1
|
Ali Sahin M, Yokuşoğlu M, Kuralay E, Ozal E. Can Right Ventricular Branch Bypass Alleviate Right Ventricular Dysfunction? Tex Heart Inst J 2022; 49:487993. [PMID: 36315844 PMCID: PMC9632377 DOI: 10.14503/thij-21-7607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Right ventricle (RV) dysfunction after a coronary artery bypass grafting procedure is a challenge that adversely affects RV filling pressure and contraction. This study sought to determine whether additional bypass of an RV branch would lessen RV dysfunction. METHODS Patients with severe right coronary artery (RCA) stenosis were divided into 2 groups. Group 1 patients (n = 50) had a single distal bypass on the RCA. Group 2 patients (n = 50) had both distal RCA and additional bypass on the RV branch of the RCA. Right ventricular function was examined by echocardiogram by measuring transannular plane systolic excursion, fractional area change, tissue Doppler S-wave velocity, and inferior vena cava diameter. RESULTS Transannular plane systolic excursion and fractional area change measurements rapidly decreased below the cutoff in both groups, but group 2 patient values reached normal limits at 90 days. Tissue Doppler S-wave velocity reached the normal limit in 7 days. Inotropic agents were required in 11 patients in group 1 and 2 patients in group 2 (P = .013). The mean (SD) intensive care unit stay was 2.11 (1.12) days and 1.45 (0.71) days (P = .033), and the hospital stay was 7.32 (1.44) days and 6.22 (0.45) days in groups 1 and 2, respectively (P = .027). CONCLUSION The data in this study suggest that an additional graft on the RV branch of the RCA (eg, conus, marginal, any good runoff vessels on the RV) prevents severe RV dysfunction and allows for rapid recovery of RV dysfunction after off-pump coronary surgery.
Collapse
Affiliation(s)
- Mehmet Ali Sahin
- Cardiovascular Surgery Department, Alife Hospital, Ankara, Turkey
| | | | - Erkan Kuralay
- Cardiovascular Surgery Department, Alife Hospital, Ankara, Turkey
| | - Ertugrul Ozal
- Cardiovascular Surgery Department, Alife Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Yildiz O, Seyrek M, Gul H, Un I, Yildirim V, Ozal E, Uzun M, Bolu E. OP-054 Testosterone Relaxes Human Internal Mammary Artery in Vitro. Am J Cardiol 2015. [DOI: 10.1016/j.amjcard.2015.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Kirdemir P, Yildirim V, Kiris I, Gulmen S, Kuralay E, Ibrisim E, Ozal E. OP-131 Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients? Am J Cardiol 2015. [DOI: 10.1016/j.amjcard.2015.01.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
4
|
Bolcal C, Yildirim V, Doganci S, Sargin M, Aydin A, Kuralay E, Ozal E, Demirkilic U, Oz BS, Sayal A, Tatar H. OP-018 Do N-Acetylcystein, Beta-Glucan, and Coenzyme Q10 Mollify Myocardial Ischemia-Reperfusion Injury? Am J Cardiol 2015. [DOI: 10.1016/j.amjcard.2015.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Abstract
<p>Coronary artery aneurysm (CAA) is a rare entity, defined as localized dilation that exceeds the normal vessel diameter by a factor of 1.5. A giant CAA is described as a very large dilation, when diameter exceeds 20 mm. CAA has a preva-lence of 0.02% [Markis 1976]. Different factors may lead to CAA formation, including Kawasaki disease, atherosclerosis, congenital malformations, autoimmune and infectious disor-ders, and percutaneous interventions [Hartnell 1985]. Man-agement of these patients remains controversial due to a lack of data from large series studies.</p><p>We reported a case of a young female patient, who pre-sented with an acute inferior infarction and was diagnosed with a giant right coronary artery (RCA) aneurysm. She underwent aneurysmectomy and revascularization on a beat-ing heart through a right lateral thoracotomy. Due to the minimally invasive nature of this procedure, the patient was able to recover quickly without substantial cosmetic changes.</p>
Collapse
Affiliation(s)
- Artan Jahollari
- Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
| | - Atilla Sarac
- Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
| | - Olta Tafaj
- Endocrine Research Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ertugrul Ozal
- Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
| |
Collapse
|
6
|
Sarac A, Jahollari A, Talay S, Ozkaya S, Ozal E. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency. Clin Interv Aging 2014; 9:575-9. [PMID: 24741299 PMCID: PMC3983027 DOI: 10.2147/cia.s60555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV) insufficiency. Methods External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results A complete clinical and radiological healing was observed in 50 patients (60%). In 13 cases (15.6%), a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6%) developed superficial vein thrombosis, and only one patient (1.2%) developed deep vein thrombosis. Contact was lost from 32 patients (38.5%) for different reasons. Conclusion External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping.
Collapse
Affiliation(s)
- Atilla Sarac
- Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey
| | - Artan Jahollari
- Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey
| | - Sureyya Talay
- Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey
| | - Sevket Ozkaya
- Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Ertugrul Ozal
- Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey
| |
Collapse
|
7
|
Akgul O, Uyarel H, Pusuroglu H, Gul M, Turen S, Bulut U, Baycan O, Ozal E, Cetin M, Uslu N. Predictive value of elevated cystatin C in patients undergoing primary angioplasty for ST elevation myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Guler A, Sahin MA, Cingoz F, Ozal E, Demirkilic U, Arslan M. Can cardiac surgery be performed safely on patients with haematological malignancies. Cardiovasc J Afr 2013; 23:194-6. [PMID: 22614661 PMCID: PMC3721910 DOI: 10.5830/cvja-2011-053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/06/2011] [Indexed: 12/03/2022] Open
Abstract
Introduction 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. Methods 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. Results 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 non-detectable causes. Conclusion Conclusion: 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.
Collapse
Affiliation(s)
- A Guler
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
9
|
Guler A, Sahin MA, Yucel O, Yokusoglu M, Gamsizkan M, Ozal E, Demirkilic U, Arslan M. Proanthocyanidin prevents myocardial ischemic injury in adult rats. Med Sci Monit 2012; 17:BR326-331. [PMID: 22037735 PMCID: PMC3539496 DOI: 10.12659/msm.882042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Proanthocyanidin is a bioflavonoid known to have protective effect against oxidative injury. We investigated the cardioprotective effect of proanthocyanidin. Material/Methods Thirty-two Rattus Norvegicus rats were categorized equally as the control group (CG), proanthocyanidin group (PCG), ischemia group (IG) and proanthocyanidin-treated group (PCT). Rats in CG and IG were fed standard rat food and PCG and PCT were fed standard rat food plus proanthocyanidin (100 mg/kg/day twice a day by oral gavage) for 3 weeks. In CG and PCG the myocardial samples were prepared immediately, and in IG and PCT hearts were placed in transport solution and kept at 4°C for 5 hours, then prepared for evaluation. Malondialdehyde (MDA) level, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities were measured. Results MDA levels were significantly higher in IG and PCT than in CG and PCG. The activity of SOD was significantly lower in IG and higher in PCG than in the other groups. The activity of GPx was significantly lower in IG than in the other groups. The activities of CAT were significantly lower in IG and PCT than in the other groups and were significantly lower in IG than PCT. Histopathologic evaluation revealed normal findings in CG and PCG. While ischemic injury was observed in IG, the content of muscle fibers was better preserved in PCT. Conclusions Proanthocyanidin may have a protective effect on myocardial ischemic injury.
