[Show abstract][Hide abstract] ABSTRACT: A paraganglioma is a rare tumor that develops out of extra-adrenal chromaffin cells and pheochromocytomas originating from the adrenal medulla. Early diagnosis and surgical planning are crucial, since the tumor secretes catecholamine and is adjacent to large vessels in the abdomen. Furthermore, since complete resection improves the prognosis, we recommend a meticulous surgical technique. Here, we present a case of paraganglioma in a 32-year-old male patient who initially presented with a stomachache. After conducting the required tests, we resected the tumor that was pressing against the vena cava in the interaortocaval region.
[Show abstract][Hide abstract] ABSTRACT: Peripheral arterial aneurysms (PAA) may rupture, cause emboli and ischemia, and local symptoms due to compression.
A total of 109 patients who underwent surgery for PAA were analyzed retrospectively, including clinical presentation, surgical procedures used, and postoperative follow-up data obtained 10 days after discharge.
True aneurysm was present in 59 (54.1%) patients and pseudoaneurysm in 50 (45.9%). The femoral artery was the most common location. The surgical procedures used were as follows: graft interposition in 31 patients, bypass with synthetic or autologous grafts in 33 patients, aneurysm ligation in 5 patients, primary repair in 41 patients, and patch angioplasty reconstruction in 7 patients. One patient died as a result of massive hemorrhage. In four patients, amputation had to be performed.
It is possible to prevent amputation and other complications, including mortality, during the surgical treatment of symptomatic and asymptomatic PAA.
Full-text · Article · Jan 2010 · Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē
[Show abstract][Hide abstract] ABSTRACT: Intimal hyperplasia is a major cause of restenosis after the interventional or surgical treatment of occlusive arterial disease. We investigated the effects of clopidogrel, calcium dobesilate, nebivolol, and atorvastatin on the development of intimal hyperplasia in rabbits after carotid venous bypass surgery. We divided 40 male New Zealand rabbits into 4 study groups and 1 control group. After occluding the carotid arteries of the rabbits, we constructed jugular venous grafts between the proximal and the distal segments of the occluded artery. Thereafter, group 1 (control) received no medication. We administered daily oral doses of clopidogrel to group 2, calcium dobesilate to group 3, nebivolol to group 4, and atorvastatin to group 5. The rabbits were killed 28 days postoperatively. The arterialized jugular venous grafts were extracted for histopathologic examination. Intimal thicknesses were 42.87 +/- 6.95 microm (group 2), 46.5 +/- 9.02 microm (group 3), 34.12 +/- 5.64 microm (group 4), and 48.37 +/- 6.16 microm (group 5), all significantly less than the 95.12 +/- 9.93 microm in group 1 (all P < 0.001). Medial thicknesses were 94 +/- 6 microm (group 2), 101.5 +/- 13.52 microm (group 3), 90.5 +/- 9.69 microm (group 4), and 101.37 +/- 7.99 microm (group 5), all significantly thinner than the 126.62 +/- 13.53 microm in group 1 (all P < 0.001). In our experimental model of carotid venous bypass grafting in rabbits, clopidogrel, calcium dobesilate, nebivolol, and atorvastatin each effectively reduced the development of intimal hyperplasia. Herein, we discuss our findings and review the medical literature.
Full-text · Article · Oct 2009 · Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
[Show abstract][Hide abstract] ABSTRACT: Penetrating cardiac injuries have a rather high mortality and require a rapid diagnosis and emergency surgical intervention. The aim of this study was to present and discuss our experience with penetrating heart wounds.
Sixteen patients with penetrating cardiac injury underwent surgical treatment at the Department of Cardiovascular Surgery between 1985-2007. The patients ranged in age from 6 to 71 years (mean age 45.1 years). The cause of cardiac injury was stab wounds in 8 patients (50%), iatrogenic reasons in 6 patients (37.5%) and shotgun wounds in 2 patients (12.5%).
