Evaluation of systemic immune-inflammation index in acute deep vein thrombosis: A propensity-matched.

OBJECTIVE: Deep vein thrombosis (DVT) progressing to pulmonary embolism is an important cause of mortality and morbidity worldwide. At present, color Doppler ultrasound is the most effective examination method for the diagnosis of DVT. The systemic immune-inflammation index (SII) has been introduced as a new indicator of comprehensive systemic immune thrombosis and inflammatory status in the body. We believe that the SII might be more specific and sensitive than the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). In the present study, we aimed to evaluate the predictive potential of the SII, NLR, and PLR in the diagnosis of DVT. METHODS: The data of patients aged >18 years who were diagnosed with acute DVT in our hospital between June 2017 and June 2021 were retrospectively reviewed. During the study period, the data of 155 patients with acute DVT and 179 healthy control patients without DVT were included in the study. A propensity score analysis (1:1) was performed to eliminate differences between the two groups, and 63 patients from each group were included in the present study. RESULTS: When the complete blood count parameters were examined between the patients with acute DVT and the control group, the hemoglobin, hematocrit, lymphocyte count, and platelet distribution width were lower in the DVT group. In contrast, the white blood cell count, neutrophil count, platelet count, NLR, PLR, SII, and mean platelet volume were higher in the DVT group. The changes in hemoglobin (P = .001), hematocrit (P = .001), white blood cell count (P = .001), neutrophil count (P = .001), lymphocyte count (P = .001), platelet count (P = .001), NLR (P=.001), PLR (P = .001), SII (P = .001), and mean platelet volume (P = .031) were significant on statistical analysis. However, the changes in the platelet distribution width were not significant (P = .794). The area under the curve for the NLR and PLR was 0.797 (95% confidence interval [CI], 0.747-0.848; P < .001) and 0.788 (95% CI, 0.737-0.840; P = .01), respectively. The sensitivity and specificity for an NLR >3.00 was 71.0% and 68.7%, respectively. The sensitivity and specificity for a PLR >142.66 was 70.3% and 68.5%, respectively. The area under the curve for SII was 0.861 (95% CI, 0.820-0.902; P < .001), with a sensitivity of 78.1% and specificity of 73.1% for an SII >755.54. CONCLUSIONS: The SII can be used as an auxiliary diagnostic test for patients with venous thrombosis. This parameter is superior to the NLR and PLR with high sensitivity and specificity for patients with venous thrombosis.

Protective effects of safranal on kidney tissue in a rat model of distant ischemia-reperfusion injury with infrarenal aortic occlusion.

Background/aim: Ischemia-reperfusion (IR) injury to a part of the body can cause damage to distant organs such as the kidney and heart. This study investigated the protective effects of safranal against IR-induced renal injury. Materials and methods: Used in this study were 24 Wistar Albino male rats, which were divided into 3 equal and randomised groups. The sham group underwent laparotomy only. In the IR group, the infrarenal aorta was clamped for 1 h, and then reperfused for 2 h. In the IR-safranal group, safranal was administered 30 min before the procedure and IR injury was induced in the same way as in the IR group. After the procedure, blood and tissue samples were collected from the rats for biochemical and histopathological analyses. Antioxidant capacity and proinflammatory cytokine analyses were performed on the blood samples. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was performed to determine the number of cells undergoing apoptosis in the kidney tissue. Results: The estimated glomerular filtration rate, an indicator of renal function, was lower in the IR group (p1 = 0.024 vs. p3 = 0.041, respectively) compared to the other groups, while creatinine levels were higher in the IR group compared to the other groups (p1 = 0.032 vs. p2 = 0.044, respectively). The blood urea nitrogen level was higher in the IR group than in the other groups (p1 = 0.001vs p2 = 0.035, respectively). The total antioxidant and total oxidant status, indicating tissue oxidative stress, did not differ between groups (p = 0.914 vs. p = 0.184, respectively). Among the proinflammatory cytokines, the interleukin-1ß (IL-1ß) and IL-6 levels were significantly higher in the IR group (p = 0.034 vs. p = 0.001, respectively), but the tumour necrosis factor-α (p = 0.19), and interferon-γ (p = 0.311) levels did not differ between groups. Histopathological examination showed significantly less damage to glomerular and tubular cells in the IR-safranal group (p < 0.001). The number of TUNEL-positive cells was higher in the IR group compared to the other groups (p < 0.001). Conclusion: Safranal may have protective effects against kidney damage caused by distant ischemia-reperfusion injury.

