Confounding giant right atrial mass.

BACKGROUND: Primary cardiac tumors are uncommon, with approximately 70-80% classified as benign. Myxomas constitute roughly half of all benign cardiac tumors, while cardiac hydatid cysts are exceptionally rare. Shortness of breath is a prominent symptom associated with these conditions. Echocardiography serves as the primary diagnostic tool, enabling early detection. The preferred course of action involves the surgical excision of the mass. CASE PRESENTATION: Our first case, a 51-year-old female presented to the cardiology outpatient clinic with complaints of shortness of breath and palpitations persisting for 3 months. Physical examination and tests were within normal limits. Echocardiography revealed a right atrial myxoma measuring 65 * 35 mm. Despite not affecting valve and ventricular functions, the mass was surgically resected. Our second case, a 55-year-old male admitted to the cardiology clinic with recurrent fever, shortness of breath, and chest pain. Physical examination and tests were normal. Echocardiography revealed an echogenic mass with a septate appearance adhering to the free wall of the right atrium. The patient, diagnosed with a hydatid cyst, underwent surgical resection. CONCLUSIONS: We came across two different cases of RA masses which happened to be myxoma and hydatid cysts, and we managed accordingly. The right atrial myxomas typically present with nonspecific shortness of breath unless they cause valve obstruction. In cases where clinical findings suggest infection in the right atrial masses, it is essential to consider hydatid cyst as a potential diagnosis alongside the initial consideration of vegetation.

Surgical and Histopathological Results in Carotid Body Tumors.

OBJECTIVE: The possible relationships between the histopathological findings of carotid body tumors and age, gender, tumor diameter, and Shamblin classification were investigated. In addition, preoperative embolization status, development of neurological complications, need for vascular reconstruction, hemoglobin change, and discharge time were examined and the effects of these variables on each other were analyzed. METHODS: Between 2008 and 2022, 46 cases who underwent carotid body tumor excision were examined retrospectively. The cases were followed for an average of 81 months postoperatively. Histopathological materials were reexamined and the effect of categorical variables was analyzed. RESULTS: Mean tumor diameter was 3.55 ± 1.26 cm, mean discharge time was 3.91 ± 2.37 days, and mean hemoglobin change was 1.86 ± 1.25. Neurological complications developed in 13% of cases. The amount of hemoglobin change was significantly (p = 0.003) higher in those who developed neurological complications, whereas the tumor diameter and discharge time were found to be insignificantly higher. Surgical complications requiring vascular repair occurred in 10.8% of cases. Tumor diameter (p = 0.017) and hemoglobin change (p = 0.046) were significantly higher in these patients. There were significant correlations between higher Shamblin classification and tumor diameter, discharge time, postoperative hemoglobin value, and number of surgical and neurological complications. No significant difference was found between Ki-67, capsular invasion, mitosis, pleomorphism, prominent nucleoli, mean island diameter, and tendency of islands to merge with categorical variables. CONCLUSION: As the tumor diameter increases, the operation becomes more difficult and the postoperative complication rate increases. We think that subadventitial and capsular removal of the tumor is effective in preventing recurrence. To reach a histopathological conclusion, a larger series of studies including tumors with high Ki-67 and mitosis rates, large size, and one or more of the criteria for necrosis are needed.

Effects of Combined Sertraline and Magnesium in Rat Atrium.

The objective of this study is to determine the synergistic effects of an antioxidant ion Mg+2, combined with selective serotonin reuptake inhibitor sertraline, in treatment or prevention of major depression and regulation of inotropic effect in the early postoperative period. Adult male 40 Wistar albino rats were randomly divided into 6 groups. Three to 4-mm long atrium strips were placed in organ bath, tension was adjusted to 2 g. Isometric contractions were induced with 10-3 M adrenaline. Group 1 was the control group, cumulative sertraline was given to group 2, cumulative MgSO4 to group 3, combined cumulative sertraline and MgSO4 to group 4, intraperitoneal sertraline injection for 29 days to group 5, and intraperitoneal MgSO4 injection for 14 days to group 6. Changes in weight, tensions, bleeding/clotting time, and biochemical findings were evaluated statistically. Isometric tension relationship between groups 1 and 3 was statistically significant after 4 mmol/L MgSO4 (p < 0.05). A rapid inhibition of contraction was observed in group 4. Inhibition of spontaneous contractions of groups 5 and 6 was found to be statistically significant at close values, p < 0.05. When blood clotting times were compared, a statistically marked decrease was found in group 6, p < 0.05. Compared to control group, there was a significant decrease in blood lipids in group 4. While LDH and CK-MB increased from plasma enzymes in groups 5 and 6, no significant change was observed in NT-proBNP. Combined treatment of high dose MgSO4 with antidepressants for pre or post-operative depression may cause fatal risks. Shortening clotting time may increase the risk of embolism and stroke. In order to reduce the risk of post-operative depression preoperatively, care should be taken when using magnesium combined with antidepressants and more studies are needed to be considered.