Exposure to the heart was accomplished by a median sternotomy in 12 patients (75%) and a left-sided anterolateral thoracotomy in 4 patients (25%). The right ventricle (RV) was injured in 7 patients (43.75%), left ventricle (LV) in 3 patients (18.75%), left atrium (LA) in 1 patient (6.25%), LV+LA in 1 patient (6.25%), and coronary arteries in 4 patients (25%). Cardiac wounds were treated by simple suture technique over Teflon or pericardial pledgets in all patients. Two patients died in the early postoperative period.
The basis for successful management of penetrating cardiac trauma is effective resuscitative measures followed by early detection and definition and emergency surgical treatment of the injury.
No preview · Article · May 2009 · Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
[Show abstract][Hide abstract] ABSTRACT: Percutaneous interventions are increasingly used in the treatment of cardiac diseases which are resistant to medical treatment.
However, the complications caused by these interventions can lead to serious results. In this article, we present a case of
a successful combination of interventional and surgical treatment methods, following the development of left atrial perforation
during radiofrequency catheter ablation (RFA), in a patient with atrial fibrillation resistant to medical treatment.
Preview · Article · Feb 2009 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Placement of an external support has been reported to prevent intimal hyperplasia of vein grafts. In this study, we investigated the effect of HA/CMC on intimal hyperplasia in a rabbit model.
Right jugular vein to common carotid artery bypass grafting was performed in 24 female New Zealand white rabbits (2.5-3.0 kg). Animals were divided into two groups: control group (n=12) and HA/CMC group (n=12). Absorbable membrane barrier was wrapped around vein grafts in HA/CMC group. In control group, no material was applied following venous graft bypass.
At 1 month, in the vein grafts supported with the HA/CMC membrane neointimal thickening was significantly less (109 microm [IQR, 78-166]) compared to the unsupported control grafts (220 microm [IQR; 101-312]; p<0.001). Medial thickening in the HA/CMC group (128 microm [IQR, 101-181]) compared to unsheathed control grafts (182 microm [IQR, 131-255] p<0.001) was also significantly less.
Periadventitial placement of HA/CMC as an absorbable membrane inhibits intimal hyperplasia of vein bypass grafts in a rabbit model.
[Show abstract][Hide abstract] ABSTRACT: An increasing number of patients are found to be unsuitable for revascularization by conventional approaches to the epicardial vessels. Transmyocardial laser revascularization (TMR) is a treatment choice for patients who have refractory angina pectoris when bypass surgery or percutaneous transluminal angioplasty is not indicated. Transmyocardial laser revascularization leads to significant improvements in angina. It also improves quality of life, reduces hospital readmission rates and may improve exercise tolerance. However, the technique does not effect survival, ejection fraction, cardiac events and myocardial perfusion with nuclear studies. Further results from ongoing trials are awaited with interest.
Full-text · Article · Mar 2008 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: In this study, we present a 55-year-old female patient who suffered from atrial septal defect (ASD) and retrosternal toxic goitre simultaneously. The patient had been treated with a 300 mg/day dose of propylthiouracil for 20 days prior to operation. This patient has been operated on for both disorders and has recovered.
Full-text · Article · Sep 2007 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
[Show abstract][Hide abstract] ABSTRACT: There is still no consensus on the age and surgical method to be preferred for total correction in Fallot Tetralogy. In this study, we aimed to evaluate the results of patients who underwent total correction surgery at a relatively early age with classic transventricular method. Following the diagnosis of Fallot Tetralogy, surgery was conducted on 54 patients from January 1984 to June 1994 and on 59 patients from July 1994 to September 2003 in the Cardiovascular Surgery Clinic. A total of 113 patients were retrospectively reviewed for the evaluation of surgical methods, age distribution and post-operative clinic outlooks. Hospiatal mortality was 8.84 % (10 patients) among 113 patients on whom total correction had been conducted. The follow-up procedures conducted in the late post-operative period (3-12 years) revealed that, of the 113 patients, 81 patients (78.64 %) had NYHA Class I, 16 patients (15.53 %) had Class II and 6 patients (5.83 %) had NYHA Class III functional cpacity. Late period mortality was 2.91 % (3 patients). The age of total correction for patients of Fallot Tetralogy has been decreasing recently. Today, in many clinics, total correction surgery, instead of palliative shunt operation, is being conducted in order to prevent exposure of the organism to persistent hypoxemia in the early period. To this end, there are several surgical methods (transventricular/transatrial) to choose. As we emphasize in this study, patients can have an almost normal life expectancy thanks to the transventricular method and transannular patch (if required) both of which have been routinely conducted in our clinic.