Outcomes of Arteriotomy Closure Technique for Carotid Endarterectomy: Bovine Pericardial Patch Closure versus Primary Closure

ABSTRACT Introduction: The aim of our study was to compare the primary closure (PRC) and patch angioplasty closure (PAC) of carotid artery following carotid endarterectomy (CEA). Methods: Data of patients who underwent CEA in the period from January 2005 to June 2020 were reviewed through files. Demographic characteristics, information about the operation, and postoperative follow-up outcomes of the patients were compared. Results: Of the 144 CEA cases included in the study, PRC and PAC were applied to 62 (43.7%) and 82 (56.3%) patients, respectively, for the carotid artery closure. Duration of surgery and carotid artery clamping time were not different between the PRC and PAC groups (106.73±17.13 minutes vs. 110.48±20.67 minutes, P=0.635; 24.25±11.56 minutes vs. 25.19±8.99 minutes, P=0.351, respectively). Postoperative respiratory impairment was more common in the PRC group (P=0.012); however, nerve injuries (P=0.254), surgical wound hematomas (P=0.605), surgical site infections (P=0.679), and mortality (P=0.812) were not significantly different between the groups. During the mean patient follow-up time of 26.13±19.32 months, restenosis was more common in the PRC group than in the PAC group (n=26, 41.9% vs. n=4, 4.9%, respectively; P=0.003). Frequencies of stroke (n=4, 2.8% vs. n=2, 2.4%, respectively; P=0.679), transient ischemic attacks (n=2, 1.4% vs. n=0, 0%, respectively; P=0.431), and mortality (n=4, 6.5% vs. n=4, 4.9%, respectively; P=0.580) were not significantly different between the PRC and PAC groups. Conclusion: We are of the opinion that the PAC method is effective and safe for carotid artery closure in patients undergoing CEA.

Outcomes of Arteriotomy Closure Technique for Carotid Endarterectomy: Bovine Pericardial Patch Closure versus Primary Closure.

INTRODUCTION: The aim of our study was to compare the primary closure (PRC) and patch angioplasty closure (PAC) of carotid artery following carotid endarterectomy (CEA). METHODS: Data of patients who underwent CEA in the period from January 2005 to June 2020 were reviewed through files. Demographic characteristics, information about the operation, and postoperative follow-up outcomes of the patients were compared. RESULTS: Of the 144 CEA cases included in the study, PRC and PAC were applied to 62 (43.7%) and 82 (56.3%) patients, respectively, for the carotid artery closure. Duration of surgery and carotid artery clamping time were not different between the PRC and PAC groups (106.73±17.13 minutes vs. 110.48±20.67 minutes, P=0.635; 24.25±11.56 minutes vs. 25.19±8.99 minutes, P=0.351, respectively). Postoperative respiratory impairment was more common in the PRC group (P=0.012); however, nerve injuries (P=0.254), surgical wound hematomas (P=0.605), surgical site infections (P=0.679), and mortality (P=0.812) were not significantly different between the groups. During the mean patient follow-up time of 26.13±19.32 months, restenosis was more common in the PRC group than in the PAC group (n=26, 41.9% vs. n=4, 4.9%, respectively; P=0.003). Frequencies of stroke (n=4, 2.8% vs. n=2, 2.4%, respectively; P=0.679), transient ischemic attacks (n=2, 1.4% vs. n=0, 0%, respectively; P=0.431), and mortality (n=4, 6.5% vs. n=4, 4.9%, respectively; P=0.580) were not significantly different between the PRC and PAC groups. CONCLUSION: We are of the opinion that the PAC method is effective and safe for carotid artery closure in patients undergoing CEA.

Does Anzer Propolis Have a Protective Effect on Rabbit Spinal Cord Ischemia/Reperfusion Injury?*

