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Background Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques Methods 89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in Turkiye Yuksek Ihtisas Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic parameters and reoperation rates were investigated. Results Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4 years. According to the transthoracic echocardiographic evaluations, 8 (9%) patients had moderate and 81 (91%) patients had severe mitral insufficiency. When preoperative and postoperative values were compared statistically significant improvement in functional capacity of patients according to NYHA classification has been noted. (2.1±0.5 ; 1, , p=0.001) Improvements in left ventricular end diastolic diameter (5.5±0.7 cm ; 5±0.6 cm, p=0.001), left ventricular end sistolic diameter (3.8±0.6 cm ; 3.6±0.6 cm, p=0.004 ), left atrium diameter (4.8±0.9 cm ; 4.3±0.6 cm, p=0.001) and pulmonary artery pressure (44.3±13.4 mmHg; 32.1±5.4 mmHg, p=0.001) were statistically significant. Conclusions In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.

BACKGROUND Carotid artery stenosis (CAS) is one of the major causes of stroke in coronary artery bypass grafting (CABG). AIMS The aim of this study was to determine which age groups require screening for CAS using carotid duplex ultrasound in asymptomatic patients undergoing CABG. METHODS We included 644 neurologically asymptomatic consecutive patients (mean [SD] age, 63.9 [8.8] years; men, 453 [70.3%]) who underwent elective isolated CABG between June 2015 and June 2020. Clinical, demographic, and radiological data as well as coronary angiography results were retrospectively reviewed. Patients were classified into 4 age groups: 40 to 50, 51 to 60, 61 to 70, and >70 years, as well as 3 groups depending on the CAS degree: 50% or less, 50% to 70%, and 70% or greater. Regression analysis was applied across the selected parameters to identify risk factors for significant CAS, and receiver operating characteristic analysis, to determine cutoff age and SYNTAX score of patients who had to be screened before CABG. RESULTS Overall, 8 (1.1%) patients included in the present study had stroke following CABG. Cutoff values of the SYNTAX score and CAS of 70% or greater were found to be 27 and 64 years, respectively. The sensitivity and specificity of the cutoff value were 98.4% to 98.3% and 74.3% to 55.1%, respectively. The area under the curve was 0.98 and 0.73, respectively. CONCLUSIONS Based on the receiver operating characteristic analysis, we recommended to perform screening for CAS in patients older than 64 years and with a SYNTAX score of 27 or higher, even if they are asymptomatic. WOS:000613427100005 2-s2.0-85100445536 PubMed: 33078919

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavail-ability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations. © 2018 Daedalus Enterprises.

Background: In procedures involving surgical maneuvers such as cannulation, clamping, or proximal anastomosis where aortic manipulation is inevitable, a preliminary assessment of atherosclerotic plaques bears clinical significance. In the present study, our aim was to evaluate the frequency and distribution of aortic calcifications in patients undergoing coronary artery bypass grafting (CABG) surgery to propose a morphological classification system. Methods: A total of 443 consecutive patients with coronary artery disease were included in this study. Preoperative non-contrast enhanced computed tomography images, in-hospital follow-up data, and patient characteristics were retrospectively evaluated. Results: Whereas 33% of patients had no calcifications at any site in the aorta, 7.9%, 75.4%, and 16.7% had calcifications in the ascending aorta, aortic arch, and descending aorta, respectively. Focal small calcifications were the most common type of lesions in the ascending aorta (3.9%), whereas 9 patients (1.4%) had porcelain ascending aorta. We defined four types of patients with increasing severity and extent of calcifications. Conclusions: Based on the frequency and distribution of calcifications in the thoracic aorta, we propose a classification system from least to most severe for coronary artery disease patients who are candidates for CABG.

Coronaryartery disease with ascending aorta aneurysm surgery may be troublesome forboth the surgeon and the patient. Because so many patients have otherconcomitant diseases such as cancer, severe left ventricular dysfunction,hemodialysis-dependent chronic renal failure, poor nutritional status, obesity,chronic obstructive pulmonary disease (COPD), and cerebrovascular event history.These diseases increase the risk of postoperative mortality and morbiditybecause of the use of extracorporeal circulation and aortic cross-clampingintraoperative. Off-pump reduction aortoplasty may be the right decision forrisky patients with ascending aortic aneurysm and coronary artery disease. Thisreport presents 3 cases of off-pump reduction aortoplasty and concomitantcoronary artery bypass grafting (CABG)., Koronerarter hastalığı ile birlikte yapılan asendan aort cerrahisi hem cerrah hem dehasta için zorlu olabilmektedir. Çünkü bir kısım hastanın kanser, düşük solventrikül fonksiyonu, diyalize bağımlı kronik böbrek yetmezliği, kötü beslenmedüzeyi, obezite, kronik obstrüktif akciğer hastalığı (KOAH) ve serebrovaskülerhastalık öyküsü gibi eşlik eden diğer hastalıkları olabilir. Bu hastalıklarintraoperatif ekstrakoporeal dolaşım kullanımı ve aortun kros-klemplenmesinedeniyle post-operatif mortalite ve morbiditeyi artırırlar. Off-pump küçültücüaortoplasti asendan aort anevrizması ve koroner arter hastalığının olduğuriskli hastalar için uygun karar olabilir. Bu raporda off-pump küçültücüaortoplasti ve eşzamanlı koroner arter bypass cerrahisi yapılan üç olgusunulmuştur.

