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1.
J Cardiothorac Surg ; 18(1): 258, 2023 Sep 11.
Article in English | MEDLINE | ID: mdl-37697290

ABSTRACT

BACKGROUND: Hypersensitivity reactions to heparin are uncommon conditions but pose a serious clinical problem for patients requiring cardiopulmonary bypass. Bivalirudin is a reversible direct thrombin inhibitor that can be used instead of heparin. CASE REPORT: A 49-year-old male patient was admitted to our hospital for coronary artery bypass graft operation with mitral insufficiency and tricuspid valve insufficiency. Heparin allergy was confirmed by skin biopsy and skin tests. Due to this allergy, we used bivalirudin (Bivacard VEM drug, Turkey) during the surgery. A loading dose of 1.0 mg/kg (100 mg) bivalirudin was administered through the central line and a continuous infusion of 2.5 mg/kg/h of the anticoagulant was initiated following the approved protocol. Serial ACTs were obtained at 15-minute intervals during the procedure and the measurements were 330s, 320s, 350s, 360s, and 340s consecutively. Additional boluses of 0.5 mg/kg (50 mg) were administered for each measurement. Left anterior descending, obtuse marginal arteries and the right coronary artery were grafted with the left internal mammary and saphenous veins. Also, mitral valve replacement with St Jude mechanical heart valve and tricuspid ring annuloplasty was performed with Medtronic Duran ring. After the surgery, the patient had an uneventful period in the postoperative intensive care unit with a total of 600ml and 300ml chest tube drainage for two days and was discharged on the 7th day. CONCLUSION: Alternative anticoagulation strategies are needed for cardiopulmonary bypass in patients unable to use heparin. Bivalirudin may be recommended as a viable alternative anticoagulant in patients with heparin allergy during cardiopulmonary bypass. However, each patient should be evaluated individually and it should not be forgotten that more than recommended doses may be needed.


Subject(s)
Cardiopulmonary Bypass , Hypersensitivity , Male , Humans , Middle Aged , Heparin/adverse effects , Anticoagulants/adverse effects
2.
Cureus ; 15(12): e50809, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38249167

ABSTRACT

A 47-year-old woman was admitted to the hospital because of dyspnea for the past three months. She was previously diagnosed with pulmonary embolism. She had been operated on for a colon tumor five years ago and no residual cancer was detected on oncological follow-up. Her transthoracic echocardiographic and transesophageal echocardiographic evaluation showed a hypertrophic right ventricle occupied by a 2.7 x 4.8 cm immobile mass obliterated to the right ventricle cavity. All the non-invasive tests were consistent with thrombus prediagnosis. She underwent surgery. Mass was resected from the right ventricle as much as possible. Histopathology of surgical material revealed metastatic spindle cell adenocarcinoma. We aim to increase the awareness of the differential diagnosis of thrombus or tumor, thereby leading to appropriate management.

4.
J Card Surg ; 35(4): 942-945, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32107796

ABSTRACT

Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.


Subject(s)
Aneurysm/complications , Aneurysm/surgery , Coronary Artery Bypass/methods , Organ Sparing Treatments/methods , Plastic Surgery Procedures/methods , Pulmonary Artery/surgery , Pulmonary Valve Insufficiency/etiology , Vascular Surgical Procedures/methods , Adult , Coronary Artery Disease/etiology , Female , Humans , Hypertension, Pulmonary/etiology , Treatment Outcome
6.
J Tehran Heart Cent ; 10(3): 117-21, 2015 Jul 03.
Article in English | MEDLINE | ID: mdl-26697083

ABSTRACT

BACKGROUND: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. METHODS: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. RESULTS: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). CONCLUSION: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs.

7.
Tex Heart Inst J ; 41(1): 91-3, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24512412

ABSTRACT

Percutaneous closure of atrial septal defects in adults has emerged as an alternative to surgery. We report a sequela of such closure in a 16-year-old boy: embolization of the atrial septal defect occluder into the main pulmonary artery when the patient experienced an episode of intense coughing immediately after device deployment. We removed the device surgically and closed the atrial septal defect in a standard manner, with an autologous pericardial patch.


Subject(s)
Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Device Removal , Foreign-Body Migration/surgery , Heart Septal Defects, Atrial/therapy , Prosthesis Failure , Pulmonary Artery/surgery , Septal Occluder Device/adverse effects , Adolescent , Cardiac Surgical Procedures , Foreign-Body Migration/diagnosis , Foreign-Body Migration/etiology , Heart Septal Defects, Atrial/diagnosis , Heart Septal Defects, Atrial/surgery , Humans , Male , Pericardium/transplantation , Prosthesis Design , Pulmonary Artery/diagnostic imaging , Radiography , Treatment Outcome
8.
Anadolu Kardiyol Derg ; 14(3): 286-91, 2014 May.
Article in English | MEDLINE | ID: mdl-24566554