Relationship Between Cardiac Surgery and Acute Ischemic Stroke: An Examination in Terms of Clinical, Radiological, and Functional Outcomes and Possible Pathophysiological Mechanisms.

AIM: The aim is to discuss the clinical characteristics, time, anatomical vascular distribution, radiological features, functional outcomes after stroke and possible pathophysiological mechanisms of acute ischemic stroke (AIS) that develop after cardiac surgery. METHOD: A total of 3,474 patients, who underwent cardiac surgery between 2015-2020, retrospectively were analyzed. Forty-nine patients, who developed AIS and had brain CT and diffusion MR images during hospitalization, were included in the study. RESULTS: AIS distribution was at 53% CABG, 12.2% isolated mitral valve, 8.1% isolated aortic valve, and 26.5% combined surgical procedures. Patients with a ≤2 days (P = 0.03) preop preparation time and body surface area (BSA) of <1.85 m2 (P = 0.02) had a high discharge rate. While newly developing AF was low in the early stroke group, it was higher in the late stroke group (P = 0.02). A history of previous cerebrovascular events was found in 3.3% of the patients. Postoperative new AIS was detected in 7.8% of those with a history of cerebrovascular events. Total anterior circulation infarction (TACI) case rate was 8.1%, partial anterior circulation infarction (PACI) 12.2%, posterior circulation infarction (POCI) 24.4%, cortical border zone infarction (CBZI) 30.6%, combined POCI + CBZI 12.2%, multiple territorial infarcts (MTI) 10.2%, and lacunar circulation infarction (LACI) rate was 2%. The modified Rankin Scale means following AIS was 3.45. The worst Rankin score was 5.75 in CABG+MVR cases; it was found to be 5 in the valve + ascending aorta case and 5 in the five bypass cases. CONCLUSION: Calculation of cerebrovascular reserve with extra/intracranial vascular imaging is important in patients with multiple risk factors, whose association with stroke has been determined before cardiac surgery. We believe that cardiovascular surgery and neurology multidisciplinary prospective randomized studies should be conducted to obtain pre-, peri- and post-procedural risk calculation scales, according to cardiac surgery type and to reshape surgical procedures accordingly.

Giant left atrial capillary haemangioma invading left-main coronary artery.

Cardiac haemangiomas are rare cases and can be seen at any age of life. A 49-year-old woman was admitted to our hospital with chest pain. A well-circumscribed soft tissue mass extending from the pulmonary artery truncus to the left ventricular inferior neighborhood. Following surgical resection, the patient was discharged 4 days after surgery.

Assessing volumetric changes in abdominal aortic aneurysms following endovascular repair.

OBJECTIVE: Volumetric changes in the aneurysm sac were evaluated following endovascular aortic repair (EVAR) in intact abdominal aortic aneurysm (AAA) patients who underwent EVAR. METHODS: Fifty-two patients, who underwent EVAR from 2015 to 2019, were analysed retrospectively. A total of 158 computed tomography angiography scans was examined by performing reconsctructive volumetric calculations. Total aneurysm volume (TAV), patent lumen volume (PLV) and thrombuscoated aneurysm wall volume (TCAWV) were calculated. The results obtained at six, 12 and 24 months postoperatively were compared with those of the pre-operative period. RESULTS: Mean TAV had regressed 7% by the sixth month (p = 0.1), 27% by the 12th month (p = 0.0003) and 19% by the 24th month (p = 0.0008). Mean TCAWV had increased 2% by the sixth month (p = 0.3), and regressed 26% by the 12th month (p = 0.3) and 14% by the 24th month (p = 0.8). Mean PLV had regressed by 20% by the sixth month (p = 0.008), 29% by the 12th month (p = 0.0002) and 26% by the 24th month (p = 0.0006). For each individual proximal, middle and distal measurement, regression was observed at six and 12 months; however, an increase was observed at 24 months compared to the previous follow ups. CONCLUSIONS: The expansion measurements of TAV in the 24th month support the doubts on the medium- to long-term results of EVAR. The largest regression in the aneurysm sac was observed in the distal portion, then in the proximal portion, and the least regression was observed in the middle section.