Abstract Introduction: In this study, Anzer propolis, which can only be obtained from the Eastern Black Sea region in Turkey, is studied for its effect on spinal cord ischemia/reperfusion injury. Methods: A total of 12 healthy male New Zealand White rabbits with an average weight of 3.0 to 3.5 kg were separated into two blind and randomized groups: the ischemia/reperfusion group (n=6) and the treatment group (n=6). Each rabbit in the treatment group was given a dose of 100 mg/kg of ethanol-dissolved Anzer propolis orally 1 hour before surgery. Blood samples were examined at the 0th hour and postoperatively at the 24th and 48th hours. Tissue samples were taken at the 48th hour during the sacrification. Results: There was a statistically significant difference between the two groups in terms of postoperative Tarlov scoring (P=0.012). There was a difference between the two groups in terms of the blood levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) at the 48th hour, myeloperoxidase (MPO) at the 24th and 48th hours, ischemia-modified albumin (IMA) at the 24th hour, and intercellular adhesion molecule-1 (ICAM-1) and total oxidant status (TOS) at the 48th hour (P<0.005). There was also a difference between the two groups in terms of apoptotic index data obtained with the terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP nick‐end labelling (TUNEL) method in the histopathological examination (P=0.001). In the transmission electron microscopic (TEM) analysis, while ischemia/reperfusion group generally had axon-myelin separation, axoplasmic dissolution and myelin separation, the propolis treatment group had normal myelin sequencing. Discussion: In our study, after biochemical, histopathological, ultrastructural and neurological functional examination, it was demonstrated that Anzer propolis has sufficient neuroprotective effect on spinal cord ischemia/reperfusion injury in rabbits.

Does Anzer Propolis Have a Protective Effect on Rabbit Spinal Cord Ischemia/Reperfusion Injury?

INTRODUCTION: In this study, Anzer propolis, which can only be obtained from the Eastern Black Sea region in Turkey, is studied for its effect on spinal cord ischemia/reperfusion injury. METHODS: A total of 12 healthy male New Zealand White rabbits with an average weight of 3.0 to 3.5 kg were separated into two blind and randomized groups: the ischemia/reperfusion group (n=6) and the treatment group (n=6). Each rabbit in the treatment group was given a dose of 100 mg/kg of ethanol-dissolved Anzer propolis orally 1 hour before surgery. Blood samples were examined at the 0th hour and postoperatively at the 24th and 48th hours. Tissue samples were taken at the 48th hour during the sacrification. RESULTS: There was a statistically significant difference between the two groups in terms of postoperative Tarlov scoring (P=0.012). There was a difference between the two groups in terms of the blood levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) at the 48th hour, myeloperoxidase (MPO) at the 24th and 48th hours, ischemia-modified albumin (IMA) at the 24th hour, and intercellular adhesion molecule-1 (ICAM-1) and total oxidant status (TOS) at the 48th hour (P<0.005). There was also a difference between the two groups in terms of apoptotic index data obtained with the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labelling (TUNEL) method in the histopathological examination (P=0.001). In the transmission electron microscopic (TEM) analysis, while ischemia/reperfusion group generally had axon-myelin separation, axoplasmic dissolution and myelin separation, the propolis treatment group had normal myelin sequencing. DISCUSSION: In our study, after biochemical, histopathological, ultrastructural and neurological functional examination, it was demonstrated that Anzer propolis has sufficient neuroprotective effect on spinal cord ischemia/reperfusion injury in rabbits.

Incidence, follow-up and outcomes of incidental abdominal aortic aneurysms in computed tomography.

OBJECTIVES: The goal of our study was to determine the prevalence of abdominal aortic aneurysms (AAAs) that were incidentally diagnosed by computed tomography applied for different reasons and to discuss the risk factors that may cause AAA. METHODS: A total of 5396 abdominal computed tomography examinations were performed, and the 103 incidentally detected AAAs were included in the study. Patients with and without AAA were compared in terms of age, gender, thoracic and abdominal aortic diameters and comorbid diseases. RESULTS: The prevalence of the AAAs was 1.9%. Old age and male gender were significantly different between the groups (P < 0.001). The reason for applying computed tomography in 52 (50.5%) patients with AAA was associated with malignancy. In the evaluation of all patients in the study, the aortic diameter was determined to be larger in patients with malignancy than in patients without malignancy (18.07 ± 4.1 mm vs 17.7 ± 3.9 mm, respectively; P < 0.001). The thoracic aortic diameter was wider in patients with AAA compared to that in patients without AAA (37.2 ± 3.9 mm vs 33.9 ± 5.2 mm, respectively; P < 0.001). The presence of coronary artery disease, diabetes mellitus, hypertension and a history of smoking in patients with AAA was significantly different from that of patients without AAA (P < 0.001). There was no significant difference between the groups in terms of hyperlipidaemia and chronic obstructive pulmonary disease (P = 0.52 and P = 0.15, respectively). CONCLUSIONS: Screening of older men with diseases such as malignancy, hypertension, diabetes mellitus and coronary artery disease for AAA is important for the early diagnosis and treatment of this disease.

Surgical Treatment for Patent Ductus Arteriosus: Our Experience of 12 Years.

