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ABSTRACT: Patent ductus arteriosus is one of the most common congenital cardiac pathologies, besides patency of ductus may be somewhat vital for various congenital cardiac defects, otherwise death is inevitable. Anatomically, ductus is single and located between the descending aorta and the pulmonary artery. The review of the literature reveals presence of more than one ductus arteriosi in sporadic cases, most commonly associated with aortic arch anomalies. In this report, we present a nine-month-old baby with the diagnosis of ventricular septal defect (VSD), pulmonary atresia (PA), nonconfluent pulmonary arteries, and bilateral patent ductus arteriosi. He underwent a successful pulmonary reconstruction and central-shunt operation with modified aortopulmonary window technique without cardiopulmonary bypass. This is a very rare case with double ductus arteriosi associated with VSD, PA, and nonconfluent pulmonary arteries.
Journal of Cardiac Surgery 01/2011; 26(1):107-10. · 0.87 Impact Factor
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ABSTRACT: Hypoplastic infrarenal aorta or infrarenal aortic coarctation is an uncommon vascular pathology characterized with diffuse stenosis in the infrarenal abdominal aorta. It is a variant of atherosclerotic occlusive diseases. The exact incidence and etiology are not known. Presenting symptoms are versatile and incidentally most of the patients have severe hypertension with an unidentified mechanism. Here, we report a 49-year-old male patient diagnosed with abdominal aortic coarctation together with the review of the literature. He underwent successful revasvcularization of the lower extremities.
Wiener Medizinische Wochenschrift 07/2010; 160(13-14):372-5.
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ABSTRACT: Pain after coronary artery bypass graft (CABG) surgery remains a significant problem and may cause serious complications because of restricted breathing and limited early mobilization. The aim of this study was to assess the effects of intrapleural analgesia on the relief of postoperative pain in patients undergoing CABG surgery.
Postoperative pain, pulmonary function tests, and outcomes were compared with a placebo group after CABG surgery in a double-blind randomized clinical trial. Settings: Cardiovascular surgery clinic.
One hundred twenty-five patients with decreased lung function were studied.
Group A (62 patients) received 20 mL of 0.5% bupivacaine bilaterally in the intrapleural spaces every 6 hours for 4 days, and group B (63 placebo patients) received sterile saline solution.
Group A had a significantly shorter extubation time than the placebo group (8 +/- 1 h v 10 +/- 4 hours, p < 0.001). Blood gas analysis showed higher PaO2 and lower PaCO2 levels in group A. The patients receiving bupivicaine had significantly higher FEV1, FCV, VC, MVV, PEF, and FEF 25-75% values postoperatively when compared with the placebo group. Postoperative analgesic requirements and visual analog pain scales were significantly lower in group A. The intensive care unit stay in group A was shorter (1.2 +/- 0.7 v 1.4 +/- 0.6 days, p = 0.04); however, the hospital stay did not differ between groups.
Improvement in lung function parameters correlating with decreased postoperative pain with intrapleural bupivacaine was observed. Intrapleural analgesia provided a good level of analgesia, improved respiratory performance, and allowed rapid mobilization, which led to a reduction of postoperative respiratory complications.
Journal of Cardiothoracic and Vascular Anesthesia 01/2008; 21(6):816-9. · 1.64 Impact Factor
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ABSTRACT: Although truncus arteriosus is often treated with low mortality and morbidity rates, truncal valve patency and aortic arch and coronary artery anomalies are factors that can contribute to a worse outcome. In this report, we present our experience with the combination of Rastelli and Norwood procedures for the treatment of Type I truncus arteriosus that was complicated by a hypoplastic aortic arch.
