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BACKGROUND Cornelia de Lange syndrome (CdLS) is a congenital multisystemic genetic disorder. The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years. However, they still more frequently undergo cardiac surgery. There are some challenges for clinicians when faced with CdLS patients. We present the perioperative management of a child with CdLS undergoing open-heart surgery. CASE SUMMARY Severe pulmonic and subpulmonic valvular stenosis, enlargement of the right side of the heart, mild tricuspid regurgitation, atrial septal defect, and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis, developmental delay, and malnutrition. Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve, therefore it was decided to perform an open surgical repair. Following a successful and uncomplicated intraoperative course, the patient was extubated on postoperative day 5, and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10, respectively. Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed, and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32. The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems. CONCLUSION This is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.

AIM Information regarding the impact of the anesthesia technique on the neurological outcome of patients receiving carotid endarterectomy (CEA) is scarce. CEA requires the clamping of the ipsilateral carotid artery. Cerebral oximetry is based on near-infrared spectroscopy (NIRS) and can detect hypoperfusion during carotid artery clamping. This retrospective study compares the effects of sevoflurane and propofol anesthesia on perioperative cerebral oxygenation in patients undergoing CEA under general anesthesia by using NIRS monitoring. MATERIAL AND METHODS The perioperative data of 33 patients undergoing CEA were retrospectively evaluated. The study groups were organized according to the anesthesia drugs used for maintenance: sevoflurane (n = 17) and propofol (n = 16). The regional cerebral oxygen saturation (rScO2) of the ipsilateral and contralateral hemispheres was monitored continuously using a NIRS instrument and analyzed at specific time points starting from induction to the 12th hour postoperation. The data were analyzed using the appropriate tests, and a p value of 0.05 was considered significant. RESULTS Compared with those of groups with non-clamped hemispheres, the rScO2 values of the sevoflurane and propofol groups decreased significantly during clamping (p 0.05) and increased to above-preoperative values after declamping (p 0.05). When the sevoflurane and propofol groups were compared, a significant decrease in rScO2 was noted during extubation in the sevoflurane group (p 0.05). In the propofol group, female patients had significantly lower rScO2 values compared with male patients during clamping of the carotid artery (p 0.05). None of the observed decreases were greater than 20%, which is considered an indication for shunting. CONCLUSION Our NIRS monitoring results indicate that sevoflurane or propofol anesthesia does not generally cause significant differences in cerebral oxygenation during and after cross-clamping in patients undergoing CEA. The finding of sex-related differences in cerebral oxygenation in patients receiving propofol and decreased oxygenation during extubation in patients receiving sevoflurane warrants further studies.

Korumasız triküspid kapak nadir görülen bir malformasyondur. Triküspid kapak ve subvalvüler aparatın tam veya kısmi agenezisi ile karakterizedir. Triküspid kapak yapılarının tamamen yokluğu genellikle pulmoner atrezi ve sağlam ventriküler septum ile ilişkilidir. Korumasız triküspid kapak orifis tanısı konulan iki vaka bildiriyoruz. Korumasız triküspid kapak orifisi literatürde nadir bildirildiği için bu olgular sunuldu., Unguarded tricuspid valve orifice is a rare malformation. It is characterized by complete or partial agenesis of the tricuspid valvular and subvalvular apparatus. The complete absence of tricuspid valve structures is often associated with pulmonary atresia and intact ventricular septum. We report on two cases diagnosed as unguarded tricuspid valve orifice. These cases were presented because of unguarded tricuspid valve orifice is reported rare in the literature

WOS: 000517820600016, PubMed: 31984703, Infective endocarditis (IE) is a rare but a potentially life-threatening infectious disease. Atypical presentations cause delays in the diagnosis. Neurological involvement such as meningitis or meningismus, are especially common in mitral valve endocarditis, but unusual in tricuspid valve endocarditis. Although few cases of right-sided IE have been reported with neurological symptoms in adults, children have not been described in literature. A nine-year-old girl with congenital ventricular septal defect (VSD) was admitted with fever, headache and neck stiffness. Her clinical symptoms and cerebrospinal fluid findings supported the aseptic meningitis. On ceftriaxone therapy day 3, her complaints were resolved; nine days later she was admitted with fever and neck stiffness again. Further investigation for fever source with echocardiogram revealed a tricuspid valve endocarditis. Antibiotic therapy was completed after 6 weeks. Cardiac surgery was performed for VSD and tricuspid valvular insufficiency.