Collapse
Affiliation(s)
- Adem Guler
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Cingoz F, Bingol H, Ozal E, Tatar H. Coronary subclavian steal syndrome in a patient with Behçet's disease. Thorac Cardiovasc Surg 2010; 58:244-6. [PMID: 20514586 DOI: 10.1055/s-2006-924699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a case of a 44-year-old woman with Behçet's disease, who underwent coronary artery bypass surgery. The patient was readmitted with symptoms of dizziness and angina pectoris that became more severe with movement of her left arm. Angiography revealed a totally occlusive stenosis, caused by coronary subclavian steal syndrome, which was detected in the left subclavian artery. The aim of this report is to emphasize the relationship between Behçet's disease and vascular occlusive changes.
Collapse
Affiliation(s)
- F Cingoz
- Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
| | | | | | | |
Collapse
|
11
|
Guler A, Ali Sahin M, Doganci S, Atilgan K, Ozal E, Tatar H. PP-133 A SYSTEMIC EMBOLUS, ORIGINING FROM A THROMBI, WITH A WIDE PEDICLE, IN ASCENDING AORTA, GOES ASYMPTOMATIC. Int J Cardiol 2010. [DOI: 10.1016/s0167-5273(10)70278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
12
|
Kucukarslan N, Tatar T, Uzun M, Yavuz I, Ozal E, Tatar H. Coronary Artery Bypass Surgery in Patients with Malignancy: A Single-Center Study with Comparison to Patients Without Malignancy. J Card Surg 2009; 24:151-5. [DOI: 10.1111/j.1540-8191.2009.00815.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Kucukarslan N, Kirilmaz A, Sungun M, Ozal E, Ulusoy RE, Sanisoglu Y, Tatar H. Harvesting of the Radial Artery: Subfasciotomy or Full Skeletonization: A Comparative Study. J Card Surg 2008; 23:341-5. [DOI: 10.1111/j.1540-8191.2008.00681.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Kirdemir P, Yildirim V, Kiris I, Gulmen S, Kuralay E, Ibrisim E, Ozal E. Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence After Coronary Artery Bypass Operations in Diabetic Patients? J Cardiothorac Vasc Anesth 2008; 22:383-7. [DOI: 10.1053/j.jvca.2007.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Indexed: 01/04/2023]
|
15
|
Kucukarslan N, Kirilmaz A, Ulusoy E, Baysan O, Yildirim V, Ozal E, Sahin MA, Tatar H. Eleven-year experience in diagnosis and surgical therapy of right atrial masses. J Card Surg 2007; 22:39-42. [PMID: 17239209 DOI: 10.1111/j.1540-8191.2007.00335.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tumors arising from the right atrium are quite rare, and require special care during differential diagnosis for their management. A review of surgical experience with right atrial tumors in 11 patients from our institution has been presented in this article. METHODS Eleven cases, operated for a tumor mass in the right atrium in our institution between January 1993 and December 2004, were retrospectively reviewed for their clinical presentation, diagnostic workup, method of surgical procedure, and histopathologic findings. Electrocardiogram, transthoracic, and transesophageal echocardiography, computerized tomography, and nuclear magnetic resonance imaging were available for all patients during the diagnostic evaluation. Surgical procedure notes, photos, and file recordings were reviewed when available. The surgeons were also interviewed when necessary. RESULTS Right atrial tumors were diagnosed in 11 patients (6 males and 5 females). The average age of the patients was 34 +/- 11 years (ranging between 21 and 65 years). The histopathological examination of the surgically removed specimen revealed a benign tumor in eight patients (73%), and a malignant process in three (23%). In eight patients with a benign tumor, atrial myxoma was the leading cause in half of the cases. Hydatid cyst (n = 2), lipoma (n = 1), and right atrial thrombus (n = 1) were detected in the remaining four patients. One patient died of heart failure after surgery. The diameters of the excised masses were 2 +/- 0.5 cm versus 7 +/- 1 cm. CONCLUSIONS Tumors of the right atrium are rarely seen, and necessitate a unique attention during the process of diagnosis and surgical treatment. We present our surgical experience of 11 patients with right atrial mass. The differentiation of the right atrial tumors with the diagnostic tools before surgery, the determination of the spreading, and the structural properties of the mass may designate surgical approach and prognosis.
Collapse
Affiliation(s)
- Nezihi Kucukarslan
- Gata Military Medical Faculty, Department of Cardiovascular Surgery, Etlik, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Bolcal C, Yildirim V, Doganci S, Sargin M, Aydin A, Eken A, Ozal E, Kuralay E, Demirkilic U, Tatar H. Protective effects of antioxidant medications on limb ischemia reperfusion injury. J Surg Res 2007; 139:274-9. [PMID: 17349658 DOI: 10.1016/j.jss.2006.10.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 10/24/2006] [Accepted: 10/25/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND N-acetylcysteine, beta-glucan, and coenzyme Q(10) were shown to have antioxidant and anti-inflammatory effects on reperfusion injury. The aim of our study was to determine and evaluate the effects of these agents on ischemia reperfusion injury of limb. MATERIAL AND METHOD Forty-four New Zealand white rabbits, all female, weighing between 2.3 to 4.2 (mean 3.8) kg, were used in the study. Four study groups were arranged of 11 animals each, by randomization. The first group was the control group (Group C), the other groups were the Group Q, which was medicated with coenzyme Q10, the Group betaG, which was medicated with beta-glucan, and the Group N, medicated with N-acetylcysteine. After baseline measurements, for the ischemia-reperfusion experiments, common iliac artery was clamped and collateral flow was occluded by a rubber arterial tourniquet wrapped around the thigh at the proximal third of the leg. After 60 min of transient ischemic period, the limb was perfused for 180 min. After perfusion, biopsy was taken from the adductor magnus muscle. Second blood sampling was done after reperfusion period. Blood and tissue analysis were done and evaluated statistically. RESULTS Baseline and post-reperfusion levels of glutathione peroxidase (GPx), super oxide dismutase (SOD), malonyldialdehyde (MDA), and nitric oxide (NO) changed significantly. While MDA levels increased in the control group, it decreased in the other study groups. The increase in GPx and SOD levels were significant in all groups except the control group. Levels of NO were found to have decreased in the control group, whereas it had increased in the other groups. CONCLUSION Antioxidant medication may help lowering limb ischemia reperfusion injury. All mentioned medications in our study are shown to be able to have an effective role for preventing ischemia reperfusion injury to some extent through their antioxidant properties.
Collapse
Affiliation(s)
- Cengiz Bolcal
- Department of Cardiovascular Surgery, Gulhane Military Academy of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
We report a case of orthotopic heart transplantation in a 42-year-old man who had cardiomyopathy with severe biventricular heart failure, ascites, and large umbilical hernia. He successfully received an orthotopic heart transplantation. After heart transplantation, renal failure was noted. Ascites and renal failure were successfully managed with repeated paracentesis. His cardiac and abdominal symptoms subsided gradually following transplantation. His umbilical hernia was repaired 55 days after the heart transplantation because of strangulation. In this case study, we report a patient with ascites who was treated for postoperative renal failure with repeated paracentesis.
Collapse
Affiliation(s)
- Faruk Cingoz
- Gulhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey.
| | | | | | | |
Collapse
|
18
|
Kucukarslan N, Ozal E, Temizkan V, Tatar H. Diagnostic and surgical approach to a descending thoracic aorta saccular aneurysm case. J Card Surg 2007; 22:142-4. [PMID: 17338750 DOI: 10.1111/j.1540-8191.2007.00373.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Descending aorta saccular aneurysms are seen less than fusiform aneurysms. All symptomatic saccular aneurysms must be operated. In this study, we present a saccular aneurysm case developed at the descending aorta 1 year after a motor vehicle crash. Following an aorta-LAD saphenous vein graft anastomosis performed in beating heart, the aneurysm neck was closed with a Dacron patch under deep hypothermic circulatory arrest. All signs and symptoms removed dramatically after the operation. Regarding this case, we recommend that the surgical treatment must be performed in accordance with localization and specialties of aortic aneurysms.
