Surgical management of axillosubclavian vascular injuries

Objective: Complex surgical exposures to upper extremity injuries required for conventional surgery correlate with a high morbidity and mortality. We present our results with conventional surgery following injuries of the subclavian and axillary vessels. Methods: Between November 2007 and March 2012, 29 cases with subclavian-axillary vascular injury were operated. Diagnostic and treatment methods, associated organ injury, morbidity and mortality rates in these cases were respectively reviewed. Results: The causes of injuries were stab wounds in 11 cases [37.9%], gunshot wounds in 9 cases [31%], iatrogenic injuries in 5 cases [17.2%] and blunt trauma 4 cases [13.7%]. Eight patients [27.5%] had isolated arterial injury while 21 patients [72.4%] had coexisting organ injury [vein, bone, soft tissue, nerve]. Primary repair and usage of saphenous vein were the most common surgical methods. One patient died due to myocardial infarction. [Mortality 3.4%] Conclusions: Vascular injuries of axillosubclavian are frequently associated with neurogenic, osseous and soft tissue injuries and should have early intervention. Conventional surgery remains the choice of treatment in patients with poor status and urgency

Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients withnon ST-elevated acute coronary syndrome

We aimed to study the predictive value of the neutrophil-lymphocyte ratio [NLR] for left ventricular systolic dysfunction [LVSD] in patients with non ST-elevated acute coronary syndrome [NST-ACS]. A total of 405 patients [mean age 62 years and 75% male] with NST-ACS were included in the study. The study population was divided into tertiles based on admission NLR values. The low, medium and high tertiles defined as NLR 3.2 [n=135], respectively. The patients in the high NLR group were older [p<0.001], have higher rate of diabetes mellitus [p=0.028] and non-ST elevated myocardial infarction [NSTEMI] [p<0.001] and have lower left ventricular ejection fraction [LVEF] [p<0.001]. Baseline WBC [p=0.02] and neutrophil [p<0.001] levels and NLR [p<0.001] were significantly higher, baseline hemoglobin [p=0.044], hematocrit [p=0.019] and lymphocyte [p<0.001] levels were significantly lower in the high NLR group. NLR was negatively correlated with LVEF in correlation analysis. An NLR >3.2 and age >/= 70 were found to be an independent predictor of systolic dysfunction in multivariate analyses. An NLR >3.2 is a useful predictor for LVSD in patients with NST-ACS. The practice of using an NLR count on admission may be useful for identifying high-risk patients and their associated treatment methods

Atrial septal defect repair; our early and mid-phase results

Atrial septal defect is one of the most commonly encountered congenital heart diseases in adults. The effect of age of the patient to the surgery is disputable. The purpose of this report was to evaluate surgical repair in patients with ASD who are operated in our clinic. Total 40 patients were subjected to surgical repair due to ASD in Van Yuksek Ihtisas Education and Research Hospital between February 2006 and April 2009. Twenty seven of the patients were female and 13 were male, their ages differed between 8 and 71 and mean age of the patients was 33.70 +/- 14.04. Operative mortality did not occur. Two of our patients had coronary arterial disease in addition to ASD. ASD repair was performed together with coronary bypass surgery. Closing of ASD resulted in an increase in left ventricular ejection fraction, and a decrease in pulmonary arterial pressure and cardiothoracic ratio. Recovery in the functional capacity was observed post-surgery according to NYHA. In this series, surgical results of the patients of various ages, with ASD closed were positive

effects of 21 and 23 milimeter aortic valve prosthesis on hemodynamic performance and functional capacity in young adults

Early and medium-term improvement of functional capacity and regression of left ventricular hypertrophy was evaluated in the young adult patient group following application of 21 mm or 23 mm bileaflet aortic mechanical valve prosthesis due to aortic stenosis. Twenty two patients [10 male, 12 female; mean age 27 +/- 8.2 [19-43]] who underwent isolated aortic valve replacement due to rheumatic aortic stenosis, were included in the study. 21 mm and 23 mm bileaflet mechanical prosthesis was used respectively in eight and fourteen patients. The mean body surface area was 1.86 m[2] and 1.68 m[2] respectively in 23 mm and 21 mm prosthesis while 1.73 +/- 0.25 m[2] for the whole group. Functional capacity was New York Heart Association [NYHA] class II in 9 patients and class III in thirteen patients. Implantation was performed without enlarging the aortic root in all except four patients. In all patients transvalvular gradients, effective orifice area and the diameter of left ventricle were measured with transthoracic echocardiography during rest and after maximal exercise. Mean follow-up was 34 +/- 12 months [range 11-57 months]. There were no postoperative complications or deaths. All the patients were assessed as NYHA class I with regards to functional capacity [p=0.01]. Significant improvements were determined in postoperative mean transvalvular gradient [p=0.005] and left ventricular mass index [p=0.01] when compared with preoperative values. Our findings show that replacement with 21 mm and 23 mm mechanical prosthesis provides a significant improvement in regression of symptoms and increase of functional capacity in young adults in early and mid-period without increasing mortality and morbidity

Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes

Prior studies have demonstrated the relationship between cardiovascular diseases and fragmented QRS [fQRS]. fQRS was also associated with ventricular arrhythmias. Our objective was to find out the relationship between fQRS and paroxysmal atrial fibrillation [PAF]. A total of 301 patients without overt structural heart disease were prospectively included in the study. Patients were divided in to 2 groups according to presence of fQRS. Multivariate logistic regression analysis was used to assess the predictive value of fQRS for predicting PAF. One hundred and three patients had fQRS. Patients with fQRS were older [53 +/- 16.8 vs 45.3 +/- 17.2, p < 0.001], with larger left atrium [LA] [33.2 +/- 5.9 vs 30.1 +/- 5.9 mm, p=0.001], with thicker interventricular septum [IVS] [10.2 +/- 1.9 vs 9.5 +/- 2.3 mm, p=0.032], more diabetic [19.8 vs 10.6%, p=0.029] and have more PAF episodes [22.3 vs 4.1%, p < 0.001] in comparison with patients without fQRS. fQRS was an independent predictor of detecting PAF episode [odds ratio, 9.69; 95% confidence interval, 2.46-38.15, p=0.001]. Hypertension and diabetes mellitus were also predictive. The presence of fQRS independently predicted PAF episodes in holter monitoring [HM]. Further studies are needed to clarify the clinical implications of this finding

Relationship between atrial fibrilation and coronary bypass surgery

Atrial fibrillation [AF] is the most common arrhythmia seen after coronary artery surgery. The purpose this study was to determine incidence of AF that develops after coronary surgery and the factors affecting its development. Four hundred and forty eight patients who had coronary bypass surgery between February 2007 and September 2011 in the Cardiovascular Surgery Clinic were included in the study. Patients with history of chronic renal failure, redo coronary bypass surgery, valvular disease, thyroid disease, ventricular aneurysm and treatment with beta-blockers were excluded from the study of EF. Two hundred and ninety nine patients were male and 149 were female and their age varied between 38 and 85 and their mean age was 61 +/- 5. Surgery was performed on beating heart on 178 patients and the others were operated with cardiopulmonary bypass [CPB]. Advanced age, male sex and history of hypertension was more in AF developed patient group. There was no difference between AF developed group and the other group in terms of diameter of left atrium, ejection fraction [EF], CPB time and cross clamp time. Advanced age, male sex, hypertension and prolonged P-wave duration are the factors that are associated with AF after coronary surgery. Avoidance of CPB does not decrease AF development