WOS: 000468529200010, PubMed: 31113202, OBJECTIVES: The purpose of this study was to determine the effects of hypothermia and normothermia on the isolated human saphenous vein (SV) and internal mammary artery (IMA) responses to dexmedetomidine. METHODS: The response of human IMA and SV strips with (E+) and without (E-) endothelium subjected to cumulative concentrations of (10(-9), 0(-6) M) dexmedetomidine were recorded at 37 degrees C and at 28 degrees C. OnE-way ANOVA was used for analysis. A p < 0.05 was considered significant. RESULTS: At 37 degrees C dexmedetomidine resulted in similar signifi cant concentration-dependent contractions in both E+ and E-SV strips (p < 0.05). At 37 degrees C dexmedetomidine resulted in signifi cant concentration-dependent contractions in E+ IMA strips, these contractions were significantly lower at all concentrations of dexmedetomidine in E-compared to E+ IMA strips (p < 0.05). When results between similar groups of SV and IMA strips were compared, the contractions were significantly higher in the IMA strips in E+ and E-at 37 degrees C and also E-28 degrees C groups compared to SV (p < 0.05). CONCLUSION: In conclusion, dexmedetomidine causes in vitro vasoconstriction in human IMA and SV grafts. These contractions are greater in IMA compared to SV grafts. Endothelium-derived pathways are possibly involved in the contractile responses of IMA. Moderate hypothermia augments vasoconstriction in SV grafts

WOS: 000384800700003, PubMed: 27701483, Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomalies. They are induced by an incomplete coalescence of foetal lacunae during the development of the pericardium. Pericardial cysts are usually unilocular, well marginated spherical or teardrop shaped and may be attached to the pericardium directly or by a pedicle. Of all pericardial cysts, 70 to 75% are located at the right cardiophrenic angle. We report a case that was incidentally diagnosed with only chest magnetic resonance imaging because of a paracardiac mass. In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy.

WOS: 000376566300024, Double outlet right ventricle is a rare cardiac malformation of all congenital cardiac defects. It is a heterogeneous group of abnormal ventriculoarterial connections. Both great arteries (pulmonary artery and aorta) arise primarily from the morphological right ventricle. Double outlet right ventricle with discordant atrioventricular connections have been reported rarely in the literature. We report a newborn with double outlet right ventricle with discordant atrioventricular connections arid hypoplastic pulmonary arteries. We reported a rare complex cardiac malformation diagnosed by echocardiography. Segmental approach and sequential analysis of cardiac segments by echocardiography are the clue for diagnosis of complex cardiac ma formations

Background : Peri-operative management of infants with trisomy 18 syndrome is challenging due to various congenital cardiac and facial anomalies. Case report : We report the anaesthetic management of a 13-day-old neonate with 1 540 g body weight, undergoing closure of patent ductus arteriosus and pulmonary artery banding. Anaesthesia was induced with sevoflurane, fentanyl and rocuronium. Despite dysmorphic facial features, ventilation and endotracheal intubation were achieved uneventfully. Anaesthesia was maintained with sevoflurane and fentanyl and was uneventful. The patient was transferred to the neonatal ICU intubated and with ventilatory support. The baby was extubated on the second day post-operatively. Conclusion : Our knowledge of the proper anaesthetic technique for children undergoing palliative or corrective surgery is limited. Further case reports will increase our experience in peri-operative management of children with trisomy 18.

