Search

Truncus bicaroticus is a very rare vascular malformation. In this report, we present a very rare anomaly in a patient with left internal carotid artery stenosis together with truncus bicaroticus and right vertebral artery originating from the right common carotid artery. [ABSTRACT FROM AUTHOR]

Dissection of the internal carotid artery is very rare; however, it is diagnosed more frequently with increasing radiographic diagnostic tools. Patients may be completely asymptomatic or may present with symptoms ranging between localized pain to severe cerebral ischemic events. Treatment is usually medical or with interventional radiographic tools. In this report, we present surgical management of internal carotid artery dissection in a 61-year-old female patient., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Endovascular stent graft repair of the thoracic aorta sometimes requires debranching of the aortic arch and reimplantation of the left common carotid and left subclavian arteries to the brachiocephalic trunk. Cerebral protection has utmost importance during such a procedure. The surgical technique detailed here offers pulsatile flow inside the internal carotid arteries despite proximal clamping of the common carotid arteries throughout the whole procedure., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Aortic aneurysms and stenosis are widely treated with endovascular procedures in the current era. In this report, we present endovascular stent grafting for symptomatic treatment of severe thoracic aortic stenosis caused by an aortic sarcomatoid carcinoma in a 73-year-old female. The peri- and post-operative courses were complicated with tumor embolisms that were managed by both endovascular and surgical measures., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: We aimed to assess the biochemical and histopathologic effects of Ginkgo biloba extract (EGb) in an ischemia-reperfusion (IR) model of spinal cord ischemia induced by cross-clamping of the infrarenal abdominal aorta., Methods: A total of 24 Sprague-Dawley rats were divided into 3 groups as group 1: control (sham laparotomy), group 2: IR, and group 3: IR+EGb treatment (IR+T) group. All subjects were euthanized 2 days postsurgery and their spinal cords were removed. Tissue malondialdehyde, superoxide dismutase, glutathione (GSH), and glutathione peroxidase levels were measured, and the spinal cord tissue samples were examined histopathologically., Results: No significant difference was detected in ischemia markers between control, IR, and IR+T groups, with the exception of GSH, which was significantly lower in the IR group. GSH levels in group 1 and group 3 were similar. The group 2 displayed significant ischemic damage to the medulla spinalis. This damage was less pronounced in group 3 compared with group 2 only, but in extent and intensity comparable with the controls., Conclusions: Although we were not able to demonstrate a uniform effect of EGb on biochemical markers of IR injury, the histopathologic data appear to show a protective effect conferred on the spinal cord tissue by EGb., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population., Patients and Methods: Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups., Results: Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ., Conclusion: There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.

Mediastinal cysts are extremely rare clinical disorders. They usually have a pericardial origin. In this report, we present a 27-year-old male patient with a mediastinal bronchogenic cyst together with clinical presentation and management of the pathology.

Behcet's disease is an autoimmune multisystemic disorder on vasculitis base. Cardiovascular involvement is the most important predictor of morbidity and mortality. The treatment should be planned carefully for pathologies requiring interventions. In our report, we present a 45-year-old patient with spontaneous superficial femoral artery pseudoaneurysm, our treatment strategy, and circumstances we faced.

Extracardiac off-pump is reported to result in better early hemodynamics and shorter mechanical ventilation periods. We present a case report of extracardiac off-pump Fontan in a 5-year-old girl with single ventricle and dextrocardia.

Endovascular stent grafting is applied for the treatment of different aortic pathologies in the current medical era. It may be lifesaving in patients with comorbidities and virtually inoperable when adopting conventional techniques. This manuscript reports on a 40-year-old patient, who was previously treated for a mycotic saccular aneurysm at the aortic arch and who presented with a descending aortic rupture at the mid-term follow-up. The descending aortic rupture was also managed successfully by endovascular measures.

Patent ductus arteriosus is one of the most common congenital cardiac pathologies, besides patency of ductus may be somewhat vital for various congenital cardiac defects, otherwise death is inevitable. Anatomically, ductus is single and located between the descending aorta and the pulmonary artery. The review of the literature reveals presence of more than one ductus arteriosi in sporadic cases, most commonly associated with aortic arch anomalies. In this report, we present a nine-month-old baby with the diagnosis of ventricular septal defect (VSD), pulmonary atresia (PA), nonconfluent pulmonary arteries, and bilateral patent ductus arteriosi. He underwent a successful pulmonary reconstruction and central-shunt operation with modified aortopulmonary window technique without cardiopulmonary bypass. This is a very rare case with double ductus arteriosi associated with VSD, PA, and nonconfluent pulmonary arteries., (© 2010 Wiley Periodicals, Inc.)