[Show abstract][Hide abstract] ABSTRACT: In this study, we examined the adherence of slime-producing standard Staphylococcus epidermidis strain ATCC 12228 to Dacron and polytetrafluoroethylene (PTFE) grafts in in vitro medium either containing salicylate or not. Dacron and PTFE graft pieces of standard size were placed in trypticase soy broth either containing 5 mM acetylsalicylic acid solution or not. These soy broths also contained 1 x 10(7) colony-forming units/mL S. epidermidis ATCC 12228. The incubation period lasted for 18 hr at 37 degrees C. The bacteria on the graft were freed by vortexing. The obtained bacteria suspension was diluted serially. Afterward, the suspension was plated on 5% sheep blood agar and counted after overnight incubation. In this study, we demonstrate that aspirin of an ideal concentration (5 mM) decreased the adherence of slime-producing S. epidermidis strain to Dacron and PTFE grafts. The mean number of colonies was significantly lower for both Dacron and PTFE groups in salicylated medium. We believe that aspirin provided in the postoperative period can, by maintaining the ideal serum level, decrease graft infections emerging due to coagulase-negative staphylococcus.
No preview · Article · Aug 2007 · Annals of Vascular Surgery
[Show abstract][Hide abstract] ABSTRACT: This study compared the effects of different methods of papaverine application on free blood flow and harvesting time of the internal thoracic artery for coronary bypass grafting. Patients were randomly divided into 3 groups of 25 each: group 1 had papaverine injected into the endothoracic tissue around the internal thoracic artery before dissection, group 2 had papaverine injected into the periarterial tissues of the internal thoracic artery pedicle, and group 3 had intraluminal papaverine applied retrogradely into the internal thoracic artery. Mean blood flow was 56.3 +/- 21.3, 21.1 +/- 13.2, and 20.9 +/- 9.1 mL x min(-1) in groups 1, 2, and 3, respectively, immediately after harvesting. Flow in group 1 was significantly better than that in groups 2 and 3. Immediately before anastomosis, mean flow was 89.8 +/- 19.1, 97.6 +/- 35.4, and 95.9 +/- 19.9 mL x min(-1) in groups 1, 2, and 3, respectively, with no significant difference among groups. Internal thoracic artery harvesting times were shorter in group 1 than in groups 2 and 3. Administering papaverine into the endothoracic fascia of the internal thoracic artery bed prior to dissection is a reliable method that facilitates rapid harvesting of the graft without causing trauma and consequent spasm.
No preview · Article · Jul 2007 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: Dans cette étude, nous avons examiné l'adhérence de la souche de référence Staphylococcus epidermidis ATCC 12228 productrice de slime à des prothèses en Dacron et en polytétrafluoroéthylène (PTFE) dans un milieu in vitro contenant ou pas du salicylate. Des morceaux de prothèse en Dacron et en PTFE de taille standard étaient placés dans un bouillon trypticase soja contenant 5 mM d'une solution d'acide acétylsalicylique ou pas. Ces bouillons de soja contenaient également 1 x 107 unités formant colonie/mL de S. epidermidis ATCC 12228. La période d'incubation durait 18 heures à 37°C. Les bactéries adhérant aux prothèses étaient libérées par vortexage. La suspension de bactéries obtenue était diluée en série. Les différentes dilutions étaient ensemencées sur des géloses contenant 5% de sang de mouton soumises à un décompte bactérien après incubation d'une nuit. Dans cette étude, nous démontrons que l'aspirine à une concentration idéale (5 mM) diminue l'adhérence de la souche de S. epidermidis productrice de slime sur les prothèses en Dacron et en PTFE. Le nombre moyen de colonies était sensiblement inférieur pour les groupes Dacron et PTFE en présence d'aspirine. Nous pensons que l'administration d'aspirine en postopératoire peut, en maintenant un niveau sérique idéal, diminuer l'incidence des infections de prothèse dues aux staphylocoques coagulase négative.