Atrial fibrillation (AF) is a common arrhythmia, after cardiac surgery, and it is associated with a twofold increase in cardiovascular mortality and morbidity. Reperfusion injury and inflammation associated with cardiac surgery are thought to be involved in its pathogenesis. Heat shock proteins (HSPs) are a family of chaperone proteins which assist in preservation of cellular integrity by maintaining proteins in their correctly folded state. The aim of this study was to investigate pre-postoperative heat shock protein70 (HSP70) and high-sensitivity C-reactive protein in serum from patients in preoperative sinus rhythm. We prospectively screened 45 consecutive patients admitted to the hospital for elective coronary artery bypass surgery (CABG). Electrocardiogram characteristics and cardiovascular risk profile were documented. Pre- and postoperative blood samples were collected. HSP70 value was 8.9 +/- 4.8 ng/mL in Group A (study group) preoperatively and decreased to 7.7 +/- 7.0 ng/mL postoperatively. In contrast, preoperative value of HSP70 was 4.2 +/- 2.2 ng/mL and decreased to 2.7 +/- 2.6 ng/mL postoperatively in Group B (control group). Statistical analysis showed significant difference regarding preoperative HSP70 levels in Group A compared to Group B. To our knowledge, with this study, the association of pre- and postoperative circulating HSP70 with postoperative AF was demonstrated for the first time.

Background. Open heart surgery still involving major bleeding continues to be a major challenge after cardiac surgery and is also a significant cause of morbidity and mortality. Most hemostatic factors are intercorrelated with postoperative bleeding, and fibrinogen seems the most fundamental hemostatic risk factor for open heart surgery. Methods. The study included 97 patients who underwent elective coronary artery surgery (78 men and 19 women; mean age, 60.9 ± 10.3). Preoperative blood samples were obtained and preoprative quantitative determination of plasma fibrinogen levels were measured by the clotting method of Clauss using the fibrinogen kit. Patients were operated on by the same team and the same tecnique. The total amount of drainage blood from chest tubes was recorded after termination of operation. Results. There were statistical significance between the f ibrinogen levels and the drainage (r = –0.897, P < .001). Chest drainage was a mean of 972 mL (range, 240-2445 mL) in the first 48 hours after sternotomy closure. Fibrinogen level and relation to age was statistically significant (P = .015). There was no statisticaly significance between fibrinogen levels and gender (male gender = 400.7 ± 123.0 versus female gender = 395.6 ± 148.1; P = .877) and between drainage and gender (male gender = 968.2 ± 538.5 versus female gender = 990.0 ± 554.7; P = .876). Two patients (2%) died early after the surgery. There were no significant differences between the postoperative bleeding and cardiopulmonary bypass time (P = .648) or cross-clamp time (P = .974). Conclusions. The results of this study suggested that low preoperative fibrinogen level appears to be a useful diagnostic marker to assess the activity of the coagulation system, and that its preoperative level may serve as a potential risk factor for postoperative bleeding after coronary artery bypass surgery.