Predictive Value of Neutrophil-to-Lymphocyte, Aspartate-to-Alanine Aminotransferase, Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratios in Severity and Side of Carotid Artery Stenosis: Are Those Significant?

BACKGROUND: Atherosclerosis is a chronic disease that leads to mortality and morbidity by affecting arterial vascular structures. Carotid artery is one of these arterial structures and occlusive disease of carotid artery may cause stroke or cranial ischemic infarction. Inflammation plays a role in the atherosclerotic process. In this study, we aimed to discuss the relationship between the severity and side of carotid artery occlusion and novel inflammatory parameters include platelet-to-lymphocyte, neutrophil-to- lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios. METHODS: One-hundred-fifteen patients who had carotid artery stenosis between 50%-99% and 115 healthy subjects with no carotid artery stenosis or additional disease were included in the study. The relationship between the side and degree of the lesion and platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios were studied in the patient group. The patients with carotid artery stenosis and the healthy subjects were compared, in the terms of same parameters. Data were evaluated statistically. RESULTS: There were no statistically significant differences between the groups, in the terms of platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios and the degree of stenosis. There was no statistically significant difference between the sides of the lesions and the parameters above except lymphocyte-to-monocyte ratio. It was statistically significantly higher in left-sided lesions. Aspartate-to- alanine aminotransferase and neutrophil-to-lymphocyte ratios were markedly higher in the patient group, when compared to controls. CONCLUSION: Platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to- alanine aminotransferase ratios are inexpensive, easy, fast, and reproducible parameters that can be used in determining the prediction of carotid artery stenosis.

Management of Cardiac Surgery in a Pandemic Region Hospital: Precautions, Results and Experiences During COVID-19.

OBJECTIVE: The aim of the present study was to share the experiences gained from emergency and semiemergency cases of open heart surgery performed during the COVID-19 outbreak in Necmettin Erbakan University Meram Medical Faculty Hospital, which was defined as a pandemic hospital by Turkish Ministry of Health and provided third degree health services. MATERIALS AND METHODS: A total of 54 patients were retrospectively analyzed between 23 March and 22 May 2020, who were diagnosed to have aortic dissection, coronary artery disease, and heart valve diseases. RESULTS: Thirty-two CABG, 12 valve surgery, 6 aortic surgery, 4 CABG + valve surgeries were performed. During the postoperative follow-up of 11 patients, who were suspicious of COVID-19, 8 of them displayed respiratory problems and partial oxygen depletion and required continuous positive airway pressure. The hospitalization duration of COVID-19-suspicious patients were approximately 5 days longer than that of normal patients. In one of the patient, who was treated positive for COVID-19, acute coronary syndrome developed and CABG was performed following the treatment. CONCLUSION: During the pandemic period, acute cardiac diseases needing urgent surgery could be misdiagnosed because of similar symptoms with COVID-19 and the health care practitioners concentrated with the COVID-19 primarily. On the other hand, pandemic fear could cause delayed admission to the hospital and increased postoperative mortality and morbidity. When a COVID-19-positive or -suspicious patient undergo open-heart surgery, problems resulting from both COVID-19 infection and cardiopulmonary bypass-associated systemic effects could arise. The combination of these two cases could worsen the complications.

Comparison between the Effects of Bretschneider's HTK Solution and Cold Blood Cardioplegia on Systemic Endothelial Functions in Patients who Undergo Coronary Artery Bypass Surgery: a Prospective Randomized and Controlled Trial.

OBJECTIVE: To investigate the effects of Bretschneider's histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia on systemic endothelial functions. METHODS: A total of 50 patients who underwent isolated coronary artery bypass surgery between March 2018 and May 2018 were randomly divided into two groups - group 1 (Bretschneider's HTK solution, n=25) and group 2 (cold blood cardioplegia, n=25). Data related to the indicators of endothelial dysfunction were recorded. Flow-mediated dilation was measured together with the assessment of the values of endothelin-1, von Willebrand factor, and asymmetric dimethylarginine to identify endothelial dysfunction. Then, the two groups were compared regarding these values. RESULTS: The most significant result of our study was that the endothelin-1 level was significantly higher in group 2 than in group 1 (P<0.001). The value of flow-mediated dilation was found to increase to a lesser degree on the postoperative days compared to the value at the day of admission in group 1 (P=0.002 and P=0.030, respectively). CONCLUSION: Cardiopulmonary bypass leads to endothelial dysfunction. Our results revealed that Bretschneider's HTK solution causes less severe endothelial injury than cold blood cardioplegia.