Collapse
Affiliation(s)
- Nezihi Kucukarslan
- Department of Cardiovascular Surgery, Gata Military Medical Faculty, Etlik, Ankara, Turkey.
| | | | | | | |
Collapse
|
19
|
Kucukarslan N, Kirilmaz A, Arslan Y, Sanioglu Y, Ozal E, Tatar H. Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy. Pediatr Surg Int 2006; 22:779-83. [PMID: 16967308 DOI: 10.1007/s00383-006-1776-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2006] [Indexed: 10/24/2022]
Abstract
Alternative approaches to the standard posterolateral incision for thoracotomy have been developed to minimize its postoperative pain and wound related side effects. Muscle-sparing (MS) thoracotomy has been a well-known substitution to the standard posterolateral thoracotomy for this purpose; however it has not been studied in the pediatric age group in detail. We studied retrospectively the patients with thoracotomy for non-cardiac, thoracic surgical procedures. Group 1 included the patients with standard posterolateral thoracotomy for the surgery. The patients with MS thoracotomy composed group 2. The related data were collected retrospectively. The early postoperative morbidities (time requiring for regaining shoulder girdle movement, extubation, intensive care unit stay, and hospital stay) and late musculoskeletal anomalies (scoliosis, elevation of the shoulder, winged scapula, asymmetry of the nipples) were compared between groups. A total of 90 patients were included in the study. Group 1 constituted 50 patients with an average age of 4.24 +/- 2.91 years. Group 2 included 40 patients with an average age of 4.20 +/- 2.92 years. Comparison of the demographics and the baseline characteristics of the patients were not different between groups. In comparison of operative characteristics, there was lesser morbidity in group 2 as re-exploration for bleeding, wound infection, wound healing and fewer intensive care unit and hospital stay days. Late follow-up revealed a significant increase in musculoskeletal deformities in group 1. We conclude that muscle-sparing incision should be preferred to the standard posterolateral thoracotomy in pediatric age.
Collapse
Affiliation(s)
- Nezihi Kucukarslan
- Department of Cardiovascular Surgery, GATA Military Medical Faculty, Etlik, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
20
|
Kucukarslan N, Kirilmaz A, Ulusoy E, Yokusoglu M, Gramatnikovski N, Ozal E, Tatar H. Tricuspid Insufficiency Does Not Increase Early After Permanent Implantation of Pacemaker Leads. J Card Surg 2006; 21:391-4. [PMID: 16846419 DOI: 10.1111/j.1540-8191.2006.00251.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interference between pacemaker (PM) lead and tricuspid apparatus may cause tricuspid regurgitation (TR). However, data regarding TR in patients with implanted PM are controversial. Our aim is to find out the degree of TR in a group of patients before and following PM implantation in a prospective manner. METHODS The study group consisted of the patients referred for implantation of permanent PM or implantable cardioverter defibrillator (ICD). All patients underwent two-dimensional and Doppler echocardiographic evaluation before and after device implantation. The severity of TR was qualitatively classified into four groups as normal or trivial, mild, moderate, or severe. All studies were reviewed for accuracy by a second independent interpreter. RESULTS Sixty-one patients (mean age 53 +/- 8 years, 44 male) referred for PM (n = 55) or ICD (n = 6) implantation consisted of the study population. Echocardiographic degree of TR was mild in 21 (70%), moderate in 7 (23%) and severe in 2 (7%) patients before PM implantation. Following device implantation, mild TR was noted in 23 (76%), moderate in 10 (33%), and severe in 2 (6%) cases. After the procedure, the TR severity was increased from normal/trivial to mild in 5 (16%) cases and from mild to moderate in 3 (10%). There was no worsening of the severity of TR in patients with moderate regurgitation following device implantation. The severity of TR did not change at a mean follow-up of 6 +/- 3 months. CONCLUSIONS New or worsening TR is relatively rare after PM implantation. It is not associated with an acute worsening or clinical deterioration. But echocardiographic follow-up is recommended to monitor other complications in chronic phase.
Collapse
Affiliation(s)
- Nezihi Kucukarslan
- GATA Military Medical Hospital, Department of Cardiovascular Surgery, Etlik, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
21
|
Bolcal C, Iyem H, Sargin M, Mataraci I, Yildirim V, Doganci S, Ozal E, Demirkilic U, Tatar H. Comparison of magnesium sulfate with opioid and NSAIDs on postoperative pain management after coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2006; 19:714-8. [PMID: 16326293 DOI: 10.1053/j.jvca.2005.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study measured the effectiveness of magnesium sulfate during and after coronary artery bypass grafting (CABG) on postoperative pain and respiratory functions, and compared it with 2 other well-known and widely used analgesic agents: codeine and diclofenac, a nonsteroidal anti-inflammatory drug (NSAID). DESIGN Prospective unblinded study. SETTING Single institution. PARTICIPANTS Patients undergoing CABG. INTERVENTIONS Patients were divided into 3 groups. In group A (n = 50), intraoperative magnesium sulfate, 2 g/70 kg, was infused intravenously and was continued during the first 3 days postoperatively. In group B (n = 50), codeine, 60 mg/70 kg, was given orally 4 times a day for 3 days. In group C (n = 50), diclofenac sodium, 75 mg, was given orally twice a day for 3 days. MAIN RESULTS On the first postoperative day the visual analog scale (VAS) score was greater than 5 in all groups. On the second day the VAS score was greater than 5 in groups B and C, and was less than 5 in group A. On the third day the VAS score was less than 5 in all groups. During the first 2 postoperative days the need for morphine was significantly less in group A than in the other 2 groups. Preoperative respiratory function tests (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC) were similar in each group. The FEV1, FVC, and FEV1/FVC values on the postoperative first, second, and third days were significantly higher in group A. CONCLUSIONS Magnesium sulfate can be a beneficial adjuvant therapy for pain after CABG. In this respect, especially in patients with respiratory problems or intolerance to NSAIDs, magnesium sulfate can be a better choice than NSAIDs and opioids.
Collapse
Affiliation(s)
- Cengiz Bolcal
- Department of Cardiovascular Surgery, Gulhane Military Academy of Medicine, Ankara, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Preliminary clinical studies of testosterone therapy in male patients with coronary artery disease raised promising results. However, there is no study on in vitro effects of testosterone in human isolated arteries. We investigated the effect of testosterone on contractile tone of human isolated internal mammary artery. The responses in human internal mammary artery (IMA) were recorded isometrically by a force-displacement transducer in isolated organ baths. Testosterone (10 nM to 100 microM) was added cumulatively to organ baths either at rest or after precontraction with KCl (68 mM) and PGF2alpha (10 microM). Testosterone-induced relaxations were tested in the presence of cyclooxygenase inhibitor indomethacin (10 microM), nitric oxide synthase inhibitor Nomega-nitro-L-arginine methyl ester (L-NAME, 1 microM), nonselective large-conductance Ca2+-activated and voltage-sensitive K+ channel inhibitor tetraethylammonium (TEA, 1 mM), ATP-sensitive K+ channel inhibitor glibenclamide (GLI, 100 microM), and voltage-sensitive K+ channel inhibitor 4-aminopyridine (4-AP, 1 mM). Testosterone produced relaxation in human IMA (Emax 33% and 41% of KCl- and PGF2alpha-induced contraction, respectively). Vehicle had no significant relaxant effect. Except for TEA, the relaxation at low concentrations is not affected by either K+ channel inhibitors (GLI and 4-AP) or L-NAME and indomethacin. We report for the first time that supraphysiological concentrations of testosterone induce relaxation in IMA. This response may occur in part via large-conductance Ca2+-activated K+ channel-opening action.