Background Central venous catheterization is an invasive procedure that must be performed during cardiovascular surgery. The addition of ultrasound guidance to the catheterization technique has shown effectiveness in reducing complications because it allows for the visualization of anatomical variations prior to intervention and the continual visualization of the needle during the placement. The purpose of this study was to evaluate the effectiveness of needle-guiding ultrasound for internal jugular venous cannulation. Method Patients undergoing coronary bypass surgery at Hitit University, department of cardiovascular surgery, from January 2014 to June 2018, were included in the study. The patients were divided into two groups: those with catheterization with ultrasound guidance (Group U) and those with catheterization performed with the anatomic landmark technique (Group L). Results A total of 584 cases were investigated. The success of the procedure and complication rates for both methods were compared. Central vein catheterization with ultrasonography produced success and complication rates significantly better than those for catheterization using the landmark technique (p=0.04 and p=0.00001, respectively). Conclusion This study demonstrated that the use of ultrasonography for internal jugular vein catheterization for patients undergoing coronary bypass surgery significantly reduced the complication rates as compared to those of patients where the landmark technique was used for catheterization. WOS:000461529800003 PubMed: 31007984

WOS: 000475389300005, PubMed: 31237550, Background: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. Methods: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. Results: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. Conclusion: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.

WOS: 000474629300005, PubMed: 32082875, Background: This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. Methods: Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3 +/- 15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve repair was performed with de Vega a nnuloplasty technique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. Results: Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p< 0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. Conclusion: Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting.

In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.

Background: This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen. Methods: Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy. Results: Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded. Conclusion: Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecularweight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ?5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman. © 2018 All right reserved by the Turkish Society of Cardiovascular Surgery. Amaç: Bu çalışmada, farklı antikolagülan rejimlerinin protez kapak ile ilişkili komplikasyonlar ve feto-maternal mortalite ve morbidite üzerindeki etkileri araştırıldı ve en ideal antikolagülan tedavi rejimi belirlendi. Çalış­ma­ planı:­ Ocak 1990 - Aralık 2015 tarihleri arasında mekanik kalp kapak replasmanı yapılan gebe kadınlarda antikoagülan tedavi rejimleri, retrospektif olarak incelendi. Mekanik kalp kapak replasmanı sonrası 57 hastada 72 gebelik gözden geçirildi ve dört farklı rejim belirlendi ve gebeliğin farklı trimesterlerinde değerlendirildi. Bulgu­lar:­ Yetmiş iki gebeliğin, 40'ı sağlıklı yeni doğanla, 35’i (%48.6) sağlıklı yenidoğan, dördü (%5.6) prematüre doğum ve biri (%1.4) düşük doğum ağırlığı ile sonuçlandı. On sekiz (%25) terapötik ve 12 (%16.7) spontan düşüğün yanı sıra, iki (%2.8) ölü doğum izlendi. Gebelik süresince veya post-partum dönemde, yedi gebede kapak trombozu gelişti. Altı hastada (%10.5) kanama ve yine altı (%10.5) hastada periferik emboli meydana geldi. Maternal mortalite görülmedi. Sonuç:­ Gebelik sırasında en ideal antikoagülasyon rejimine ilişkin tam bir fikir birliği olmamasına rağmen, birinci trimesterde varfarinin teratojenisite ve artmış düşük riskini önlemek için doz ayarlamalı fraksiyone olmayan heparin veya düşük molekül ağırlıklı heparin ile değiştirilmesi uygundur. Düşük molekül ağırlıklı heparinin uygulaması kolaydır ve güvenilir bir şekilde izlenebilir ve başarılı gebelik sonuçlarına da vesile olabilir. Ancak, gebeliğin tüm trimesterleri süresince, günde ?5 mg varfarini geçmemek kaydıyla kullanılacak varfarin, embriyopati riskinin gebe tarafından kabul edildiği durumlarda, alternatif bir seçenek olabilir.