Comparison between the effects of bretschneiders htk solution and cold blood cardioplegia on systemic endothelial functions in patients who undergo coronary artery bypass surgery: a prospective randomized and controlled trial

Abstract Objective: To investigate the effects of Bretschneider's histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia on systemic endothelial functions. Methods: A total of 50 patients who underwent isolated coronary artery bypass surgery between March 2018 and May 2018 were randomly divided into two groups - group 1 (Bretschneider's HTK solution, n=25) and group 2 (cold blood cardioplegia, n=25). Data related to the indicators of endothelial dysfunction were recorded. Flow-mediated dilation was measured together with the assessment of the values of endothelin-1, von Willebrand factor, and asymmetric dimethylarginine to identify endothelial dysfunction. Then, the two groups were compared regarding these values. Results: The most significant result of our study was that the endothelin-1 level was significantly higher in group 2 than in group 1 (P<0.001). The value of flow-mediated dilation was found to increase to a lesser degree on the postoperative days compared to the value at the day of admission in group 1 (P=0.002 and P=0.030, respectively). Conclusion: Cardiopulmonary bypass leads to endothelial dysfunction. Our results revealed that Bretschneider's HTK solution causes less severe endothelial injury than cold blood cardioplegia.

Relaxation matters: comparison of in-vitro vasodilatory role of botulinum toxin-A and papaverine in human radial artery grafts.

BACKGROUND: Radial artery (RA) is widely used in coronary artery bypass (CABG) surgery and the prevention of spasm is crucial for graft patency. Botulinum toxin A (BTX-A) and B are commonly used for aesthetic reasons and neuromuscular disorders. They are proven to raise blood flow and increase survival of ischemic skin flaps. In this study we evaluated and compared the vasodilator effects of BTX-A and papaverine on human RA grafts. METHODS: After resting 60 min in isolated organ baths, human RA grafts were examined. Contraction responses for different doses of serotonin (5-HT) and endothelin-1 (ET-1) were evaluated as a percent of maximum contraction response elicited by 80 mM potassium chloride (KCl). The inhibitory effects of BTX-A and papaverine on contraction responses taken at the 0th hour were compared with the 1st and 2nd hour responses. Inhibitory effects of BTX-A and papaverine against the contractile agent were evaluated by comparing the results of the first and last (0th and 2nd hour) application. RESULTS: In low concentrations, when we compared the effects of BTX-A (10- 8 M) and papaverine (10- 6 M) on 5-HT, papaverine was found to be more effective at both the 0th and 2nd hour (p < 0.05). Both BTX-A and papaverine inhibited the maximum contractile effect of ET-1 to the same extent at the 0th hour; but, the inhibitory effect of BTX-A was significantly stronger at the 2nd hour (p < 0.05). In high concentrations, when we compared the effects of BTX-A (10- 6 M) and papaverine (10- 4 M) on 5-HT, papaverine showed stronger inhibition (p < 0.05), whereas both agents had similar action of inhibition on ET-1 mediated maximum contraction responses. CONCLUSION: BTX-A inhibits both ET-1 and 5-HT induced contractions and its effectiveness does not decrease over time as observed with papaverine. This study is the first in the literature using human RA for prevention of vasospasm by BTX-A.

Gradual treatment of arteriovenous fistula in femoral vessels as a complication of coronary angiography

Abstract Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.

Left Atrial Giant Cell Myocarditis Presenting as a Tumor: First-in-Man Case Report.

Giant cell myocarditis is a rare and highly lethal disorder with resultant cardiac insufficiency. It necessitates aggressive immune suppression therapy, although the results are often fatal. When it affects only the atria, the characteristics of the disease changes completely. In this case report, we present atypical presentation of atrial giant cell myocarditis with mass lesion, which completely resolved after successful surgical resection without immuno suppression therapy.

Left atrial giant cell myocarditis presenting as a tumor: first-in-man case report

Abstract Giant cell myocarditis is a rare and highly lethal disorder with resultant cardiac insufficiency. It necessitates aggressive immune suppression therapy, although the results are often fatal. When it affects only the atria, the characteristics of the disease changes completely. In this case report, we present atypical presentation of atrial giant cell myocarditis with mass lesion, which completely resolved after successful surgical resection without immuno suppression therapy.