Heart Surgery Forum 02/2007; 10(1):E6-8. · 0.63 Impact Factor
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The Annals of thoracic surgery 02/2007; 83(1):356-7; author reply 357-8. · 3.74 Impact Factor
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The Annals of thoracic surgery 08/2006; 82(1):382; author reply 383. · 3.74 Impact Factor
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Circulation 07/2006; 113(24):e869-70. · 14.74 Impact Factor
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European Journal of Cardio-Thoracic Surgery 06/2006; 29(5):864; author reply 865. · 2.55 Impact Factor
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The Journal of thoracic and cardiovascular surgery 03/2006; 131(2):474-5. · 3.41 Impact Factor
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ABSTRACT: The determination of postoperative course after cardiac surgery has always been a challenging issue. It is more sophisticated in the pediatric age group. The aim of this investigation was to identify whether increased concentrations of lactate in arterial blood has a predictive value for postoperative morbidity and mortality after heart surgery.
From May 2002 to June 2003, 60 infants operated on at the authors' institution were included in this prospective study. The patients were divided into 2 groups according to their respective postoperative serum lactate values. After the stabilization period in the intensive care unit (first 3 hours postoperatively), samples for serum lactate were obtained from arterial blood at 3 (t1), 6 (t2), and 12 hours (t3) postoperatively. The patients were subdivided into 2 groups according to their respective mean serum lactate values. A value of 4.8 mmol/L (3 times the normal upper limit) was chosen as a threshold for serum lactate. The patients with a mean value of greater than 4.8 mmol/L (group 1) were compared with the remaining group of patients (group 2). The relationship between serum mean lactate level and intraoperative and postoperative clinical variables was evaluated.
Among the patients in this study, 26 (43.3%) had a serum mean lactate level more than 4.8 mmol/L and 34 (56.7%) had a level of 4.8 mmol/L or less. Age, aortic cross-clamping time, cardiopulmonary bypass time, and the lowest hematocrit during cardiopulmonary bypass were significant variables that influenced the postoperative serum mean lactate level. Six patients died in the postoperative period and 54 infants survived. The hospital mortality was significantly higher in group 1 than in group 2 (19.0% v 2.9%; p = 0.037, kappa = 0.179). Multivariate analysis revealed that serum mean lactate level correlated significantly with inotrope score, intubation time, and intensive care unit stay.
Blood lactate concentration of 4.8 mmol/L or higher during the early postoperative hours identifies a group of patients with increased risk of postoperative morbidity and mortality.
Journal of Cardiothoracic and Vascular Anesthesia 03/2006; 20(1):43-7. · 1.64 Impact Factor
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ABSTRACT: Endovascular grafts have been widely used for the treatment of aneurysms since the early 1990s. They are preferred especially for use in patients in whom conventional surgical methods carry high risks of death and morbidity. Increasing operator experience and technical refinements in endovascular grafting have enabled these procedures to be performed even in critical segments of the aorta, such as the thoracic and arch levels. In this report, we present the case of a patient who was treated successfully with an endovascular graft for a mycotic saccular aneurysm located just below the left subclavian artery.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2006; 33(3):371-5. · 0.65 Impact Factor
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ABSTRACT: Systemic inflammatory response and capillary leak syndrome, caused by extracorporeal circulation, have negative effects on the function of vital organs during the postoperative period. Modified ultrafiltration (MUF) has been developed as an alternative method to reduce the detrimental effects of cardiopulmonary bypass. The aim of this prospective, randomized study is to analyze the effects of MUF in a pediatric population undergoing congenital cardiac surgery.
Twenty-seven patients who underwent open-heart surgery at our institution were included in this prospective study. They were randomized into two groups as follows: Group I (n=14) of conventional ultrafiltration during bypass and Group II (n=13) receiving both conventional and modified ultrafiltration during and after the cessation of the bypass, respectively. The amount of prime volume, postoperative chest drain loss, transfusion requirements, hemodynamical parameters, duration of mechanical ventilatory support, and length of intensive care unit stay were compared between the two groups. During the postoperative period, the concentrations of hematological, biochemical and inflammatory parameters were also compared by analyzing the blood samples obtained at various time points.
