Achondroplasia with co-morbid CHD is rare, as are reports of surgical treatment for such patients... more Achondroplasia with co-morbid CHD is rare, as are reports of surgical treatment for such patients. We present the case of a 13-year-old girl with achondroplasia and ventricular septal defect. Her ventricular septal defect was surgically repaired focussing on the cardiopulmonary bypass flow, healing of the sternum, and her frail neck cartilage. The surgery and recovery were without complications.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2007
neural-tube defects and cardiovascular defects. Cardiac malformations were also found to be assoc... more neural-tube defects and cardiovascular defects. Cardiac malformations were also found to be associated with carbamazepine as polytherapy (2, 3). One case has been reported with carbamazepine usage as monotherapy during pregnancy where the child was diagnosed with transposition of the great arteries and atrial septal defect following birth (5). When evaluated with the previously reported case, our case suggests that the concurrence of carbamazepine usage, thought to be reasonably safe as monotherapy during pregnancy, and TGA development is not coincidental. It would be prudent to suggest an association between the various drugs and this malformation, though it is clear that two cases do not make the association casual and more extensive studies are required. However, we feel that keeping the concurrence of cardiac malformations in mind in epileptic pregnant mothers using carbamazepine would be prudent. Our aim was to draw attention to the rare concurrence of maternal usage of carbamazepine, and cardiac anomaly in the child by presenting a case.
Although conventional inotropic drugs are well examined for myocardial support during weaning fro... more Although conventional inotropic drugs are well examined for myocardial support during weaning from cardiopulmonary bypass (CPB), there is limited experience about a new calcium sensitiser drug, levosimendan. We aimed to investigate effects of early infusion of 'levosimendan' started per-operatively without a loading dose, on outcomes of patients experiencing difficultly to wean from CPB after coronary artery bypass grafting (CABG). Material and Methods: Forty two consecutive patients undergoing CABG with high Euroscores (>6) were included in the study. Patients received levosimendan at a rate of 0.1 mcg/kg/min (without a loading dose) per-operatively for 24 h. All patients also received dopamine (5-15 mcg/kg/min), 39 patients adrenaline (0.03-0.2 mg/kg/min) and 9 patients were additionally administered dobutamine (6-20 mcg/kg/min). Intra-aortic balloon pump was implanted to four patients who failed to wean from CPB. Pre-and post-operative demographic, echocardiographic and hemodynamic parameters, as well as operative data were analysed. Results: Mean patient age was 61.36±9.1 years (min:39, max:77). Mean extubation time of patients was 18.34±6.2 hours (min:9, max:34) and mean surgical intensive care unit stay was 5.45±2.3 days (min:1, max:15). In comparison to the pre-operative measurements patients showed statistically significant increase of left ventricle ejection fraction (LVEF) and decrease of left atrial, left ventricular end diastolic and right ventricular end diastolic diameters following levosimendan administration in the post-operative period. Increase of pro-BNP level on the 3rd postoperative day was also statistically significant (p=0.047). However, pro-BNP levels on the post-operative 6th month was not significantly different from pre-operative levels (p=0.4). Heart rate and invasive systolic and diastolic blood pressure levels were recorded at 23rd hour of perfusion and compared with those of 1 hour after its cessation. Although heart rate remains almost constant (p=0.13), increase in systolic and diastolic blood pressures was markedly statistically significant (p=0.0001). Conclusion: Levosimendan appears to be an efficient drug if used in addition to conventional inotropics for the management of low cardiac output syndrome states before, during or after onpump cardiac surgery.
Myxomas are the most common benign tumors of the heart. This study presents single-institutional ... more Myxomas are the most common benign tumors of the heart. This study presents single-institutional 22 years experience on cardiac myxomas. The records of 9756 consecutive cases of open heart surgery between 1985 and 2007 revealed 0.23% myxoma. Age ranged between 12 and 77 years and male to female ratio was 7:17. Myxomas originated from the left atrium (15 patients), mitral valve (3 patients), right atrium (2 patients), right atrium and right ventricle (2 patients), right ventricle (1 patient), and left ventricle (1 patient). Three patients were operated for multiple myxomas. Myxomas were resected through right atriotomy, right atriotomy and pulmonary arteriotomy, left atriotomy, biatrial approach, or left ventriculotomy depending on the tumor location. Mean follow-up time was 11.5 years. Mortality occurred in 6 patients (1 early, 5 late deaths). No myxoma recurrence was detected. Myxomas should be resected leaving no remnant mass, without delay when they are diagnosed.
Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial ... more Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2011
Amaç: Atriyal izomerizm, kalp gibi normalde asimetrik olan organlardaki lateralizasyon defektleri... more Amaç: Atriyal izomerizm, kalp gibi normalde asimetrik olan organlardaki lateralizasyon defektleriyle karakterize olan doğumsal bir anomalidir. Atriyal izomerizmin, erken gelişim sırasındaki moleküler defektler nedeniyle oluştuğu düşünülmektedir. NKX2-5, kardiyogenezi başlatan ve kardiyogenezin sonraki transkripsiyonel olaylarını düzenleyen kalbe özgü bir transkripsiyon faktörüdür. HAND1 ise kalpte ekspres olan, asimetrik ekspresyon paterni ile karakterize başka bir transkripsiyon faktörüdür. Çalışmamızda, NKX2-5 ve HAND1 genlerindeki mutasyonların atriyal izomerizm etiyolojisinde rol oynayıp oynamadığını anlamak için, atriyal izomerizm hastalarında bu iki geni incelemeyi amaçladık. Yöntemler: Bu vaka-kontrol çalışması atriyal izomerizm tanısı alan veya atriyal izomerizm nedeniyle cerrahi tedavi gören 70 hasta ve HAND1 için 80, NKX2-5 için, 40 sağlıklı kontrolden oluşturulmuştur. NKX2-5 ve HAND1 genlerinin tüm ekzonları ve ekzon-intron sınırları SSCP ile analiz edilmiş, şüpheli örnekler mutasyon analizi için dizilenmiştir. Bilinen polimorfizmler ve mutasyonlar için uygun restriksiyon enzimi ile enzim kesimi uygulanmıştır. Hasta ve kontrol grupları arasındaki allel ve genotip sıklıklarını Ki-kare ve Fisher testleri kullanılarak karşılaştırıldı. Bulgular: Kontrol ve hastalarda, HAND1 geninin intronik bölgesinde bir C>G dönüşümü tanımladık. Mutant allelin hasta grubundaki sıklığı (%11.42) kontrol grubundakinden (%2.5) daha yüksek bulundu (p=0.046). Mutant allel taşıyan genotipler ile atriyal izomerizm arasındaki bağlantı sınırda anlamlı bulundu (p=0.054). NKX2-5 geninde, bir hastada heterozigot durumda Q170X (Gln170ter) mutasyonu tanımladık. Tanımlanan dizi farklılıkları ile hastaların klinik özellikleri arasında herhangi bir ilişki bulunmadı.
Myxomas are the most common benign tumors of the heart. This study presents single-institutional ... more Myxomas are the most common benign tumors of the heart. This study presents single-institutional 22 years experience on car-diac myxomas. The records of 9756 consecutive cases of open heart surgery between 1985 and 2007 revealed 0.23% myxoma. Age ...
Surgical management of congenital malformati-on of the mitral valve in the paediatric age group r... more Surgical management of congenital malformati-on of the mitral valve in the paediatric age group re-mains a therapeutic challenge. Reconstructive techni-ques in infants and children have been evolved more slowly than in adults due to large variability of mitral disease and the ...
