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We have analyzed our single-center immediate and follow-up results in the management of acute iliofemoral deep vein thrombosis (IFDVT) using pharmacomechanical catheter-directed thrombolysis (PMCDT) to determine the safety, accuracy, and effects on quality of life and whether this treatment strategy prevents post-thrombotic syndrome (PTS).The cases of 230 patients who had undergone PMCDT to treat IFDVT from January 2017 to December 2018 were retrospectively reviewed. The preoperative, operative, and postoperative variables, Marder scores, outcomes, and follow-up assessments with the Villalta score and venous clinical severity score were investigated.Anatomic success was achieved for 95.2% of the 230 patients. The mean Marder score had decreased from 12.65 ± 2.1 to 2.4 ± 1.3 postoperatively (P .01). Early recurrent thrombosis had developed in 13 patients (5.65%). The primary patency at the 1-, 6-, and 12-month follow-up visits was 94.0%, 87.2%, and 81.7%, respectively. From 1 to 6 months, the Villalta score had decreased from 8.32 ± 4.14 to 3.43 ± 0.61 and the venous clinical severity score had decreased from 4.0 ± 1.8 to 1.82 ± 0.36 (P .05). No statistically significant difference was found in the PTS severity scores at 12 months of follow-up compared with at 6 months. The mean change in the venous disease-specific quality of life from baseline to 12 months was 29.41 ± 1.99 (P = .029). The total recurrence rate was 19.63% at 1 year.For a select group of patients with acute IFDVT, the use of PMCDT and postoperative anticoagulation therapy offered significant reductions in clot burden, leg pain, and swelling, achieving a significant reduction in PTS severity scores at 6 months.

Coarctation of the aorta (CoA) forms 6-8% of congenital heart diseases (CHD). This narrowing typically occurs in the proximal descending aorta, close to the insertion of the patent ductus arteriosus and can be found with a number of concomitant diseases. CoA is a common cause of secondary arterial hypertension in young adults. Although CoA can be an isolated CHD, it is also commonly found in other congenital syndromes and cardiovascular anomalies. Herein this review paper we reported a brief history of management of aortic coarctation, and current treatment modalities concentrated on stent placement supported with two novel cases.

Background Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. Methods This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( n = 101) had a single dose of del Nido cardioplegia, group 2 ( n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. Results Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. Conclusions Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.

Aim: We aimed to compare the stability of pharmacologic profile, rate of symptomatic recurrent venous thromboembolism, major bleeding and the net clinical benefit on the regimen with vitamin K antagonist (VKA), low molecular weight heparin (LMWH) and direct oral anticoagulant (DOAC) for long-term anticoagulation in patients undergoing pharmaco-mechanical catheter-directed thrombolysis (PMCDT) for the treatment of deep vein thrombosis (DVT). Material and Methods: During the period from January 2019 until June 2019, data of 112 patients who underwent PMCDT for the treatment of acute iliofemoral DVT in our institution with long-term apixaban (Pfizer, Turkey) medication were prospectively collected (Group 1-DOAC). Data of control groups within January 2017- December 2018 period were collected retrospectively. Control groups consisted of PMCDT patients with extended LMWH (Tinzaparin, Abdi Ibrahim Pharma, Turkey) treatment (Group 2-LMWH; N=119) and with VKA (Coumadin, Eczacibasi Pharma, Turkey) treatment (Group 3- Control; N=111). Results: Patients treated with VKA showed a significant incompliance starting from third month up to one year. Patency rate diminished significantly below 70%. 32% of VKA patients were out of therapeutic range even in the first month leading to 40% at the end of the year. Likert Scale, Villalta/VCCS and VEINES-QOL-Sym scores confirmed the clinical data. Conclusion: This study highlights the potential role of DOAC as a reasonable alternative to VKAs/LMWH in the long-term anticoagulation strategy for DVT. We await larger clinical trials to support these findings and establish the role of DOAC as the standard of care for patients with DVT., Amaç: Derin ven trombozu (DVT) tedavisi için farmakomekanik katater aracılı trombliz (FMKAT) yapılan hastalarda; vitamin K antagonistlerini(VKA), düşük molekül ağırlıklı heparini (DMAH) ve direk oral antikoagülan ajanları (DOAK) farmakolojik profilllerinin stabilitesine, semptomatik rekürren venöz tromboembolik, major kanama ve klinik fayda oranlarına göre karşılaştırmayı hedefledik.Gereç ve Yöntemler: Ocak 2019 ile Haziran 2019 tarihleri arasında kliniğimizde akut iliofemoral DVT tanısı ile FMKAT yapılan ve uzun dönemde apixaban (Pfizer, Türkiye) tedavisi ile takip edilen 112 hastanın verileri toplandı. (Grup 1- DOAK) Kontrol gruplarının dataları ise Ocak 2017 ile Aralık 2018 tarihleri arasında yine kliniğimizde akut iliofemoral DVT tanısı ile FMKAT yapılan ve uzun dönemde DMAH (Tinzaparin, Abdi Ibrahim İlaç, Türkiye) tedavisi (Group 2-DMAH; N=119) ve VKA(Coumadin, Eczacibasi İlaç, Türkiye) tedavisi (Grup 3- Kontrol N=111) hastalardan toplandı.Bulgular: VKA tedavisi ile takip edilen hastalarda 3.aydan başlayıp 1 yıla kadar ki takip sürelerinde belirgin oranda tedaviye uyumsuzluk saptandı. Patens oranları %70'in altındaydı. VKA hastalarının %32'si yıl sonunda terapötik dozlarda değildi. Likert skalaları, Villalta/VCCS ve VEINES-QOL-Sym skorlama sistemlerinin sonuçları klinik sonuçlar ile uyumluydu.Sonuç :Bu çalışma DOAK'ların DVT hastalarında tedavi için DMAH ve VKA'lara mantıklı bir alternatif seçenek olduğunu gösterdi. DOAK tedavisinin DVT hastalarında standart bir tedavi olarak tercih edilebilmesi için bizim elde ettiğimiz sonuçları destekleyecek geniş kapsamlı klinik çalışmaların sonuçları beklenmektedir

