[Show abstract][Hide abstract] ABSTRACT: The bicuspid aortic valve is known to be the most common congenital cardiac malformation, with an approximate incidence rate of 1-2% in the general population. Most patients are unaware of the disease until the onset of infective endocarditis, which is a life-threatening complication that may affect a heart valve or other cardiac structures at the site of endothelial damage. A 22-year-old man presented to our internal medicine clinic with a complaint of acute onset dyspnea and fatigue. His body temperature was 38 (°)C. A diastolic murmur was detected at the right sternal border. Two-dimensional transthoracic echocardiography revealed severe aortic insufficiency, and two-dimensional transesophageal echocardiography showed that the aortic valve was bicuspid. There was also a flail lesion extending the left ventricular outflow tract, resulting in pathological coaptation and severe aortic insufficiency. The patient was referred to our cardiovascular department for surgery. We herein present this case of a bicuspid aortic valve complicated by infective endocarditis due to the underlying disease of chronic otitis media related to a rare pathogen: Alloiococcus otitidis. The patient underwent a successful aortic valve replacement surgery due to aortic insufficiency following infective endocarditis. He was discharged on the 16(th) postoperative day in good condition.
[Show abstract][Hide abstract] ABSTRACT: Compartment syndrome, occurring rarely after prolonged surgery in the lithotomy position, is a clinical statement, which may result in catastrophic complications. Compartment syndrome, which is commonly seen after major pelvic surgery is reported most commonly after prolonged urological procedures with an estimated incidence of 1 in 500 cases. . Compartment syndrome has similar clinical findings with deep venous thrombosis, which is common in clinical practice of cardiovascular surgeons. It is important to make differential diagnosis of compartment syndrome to avoid the complications that are preventable with early diagnosis. In our case, at first our diagnosis was deep venous thrombosis because of the malignity story, and similar clinical findings. However, as a result the compartment syndrome was the current diagnosis. We want to present a case of compartment syndrome , which must be keep in mind in the diagnosis of deep venous thrombosis, in the light of current literature.
No preview · Article · Jan 2015 · Gulhane Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Background:
Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery.
There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD.
There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality.
The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.
Full-text · Article · Nov 2014 · Cardiovascular journal of Africa
[Show abstract][Hide abstract] ABSTRACT: Background
We aimed to examine the effects of topical hypothermia on inflammatory markers in patients undergoing coronary artery bypass surgery.
Fifty patients undergoing isolated coronary artery bypass surgery were included the study. They were randomised to two groups. Mild hypothermic cardiopulmonary bypass (28–32°C) was performed on both groups using standardised anaesthesiology and surgical techniques. Furthermore, topical cooling with 4°C saline was performed on patients in group I. We recorded peri-operative and intra-operative results of blood samples, pre-operative and postoperative outcomes of electrocardiography and echocardiography, diaphragm levels on X-ray, and the necessity of positive inotropic medication and intra-aortic balloon pump (IABP).
Time-dependent changes in blood samples were compared between the two groups. The changes on complement 3 (C3) and TNF-α levels were more significant in group I than group II (p < 0.05 and p < 0.001, respectively). Spontaneous restoration rate of sinus rhythm was higher in group II than group I (80 vs 32%, p < 0.01). Atrial fibrillation was seen in six patients in group I and one patient in group II (p < 0.05). IABP was performed on four patients (16%) in group I (p < 0.05). Diaphragmatic paralysis was seen in seven patients in group I but not in group II (p < 0.01). Partial pericardiotomy rates were compared within the groups but there was no statistically significant difference (p > 0.05). One patient in group I died on the 18th postoperative day, but operative mortality rate was not statistically significant between the two groups (p > 0.05).
Topical hypothermia had a negative impact on inflammatory markers and postoperative morbidities.
Preview · Article · Apr 2014 · Cardiovascular journal of Africa
[Show abstract][Hide abstract] ABSTRACT: The aim of this retrospective study was to compare the short-term outcomes of surgical versus transcatheter closure of secundum atrial septal defect (ASD) in adults.
From January 2008 to October 2012, 229 patients aged 18 years and older with significant isolated secundum ASDs were admitted to our hospital. We focused only on objective data obtained from their medical records. We collected and compared a total of 163 patients with isolated secundum ASD, who were treated with device occlusion or surgical closure, and had no missing data. Postoperative outcomes, rhythm disturbances, residual ASD, infection rates and length of hospital stay were compared.
Complete follow-up data were available for 42 (46%) patients in the device group and for 121 (87%) in the surgery group. Complete closure was observed in 41 of the 42 patients (97.6%) in the device group (p = 0.258) and in all 121 in the surgery group (100 %) (p > 0.05). There were no mortalities. The mean length of hospital stay in the device group was 1.92 ± 0.43 days and in the surgery group 7.14 ± 0.14 days (p < 0.01).
