ABSTRACT
BACKGROUND: Myxomas are primary cardiac tumours that may be detected incidentally due to embolic events, intracardiac obstructive features or non-specific structural symptoms. The aim of this study was to share our experience of clinical features, diagnostic methods, surgical procedures and postoperative follow up of surgically treated cardiac myxomas. METHODS: Data of 34 patients who underwent surgery for a cardiac myxoma between January 2006 and June 2022 were retrospectively analysed. Group 1 (n = 19) consisted of patients who were symptomatic and group 2 ( n = 15) patients were asymptomatic. The medical records of the patients, their clinical status, diagnostic methods, operation information and postoperative course data were collected and recorded. RESULTS: A total of 34 patients (16 female; mean age 54.5 ± 8.8 years) underwent cardiac myxoma resection with cardiopulmonary bypass. Fifteen (44.1%) patients were diagnosed incidentally with asymptomatic myxoma. An additional cardiac surgical procedure was performed in six patients (17.7%). The 34 cardiac myxomas that were surgically resected were localised in the left atrium in 25 patients (73.5%) and in the right atrium in nine patients (26.5%). Patients' most common symptoms were dyspnoea (42.1%), palpitations (21.1%), ischaemic stroke (15.8%) and syncope (10.5%). There was no incident of 30-day mortality and no recurrence was observed in any patient during the follow-up period. The duration of surgical intervention in symptomatic patients was significantly shorter than in asymptomatic patients (p = 0.0001), but there was no statistical difference in terms of characteristics. CONCLUSIONS: Myxomas are benign tumours, but they are serious pathologies that require early treatment because of signs of obstruction, embolic complications and confusion, with left atrial thrombus in the differential diagnosis.
ABSTRACT
OBJECTIVE: Recent studies suggest that increased red blood cell distribution width may be associated with increased risk of atrial fibrillation. This study aimed to evaluate the relationship between pre-operative and postoperative erythrocyte distribution volume, postoperative atrial fibrillation and related adverse events in patients undergoing isolated coronary artery bypass surgery. METHODS: A total of 790 patients (611 males, mean age 58.3 ± 6.2 years) in pre-operative sinus rhythm, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass at the same centre and by the same surgical team between January 2015 and December 2021, were enrolled retrospectively. Two groups were created, group 1 (n = 183) and group 2 (n = 607), with regard to the occurrence of atrial fibrillation in the early postoperative period or not, respectively. Clinical and demographic data, biochemical and complete blood count parameters, and intra-operative and postoperative data of the patients were recorded. Univariate and subsequent multivariate logistic regression analysis was done to determine significant clinical factors and independent predictors of postoperative atrial fibrillation. RESULTS: Among the patients, 182 (23.2%) developed atrial fibrillation during the 72 hours postoperatively. Pre-operative and postoperative first-, third- and seventh-day red blood cell distribution volume (p = 0.0001), C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis showed elevated pre-operative and postoperative first-, thirdand seventh-day red blood cell distribution volume, erythrocyte sedimentation rate and C-reactive protein as independent predictors of early postoperative atrial fibrillation. CONCLUSIONS: Pre-operative and postoperative red blood cell distribution volume was found to be an independent predictor of atrial fibrillation and associated adverse events in the early postoperative period of isolated coronary artery bypass grafting.
ABSTRACT
Aim: The aim of the article was to study the role of the time between cardiac catheterization and cardiac surgery in the development of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting was investigated. Material and methods: A total of 1196 patients (832 males, 364 females; mean age 60.8 ±8.2 years; range: 32-74 years) operated between November 2006 and June 2014 at the same centre and by the same team for isolated coronary artery bypass grafting with cardiopulmonary bypass, whose preoperative serum creatinine level was < 1.5 mg/dl, were enrolled in the study. Patients were divided into group 1 - with acute kidney injury in the early postoperative period (n = 207) and group 2 - without (n = 989). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was performed to determine independent predictors of acute kidney injury. Results: A total of 207 (17.3%) patients developed acute kidney injury during 72 h postoperatively. Regarding the time interval between coronary angiography and coronary artery bypass grafting, there was a statistically highly significant difference between the patients with and without acute kidney injury (7.8 and 11.9 days, respectively; p = 0.0001). Postoperative C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis revealed the time between cardiac catheterization and surgery (p = 0.0001), increased postoperative C-reactive protein (p = 0.007 and p = 0.0001, respectively), and erythrocyte sedimentation rate (p = 0.0001) as independent predictors of early postoperative acute kidney injury in patients undergone isolated coronary artery bypass grafting. Conclusions: If patients to be operated on are stable from a cardiac aspect, limitation of surgery in the early period following catheterization results in reduction of the incidence of postoperative acute kidney injury.
ABSTRACT
BACKGROUND: Iloprost, which has efficacy in the microvascular space, is shown to have beneficial effects on the kidney, which has an extensive microvascular network. OBJECTIVE: We aimed to evaluate the effect of iloprost treatment on kidney functions in patients with critical limb ischemia. METHODS: Forty-eight patients with critical limb ischemia who were not suitable for revascularization and who were treated with iloprost were evaluated prospectively in our clinic between September 2010 and December 2012. The patients were divided into 2 groups as patients with chronic renal dysfunction (Group I) and patients with normal renal function (Group II). Urine albumin:creatinine ratio and glomerular filtration rate (GFR) calculated using serum creatinine and serum cystatin C (GFRcyc) were used to establish the presence of renal dysfunction. The decrease analgesic requirement, walking distance, reduction in ulcer diameter, the increase in ankle-brachial index, and changes in The Society of Vascular Surgery/International Society of Cardiovascular Surgery criteria were used in the evaluation of treatment response. RESULTS: Opioid analgesic requirement and decubitus pain disappeared after treatment in 58.3% (n = 28) of subjects. Walking distance increased in 66.6% (n = 32). Iloprost treatment significantly increased ankle-brachial index (P < 0.01). In Group I the levels of serum urea, creatinine, and cystatin C significantly decreased (P < 0.05), whereas GFRcyc and GFR calculated using the equation of the Chronic Kidney Disease Epidemiology Collaboration (ie, GFR expressed for specified race, sex, and serum creatinine in milligrams per deciliter) was increased significantly compared with pretreatment levels (P < 0.05). No significant change was observed in urine albumin:creatinine ratio (P > 0.05). CONCLUSIONS: The use of iloprost in critical limb ischemia can slow down the progress of early stage renal damage. GFRcyc and cystatin C, which are indicators of early stage chronic renal dysfunction, can be used for the evaluation of treatment response.