Amaç: Kanama kalp cerrahisinde önemli bir sorundur ve artan morbidite ve mortalite ile ilişkili yüksek allojenik kan transfüzyonu riskine yol açar. Son yıllarda, literatürdeki çalışmalar desmopresinin (1-deamino-8-D-arginin vazopressin, DDAVP) cerrahi müdahalelerden sonra kan kaybını azalttığını bildirmişlerdir. Bu çalışmanın amacı, kardiyologlar tarafından P2Y12 inhibitörleri ile tedavi edilen ve acil koroner arter baypas greftleme (KABG) ameliyatı geçiren hastalarda desmopressin ve traneksamik asidin kan ürünü kullanımı ve postoperatif kanama üzerindeki etkisini analiz etmektir. Gereç ve Yöntemler: Acil izole KABG ameliyatı geçiren ve öncesinde P2Y12 inhibitörleri ile tedavi edilmiş 62 erişkin hastanın prospektif olarak toplanan verileri retrospektif olarak incelendi. Hastaların perioperatif verileri birlikte demografik verileri, laboratuvar bulguları, göğüs tüplerinden kan kaybı miktarı, kan ürünü kullanım miktarı, yeniden torakotomi ihtiyacı, morbidite ve mortalite sonuçları değerlendirildi. Hasta popülasyonu iki gruba ayrıldı: Grup I: Perioperatif traneksamik asit ve DDAVP alan hastalar (n=26); ve Grup II: Perioperatif olarak sadece traneksamik asit alan hastalar (n=36). Bulgular: İki hasta grubu başlangıçta benzer özelliklere sahipti. Grup I ve II arasında göğüs tüplerinden postoperatif kan kaybı, yeniden torakotomi, alyuvar ve trombosit transfüzyonları açısından istatistiksel olarak anlamlı fark vardı (p, Aim: Bleeding is a major problem in cardiac surgery, and results in a high risk of allogeneic blood transfusion associated with increased morbidity and mortality. In recent years, studies in the literature reported that desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) reduces the blood loss after surgical interventions. The aim of the present study is to analyze the effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding in patients that were pretreated with P2Y12 inhibitors by cardiologists and undergone emergent coronary artery bypass grafting (CABG) surgery. Material and Methods:The prospectively collected data of 62 adult patients who underwent emergent isolated CABG surgery and pretreated with P2Y12 inhibitors by cardiologists were retrospectively reviewed. The perioperative data of the patients included their demographic data, laboratory findings, the amount of blood loss from chest tubes, the amount of blood product use, need of re-thoracotomy, morbidity and mortality. The patient population was divided into two groups: Group I: Patients that received tranexamic acid and DDAVP perioperatively (n=26); and Group II: Patients that received only tranexamic acid perioperatively (n=36). Results: The two groups of patients had similar characteristics at baseline. There was a statistically significant difference between Group I and II regarding postoperative blood loss from the chest tubes, re-thoracotomy, red blood cell and thrombocyte transfusions (p

Aim: Atherosclerotic carotid artery stenosis (CS) is responsible for ~20% of strokes. The management of CS in an asymptomatic patient has been less clear. In situations were carotid endarterectomy (CEA) is thought to be more risky, surgeons must also have enough experience and capability to perform carotid artery stenting (CAS) to provide suitable, patient-tailored treatment. In this study, the same investigator performed all interventions (CAS and CEA), and one type of stenting device and EPD was used. In addition, periprocedural monitoring was carried out for at least 24 h. The objective of this study was to compare procedural results and 12-month follow-up outcomes of patients who were treated by the same operator- either CAS or CEA- in one year. Material and Methods: A retrospective single-center review involving asymptomatic patients with severe stenosis of the ICA caused by atherosclerotic disease who was treated with either stenting with embolic protection (Group 1, n=17) or carotid endarterectomy (group 2, n=18) according to their clinical and anatomical risk profile between 1 January 2018 and 31 December 2018 at Numune Research and Training Hospital, Department of Cardiovascular Surgery, Ankara-Turkey was conducted. A duplex ultrasound (DUS) and neurological assessment was obtained prior to hospital discharge as a baseline, 30-days, 6 months, and 1 year thereafter. Patients’ demographic and clinical characteristics, angiographic variables, primary endpoints including the composite of death, stroke and myocardial infarction during the 30 days after the procedure or ipsilateral stroke during the 365 days after the procedure was compared. Primary endpoints also including primary technical success, periprocedural clinical success, primary patency, clinical failure, periprocedural adjunctive maneuvers and secondary endpoints including complications, freedom from clinically driven target-lesion revascularization at 12 months, freedom from death, freedom from all stroke and freedom from restenosis rates were assessed and compared between the groups. Results: High-risk anatomical criteria were present in 8 (47.0%) patients, high-risk clinical criteria were present in 11 (64.7%) patients. Group 2 patients were older (67.7±7.4 vs 71.2± 6.9, p

Minimally invasive techniques in the surgical treatment of congenital heart diseases have gained popularity recently. Right infra-axillary vertical thoracotomy (RIAVT) is one of these techniques. The aim of this study is to investigate the postoperative morbidity and cosmetic results of the right infraaxillary thoracotomy technique and compare them with the results in the literature.All patients who had undergone cardiac surgery using RIAVT at the Ankara City Hospital Pediatric Cardiovascular Surgery Clinic between 2019 and 2021 were enrolled in the study. Preoperative echocardiographic diagnoses, intraoperative surgical data and postoperative morbidity data of the patients was obtained. In addition, surgical incision length was measured and recorded for the evaluation of cosmetic outcome. This data was then compared with data from similar studies in the literature.Between January 2019 and December 2021, 59 patients were operated on using RIAVT. Of the RIAVT patients, 45 (76%) were female and 14 (24%) were male. The mean weight of the patients was 22.38±12.48 kg. Although the youngest patient was a 5-month-old infant weighing 4 kg, the oldest one was 15-years-old weighing 57 kg. Isolated secundum atrial septal defect (ASD) repair (primary or patch) was performed in 47 patients. One (1) patient with Primum ASD and mitral cleft, 1 patient with secundum ASD and perimembranous ventricular septal defect (VSD) repair, nine patients with high venosum ASD and PAPVC, and one patient with a discrete subaortic membrane were operated on. The surgical incision length was between 4 to 5 cm.RIAVT is an important surgical alternative to median sternotomy in selected cases with certain pathologies. It can be performed safely in various congenital heart anomalies and provides excellent functional and cosmetic results in the long-term when compared to other surgical methods.

