SARS-CoV-2 infection-associated thoraco-abdomino-iliac thrombosis in a patient without cardiac and systemic co-morbidity

Acute pulmonary damage and vascular coagulopathy occur frequently in patients with severe acute respiratory syndrome coronavirus 2 infection in relation to coronavirus disease (COVID-19). The inflammatory process accompanying the infection and excessive coagulation state is one of the most important causes of patient death. The COVID-19 pandemic remains a major challenge for healthcare systems and millions of patients worldwide. In this report, we present a complicated case of COVID-19 associated with lung disease and aortic thrombosis.

Successful Surgical Treatment of Coronary Aneurysm, Ascending Aortic Aneurysm, and Bicuspid Aorta for a Kawasaki Disease Patient

Kawasaki disease was first reported in 1967, and it was classified as an autoimmune vasculitis of the small and medium arteries. It is a self-limiting condition that occurs mostly in childhood, but it may involve complications — such as coronary artery aneurysms, myocardial ischemia, and arrhythmias — with significant morbidity and mortality that occur later in life. In this article, we present the association of an ascending aortic aneurysm with bicuspid aortic disease in addition to coronary aneurysm in a 55-year-old patient diagnosed with Kawasaki disease.

Successful Combined Treatment of Giant Carotid Body Tumor with Embolization Applied before Surgery

Carotid body tumors are defined as unusual tumors of neuroectodermal origin that occur in the carotid bifurcation. These generally benign masses grow slowly; then, they become symptomatic with enlargement. In this study, we present a case of a 66-year-old female patient diagnosed with a carotid body tumor with a diameter of 8×9×10 cm. The patient was surgically treated 2 days after embolization due to the wideness of the mass and surgical comorbidity. Furthermore, this article puts emphasis on the importance of embolization before curative surgery in carotid body tumors with large and high blood supply.

Successful Conservative Treatment of Chylopericardium after Open-Heart Surgery: A Case Report

Chylopericardium is a rare complication following cardiac surgery. The incidence of this pathological condition is very low and mainly attributed to lymphatic injuries to the thymus or anterior mediastinum, thoracic duct injuries, or extensive posterior pericardial dissection with the possible interruption of major cardiac lymph channels.

A 62-year-old man was admitted to the cardiovascular surgery department for coronary bypass surgery, and the surgical procedure was performed 3 days later. Revision surgery was performed, because of the drainage associated with bleeding. In the post-revision days, the amount of serous drainage increased, and then chylous drainage occurred. After conservative treatment, the drainage of the chylous features decreased and eventually disappeared. The patient was discharged without any problem. At 6 months’ follow-up, the patient was doing well with a normal left ventricular function and without effusion.

Acute Dissection of the Ascending Aorta as a Rare Complication of Aortocoronary Bypasses Surgery: A Case Report

Many complications may ensue coronary bypass surgery. Among these complications, early or late dissection of the ascending aorta is a very rare condition. Successful surgery without life-threatening results can save lives. In this case report, we present a case of aortic dissection due to cross-clamp injury in a patient who underwent coronary artery bypass surgery. A 60-year-old female patient underwent double-vessel aortocoronary bypass surgery due to coronary artery disease. After distal bypasses were performed and the cross-clamp was removed, dissection of the aorta occurred. Consequently, axillary cannulation and ascending aortic replacement with a prosthetic graft were performed via the open technique. The saphenous vein graft was sutured to the aortic prosthetic graft, and cardiopulmonary bypass was terminated after hemodynamic stability was achieved. The patient was discharged on the 10th postoperative day, and she has been followed up for 2 years after surgery without any problems.

Post-Traumatic Dorsalis Pedis Pseudo-aneurysm Caused by Crush Injury

Introduction

This is the report of an unusual case of a dorsalis pedis artery pseudo-aneurysm resulting from trauma in a 61 year old farmer.