Objective: There is conflictingevidence with regardto the impact of preoperative atrialfibrillation(AF) on the post mitral valve (MV) repair on the early and late outcome. Methods: A total of 349 patients undergoing various MVrepair procedures for degenerative mitral regurgitation (MR) between 1997and 2003were studied.Preoperatively, 152(44%) of these patientswere in AF and 197(56%) patientswere in sinusrhythm (SR).The clinical features and the outcome in these two cohorts of patients were compared. Results: The patients in the AF group were older than their counterparts in the SR group (66 7v s 62 9 years) (p = 0.01), had a higher mean NYHA class score (2.4 0.6 vs 2.2 0.7) (p = 0.04) and were more likely to have impaired left ventricular function (60% vs 36%) (p < 0.0001). A similar proportion of patients in the AF (38%) and SR (30%) groups had additional cardiac surgical procedures (p = 0.12). Operative mortality was 3.9% in AF group versus 0.5% in SR group (p = 0.04), and operative morbidity was 27% versus 17%, respectively (p = 0.03). At latest follow up, 4% of patients that were in SR preoperatively developed AF; conversely, 2% of the patients in the AF group converted to SR. The rates of recurrent grade II or III MR (4% vs 5%) (p = 0.8) and MV re-operation (2.6% vs 2.5%) (p = 1.0) were similar in the AF and SR groups. Kaplan—Meier survival at 7 years was 75 6% versus 90 3% (p = 0.005). On Cox proportional hazards regression model, impaired LV function [(p = 0.02), hazard ratio 0.25 (95% confidence intervals (C.I.) 0.078—0.84)] and AF [(p = 0.03), hazard ratio 2.70 (95% C.I. 1.09—6.68)] were significant adverse predictors of survival. Conclusions: This study shows that in patients undergoing MV repair for degenerative MR, preoperative AF has a major negative impact on the early and late survival. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Patent ductus arteriosus (PDA) is an important problem in premature infants. Extremely low birth weight infants (ELBWI) are so fragile with respect to surgical stress that minimally invasive procedures are required. We report 26 ELBWI cases with PDA who underwent surgical closure. All had failed indomethacin treatment, or it had been contraindicated. The mean gestational age at birth was 27 weeks (range, 24-38 weeks), and the mean birth weight was 960.96 g (range, 710-1440 g). The mean age at operation was 18.06 days (range, 7-34 days), and the mean body weight at operation was 989.42 g (range, 680-1460 g). There was no surgery-related mortality or morbidity. Our surgical procedures consisted of posterior muscle-sparing thoracotomy, clipping the PDA and no ligation, and closing the thorax without a tube thoracostomy. Muscle-sparing thoracotomy reduces the likelihood of long-term physical impairment and deformity, the clipping technique minimizes the dissection of surrounding PDA tissue, and the thorax is closed without a tube. Nursing care is simplified, costs are reduced, and the number of chest x-rays needed postoperatively is reduced. We believe that surgical closure of PDA without chest tube drainage can be accomplished safely in premature infants.

Cardiopulmonary bypass (CPB) is a technique which is commonly performed without any problem in cardiac surgery. CPB can also be used in patients with a tumoral mass adherent to the great vessels, in patients with critically narrowed airway, if cross-table intubation of the distal trachea is not feasible and in patients necessitating re-do surgery with extensive adhesions because it allows extensive mobilization of the heart and great vessels without compromising their function. It also allowed the central pulmonary artery to be controlled without comprising oxygenation and complete resection of a tumor localized in the A-P window. Herein we report such patients operated with CPB without any problem.

WOS: 000334148500010, PubMed: 24807474, Purpose: Endovenous laser ablation (EVLA) for superficial venous insufficiency is traditionally performed under tumescent local anesthesia as day case surgery. The aim of this study is to evaluate the feasibility of general anesthesia in addition to tumescent anesthesia in patients undergoing EVLA. Methods: The anesthesia and clinical registration records of 341 extremities of 300 adult patients were reviewed and analyzed retrospectively. Demographic and clinical data, preoperative anesthetic evaluation data (ASA physical status, preoperative airway assessment, Mallampati score), type of supraglottic device, duration of anesthesia and surgery, any surgical and/or anesthetic complication, timing of mobilization and discharge, and postoperative course were evaluated. Results: Mean duration of operation and anesthesia was 28 (12-55) and 40 (20-65) minutes, respectively. Mobilization and discharge timing was 25 (11-45) and 139 (110-200) minutes, respectively. All patients were discharged the same day of surgery. Conclusion: The combination technique of administering general anesthesia with supraglottic device and tumescent anesthesia is a safe and effective method to reduce the patients' pain and discomfort during the EVLT procedure within the scope of day case surgery.

Cardiac sarcomas are rare malignant tumors. Angiosarcoma is the most common cardiac sarcoma and is present in up to 33% of cases. Angiosarcomas have a poor prognosis, with a short survival expectancy. We report a case of a right atrial angiosarcoma treated by partial tumor resection followed by chemotherapy.