Objectives: The aim of this study is to evaluate the safety and efficacy of the novel bidirectional cannula that ensures stable distal perfusion compared to conventional cannula in patients undergoing femoral arterial cannulation for cardiopulmonary bypass (CPB). Methods: During a 1-year period, 64 patients undergoing surgery via peripheral cannulation were prospectively randomized to receive 19 F bidirectional (Biflow™, LivaNova, Italy) or 19 F conventional (HLS Peripheral cannula, Getinge Group™, Germany) cannula with 6 F downstream line (Bicakcilar™, Turkey) for femoral artery cannulation. The primary outcome included the efficacy (adequacy of antegrade/retrograde comparative flow via cannula measured by doppler ultrasonography) and the secondary outcome was the safety (early/late complications and adverse events). Results: Percent flow (distal/proximal) after cannulation measured by doppler ultrasonography was significantly better in study group (33.1 ± 5 ml/min) versus downstream cannula (16.1 ± 4, p = 0.012). SpO2 measured by near infrared spectroscopy (NIRS) also demonstrated significantly better saturation in distal calf of the cannulated leg in bidirectional cannula group (67.5% ± 10% vs 52.5 ± 8, p = 0.04). The incidence of serious adverse events was seroma on femoral region (one patient), superficial wound infection (one patient), pseudo-hematoma (two patients) in bidirectional cannula group and in-hospital femoral embolectomy/artery repair (two patients), superficial wound infection (three patients), cannulation site hematoma (three patients) in conventional cannula group. Conclusions: This study demonstrates that in patients undergoing femoral arterial cannulation for CPB during cardiac surgery, the use of a novel bidirectional cannula is safe and easy to insert and provides stable distal perfusion of the cannulated limb.

One of the oldest and common methods of diagnosing heart abnormalities is auscultation. Even for experienced medical doctors, it is not an easy task to detect abnormal patterns in the heart sounds. Most of the digital stethoscopes are now capable of recording and transferring the heart sounds. Moreover, it is proven that auscultation records can be classified as healthy or unhealthy via artificial intelligence techniques. In this work, an artificial intelligence-powered mobile application that works in a connectionless fashion is presented. According to the clinical experiments, the mobile application can detect heart abnormalities with approximately 92% accuracy which is comparable if not better than humans since only a small number of well-trained cardiologists can analyze auscultation records better than artificial intelligence. Using the diagnostic ability of artificial intelligence in a mobile application would change the classical way of auscultation for heart disease diagnosis.

Objectives: We aimed to evaluate the potential effects of heart positioning during off-pump CABG (OPCAB) without cardiac stabilizer device on serum levels of IMA and cardiac output. Materials and Methods: This was a prospective study, in which consecutive patients who underwent isolated OPCAB were included. Data including electrocardiography and intraarterial hemodynamic monitoring parameters were recorded. Arterial pressure waveform (APW) was analyzed. Cardiac output was measured for circumflex coronary artery (Cx), diagonal coronary artery (D1), left anterior descending coronary artery (LAD), and right coronary artery (RCA) positions. Preoperative and postoperative 1, 2, 4, and 12-hour blood samples were taken for serum ischemia modified albumin measurements. Results: Forty patients who underwent OPCAB were included in the study. The mean age was 60.3 ± 10.2 years. Hospital mortality, stroke, postoperative myocardial infarction, acute kidney injury, sternal infection and re-operation for bleeding/tamponade were not observed postoperatively. Six patients (15%) who developed postoperative AF had a significantly higher mean serum IMA level compared with patients who did not.There was no statistically significant difference in preoperative and postoperative mean serum IMA levels (p = 0.925). Mean CO values measured at four different positions of the heart were not significantly different from each other except a difference between LAD and Cx(p=0.002). Conclusion: Our results showed that when the heart was in Cx anastomosis position, the cardiac output was significantly lower than LAD position; however, there was no significant serum IMA raise despite cardiac output decrease. IMA levels did not change significantly from baseline values. Patients who developed postoperative AF had higher IMA levels than patients who did not develop AF.

Objective: To investigate the correlation between cardiac output values and renal neutrophil gelatinase-associated lipocalin (NGAL) levels as a biomarker of renal ischemia. Methods: Forty patients, who underwent off-pump coronary artery bypass (OPCAB) surgery and in whom the positioning of the heart was fixed with simple suspension sutures without a mechanical stabilizer, were included in the study. Continuous cardiac output (CO) measurements were recorded using the arterial pressure waveform analysis method (FloTrac sensor system) in the perioperative period. CO was recorded every minute during non-anatomical cardiac positioning for left anterior descending artery (LAD), diagonal artery (D), circumflex artery (Cx), and right coronary artery (RCA) bypasses. Serum NGAL samples were analyzed in the preoperative, perioperative, and postoperative periods. Results: The CO values measured at various non-anatomical cardiac positions during distal anastomosis for LAD, D, Cx, and RCA were significantly lower than pre- and postoperative values measured with the heart in normal anatomical position (3.45±0.78, 2.9±0.71, 3.11±0.56, 3.19±0.81, 5.03±1.4, and 4.85±0.78, respectively, P=0.008). There was no significant difference between CO values measured at various non-anatomical cardiac positions during distal anastomosis. Although there was no significant correlation between NGAL levels and age, duration of surgery, preoperative CO, D-CO, RCA-CO, and postoperative CO measurements, there was a significant correlation between NGAL levels and LAD-CO (P=0.044) and Cx-CO (P=0.018) at the postoperative 12th hour. Conclusion: Full revascularization may be achieved by employing the OPCAB technique while using simple suspension sutures without a mechanical stabilizer and by providing safe CO levels and low risk of renal ischemia.