Background: This study aims to investigate the effects of the use of the Rapid Shallow Breathing Index on extubation success and time to extubation in patients undergoing elective isolated coronary artery bypass grafting. Methods: This prospective, randomized-controlled study included a total of 72 patients (55 males, 19 females; mean age 60.3±9.3 years; range 45 to 76 years) who underwent isolated coronary artery bypass grafting between February 2016 and November 2016. The patients were divided into two groups as the RSBI group (n=36) and the control group (n=36). The control group was extubated by conventional criteria that were routinely applied in our clinic, while the RSBI group was extubated, when the index scores became below 77 breaths per min/L, following ensuring hemodynamic stability and weaning procedure from mechanical ventilation. Results: The mean time to wean from mechanical ventilation was 5.8±1.0 hours in the RSBI group and 8.1±2.0 hours in the control group (p=0.03). Extubation protocol performed through the use of the index was found to provide 26% earlier extubation compared to the conventional extubation criteria. There was no significant difference in the postoperative follow-up parameters or clinical conditions. Conclusion: Our study results show that a practical tool such as the Rapid Shallow Breathing Index can be reliably used for making a decision in favor of extubation in patients undergoing coronary artery bypass grafting. A shortened time to extubation by the use of this index may provide substantial benefits in terms of prevention of infections, mechanical ventilation-induced lung injuries, and potential pulmonary complications. © 2018 All right reserved by the Turkish Society of Cardiovascular Surgery. Amaç: Bu çalışmada elektif izole koroner arter baypas greftleme yapılan hastalarda Hızlı Yüzeyel Solunum İndeks kullanımının ekstübasyon başarısı ve ekstübasyon süresi üzerindeki etkileri araştırıldı. Ça¬lış¬ma pla¬nı: Bu prospektif, randomize kontrollü çalışmaya Şubat 2016 - Kasım 2016 tarihleri arasında izole koroner arter baypas greftleme yapılan toplam 72 hasta (55 erkek, 19 kadın; ort. yaş 60.3±9.3 yıl; dağılım 45-76 yıl) alındı. Hastalar HYSİ grubu (n=36) ve kontrol grubu (n=36) olmak üzere iki gruba ayrıldı. Kontrol grubu kliniğimizde rutin olarak uygulanan konvansiyonel kriterlere göre ekstübe edilirken, HYSİ grubu, hemodinamik stabilizasyon sağlandıktan ve mekanik ventilasyondan ayrılma işleminden sonra indeks skorun 77 solunum L/dk. altına düştüğünde ekstübe edildi. Bulgular: Ortalama mekanik ventilasyondan ayrılma süresi HYSİ grubunda 5.8±1.0 saat ve kontrol grubunda 8.1±2.0 saat idi (p=0.03). Konvansiyonel ekstübasyon kriterlerine kıyasla, indeksin kullanıldığı ekstübasyon protokolü ile %26 daha erken ekstübasyon sağlandı. Ameliyat sonrası takip parametrelerinde veya klinik durumlarda anlamlı bir fark yoktu. So¬nuç: Çalışma sonuçlarımız, Hızlı Yüzeyel Solunum İndeksi gibi pratik bir aracın, koroner arter baypas greftleme yapılan hastalarda ekstübasyon lehine karar vermede güvenle kullanılabileceğini göstermektedir. Bu indeksin kullanımı ile ekstübasyon süresinin kısalması; enfeksiyonların, mekanik ventilasyona bağlı akciğer hasarının ve muhtemel pulmoner komplikasyonların önlenmesi açısından ciddi yarar sağlayabilir.

WOS: 000424153600005 PubMed ID: 28832097 Background and aim: The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesion has direct impact on endovascular treatment (PTCA/stent), however; different arrangement of the lesions is underestimated and not well studied. We sought to evaluate the hemodynamic effects of different stenotic lesion models and arrangements in vitro Methods: Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long and critical short lesion combination were performed and hemodynamic parameters were recorded. Results: Tandem lesions were more likely to result critical stenosis comparing single lesions with same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions were also resulted more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result more flow restriction with reference to single lesions with same stenotic ratio. Contrary to expectations, tandem short lesions were found more stenotic compared with the same degree long individual lesions. Conclusions: It is effortless to give decision for simple, discrete and individual lesions while ideal decision for long and complicated lesions may remain unclear. Even if these "gray zone" lesions considered non-critical while investigating them one by one, it must be kept in mind overall stenotic effect of these lesions may lead to a more hemodynamic impairment. Hitit University Faculty of Medicine Scientific Research Projects [TIP19002.14.002] The study was funded with the project number of TIP19002.14.002 under the coverage of Hitit University Faculty of Medicine Scientific Research Projects.

