Aorta-to-right ventricular fistula due to pectus bar migration.

A 23-year-old man, operated on for pectus excavatum with a modified Ravitch procedure, was admitted to our emergency department suffering from severe dyspnea. Massive pericardial effusion, rupture of the sinus of Valsalva, and aortic-to-right ventricular fistula were present on echocardiography. Cardiac penetration of the metal bar was detected on chest CT scan. The defect at the right sinus of Valsalva was closed with a PTFE patch, and the right aortic and ventricular ruptures were repaired primarily.

Aspirin resistance after CABG.

BACKGROUND: Temporary aspirin resistance can occur during the post-CABG period. If the factors causing resistance can be identified, the incidence of early graft occlusions can also be minimized. METHODS: 25 elective CABG cases were enrolled in the study. The platelet count, mean platelet volume, the C-reactive protein level, lipid profile, blood urea nitrogen (BUN), and creatinine levels were identified one day before the operation and on the 1st, 5th and 10th postoperative days. Optical aggregometry was used for the evaluation of aspirin response. The patients were divided into two groups: those with aspirin resistance and those with no aspirin resistance. RESULTS: The rate of postoperative aspirin resistance was found to be 60 %. No significant difference was found when the preoperative and operative data of the two groups were compared. It was found that the rapid changes observed in the postoperative platelet counts and the C-reactive protein levels were similar. CONCLUSION: Aspirin resistance is encountered during the early postoperative period in the majority of patients undergoing CABG. None of the factors studied were found to be causative for resistance formation. Further studies are required to clarify this entity.

Coronary artery stabilization causes endothelial damage: an electron microscopic study on dogs.

In recent years, to protect patients from adverse effects of cardiopulmonary bypass, off-pump coronary artery bypass operations are performed. In these operations, effective coronary artery immobilization is the standard for a fine anastomosis. This is usually maintained with the help of prolene immobilization sutures, bulldog occluders or mechanical epicardial devices. The aim of this study is to show whether these stabilization devices cause any damage to the coronary artery endothelium. Sixteen dogs are included in this study and are divided into four groups. The control group consisted of one dog (Group I) and different immobilization techniques are applied to the other groups, which were five dogs each (Groups II, III, and IV). Coronary artery biopsies are obtained, then the samples are studied under scanning electron microscope (SEM) for endothelial injury and all samples are scored. Among the techniques used, bulldog occluders caused less injury on the coronary endothelium than the prolene sutures.

Effects of hypothermia on blood endogenous endotoxin levels during cardiopulmonary bypass.

Endotoxin activates white blood cells and complement and produces a spectrum of clinical syndromes ranging from fever to septic shock. Although production of endogenous endotoxemia during cardiopulmonary bypass (CPB) has recently been reported, the role of hypothermia on endotoxemia is not clear. In this study, we evaluated the effects of moderate (24-28 degrees C) and mild (32-34 degrees C) hypothermia on blood endotoxin levels. The study population consisted of 20 patients who underwent coronary artery bypass grafting (CABG) with CPB. Moderate systemic hypothermia was applied during aortic cross-clamping in ten patients (group 1) and mild hypothermia in the remaining ten patients (group 2). The mean rectal temperatures were 26.8 +/- 1.2 degrees C in group 1 and 33.8 +/- 0.8 degrees C in group 2. The blood samples for endotoxin level measurements were obtained before CPB, during aortic cross-clamping, immediately after the release of the cross-clamp, 20 minutes after the release of the cross-clamp, after CPB, and 2 hours postoperatively. There were no endotoxins in any of the samples before CPB, but it was detected after CPB in both groups. The endotoxin levels were significantly higher in group 1 than in group 2. The present study suggests that when hypothermia is the technique of choice, the deleterious effects of endotoxemia on patients with comorbidity must be considered.