Objective Coronary artery dilations (CDs), a subgroup of coronary artery anomalies (CAAs), are re... more Objective Coronary artery dilations (CDs), a subgroup of coronary artery anomalies (CAAs), are relatively rare but important cardiac pathologies. They are considered to be linked to coronary atherosclerosis in most cases. Methods The demographic data, multi-slice computed tomographic coronary angiography data, coronary calcium score, and ascending aortic diameter (AAD) of 1538 patients were reviewed. In total, 197 (12.8%) patients (166 men, 31 women; age 15 – 84 years; mean 55.78 ± 12.32 years) with CAAs were identified, and 81 (5.3%) patients (70 men, 11 women; age 27 – 80 years; mean 56.63 ± 12.06 years) had CDs. Multiple regression and correlation analyses were performed in all 1538 patients to predict the association between the AAD and the presence of CD and thus their correlation with atherosclerosis. Results The AAD was significantly larger in patients with than without CAAs and CDs. Male sex was significantly more prevalent in patients with CAAs and CDs. According to the mul...
Gangliosides have previously been considered to be possible antigenic sites in Type 1 diabetes. L... more Gangliosides have previously been considered to be possible antigenic sites in Type 1 diabetes. Lymphocytic infiltration of Langerhans islands is the pathologic hallmark of autoimmune diabetes and may also be observed in salivary glands in experimental diabetes. Diabetic complications of parotid and submaxillary glands may therefore be related with an autoimmune process against sialoglycoconjugates of salivary gland tissue.
Background: Coronary computed tomography angiography (CCTA) is helpful in making a precise noninv... more Background: Coronary computed tomography angiography (CCTA) is helpful in making a precise noninvasive evaluation of coronary anatomy, allowing concomitant evaluation of other cardiac structures. The aim of this study was to determine the prevalence of coronary artery variations detected by 64-slice mutidetector CT. Materials and methods: The results of ECG-gated CCTA in 726 consecutive patients (mean age 58 years) were analysed retrospectively. The main indications for CCTA were atypical chest pain, angina pectoris, screening for coronary artery disease and determination of the patency of bypass grafts or stents. Acquisition was performed with a 64-detector CT scanner with retrospective ECG gating. Imaging results were assessed by experienced cardiovascular radiologist. Results: The overall incidence of coronary artery anomalies was 1.1% (8 out of 726 participants). The most common anomaly was an anomalous origin of the circumflex artery from the right coronary sinus with a retroaortic course (4 patients, 0.6%), followed by origin of right coronary artery from the left coronary sinus (2 patients, 0.3%). One patient with abnormal origin of the left main artery from the right coronary sinus (0.1%) and 1 patient with a circumflex artery origin from the proximal segment of the right coronary artery (0.1%) were observed, both with retroartic course. Conclusions: CCTA is a noninvasive imaging technique useful for the precise evaluation of variations of the coronary arteries. This study shows similar results to other reports on this subject.
Aim: Although conventional inotropic drugs are well examined for myocardial support during weanin... more Aim: Although conventional inotropic drugs are well examined for myocardial support during weaning from cardiopulmonary bypass (CPB), there is limited experience about a new calcium sensitiser drug, levosimendan. We aimed to investigate effects of early infusion of 'levosimendan' started per-operatively without a loading dose, on outcomes of patients experiencing difficultly to wean from CPB after coronary artery bypass grafting (CABG). Material and Methods: Forty two consecutive patients undergoing CABG with high Euroscores (>6) were included in the study. Patients received levosimendan at a rate of 0.1 mcg/kg/min (without a loading dose) per-operatively for 24 h. All patients also received dopamine (5-15 mcg/kg/min), 39 patients adrenaline (0.03-0.2 mg/kg/min) and 9 patients were additionally administered dobutamine (6-20 mcg/kg/min). Intra-aortic balloon pump was implanted to four patients who failed to wean from CPB. Pre-and post-operative demographic, echocardiograph...
A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coro... more A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coronary artery bypass operation revealed a mildly dilated mediastinal silhouette, which led the cardiovascular surgery resident to schedule emergency transthoracic echocardiography (TTE), with a special note asking for detailed evaluation of the ascending aorta and aortic arch. TTE revealed a mobile atheroma at the aortic arch, which obliged the cardiac surgery team to modify their strategy to combined hemi-arcus aortae replacement and coronary artery bypass grafting (CABG). Although with transoesophageal echocardiography (TEE) a small portion of the ascending aorta may be obscured by the trachea, TEE provides higher resolution images than TTE. Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment.