Objective This study aims to compare del Nido cardioplegia (DNC) and histidine–tryptophan–ketoglutarate (HTK) cardioplegic solutions in minimally invasive aortic valve replacement (mini-AVR) surgery to discuss the safety level of myocardial protection and rationale for redosing intervals. Methods During the period from January 2017 to June 2019, 200 patients undergoing mini-AVR (solely or with concomitant procedures) were prospectively randomized to DNC ( n = 100) and HTK ( n = 100), both up to 90 minutes ischemic time. Patients with ischemic time over 90 minutes, needing a redosing, were further analyzed in 2 subgroups with DNC-R ( n = 30) and HTK-R ( n = 36). Sensitive biomarkers, in addition to routine biochemistry, were also documented at baseline (T1), after cessation of cardiopulmonary bypass (T2), and on the first postoperative day (T3). Transmural myocardial biopsies were sampled for staining. Results No statistical differences could be demonstrated in DNC and HTK groups with up to 90 minutes cross-clamp times in routine biochemical measurements and basic perioperative clinical outcomes. DNC-R showed significantly more arrhythmia/AV block incidence resulting in more extended intensive care unit (ICU) stay. Interleukin-6 and syndecan-1 in DNC and DNC-R groups were substantially higher at T2. Aquaporin-4 levels were significantly lower in the DNC-R group, demonstrating unsatisfactory response of cells to an excessive volume at T2. Conclusions DNC and HTK provided acceptable myocardial protection as single-dose applications. DNC-R had significantly unbalanced levels of biomarkers, and more arrhythmia/AV block incidence resulting in more extended ICU stay. For patients who may need redosing HTK may be preferable to DNC.

Despite the popularity of single-dose cardioplegic techniques, the time window and targeted population for successful reperfusion remain unclear. We tested currently available techniques based on cell viability and integrity to demonstrate long-term cardioprotection and clarify whether these solutions were performed on neonatal/adult endothelium and myocardium by examining different cell lines. Cell viability with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test proliferation assay and membrane integrity with the lactic dehydrogenase (LDH) cytotoxicity test were documented in a cell culture/microscopy setting on adult (human umbilical vein endothelium [HUVEC]), neonatal (H9C2-cardiomyocytes), and myofibroblast (L929) cell lines. Apoptotic cell activity and necrosis were evaluated by acridine orange/propidium iodide (AO/PI) staining. Twenty-four hours after seeding, cells were incubated in control (Dulbecco’s modified Eagle), St. Thomas and blood cardioplegia (4:1), histidine–tryptophan–ketoglutarate (HTK), and del Nido solutions at 32°C followed by an additional 6, 24, and 48 hours in standard conditions (37°C, 5% CO2). Experiments were repeated eight times. In MTT cell viability analysis, HTK protection was significantly better than the control medium in L929 cell lines at 48th hours follow-up and acted markedly better on the HUVEC cell line at 24th and 48th hours. del Nido and HTK provided significantly better protection on H9C2 (at 24th and 48th hours). Apoptotic and necrotic cell scoring as a result of AO/PI staining was found consistent with MTT results. The LDH test demonstrated that the level of cell disruption was significantly higher for St. Thomas and blood cardioplegia in H9c2 cells. Experimental studies on cardioplegia aimed at assessing myocardial protection use time-consuming and often expensive approaches that are unrealistic in clinical practice. We have focused on identifying the most effective cell types and the direct consequences of different cardioplegia solutions to document long-term effects that we believe are the most underestimated ones in the cardioplegia literature.

Successful implementation of a patient blood management program necessitates the collaboration of a strong organization and a multidisciplinary approach. We organized a meeting with broad participation in our center to establish a consensus for implementation of a specific patient blood management program. International and domestic experiences were shared, the importance of coordination and execution of different pillars in patient blood management were discussed, and the problems about the blood transfusion system were also investigated with the proposal for solutions. The data obtained from this meeting are presented to be a guide for similar large-volume tertiary hospitals for integration of a patient blood management protocol.

We present our multidisciplinary and multistep strategy in patients undergoing minimally invasive aortic valve replacement (mAVR) on minimally invasive extracorporeal circulation (MiECC) compared with control groups of a single strategy and conventional techniques. This cohort study included high-risk patients (Society of Thoracic Surgeons [STS] risk score >8%) undergoing aortic valve surgery under different strategies during the period from January 2017 until March 2019. Patients were matched for age, gender, body mass index, and STS score: group 1 (MiAVR) based on a minimally invasive technique with J-mini-sternotomy, rapid deployment valve (RDV), and type IV customized MiECC; group 2 (control-mAVR) consisted of minimally invasive technique with only J mini-sternotomy and RDV on a conventional extracorporeal system; group 3 (control-MiECC): full sternotomy and type IV customized MiECC; and group 4 (control): full sternotomy on a conventional extracorporeal system. The MiAVR group had significantly less duration of x-clamp time (35.4 ± 11 minutes), postoperative respiratory support (4.1 ± 1 hour), postoperative hemorrhage (250 ± 50 mL), and intensive care unit stay (1 ± .5 days) than the control-conventional (group 4) group. Seventy-six percent of patients did not receive any blood products in MiAVR (p = .025 vs. group 4). Incidence of atrial fibrillation (8%) and low cardiac output (14%) in MiAVR were significantly better than control. Critics of minimally invasive techniques sustain that potential advantages are offset by a longer cross-clamp and cardiopulmonary bypass duration, which may translate into inferior clinical outcomes. We advocate that our multidisciplinary approach supported by multiple technologies may be associated with faster recovery and superior outcomes than conventional minimally/conventional techniques.

The Bjork-Shiley valve (BSV) was one of the first tilting disc valve prosthesis used. We report a patient with a still functioning BS mitral valve prosthesis implanted and required a redo surgery for tricuspid valve regurgitation.

Transtorasik atesli silah yaralanmalari yuksek mortaliteye sahip olduklarindan, dogru bir yaklasimla acil mudahale gerektirirler. Yuksek mortalitenin ana nedeni, kardiak, pulmoner ve torasik buyuk damar yaralanmalarinin birlikte gorulebilmesidir. Bu olgu sunumunda, masif akciger hasarina yol acan transtorasik atesli silah yaralanmasi ile gelen genc bir kadinin acil cerrahi mudahalesi sunulmaktadir.

Abdominal aort aneurysm is an asymptomatic and potentially lethal disease which its rupture is an emergent situation. In many centers, patients presenting with ruptured abdominal aortic aneurysm (rAAA) are most often treated with open repair(OR). A 55-year-old male with acute abdominal pain admitted to our hospital. Computed tomography scan showed a rAAA. A sudden cardiac arrest occured. The patient immediately transferred to catheter laboratory with cardiogenic shock table and endovascular treatment was performed. Then he was discharged in the postoperative 7th day.