Penetrating cardiac injuries are one of the most lethal types of trauma. Early diagnosis, appropriate approach in the emergency department (ED), early resuscitation and immediate surgical intervention are essential in the management of penetrating cardiac injuries. In this study we retrospectively evaluated five patients with penetrating cardiac injuries in a 1-year period before an open heart surgery center was set up in our hospital; and we aimed to underline the importance of an appropriate and early surgical intervention without cardiopulmonary by-pass on survival. Median age of our patients was 26 years (range, 17-42 years) and all of the patients were males. Two patients were presented as cardiac arrest and they could not be survived. Three of our patients presented to our ED with cardiogenic shock and all of them recovered after the operation. Right ventricle injury was determined in two patients and both of them survived after the operation. In 3 patients, left ventricle injury was observed and 2 of them died. While 3 patients presented with gunshot injury, 2 of them presented with sharp object injury. One patient in each group was died. Three patients recovered without any complications, however 2 patients- one before operation and 1 during operation- died (survival rate: 3/5). Those 3 patients did not develop any major stationary sequela with normal LVEF in the follow-up at first and third., Penetran kalp yaralanmaları, travma çeşitleri arasında en öldürücü olanlardır. Penetran kalp yaralanmalarına uygun yaklaşımda erken tanı, acil serviste (AS) doğru müdahale, erken resüsitasyon ve acil cerrahi müdahale önemlidir. Biz bu çalışmamızda hastanemizde açık kalp cerrahisi yapılmaya başlanmasından önceki 1 yıl içerisinde, penetran kardiyak yaralanma ile AS'ye getirilen beş hastayı retrospektif olarak inceledik ve kardiyopulmoner by-pass yapılamadığı durumlarda bile, erken ve doğru cerrahi müdahalenin sağkalım üzerine olan önemini vurgulamayı amaçladık. Çalışmaya alınan hastaların ortalama yaşı 26 (17-42) yıl idi ve tümü erkekti. İki hasta AS'ye kardiyak arrest olarak getirilmişti ve bu hastalar kurtarılamadı. Üç hasta ise AS'ye kardiyojenik şok ile getirildi ve bu hastaların tümü ameliyat sonrası iyileşti. İki hastada sağ ventrikül yaralanması tespit edildi ve bu hastaların her ikisi de operasyon sonrası hayatta kaldı. Üç hastada sol ventrikül yaralanması saptandı ve bu hastaların 2'si öldü. Üç hasta ateşli silah ile yaralanırken, 2 hasta kesici alet ile yaralanmıştı. Her iki grupta birer hasta öldü. Üç hasta herhangi bir komplikasyon olmadan taburcu edildi. İki hasta, biri operasyon öncesi ve biri operasyon sırasında olmak üzere öldü (sağkalım oranı: 3/5). Bu 3 hastanın yapılan birinci ve üçüncü ay kontrollerinde sol ventrikül ejeksiyon fraksiyonları normal olarak hesaplandı ve herhangi bir major sekel oluşturan komplikasyon gelişmedi.

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups’ baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.

Amac: Bu calismada acik kalp cerrahisi sonrasi semptomatik perikardiyal efuzyonlu hastalarda en sik kullanilan iki cerrahi teknigin sonuclari karsilastirildi. Ca­lis­ma­ pla­ni:­ Eylul 2004 Eylul 2012 tarihleri arasinda, klinigimizde acik kalp cerrahisi yapilan 14.390 hastanin verileri retrospektif olarak analiz edildi. Toplam 152 hasta bu calismaya dahil edildi ve uygulanan tedavi yontemine gore iki gruba ayrildi. Subksifoid perikardial drenaj 86 hastaya (%56.6) (grup 1), yan torakotomi ile perikardiyal pencere acilmasi 66 hastaya (%43.4) uygulandi (grup 2). Bu hastalar icerisinde semptomatik perikardiyal efuzyon gelismis olan ve subksifoid perikardiyal drenaj veya yan torakotomi yontemi ile yeniden eksplore edilen hastalar analiz edildi. Ameliyat sirasi veriler, ameliyata bagli ve 30 gunluk hastane mortaliteleri acisindan karsilastirildi. Bul gu lar: Grup 2’de ameliyat teknigi tam bir basariya ulasmisken (%100), grup 1’de basari orani %87.2 idi (p

Background : We evaluated the vasodilatory effects of two antioxidants, vitamins C (ascorbic acid) and E (α-tocopherol), on radial artery and endothelium-dependent responses in patients awaiting coronary artery bypass surgery. Methods : The study was performed in three groups. The first group took 2 g of vitamin C orally (n = 31, vitamin C group), the second group took 2 g of vitamin C with 600 mg of vitamin E orally (n = 31, vitamins C + E group), and the third group took no medication (n = 31, control group). After baseline measurements were taken of the radial artery lumen diameter, flow volume and lumen area in the non-dominant radial artery, occlusion was maintained for five minutes with a pressure cuff placed around the arm. The measurements were taken again at the time of deflating the cuff, and 60 seconds later. The measurements were repeated after medication in two of the groups and after placebo in the third group. Results : We compared values of the vitamin C group with those of the vitamins C + E group, and found that the latter were higher than those of the vitamin C group but not statistically significant. In the control group, there was no statistical difference. Conclusion : Vitamin C or its combination with vitamin E significantly enhanced endothelium-dependent vasodilatation in the radial circulation of patients with coronary artery disease. Its combination with vitamin E was superior to vitamin C administration alone for endothelial enhancement but this difference was not statistically significant. We hypothesised that vitamin C or its combination with vitamin E may be used as antioxidants for arterial graft patency in patients undergoing coronary artery surgery.