MUF resulted in a significant increase in hemoglobin, hematocrit and platelet levels, and significantly reduced the amount of chest tube output and transfused blood and blood products. MUF also shortened the duration of postoperative mechanical ventilatory support, length of the intensive care unit stay and improved postoperative hemodynamical parameters. During the early postoperative hours, IL-8 is significantly reduced in patients undergoing MUF, however, the concentrations of IL-8 were similar in both groups at the end of 24 h.
MUF decreases the duration of mechanical ventilatory support, the length of intensive care unit stay, the need for blood transfusion and improves postoperative hemodynamics. It is associated with increased levels of hemoglobin, hematocrit and platelets. We can conclude that MUF attenuates the inflammatory response by decreasing the levels of inflammatory mediators.
Scandinavian Cardiovascular Journal 10/2004; 38(5):307-11. · 0.93 Impact Factor
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Indian Journal of Thoracic and Cardiovascular Surgery 01/2004; 20(3):140-141.
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ABSTRACT: Secondary cardiac involvement by malignant lymphoma is not uncommon. However, it is frequently undetected before death, because the clinical manifestations of cardiac lymphoma are usually nonspecific. We describe the multidetector computed tomography and magnetic resonance imaging findings of a secondary cardiac lymphoma case in a patient with B-cell non-Hodgkin lymphoma. It manifested as a large mass filling the right atrium and ventricle without causing tricuspid stenosis. The mass showed heterogeneous contrast enhancement on gadolinium-enhanced magnetic resonance images. The right coronary artery was encased by the mass, but no findings suggesting intraluminal involvement were detected.
European Journal of Radiology Extra.
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ABSTRACT: Takayasu arteritis is an inflammatory vascular disease that primarily affects the aorta and its major branches. In this report, we present a 47-year-old woman whose aortic arch branches were totally occluded and the cerebral circulation is dependent on a dilated right vertebral artery.
Journal of Cardiac Surgery 22(3):240-1. · 0.87 Impact Factor
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ABSTRACT: Cardiac myxomas are the most common neoplasms of the heart. They can be located in any chamber of the heart but frequently in the left atrium. In this report we present a patient who had been treated for a right ventricular myxoma originating from the interventricular septum and leading to right ventricular outflow tract obstruction.
Journal of Cardiac Surgery 22(3):227-9. · 0.87 Impact Factor
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ABSTRACT: Truncus bicaroticus is a very rare vascular malformation. In this report, we present a very rare anomaly in a patient with left internal carotid artery stenosis together with truncus bicaroticus and right vertebral artery originating from the right common carotid artery.
Journal of Cardiac Surgery 21(4):423-4. · 0.87 Impact Factor
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CardioVascular and Interventional Radiology 30(3):547-9. · 2.09 Impact Factor
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ABSTRACT: Surgical treatment of aortic coarctation is performed with low postoperative complication rates. However, some patients may require additional surgical interventions due to stenosis or re-coarctation of the aorta, and ascending-to-descending aortic bypass via right thoracotomy is a valid alternative approach in the adult population group. Risk of massive intraoperative bleeding due to adhesions at the previous left thoracotomy site and the risk of spinal cord ischemia due to aortic cross-clamping or injury to the recurrent laryngeal nerve may be avoided with right thoracotomy in such cases. In this report, we present an adult patient with re-coarctation of the aorta who was successfully treated by extra-anatomic ascending-to-descending aortic bypass via right thoracotomy without cardiopulmonary bypass.
Journal of Cardiac Surgery 22(1):58-60. · 0.87 Impact Factor
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ABSTRACT: Behcet's disease is an autoimmune multisystemic disorder based on vasculitis. In this disease, the most important predictor of morbidity and mortality is the vascular complications. Appropriate surgical interventions are critical and must be planned strategically. Here, we will describe a very rare complication of the disease; spontaneous aortic pseudoaneurysm in a 33-year-old patient.
Journal of Cardiac Surgery 21(6):589-91. · 0.87 Impact Factor