Objectives: The present study aimed to analyze the prognostic value of preoperative serum vitamin D level in patients who underwent coronary artery bypass graft (CABG) surgery. Materials and Methods: The data of 360 adult patients who underwent isolated CABG surgery were retrospectively reviewed. We reached the data of preoperative serum vitamin D [25-hydroxyvitamin D (25-OHD)] values of 305 patients. The patient population was divided into two groups based on preoperative serum 25-OHD levels with a normal range of 25-75 nmol/L (group I: patients with preoperative serum 25-OHD level

WOS:000557211400008 PubMed: 32726204 Background: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AM and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value

WOS: 000531064700002 PubMed: 32524976 Introduction: Delirium after cardiac surgery is a devastating and important complication. Delirium is defined as "disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)." In this study, we analyzed the association of preoperative vitamin D levels and postoperative delirium after cardiac surgery in patients over 65 years. Materials and methods: We retrospectively reviewed the data of 212 adult patients above 65 years of age who underwent isolated coronary artery bypass graft surgery from January 2016 to January 2018. The mean age for Group I was 69.7 +/- 7.4 and Group II was 70.6 +/- 4.8 years. There were 112 female patients in Group I and 46 female patients in Group II. The patient population was divided into 2 groups based on preoperative serum vitamin D (25-hydroxyvitamin D [25-OHD]) levels (normal range of 25-75nmol/L). Group I included patients with preoperative serum 25-OHD level= 25nmol/L. Results: The incidence of delirium in this study was 30.2%. In this study, 138 patients (65.1%) had preoperative serum 25-OHD levels = 25 nmol/L. Preoperative serum 25-OHD levels were associated with postoperative delirium after coronary artery bypass graft surgery. Our retrospective study illustrated that a lower preoperative serum level of 25-OHD was associated with postoperative delirium. Our results showed that 65.1% of patients had preoperative serum 25-OHD levels

Çoklu travma hastalarının sağkalımında erken teşhis ve tedavi oldukça önemlidir. Deneyimli hastanelerde klinikler arasında gelişmiş koordinasyon ve başarılı bir multidisipliner yaklaşım ile hastalar hayatta tutulabilir. Hastanemize araç içi trafik kazası sonrası getirilen genç bir multitravma hastasında hızlı ve etkin müdahale sonrası aldığımız yüz güldürücü sonucu paylaşmak istedik.

One of the oldest and most common methods of diagnosing heart abnormalities is auscultation. Even for experienced medical doctors, it is not an easy task to detect abnormal patterns in the heart sounds. Most digital stethoscopes are now capable of recording and transferring heart sounds. Moreover, it is proven that auscultation records can be classified as healthy or unhealthy via artificial intelligence techniques. In this work, an artificial intelligence-powered mobile application that works in a connectionless fashion is presented. According to the clinical experiments, the mobile application can detect heart abnormalities with approximately 92% accuracy, which is comparable to if not better than humans since only a small number of well-trained cardiologists can analyze auscultation records better than artificial intelligence. Using the diagnostic ability of artificial intelligence in a mobile application would change the classical way of auscultation for heart disease diagnosis.

Amaç: Venözanevrizma (VA), rüptür ve ölümcül kanamalara da sebep olabilen arteriyovenözfistüllerin sık görülen komplikasyonudur. AVF’ de venöz anevrizma çoğunluğu üstekstremite de görülür. Gereç ve Yöntemler: Materyalve Metodlar:Ocak 2018 ile Aralık 2018 tarihleri arasında toplam 12 venözanevrizma hastasına vasküler greft kullanılarak end-to-end anastomozyapılmıştır. Bulgular: Hastaların8 (%66) tanesi erkekti. Ortalama yaş 43.1 yaşdı.(25-69 yaş aralığı). Tümfistüller üst ekstremite yer alıyordu, 2 tanesi bazilik ven transpozisyonu ve10 tanesi brakiyosefalik arteriyovenöz fistüldü. Venöz anevrizma ortalama çapı4.7cm (3-7cm aralığı) tespit edildi. Tüm hastalarda kullanılan vasküler greftvasküler greft ilk 24-48 saat içinde başarılı bir şekilde AV giriş içinkullanıldı. Tartışma: Buseride anlattığımız prosedür, avf de sık görülen venöz anevrizmakomplikasyonunun çözümü için başarılı ve etkin bir yöntemdir. Postoperatifdönemde hastaların erken taburcu edilebilmesi ve VA bölgesindeki greftin 24-48saat içinde hemodiyaliz için kullanılabilir olması işlemin avantajı olarakgörülmüştür., Aim:A Venous aneurysm (VA) is one of the complicationsof arteriovenous fistulas (AVF) and may lead to rupture and potentially fatalbleeding. VA formation in AVF is mostly seenin the upper arm. Material and Methods: Between January 2018 andDecember 2018, a total of 12 VA patients underwent surgery to end-to-endanastomosis using a vascular graft. Results: Eightof the patients (66%) were males, and the mean age was 43.1 years (range 25-69years). All of the fistulas were in the upper arm; two were basilictranspositions, and 10 were brachiocephalic AVF. Mean VA diameter was 4,7 cm(range 3-7 cm). All patients cannulated successfully within 24-48 hours from thenewly placed AV access. Conclusions:The procedure we described in thisseries is a successful and effective method for the treatment of VA in AFV. Postoperatively, most of the patients discharged early,and the VA site could be used for HD in 24-48 hours.

Gizliguatr nadir karşılaşılan bir durum olmasına rağmen servikal bölgeye yapılankesilerle cerrahi olarak tedavi edilebilmektedir. Ekstraservikal yaklaşıkistisnai durumlarda başvurulan bir yöntemdir. Biz bu olgu sunumunda daha öncekardiyak cerrahi geçirmiş, gizli guatrı olan bir hastada tiroidektomi içintransservikal yaklaşım ile mini-sternotomiyi nasıl kombine ettiğimizi anlatmakistedik., Forgottengoiter is a rare condition and it is surgically managed through cervicalapproach in most cases. Extracervical management could be necessary in rarecases. We report a case of a forgotten goiter managed with thyroidectomythrough a mini-resternotomy combined with a transcervical approach as thepatient underwent previous cardiac surgery.

Lenfödem tedavisi oldukça zorlu bir tedavidir. Lenf sıvısnınvenöz sisteme drenajında mikrocerrahi yöntemlerin kullanılması bu alandakiyeniliklerdendir. Biz bu yazıdan- mikrocerrahik olarak lenfatikovenöz anastomoztekniği ile tedavi edilen bir olgumuzu sunmak istedik, Treatment of lymphedema is challenging. The application of microsurgical techniques to the drainage of lymph in to the venous system offers new possibilities in this field. Herein we aimed to report the results of our cases treated with microsurgical lymphaticovenous implantation.