Cardiac myxomas are rare benign tumors of the heart. The growth rate of these tumors remains unknown. Right atrial myxoma can simulate nonspecific constitutional symptoms, such as remittent or lasting fever, weight loss, and chronic anemia, and may escape timely diagnosis until the development of severe complications such as pulmonary hypertension due to embolism from fragments originating from the tumor mass or blockage of the right atrioventricular ostium or Budd-Chiari syndrome with acute abdominal pain. We present a case of a giant right atrial myxoma mimicking hepatic cirrhosis in a 52-year-old man.

Objective: To describe the clinical and echocardiographic outcome after mitral valve (MV) repair for active culture positive infective MV endocarditis. Patients and methods: Between 1996 and 2004, 36 patients (mean (SD) age 53 (18) years) with positive blood culture up to three weeks before surgery (or positive culture of material removed at operation) and intraoperative evidence of endocarditis underwent MV repair. Staphylococci and streptococci were the most common pathogens. All patients had moderate or severe mitral regurgitation (MR). Mean New York Heart Association (NYHA) class was 2.3 (1.0). Follow up was complete (mean 38 (19) months). Results: Operative mortality was 2.8% (one patient). At follow up, endocarditis has not recurred. One patient developed severe recurrent MR and underwent valve replacement and one patient had moderate MR. There were two late deaths, both non-cardiac. Kaplan-Meier five year freedom from recurrent moderate to severe MR, freedom from repeat operation, and survival were 94 (4)%, 97 (3)%, and 93 (5)%, respectively. At the most recent review the mean NYHA class was 1.17 (0.3) (p Conclusions: MV repair for active culture positive endocarditis is associated with low operative mortality and provides satisfactory freedom from recurrent infection, freedom from repeat operation, and survival. Hence, every effort should be made to repair infected MVs and valves should be replaced only when repair is not possible.

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction and is mostly fatal. Previous studies report that it is mostly seen in middle-aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern, and its severity is related to extent and development rate of dissection. Herein we present three cases of primary spontaneous left main coronary artery dissection. Two of the patients are men and the third patient is a non-pregnant 69-year-old woman. The cases were presented and discussed with review of the pertinent literature.

Hydatid cyst is a serious endemic parasitic disease found in cattle-raising areas of the world. Cardiac hydatid cysts are rare and appear in 0.5% to 2% of hydatid cyst cases. A 24-year-old male patient was admitted to the hospital because of chest pain. A cystic mass (4 4 3 cm) was demonstrated with transthoracic echocardiography, computed tomography, and magnetic resonance imaging. A hydatid cyst was located in the right ventricular wall near the inferior branch of the acute marginal branch of the right coronary artery and was located such that it pushed the tricuspid valve inward. The cystic materials were removed with the patient on cardiopulmonary bypass. The surgery for cardiac hydatid disease is safe, and the results are satisfactory.

WOS: 000314330300007, PubMed: 22316598, Objectives: Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. Method: Randomized patients who applied to a health-care centre were included in this study. The Tubingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. Results: A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 +/- 9.4. Conclusion: The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