Aim: Other techniques are required due to the negative influence of poor superficial venous system calibration (

research Objective: Arteriovenous fistulas (AVF) created for hemodialysis may be complicated by aneurysm formation. The aim of this article is to describe our experience with segmental saphenous graft interposition to treat AVF aneurysms. Material and Methods: Between June 2007 and June 2011, 23 patients who admitted to our clinic with symptoms related to single or multiple AVF aneurysms were included in the study. Under general anesthesia, the aneurysms were resected and a reverse saphenous vein graft was implanted in an end-to-end manner, after inflow and outflow of aneurysmatic fistula tract was clamped. Results: Aneurysms were secondary to brachial-cephalic fistula in 16 (69.5%) patients and radial-cephalic fistula in 7 (30.5%) patients. The mean follow-up period was 40.2±9.4 months, with a range 13 to 61 months. The saphenous vein thrombosed in 3 patients in brachial-cephalic fistula and in 3 patients in radial-cephalic fistula groups. There were no vascular complications in the remaining. Conclusion: Our results show that this method preserves AVF functions and prevents the complications of the aneurysms. Preservation techniques such as segmental saphenous graft interposition may be performed for treating functioning AVF aneurysms. Amaç: Hemodiyaliz amacıyla oluşturulan arteriovenöz fistüllerin önemli bir komplikasyonu, anevrizma gelişmesidir. Bu çalışmanın amacı anevrizma gelişmiş arteriovenöz fistüllerin safen ven grefti kullanılarak onarılmasıyla ilgili tecrübemizi aktarmaktır. Gereç ve Yöntemler: Haziran 2007 ve Haziran 2011 tarihleri arasında tek veya çoklu arteriovenöz fistül anevrizması nedeniyle kliniğimize başvuran 23 hasta çalışmaya dahil edildi. Genel anestezi altında, anevrizmatik fistül segmenti proximal ve distalden klemplenerek rezeke edildi ve yerine safen ven greft interpoze edildi. Bulgular: Anevrizmalar 16 (%69,5) hastada brakiyal-sefalik fistül, 7 (%30,5) hastada radiyal-sefalik fistüle sekonderdi. Hastalar ortalama 40,2±9,4 (13-61) ay takip edildi. Safen greft brakiyal-sefalik fistül ve radiyal-sefalik fistül gruplarında 3’er hastada tromboze oldu. Diğer hastalarda vasküler komplikasyon izlenmedi. Sonuç: Sonuçlar arteriovenöz fistül anevrizmalarının güvenle tamir edilerek fonksiyonlarının korunabileceğini ortaya koymuştur. Segmental safen greft interpozisyonu gibi koruyucu teknikler fonksiyonel arteriyovenöz fistül anevrizmalarını tedavi etmek için kullanılabilir.

Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

compilation Manyetik rezonans görüntüleme klinik uygulamada giderek daha sık kullanılan değerli bir tanı aracıdır. Ancak, bu görüntüleme tekniğinin kullanımı, komplikasyon oranını artırdığı için, daha önceki kardiyolojik veya kardiyovasküler cerrahi girişimler sırasında metalik implant takılan hastalarda sınırlı olabilir. Teknolojik gelişmeler sayesinde bu tür cihazlar ve manyetik rezonans görüntüleme arasındaki geçimlilik oranı artmakla birlikte, beklenmedik sonuçlar ile birlikte etkileşim riski halen birçok olguda yüksektir. Bu yazıda, kanıta dayalı veriler eşliğinde, bu hasta popülasyonunda klinik uygulamada manyetik rezonans görüntülemenin güvenirliğine ilişkin pratik bir bilgi kaynağı ve rehber sunuldu. Magnetic resonance imaging is an invaluable diagnostic tool which is increasingly more frequently used in clinical practice. However, the utility of this imaging technique may be limited in patients with metallic implants placed during previous cardiologic or cardiovascular surgical interventions due to increased complication rates. Despite increased rates of compatibility between such devices and magnetic resonance imaging thanks to technological advances, the risk of interaction with untoward consequences is still high in many cases. Herein, we describe a practical source of information and guidance on the reliability of magnetic resonance imaging in this patient population in the clinical practice in the light of evidence-based data.