ABSTRACT Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of my... more ABSTRACT Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.
The biatrial approach has been the classic means of access for left atrial myxoma resection. Incr... more The biatrial approach has been the classic means of access for left atrial myxoma resection. Increased surgical experience led cardiac surgeons to favour the uniatrial approach to reduce incisions and achieve adequate exposure. In this study, two unilateral surgical approaches were compared in 18 consecutive left atrial myxoma cases. Patients were divided into two groups according to the surgical approach: left atriotomy (group 1, n = 9) and right atriotomy trans-septal approach (group 2, n = 9). Comparison criteria included pre-and post-operative functional capacity, cardiac rhythm, left ventricular ejection fraction, pulmonary artery pressure, left atrial dimensions, cardiopulmonary bypass time, aortic cross-clamp time, drainage over 48 h postoperatively, units of blood transfused, extubation time and length of stay in the intensive care unit and hospital. No significant between-group difference was observed in any criteria except aortic cross-clamp time, which was significantly longer in group 2 than in group 1. No recurrence of myxoma occurred in either group for the 15 patients followed up. Right atrial trans-septal incision appears to be as safe and effective as the left atriotomy approach for left atrial myxoma resection.
To investigate the relationship between anticoagulation treatment and drug resistance in chest pa... more To investigate the relationship between anticoagulation treatment and drug resistance in chest pain, levels of factor Xa residual activity were determined in patients seen in intensive care with recurrent chest pain and compared with levels in patients who had no ischaemic events during hospitalization. A total of 122 patients aged 18 -75 years who were admitted to hospital with acute coronary syndrome and treated with enoxaparin were included. Of these, 62 patients had recurrent chest pain while hospitalized (group A) and 60 patients had an uneventful follow-up period (group B).
Anomalies of pulmonary veins are uncommon and vary widely in their anatomic spectrum and clinical... more Anomalies of pulmonary veins are uncommon and vary widely in their anatomic spectrum and clinical presentation. A 20-year-old woman with complaints of effort-induced dyspnea and easy fatigability was diagnosed with a third left pulmonary vein with abnormal return and arteriovenous fistula accompanied by a secundum atrial septal defect (ASD). Complete surgical repair was performed by ASD closure with a pericardial patch and triple ligation of the left vertical vein and associated third pulmonary vein. The patient was discharged on the seventh postoperative day in good health. Her last control examination was performed in the second postoperative year, revealing normal echocardiographic findings with an excellent clinical course.
The decision to repair mild-to-moderate functional tricuspid regurgitation (TR) during left-side ... more The decision to repair mild-to-moderate functional tricuspid regurgitation (TR) during left-side heart surgery remains controversial. Objectives To avoid heterogeneity in patient population, patients with TR undergoing isolated mechanical mitral valve (MV) replacement for rheumatic mitral diseases were evaluated. Between 1997 and 2009, 236 patients with mild-to-moderate functional TR underwent first-time isolated mechanical MV replacement for rheumatic mitral diseases with (n=123; repair group) or without (n=113; non-repair group) tricuspid valve (TV) repair. Survival, valve-related complications, and TV function in these two groups were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting. Follow-up was complete in 225 patients (95.3%) with a median follow-up of 48.7 months (IQR 20.2-89.5 months), during which time 991 echocardiographic assessments were done. Freedom from moderate-to-severe TR at 5 years was 92.9±2.9% in the repair group and 60.8±6.9% in the non-repair group (p<0.001 and 0.048 in crude and adjusted analyses, respectively). After adjustment, both groups had similar risks of death (HR=0.57, p=0.43), tricuspid reoperation (HR=0.10, p=0.080) and congestive heart failure (HR=1.12, p=0.87). Postoperative moderate-to-severe TR was an independent predictor of poorer event-free survival (HR=2.90, p=0.038). These findings support the strategy of correcting mild-to-moderate functional TR at the time of MV replacement to maintain TV function and improve clinical outcomes.