Collapse
Affiliation(s)
- Oguzhan Yildiz
- Department of Pharmacology, Gulhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Demirkilic U, Ozal E, Bingol H, Cingoz F, Gunay C, Doganci S, Kuralay E, Tatar H. Surgical treatment of coronary artery fistulas: 15 years' experience. Asian Cardiovasc Thorac Ann 2004; 12:133-8. [PMID: 15213080 DOI: 10.1177/021849230401200211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report our experience of surgical treatment of coronary artery fistula and focus on the electrocardiographic changes that may be seen postoperatively. Between 1988 and 2003, cardiac operations were carried out on 9,487 patients, of whom 21 had a coronary artery fistula. The mean age of these 21 patients was 36.8 +/- 4.9 years. The fistula originated from the right coronary artery in 9 cases and from the left side in 12. The fistulous connection was to the right ventricle in 5 patients, to the right atrium in 6, to the pulmonary artery in 8, and to the coronary sinus in 2. There was no operative mortality. Two patients (10%) had nonspecific electrocardiographic changes during the postoperative period. Repeat coronary angiography revealed normal coronary anatomy in both, and their electrocardiograms normalized within 2 months. Patients suspected to have myocardial ischemia related to the surgical procedure, with ST segment depression or T wave abnormalities on the electrocardiogram, should undergo repeat angiography to eliminate the possibility of coronary artery damage.
Collapse
Affiliation(s)
- Ufuk Demirkilic
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Kuralay E, Bolcal C, Cingoz F, Günay C, Yildirim V, Kilic S, Ozal E, Demirkilic U, Arslan M, Tatar H. Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience. Ann Thorac Surg 2004; 77:977-81; discussion 982. [PMID: 14992910 DOI: 10.1016/j.athoracsur.2003.09.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2003] [Indexed: 11/21/2022]
Abstract
BACKGROUND Division of the sternum is primarily a blind procedure in reoperation and carries an increased risk of injury for major cardiac structures in the presence of adhesions between the posterior table and the heart. METHODS Two hundred patients were randomly divided into two groups. Cardiopulmonary bypass was established through the femoral artery and vein in group 1 (n = 100) patients before sternal reentry. Carpentier dual-stage femoral venous return cannula was used in all group 1 patients. Cardiopulmonary bypass was performed after sternal reentry in group 2 (n = 100) patients. RESULTS Six severe cardiac injuries developed in group 2. Cardiopulmonary bypass time was 93 +/- 9 minutes in group 1 and 71 +/- 11 minutes in group 2 (p = 0.011), and the operation time was 155 +/- 23 minutes in group 1 and 185 +/- 32 minutes in group 2 (p = 0.024). Inotropic therapy was required in 52 patients in group 1 and 76 patients in group 2 (p = 0.032). Average chest drainage was 450 +/- 135 mL in group 1 and 850 +/- 250 mL in group 2 (p < 0.001). Average fresh whole blood transfusion was 3.3 +/- 1.2 U in group 1 and 5.8 +/- 0.9 U in group 2 (p = 0.033). Average intensive care unit stay was 2.2 +/- 1.3 days in group 1 and 4.5 +/- 2.3 days in group 2 (p = 0.025). Average hospital stay was 7.3 +/- 2.4 days in group 1 and 9.1 +/- 3.1 days for group 2 (p = 0.011). CONCLUSIONS Cardiopulmonary bypass by bicaval Carpentier femoral venous cannula before resternotomy not only allows adequate cardiopulmonary bypass flow but also significantly reduces the risk of cardiac injury and catastrophic hemorrhage and allows safe reopening. Although this procedure increases cardiopulmonary bypass time, the operation time, bleeding, and blood transfusion requirement are significantly reduced.
Collapse
Affiliation(s)
- Erkan Kuralay
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
OBJECTIVE Former studies have pointed out that hemodynamic stress imposed by associated valvular disease is the primary factor in the development of ascending aorta dilatation. At present, intrinsic wall pathology is blamed for dilatation and aneurysm formation in bicuspid aortic valve (BAV). MATERIALS AND METHODS Aortic valve replacement (AVR) was performed on 78 adult patients with BAV. Patients were divided into two groups. Group I (n = 27) underwent only AVR. Group II (n = 51) underwent AVR and additional ascending aorta procedures such as Shawl-Lapel aortoplasty (n = 12) and tailoring aortoplasty (n = 9). Dacron wrapping was performed after both techniques were done. Ascending aorta replacement was done on 11 patients by using composite graft. Supracoronary graft replacement was performed in 3 patients after AVR. RESULTS Ascending aorta diameter increment was 1.25 mm/year in normotensive and 2.80 mm/ year in hypertensive patients. Ascending aorta aneurysm (diameter > 55 mm) developed in eight patients in the postoperative period in group I. Ascending aorta dilatation did not develop in group II patients. Mean survival time +/- standard error (SE) was 128 +/- 11 and 99 +/- 4 months and survival possibility was 77.78% and 92.16%. Freedom from reoperation was 65.4% and 95.9% in 8 years in group I and group II, respectively. CONCLUSION Aortic wrapping with or without aortoplasty has a beneficial effect not only in dilated ascending aorta but also in all nondilated BAV patients with normal-sized aortic diameter. Ascending aorta wrapping in BAV patients preserves the endothelial lining and prevents further dilatation, aneurysm formation, and dissection.
Collapse
Affiliation(s)
- Erkan Kuralay
- Departments of Cardiovascular Surgery, Gülhane Military Medical Academy.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Affiliation(s)
- Ahmet Turan Yilmaz
- Gulhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey.
| | | | | | | |
Collapse
|
27
|
Abstract
OBJECTIVE We prospectively investigated the patency of venous repair in a quantitative fashion with measurement of vein blood flow velocities after lower extremity injuries caused by either military or civilian trauma. MATERIAL AND METHODS During a 10-year study period (March 1990 to December 2000), surgical intervention was performed after lower extremity vascular injuries in 130 patients. Most of these patients were men (n = 125), with a mean age of 23 +/- 5 years (range, 17 to 44 years). One hundred ten direct venous injuries were identified in 97 patients, involving the common femoral vein in seven, the deep femoral vein in three, the superficial femoral vein in nine, the popliteal vein in 46, and the posterior tibial (n = 21), anterior tibial (n = 17), or peroneal veins (n = 7) in 45. Popliteal vein thrombosis without apparent venous injury was found in seven patients. Bone fractures (n = 45), nerve injuries (n = 27), or extensive tissue loss (n = 7) often were associated with vascular injuries. Duplex color ultrasonography was used to evaluate patency and to measure blood flow velocity in repaired veins during the early postoperative period and at the time of late follow-up examinations. RESULTS Significant differences were seen in venous blood flow velocities between severe (extremity diameter more than twice normal) and moderate (diameter 1.5 to 2 times normal) reperfusion injuries. The mean flow velocity in repaired popliteal veins was 15 +/- 2 cm/s with severe reperfusion injuries compared with 8.4 +/- 1.1 cm/s with moderate reperfusion injuries (P <.0001). Flow velocities were lower than 5 cm/s in repaired infrapopliteal veins, and most of these veins occluded on the first postoperative day. Amputations were necessary in 11 patients, all of whom had both tibial fractures and extensive tissue loss. Sodium warfarin therapy was routinely administrated before hospital discharge. The mean follow-up period was 6.2 years (range, 1.3 to 10 years). Repaired common femoral and superficial femoral veins had relatively high patency rates (100% and 89% at 1 year, 100% and 78% at 6 years, respectively), whereas the patency rates for repaired popliteal veins were disappointing (86% at 1 year, 60% at 6 years). All seven popliteal veins that required thrombectomy in the absence of direct injuries remained patent, however. Patch angioplasty had the highest 6-year patency rate (75%) in comparison with all other techniques that were used for venous injuries (lateral repair, 58%; end-to-end anastomosis, 43%; saphenous vein graft interposition, 36%). CONCLUSION Venous repair has a high patency rate at the femoral and popliteal levels, but the patency rate for infrapopliteal venous repair is extremely poor because of low flow velocities. Therefore, we conclude that repair of infrapopliteal venous injuries is unnecessary.