Report

One year previously, the patient's right foot had been crushed under a tractor wheel. The patient complained of pain and pulsatile soaring swelling on his right foot which he noticed two months before presentation. Radiological examinations revealed a pseudo-aneurysm of the dorsalis pedis artery. Resection of the aneurysm was completed without complications. Pathological findings confirmed an aneurysm of traumatic rather than atherosclerotic aetiology.

Discussion

The patient remains under follow up without ischaemia. False aneurysms should be treated by surgical or endovascular intervention when they are detected.

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A case of traumatic infrapopliteal pseudo-aneurysm.

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Symptomatic and growing pseudo-aneurysms require interventional endovascular or open surgery.

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Even if neither symptomatic and/or large, DPA aneurysms have embolic and ischaemic risks.

Off-pump versus on-pump complete coronary artery bypass grafting: Comparison of the effects on the renal damage in patients with renal dysfunction

BACKGROUND

We aimed to compare off-pump technique with on-pump technique on renal function in patients with nondialysis-dependent renal dysfunction who underwent coronary artery bypass grafting.

METHODS

The 94 patients with renal dysfunction undergoing isolated coronary artery bypass grafting were retrospectively analyzed. No patient was receiving dialysis. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass and beating heart. Both groups were compared in terms of renal dysfunction parameters and dialysis requirement. The logistic regression models were constructed to identify risk factors associated with dialysis requirement.

RESULTS

Renal dysfunction requiring dialysis developed in 9 patients in the on-pump group. The measures analysis of variance was performed on the data that showed worsening of renal function in the on-pump group compared with the off-pump group. Cardiopulmonary bypass is significant as independent predictor for the development of postoperative dialysis.

CONCLUSION

These results suggest that off-pump coronary revascularization offers a superior renal protection and has a significantly lower risk for renal complications in patients with nondialysis-dependent renal dysfunction when compared with conventional coronary revascularization with cardiopulmonary bypass.

Is the Preoperative Administration of Amiodarone or Metoprolol More Effective in Reducing Atrial Fibrillation: After Coronary Bypass Surgery?

This study examined the influence of preoperative administration of amiodarone and metoprolol in preventing postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery.The study comprised 251 patients who underwent CABG surgery at our hospital between January 2012 and May 2014. The patients were randomly divided into 2 groups: amiodarone therapy group (n = 122 patients) and metoprolol therapy group (n = 129 patients).In the amiodarone group, the patients received amiodarone tablet orally 1 week before coronary bypass surgery and during the postoperative period. In the metoprolol group, the patients received metoprolol tablet orally 1 week before surgery and during the postoperative period. The AF development rate was retrospectively evaluated between the first 3 days and 4 weeks after surgery.AF developed in 14 patients in the amiodarone group and 16 patients in the metoprolol group 4 weeks after the operation (P = 0.612).No significant difference was observed between the groups in terms of intensive care unit and hospital stay. Furthermore, hospital charges were similar in both groups (P = 0.741).The results of the logistic regression analysis showed age, left ventricular ejection fraction, left atrial diameter, and aortic cross-clamping time to be predictors for postoperative AF.This study demonstrates that amiodarone and metoprolol have similar effects in prevention of AF after cardiac surgery. However, larger-scale studies need to be conducted to substantiate these findings.

Effect of N-acetylcysteine and allopurinol combination to protect spinal cord ischemia/reperfusion injury induced by aortic cross-clamping in rat model

Purpose

The aim of this experimental study was to determine whether combination of N-acetylcysteine and allopurinol can reduce the ischemia/reperfusion injury of spinal cord in a rat model.

Methods

Twenty-seven Spraque Dawley rats, all male, weighing between 220 to 370 (mean 325) gr were used in the study. 27 rats were divided into three groups: sham group, control group and experimental group. Abdominal aortic occlusion between the renal arteries and iliac bifurcations was carried out for 60 min with proximal and distal clip in control and experimental groups. Hindlimb motor functions were evaluated at 24, and 48 h using the Tarlov Scale. Besides, spinal cord samples were taken for determination of superoxide dismutase, and catalase activities as antioxidant enzymes, and malondialdehyde as an indicator of lipid peroxidation and xanthine oxidase levels as source hydroxyl radical for biochemical studies. Also, histopathological evaluation was made from cord tissue samples.