Cardiac valve tumors are rare, accounting for less than 10% of all primary cardiac tumors. Hemangiomas of the tricuspid valve are rarely documented in the literature. A 7 x 5 mm lesionwas determined and resected during the operation of a 17-year-old male who underwent surgery for perimembranous ventricular septal defect and documented as benign vascular proliferation; hemangioma in the pathology report. We report this case because of it’s rarity and to demostrate the importance of inspection for the lesions which can especially accompany to congenital cardiac diseases., Oldukça nadir görülen lezyonlar olan kalp kapak tümörleri kalbin primer neoplastik oluşumlarının %10 kadarını oluşturmaktadırlar. Literatürde triküspid kapakta yer alan hemanjioma oldukça nadir rastlanmaktadır. Olgumuz olan 17 yaşında erkek hasta perimembranöz ventriküler septal defekt nedeniyle opere edilirken triküspid kapağın anterior leafletinde 7 x 5 mm boyutlarında bir lezyon saptanarak eksize edilmiş ve patolojisi benign vasküler proliferasyon; hemanjiom olarak rapor edilmiştir. Bu olguyu literatürde nadir rastlanması ve özellikle konjenital operasyonlarda eşlik edebilecek patolojiler açısından inspeksiyonun önemini vurgulamak amacıyla sunmaktayız.

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research Amaç: Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi'nde yeni uygulanmaya başlanan kalp cerrahisi sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kasım 2012 ile Kasım 2013 tarihleri arasında 110 açık kalp ameliyatı gerçekleştirildi. 10 hasta (%9.1) ST elevasyonlu miyokard enfarktüsü nedeniyle acil olarak ameliyata alındı. 31'i (%29.2) atan kalpte ve 75'i (%70.8) kardiyopulmoner baypas ile olmak üzere toplam 106 hastaya koroner arter baypas greftleme yapılırken, 1 mitral onarım, 1 Bentall prosedürü, 1 triküspit kapak onarımı, 1 mitral kapak replasmanı, 1 root genişletmeyle birlikte aort kapak replasmanı ve 1 suprakoroner greft implantasyonu uygulandı. Bulgular: Bir (%0.9) hastada hastane mortalitesi görüldü. İkili antiagregan kullanmakta olan 4 (%3.6) hastaya ameliyat günü içerisinde kanama nedeniyle revizyon yapıldı. 3 (%2.7) hastada morbidite yaşandı. 11 (%10) hastada atriyal fibrilasyon gözlendi ve amiadoron tedavisi ile normal sinüs ritmi sağlandı. 5 (%4.5) hastada intraaortik balon pompası kullanıldı. Tartışma: Yaygın bir kırsal nüfusa hizmet veren Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi'nde yeni kurulan kalp cerrahisi merkezi düşük mortalite ve morbiditeyle hizmet vermektedir. Aim: We aimed to assess the clinical outcomes of our department of cardiac surgery which was newly introduced in Hitit University Corum Education and Research Hospital. Material and Method: Between November 2012 and November 2013, a total of 110 open-heart surgeries were performed. Ten out of these (9.1%) were emergency operations for acute ST elevation myocardial infarction Off-pump technique was used in 31 (29.2%) patients and cardiopulmonary bypass was used in 75 (70.8%). A total of 106 patients received coronary artery bypass grafting, 1 received mitral reconstruction,1 received Bentall procedure, 1 received tricuspid valve repair, 1 received mitral valve replacement, 1 received aortic valve replacement with aortic root enlargement and 1 received aortic supracoronary graft replacement. Results: Hospital mortality occurred in 1 (0.9%) patient. Four patients (3.6%) who were on dual antiaggregants underwent a revision for bleeding on the day of the operation. Morbidities occurred in 3 (2.7%) patients. Atrial fibrillation occurred in 11 (10%) patients and the normal sinus rhythm was achieved by amiodarone. Intraaortic balloon counterpulsation was used in 5 (4.5%) patients. Discussion: The newly introduced cardiac surgery department of the Hitit University Corum Education and Research Hospital, which provides tertiary care to a wide rural community, serves with low morbidity and mortality.

In 1973, a 10-year-old boy with rheumatic mitral stenosis underwent mitral valve replacement with use of a Starr-Edwards caged-ball valve (SECBV) model 6120. In March 2013, the adult patient presented with severe aortic stenosis and underwent mechanical aortic valve replacement. In June 2014, at age 51 years, he was admitted to our hospital with atrial fibrillation. A transthoracic echocardiogram showed an aortic valve prosthesis with mild regurgitation, left atrial enlargement to dimensions of 4.5 × 5 cm, a left ventricular ejection fraction of 0.52, and—of note—a well-functioning SECBV without regurgitation, a peak mitral velocity of 2.14 m/s, a moderate early diastolic gradient (18.37 mmHg), and a mild mean gradient (8.31 mmHg) (Fig. 1). There was no paravalvular leak. The effective orifice area of the mitral valve was 2.5 cm2—normal for this type of prosthesis. Cine fluoroscopic images of the mitral valve showed normal silicon-ball movements toward the cage in diastole and closure in systole (Fig. 2). The patient was discharged from the hospital on medical therapy and had New York Heart Association class I functional capacity one month later.