Behçet's disease is an inflammatory disease characterized by recurrent oral aphthous ulcers and various accompanying systemic pathologies. These additional pathologies include ocular and neurologic disease, genital ulcers, skin lesions, arthritis and vascular involvement. It is an inflammatory disease and most of the clinical manifestations are due to vasculitides. Behçet's disease is remarkable for its ability to affect blood vessels of all sizes of both venous and arterial sides of the circulation. Behçet's vasculitides are mostly seen in the venous system but the arterial disease may also be encountered. Among the large arteries, pulmonary artery, aorta and its branches are predominantly involved. Carotid artery involvement is rarely seen. In this article, a Behçet's patient referred with a carotid artery aneurysm is presented.

In childhood, pulmonary thromboembolism (PTE) is an uncommonbut potentially life-threatening disease. The greater numbers of venous thromboembolism (VTE) are complications of underlying risk factors such as malignancies, chemotherapy (L-asparaginase), and central venous catheter. We report a patient with acute lymphoblastic leukemia and PTE, who presented with near-syncope, and was successfully treated with low molecular weight heparin and calcium channel blockers.

We have recently shown that experimental traumatic brain injury (TBI) results in ultrastructural damage in heart tissue. The aim of this study was to determine the two antiapoptotic signals "survivin" and "aven" in rat heart tissue following TBI, and comparing the effects of erythropoietin (EPO) and methylprednisolone (MPS). Thirty-six Wistar-Albino female rats weighing 190 to 230 g were randomly allocated into six groups: group 1 underwent head trauma with no treatment; group 2 and group 3, head trauma and intraperitoneally delivered EPO (1000 IU/kg) and MPS (30 mg/kg), respectively; group 4 (vehicle), head trauma and intraperitoneal albumin (0.4 mL/rat); groups 5 and 6, control and sham-operated groups, respectively. Three-hundred g-cm impact trauma was produced by the method of weight-drop. Real-time quantitative polymerase chain reactions were used to estimate survivin and aven gene expression at the total RNA level. Both survivin and aven were higher among the treatment than the trauma group (P = .0006, .0001 and P = .0038, .0033, respectively). Comparing survivin and aven between EPO and MPS treatment groups showed no significance (P = .3027, .2171, respectively). Also, both survivin and aven were significantly higher among the treatment than the vehicle, the control, or the sham-operated groups. These findings suggested that both EPO and MPS may play important roles in the expression of antiapoptotic survivin and aven genes in heart tissue after TBI.

Background The aim of this study was to determine whether prophylactic use of calcium dobesilate (CD) can improve venous function after saphenous vein harvest in coronary artery bypass graft (CABG). Materials and Methods A total of 100 patients who underwent elective CABG were divided into four equal groups. In Group A, the greater saphenous vein (GSV) was harvested below the knee and, in Group B, through the knee till the groin. These patients remained untreated. Group C received CD in a dosage of 1500 mg po daily after the GSV was harvested below the knee. Group D received same dosage of CD after the GSV was harvested through the knee till the groin. Venous function of ipsilateral leg was evaluated clinically and by Doppler ultrasonography in the postoperative first week and second month. Results Clinical findings of venous insufficiency were observed with a similar rate between groups at both early and late periods. In Groups A and B, after 2 months, flow velocities decreased and reflux periods increased significantly. In groups C and D, treatment with CD for 2 months after saphenectomy resulted in a significant increase in flow velocities and a significant decrease in reflux periods. Patients in Groups B and D have significantly more impaired venous functions. Conclusion Saphenectomy results in ipsilateral leg venous dysfunction, which seems to be unrelated to leg swelling and to be more prominent in patients with high-level saphenectomy. In addition, to be careful about the restriction of the saphenectomy procedure into the most appropriate level, prophylactic use of CD can prevent this deterioration when it was added to varice socks.

OBJECTIVE Genetic bases for novel prothrombotic, inflammatory risk factors may play a role in the early onset of coronary artery disease. METHODS Twenty-one patients below 35 years of age who underwent coronary bypass grafting between 2002 and 2004 constituted the study group and were compared with 50 healthy, age and sex-matched controls. Gene analysis for genetic polymorphisms of angiotensin-converting enzyme, prothrombin G20210A, tumour necrosis factor-alpha G308A, factor V Leiden and interleukin-6 genes was carried out. RESULTS The control group was 98% homozygous for the factor V Leiden GG allele and 2% heterozygous for the GA allele. On the other hand, the study group was 76.2% homozygous for the GG allele, and 23.8% heterozygous for the GA allele (P

The frequencies of angiotensin-converting enzyme gene insertion/deletion, angiotensinogen-M253T, and angiotensin II type 1 receptor-A1166C polymorphisms were analyzed in 105 patients undergoing coronary artery bypass grafting (group 1) and a control group of 105 non-cardiac patients (group 2). Blood samples were obtained for biochemical analyses and DNA extraction. Genotyping was performed by polymerase-chain-reaction-based restriction analysis. According to the angiotensin-converting enzyme gene insertion/deletion polymorphism, 36.3% of patients in group 1 and 30.7% in group 2 were homozygous for the DD allele. This difference was not statistically significant. Angiotensin II type 1 receptor-A1166C genotype polymorphism was also not significantly different between the groups. The results showed the angiotensinogen-M235T polymorphism to be heterogenous. The MM homozygote frequency was significantly higher in controls (72.3%), whereas 80% of the TT homozygote frequency was in the surgical group ( p = 0.001). These results show that although there were no significant differences in angiotensin-converting enzyme gene insertion/deletion and angiotensin II type 1 receptor-A1166C genotype polymorphisms between the groups, angiotensinogen-M235T polymorphism of TT homozygote frequency was significantly associated with patients undergoing coronary artery bypass surgery.