Achondroplasia with co-morbid CHD is rare, as are reports of surgical treatment for such patients... more Achondroplasia with co-morbid CHD is rare, as are reports of surgical treatment for such patients. We present the case of a 13-year-old girl with achondroplasia and ventricular septal defect. Her ventricular septal defect was surgically repaired focussing on the cardiopulmonary bypass flow, healing of the sternum, and her frail neck cartilage. The surgery and recovery were without complications.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2007
neural-tube defects and cardiovascular defects. Cardiac malformations were also found to be assoc... more neural-tube defects and cardiovascular defects. Cardiac malformations were also found to be associated with carbamazepine as polytherapy (2, 3). One case has been reported with carbamazepine usage as monotherapy during pregnancy where the child was diagnosed with transposition of the great arteries and atrial septal defect following birth (5). When evaluated with the previously reported case, our case suggests that the concurrence of carbamazepine usage, thought to be reasonably safe as monotherapy during pregnancy, and TGA development is not coincidental. It would be prudent to suggest an association between the various drugs and this malformation, though it is clear that two cases do not make the association casual and more extensive studies are required. However, we feel that keeping the concurrence of cardiac malformations in mind in epileptic pregnant mothers using carbamazepine would be prudent. Our aim was to draw attention to the rare concurrence of maternal usage of carbamazepine, and cardiac anomaly in the child by presenting a case.
Although conventional inotropic drugs are well examined for myocardial support during weaning fro... more Although conventional inotropic drugs are well examined for myocardial support during weaning from cardiopulmonary bypass (CPB), there is limited experience about a new calcium sensitiser drug, levosimendan. We aimed to investigate effects of early infusion of 'levosimendan' started per-operatively without a loading dose, on outcomes of patients experiencing difficultly to wean from CPB after coronary artery bypass grafting (CABG). Material and Methods: Forty two consecutive patients undergoing CABG with high Euroscores (>6) were included in the study. Patients received levosimendan at a rate of 0.1 mcg/kg/min (without a loading dose) per-operatively for 24 h. All patients also received dopamine (5-15 mcg/kg/min), 39 patients adrenaline (0.03-0.2 mg/kg/min) and 9 patients were additionally administered dobutamine (6-20 mcg/kg/min). Intra-aortic balloon pump was implanted to four patients who failed to wean from CPB. Pre-and post-operative demographic, echocardiographic and hemodynamic parameters, as well as operative data were analysed. Results: Mean patient age was 61.36±9.1 years (min:39, max:77). Mean extubation time of patients was 18.34±6.2 hours (min:9, max:34) and mean surgical intensive care unit stay was 5.45±2.3 days (min:1, max:15). In comparison to the pre-operative measurements patients showed statistically significant increase of left ventricle ejection fraction (LVEF) and decrease of left atrial, left ventricular end diastolic and right ventricular end diastolic diameters following levosimendan administration in the post-operative period. Increase of pro-BNP level on the 3rd postoperative day was also statistically significant (p=0.047). However, pro-BNP levels on the post-operative 6th month was not significantly different from pre-operative levels (p=0.4). Heart rate and invasive systolic and diastolic blood pressure levels were recorded at 23rd hour of perfusion and compared with those of 1 hour after its cessation. Although heart rate remains almost constant (p=0.13), increase in systolic and diastolic blood pressures was markedly statistically significant (p=0.0001). Conclusion: Levosimendan appears to be an efficient drug if used in addition to conventional inotropics for the management of low cardiac output syndrome states before, during or after onpump cardiac surgery.
Myxomas are the most common benign tumors of the heart. This study presents single-institutional ... more Myxomas are the most common benign tumors of the heart. This study presents single-institutional 22 years experience on cardiac myxomas. The records of 9756 consecutive cases of open heart surgery between 1985 and 2007 revealed 0.23% myxoma. Age ranged between 12 and 77 years and male to female ratio was 7:17. Myxomas originated from the left atrium (15 patients), mitral valve (3 patients), right atrium (2 patients), right atrium and right ventricle (2 patients), right ventricle (1 patient), and left ventricle (1 patient). Three patients were operated for multiple myxomas. Myxomas were resected through right atriotomy, right atriotomy and pulmonary arteriotomy, left atriotomy, biatrial approach, or left ventriculotomy depending on the tumor location. Mean follow-up time was 11.5 years. Mortality occurred in 6 patients (1 early, 5 late deaths). No myxoma recurrence was detected. Myxomas should be resected leaving no remnant mass, without delay when they are diagnosed.
Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial ... more Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2011
Amaç: Atriyal izomerizm, kalp gibi normalde asimetrik olan organlardaki lateralizasyon defektleri... more Amaç: Atriyal izomerizm, kalp gibi normalde asimetrik olan organlardaki lateralizasyon defektleriyle karakterize olan doğumsal bir anomalidir. Atriyal izomerizmin, erken gelişim sırasındaki moleküler defektler nedeniyle oluştuğu düşünülmektedir. NKX2-5, kardiyogenezi başlatan ve kardiyogenezin sonraki transkripsiyonel olaylarını düzenleyen kalbe özgü bir transkripsiyon faktörüdür. HAND1 ise kalpte ekspres olan, asimetrik ekspresyon paterni ile karakterize başka bir transkripsiyon faktörüdür. Çalışmamızda, NKX2-5 ve HAND1 genlerindeki mutasyonların atriyal izomerizm etiyolojisinde rol oynayıp oynamadığını anlamak için, atriyal izomerizm hastalarında bu iki geni incelemeyi amaçladık. Yöntemler: Bu vaka-kontrol çalışması atriyal izomerizm tanısı alan veya atriyal izomerizm nedeniyle cerrahi tedavi gören 70 hasta ve HAND1 için 80, NKX2-5 için, 40 sağlıklı kontrolden oluşturulmuştur. NKX2-5 ve HAND1 genlerinin tüm ekzonları ve ekzon-intron sınırları SSCP ile analiz edilmiş, şüpheli örnekler mutasyon analizi için dizilenmiştir. Bilinen polimorfizmler ve mutasyonlar için uygun restriksiyon enzimi ile enzim kesimi uygulanmıştır. Hasta ve kontrol grupları arasındaki allel ve genotip sıklıklarını Ki-kare ve Fisher testleri kullanılarak karşılaştırıldı. Bulgular: Kontrol ve hastalarda, HAND1 geninin intronik bölgesinde bir C>G dönüşümü tanımladık. Mutant allelin hasta grubundaki sıklığı (%11.42) kontrol grubundakinden (%2.5) daha yüksek bulundu (p=0.046). Mutant allel taşıyan genotipler ile atriyal izomerizm arasındaki bağlantı sınırda anlamlı bulundu (p=0.054). NKX2-5 geninde, bir hastada heterozigot durumda Q170X (Gln170ter) mutasyonu tanımladık. Tanımlanan dizi farklılıkları ile hastaların klinik özellikleri arasında herhangi bir ilişki bulunmadı.
Myxomas are the most common benign tumors of the heart. This study presents single-institutional ... more Myxomas are the most common benign tumors of the heart. This study presents single-institutional 22 years experience on car-diac myxomas. The records of 9756 consecutive cases of open heart surgery between 1985 and 2007 revealed 0.23% myxoma. Age ...
Surgical management of congenital malformati-on of the mitral valve in the paediatric age group r... more Surgical management of congenital malformati-on of the mitral valve in the paediatric age group re-mains a therapeutic challenge. Reconstructive techni-ques in infants and children have been evolved more slowly than in adults due to large variability of mitral disease and the ...
