Transient cortical blindness can also be seen in the absence of contrast enhancement at computed tomography scan after coronary angiography

Transient cortical blindness after coronary angiography or angioplasty is a rare complication. Patients with aortocoronary bypass grafts such as internal mammary artery have a seperate risk factor probably because of the direct contrast injection to the vertebral artery during the catheterisation of the internal mammary artery ostium. In most cases, computed tomography scan revealed typical, symmetrical contrast enhancement in both occipital lobes Nevertheless, transient cortical blindness can be seen after coronary angiography without contrast enhancement at computed tomography scan

Spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy

Apical hypertrophic cardiomyopathy [HCM] is a relatively uncommon inherited disease. Spontaneous coronary artery dissection [SCAD] is also uncommonly observed, which often occurs in pregnant or post partum women but is rare in men. This report describes a 38 years old man with apical hypertrophic cardiomyopathy who developed SCAD leading to acute inferior myocardial infarction. After emergent appendectomy operation at another hospital, he was immediately transferred to the Cardiology Department of our hospital due to acute myocardial infarction. He emergently underwent coronary angiography which showed a long dissection involving the right coronary. He underwent an emergent CABG with cardiopulmonary bypass. Postoperative recovery was uneventful and he was discharged. According to our knowledge, no case of spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy unrelated to postpartum period or oral contraceptive use has been reported so far

Management of constrictive pericarditis: a comparative study between median sternotomy and left thoracotomy

Constrictive pericarditis [CP] requires pericardiectomy but the choice of surgical approach remains controversial. Hence we have reviewed our experience of pericardiectomy carried out for CP and compared the results of pericardiectomy performed by median sternotomy versus left thoracotomy with regard to functional outcomes. The study group consisted of 33 patients with CP who underwent pericardiectomy from May 1999 to January 2010 at our institution. There were 22 female and 11 male patients, ranging in age from 5 to 57 years with a mean age of 45 years. Pericardiectomy was performed via median sternotomy in 17 patients [Group A]. In the remaining 16 patients [Group B], pericardiectomy was performed via a left anterolateral thoracotomy in the fifth intercostal space. During the subsequent follow-up, both groups of patients showed a similar and significant improvement in New York Heart Association [NYHA] functional class. In the group A, the mean NYHA functional class decreased from 3.3 +/- 0.7 to 1.8 +/- 0.5 [P = 0.0004]. In group B, the mean functional class decreased from 3.2 +/- 0.9 to 1.6 +/- 0.6 [P = 0.00005]. Also, both groups had a similar and significant improvement in their mean CVP. In the group A, the mean central venous pressure [CVP] decreased from 15.2 +/- 3.1 mmHg to 8.3 +/- 3.2 mmHg [P<0.005]. In the group B, the mean CVP decreased from 15.1 +/- 4.9 mmHg to 7.7 +/- 2.4 mmHg [P<0.004]. Constrictive physiopathology is a problem primarily of the ventricles and can be alleviated by decorticating both the right and left ventricles. Therefore, CP could be relieved through the left thoracotomy or median sternotomy in most cases. However, echocardiographic findings should be considered to prefer thoracotomy or sternotomy approach

Management of penetrating heart and accompanying lung injuries

Penetrating heart injury is potentially a life threatening condition due to cardiac tamponade or exsanguinating hemorrhage. The aim of this study was to evaluate victims who were referred to our hospital with penetrating heart and accompanying lung injuries and to review our overall outcome with this type of combined injuries. Twenty patients with combined penetrating heart and lung injuries were operated at Yuzuncu Yil University Research Hospital, between May 1999 and January 2010. The diagnosis of combined heart and lung injuries was proved by surgical exploration in all cases. The surgical procedures mainly included the relief of cardiac tamponade, control of bleeding, repair of cardiac and pulmonary lacerations, and coronary artery bypass grafting if required. In this series of 20 patients; there were 18 males and two females between the age of 14 to 60 years, with a mean age of 34.8 +/- 13.5 years. Seventeen victims sustained stab wounds, and the remaining three were injured by a gunshot wounds. In 20 patients there were 22 cardiac chamber injuries. The most commonly injured cardiac chamber was the right ventricle followed by the left ventricle. In addition to the injuries to heart muscle, injuries to the coronary arteries were found in two patients. The most commonly injured lung lobe was the left upper lobe. Our experience shows that early diagnosis and immediate surgical intervention are the main factors affecting patient survival after penetrating heart and lung injuries. Therefore, heart injury should always be kept in mind in victims with penetrating thoracic injuries