Aim: Percutaneous coronary intervention is usually the initial treatment option for treatment of emergent and severe coronary atherosclerosis with suitable coronary arteries. We aimed to investigate the clinical features, morbidity and mortality rates of coronary artery bypass grafting performed following life-saving stent procedures and patency rates of these stents. Material and Method: Between January 2005 and December 2008, we performed coronary artery bypass grafting on 23 patients who had previous percutaneous coronary intervention to the culprit artery for acute myocardial infarction. Early postoperative coronary angiography was obtained for evaluation of stent patency. Results: In-hospital mortality occurred in five patients (21.7%). Coronary angiographic examination of the remaining patients revealed severe stenosis or occlusion at 16 out 20 stents (80%). The mean time interval between percutaneous coronary intervention and coronary artery bypass grafting was found to be statistically significant regarding stent patency (p=0.007). Discussion: Bypass grafting to a previously stented coronary artery may be the relevant approach even if the angiographic findings are normal, because intraoperative manipulation and systemic effects of cardiopulmonary bypass if used will result in deformity or occlusion of the stent.

research Aim: Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. The aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection. Materials and methods: We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis. Results: A total of 104 patients (79 males, mean age: 55.2 ± 14 years) were included in the final analysis. In multivariate analyses, crossclamp time, cardiopulmonary bypass time, intensive care unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a significantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01–1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-off point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specificity of 53%. Conclusion: This study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection. Aim: Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. The aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection. Materials and methods: We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis. Results: A total of 104 patients (79 males, mean age: 55.2 ± 14 years) were included in the final analysis. In multivariate analyses, crossclamp time, cardiopulmonary bypass time, intensive care unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a significantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01–1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-off point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specificity of 53%. Conclusion: This study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection.

A 65 year old woman was admitted to our hospital with dyspne. She had a medical history of hypertension. Her blood presure was 156/107 mmHg under medication. Physical examination and routine blood tests were normal. The electrocardiogram showed sinus rhythm. Standard anteroposterior chest radiography (Figure 1A) showed a widened mediastinum so a thoracic aortic aneurysm (TAA) was suspected. Transthoracic echocardiography showed normal left ventricular systolic function and also a 36x33 mm saccular aortic aneurysm with intraluminal thrombus which had extended to the lesser curvature of aorta with a narrow neck (11 mm) was seen from the suprasternal view (Figure 1B). For a more accurate assessment, we performed computed tomography angiogram of the thoracic aorta. It demonstrated that a saccular aneurysm of the mid inner curvature of aortic arch with some thrombotic material inside the aneurysm (Figures 1C, 1D). The rest of the aorta was not dilated. She had no history of severe chest or back pain, hoarseness and trauma. The patient and her family were informed about the recommended surgical and endovascular repair options if needed. The patient was initially managed conservatively with aggressive antihypertensive therapy

factPresentation Penetran kalp yaralanmaları, travma çeşitleri arasında en öldürücü olanlardır. Penetran kalp yaralanmalarına uygun yaklaşımda erken tanı, acil serviste (AS) doğru müdahale, erken resüsitasyon ve acil cerrahi müdahale önemlidir. Biz bu çalışmamızda hastanemizde açık kalp cerrahisi yapılmaya başlanmasından önceki 1 yıl içerisinde, penetran kardiyak yaralanma ile AS’ye getirilen beş hastayı retrospektif olarak inceledik ve kardiyopulmoner by-pass yapılamadığı durumlarda bile, erken ve doğru cerrahi müdahalenin sağkalım üzerine olan önemini vurgulamayı amaçladık. Çalışmaya alınan hastaların ortalama yaşı 26 (17-42) yıl idi ve tümü erkekti. İki hasta AS’ye kardiyak arrest olarak getirilmişti ve bu hastalar kurtarılamadı. Üç hasta ise AS’ye kardiyojenik şok ile getirildi ve bu hastaların tümü ameliyat sonrası iyileşti. İki hastada sağ ventrikül yaralanması tespit edildi ve bu hastaların her ikisi de operasyon sonrası hayatta kaldı. Üç hastada sol ventrikül yaralanması saptandı ve bu hastaların 2’si öldü. Üç hasta ateşli silah ile yaralanırken, 2 hasta kesici alet ile yaralanmıştı. Her iki grupta birer hasta öldü. Üç hasta herhangi bir komplikasyon olmadan taburcu edildi. İki hasta, biri operasyon öncesi ve biri operasyon sırasında olmak üzere öldü (sağkalım oranı: 3/5). Bu 3 hastanın yapılan birinci ve üçüncü ay kontrollerinde sol ventrikül ejeksiyon fraksiyonları normal olarak hesaplandı ve herhangi bir major sekel oluşturan komplikasyon gelişmedi. Penetrating cardiac injuries are one of the most lethal types of trauma. Early diagnosis, appropriate approach in the emergency department (ED), early resuscitation and immediate surgical intervention are essential in the management of penetrating cardiac injuries. In this study we retrospectively evaluated five patients with penetrating cardiac injuries in a 1-year period before an open heart surgery center was set up in our hospital; and we aimed to underline the importance of an appropriate and early surgical intervention without cardiopulmonary by-pass on survival. Median age of our patients was 26 years (range, 17-42 years) and all of the patients were males. Two patients were presented as cardiac arrest and they could not be survived. Three of our patients presented to our ED with cardiogenic shock and all of them recovered after the operation. Right ventricle injury was determined in two patients and both of them survived after the operation. In 3 patients, left ventricle injury was observed and 2 of them died. While 3 patients presented with gunshot injury, 2 of them presented with sharp object injury. One patient in each group was died. Three patients recovered without any complications, however 2 patients- one before operation and 1 during operation- died (survival rate: 3/5). Those 3 patients did not develop any major stationary sequela with normal LVEF in the follow-up at first and third.