Objective Coronary artery dilations (CDs), a subgroup of coronary artery anomalies (CAAs), are re... more Objective Coronary artery dilations (CDs), a subgroup of coronary artery anomalies (CAAs), are relatively rare but important cardiac pathologies. They are considered to be linked to coronary atherosclerosis in most cases. Methods The demographic data, multi-slice computed tomographic coronary angiography data, coronary calcium score, and ascending aortic diameter (AAD) of 1538 patients were reviewed. In total, 197 (12.8%) patients (166 men, 31 women; age 15 – 84 years; mean 55.78 ± 12.32 years) with CAAs were identified, and 81 (5.3%) patients (70 men, 11 women; age 27 – 80 years; mean 56.63 ± 12.06 years) had CDs. Multiple regression and correlation analyses were performed in all 1538 patients to predict the association between the AAD and the presence of CD and thus their correlation with atherosclerosis. Results The AAD was significantly larger in patients with than without CAAs and CDs. Male sex was significantly more prevalent in patients with CAAs and CDs. According to the mul...
Gangliosides have previously been considered to be possible antigenic sites in Type 1 diabetes. L... more Gangliosides have previously been considered to be possible antigenic sites in Type 1 diabetes. Lymphocytic infiltration of Langerhans islands is the pathologic hallmark of autoimmune diabetes and may also be observed in salivary glands in experimental diabetes. Diabetic complications of parotid and submaxillary glands may therefore be related with an autoimmune process against sialoglycoconjugates of salivary gland tissue.
Background: Coronary computed tomography angiography (CCTA) is helpful in making a precise noninv... more Background: Coronary computed tomography angiography (CCTA) is helpful in making a precise noninvasive evaluation of coronary anatomy, allowing concomitant evaluation of other cardiac structures. The aim of this study was to determine the prevalence of coronary artery variations detected by 64-slice mutidetector CT. Materials and methods: The results of ECG-gated CCTA in 726 consecutive patients (mean age 58 years) were analysed retrospectively. The main indications for CCTA were atypical chest pain, angina pectoris, screening for coronary artery disease and determination of the patency of bypass grafts or stents. Acquisition was performed with a 64-detector CT scanner with retrospective ECG gating. Imaging results were assessed by experienced cardiovascular radiologist. Results: The overall incidence of coronary artery anomalies was 1.1% (8 out of 726 participants). The most common anomaly was an anomalous origin of the circumflex artery from the right coronary sinus with a retroaortic course (4 patients, 0.6%), followed by origin of right coronary artery from the left coronary sinus (2 patients, 0.3%). One patient with abnormal origin of the left main artery from the right coronary sinus (0.1%) and 1 patient with a circumflex artery origin from the proximal segment of the right coronary artery (0.1%) were observed, both with retroartic course. Conclusions: CCTA is a noninvasive imaging technique useful for the precise evaluation of variations of the coronary arteries. This study shows similar results to other reports on this subject.
Aim: Although conventional inotropic drugs are well examined for myocardial support during weanin... more Aim: Although conventional inotropic drugs are well examined for myocardial support during weaning from cardiopulmonary bypass (CPB), there is limited experience about a new calcium sensitiser drug, levosimendan. We aimed to investigate effects of early infusion of 'levosimendan' started per-operatively without a loading dose, on outcomes of patients experiencing difficultly to wean from CPB after coronary artery bypass grafting (CABG). Material and Methods: Forty two consecutive patients undergoing CABG with high Euroscores (>6) were included in the study. Patients received levosimendan at a rate of 0.1 mcg/kg/min (without a loading dose) per-operatively for 24 h. All patients also received dopamine (5-15 mcg/kg/min), 39 patients adrenaline (0.03-0.2 mg/kg/min) and 9 patients were additionally administered dobutamine (6-20 mcg/kg/min). Intra-aortic balloon pump was implanted to four patients who failed to wean from CPB. Pre-and post-operative demographic, echocardiograph...
A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coro... more A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coronary artery bypass operation revealed a mildly dilated mediastinal silhouette, which led the cardiovascular surgery resident to schedule emergency transthoracic echocardiography (TTE), with a special note asking for detailed evaluation of the ascending aorta and aortic arch. TTE revealed a mobile atheroma at the aortic arch, which obliged the cardiac surgery team to modify their strategy to combined hemi-arcus aortae replacement and coronary artery bypass grafting (CABG). Although with transoesophageal echocardiography (TEE) a small portion of the ascending aorta may be obscured by the trachea, TEE provides higher resolution images than TTE. Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment.
