Search

Percutaneous closure of an atrial septal defect (ASD) has emerged as an alternative to surgery. A 54-year-old woman with a history of percutaneous ASD closure with a 30-mm Cardia Ultrasept septal occluder (Cardia Inc., Eagan, MN, USA) comprising 2 discs made of Nitinol wire mesh covered with polyvinyl alcohol (PVA) membrane, was admitted to the hospital with unstable angina pectoris. In a routine examination, transthoracic echocardiography revealed a left-to-right shunt through the device. Transesophageal echocardiography (TEE) also demonstrated significant left-to-right shunt through the central portion of the prosthesis. Coronary angiography was performed, which disclosed severe stenosis in the right and left anterior descending coronary arteries. Three-dimensional TEE showed multiple perforations of the PVA membrane with intact nitinol frame. Surgical removal of failing device and closure of the ASD with a pericardial patch was performed together with coronary artery bypass graft surgery. On perioperative view, the device appeared to have been correctly implanted, and the device frame was completely intact; however, the PVA membrane of both the right and left discs had almost completely disappeared and there was incomplete endothelialization around the frame. Surgeons must be aware of this rarely seen complication and they should re-examine all patients implanted with Cardia devices in regular follow-up examinations for a long period of time.

Introduction: Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) operation is associated with increased risk of prolonged hospitalisation, health expenses and adverse clinical outcomes. Aim : To investigate the relationship of atrial fibrillation after an isolated coronary artery bypass operation with levels of mean platelet volume and C-reactive protein. Material and methods: Among 1240 patients who underwent operations for isolated coronary artery bypass grafting with cardiopulmonary bypass between January 2007 and May 2014, 1138 (91.8%) patients with preoperative normal sinusal rhythm were enrolled in the study. Patients were assigned to group 1 (n = 294) comprising patients who developed atrial fibrillation in the first 72 postoperative hours or group 2 (n = 844) comprising patients who remained in normal sinusal rhythm in the postoperative period. Results : The incidence of postoperative atrial fibrillation was 25.8%. The preoperative mean platelet volume (fl) and C-reactive protein (mg/dl) values in group 1 were 9.1 ±0.5 and 1.1 ±0.9 respectively, while these values were 8.3 ±0.6 and 0.5 ±0.3 respectively in group 2, which was statistically significant (p = 0.0001). Length of stay in the hospital (p = 0.0001) was higher in group 1. The values of mean platelet volume (fl) and mean C-reactive protein (mg/dl) were 9.9 ±0.9 and 30.9 ±3.4 respectively in group 1, while the values of mean platelet volume (fl) and mean C-reactive protein (mg/dl) were 8.8 ±0.6 and 24.9 ±4.8 respectively in group 2 (p = 0.0001 for mean platelet volume, p = 0.0001 for C-reactive protein). The difference between the groups was statistically significant in terms of postoperative neurologic events (p = 0.0001) and hospital mortality (p = 0.001). Increased C-reactive protein and mean platelet volume levels were found to be independent predictors of postoperative atrial fibrillation. Conclusions : In our study, elevated preoperative mean platelet volume and C-reactive protein levels were associated with development of postoperative atrial fibrillation.

Asymptomatic venous thromboembolism is surprisingly frequent following coronary artery bypass surgery. In most cases, this situation is not clinically important, however it may lead to clinical conditions such as deep venous thrombosis and pulmonary embolism which are life threatening with high morbidity and mortality. Pulmonary thromboembolism following coronary artery bypass surgery is a rare complication. Although there is not a standard therapy protocol, early diagnose and therapeutic approach are vitally important for a successful result. Sixty three year old male patient was operated coronary artery bypass grafting with cardiopulmonary bypass. Respiratory and cardiac arrest following sudden syncope occured during mobilization on the 3rd postoperative day in the inpatient clinic. The transthoracic echocardiographic imaging revealed thrombus in the apical segment of the right ventricle, and thrombus in bilateral pulmonary arteries were found in the spiral computerized tomography scan. Thrombolytic therapy was administered with the diagnosis of acute pulmonary embolism. The clinical and radiological findings were resolved on the 48th hour of therapy. In this paper, we aimed to present thrombolytic therapy and its efficiency in a case of massive (high risk) pulmonary embolism in the early postoperative period following coronary artery bypass surgery for which the ethiologic factor was thought to be the thrombus in the right ventricle.