Objective: Effects of diabetes mellitus on myocardium were investigated, by assessing levels of heat shock protein (HSP) 70, and efficacy of glutamine was tested., Materials and Methods: Thirty male rats were divided into three groups: control group (Group 1), diabetic group (Group 2) and glutamine-induced diabetic group (Group 3). Diabetes was created by intravenous streptozocin injection. Rats were examined one month later for cardiac complications of diabetes. Serum and tissue samples were obtained to measure HSP 70 levels., Results: Following streptozocin administration, glucose levels increased markedly. This resulted in a significant increase in HSP 70 in serum and tissues. When Group 3 was compared with other groups, HSP 70 was more increased in serum and tissues. When Groups 2 and 3 were compared, more increased HSP 70 values were observed in Group 3, statistical significance was obtained for left atrial and left ventricular HSP 70 levels. Elevated blood glucose was correlated with elevated HSP 70 levels. Increased serum HSP 70 levels were correlated with tissue HSP 70 values., Conclusions: HSP 70 levels increase in the myocardium of rats in diabetes mellitus as a protective mechanism. Levels of HSP 70 may further be increased with parenteral administration of glutamine. Efficacy of glutamine is more pronounced in left heart structures.

Primary intrabronchial neurilemmas, also called schwannomas, are extremely rare tumors that originate from Schwann cells. We report a case of intrabronchial schwannoma arising in the left main bronchus in an 8-year-old child. The diagnosis was made by bronchofiberscopic biopsy. Although the tumor was benign, the patient was subjected to left pneumonectomy because of destruction of the pulmonary parenchyma distal to the obstruction. The diagnosis of intrabronchial schwannoma was supported pathologically with characteristic findings on Antoni A and Antoni B areas. This case is unique in that it is the youngest case in the literature., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Hypoplastic infrarenal aorta or infrarenal aortic coarctation is an uncommon vascular pathology characterized with diffuse stenosis in the infrarenal abdominal aorta. It is a variant of atherosclerotic occlusive diseases. The exact incidence and etiology are not known. Presenting symptoms are versatile and incidentally most of the patients have severe hypertension with an unidentified mechanism. Here, we report a 49-year-old male patient diagnosed with abdominal aortic coarctation together with the review of the literature. He underwent successful revasvcularization of the lower extremities.

Background: Cerebral injury is a well-known complication after cardiac surgery with cardiopulmonary bypass (CPB), especially in adult patients. Specific biochemical markers like neuron-specific enolase (NSE) and S-100beta protein were developed previously for early detecting neuronal damage after CPB. Corticosteroids are shown to reduce multisystemic deleterious effects of cardiopulmonary bypass due to their anti-inflammatory characteristics. The aim of this study is to demonstrate the decrease of serum neuron-specific enolase levels in patients who received corticosteroids before CPB., Methods: Thirty patients scheduled for elective coronary bypass surgery were included in the study. Patients were divided randomly into two groups as the control group (n = 15) who underwent a standard coronary bypass surgery without any additional medication and the study group (n = 15) who received 1 gm of methylprednisolone before CPB. Blood samples for analysis of serum NSE, interleukin-6 (IL-6), and IL-10 were drawn before CPB, 4 and 24 hours after the end of extracorporeal circulation., Results: Serum cytokine and NSE levels were significantly increased after CPB above their normal range in both groups. In the study group, IL-6 and NSE levels were significantly reduced while IL-10 levels were much higher after CPB. High NSE levels significantly correlated with IL-6 levels in the control group., Conclusion: The lower levels of NSE in patients who received methylprednisolone may suggest that corticosteroids might be useful in decreasing possible neuronal damage during heart surgery. However, we were not able to demonstrate an adverse neurological outcome.

Background: Diabetes mellitus (DM) alters arterial wall compliance and causes aortic stiffness, which is a predictor of vascular mortality. Heat shock proteins (HSPs) are involved in the protection of cells under stress. We evaluated aortic stiffness in DM and the effects of glutamine (which induces HSP 70) on HSP 70 levels in experimental DM., Materials and Methods: Male Sprague-Dawley rats (n = 30) were divided into three groups: Control (Group 1), DM (Group 2) and glutamine-treated DM (Group 3). DM was induced using streptozocin injection. Group 3 rats received two doses of glutamine during the fourth week. Blood and infrarenal aortic tissue samples were obtained for analysis at the end of the fourth week., Results: Compared with Group 1, serum HSP 70 levels were significantly increased in Groups 2 and 3. Aortic HSP 70 was increased in DM. There was a significant difference in aortic HSP 70 with glutamine injection (Group 1 versus Group 3). DM also interfered with the elastin content of the aorta. There was a significant correlation between the serum glucose and serum and aortic HSP 70 levels and between serum and aortic HSP 70 levels; as well as between severity of DM and aortic elastin levels., Conclusions: DM causes aortic stiffness and this may contribute to the increase in mortality and morbidity associated with DM. The expression of HSP 70 may become a therapeutic target.