Collapse
Affiliation(s)
- Erkan Kuralay
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlik/Ankara, Turkey 06010.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE Total correction of classic tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure with a principal theoretical aim of minimizing structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to a right ventricular approach. However, it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. METHODS Nineteen patients were reviewed who had repair of isolated TOF by this technique from 1993 to 2001. The mean age of patients was 5 +/- 2 years. Transatrial-transpulmonary approach was performed for all patients. To make the infundibular muscle-bundle resection easier and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. Tricuspid valve detachment in order to improve the exposure was done in 11 patients. All patients were followed up in our clinic at regular six-month intervals by echocardiography. RESULTS There was no early or late mortality nor reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. CONCLUSIONS On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases gives excellent early and mid-term results.
Collapse
Affiliation(s)
- Ahmet Turan Yilmaz
- Gulhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
29
|
Ozal E, Yilmaz AT, Oz BS, Gunay C, Tatar H. Pedicled LIMA graft to the posterior coronary artery: which side to be anastomosed, dorsal or ventral? J Card Surg 2002; 17:394-7. [PMID: 12630536 DOI: 10.1111/j.1540-8191.2001.tb01165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
It has not clearly been defined in the literature which side of the pedicled LIMA graft should be anastomosed to the posterior coronary arteries. Using the ventral side of pedicled LIMA graft causes an 180 degree torsion of the pedicle. Sometimes this torsion may cause reduction or cessation of LIMA flow as we have seen in two of our patients. In this paper we point out that using the dorsal side of the pedicled LIMA graft for anastomosis to the posterior coronary arteries is helpful.
Collapse
Affiliation(s)
- Ertugrul Ozal
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE Total correction of classical tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure in the goal to minimize structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to the right ventricular approach. However it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. METHODS Nineteen patients who had repair of isolated TOF using this technique from 1993 to 2001 were reviewed. The mean age of patients were 5 +/- 2 years. Transatrial-transpulmonary approach were performed for all patients. To make easier the infundibular muscle bundles resection and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. To improve exposure, tricuspid valve detachment was performed in 11 patients. All patients were followed-up in our clinic every 6 months using echocardiography. RESULTS There were no early or late deaths, and no reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA Class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. CONCLUSION On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases shows excellent early and mid-term results.
Collapse
Affiliation(s)
- Ahmet Turan Yilmaz
- Gulhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma in complete arterial coronary artery bypass grafting (CABG). Using sequential grafting techniques, CABG is possible with only two arterial grafts in multi-vessel coronary artery disease (CAD). However, sequential grafting may not be convenient for all circumstances and sometimes surgical technique may be challenging. We present our experience in the use of radial artery (RA) Y-graft on a routine basis. METHODS Between January 1996 and November 2001, 127 patients (aged 63+/-8 years) with the diagnosis of multi-vessel disease underwent complete arterial revascularization using left internal mammarian artery (LIMA) and RA. Left ventricular ejection fraction ranged from 23 to 65% (mean 51+/-11%). Triple-vessel disease was present in 73.2% of patients. We used the division technique of RA during harvesting and formation of one or more composite Y-grafts of the RA itself to allow end-side rather than sequential anastomoses without any significant decrease the usable conduit length. The results of this technique were compared with the data of patients (n=109) who underwent completely arterial CABG with the use of the multiple arterial grafts in the same period. RESULTS LIMA was anastomosed to the left anterior descending coronary artery (LAD) system in all patients. Two to four (mean 2.8+/-0.6) anastomoses were performed with RA Y-graft per patient. Proximal end of the radial graft was anastomosed to LIMA (60.6%) or aorta (39.4%). Mean operating time was 185 (45 min; bypass time, 68+/-23 min; and cross-clamp time, 49+/-17 min). Perioperative intraaortic balloon pump was necessary in five patients (3.9%). There was no operative mortality or morbidity. During the follow-up period of 2-30 months, none of the patients had any complication. Postoperative coronary angiography in 54 patients (42.5%) documented excellent early patency rates (LIMA 100%, and RA 98.1%). CONCLUSIONS We believe that keeping our technique in their armamentarium will be useful for cardiac surgeons as an alternative method during complete arterial revascularization. This approach allows for complete arterial revascularization in multi-vessel CAD using only single IMA and RA grafts with excellent early results.
Collapse
Affiliation(s)
- Ahmet Turan Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE Although the incidence of complete heart block and residual shunt following closure of ventricular septal defects is very low in modern series, the risk of these complications still exists. Closing the inferior margin of a perimembranous VSD in the beating heart, may in some cases, be a safe technique which eliminates the risk of atrioventricular block and residual shunt. METHODS In 17 patients operated on for isolated VSD (Group I), the inferior margin of the defect was closed in the beating heart. The results of this technique have been compared with another 158 patients (Group II) in whom the VSD was closed under cardioplegic arrest. RESULTS In Group I complete atrioventricular block developed during the placing or tying down of the sutures in 2 patients (11.7%). Normal sinus rhythm returned in 2 minutes following removing and replacement. Additional sutures were placed for residual shunt in 3 patients (17.6%). Of the 158 patients in Group II, there was complete atrioventricular block in 12 (7.5%) in the early postoperative period, and 4 (2.5%) later required a permanent pacemaker. Endocarditis prophylaxis was given to 13 patients (8.2%) because of hemodynamically insignificant residual shunts. Three patients (1.9%) were reoperated for a significant shunt. CONCLUSIONS Closing the inferior margin of a perimembranous VSD in the beating heart is a safe technique which eliminates the risk of atrioventricular block and residual shunt.
Collapse
Affiliation(s)
- Ertugrul Ozal
- Gulhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
33
|
Zeybek N, Taş H, Kaymakçioğlu N, Cetiner S, Ozal E, Sen D. [Gastrointestinal hemorrhage due to traumatic superior mesenteric artery aneurysm (case report)]. Ulus Travma Derg 2001; 7:274-6. [PMID: 11705086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
We report the case of a 21-year-old male patient with superior mesenteric artery aneurysm due to missed arterial injuries, its complications of enteric fistula and results of surgical treatment. The aneurysm was excised, enteric fistula was closed and aorta-mesenteric bypass using saphenous vein graft was performed. The hemorrhage became masked because of the tamponade in the mesentery during penetrating abdominal injury and initial surgery, and the late complication of false aneurysm came on the scene in follow up. Aorta-mesenteric bypass by a transmesenteric approach provides successful result in surgical treatment of superior mesenteric artery aneurysm.
Collapse
Affiliation(s)
- N Zeybek
- GATA Genel Cerrahi Kliniği ve, Ankara
| | | | | | | | | | | |
Collapse
|
34
|
Abstract
One of the biggest problems encountered during complete arterial revascularization is difficulty obtaining sufficient graft length to perform multiple distal anastomoses. We describe a technique of dividing the radial artery during harvest and forming one or more composite Y-grafts to allow end-to-side rather than sequential anastomoses without substantially decreasing usable conduit length. This approach has merit and may be helpful in some patients who require complex arterial grafting.