Gradual Treatment of Arteriovenous Fistula in Femoral Vessels as a Complication of Coronary Angiography.

Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.

Transaortic accessory mitral valve excision in an adult patient: Case report.

Accessory mitral valve tissue is a rare congenital cardiac anomaly, and is usually incidentally detected in childhood. In this case, we present a 65-year-old man with aortic stenosis originating from an accessory mitral valve leaflet attached to the anterior mitral leaflet. Interestingly enough, the patient's accessory mitral valve remained undetected for years until he became symptomatic for degenerative aortic stenosis. Aortic valve replacement and excision of the accessory mitral valve attached to the anterior mitral leaflet was performed with a transaortic approach instead of atriotomy. It was also unusual to see accessory mitral valve tissue with aortic stenosis instead of other frequently associated congenital anomalies.

Full metal jacket: transfemoral aortic valve implantation for regurgitant valve after endovascular aortic repair.

Transfemoral aortic valve implantation has become an almost routine interventional procedure for severe aortic stenosis in high-risk patients. Over time an increased number of experiences has led to unusual procedures. In this report, we present a successful valve-in-valve transfemoral aortic valve implantation in a patient with aortic regurgitation, who previously had debranching and thoracic endovascular aortic repair operations.

New World's old disease: cardiac hydatid disease and surgical principles.

BACKGROUND: Hydatid cyst is a parasitic disease caused by infection with the Echinococcus granulosus tapeworm larva. It is a major public health problem in endemic regions. Cardiac involvement of the disease is rare. METHODS: Between 1985 and 2015, 12 patients were admitted to our clinic with a possible diagnosis of cardiac hydatid disease. Of these patients, six (50%) were male and six (50%) were female. Mean age of the patients was 42.6 years. RESULTS: The most common location of cardiac hydatid disease was left sided (six patients, 50%). Five (41.7%) patients had cysts located in the right heart, whereas one (8.3%) had a cyst in the interventricular septum. Eleven (91.7%) of the patients were operated on via median sternotomy and the remaining one was operated on via a left anterolateral thoracotomy. Ten (83.3%) of the patients were operated on using cardiopulmonary bypass under moderate hypothermia, whereas the remaining two (16.7%) had off-pump surgery. There was no surgical mortality in our series. All patients were discharged with medical therapy (mebendazole or albendazole) for the duration of six months. No recurrences were observed in their follow ups. CONCLUSION: Although cardiac hydatid disease is rare, its prevalence seems to have increased in the last decade. Any patient with suspected cardiac symptoms suggesting mass lesions should be considered for a differential diagnosis of cardiac hydatid disease, especially in developing countries. Definitive treatment is removal of the cyst, combined with medical therapy.

[Evaluation of post-operative flow and diameter changes in brachial and ulnar arteries in coronary artery bypass surgery patients in which the radial artery is used as graft]. / Koroner arter baypas cerrahisinde radiyal arter grefti kullanilan hastalarda ameliyat sonrasi dönemde brakiyal ve ulnar arterlerde meydana gelen akim ve çap degisikliklerinin incelenmesi.

OBJECTIVE: The radial artery is widely used in coronary bypass surgery. In these patients, forearm and hand circulation is provided by the ulnar artery. This study aimed to investigate post-operative changes in flow and diameter in brachial and ulnar arteries in patients undergoing coronary bypass surgery in which the radial artery is used as graft. METHODS: Between September 2007 and September 2008, 20 patients (16 men, 4 women; mean age 57.8 years; range 44 to 70 years) underwent elective coronary bypass surgery at our clinic. The radial artery was used as graft in all cases. Pre-operatively, adequacy of the ulnar artery for forearm circulation was investigated by Allen test and duplex ultrasonography. Basal flow and diameter values of the brachial and ulnar arteries were measured. Control duplex ultrasound measurements were performed at three months post-operatively. Flow and diameter changes in the brachial and ulnar arteries were recorded. RESULTS: Significant increase was shown in ulnar artery flow and diameter values in post-operative measurements. A significant increase was observed in brachial artery diameter, accompanied by a relative decrease in flow value. There were no mortality or ischemic complications in our study. Transient paresthesia as a neurological complication was observed in 4 patients. CONCLUSION: Radial artery use for coronary bypass surgery leads to significant changes in ulnar and brachial arteries. All flow and diameter changes can be detected by color Doppler ultrasonography in the early stages. These adaptation mechanisms show that the radial artery can be safely harvested as graft material.