Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Detected by Echocardiography in an Asymptomatic Young Athlete.

The anomalous origin of the coronary artery from the pulmonary artery (ALCAPA) is the most common congenital coronary artery anomaly. Up to 90% of patients die during the first year of life. It is unusual for an ALCAPA patient to survive to adulthood. We present a case of an asymptomatic young athlete with ALCAPA, in which the diagnosis was established by echocardiography during pre-participation physical evaluation. The patient underwent surgical closure of the left main coronary artery ostium through the inside of the main pulmonary artery and coronary artery bypass grafting. He was discharged after 6 days and remained well during follow-up visits. We emphasize the importance of echocardiographic examination during pre-participation cardiovascular screening in young athletic populations to avoid sudden death related to ALCAPA.

Pretreatment with methylprednisolone improves myocardial protection during on-pump coronary artery bypass surgery.

BACKGROUND: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). METHODS: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. RESULTS: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001). CONCLUSIONS: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.

Endovascular treatment of abdominal aortic aneurysm in a 26-year-old man. A case report and 10-year follow-up.

We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-year follow-up. A young patient presenting with an abdominal aortic aneurysm is extremely rare, and data describing this population are limited. Open aneurysm repair (OAR) is the treatment of choice in these patients. However, since its introduction, endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. The long-term durability and late complications after EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. Our good long-term outcome will help to support the use of EVAR as a reasonable alternative to OAR in young patients with suitable anatomic findings.

Aspergillus flavus endocarditis of the native mitral valve in a bone marrow transplant patient.

BACKGROUND: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous drug use are the risk factors for developing infection. CASE REPORT: We report a case of Aspergillus flavus native mitral valve endocarditis in a patient who had allogeneic stem cell transplantation in the past due to myelodysplastic syndrome. CONCLUSIONS: Although it is rare and there is limited experience available with the diagnosis and treatment, early recognition and therapeutic intervention with systemic antifungal therapy and aggressive surgical intervention are critical to prevent further complications that may eventually lead to death. In addition, better novel diagnostic tools are needed to facilitate more accurate identification of patients with invasive Aspergillus and to permit earlier initiation of antifungal treatment.

Pinball-Like Free-Floating Left Atrial Ball Thrombus Presenting with Hemiplegia: A Challenging Treatment Decision.

We describe a case of a patient with a history of chronic atrial fibrillation who presented with sudden onset of left hemiplegia. Nine months earlier the longstanding warfarin therapy had been suspended due to a hemorrhagic stroke. Transthoracic echocardiography revealed a large free-floating highly mobile mass in the left atrium and severe mitral valve regurgitation. Due to the potential risk of an embolic event or a hemodynamic collapse, a decision to carry out an emergency operation was made irrespective of the neurological condition of the patient. Unfortunately, the patient died on the 18th postoperative day after a freshly occurring hemorrhagic stroke.

Endovenous laser ablation with 980-nm diode laser: early and midterm results.

OBJECTIVE: Endovenous laser ablation (EVLA) is an efficient method to treat incompetent great saphenous veins (GSV) with high occlusion rates. The aim of this prospective study is to demonstrate the treatment outcomes of EVLA of incompetent GSV with a 980-nm diode laser in an ambulatory setting. BACKGROUND DATA: EVLA of the incompetent GSV with a 980-nm diode laser appears to be an extremely safe technique. There are several treatment alternatives available. Among the emerging techniques, EVLA is one of the most promising. METHODS: Ninety eight patients (103 limbs) with symptomatic varicose veins secondary to GSV insufficiency treated with 980-nm EVLA were prospectively studied. In all patients, laser energy was administered with constant pullback of fiberoptic laser catheter under tumescent anesthesia. The patients were assessed and followed by clinical examination and venous duplex ultrasonography. Pain scores of the patients from discharge to their first follow-up visit (7 days) were recorded by using visual analog scale (VAS). Patient satisfaction was assessed and recorded at 6 month follow-up. RESULTS: All patients tolerated EVLA procedure well, and were discharged from hospital on the same day with ablation procedure. The overall success rate was 97.5% in 98 patients. Mean length of measured treated vein segment was 29.93±6.36 cm. Mean applied total energy was 2006.24±480.16 J. Major complications such as deep vein thrombosis and skin burns were not seen. Most of the complications were minor and improved quickly. All patients returned to daily activities within 2 days. CONCLUSIONS: EVLA of the GSV insufficiency using 980-nm diode laser is an effective and safe technique with a high patient satisfaction rate. The advantages of the procedure are that it is performed as an outpatient procedure, provides early mobilization, causes minimal cessation of daily activities, and avoids classic surgical complications.

A new practical alternative for the control of sternal bleeding during cardiac surgery: Ankaferd Blood Stopper.

The control of sternal bleeding during cardiac surgery can sometimes be a challenging and time-consuming problem for surgeons. Several alternatives for the control of sternal bleeding are on the market. Bone wax is a well-known alternative used by many cardiac surgeons for the control of bleeding. It is effective and cheap; however, it inhibits ossification of the sternum and can cause infections and sternal wound healing problems after cardiac surgery. Consequently, control of sternal bleeding without the use of bone wax requires meticulous preparation. Ankaferd Blood Stopper (ABS) (Ankaferd Saglik Ürünleri, Istanbul, Turkey) is a unique folkloric medicinal plant extract that has been used in Turkish traditional medicine as a hemostatic agent. We present a practical alternative technique for the control of sternal bleeding during cardiac surgery with the use of ABS.

Surgical treatment of a bronchial cyst causing compression to the left atrium and pulmonary artery.

Bronchogenic cysts that formed during the development of the tracheobronchial tree in the gestational period are mostly asymptomatic until adulthood. Cysts localized in the middle mediastinum, specifically in the subcarinal region, on the other hand, may cause serious symptoms by compressing the heart and major vessels due to their close proximity. In this report it is suggested that surgical resection of a giant bronchogenic cyst that compresses the heart and great vessels should be securely performed in the presence of a readily available cardiopulmonary bypass capability.

Sarcoidosis and coronary bypass surgery: a case report.

Sarcoidosis, a chronic granulomatous disease with unknown etiology and pathogenesis, affects the skin and many other organs and has a course characterized by remissions and relapses. We describe a patient with sarcoidosis, which we diagnosed retrospectively after we had difficulties in harvesting the left internal thoracic artery because of giant and disseminated mediastinal lymphadenopathies on the anterior thoracic wall during urgent coronary artery bypass surgery.