Results

The experimental group subjects had better neurological functions than control group subjects. In experimental group; superoxide dismutase and catalase levels increased, while malondialdehyde and xantine oxidase levels decreased as compared with control group. Histopathological examination showed that experimental group had less cell degeneration, hemorrhage, edema and inflammation loss than control group.

Conclusions

This study offers that combined use of N-acetylcysteine and allopurinol might help protect the spinal cord against ischemia/reperfusion injury.

On-pump beating heart coronary revascularization: Is it valid for emergency revascularization?

BACKGROUND

On-pump beating heart coronary artery bypass grafting (CABG) may be considered as an alternative to the conventional on-pump surgery in patients presenting with acute coronary syndrome requiring emergency revascularization. This study reports our clinical experience and early outcomes with the on-pump beating heart coronary surgery on patients with acute coronary syndrome.

DESIGN AND SETTINGS

A retrospective study conducted from August 2009 to October 2015, in a regional training and research hospital in Turkey.

METHODS

A total of 1432 patients underwent isolated CABG at our institution. A total of 316 of these patients underwent the on-pump beating heart procedure without cardioplegic arrest by the same surgeon.

RESULTS

The time interval from the onset of acute myocardial infarction to CABG was 10 (2.2) hours. The mean number of grafts was 3.0 (0.6). Hospital mortality was 2.9% (9 patients). Twelve patients had low cardiac output syndromes after surgery. Eight of them had renal dysfunction but none of them needed hemodialysis. The mean intensive care unit stay was 3 (2) days and the mean hospital length of stay was 7 (4) days.

CONCLUSION

We think that the on-pump beating heart revascularization technique can be a good choice for emergency CABG of high-risk patients with a multivessel coronary artery disease.

On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes

BACKGROUND

We sought to evaluate the effects of on-pump beating-heart versus conventional coronary artery bypass grafting techniques requiring cardioplegic arrest in patients with coronary artery disease with left ventricular dysfunction.

METHODS

We report the early outcomes associated with survival, morbidity and improvement of left ventricular function in patients with low ejection fraction who underwent coronary artery bypass grafting between August 2009 and June 2012. Patients were separated into 2 groups: group I underwent conventional coronary artery bypass grafting and group II underwent an on-pump beating-heart technique without cardioplegic arrest.

RESULTS

In all, 131 patients underwent coronary artery bypass grafting: 66 in group I and 65 in group II. Left ventricular ejection fraction was 26.6% ± 3.5% in group I and 27.7% ± 4.7% in group II. Left ventricular end diastolic diameter was 65.6 ± 3.6 mm in group I and 64.1 ± 3.2 mm in group II. There was a significant reduction in mortality in the conventional and on-pump beating-heart groups (p < 0.001). Perioperative myocardial infarction and low cardiac output syndrome were higher in group I than group II (both p < 0.05). Improvement of left ventricular function after the surgical procedure was better in group II than group I.

CONCLUSION

The on-pump beating-heart technique is the preferred method for myocardial revascularization in patients with left ventricular dysfunction. This technique may be an acceptable alternative to the conventional technique owing to lower postoperative mortality and morbidity.

Surgical treatment of a case with rapidly growing mass lesion after trauma: on the left forearm arteriovenous malformation

In this case, we report a vascular malformation with high flow pattern complicated with trauma. A postoperative histopathology examination confirmed an arterio-venous malformation in specimens of surgical excision material. In our opinion, posttraumatic progression of a vascular malformation is an emergency and requires an urgent evaluation with surgery at any localization of the body.

Mycotic pseudoaneurysm of the ascending aorta following purulent pericardial effusion diagnosed by multi-slice computed tomography

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.