The transcatheter approach for closure of ASDs is an effective and safe treatment option when performed for certain indications. Broadening the spectrum of indications may cause some adverse events. Surgical treatment remains a good alternative for all patients with ASDs and can be performed safely in order not to increase procedure-related complications.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to show the efficacy and results of aneurysm reconstruction that was developed for relieving the patients from pain and mass effects and to give an early hemodialysis option.
Medical records were retrospectively screened over a period of 17 years to identify patients diagnosed with and surgically treated for aneurysm of an AV fistula. Twenty-eight patients were included in this study. The mean average age was 44 ± 3 years (31-60). Seventeen (60.7%) patients were female. Twenty-two (78.5%) patients had hypertension and 9 (32.1%) patients had diabetes mellitus. Aneurysm was examined by using ultrasonography to reveal the flow dynamics. The aneurysm was resected and an appropriate sized graft was interposed under local anesthesia. The same vein was dissected and anastomosed over the graft in an end-to-side fashion.
Mean aneurysm diameter was 40 ± 12 mm. All aneurysm tissues and thrombotic materials were removed from the surgical field. Mean graft length was 37 ± 11 mm. Three (10.7%) patients need surgical revision because of postoperative bleeding. Dermal necrosis occurred in 1 (3.5%) patient. Infection was noted in 1 (3.5%) patient. Vascular access was started from the reconstructed venous area 2 or 4 days later in all patients. The patency rate was 100% in three years.
Surgical reconstruction of the arteriovenous fistula aneurysm can be safely performed in hemodialysis patients with low complication rates. It gives early vascular access with high patency rates. All patients are relieved from pain and distended mass effect.
Preview · Article · Mar 2014 · Polish journal of cardio-thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: The aim of the study is to show the effects of cytoimmunological monitoring and its role in the patient's follow-up period after heart transplantation.
Between 2002 and 2009, 8 patients underwent heart transplantation at Gulhane Military Medical Academy Hospital. Seven patients were male. The average age was 43 ± 12 years. Donor hearts were implanted orthotopically in all patients. The patients were then subjected to cytoimmunological monitoring and endomyocardial biopsy. 431 laboratory blood tests were carried out for all patients to analyze their cytoimmunological profiles and diagnose a possible infection or rejection.
The total and average follow-up periods were 17.5 patient years and 30 ± 36 months (1-120 months), respectively. The first patient had two rejection episodes in 3 months. A viral infection was diagnosed in the third patient, who had painful muscle spasms in both lower limbs and the CD4/CD8 ratio was below 0.4. In the fourth patient, the CD4/CD8 ratio suddenly increased and a urinary infection was diagnosed. Only one patient passed away in the early period (less than 30 days). Four patients died because of an infection or hemodynamic deterioration within three months.
Cytoimmunological monitoring is a simple and effective technique of evaluating the patient's immunological profile. It may provide an adjunctive laboratory test and may decrease the number of endomyocardial biopsies.
Preview · Article · Mar 2014 · Polish journal of cardio-thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We investigated the effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits.
Eighteen New Zealand male rabbits were randomized into two groups, as drug (Group B) and non-drug (Group A). The right carotid artery of all the subjects was transected and anastomosed end-to-end with 10/0 polypropylene suture. The left carotid artery was left intact. Group B subjects received 30 mg/kg/day oral bosentan for 21 days, starting 3 days before the operation. Group A subjects did not receive any medication. After 28 days, the anastomoses site and the contralateral control site were removed, and samples were investigated histomorphometrically.
Significant intimal hyperplasia was observed at all anastomoses compared to the non-anastomotic left side. Bosentan decreased significantly the intimal area [Group A: 48.3 µm(2) (37.1 µm(2)-65.7 µm(2)), Group B: 31.4 µm(2) (12.2 µm(2)-63.2 µm(2)), (p=0.04)] and intima/media area ratio [Group A: 0.49 (0.13-0.74), Group B: 0.22 (0.09-0.37), (p=0.024)] compared to the non-drug group.
According to our investigation, bosentan decreased the intimal hyperplasia developed in a rabbit carotid artery model. Further investigations are needed to support the potential clinical utilization of bosentan after vascular interventions.
Full-text · Article · Mar 2014 · Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
[Show abstract][Hide abstract] ABSTRACT: We aimed to highlight the use of a minimally invasive approach in uncomplicated congenital heart surgery.
We investigated retrospectively 32 children below 10 years of age who underwent elective closure of ostium secundum type (n = 27), sinus venosus type (n = 4) and ostium primum type (n = 1) atrial septal defects through a limited skin incision and partial lower sternotomy between August 2001 and December 2008. All patients had cannulation through the same incision for cardiopulmonary bypass.
