Clinical and hemodynamic follow-up of a patient after operation for dissection of an ascending aortic aneurysm secondary to coarctation of the aorta.

We present clinical follow-up of a 20-year-old male with an aortic aneurysm secondary to aortic coarctation. The diagnosis of aortic aneurysm secondary to aortic coarctation was made in 1997. The patient did not agree to undergo any invasive or therapeutic procedures at that time. He presented to an emergency unit with severe chest pain after chest trauma obtained during judo exercises in 1998. Two-dimensional echocardiography showed bicuspid aortic valves, an ascending aortic aneurysm 6 cm in diameter with an intimal flap and false lumen, aortic coarctation distal to the left subclavian artery, and aortic insufficiency secondary to annular dilatation. Type II aortic dissection was confirmed by transesophageal echocardiography, which showed the dissection was confined to the ascending aorta. The dissection extended to the beginning of the arcus aorta. Following stabilization of the patient's clinical condition, balloon coarctation angioplasty was performed to reduce afterload and hypertension and to facilitate femoral artery cannulation for cardiopulmonary bypass. Surgical procedures included resection of the aortic valve and prosthetic valve implantation, resection of the ascending aorta, and interposition of a 22 mm Hamashied tubular vascular graft. At a follow-up visit 6 years later, the patient reported being easily fatigued and having palpitations. He had been suffering from hemolytic anemia and mild renal function impairment. Cardiac catheterisation and angiography showed a 40 mmHg gradient due to kinking of the aortic graft and no gradient at the coarctation site. We postulated the kinking of the aortic vascular graft may be related to an inappropriate vascular graft length. We also thought that the severe hemolysis was attributable to the disturbance of blood flow by a jet of blood at the site of the kinking aortic vascular graft. A second operation was performed because the renal function of the patient had decreased progressively and hemolysis symptoms increased. After the second operation, hemolysis on peripheral blood smears had disappeared and renal function had shown progressive improvements.

Clinical, bacteriologic and echocardiographic evaluation of infective endocarditis in Ankara, Turkey.

This study consists of a retrospective evaluation of microbiologic, echocardiographic, and clinical characteristics of patients with infective endocarditis seen at Türkiye Yüksek Ihtisas and SSK Ihtisas Hospitals during the previous 5 years to provide a basis for comparison with other series. The study was performed retrospectively. The mean age of the patient population, which consisted of 74 cases, was considerably low (24.6+/-12.3 yr). The majority of the patients were male (male/female = 1.96). Rheumatic valvular disease was the underlying cardiac pathosis in 66% of the cases. Congestive heart failure, embolic episodes, and mortality were more frequent among those with echocardiographically demonstrable cardiac vegetations. The microbiologic profile was considerably different from that of other series. In addition, this population showed a higher rate of congestive heart failure compared to other series. The patients with infective endocarditis in this series in the previous 5 years were found to be different from series reported from western countries.