ABSTRACT

OBJECTIVE: The main purpose of this study was to assess the patency of left internal thoracic artery (LITA) graft by using color Doppler ultrasonography (CDUSG) and furthermore to determine the sensitivity and specificity of CDUSG for patency by using coronary angiography as the reference standard. METHODS: This study is an observational cohort study on diagnostic accuracy that was held between August 2008 and October 2009. CDUSG was performed in 138 consecutive patients who had angina symptom or positive ischemic findings following coronary artery bypass surgery. LITA blood flow velocity at peak-systole (PSV), diastole (PDV) and end-diastole (EDV) was recorded. All patients were also assessed by coronary angiography for LITA graft patency. Statistical analysis was performed by using independent samples t-test, Mann-Whitney U test, chi-square test and receiver operating curve analyses (ROC). RESULTS: Seventy-eight of all patients had functional LITA grafts and 59 patients had dysfunctional LITA grafts according to CDUSG-derived parameters, whereas we cannot conclude about one patient's LITA graft functionality. The LITA grafts were visualized angiographically in all cases. Of all 138 patients, 60 patients had dysfunctional LITA grafts after angiographic evaluation. The ROC analyses showed that PDV (AUC=0.899, 95% CI 0.844 to 0.953; p<0.001) and EDV (AUC=0.900; 95% CI 0.847 to 0.953; p<0.001) values were also strongly associated with graft functionality. We found out that CDUSG predicts LITA graft functionality with a sensitivity and specificity of 100% and 98.4% respectively. The accuracy of the CDUSG was calculated as 99.3%. CONCLUSION: CDUSG is a reliable non-invasive method for assessment of LITA graft patency.


Subject(s)
Coronary Artery Disease/surgery , Mammary Arteries/physiopathology , Vascular Patency , Aged , Blood Flow Velocity , Cohort Studies , Coronary Angiography , Coronary Artery Disease/blood , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/pathology , Echocardiography, Doppler, Color , Female , Humans , Internal Mammary-Coronary Artery Anastomosis , Male , Middle Aged , Predictive Value of Tests , Pulsatile Flow , ROC Curve
9.
Cardiovasc J Afr ; 24(7): 260-4, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24217302

ABSTRACT

OBJECTIVE: Levosimendan has anti-ischaemic effects, improves myocardial contractility and increases systemic, pulmonary and coronary vasodilatation. These properties suggest potential advantages in high-risk cardiac valve surgery patients where cardioprotection would be valuable. The present study investigated the peri-operative haemodynamic effects of prophylactic levosimendan infusion in cardiac valve surgery patients with low ejection fraction and/or severe pulmonary arterial hypertension. METHODS: Between May 2006 and July 2007, 20 consecutive patients with severe pulmonary arterial hypertension (systolic pulmonary artery pressure ≥ 60 mmHg) and/or low ejection fraction (< 50%) who underwent valve surgery in our clinic were included in the study and randomised into two groups. Levosimendan was administered to 10 patients in group I and not to the 10 patients in the control group. Cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) were recorded for each patient preoperatively and for 24 hours following the operation. RESULTS: CO and CI values were higher in the levosimendan group during the study period (p < 0.05). MPAP and PVR values were significantly lower in the levosimendan group for the 24-hour period (p < 0.05) and SVR values were significantly lower after 24 hours in both groups. When clinical results were considered, no difference in favour of levosimendan was detected regarding the mortality and morbidity rates between the groups. CONCLUSION: Levosimendan improved the haemodynamics in cardiac valve surgery patients with low ejection fraction and/or severe pulmonary arterial hypertension, and facilitated weaning from cardiopulmonary bypass in such high-risk patients when started as a prophylactic agent.


Subject(s)
Cardiovascular Agents/administration & dosage , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Hemodynamics/drug effects , Hydrazones/administration & dosage , Hypertension, Pulmonary/drug therapy , Pulmonary Artery/drug effects , Pyridazines/administration & dosage , Arterial Pressure/drug effects , Cardiopulmonary Bypass , Drug Administration Schedule , Familial Primary Pulmonary Hypertension , Heart Valve Diseases/complications , Heart Valve Diseases/diagnosis , Heart Valve Diseases/physiopathology , Heart Valve Prosthesis Implantation/adverse effects , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/physiopathology , Infusions, Parenteral , Pulmonary Artery/physiopathology , Severity of Illness Index , Simendan , Stroke Volume/drug effects , Time Factors , Treatment Outcome , Turkey , Vascular Resistance/drug effects
10.
J Card Surg ; 28(4): 421-6, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23731176