A pericardial patch was used to close the defect in 8 patients and direct suturing in 24. The mean time from the skin incision to cannulation was 56 ± 23 min. Total bypass time was 27 ± 12 min, and crossclamp time was 15 ± 8 min. Mean length of hospital stay was 4 ± 2 days. We did not encounter any complications or mortality.
A minimally invasive approach, consisting of a limited skin incision and partial lower sternotomy, is a safe, reliable, and cosmetically advantageous method in uncomplicated congenital heart disease surgery, which can be performed widely, and may replace the standard approach without increasing mortality and morbidity.
No preview · Article · Aug 2013 · Asian cardiovascular & thoracic annals
[Show abstract][Hide abstract] ABSTRACT: Chylopericardium is a rare complication of cardiac surgery that is performed from a midline sternotomy. Here we present a case of a 61-year-old male patient with late-onset postoperative chylopericardium following combined coronary artery bypass grafting and mitral valve surgery, and the applied treatment modality.
[Show abstract][Hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) has traditionally been recognised as a predictor of poorer early outcomes in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to analyse the impact of different COPD stages, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric criteria, on the early surgical outcomes in patients undergoing primary isolated non-emergency CABG METHOD: Between January 2008 and April 2012, 1 737 consecutive patients underwent isolated CABG in the Department of Cardiovascular Surgery of Gulhane Military Academy of Medicine; 127 patients with the diagnosis of moderate-risk COPD were operated on. Only 104 patients with available pulmonary function tests and no missing data were included in the study. Two different treatment protocols had been used before and after 2010. Before 2010, no treatment was applied to patients with moderate COPD before the CABG procedure. After 2010, a pre-treatment protocol was initiated. Patients who had undergone surgery between 2008 and 2010 were placed in group 1 (no pre-treatment, n = 51) and patients who had undergone surgery between 2010 and 2012 comprised group 2 (pre-treatment group, n = 53). These two groups were compared according to the postoperative morbidity and mortality rates retrospectively, from medical reports.
The mean ages of the patients in both groups were 62.1 ± 7.6 and 64.5 ± 6.4 years, respectively. Thirty-nine of the patients in group 1 and 38 in group 2 were male. There were similar numbers of risk factors such as diabetes, hypertension, renal disease (two patients in each group), previous stroke and myocardial infarction in both groups. The mean ejection fractions of the patients were 53.3 ± 11.5% and 50.2 ± 10.8%, respectively. Mean EuroSCOREs of the patients were 5.5 ± 2.3 and 5.9 ± 2.5, respectively in the groups. The average numbers of the grafts were 3.1 ± 1.0 and 2.9 ± 0.9. Mean extubation times were 8.52 ± 1.3 hours in group 1 and 6.34 ± 1.0 hours in group 2. The numbers of patients who needed pharmacological inotropic support were 12 in group 1 and five in group 2. Duration of hospital stay of the patients was shorter in group 2. While there were 14 patients with post-operative atrial fibrillation (PAF) in group 1, the number of patients with PAF in group 2 was five. Whereas there were seven patients who had pleural effusions requiring drainage in group 1, there were only two in group 2. There were three mortalities in group 1, and one in group 2. There were no sternal infections and sternal dehiscences in either group.
Pre-treatment in moderate-risk COPD patients improved post-operative outcomes while decreasing adverse events and complications. Therefore for patients undergoing elective CABG, we recommend the use of medical treatment.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods.
Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative In-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS).
The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1.
Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.
[Show abstract][Hide abstract] ABSTRACT: Surgical strategy in patients with haematological malignancies must be planned and carried out with the specific aim of decreasing postoperative complications. The aim of this study was to present our experience on patients previously diagnosed with haematological malignancies who subsequently underwent cardiac surgery. We include data to assist other surgeons predict factors affecting postoperative morbidity and mortality in this group of patients.
Fifteen patients diagnosed with haematological malignancies who had cardiac surgery were retrospectively analysed. Eight patients had chronic lymphocytic leukaemia, six had non-Hodgkin's lymphoma and the rest had chronic myelocytic leukaemia. Coronary artery bypass graft surgery was performed on all of them.
There were no hospital mortalities. The average follow-up period was 35 ± 11 (23-56) months. Three patients required early postoperative re-operation because of excessive bleeding. No mortalities were seen in the early postoperative period. There were five (33%) deaths during the late follow-up period. Three patients were lost due to intracranial bleeding (confirmed by autopsy) in the 16th, 23rd and 38th months after surgery. The remaining two patients had sudden death in the eighth and 55th months from nondetectable causes.
Cardiac surgery can be performed with acceptable early postoperative outcomes in patients with haematological malignancies. Intracranial bleeding is an important factor contributing to late mortality and patient selection and risk stratification are crucial to improving surgical benefits.