Calcification And Atheroma Plaques: Is There Any Impact On The Anatomical Features Of The Aortic Root And Its Elements?

OBJECTIVES: Morphometric information of the structures within the borders of the aortic root is a guide for surgical interventions. It is essential to determine the effects of aortic calcification and atheroma plaque findings on the structures of this region. This study aims to establish the normal values of aortic root structures and to investigate the impact of pathologic findings in order to guide diagnosis and treatment in the clinic. METHODS: The aortic root structures were morphometrically analyzed in fresh hearts of 110 patients (89 males, 21 females) brought to the forensic medicine institution. The distances between the bases of the aortic sinuses, their widths and heights, and the lengths of the commissures were measured to differentiate between pathologic and non-pathologic aortic classes. Parameters were compared according to gender, age, body mass index and body surface area. RESULTS: The mean age was 44.71±15.57 years in 21 female patients and 53.66±15.67 years in 89 male patients. The results of the pathologic aorta group with calcification and atheroma plaque findings were higher than the non-pathologic aorta group in all parameters (p<0.05). CONCLUSIONS: Calcification and the presence of atheroma plaque in the aorta increase the size of the structures at the aortic root. Gender, age, body mass index and body surface area are among the criteria that will cause changes in the structures of this region. These results will help surgeons to know the normal values of aortic root structures and to consider the effects of pathologic findings in aortic valve repair operations.

Single center two years' experience of Ozaki procedure: Early follow-up.

The Ozaki Procedure is an innovative surgical technique aiming of aortic valve neocuspidization using glutaraldehyde-treated autologous pericardium was first developed by Ozaki et al in 2007. With this newly developed technique, valve replacement was achieved without using prosthetic material due to both aortic stenosis and aortic insufficiency. Between December 2020 and December 2022, a total of 59 patients were operated on with the Ozaki Procedure due to aortic valve pathologies in our center. We evaluated the pre- and postoperative as well as the first-month data of a total of 44 patients with isolated the Ozaki Procedure and compared their echocardiographic changes. Patients with isolated aortic valve pathology were included in the study. Fifteen patients who underwent simultaneous coronary artery bypass surgery and Ozaki Procedure were excluded from the analysis. In the first month after the operation, n:2 (%4.5) patients died. When the preoperative and postoperative 1st month echocardiographic data of the remaining patients were compared, it was found that the decrease in mean gradient, max gradient and peak velocity values in the aortic valve was statistically significant. This is due to the fact that reaching neo-valves has very similar hemodynamics to the native aortic valve. Aortic valve neocuspidization by Ozaki Procedure may be a viable alternative to both surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation. Its popularity and application is increasing all over the world. Short and mid-term results are available in the literature. The short and mid-term results are good, and the long-term results are hopeful.

Efficiency of Thyroid Function Test in the Prediction of Atrial Fibrillation Following Open Heart Surgery.

OBJECTIVE: To analyse the efficiency of thyroid function tests (thyroid stimulating hormone, thyroxine and tri-iodothyronine) on prediction of postoperative atrial fibrillation. STUDY DESIGN: Meta-analysis. Place of Study: Siyami Ersek Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. METHODOLOGY: Literature review was carried out in PubMed, Science Direct and Ovid Database. No date limitations was applied. Trials, which evaluated the preoperative levels of thyroid stimulating hormone, thyroxine and tri-iodothyronine in cardiac surgery patients, were included. Only the articles in English language were reviewed. We evaluated the results with fix or random effect models according to the presence of heterogeneity (I2 >25%). RESULTS: Five hundred and forty-seven articles were obtained after screening of databases. After checking over the titles and abstracts, five trials were included which covered 380 patients and complied with inclusion criteria. According to results of analysis, there was no significant relationship between postoperative atrial fibrillation and thyroid stimulating hormone (SMD: 0.38, 95%CI -0.46-1.23, p=0.375), and also thyroxine (SMD: 0.006, 95% CI -0.29-0.30, p=0.966). However, tri-iodothyronine (SMD: -1.06, 95% CI -2.08- -0.03, p=0.04) was correlated with development of atrial fibrillation. Heterogeneity was observed in three parameters (I2; for TSH: 92.45%, for T3: 93.08% and for T4: 31.78%). CONCLUSION: Preoperative levels of tri-iodothyronine was an effective parameter for predicting postoperative atrial fibrillation after cardiac surgery, but there was a need of larger trials for eliminating heterogeneity for all of the parameters of thyroid function tests. Key Words: Cardiac surgery, Atrial fibrillation, Thyroid stimulating hormone, Thyroxine, Tri-iodothyronine.