Interruption of the inferior vena cava and azygos continuation in a child with partial atrioventricular septal defect

Congenital pathologies of the inferior vena cava are uncommon. Isolated congenital interruption of the inferior vena cava with azygos vein continuation could be considered part of the group of venous return anomalies. The major significance of this anomaly is its association with complex cardiac defects and the associated technical difficulties at the time of cardiac catheterization and abdominal surgery or interventional procedures. In our case, we describe a common atrium and partial atrioventricular septal defect in an 8-year-old girl with infrahepatic interruption of the inferior vena cava and azygos continuation without polysplenia. Magnetic resonance angiography and computed tomography, together with a clinical awareness of this pathology, can be used to diagnose this entity.

Primary Arteriovenous Fistulas in the Forearm for Hemodialysis: Effect of Miscellaneous Factors in Fistula Patency

BACKGROUND

The provision and maintenance of vascular access remains a major cost to end-stage renal failure programs. In addition, vascular access occlusion, results in significant morbidity in hemodialysis patients. Age, gender, diabetes mellitus, malignancy, smoking habits, administration of heparin per hemodialysis session, previous dialysis catheter insertion, number of hemodialysis sessions and location of the fistula may be associated with survival of the primary arteriovenous fistula. We examined the effects of various factors on fistulas in 412 chronic renal insufficiency patients.

METHODS

From 1995 to 2004, 412 arteriovenous fistulas were created by the Department of Cardiovascular Surgery at the Medical Faculty of Atatürk University for hemodialysis. The mean age of the patients was 45 years (range 6 to 62 years). We evaluated the effects of various factors for patency rates in the patients who had primary arteriovenous fistulas. Primary patency was defined as the duration of fistula patency without revision. Twenty-eight patients (6.7%) with ischemic cardiac disease did not require surgical interference. Analyzed data were age, gender, smoking habits, diabetes mellitus, malignant neoplasm, previous dialysis catheter insertion, number of hemodialysis sessions, and fistula location.

RESULTS

In 298 patients, where lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively, in the other 114 patients, where upper-arm fistulas were created, these rates were 84.0%, 72.2%, 53.3%, 39.8%, and 12.3%, respectively. There was no significantly difference between the upper-arm fistulas and the lower-arm fistulas statistically (p = 0.069). Factors affecting the primary patency of arteriovenous fistulas were diabetes mellitus (p = 0.0001), hemodialysis counts > or =3 per week (p < 0.0005), presence of malignancy (p < 0.0005), previous catheter insertion (p < 0.0007), and administration of heparin per hemodialysis session (p = 0.0008).

CONCLUSION

While primary arteriovenous fistula patency was shortened in chronic renal insufficiency patients with diabetes mellitus, presence of malignancy, and previous catheter insertion, patency was longer in patients with heparin used for hemodialysis and hemodialysis count per week (> or =3).

Cardiac echinococcosis: recurrent intramyocardial-extracardiac hydatid cysts with pericardial protrusion

A 26-year-old male patient was diagnosed with an isolated recurrent intramyocardial-extracardiac hydatid cyst with pericardial protrusion after being admitted with chest pain and palpitation. He had undergone surgical resection of an intramyocardial pericardial hydatid cyst without cardiopulmonary bypass 10 years earlier. In the current admission, the results from transthoracic and transesophageal echocardiography and multislice computed tomography were confirmed by serological and histopathological tests. The cyst was excised under cardiopulmonary bypass, and the patient was treated postoperatively with albendazole for 9 months. His clinical status improved postoperatively and he was asymptomatic without signs of recurrence as determined by echocardiography.

Effects of ascorbic Acid, alpha-tocopherol and allopurinol on ischemia-reperfusion injury in rabbit skeletal muscle: an experimental study

PURPOSE

Ischemia reperfusion injury to skeletal muscle, following an acute arterial occlusion is important cause of morbidity and mortality. The aim of the present study was to determine and evaluate the effects of ascorbic acide, alpha-tocopherol and allopurinol on ischemia reperfusion injury in rabbit skeletal muscle.