ABSTRACT

OBJECTIVE: The aim of this study is to assess mid-term outcomes of reduction aortoplasty and wrapping technique which is an alternative method to replacement of the aorta in ascending aortic aneurysms. We aimed to show the efficacy of this technique especially when used for patients with increased perioperative mortality or morbidity due to their concomitant pathologies. MATERIALS AND METHODS: From March 2009 to May 2011, 22 patients underwent reduction aortoplasty and wrapping for ascending aortic aneurysm. The study group consisted of 16 male and six female patients with a mean age of 68 ± 13.1 years. Linear plication with wrapping was performed as concomitant surgery in 20 patients and as a primary procedure in two patients. The diameter of the aorta was measured using a computed tomography scan 12 months after surgery and was compared with the preoperative value. RESULTS: Mean aortic clamp and cardiopulmonary bypass times were 91.0 ± 58.1 and 150.7 ± 80.9 minutes, respectively. Mortality was 9.1%. In no case was the postoperative death related to the aortoplasty procedure. The mean postoperative ascending diameter was 29.5 ± 1.04 mm (vs. preoperative 49.1 ± 4.1 mm, p < 0.001). Mean follow-up time was 17.2 ± 8.88 months. During the follow-up period we observed that there were no findings to suggest redilatation. CONCLUSION: Linear plication with external wrapping is a therapeutic option with promising mid-term results, in carefully selected, high surgical risk patients with an ascending aortic aneurysm.


Subject(s)
Aorta/surgery , Aortic Aneurysm/surgery , Vascular Surgical Procedures/methods , Aged , Aged, 80 and over , Aorta/pathology , Aortic Aneurysm/mortality , Aortography , Cardiopulmonary Bypass , Constriction , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Vascular Surgical Procedures/mortality
11.
Tex Heart Inst J ; 40(5): 612-4, 2013.
Article in English | MEDLINE | ID: mdl-24391339

ABSTRACT

Arteriovenous fistula is defined as an abnormal communication between the arterial and venous systems. The complexity of congenital arteriovenous malformations makes treatment challenging. We present the case of a 23-year-old woman who had a complex congenital arteriovenous malformation in her left leg and a history of 2 unsuccessful coil-embolization procedures. We ligated all the feeding arteries of the arteriovenous malformation in the region of the superficial femoral artery, and the surgery was successful without sequelae. The patient returned 2 years later with thrombosis of the great saphenous vein and underwent a second operation. The thrombosed vein and all varicosities were excised successfully. Surgery can be an effective method for correcting complex congenital arteriovenous malformations, especially in the lower limbs. A 2-staged surgical approach like ours might be a good option in suitable patients.


Subject(s)
Arteriovenous Malformations/surgery , Leg/blood supply , Vascular Surgical Procedures/methods , Angiography , Arteriovenous Anastomosis , Arteriovenous Malformations/diagnosis , Female , Femoral Artery/abnormalities , Femoral Artery/surgery , Follow-Up Studies , Humans , Saphenous Vein/abnormalities , Saphenous Vein/surgery , Ultrasonography, Doppler, Color , Young Adult
12.
Innovations (Phila) ; 5(6): 439-43, 2010 Nov.
Article in English | MEDLINE | ID: mdl-22437640

ABSTRACT

OBJECTIVE: : Thrombosis of mechanical heart valve prosthesis is a rare fatal complication after heart valve replacement. Although surgical intervention is the suggested treatment in many series, fibrinolytic treatment offers a good alternative. We describe eight cases with mechanical aortic valve thrombosis and compare their results after fibrinolytic treatment or redo aortic valve replacement. METHODS: : Between February 2008 and March 2009, eight patients with previous mechanical prosthetic aortic valve replacement history were admitted to our center with mechanical aortic valve thrombosis. Four patients were operated, and the remaining four patients received low-dose fibrinolytic treatment. All patients' data were collected prospectively. RESULTS: : Two of the four operated patients died. In the fibrinolytic group, all patients totally recovered, and there was no mortality or morbidity during the follow-up period. CONCLUSIONS: : We thought that fibrinolytic treatment is a feasible and effective method for thrombosed mechanical aortic valve. However, much more populated patient groups are needed for the vigorous inference.

13.
Tex Heart Inst J ; 34(3): 363-5, 2007.
Article in English | MEDLINE | ID: mdl-17948089

ABSTRACT

Aortic arch aneurysm, pseudocoarctation, and coronary artery stenosis are extremely rare in Behçet's syndrome. We present the case of a 25-year-old man with Behçet's syndrome who underwent coronary artery bypass grafting for severe stenosis in the proximal left anterior descending coronary artery and concomitant surgical correction of a saccular aneurysm that was causing pseudocoarctation of the aortic arch. The surgery was successful.


Subject(s)
Aortic Aneurysm, Thoracic/etiology , Aortic Coarctation/etiology , Behcet Syndrome/complications , Coronary Stenosis/etiology , Adult , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Coarctation/diagnostic imaging , Blood Vessel Prosthesis Implantation , Coronary Angiography , Coronary Stenosis/surgery , Humans , Male
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