Amaç: Açık kalp cerrahisinde perfüzyon ısısının inflamatuar cevap ve sonuçlar üzerine etkilerinin araştırılması. Yöntemler: Toplam 49 hasta iki gruba bölünmüştür, Grup 1 (n24) normotermik opere edilmiş,gurup 2 (n25) hipotermik kardiyopulmoner bypass (KPB) altında opere edilmiştir. Preoperatif ve postoperatif dönemde interleukin-6 (IL6) ve high sensitive CRP (hsCRP) seviyeleri için kan örnekleri alınmıştır. Bulgular: Kardiyopulmoner bypassın sonunda IL-6 değerleri normotermik opere edilmiş grupta hipotermik gruba oranla belirgin olarak düşük bulun- muştur (Grup 1: 34.014.9-Grup 2: 53.041. p0.05). Postoperatif 12. saatte, IL6 seviyeleri düşmeye başlamıştır, Grup 1: 25.29.2, Grup 2: 34.021.2 (p0.05). Yirmi dördüncü saatte IL-6 seviyeleri Grup 1: 20.48.1, Grup 2: 29.621.1 olarak bulunmuştur (p0.05). High sensitive CRP değerleri Grup 1: 16.13.4, Grup 2: 18.53.6 (p0.05). Postoperatif 12. ve 24. saatte, hsCRP seviyeleri düşmeye başlamıştır Grup 1: 12.82.6-Grup 2: 13.22.9 12 h. saat, p0.05 ve Grup 1: 12.32.6-Grup 2: 14.22.8 24.saat, p0.05). Grup 1de KPB ve extubasyon süreleri Grup 2ye göre belirgin kısadır (63.119.1 dakika- 82.0 19.2 min. (p 0.01)) ve (8.92.5 saat - 11.64.6 saat (p0.05). Grup 1 ve Grup 2 karşılaştırıldığında drenaj miktarı 633.1390.4 mL - 981.8438.0 mL (p0.05), kan kullanımı 2.70.7 torba-4.20.5 torba (p0.01), yoğun bakım süresi 2.50.5-4.00.6 gün, (p0.01) bulunmuştur. Tüm bu sonuçlar normotermik grubun hastane yatış süresini olumlu etkilemiştir 7.20.5 gün-8.00.6 gün (p0.01). Sonuç: Normotermik KPB stratejisi en az hipotermik KPB kadar güvenli olmasının yanı sıra inflamatuar cevabı azaltmış ve daha iyi sonuçlar vermiştir., Objective: To evaluate the effects of perfusion temperature on inflammatory response, and outcome in patients undergoing open heart surgery. Methods: Forty nine patients were assigned to 2 groups, group I (n24) normothermic cardiopulmonary bypass (CPB) and group II (n25) hypother- mic CPB. Blood samples were collected preoperatively and postoperatively for interleukin-6 (IL6) and high sensitive CRP (hsCRP). Concerning the variables, there were no significant preoperative differences between the groups. Results: At the end of CPB, mean plasma levels of IL-6 was significantly lower in the normothermia group (Group 1: 34.0±14.9 vs. Group 2: 53.0±41. p0.05). In 24 h, the IL-6 concentrations were 20.4±8.1 in Group 1 and 29.6±21.1 in Group 2 (p>0.05). High sensitive CRP levels were significantly higher at the end of CPB than the preoperative levels (Group 1: 16.1±3.4 vs. Group 2: 18.5±3.6, p0.05 and Group 1: 12.3±2.6 vs. Group 2: 14.2±2.8 at 24 h, p>0.05). Normothermic CPB resulted in a shorter CPB time; 63.1 ±19.1min. vs 82.0 ±19.2 min. (p

We aimed to evaluate whether leptin and ghrelin responses to cardiopulmonary bypass (CPB) are dependent on type 2 diabetes and whether these responses are associated with interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), cortisol and insulin.We examined stress-response patterns in plasma leptin, ghrelin, hsCRP, IL-6, cortisol and insulin levels before and up to 5 days after cardiopulmonary bypass in 20 patients with type 2 diabetes and 20 patients without diabetes.Plasma leptin levels increased significantly in both groups (p0.05) and rose significantly higher in diabetics when compared with nondiabetic patients (p=0.004). Plasma ghrelin levels increased significantly only in diabetics (p=0.033). Patients with and without diabetes showed significantly elevated serum concentrations of IL-6, hsCRP, cortisol and insulin (p0.005 for IL-6, hsCRP; p0.05 for cortisol, insulin) but the difference between the two groups was nonsignificant. Leptin was independently predicted by hsCRP (p0.05, F=2.9), gender (women p0.001, F=4.7), body mass index (BMI p0.0001, F=6.1) whereas ghrelin levels were not associated with any variables in the total patient population. (critical F=2.26, p≤0.05).Acute phase response in diabetics differs by higher leptin levels independent of BMI, gender and IL-6, hsCRP, insulin and cortisol levels.