Mucopolysaccaridosis syndromes are metabolic disorders that are inherited in an autosomal recessive pattern, and demonstrate cardiovascular involvement that, on rare occasions, results in surgery. The case is presented of a 12-year-old boy with symptoms and signs of congestive heart failure who was referred to the authors' department for severe mitral and aortic valvular stenosis. The patient was shown to have the somatic characteristics of mucopolysaccharidosis, while urinalysis indicated the presence of chondroitin sulfate B. Mitral and aortic valve replacements were carried out, using bileaflet mechanical valves with a standard median sternotomy and cardiopulmonary bypass. A bileaflet preservation technique was adopted during mitral valve replacement to provide better hemodynamics. Severe cardiac involvement in mucopolysaccharidosis requiring cardiac surgery in pediatrics has been rarely documented. A low-profile bileaflet mechanical valve, enabling a larger-sized valve insertion, is preferred in order to avoid patient-prosthesis mismatch during somatic growth of the patient.

Ectasia at the proximal arterial structures is a phenomenon secondary to distal arteriovenous (AV) fistulae and proximal arterial structures must be evaluated carefully prior to an intervention to the lesion especially in long lasting AV fistulae. In this report we present the images of a 58-year-old male patient with a 25-year history of gun shot injury and arteriovenous fistula formation at the femoral region.

Aortoenteric fistula is a dramatic and rare complication, which may occur following abdominal aortic surgery. In this report, we present images of a 65-year-old patient who presented with acute peritonitis two months after aortobifemoral bypass grafting operation with a bifurcated dacron graft. Colonoscopy clearly showed the pathology leading to acute abdomen: Intestinal fistulization of the graft.

The last-stage palliation of patients with single ventricle physiology hearts is Fontan procedure and its modifications that can be performed with or without cardiopulmonary bypass in the current era. Pulmonary vasculature and status of the lungs are critically important for the success of the operation. In this report, we present a 10-year-old patient with single ventricle heart and severely hypoplastic unilateral pulmonary artery and respective lung due to kyphoscoliosis who underwent extracardiac Fontan procedure without cardiopulmonary bypass, successfully.

Infrainguinal revascularization is an effective method of treatment for femoropopliteal/tibial occlusive diseases. However, these bypass grafts are prone to stenosis. In this retrospective study, the authors investigate the association of gender with patency of infrainguinal bypass grafts. The outcomes for consecutive 375 male and 200 female patients who underwent infrainguinal bypass surgery for arterial occlusive disease are compared, and associations with characteristics of the patients, surgical procedure, and graft stenosis are determined. It is found that several demographic, biochemical, and etiological factors could influence the patency of bypass procedures in different genders. However, infrainguinal arterial reconstruction procedures performed in women have a worse outcome when compared with that in men.

Acute presentation of critical peripheral arterial ischemia in an unstable cardiac patient is a challenge to the surgeon. Coexistence of two entities is usually managed with a staged approach; however, decision to treat which entity first may be difficult clinically. We present a 49-year-old man with acute infrarenal aortic occlusion and cardiac ischemia who was treated with single-stage ascending aorta-bifemoral bypass following saphenous vein grafting to left anterior descending artery. Concomitant coronary and peripheral vascular revascularization is a practical method with a high flow inflow source as ascending aorta. We believe that a single-stage approach may be performed in the unstable patient as presented in this report.

Background: The approach to acute and chronic type B aortic dissection has changed significantly over the past years. In this aspect, we have reviewed our single-center experience in surgery for type B dissections and compared the current data presented by other centers., Methods: Twenty-nine patients operated at our center for type B aortic dissection (14 acute, 15 chronic) were reviewed over the years between 1996 and 2004. All patient data in addition to immediate and late outcome following surgery were noted., Results: The mean age in acute and chronic groups was 53 +/- 16 versus 62 +/- 12 years, respectively (p = 0.1). Hospital mortality was 4 patients. The mean period in the intensive care unit was 4.2 +/- 3.1 days. Follow-up time was 36 +/- 11 months. Median interval between the initial symptoms and surgery was 3.8 days for acute cases. No patients underwent reoperation in acute patients; whereas 3 underwent reoperation in the chronic group. False lumen patency rates in acute and chronic dissections were 16.7% versus 46% after 24 months (p< 0.05). Distal anastomoses included both true and false lumens in 83% of the chronic cases with false lumen patency. The mean reoperation-free survival was 79.35 months with standard error of 5.57 months (95% CI, 68.42 to 90.27) in all patients., Conclusions: Open surgery in acute type B dissections yielded excellent immediate and long-term durability in our series with no false lumen patency or aortic expansion. However, incorporation of both false and true lumina into distal anastomosis in patients with chronic dissection resulted in false lumen patency with aortic expansion.

Klippel-Trenaunay syndrome is an inherited disorder that is known to affect the venous system. Besides venous pathologies, arterial stenosis and aneurysmatic dilatations are extremely rare. In this report, we present a 7-year-old boy with Klippel-Trenaunay-(Weber) syndrome who developed iliac and femoral artery aneurysms and stenosis at different levels in his lower limb.

Aortic arch reconstruction remains a challenge for the cardiothoracic surgeon. We present our simplified technique in which we used two grafts for arch reconstruction without circulatory arrest. It is a relatively easy and quick technique consisting of a unique modification of the selective antegrade cerebral circulation system without the need for circulatory arrest in selected cases.