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1.
Appl Bionics Biomech ; 2021: 2169431, 2021.
Article in English | MEDLINE | ID: mdl-34659454

ABSTRACT

BACKGROUND: Stainless steel wires are still commonly used as a sternum closure technique. However, it can cause fatal complications due to rupture and dehiscence. It was anticipated that the sternal Cable System (Pioneer Surgical Technology Inc., Marquette, MI, USA) could provide a better sternal fixation and reduce the possible complications. Materials and Method. A total of 100 patients (57 male, 43 female) at high risk of dehiscence were included in this prospective observational study. Among those with EuroSCORE value of 4 and above, patients with chronic lung disease, chronic kidney disease, diabetes mellitus, obesity, smoking, body mass index, advanced age, and resurgery were operated in two separate centers. Standard steel wires (n: 51) used for sternotomy were compared with the sternal cable (n: 49). Early and late sternal dehiscence rates were compared in the study. The relationship between risk factors causing dehiscence and both methods was assessed statistically. RESULTS: Early dehiscence rates were 6.4% in those closed with a sternal cable (n: 3) and 11.8% in those closed with a sternal wire (n: 6) (p < 0.05)). In risky patients, body mass index was the most determining parameter in terms of sternum dehiscence risk. CONCLUSION: In risky patients, we recommend the sternal cable system as a good and reliable closure technique to achieve a more stable and compact sternum.

2.
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
3.
Ulus Cerrahi Derg ; 30(1): 51-3, 2014.
Article in English | MEDLINE | ID: mdl-25931881

ABSTRACT

Type 1 aortic dissection is a catastrophic clinical entity originating from the ascending aorta. Clinical suspicion in patients with epigastric pain, chest pain and gastrointestinal symptoms might be life saving. Aortic dissection and acute mesenteric ischemia might be confusing in diagnosis of patients with epigastric pain, chest pain, gastrointestinal symptoms and high white blood cell count and D-dimer. In this case report of a patient who was admitted to the emergency room with a presentation resembling acute mesenteric ischemia, this diagnosis was excluded within the first 24 hours as a result of clinical suspicion. In this case report, the successful management in diagnosis and treatment of a 30-year-old male patient with type 1 aortic dissection is discussed in light of the literature.

4.
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
5.
Eur J Echocardiogr ; 11(5): E22, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20080868

ABSTRACT

In this report, we describe a case with severe tricuspid stenosis associated with partial luminal obstruction of the right atrium and vena cava superior secondary to transvenous pacemaker leads in a 49-year-old patient who had a permanent pacemaker implanted 17 years ago. The patient had no specific symptoms related to above findings; however, after clinical suspicion, transthoracic and transoesophageal echocardiographic examination showed large mobile masses attached to the thickened transvenous pacemaker leads. Leads and generator were removed surgically, but some parts of transvenous leads could not be extracted due to massive fibrotic adhesions. It is possible that such cases will be more common due to increasing number of cardiac rhythm device implantations.


Subject(s)
Cardiac Pacing, Artificial/adverse effects , Foreign Bodies/complications , Heart Atria/pathology , Tricuspid Valve Stenosis/etiology , Tricuspid Valve/pathology , Vena Cava, Superior/pathology , Endocardium , Foreign Bodies/surgery , Heart Atria/diagnostic imaging , Heart Atria/surgery , Humans , Male , Middle Aged , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/surgery , Tricuspid Valve Stenosis/diagnostic imaging , Tricuspid Valve Stenosis/surgery , Ultrasonography , Vena Cava, Superior/diagnostic imaging , Vena Cava, Superior/surgery
6.
J Card Surg ; 24(3): 256-9, 2009.
Article in English | MEDLINE | ID: mdl-19438777

