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The SYNTAX score (SS) and SS II, which include additional clinical parameters, are widely used today for deciding revascularization following coronary angiography. We investigated the association between the presence and severity of carotid artery disease (CrAD) using the SS and SS II in 287 patients who underwent coronary artery bypass grafting. We based this investigation on the known association between coronary artery disease and CrAD. A significant association was observed between the groups with and without CrAD in terms of SS II values (28.4 ± 9.6 vs 21.4 ± 7.7, respectively; P < .001). A significant difference was also observed when stenosis was classified according to severity as 70% ( P < .001). The results indicated a positive correlation between the presence and severity of CrAD as SS II increased ( r = 0.187, P = .005). According to the results of multivariate logistic regression analysis, the SS II was an independent predictor of CrAD.

Secundum atrial sepal defect and patent ductus arteriosus are the most frequently encountered congenital heart diseases. They are treated with percutaneous modalities with high success rates and low morbidity and mortality rates. Peri-procedural complications may occur in the early period or in late follow-up. The most striking feature when complications occur is the high mortality rates observed when surgical treatment is required. Here we report one case with patent ductus arteriosus surgically treated due to broken coil and two cases of atrial septal defect directed to surgery one in the early (with the suspicion of device embolization during the procedure) and one in the late post-procedure period (residual shunt) of device closure. First two patients were directed to emergent surgery, whereas the last one underwent elective surgery. Coil was removed in the case with ductus. There was no embolus due to the device in the second case and defect was closed with a patch. The device was removed and patch closure of the defect was performed in the third case. We believe that, these percutaneous modalities should be employed in centers where cardiac surgical back-up is available., Sekundum atrial septal defekt ve patent duktus arteriozus en sık karşılaşılan konjenital kalp hastalıklarıdır. Bu patolojiler, perktütan girişimlerle yüksek başarı, düşük morbidite ve mortalite oranları ile tedavi edilmektedir. Periprosedürel komplikasyonlar erken dönemde ya da geç takip sırasında oluşabilmektedir. Bu komplikasyonlar oluştuğunda cerrahi tedavi gerekli ise yüksek mortalite oranları ile karşılaşılmaktadır. Biz burada kırılmış 'coil' sebebiyle cerrahi uygulanan bir patent duktus arteriozus vakası ve biri erken (işlem sırasında cihaz embolisi şüphesi), diğeri geç dönemde (rezidü kaçak) komplike olmuş cihaz ile kapatılmış iki atriyal septal defekt vakasını bildiriyoruz. İlk iki hasta acil şartlarda, diğeri ise elektif olarak opere edilmiştir. Duktus vakasında 'coil' çıkarılmıştır. İkinci vakada cihaz embolisi saptanmamış, defekt yama ile kapatılmıştır. Üçüncü vakada ise cihaz çıkartılmış, yama ile defekt kapatılmştır. Biz perkütan girişimlerin, kalp cerrahisi desteğinin sağlanabildiği merkezlerde yapılması gerekliliğine inanıyoruz.

Cardiac myxomas are the most common primary benign tumors of the heart and appears particularly in the left atrium. Myxomas exhibit a wide spectrum of symptoms from asymptomatic to very serious according to the localisation of the tumours. Only 5% of these tumours occur in the right and left ventricles. We report an unusual case of a 21-year-old woman with a leukemia in remission, in whom routine transthorasic echocardiographic examination demonstrated an incidental left ventricular mass. The patient underwent successful resection of the left ventricular mass under cardiopulmonary bypass through the left atrial approach. Histopathologic examination was diagnostic for myxoma. In this case, the presentation of the mass was atypical for two reasons: the tumour was a cardiac myxoma in the left ventricular localisation and in a patient with leukemia in remission.

A 78-year-old woman with a history of hypertension and end-stage renal disease was admitted to our hospital for routine control. On physical examination, blood pressure was 145/90 mmHg and pulse rate was 100 beats/min. The electrocardiogram revealed sinus tachycardia and laboratory findings were unremarkable except for kidney function tests. Transthoracic echocardiography (TTE) revealed normal left ventricular systolic functions with moderate concentric hypertrophy. The apical four-chamber view revealed a spherical cavitylike mass of diameter of 3.5 cm adjacent to the left atrioventricular groove (Fig 1a). Subsequently, transesophageal echocardiography (TEE) was performed in order to identify the cystic mass, which contained thrombotic material (Fig 1b). Enhanced computed tomography (CT) angiography showed a giant, partially-thrombotic coronary artery aneurysm (CAA) (Fig 1c). Diagnostic coronary angiography confirmed the giant CAA (27x42 mm in size) arising from the proximal segment of the circumflex coronary artery (Fig 1d). Covered stent implantation was offered promptly, but refused by the patient. Presently, she is under conservative treatment with warfarin and follow-up observation. CAA is defined as a dilatation of the coronary artery that is more than 1.5 times the diameter of normal adjacent segments. Giant CAAs are extremely rare anatomic occurrences. Although there is no uniform definition, they are variously defined as more than 20 to 50 mm in size. Etiological factors include atherosclerosis, Kawasaki disease, congenital malformations, chest trauma, connective tissue diseases, autoimmune diseases and coronary interventions. Although the present patient was asymptomatic, a giant CAA may cause coronary artery rupture, thromboembolism or haemodynamic problems related to compression. A variety of imaging techniques have been used to view giant CAAs. Although noninvasive imaging methods including echocardiography, computed tomography, and magnetic resonance imaging can detect some CAAs, coronary angiography remains the gold standard and provides important information on the size, shape, location, and number of aneurysms. 210