Collapse
Affiliation(s)
- A T Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
35
|
Ozal E, Us MH, Bingöl H, Oz BS, Kuralay E, Tatar H. [Therapeutic approach in vascular injuries of the lower extremity: Amputation or limb salvage]. Ulus Travma Derg 2001; 7:181-4. [PMID: 11705221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The management of lower extremity trauma with vasculary involvement should be directed toward to the salvage of the extremity or to the primary amputation according to the additional pathologies, parameters of the patient and the extremity. We investigated the efficiency of Mangled Extremity Severity Score (MESS) system which is proposed as an grading system to evaluate the change to extremity salvage or the risk for onset of systemic complications. 81 patients with lower extremity trauma were analyzed according to MESS criteria. 79 of the patients were men and mean age was 23 +/- 4. Fourteen patients had higher MESS score. (MESS > 7). Seven of them were older than 50 years. Primary amputation was performed in four of these 7 patients. Vascular repair was performed in three of patients. Multiorgan failure was developed in two of them and both patients died. Secondary amputation was performed to another patients underwent vasculary repair who had MESS > 7 score. Primary amputation was not performed directly in young patients who had MESS > 7. Secondary amputation was required in two of these patients. MESS scoring system can easily predict amputation in older patients but may cause unnecessary amputation in young patients.
Collapse
Affiliation(s)
- E Ozal
- Gülhane Askeri Tip Akademisi, Kalp ve Damar Cerrahisi, 06018 Etlik, Ankara.
| | | | | | | | | | | |
Collapse
|
36
|
Ozal E, Oz BS, Kucukarslan N, Gunay C, Yilmaz AT, Tatar H. Removal of the thrombosed prosthetic axillofemoral graft. Am J Surg 2001; 181:28-9. [PMID: 11248172 DOI: 10.1016/s0002-9610(00)00531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Late thrombosis of prosthetic graft material is rarely managed successfully by simple thrombectomy or thrombolytic therapy. Replacement with a new graft may be necessary. Although several techniques have been described, mobilizing and removing an old thrombosed prosthetic graft is usually extremely difficult because of a firm attachment to its tunnel. This attempt is more difficult especially for ringed grafts. We describe a simple technique of using an internal varicose vein stripper for the removal of such a late thrombosed axillofemoral spiral polytetrafluoroethylene graft and positioning a new graft into the old tunnel.
Collapse
Affiliation(s)
- E Ozal
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, 06018 Etlik, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND The aim of our study was to evaluate the effect of chordal transfer around the cleft on left atrioventricular valve competence in the late postoperative period. METHODS Forty-four adult patients underwent surgical correction of partial atrioventricular septal defect between 1983 and 1997. Fenestration was found in 8 patients (18.2%) and cleft, in 35 (79.5%). There was no chordal support of the free edges of the left superior and left inferior leaflets around the cleft in 18 patients. Two chordae were mobilized from the left lateral leaflet and reimplanted into the tip of the left superior and left inferior leaflets around the cleft. RESULTS At 5 years postoperatively, left atrioventricular valve insufficiency was severe in 5 patients and moderate in 11 patients who had had cleft closure alone. In contrast, severe valvular insufficiency was present in only 1 patient in the group with chordal transfer (p < 0.05). Reoperation was done in 5 patients with isolated cleft closure. Left AV valve replacement was performed in 1 patient. CONCLUSIONS Chordal transfer plus cleft closure with interrupted sutures significantly reduces early and late left atrioventricular valve incompetence and also decreases the rate of reoperation.
Collapse
Affiliation(s)
- E Kuralay
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
38
|
Kuralay E, Ozal E, Demirkili U, Tatar H. Effect of posterior pericardiotomy on postoperative supraventricular arrhythmias and late pericardial effusion (posterior pericardiotomy). J Thorac Cardiovasc Surg 1999; 118:492-5. [PMID: 10469966 DOI: 10.1016/s0022-5223(99)70187-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this prospective study was to evaluate the effectiveness of posterior pericardiotomy from the point of pericardial effusion related with supraventricular tachycardia and development of delayed posterior cardiac effusions. MATERIALS AND METHODS This prospective randomized study was carried out in 200 patients undergoing coronary artery bypass surgery in Gülhane Medical Academy Department of Cardiovascular Surgery between June 1996 and June 1997. Patients were divided into 2 groups; each group included 100 patients. Longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in group I patients. Posterior pericardiotomy was not done in group II. RESULTS Atrial fibrillation was developed in 6 patients (6%) in group I and in 34 patients (34%) in group II (P =.0000007). Atrial flutter and other supraventricular arrhythmia prevalence was not statistically significant. Early and late pericardial effusion were developed 54% and 21%, respectively, in group II, but neither early nor late pericardial effusion were developed in group I (P =.00001). Delayed pericardial tamponade was also significantly lower in group I (0% vs 10%; P =.001). CONCLUSION Posterior pericardiotomy is technically easy to perform and a safe and effective technique that reduces not only the prevalence of early pericardial effusion and related atrial fibrillation but also delayed posterior pericardial effusion and tamponade.
Collapse
Affiliation(s)
- E Kuralay
- Gülhane Military Medical Academy, Cardiovascular Surgery Department, Ankara, Turkey
| | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Membranectomy and myectomy are standard therapy for discrete subaortic stenosis (DS) and are associated with low rates of endocarditis, recurrence, and aortic insufficiency. Extensive myectomy increases risk of complications such as conduction tissue damage and iatrogenic ventricular septal defect (VSD). MATERIALS AND METHODS Forty-five adult patients with DS underwent operations in Gulhane Military Medical Academy. Exertional dyspnea was the principal symptom in 29 (64.4%) patients. Transesophageal echocardiography (TEE) was performed routinely in all patients to assess the length and depth of needed myectomy during the perioperative period. Aortic insufficiency (AI) was also noted preoperatively in 31 (68.9%) and a history of aortic valve endocarditis was present in 4 (8.9%) patients. RESULTS Myectomy was performed according to TEE measurements. An average of 10 mm in width, 10 mm in depth, and 2.3 mm in length of septal tissue was resected. The mean left ventricle-aorta peak systolic gradient decreased from 70.2+/-9.7 to 17.2+/-2.7 mmHg (p < 0.001). Aortic valve repair was performed in 8 (7.8%) patients and aortic valve replacement in 11 (24.4%) patients at the initial operation. Iatrogenic VSD did not occur in any of the patients. Average postoperative left ventricular outflow tract diameter was 21+/-1.5 mm. Temporary complete heart block occurred in three patients. There was an early residual gradient (36+/-8 mmHg) resulting from temporary hypercontraction that decreased (18+/-5 mmHg) in the first postoperative day. CONCLUSIONS Myectomy under perioperative TEE measurement is safe and effective in the treatment of DS. TEE-guided myectomy reduces complications such as complete heart block and iatrogenic VSD.
Collapse
Affiliation(s)
- E Kuralay
- Cardiovascular Surgery Department, Gulhane Military Medical Academy, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
40
|
Abstract
PURPOSE OF THIS STUDY Vascular injuries caused by high-velocity military missiles are associated with bone fracture, soft-tissue, nerve and tendon injuries. In this study we will discuss the surgical strategy and results of vascular injuries, which require a different approach from primary and elective surgical procedure. BASIC METHODS Surgical interventions were performed in 116 patients. Vascular lesions were localized on the lower extremity in 53, upper extremity in 55, and nine were in other regions. Vascular injuries were concomitant with bone fracture in 46 and nerve injuries in 36 patients. Vascular repair was performed after orthopedic stabilization in vessels with an ischemic period of less than 4 hours. PRINCIPAL FINDINGS Fasciotomy was performed after vascular repair in the 22 cases that had arrived after 8 hours. Amputation was required in two cases. There was one mortality. CONCLUSIONS The best results are obtained when a multidisciplinary and emergency approach are used by the team of vascular, orthopedic, plastic and neurosurgeons who are experienced in military injuries.