Introduction Patent ductus arteriosus (PDA) is a congenital heart disease that, if left untreated, can lead to pulmonary hypertension, congestive heart failure, and death. Here, we aimed to assess postoperative cardiac hemodynamic changes and surgical techniques, as well as early and late postoperative findings in surgically treated PDA patients. Materials and methods We retrospectively analyzed the data belonging to 126 patients whose PDA was surgically closed in our clinic from January 2001 to December 2012. With echocardiography being a standard in diagnosis and follow-up, angiography and computed tomography were also used in the presence of pulmonary hypertension and congenital heart disease, when needed. Postoperative data were compared between isolated PDA patients and those with congenital cardiac deformities. Results Evaluating the patients' pulmonary artery pressure (PAP), pulmonary hypertension was detected in 121 patients (96.0%). Preoperative PAP was significantly higher in PDA patients with congenital heart disease compared to the isolated PDA group (p<0.05). PAP decreased significantly in postoperative follow-up in both groups (p<0.05). However, this decrease was faster in the isolated PDA group than in patients with congenital heart disease and right-left shunt accompanying PDA (p<0.05). Regarding the correlation between ductus diameters and preoperative PAP, we found that as ductus diameter increased, PAP increased significantly (p<0.05). Conclusions In PDA patients, closing the ductus is necessary to prevent pulmonary and cardiac complications. Surgical closure remains one of the most effective methods for this, although there is little difference between surgical treatment methods in terms of mortality.

The Effectiveness of Endovenous Radiofrequency Ablation Application in Varicose Vein Diseases of the Lower Extremity.

We aimed to determine the outcome, complications, and quality of life effects of radiofrequency ablation (RFA) in the treatment of superficial venous insufficiency. A total of 134 extremities from 100 patients were evaluated in this retrospective study performed at the Cardiovascular Surgery Department of Atatürk University Faculty of Medicine. Treatment success was determined by occlusion. The clinical, etiologic, anatomic, and pathophysiologic (CEAP) and venous clinical severity score (VCSS) scores of patients were assessed pre- and postoperatively to evaluate clinical outcome and quality of life. The pain was assessed with the Wong-Baker score. Complications and their frequency were assessed and recorded. Treatment success, as measured by occlusion rate, was 99% percent. Prior to treatment, the CEAP clinical score was C2 (81.0%), while after treatment, it was C0 (54.0%) (p<0.001). The pretreatment median VCSS score was 5 (min-max: 1-9) while the post-treatment median was 1 (min-max: 1-3) (p<0.001). The mean pain score was 1.34; only one patient reported a score of 6 while the minimum score was 1. A total of 15 complications occurred; only one was a major complication (deep vein thrombosis or DVT) while the remaining 14 were minor complications. While longstanding surgical treatments still provide significant success, the RFA technique not only surpasses them in success rate but also in terms of pain, complications, and better patient satisfaction. The results of our study indicate that RFA is an effective and safe option for the treatment of superficial venous insufficiency.

Treatment of pericardial effusion through subxiphoid tube pericardiostomy and computerized tomography- or echocardiography - guided percutaneous catheter drainage methods

Abstract Objective: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography- or Echocardiography - Guided Percutaneous Catheter Drainage Methods.

OBJECTIVE: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. METHODS: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. RESULTS: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. CONCLUSION: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms.

OBJECTIVE: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. METHODS: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). RESULTS: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). CONCLUSION: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

Application of circular patch plasty (dor procedure) or linear repair techniques in the treatment of left ventricular aneurysms

Abstract Objective: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. Methods: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). Results: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). Conclusion: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

Surgical Management of Aortic Coarctation from Infant to Adult.