Background: In this article, we aimed to determine the diagnostic role of ischemia-modified albumin (IMA) in the evaluation of patients with deep venous thrombosis (DVT). Methods: Fifty-five patients with a diagnosis of DVT and 47 healthy subjects as the control group were included in the study. Blood samples of the patients were obtained within the first 24 hours after DVT diagnosis for IMA analysis. Patient and control groups were compared with respect to IMA levels. Results: We found that HDL and albumin levels were significantly higher in the control group. However, we could not determine a significant increase in IMA levels in patients with DVT when compared to the control group. Conclusions: Our study revealed that IMA is not a useful marker in the diagnosis of DVT.

Background. Wound infection after median sternotomy for cardiac or thoracic surgery is a serious complication, and there is a lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis treated with longitudinally affixed titanium plates on sternal halves. Methods. The technique was composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. The series included 21 patients who developed sternal non-union resulting from mediastinitis. Mobilization of muscular flaps was performed in 8 cases. This technique also consists of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Antibiotherapy based on culture and sensitivity data continued for 4 to 7 weeks. Results. Twenty patients achieved complete wound healing without further operative intervention or major complication. Nineteen patients treated with this technique survived. One patient died from sepsis after developing residual focus of chondritis and undergoing wide resection of cartilage, and 1 patient died from complications of severe stroke. Conclusion. We had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.

A 61-year-old man who had undergone an iliofemoral bypass with an expanded polytetrafluoroethylene (PTFE) graft was readmitted to our hospital for the investigation and treatment of a possible complication of the surgery. A tender, pulsatile, bulging mass, about the size of an adult fist, was palpated around the left lower abdominal region. Diagnostic procedures showed a large low-density area around the PTFE graft and angiography revealed a patent graft with no anastomotic leakage. An operative inspection revealed the mass to be a large perigraft seroma. The PTFE graft was covered with a saphenous vein strip, a treatment that has not previously been mentioned in the literature. The success of this strategy was confirmed by clinical observations and diagnostic procedures including ultrasonography and computed tomography, with no sign of recurrence for 5 months.

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

We presented a case of hemothorax secondary to inferior vena cava (IVC) aneurysm. A 47-year-old woman was presented to our hospital with nausea, vomiting, and right superior abdominal pain. There was pleural effusion on the right side of the posteroanterior chest x-ray for which a thoracentesis was performed and serohemorrhagic fluid was determined. Biochemical tests showed a mixed transudate and hemorrhage (hemothorax). Cytology was negative for malignancy. Computed tomography revealed a right-sided pleural effusion and a suprahepatic mass that was neighboring IVC and right atrium. Suprahepatic IVC aneurysm without venous obstruction was shown by magnetic resonance imaging and angiography. Mass was explored with right thoracotomy through sixth intercostal space, and the aneurysmal mass was seen and dissected from neighboring tissues. The mass was discrete and directly related to IVC just above the right hepatic vein entrance. After the excision of the aneurysm, the IVC wall was repaired. Histopathologic examination confirmed our diagnosis as venous aneurysm. The patient was discharged without any complication on the sixth postoperative day.

Background: Atrial fibrillation (AF) after coronary artery bypass graft surgery constitutes the most common sustained arrhythmia and results in many complications. The purpose of this study was to assess the effects of prophylactic use of beta-blockers against atrial fibrillation in off-pump surgery patients in the early postoperative period. Methods: From 2002 to 2005, 78 patients were enrolled and 41 patients received 50 mg metoprolol succinate daily, which was initiated minimum four days before surgery. Preoperative beta-blocking therapy was continued until the morning of surgery. Thirty-seven patients were free of beta-blocker therapy. Esmolol was used within same range of doses in both groups during operations. Both groups recieved metoprolol succinate following operations. The frequency of AF occurrence was analysed from the operation time to the sixth postoperative day. Results: Sixteen patients developed AF with an overall incidence of 22.5%. Four patients from the study group and three patients from the control group were excluded from the study because of transfer to on-pump surgery. There was no difference with regard to the number of grafts carried out, duration of operations and ventilation, intensive care unit stay and inotropic need among groups. Length of hospital stay did not differ among groups either. There was a higher incidence of postoperative AF in patients without beta-blocker prophylaxis (11.7–32.4% P = 0.049). Conclusion: Low-dose postoperative beta-adrenergic blockade is valuable for patients who receive these medications before off-pump coronary artery bypass grafting procedures and may be beneficial against AF in all patients.

The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle, as the anterolateral muscle has dual blood supply, whereas the posteromedial papillary muscle has a single blood supply. We present a a 49 years old male patient who has presented with chest pain and dyspnoea. A transesophageal echocardiogram was performed which showed that the mitral valve was normal in thickness with a flail anterior leaflet not coapting with the posterior leaflet due to the coronary artery disease. The patient underwent a mitral valve replacement and left anterior coronary artery and obtuse marginal bypass grafting.

Deep venous thrombosis is frequently seen in lower extremities. However, when seen in the iliac level, mass effect of an underlying pathology must be considered. In this report, we present two cases with upper region deep venous thrombosis, which had underlying pathologies of appendicitis and non-Hodgkin lymphoma. Keywords: Deep venous thrombosis, Etiology, Emergency department