BACKGROUND: The main objective was to evaluate the protective effect of erythropoietin on lung ultrastructure against damage in rats after traumatic brain injury. METHODS: We used forty Wistar-Albino female rats weighing 170-200 gr. The rats were allocated into five groups. The first group was the control and the second was the craniotomy without trauma. The third group was the trauma group. The fourth and fifth groups were erythropoietin (1000 IU/kg) and vehicle (0.4 mL/rat) groups, respectively. A weight-drop method was used for achieving head trauma. Samples were obtained from pulmonary lobes 24-hour post injury. Lipid peroxidation levels were determined and electron microscopic scoring model was used to reveal the ultrastructural changes. RESULTS: Ultrastructural evaluation revealed pathologic changes in the trauma group compared with the control group (p < 0.05). Lipid peroxidation levels were found to be higher in the trauma group (p < 0.05). Erythropoietin significantly reduced both the ultrastructural pathologic changes and the lipid peroxidation levels in the treatment group (p < 0.05). CONCLUSIONS: Erythropoietin protects the ultrastructure of pneumocyte type II cells against damage after traumatic brain injury.

Cardiac injury, occurred after traumatic brain injury (TBI), has been recognized for more than a century. Bcl-2 is a key regulatory component of the mitochondrial cell death pathway, and its overexpression is cytoprotective in many cell types. The therapeutic agents, which induce the expression of bcl-2 protein, might provide a new therapy to prevent cardiac myocyte damage following TBI. In this study, we investigated whether methylprednisolone I sodium succinate (MPSS) influences the expression of bcl-2 in the heart. Wistar-Albino female rats underwent TBI (300 g/cm) generated by the weight-drop method, and were left untreated (n = 6) or treated with either MPSS (30 mg/kg) (n = 6) or vehicle (albumin solution) (n = 6). The heart was isolated from each animal with TBI. For comparison, the hearts were isolated from sham-operated (n = 6) and control rats (n = 6). The relative expression of bcl-2 mRNA in the heart was quantitated by real-time polymerase chain reaction. We also assessed lipid peroxidation in the heart tissue by determining the concentration of thiobarbituric acid-reactive substances (TBARs) as an indicator of tissue damage. The bcl-2 expression level was significantly higher in the hearts of MPSS-treated rats compared to that of other TBI groups (p < 0.0001). Moreover, TBI increased the lipid peroxidation in the heart, which was significantly reduced by the treatment with MPSS (p < 0.0001). These findings provide evidence for the efficacy of MPSS in protection of cardiac myocytes to achieve optimal heart donation after TBI in heart transplantation. (c) 2005 Tohoku University Medical Press.

Background: Inflammation plays a pivotal role in the pathogenesis of organ dysfunction after cardiopulmonary bypass (CPB). The aim of this study was to investigate whether pentoxifylline (PTX) has effects on the inflammatory process and leukocytes in cardiac surgery patients undergoing CPB. Material and methods: A double-blind, prospective, randomized, placebo-controlled study was undertaken to assess the effect of PTX on leukocyte counts, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels in 60 patients undergoing CPB for elective coronary artery bypass grafting. In 30 patients, 200 mg of PTX was added to 500 mL NaCl and perfused for 180 min after induction of anaesthesia and also 100 mg of PTX was added to the warm cardioplegic solution; another 30 patients received saline solution as placebo. Results: All measurements were performed before PTX infusion (T0), after induction of anaesthesia (T1), 30 min after weaning from CPB (T2), and 6 hours (T3) and 24 hours postoperatively (T4). PTX did not change the percentage of eosinophils, basophils, neutrophils, monocytes, or lymphocytes, or CRP levels. In the control group, however, total leukocyte count and IL-6 level at T3 and T4 period were significantly higher than the study group. The progressive increment in TNF-α level observed at each period was also significantly prominent in the control group. Conclusion: CPB-related whole body inflammatory response could be partially inhibited by intraoperative PTX administration. This effect of PTX would be helpful in preventing the well-known complications of CPB-induced systemic inflammation.

We aimed to demonstrate the time dependent ultrastructural changes in tracheobronchial epithelia after traumatic brain injury. And also, protective effect of erythropoietin was demonstrated.We used 56 Wistar-Albino female rats weighing 170 to 200 g. The rats were allocated into 7 groups. First group was the control. The second underwent craniotomy without trauma. The third, fourth, and fifth groups were respectively 2-, 8-, and 24-hour trauma groups. The sixth and seventh groups were respectively treatment (erythropoietin, 1,000 IU/kg) and vehicle (0, 4 ml/rat) groups. Weight-drop method was used for achieving head trauma. Samples were obtained from both trachea and main bronchi. Modified electron microscopic scoring model was used to reveal the ultrastructural changes in both trauma and treatment groups.There was no statistical difference between control and sham groups (p0.05). Scores of all trauma groups were significantly different from the controls (p0.05). Trauma produced obvious gradual damage on ultrastructure of the tracheobronchial epithelia. Erythropoietin decreased tracheobronchial scores after traumatic brain injury in significant levels. Erythropoietin attenuated ultrastructural scores for each organelle in significant levels (p0.05 for each organelle).The data suggested that ultrastructural damage is obvious at 2 hours deteriorating with time. Erythropoietin protects epithelia against damage after traumatic brain injury. Pharmaceutical lung preservation may help gaining efficacious donor lungs in brain death. But, further time dependent experiments are needed to determine the liability of the donor lung after traumatic brain injury. This fact is to be known for achieving higher graft survival rates.

The purpose of this study was to investigate whether erythropoietin (EPO) has an effect on the expression of bcl-2 in rat cardiac myocytes following experimental isolated traumatic brain injury (TBI). Forty-eight Wistar-Albino female rats were randomly allocated into eight groups. Groups AC and BC were controls; groups AS and BS were sham-operated animals. Groups A1 and B1 underwent head trauma without treatment. Groups A2 and B2, head traumas plus EPO intraperitoneally (1000 IU/kg); groups A3 and B3, the vehicle groups, head traumas and intraperitoneal albumin (0.4 ml/rat). The method of weight drop was used to produce impact trauma at 24 hours after injury. Samples obtained from the left ventricle were assayed for lipid peroxidation and bcl-2 gene expression using real-time quantitative polymerase chain reactions. Lipid peroxidation in the heart tissue was determined by the concentration of thiobarbituric acid reactive substances (TBARs). The results showed that administration of EPO significantly reduced the increase in lipid peroxidation by-products after moderate or severe trauma. The bcl-2 expression was significantly higher in EPO (A2 and B2) compared to trauma groups (A1 and B1) suggesting a protective effect. These findings suggest that EPO may play an important role in the expression of bcl-2 and decrease in TBARs-the end product of lipid peroxidation in myocytes-after moderate or severe TBI.