ABSTRACT Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of my... more ABSTRACT Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.
The biatrial approach has been the classic means of access for left atrial myxoma resection. Incr... more The biatrial approach has been the classic means of access for left atrial myxoma resection. Increased surgical experience led cardiac surgeons to favour the uniatrial approach to reduce incisions and achieve adequate exposure. In this study, two unilateral surgical approaches were compared in 18 consecutive left atrial myxoma cases. Patients were divided into two groups according to the surgical approach: left atriotomy (group 1, n = 9) and right atriotomy trans-septal approach (group 2, n = 9). Comparison criteria included pre-and post-operative functional capacity, cardiac rhythm, left ventricular ejection fraction, pulmonary artery pressure, left atrial dimensions, cardiopulmonary bypass time, aortic cross-clamp time, drainage over 48 h postoperatively, units of blood transfused, extubation time and length of stay in the intensive care unit and hospital. No significant between-group difference was observed in any criteria except aortic cross-clamp time, which was significantly longer in group 2 than in group 1. No recurrence of myxoma occurred in either group for the 15 patients followed up. Right atrial trans-septal incision appears to be as safe and effective as the left atriotomy approach for left atrial myxoma resection.
To investigate the relationship between anticoagulation treatment and drug resistance in chest pa... more To investigate the relationship between anticoagulation treatment and drug resistance in chest pain, levels of factor Xa residual activity were determined in patients seen in intensive care with recurrent chest pain and compared with levels in patients who had no ischaemic events during hospitalization. A total of 122 patients aged 18 -75 years who were admitted to hospital with acute coronary syndrome and treated with enoxaparin were included. Of these, 62 patients had recurrent chest pain while hospitalized (group A) and 60 patients had an uneventful follow-up period (group B).
Anomalies of pulmonary veins are uncommon and vary widely in their anatomic spectrum and clinical... more Anomalies of pulmonary veins are uncommon and vary widely in their anatomic spectrum and clinical presentation. A 20-year-old woman with complaints of effort-induced dyspnea and easy fatigability was diagnosed with a third left pulmonary vein with abnormal return and arteriovenous fistula accompanied by a secundum atrial septal defect (ASD). Complete surgical repair was performed by ASD closure with a pericardial patch and triple ligation of the left vertical vein and associated third pulmonary vein. The patient was discharged on the seventh postoperative day in good health. Her last control examination was performed in the second postoperative year, revealing normal echocardiographic findings with an excellent clinical course.
The decision to repair mild-to-moderate functional tricuspid regurgitation (TR) during left-side ... more The decision to repair mild-to-moderate functional tricuspid regurgitation (TR) during left-side heart surgery remains controversial. Objectives To avoid heterogeneity in patient population, patients with TR undergoing isolated mechanical mitral valve (MV) replacement for rheumatic mitral diseases were evaluated. Between 1997 and 2009, 236 patients with mild-to-moderate functional TR underwent first-time isolated mechanical MV replacement for rheumatic mitral diseases with (n=123; repair group) or without (n=113; non-repair group) tricuspid valve (TV) repair. Survival, valve-related complications, and TV function in these two groups were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting. Follow-up was complete in 225 patients (95.3%) with a median follow-up of 48.7 months (IQR 20.2-89.5 months), during which time 991 echocardiographic assessments were done. Freedom from moderate-to-severe TR at 5 years was 92.9±2.9% in the repair group and 60.8±6.9% in the non-repair group (p<0.001 and 0.048 in crude and adjusted analyses, respectively). After adjustment, both groups had similar risks of death (HR=0.57, p=0.43), tricuspid reoperation (HR=0.10, p=0.080) and congestive heart failure (HR=1.12, p=0.87). Postoperative moderate-to-severe TR was an independent predictor of poorer event-free survival (HR=2.90, p=0.038). These findings support the strategy of correcting mild-to-moderate functional TR at the time of MV replacement to maintain TV function and improve clinical outcomes.
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Papers by A. Hatemi