OBJECTIVE: In the present study, we aimed to retrospectively investigate the early and late results of different surgical treatment techniques applied in different age groups with coarctation of the aorta (CoA). MATERIALS AND METHODS: Between January 2007 and February 2017, 26 patients (12 males, 14 females; mean age: 12.2±12.4 years; range: 29 days-34 years) who underwent surgery with the diagnosis of CoA were evaluated. Overall, 11 of these patients (42.3%) were in the infantile period, whereas 15 patients (57.7%) aged between 6 and 34 years. Resection and end-to-end anastomosis were performed in 13 patients (50%). Bypass grafting was performed in six patients (23.1%), and patch plasty was performed in seven patients (26.9%). RESULTS: A patient (3.8%) who was operated on during the infantile period died early, whereas another patient (3.8%) died 2 years after the surgery. Recoarctation was detected in two patients. A patient underwent balloon dilatation, whereas another patient underwent balloon dilatation and stenting. In patients who underwent re-section and end-to-end anastomosis based on postoperative echocardiography results during follow-up, a lower statistically significant gradient was observed compared with the preoperative period. Despite the decrease in the left ventricular systolic diameter (LVSD) and the increase in the ejection fraction (EF) the decrease in LVSD and increase in EF were not statistically significant. In patients who underwent patch plasty or graft interposition, the low values of the gradient and left ventricular diastolic diameter in the postoperative follow-up were statistically significant. However, the decrease in LVSD and increase in EF were not statistically significant. CONCLUSIONS: Our clinical experience suggests that repairing with resection and end-to-end anastomosis is a more appropriate treatment option during the infancy, whereas patch plasty or bypass grafting may be preferred in advanced ages.

Letter To The Editor.

We read the letter of F. Rudman et al [Rudman 2017] about our article entitled "Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy" [Colak 2016]. We thank them for their evaluations.

Intraoperative transit-time flow measurement in on-pump coronary artery bypass graft surgery: Single center experience.

BACKGROUND: This study aims to evaluate the effects of graft dysfunction detected by intraoperative transit-time flow measurement on the outcomes of on-pump coronary artery bypass graft surgery. METHODS: A total of 1,240 patients (856 males, 384 females; mean age 57.4±12.1 years; range, 47 to 74 years), who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy performed by the same surgical team, were reviewed retrospectively. With the introduction of transit-time flow measurement into practice at our clinic in 2006, all patients regularly underwent transit-time flow measurement during surgery in order to evaluate the graft patency. Interpretation of the data obtained using the transit-time flow measurement in patients who underwent surgery has directed our decision as to whether to perform graft revision. Patients were evaluated for early- and late-period mortality/ morbidity, perioperative and postoperative myocardial infarction, and intraaortic balloon requirement. RESULTS: A total of 3,596 grafts in the perioperative period was evaluated using transit-time flow measurement. Anastomosis/graft revision, new anastomosis/patch plasty to distal native artery or free left internal mammary artery graft was performed in 146 grafts of 143 patients in whom transittime flow measurement showed insufficient patency. Four of six patients who developed peri/postoperative myocardial infarction were found to have perioperative hypotension, ST elevation, and wall motion abnormality on transesophageal echocardiography before closure of the sternum. The flow was corrected by extending the short length of the grafts with insufficient flow after transit-time flow measurement and it was recorded that transit-time flow measurements were at normal values at these four grafts. Two patients developed acute myocardial infarction in the postoperative period and stent was applied in one vessel of each patient; however, one of these patients died. Sixteen patients were inserted intraaortic balloon pump, four of which being in the preoperative period. Revision surgery was performed due to bleeding in 56 patients and sternal infection in 12 patients. Of all patients, 28 (2.3%) died in the early postoperative period. CONCLUSION: We believe that transit-time flow measurement may be an important tool in evaluating graft function and contribute to eliminate the causes of graft failure during surgery.

Surgical treatment with wrapping of the moderately-dilated ascending aorta.

BACKGROUND: The aim of this study is to present early and mid results associated with the treatment of dilatation of the ascending aorta using the wrapping technique. METHODS: A total of 54 patients (16 males, 38 females; mean age 56.9±12.7 years; range 21 to 77 years) who were subjected to the wrapping technique due to dilatation of the ascending aorta between January 2010 and Fabruary 2017 were retrospectively analyzed. The Dacron grafts were used in all patients. Wrapping was performed in all patients in combination with the other cardiac surgical procedures. Wrapping was performed with aortoplasty in 32 patients and as an isolated procedure in 22 patients. Preoperative clinical findings, concomitant cardiac procedures, intraoperative parameters, postoperative early and long-term outcomes were evaluated. The ascending aorta and descending aorta diameters, ejection fraction, left ventricle end-diastolic and end-systolic diameters were measured using a computed tomography scan and/or transthoracic echocardiography after surgery, and was compared with the preoperative values. RESULTS: The median follow-up was 3.8 (range, 1 to 7) years. No intraoperative complication associated with the wrapping procedure was reported in any of the patients. One patient died during the early postoperative period. Relapse-free intra-arterial fibrinolysis was used to correct postoperative cerebral infarct in one patient without any sequelae. Revision surgery was required in two patients due to bleeding and in another two patients due to sternal dehiscence. A postoperative decrease in the aortic diameter and an increase in the ejection fraction were found to be statistically significant. Findings such as sinus of Valsalva and distal aortic dilation, rupture, pseudoaneurysm, and graft mobilization were not observed during follow-up. CONCLUSION: Our study results show that the wrapping techniques may be safely performed in patients with moderate dilatation of the aorta who do not require replacement of the ascending aorta.