Background Pseudoaneurysms (PsAns) of the popliteal and tibioperoneal arteries are very rare and occur as a late complication after arterial injury. This study was undertaken to describe the management of PsAns of the popliteal and tibioperoneal arteries after gunshot injuries in a civilian vascular surgical unit with a large trauma workload. Methods A retrospective review of the records of nine patients treated between January 1998 and November 2001 at the Thoracic and Cardiovascular Surgery Department of Numune Education and Research Hospital was undertaken. Results Nine PsAns of the popliteal and tibioperoneal arteries after gunshot injuries were treated. The delay in diagnosis from the time of injury ranged from 15 days to 14 months, with a median delay of 75 days. One case with graft occlusion was noticed in a patient with a popliteal artery PsAn. In these cases, the early and late patency rate and limb salvage were 100%. Conclusion Early diagnosis of popliteal and tibioperoneal PsAns is an important factor in successful surgical reconstruction. The operative procedures will be simple if the interval between injury and operation is short, and surgical treatment for PsAns includes reconstruction of both arterial and venous arteries.

The aim of the present study was to evaluate the possibility that aminophylline could serve as a potential myocardial protectant by measuring cardiac troponin T (TnT) and troponin I (TnI) during coronary artery bypass grafting (CABG). Twenty patients were randomly divided into two groups. Ten patients received aminophylline, 200 mg orally per day for 3 days preoperatively (aminophylline group, AG), and 10 patients received placebo (control group, CG). Blood samples were collected before induction of anesthesia (T0), after 30 min of aortic cross clamping (ACC) (T1), and 1, 24, and 48 h postoperatively (T2, T3, T4). Serum concentrations of TnT, TnI, and creatine kinase-MB (CK-MB) were measured. Perioperative hemodynamic data were recorded and cardiac hemodynamics were evaluated by echocardiography preoperatively and 5-7 days after surgery. There were no adverse events in either group. Preoperative serum levels of TnT and TnI were similar. Their concentrations increased after T1 and, peaked at T2 (0.50+/-0.30 vs. 0.30+/-0.40 ng/ml, and 0.50+/-0.30 vs. 7.90+/-2.70 ng/ml, respectively, P

Objective: The aim of this study was to analyze the transaxillary surgical approach and results of thoracic outlet cases in our clinic in the light of the recent literature data. Methods: Between 1996 and 2002 a series of 35 cases diagnosed as thoracic outlet syndrome (TOS) hospitalized and surgically treated in our clinic have been studied retrospectively. Results: Twenty-six of our cases were females (75%) and the mean age was 25 ^ 1 (17‐ 40 years). The most important symptom was localized pain in the arm. In 90% of the cases the Adson, hyperabduction and abduction external rotation (AER) tests were positive. There was paresthesia in 30 cases (85%), atrophy in 3 cases (10%), and cyanosis in 6 cases (20%). Preoperative electromyogram (EMG) was demonstrated as 56.7 m/s (50 ‐ 65) and postoperative EMG was demonstrated as 65.1 m/s (60 ‐ 71). Postoperative EMG values were significantly higher than the preoperative EMG values ðp , 0:001Þ. All patients were operated using the transaxillary approach. A total number of 40 operations were performed. Upon radiological investigation ðn ¼ 17Þ 50% of the patients were found to have cervical ribs. In 30 cases (85%) the results were very good and in four cases (12%) good, and in one case (3%) the results were bad. There was no recurrence and reoperation in the long term follow-up. Conclusion: Careful patient history and physical examination should be done by a team, which consists of thoracic surgeon, physical therapy specialist, and a neurologist. Total resection of the first-rib with periosteally should be preferred in all of these cases with accompanying pathologies such as cervical rib, fibrous ligaments, and scalenius muscles. The transaxillary approach has provided a good exposure for the resection of cervical ribs, the firstrib and excision of fibrous ligaments and scalenius muscle by a perfect cosmetic result. All the patients should be encouraged for 2 months of physical exercises starting from early postoperative period. q 2003 Elsevier B.V. All rights reserved.

Diabetes is a well- identified major risk factor for cardiovascular diseases. This study was performed to evaluate the effect of diabetes and impact of glycemic control on internal thoracic artery (ITA) morphology by electron microscopy.Thirty patients scheduled for coronary artery bypass grafting were enrolled in this study. Samples of ITA were taken during the surgery for electron microscopic evaluation. Group I (n = 10) consisted of diabetics who have poor glycemic control (HbA1c7.5%), group II (n = 10) of well-regulated (HbA1c = 4.4% to 6.2%) diabetic patients, and group III (n = 10) of nondiabetic patients. Samples were prepared as ultrathin sections and an original semiquantitative method of scoring was applied to describe the morphologic changes of endothelium. Final scores were analyzed with analysis of variance and post hoc analysis.In group I large vacuoles, swollen mitochondria were seen in endothelial cells and subendothelial edema was prominent. Endothelia (2.5 ± 1.2), arterial wall (2.0 ± 0.0), and endothelial mitochondria (2.9 ± 1.3) scores of group I were significantly higher than the other 2 groups (p0.001). The samples of group II and group III did not show significant differences with each other. The correlation between HbA1c values and total endothelial scores statistically significant (r = 0.912; p0.001).There is a correlation between HbA1c values and morphologic changes of ITA graft. Uncontrolled diabetes is an important predictor of morphologic changes evidenced by the ultrastructural findings. These ultrastructural changes were not as prominent in the diabetes mellitus patients with well controlled metabolic statuses and patients without diabetes.

Cerebral venous thrombosis in various clinical conditions, such as congenital heart disease (CHD) and hyper-coagulable states, have been recognized previously. However, dural sinus thrombosis in a pediatric patient with Antiphospholipid Syndrome (APLS) after the repair of a ventricular septal defect (VSD) has not been reported yet. A child who underwent an operation for the surgical repair of VSD under cardiopulmonary bypass (CPB) developed a stroke after the procedure. A cranial computer tomography (CT) scan of the patient showed dural sinus thrombosis and severe cerebral edema. APLS and CPB were thought to be the only risk factors of dural sinus thrombosis. This observation warrants attention and screening should be taken into consideration in patients with APLS who carry a higher risk for dural sinus thrombosis after CPB.