Collapse
Affiliation(s)
- U Demirkiliç
- Gülhane Military Medical Academy, Cardiovascular Surgery Department, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
41
|
Yilmaz AT, Demirkilic U, Kuralay E, Arslan M, Ciçek S, Ozal E, Bingöl H, Tatar H, Oztürk OY. Long-term prevention of atrial fibrillation after coronary artery surgery. Panminerva Med 1997; 39:103-5. [PMID: 9230619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED We researched the necessity of quinidine fumarate or acebutolol prophylaxis in patients in whom atrial fibrillation occurred in the postdischarge period and returned to sinus rhythm after coronary artery surgery. DESIGN Prospective review. PATIENTS Since 1992, 60 patients were chosen in whom atrial fibrillation occurred in early postoperative period. There were no significant differences between them and they were separated into 3 groups. In group I (20 patients) we did not give any drug, in group II (20 patients) quinidine fumarate was given and in group III (20 patients) acebutolol was given and patients were controlled for 90 days. RESULT Atrial fibrillation occurred in one patient in group I, (5%), two in group II (10%) and two in group III (10%), (p < 0.05). Different from the other groups, atrial fibrillation was asymptomatic with low ventricular response in group III. CONCLUSIONS There were no significant differences among three groups statistically, so we suggested that long-term prevention of atrial fibrillation with quinidine fumarate or acebutolol was not necessary after coronary artery surgery.
Collapse
Affiliation(s)
- A T Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Yilmaz AT, Demirkiliç U, Ozal E, Tatar H, Oztürk OY. Aneurysms of the sinus of Valsalva. J Cardiovasc Surg (Torino) 1997; 38:119-24. [PMID: 9201120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the properties of the coexistent cardiac anomalies associated with the aneurysm of sinus of Valsalva (ASV) and examine the long-term surgical results after operation. PATIENTS From 1980 to 1994, nine patients (median age 22 years) underwent surgical correction of ASV. Aneurysms originated from the right (n = 5), noncoronary (n = 3) and left coronary sinus (n = 1) and entered into right ventricle (n = 5), right atrium (n = 3). In one patient, ASV originated from the left coronary sinus and unruptured. Coexistent cardiac lesions were aortic valve insufficiency (n = 4), ventricular septal defect (n = 5), patent foramen ovale (n = 1), right ventricular outflow tract obstruction (n = 1) and coronary artery anomaly (n = 2). All patients were symptomatic (sudden onset of symptoms in 3, gradual onset in 6). INTERVENTIONS Ruptured ASVs were repaired by double approach in which both the involved chamber and the aortic root. Concomitant aortic surgery was performed in four patients (2 replacement, 2 valvuloplasty). VSDs were closed by patch in 4 and by direct suture in 1. RESULTS The incidence of coexisting coronary artery anomaly was 22.2%. There was no hospital and late mortality. The mean follow-up period was 6.8 years (range 1 to 14 years). There were no reoperation for leaks of VSD, recurrence of aneurysm and aortic regurgitation. Eight patients were found to be in New York Heart Association class I, one patient in class II. CONCLUSION The risk of the recurrent fistula or VSD is prevented by double approach technique, and also this approach reduces the incidence of late aortic insufficiency. Routinely preoperative coronary angiography must be performed for determine of coronary anomaly.
Collapse
Affiliation(s)
- A T Yilmaz
- Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Military vascular injuries frequently result from fragment wounds while civilian vascular injuries usually are caused by gunshot wounds. The natural history of untreated major injuries by small low velocity fragments is not well known. This study evaluated the nature of these wounds. METHODS From 1990 to 1995, 40 patients with a delayed diagnosis of an arterial injury in the extremity, abdomen, or neck were treated. The median delay between injury and diagnosis was 60 days. All patients had been seen at other military hospitals immediately after trauma. RESULTS During initial hospitalization, immediate exploration had been performed in 23 patients and arteriogram in 3 patients. According to analysis of the records of patients, none of them had hard signs of vascular injury at the time of initial evaluation after trauma. Complications of missed arterial injuries included the following: false aneurysm, 21 (52.5%); arteriovenous fistula, 14 (35%); and occlusion, 5 (12.5%). The superficial femoral artery (n = 11) was the most commonly injured vessel. The remaining arteries included the following: carotid, 2; vertebral, 1; subclavian, 5; axillary, 2; brachial, 3; radial or ulnar, 2; internal iliac, 2; common femoral, 1; profunda femoris, 2; popliteal, 1; tibioperoneal, 8. Thirty-eight patients had penetrating wounds (21 fragments, 9 gunshot, 3 shotgun, 5 stab wounds), and only 2 patients had blunt trauma. All patients underwent surgery. There were no deaths and no loss of extremity, but 10 patients had fair results and only 4 patients required later reoperation. CONCLUSION Traumatic arterial injuries that particularly are caused by low-velocity small fragment wounds can result in serious delayed complications months or even years after the injury. Patients with penetrating injuries must be closely monitored, and arteriography is recommended to evaluate the conditions of patients with potential vascular injury even when overt clinical signs or symptoms of vascular injury are absent.
Collapse
Affiliation(s)
- A T Yilmaz
- Gülhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
OBJECTIVE The aneurysm of the membranous septum (AMS) has often been considered as benign in the minds of many previous investigators. We have analyzed the complications with AMS in adult patients. METHODS Fifty-one cases (20%) of AMS in 254 adult patients with perimembranous ventricular septal defect (VSD) are described. The diagnosis of AMS was based on angiographic criteria. Thirty-nine (76.5%) of the 51 patients with AMS were aged between 20 and 29 years. All patients but one with AMS had a pulmonary-to-systemic flow (Qp/Qs) of less than 2.3 (range 1-2.1, mean 1.4). In a patient who had a ruptured aneurysm, the Qp/Qs was 2.7. There were six main complications affected by AMS and/or VSD; aortic valve prolapse in 24 patients (47%), aortic regurgitation in 15 (29.4%), tricuspid insufficiency in nine (17.6%), right ventricular outflow tract obstruction in two (4%), and rupture of the aneurysm in one patient (2%). Seven patients (13.7%) had prior bacterial endocarditis. All patients underwent surgery. Aneurysm and VSD were closed by direct suture in nine and with a patch in 42 patients. Aortic valve repair was performed in 13 patients in whom regurgitation was mild to moderate, and replacement was required in two patients with severe aortic regurgitation. RESULTS There were no early or late deaths. Residual communication and recurrence of the aneurysm was noted three and seven years postoperatively in two patients where VSD had been closed by direct suture. CONCLUSIONS According to present data, aneurysm formation functionally reduces the VSD size, but it has the potential consequence of promoting tricuspid insufficiency, aortic valve prolapse, right ventricular outflow tract obstruction, rupture and bacterial endocarditis. Therefore, we recommend that AMS should be resected completely and the defect produced closed with a patch in order to prevent further enlargement and consequent complications even if there are no cardiac symptoms.
Collapse
Affiliation(s)
- A T Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | |
Collapse
|
45
|
Yilmaz AT, Arslan M, Demirkliç U, Kuralay E, Ozal E, Bingöl H, Oz BS, Tatar H, Oztürk OY. Late posterior cardiac tamponade after open heart surgery. J Cardiovasc Surg (Torino) 1996; 37:615-20. [PMID: 9016978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Late cardiac tamponade after open heart surgery is a relatively uncommon, but potentially serious complication. We retrospectively analyzed 14 patients who had posterior cardiac tamponade 13 to 210 days after open heart surgery. PATIENTS Between May 1988 and July 1995, 3150 adult patients underwent open heart surgery at the Gülhane Military Medical Academy. In 35 of 3150 patients (1.11%) late pericardial effusions developed, and in 14 (0.44% of 3150 consecutive open heart surgery performed on adult patients in our center) of these patients had posterior tamponade. There were moderate symptoms including fatigue, malaise, and dyspnea on exertion in all patients. The diagnosis was made by echocardiography in 13 patients, and by tomographic scanning in 1 patient. Analysis of these 14 patients revealed that all of them had hemodynamic criteria consistent with tamponade physiology on right heart catheterization with Swan-Ganz catheters. RESULTS Echocardiography guid pericardiocentesis through the left anterior axillary line was effective in decompressing of posterior cardiac tamponade in 10 of 14 patients. Three patients required operative surgical drainage after unsuccessful pericardiocentesis through subxiphoid area. Two patients who underwent surgical drainage died, and in one patient surgical pericardiotomy had complete evacuation of posterior pericardial fluid with major complication. CONCLUSIONS 2-D echocardiography guid pericardiocentesis through left anterior axillary line was found to be a useful, safe, and simple technique. It can be used as an alternative treatment to surgical pericardiotomy for posterior cardiac tamponade after open heart surgery.