research Objective: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephal- ic and brachio-cephalic fistula. Methods: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultra- sonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/ brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. Results: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12 th month and 82% in 24 th month in SVI group while it was 88% in 12 th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12 th month and 93% in 24 th month for SVI group while 96% in 12 th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). Conclusion: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and second- ary patency, lower complication rate and cost when compared with PTFE grafts. Objective: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephal- ic and brachio-cephalic fistula. Methods: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultra- sonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/ brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency. Results: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12 th month and 82% in 24 th month in SVI group while it was 88% in 12 th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12 th month and 93% in 24 th month for SVI group while 96% in 12 th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007). Conclusion: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and second- ary patency, lower complication rate and cost when compared with PTFE grafts.

In graft-replacement surgery of the ascending aorta and aortic arch, 2 separate grafts are frequently needed in order to construct a more physiologically configured aorta. We describe a new cutting method for accurate performance of graft-to-graft anastomosis. © 2015 by the Texas Heart ® Institute, Houston.

research Amaç: Bu çalışmada ileri evre distal periferik arter hastalığı olan amputasyon adayı diyabetik hastalarda uygulanan cerrahi distal revaskülarizasyon ile medikal tedavinin sonuçları karşılaştırıldı. Ça­lış­ma pla­nı: Mart 2008 - Kasım 2010 tarihleri arasında diyabetik ayak ve kritik uzuv iskemisi nedeniyle kliniğimize başvuran 40 hasta prospektif olarak çalışmaya dahil edildi. Tüm hastalar Fontaine sınıf 4 olarak sınıflandırıldı. Hastaların 21’ine (ort. yaş 63.5 yıl) diz altı cerrahi revaskülarizasyon uygulanırken, 19’una (ort. yaş 67.9 yıl) medikal tedavi uygulandı. Medyan takip süresi 28 aydı (dağılım 16-47 ay). Hastaların klinik bulguları, amputasyon kayıtları ve greft açıklık oranları kaydedildi. Bul­gu­lar: Takip süresince cerrahi grubunda yedi hastada greft darlığı gözlendi. Cerrahi grubunda primer ve sekonder greft açıklık oranları sırasıyla %66.7 ve %80.9 idi. Ortalama uzuv kayıpsız geçen süre cerrahi grupta 42.3±2.7 ay iken medikal tedavi verilen hastalarda 31.5±4.1 ay idi. Ameliyat sonrası 12, 24 ve 30 aylık ekstremite korunması oranı sırasıyla %90.5, %85.7 ve %81 idi. Medikal tedavi verilen hastalarda ise 12 ve 24 aylık ekstremite korunması oranı sırasıyla %78.9 ve %52.6 olarak saptandı (p

other A 67-year-old man presented with chest pain of three-month duration that occurred with moderate effort 20 years after coronary artery bypass graft surgery using the left internal mammarian artery (LIMA) to the left anterior descending artery and a sequential saphenous vein graft (SVG) to the diagonal branch and obtuse marginal artery.

Pneumocystis jiroveci is an important cause of mortality and morbidity among heart transplant recipients. This raises the question of prophylactic treatment for this infection. Trimethoprimsulfamethoxazole is commonly used in P. jiroveci pneumonia prophylaxis with mild to severe adverse effects. We present the use of inhaled pentamidine as P. jiroveci prophylaxis in a patient with an allergy to trimethoprim sulfamethoxazole.

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