ABSTRACT

BACKGROUND: Primary cardiac tumors are rarely seen and have an incidence of 0.3% of all open-cardiac operations. Among those, myxoma is the most common cardiac tumor. There are only a few reports of such tumors from Turkey. METHODS AND RESULTS: We report our experience with 67 patients with primary cardiac myxoma operated on at our institute between December 1990 and October 2006. The study group comprised 22.38% males and 77.61% females with a mean age of 46.29 (+/-18.29) years. The predominant symptoms were dyspnea and palpitation. In addition, 3 patients presented with peripheral embolism with impending limb ischemia that necessitated emergency embolectomy. Echocardiography was generally enough for the demonstration of the myxomas. Two sporadic myxomas (%2.98) and one familial myxomas (1.49%) presented with recurrence. There were three (4.47%) hospital mortalities. Two patients (2.27%), with preoperative decompensation, died after tumor resection, from progressive low cardiac output. One patient, with preoperative massive pulmonary embolus, died two days after operation, from right ventricle insufficient. CONCLUSION: In conclusion, we herein summarized surgical results with primary cardiac myxomas. Surgical excision of primary cardiac myxomas tends to show excellent results after surgical excision.


Subject(s)
Cardiac Surgical Procedures/methods , Heart Neoplasms/surgery , Myxoma/surgery , Adolescent , Adult , Aged , Cardiac Catheterization , Echocardiography , Electrocardiography , Female , Follow-Up Studies , Heart Arrest, Induced/methods , Heart Neoplasms/diagnosis , Heart Neoplasms/epidemiology , Humans , Incidence , Male , Middle Aged , Myxoma/diagnosis , Myxoma/epidemiology , Neoplasm Recurrence, Local/epidemiology , Radiography, Thoracic , Retrospective Studies , Survival Rate/trends , Treatment Outcome , Turkey/epidemiology , Young Adult
8.
J Am Soc Echocardiogr ; 21(10): 1178.e1-3, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18926394

ABSTRACT

We report a left ventricular pseudoaneurysm, an unusual complication of mitral valve replacement (MVR) in a 65-year-old man who had undergone coronary artery bypass grafting and MVR surgery two years ago. The patient was referred to our clinics because of progressive exertional dyspnea and palpitations. Transthoracic and transesophageal echocardiography showed a large pseudoaneurysm of the posterolateral left ventricular wall and computerized tomographic angiography (CTA) demonstrated the location and the size of the pseudoaneurysm and its neck. Urgent surgical repair was accomplished without complications.


Subject(s)
Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Heart Injuries/diagnostic imaging , Heart Injuries/etiology , Heart Valve Prosthesis/adverse effects , Heart Ventricles/diagnostic imaging , Heart Ventricles/injuries , Mitral Valve/diagnostic imaging , Aged , Heart Valve Prosthesis Implantation/adverse effects , Humans , Male , Rupture/diagnostic imaging , Rupture/etiology , Ultrasonography
9.
Asian Cardiovasc Thorac Ann ; 13(2): 153-6, 2005 Jun.
Article in English | MEDLINE | ID: mdl-15905345

ABSTRACT

The frequencies of angiotensin-converting enzyme gene insertion/deletion, angiotensinogen-M253T, and angiotensin II type 1 receptor-A1166C polymorphisms were analyzed in 105 patients undergoing coronary artery bypass grafting (group 1) and a control group of 105 non-cardiac patients (group 2). Blood samples were obtained for biochemical analyses and DNA extraction. Genotyping was performed by polymerase-chain-reaction-based restriction analysis. According to the angiotensin-converting enzyme gene insertion/deletion polymorphism, 36.3% of patients in group 1 and 30.7% in group 2 were homozygous for the DD allele. This difference was not statistically significant. Angiotensin II type 1 receptor-A1166C genotype polymorphism was also not significantly different between the groups. The results showed the angiotensinogen-M235T polymorphism to be heterogenous. The MM homozygote frequency was significantly higher in controls (72.3%), whereas 80% of the TT homozygote frequency was in the surgical group ( p = 0.001). These results show that although there were no significant differences in angiotensin-converting enzyme gene insertion/deletion and angiotensin II type 1 receptor-A1166C genotype polymorphisms between the groups, angiotensinogen-M235T polymorphism of TT homozygote frequency was significantly associated with patients undergoing coronary artery bypass surgery.


Subject(s)
Angiotensinogen/genetics , Coronary Artery Bypass , Coronary Disease/genetics , Receptor, Angiotensin, Type 1/genetics , Renin-Angiotensin System/genetics , Aged , Coronary Disease/surgery , DNA Transposable Elements , Female , Gene Deletion , Gene Frequency , Humans , Male , Middle Aged , Polymerase Chain Reaction , Polymorphism, Genetic
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