METHODS

Forty-eight New Zealand white rabbits, all male, weighing between 2.5 to 3.0 (mean 2.8) kg, were used in the study. They were separated into four groups. Group I was the control group without any drugs. The other groups were treatment groups (groups II, III, and IV). Group II rabbits administrated 50 mg/kg ascorbic acide and 100 mg/kg alpha-tocopherol 3 days prior to ischemia, group III rabbits received 50 mg/kg allopurinol 2 days prior to ischemia, and group IV rabbits were administrated both 50 mg/kg ascorbic acide, 100 mg/kg alpha-tocopherol 3 days prior to ischemia and 50 mg/kg allopurinol 2 days prior to ischemia. Two hours ischemia and 2 hours reperfusion were underwent to the treatment groups. At the end of the reperfusion periods, muscle samples were taken from rectus femoris muscle for determination of superoxide dismutase, catalase and glutathione peroxidase activities as antioxidant enzymes, and malondialdehyde as an indicator of lipid peroxidation and xanthine oxidase levels as source hydroxyl radical. Besides, histopathological changes (edema, inflammation, ring formation and splitting formation) were evaluated in the muscle specimens.

RESULTS

In the treatment groups; superoxide dismutase (U/mgprotein), catalase (U/mgprotein), and glutathione peroxidase (U/mgprotein) levels increased, malondialdehyde (nmol/mgprotein) and xanthine oksidase (mU/mgprotein) levels decreased compared to control I ( p < 0.05). Increase of superoxide dismutase, catalase, and glutathione peroxidase levels were the highest and decrease of malondialdehyde and xanthine oxidase levels were the highest in group IV compared to groups II and III, but no significant as statistically. Also amount of cellular injury in group II, III, and IV were lower than group I.

CONCLUSIONS

Antioxidant medication may help lowering ischemia reperfusion injury. In our study, all drug medications are shown to be able to have an effective role for preventing ischemia reperfusion injury. Moreover, ascorbic acide + alpha-tocopherol + allopurinol group (group IV) may have a beneficial effect to decrease the local and systemic damage due to ischemia-reperfusion injury.

The effect of surgical treatment for secundum atrial septal defect in patients more than 30 years old

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Pseudoaneurysm of the Left Coronary Ostial Anastomoses as a Complication of the Modified Bentall Procedure Diagnosed by Echocardiography and Multislice Computed Tomography

We report the case of a patient with a pseudoaneurysm of the left coronary ostial anastomoses diagnosed 6 years after a Bentall procedure with coronary button anastomoses had been performed. Preoperatively, the pseudoaneurysm of the ascending aorta was diagnosed by transesophageal echocardiography and multislice tomography, and the diagnosis was confirmed by surgery. Intraoperatively, the dehiscence of the button anastomosis of the left coronary artery was determined. The operative technique for the repair of the left coronary anastomosis dehiscence was direct closure through a sternotomy using extracorporeal circulation. The patient was discharged on the twelfth day without problems. In conclusion, we demonstrated that the patient with a pseudoaneurysm after a conduit operation of the ascending aorta can be prediagnosed by using echocardiography and multislice tomography.

An atypically localized atrial myxoma: a case report

Atypical cardiac myxomas are rare occurrences and may present with a variety of clinical manifestations depending on the location and morphology. A 46-year-old woman had a 4 x 3 x 2-cm myxoma originating from the superior wall of the left atrium, found by echocardiography and multislice tomography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a narrow-base stalk originating from the right wall of the left atrium in between the right upper and lower pulmonary vein. The patient recovered without complication and was discharged 6 days after the operation. At 1-year follow-up, echocardiography revealed normal cardiac function without reccurence in terms of mass. Although up to 80% of myxomas are localized in the left atrium, of which 75% involve in the interatrial septum, it should not be forgotten that myxomas can appear in an atypical localization, as occurred in our case.