples were taken for biochemical and histopathological studies.
The group 2 subjects had better neurological functions than group 1 subjects (P < 0.01). In group 2; superoxide dismutase and glutathione peroxidase levels increased, while malondialdehyde and xanthine oxidase levels decreased as compared with group 1 (P < 0.05). A histopathological examination showed the group 2 samples to have fewer bleeding points and less neuron loss.
We concluded that antioxidant agent combinations (diltiazem, N-acetylcysteine, and catalase) applied after ischemia might thus help protect the spinal cord against ischemia and reperfusion injury.
Surgery Today 01/2008; 38(3):237-44. · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 57-year-old female patient with a mass adjacent to the left ventricle coursing along the left anterior descending artery has been reported. The maximum possible resection was performed at a maximum degree; however without complete removal. Histological examination revealed a benign primary schwannoma of the heart. To our knowledge, this is the first reported case of benign schwannoma of left ventricle in an adult.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to evaluate the effect of detection of graft dysfunction by intraoperative transit time flow measurement (TTFM) on the surgical results of on-pump coronary artery bypass grafting.
Two hundred patients undergoing on-pump isolate coronary artery bypass grafting via median sternotomy performed by the same surgical team were included into the study. TTFM was routinely performed for assessment of graft patency during operation after a transit time flow meter became available in our center in February 2006. The last 100 consecutive patients before this date formed the control group (Group A), and the first 100 consecutive patients after this date formed the study group (Group B). Interpretation of the values obtained using the TTFM in Group B patients has allowed us to reach a decision whether or not to revise a graft. Preoperative and postoperative variables of the two groups were compared.
The clinical features of control and study groups were comparable. We assessed patency of 303 grafts using TTFM. Revision was required for nine grafts in nine patients based on unsatisfactory TTFM findings. Incidences of overall mortality (p<0.05), peri- or postoperative myocardial infarction (p<0.05) and intraaortic balloon pump insertion (p<0.05) were significantly lower in Group B than Group A.
We believe that TTFM seems to be a crucial tool for deciding if a graft is well-functioning or not, and it allows for improvement of graft failure during operation. Our results suggest that detection of graft dysfunction intraoperatively by TTFM improves the surgical outcome.
European Journal of Cardio-Thoracic Surgery 08/2007; 32(2):313-8. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brachial plexus injury is a rare complication after median sternotomy. We investigated that injury to the brachial plexus was retrospectively assessed in the results of three patients who underwent median sternotomy for open heart surgery.
All patients were placed in the hands-up position after right internal jugular vein cannulation, and the internal mammary artery was prepared for all of those. Nerve conduction measurements and electromyography were performed besides neurological examination.
Brachial plexus injury was detected in three cases (0.5%) of 575 patients who underwent coronary artery bypass grafting with median sternotomy. The main symptoms were continuous pain, and motor and sensory disturbances at the affected upper extremity (left arm in all cases). The common feature was that in all cases the left internal mammary artery was harvested. While the symptoms were relieved in two patients about six months after the operation, the other one had intractable pain and paresthesia.
The most important measure is careful sternal retraction and use of the hands-up position for the low incidence and benign course of brachial plexus problems. Inappropriate sternal retraction during preparation of internal mammary artery should be avoided.
Interactive Cardiovascular and Thoracic Surgery 05/2007; 6(2):235-7. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 47-year-old male was admitted to our clinic with the complaints of chest pain, limitation of cervical movements, progressive dyspnea, and painless cervical mass. The cervical mass dimensions were approximately 15 x 20 x 25 cm. Laboratory studies revealed a recurrent hyperthyroid state. After the thyroid hormones were maintained in a euthyroid condition, a coronary angiogram was made. It revealed progressive ischemic heart disease. Combined cardiac surgery and total thyroidectomy were performed. The postoperative course was uneventful without any of the problems associated with hyperthyroidism or hypothyroidism. Combined thyroid and cardiac surgery is feasible with little risk for both operations if the perioperative levels of the thyroid hormone are maintained in a euthyroid or hypothyroid state.
The Thoracic and Cardiovascular Surgeon 03/2007; 55(1):56-8. · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect.
We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation.
The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period.
Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.
Heart Surgery Forum 02/2007; 10(5):E376-80. · 0.63 Impact Factor