No preview · Article · Jul 2007 · Annales de Chirurgie Vasculaire
[Show abstract][Hide abstract] ABSTRACT: The insufficiency of the lower extremity venous system is frequently seen in the population. There are many approaches to treat the venous insufficiency in the lower extremities including surgery. External valvular support application is one of the surgical procedures using to treat the regurgitation of the valves in the superficial or deep venous system. Between April 2001 and July 2003, external valve support application was performed on 30 patients in our clinic. The preoperative, perioperative and postoperative data were collected from the patients. There was an 18-month follow-up of patients in average. In 27 of the patients resolvement of the reflux was seen. We think that the favourable short and mid-term results of the external valve support application need to be borne out by longer and more comprehensive study of larger groups.
[Show abstract][Hide abstract] ABSTRACT: We have reported the short- and long-term results of mitral valve replacement in this article.
Mitral valve replacement was conducted in 276 patients in our clinic between January 1989 and March 2005. The youngest patient was 4 years old and the oldest patient was 74 years old. Mean age was 40.08 +/- 1.06 y. Of these patients, 41.3% were men and 58.7% were women. The reason for operation was mitral stenosis in 96 patients (34.78%), mitral insufficiency in 78 patients (29.26%) and mitral stenosis plus mitral insufficiency in 102 patients (36.96%). The aetiology of mitral valve lesions was acute rheumatic fever in 208 patients (75.36%). The aetiology of mitral valve lesions was degenerative in 37 patients (13.41%), ischaemic in 23 patients (8.33%) and congenital in 8 patients (2.9%).
In the 5, 10 and 15-year periods, the actual survival rates were 87.64% +/- 2.02%, 83.35% +/- 2.38% and 68.19% +/- 5.63%, respectively. Thromboembolism was observed in 38 patients (13.77%). The rates of actual freedom from thromboembolism in the 5, 10 and 15-year periods were 93.08% +/- 1.53%, 88.48% +/- 1.99% and 81.06% +/- 3.43%, respectively. Of the 276 patients who had been observed for 15 years, 5 had (1.81%) valvular thrombosis. The rates of actual freedom from valvular thrombosis in the 5, 10 and 15-year periods were 98.89% +/- 0.64%, 98.04% +/- 0.87% and 98.04% +/- 0.87%, respectively. In the 15-year period, 23 patients (8.33%) had haemorrhage due to anti-coagulation. The rates of actual freedom from haemorrhage due to anti-coagulation in the 5, 10 and 15-year periods were 95.64% +/- 1.23%, 93.40% +/- 1.56% and 87.73% +/- 2.96%, respectively. Seven patients (2.54%) had prosthetic valvular endocarditis. The rates of actual freedom from endocarditis in the 5, 10 and 15-year periods were 98.51% +/- 0.74%, 97.60% +/- 0.97% and 97.01% +/- 1.13%, respectively. Nine patients (3.27%) were re-operated. The rates of actual freedom from re-operation in the 5, 10 and 15-year periods were 97.45% +/- 0.95%, 96.58% +/- 1.12% and 96.58% +/- 1.12%, respectively.
St. Jude Medical mechanical valve prosthesis has been the valve of choice in our clinic owing to its excellent haemodynamic properties and low rates of complication.
No preview · Article · Nov 2006 · Acta cardiologica