Collapse
Affiliation(s)
- A T Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ciçek S, Demirkiliç U, Ozal E, Kuralay E, Bingol H, Tatar H, Ozturk OY. Postoperative use of aprotinin in cardiac operations: an alternative to its prophylactic use. J Thorac Cardiovasc Surg 1996; 112:1462-7. [PMID: 8975837 DOI: 10.1016/s0022-5223(96)70004-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Aprotinin reduces blood loss after cardiopulmonary bypass. Although there can be little doubt about the efficacy of aprotinin, its safety has been questioned recently and is still under investigation. Because of the potential for complications and the high cost, a selective strategy limiting drug delivery to patients with established postoperative bleeding will be more reasonable. METHODS In a prospective, randomized, double-blind trial we studied the effect of postoperative low-dose (2 million kallikrein inactivator units) aprotinin on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. Fifty-seven patients were randomly assigned to two groups: aprotinin or placebo. RESULTS The two groups were comparable in all demographic and surgical variables. Postoperative chest tube drainage was significantly less in the aprotinin group than in the placebo group (410 ml vs 696 ml, p < 0.01). The use of homologous blood products was significantly less in the aprotinin group than in the placebo group (0.4 +/- 0.5 unit vs 1.7 +/- 0.9 unit for packed red blood cells and 0.8 +/- 1.3 unit vs 2.3 +/- 1.6 unit for fresh frozen plasma). CONCLUSIONS Our results suggest that postoperative aprotinin reduces blood loss and transfusion requirements and provides the opportunity to restrict its use selectively to patients with excessive postoperative bleeding.
Collapse
Affiliation(s)
- S Ciçek
- Department of Cardiovascular Surgery, GATA Gülhane School of Medicine, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Two patients, aged 20 and 21 years, with supravalvular aortic stenosis and aneurysms of the coronary arteries are described. In supravalvular aortic stenosis, dilatation of the sinuses of Valsalva and multiple abnormalities of one or both coronary arteries are common. Aneurysm of coronary artery has not been well recognized as a lesion associated with supravalvular aortic stenosis. The operation in these patients was limited to relief of the supravalvular obstruction.
Collapse
Affiliation(s)
- A T Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
BACKGROUND This study examined the septal cleft and septal commissure of the left atrioventricular (AV) valve, which are two different anatomical structures. METHODS We presented 36 cases of adult partial atrioventricular septal defect. A distinction was made between patients based on the anatomy of the anterior leaflet of the left AV valve. The left AV valve appeared to be normal or to have minimal radial openings from the free edge of the anterior leaflet of the left AV valve in 10 patients (28%). There was a septal commissure structure in 8 (22%), and a septal cleft structure in 18 (50%) patients. In the commissure type anatomy, leaflet coaptation was usually adequate and no or mild degree of left AV regurgitation existed preoperatively. Cleft type structure usually was associated with some degree of left AV regurgitation. Attempts were made to close the septal clefts and leave the septal commissures unsutured during the repair of the partial AV septal defects. RESULTS We have not found any increase of left AV regurgitation in patients with commissures during the follow-up period. Closure of the cleft successfully eliminated regurgitation. Long-term results for septal cleft and septal commissure after repair of partial AV septal defect were excellent with survival of 100% and freedom from reoperation of 100% at mean 6.5 years. CONCLUSIONS Septal cleft and septal commissure should be considered two different structures. Repairing procedures for left AV valve abnormalities associated with partial AV septal defect should only be done in patients who have cleft type of leaflet structure.
Collapse
Affiliation(s)
- A T Yilmaz
- Gülhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara-Turkey
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND Aprotinin has been used increasingly to reduce postoperative blood loss in open heart operations. Although it was reported as safe in earlier studies, the overall safety of prophylactic use has been questioned recently. Because of the potential for complications and the high cost, it will be reasonable to use aprotinin more selectively in the postoperative period. METHODS We prospectively studied the effect of postoperative low-dose aprotinin (2 million kallikrein inactivator units [280 mg]) on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. Seventy-five patients were randomly assigned to three groups: prophylactic high-dose aprotinin (group 1), postoperative aprotinin (group 2), or a nonmedicated control group (group 3). RESULTS The three groups were comparable in all demographic and operative variables. Postoperative chest tube drainage was significantly decreased in both aprotinin groups compared with that in the control group (295 mL in group 1 and 325 mL in group 2 versus 411 mL in group 3; p < 0.05). No significant difference was seen between the two aprotinin groups. The use of homologous blood products was significantly less in group 1 and group 2 than in group 3 (1.15 +/- 1.13 U and 1.35 +/- 1.30 U versus 2.55 +/- 1.09 U; p < 0.05). CONCLUSIONS Our results suggest that postoperative aprotinin reduces blood loss and transfusion requirements comparably with prophylactic high-dose aprotinin. Thus, one can restrict its use to patients with excessive postoperative bleeding.
Collapse
Affiliation(s)
- S Ciçek
- Department of Cardiovascular Surgery, GATA Gülhane School of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
50
|
Yilmaz AT, Demírkiliç U, Arslan M, Kurulay E, Ozal E, Tatar H, Oztürk O. Long-term prevention of atrial fibrillation after coronary artery bypass surgery: comparison of quinidine, verapamil, and amiodarone in maintaining sinus rhythm. J Card Surg 1996; 11:61-4. [PMID: 8775337 DOI: 10.1111/j.1540-8191.1996.tb00010.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM OF STUDY To evaluate the necessity and efficacy of quinidine fumarate, verapimil, or amiodarone prophylaxis for sinus rhythm maintenance in patients who experienced atrial fibrillation after coronary artery bypass surgery. METHODS Between 1992 and 1995, this prospective, randomized, placebo-controlled study examined 120 patients in whom atrial fibrillation occurred and was restored to sinus rhythm by pharmacological therapy or direct current cardioversion in the immediately postoperative period after coronary artery by-pass surgery. There were no significant differences in perioperative characteristics among the patients, who were randomly separated into four groups in the course of discharge. In group 1 (n = 30), patients did not receive antiarrhythmic drugs. Quinidine fumarate was given in group 2 (n = 30), verapimil in group 3 (n = 30), and amiodarone in group 4 (n = 30). Patients were monitored six times over a 90-day postoperative period by 24-hour Holter monitoring and routine examination. RESULTS The recurrent atrial fibrillation usually developed within 15 days of discharge. Atrial fibrillation occurred in one patient (3.33%) in group 1, and two each (6.66%) in groups 2, 3, and 4. Atrial fibrillation was asymptomatic and occurred with slow ventricular response in groups 3 and 4. Side effects occurred in 5 patients (16.6%) given quinidine, 1 patient given amiodarone, but in no patient given verapimil. CONCLUSIONS There were no significant differences in the maintenance of sinus rhythm among the four groups, so we suggest that long-term prevention of atrial fibrillation in patients with coronary artery bypass grafting was not necessary at the postdischarge period.
Collapse
Affiliation(s)
- A T Yilmaz
- Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|