Management of traumatic brachial artery injuries: a report on 49 patients

The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability. The purpose of our study was to review our experience with brachial artery injuries over a 9-year period, describing the type of injury, surgical procedures, complications, and associated injuries. Forty-nine patients with brachial artery injury underwent surgical repair procedures at our hospital, from the beginning of May 1999 to the end of June 2008. The brachial artery injuries were diagnosed by physical examination and Doppler ultrasonography. Depending on the mode of presentation, patients were either taken immediately to the operating room for bleeding control and vascular repair or were assessed by preoperative duplex ultrasonography. This study group consisted of 43 males and 6 females, ranging in age from 6 to 65 years with a mean [SD] age of 27.9 [6.7] years. The mechanism of trauma was penetrating in 45 patients and blunt in the remaining 4 patients. Stab injury was the most frequent form of penetrating trauma [24 of 45]. Treatment included primary arterial repair in 5 cases, end-to-end anastomosis in 28 cases, interposition vein graft in 15 cases, and interposition-ringed polytetrafluoroethylene graft in 1 case. Associated injuries were common and included venous injury [14], bone fracture [5], and peripheral nerve injury [11]. Fifteen patients developed postoperative complications. One patient underwent an above-elbow amputation. Prompt and appropriate management of the brachial artery injuries, attention to associated injuries, and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage

Management of primary venous aneurysms

Venous aneurysms are a relatively rare abnormality. Unlike arterial aneurysms, venous aneurysms are a much less frequent abnormality. The purpose of our study was to review our experience in the management of venous aneurysms. Nine patients with venous aneurysms, who had undergone operation in the Department of Cardiovascular Surgery, Yuzuncu Yil University Medical School, Van, Turkey, during the period September 1997 through to May 2003, were included in this study. There were 5 female and 4 male patients, ranging in age from 16-47-years with a mean age of 31 +/- 7 years. They were diagnosed by color flow duplex imaging. Eight patients had saccular aneurysm; the remaining one patient with basilar vein aneurysm, had fusiform aneurysm. Aneurysms were located the lower extremities in 4 cases, the upper extremity in 4, and external jugular vein in one. Aneurysms size ranged from 2, 3 to 5, 5 cm [mean 3, 6 cm]. There were no symptoms in 2 patients [cephalic vein aneurysm in one patient, short saphenous vein aneurysm in one]. These patients were operated on for cosmetic purposes. Six patients complained of pain associated with a subcutaneous swelling. The remaining one patient with popliteal vein aneurysm complained of extremity pain, associated with deep venous thrombosis. All patients underwent surgery under local anesthesia. In 7 patients, aneurysms were resected and venous continuity with a graft was found unnecessary. End to end anastomosis was performed in 2 patients [popliteal vein aneurysm in one and axillary vein aneurysm in one]. During follow up period, there were no recurrences. Venous aneurysms may cause thrombophlebitis, thrombus formation, pulmonary embolism and theoretical complication of spontaneous rupture. Varicose veins, hemangiomas, lymphocele, hernias, hygromas, arteriovenous fistulas and similar subcutaneous swellings located subcutaneous venous spaces should be considered in the differential diagnosis. Consequently, we suggest that surgical treatment be performed to prevent subsequent complications in all cases