Endovascular Stent Graft Repair of Localized Acute Aortic Intramural Hematoma: A Case Report and Literature Review.

Aortic intramural hematoma (IMH) is a variant of acute aortic syndrome, which can be life-threatening. Ascending aorta IMHs, particularly accompanied by penetrating aortic ulcer (PAU), can cause dissection, rupture, and cardiac tamponade. Therefore, early surgical treatment is recommended for IMHs of the ascending aorta. Herein, we present the case of a 60-year-old male patient who was on warfarin sodium treatment and in whom an IMH localized to the arcus aorta was detected incidentally via computed tomography, with the suspicion of pulmonary embolism, and an endovascular stent graft was inserted into the arcus aorta. This case highlights the importance of following ulcerated aortic plaques and suggests that IMH can be successfully treated with endovascular stent grafting.

The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury.

PURPOSE: The purpose of this study was to evaluate the efficiency and feasibility of dual-energy computed tomography (DECT) used in the diagnosis of cardiac contusion with the mildest blunt cardiac injury. MATERIAL AND METHODS: This study was performed between February 2014 and September 2015; a total of 17 consecutive patients (10 men and 7 women; median age, 51 years [range: 20-78]) were enrolled in the study. The DECT was performed within 48 hours of the trauma and a subsequent follow-up DECT was performed a little less than 1 year after the first examination. All examinations were analyzed on iodine map images by 2 experienced radiologists. Interobserver and intraobserver agreement was calculated. The correlation of initial troponin level, age, and sex with number of contusion areas in the left ventricle and complete recovery of contusion were measured. RESULTS: The contusion areas were amorphous, with considerable variation in their size, shape, and density. Contusions were primarily located in the left free wall of the ventricle, the ventricular septum, and the apex, respectively. In 10 patients, contusion areas disappeared on follow-up examination. In 4 patients, the contusion areas decreased but were still present in the follow-up examination. The interobserver agreements were almost perfect with respect to the presence of cardiac contusion, the anatomic location of contusions, and the contusion areas (kappa values of 1.0, 1.0, and 0.9 for intraobserver agreement and 1.0, 1.0, and 1.0 for intraobserver agreement, respectively). Correlations were found between age of patients and complete recovery of contusion (P = 0.01). CONCLUSIONS: Dual-energy computed tomography can show cardiac contusion and could be useful and feasible for the diagnosis and follow-up of blunt cardiac injuries. Dual-energy computed tomography is a new, user-independent, and valuable imaging technique.

Repeated Courses of Oral Ibuprofen in Premature Infants with Patent Ductus Arteriosus: Efficacy and Safety.

BACKGROUND: There are limited data about the results of repeated oral ibuprofen (OIBU) treatment. This study aimed to describe patent ductus arteriosus (PDA) closure rates and adverse events after repeated courses of OIBU in premature infants with PDA. METHODS: Preterm infants with hemodynamically significant (hs)PDA were enrolled in the study. If the first course of OIBU treatment failed, a second and, if required, third course was administered. RESULTS: A total of 100 patients received OIBU. In six patients, treatment could not be completed due to death (n=3) and side effects (n=3). In three patients, adverse effects related to OIBU (thrombocytopenia and impairment of renal function) developed during the first course. During the second and third courses, no new adverse event occurred. After all courses, the PDA closure rate was determined as 88%. The rate was 71% after the first course, 40% after the second course, and 35% after the third course. Although the second course resulted in a significant increase in the closure rate (p<0.05), the rate did not increase significantly with the third course (p>0.05). The mean postnatal age at the start of the first dose of OIBU was not significantly different among the responders and non-responders to the first course (p>0.05). Clinical characteristics did not affect the closure rate significantly. The number of courses did not have a significant effect on death, when gestational age and birth weight were used as covariates [p=0.867, Exp(B)=0.901, 95% confidence interval=0.264-3.1]. CONCLUSION: A second course of OIBU seems effective and safe for use in preterm infants with hsPDA. Although a third course of OIBU results in PDA closure in some additional patients, the difference is not significant. Thus, surgical ligation should be considered after the second course, especially in patients with signs of severe heart failure.