PubMed ID: 22257801, Objectives: A growing body of data illustrates the importance of microalbuminuria (MAU) as a strong predictor of cardiovascular risk in the hypertensive population. The present study was designed to define the prevalence of MAU and associated cardiovascular risk factors among Turkish hypertensive outpatients. Study design: Representing the Turkish arm of the multinational i-SEARCH study involving 1,750 sites in 26 countries around the world, a total of 1,926 hypertensive patients from different centers were included in this observational and cross-sectional survey study. Patients with reasons for a false-positive MAU test were excluded. The prevalence of MAU was assessed using a dipstick test, and patients were inquired about comorbidities, comedication, and known cardiovascular risk factors. Results: The overall prevalence of MAU was 64.7% and there was no difference between genders. Most of the patients (82.5%) had uncontrolled hypertension, 35.6% had dyslipidemia, and 35.5% had diabetes, predominantly type 2. Almost one-third of the patients (26.4%) had at least one cardiovascular-related comorbidity, with 20.3% having documented coronary artery disease (CAD). Almost all patients (96.8%) had one or more risk factors for cardiovascular disease in addition to hypertension, including family history of myocardial infarction or CAD, diabetes, dyslipidemia, lack of physical exercise, and smoking. A trend towards higher MAU values in the presence of CAD was determined. Conclusion: Microalbuminuria tests should be routinely used as a screening and monitoring tool for the assessment of subsequent cardiovascular morbidity and mortality among hypertensive patients. © 2011 Turkish Society of Cardiology.

Atrial fibrillation (AF) is a common arrhythmia, after cardiac surgery, and it is associated with a twofold increase in cardiovascular mortality and morbidity. Reperfusion injury and inflammation associated with cardiac surgery are thought to be involved in its pathogenesis. Heat shock proteins (HSPs) are a family of chaperone proteins which assist in preservation of cellular integrity by maintaining proteins in their correctly folded state. The aim of this study was to investigate pre-postoperative heat shock protein70 (HSP70) and high-sensitivity C-reactive protein in serum from patients in preoperative sinus rhythm. We prospectively screened 45 consecutive patients admitted to the hospital for elective coronary artery bypass surgery (CABG). Electrocardiogram characteristics and cardiovascular risk profile were documented. Pre- and postoperative blood samples were collected. HSP70 value was 8.9 +/- 4.8 ng/mL in Group A (study group) preoperatively and decreased to 7.7 +/- 7.0 ng/mL postoperatively. In contrast, preoperative value of HSP70 was 4.2 +/- 2.2 ng/mL and decreased to 2.7 +/- 2.6 ng/mL postoperatively in Group B (control group). Statistical analysis showed significant difference regarding preoperative HSP70 levels in Group A compared to Group B. To our knowledge, with this study, the association of pre- and postoperative circulating HSP70 with postoperative AF was demonstrated for the first time.

Background. Postoperative atrial fibrillation (AF) plays a major role in the determination of hemodynamic deterioration and can be associated with cardiovascular events after coronary artery surgery. Elevated interleukin (IL)-6 and Creactive protein (CRP) levels in patients with AF suggest a role of inflammation in the pathogenesis of AF. We conducted a study to investigate the correlation between postoperative AF and IL-6 and high-sensitivity CRP (hsCRP).Materials and Methods. Forty-nine patients with a mean age of 60.3 ± 10.7 years were enrolled in this study. Preoperative and postoperative first day blood samples were collected to assess the IL-6 and hsCRP levels. IL-6 levels were measured by enzyme-linked immunosorbent assay, and hsCRP was measured by rate turbidimetry method.Results. Fourteen patients (28.5%) developed AF postoperatively. Patients who developed AF showed elevated serum concentrations of postoperative first day IL-6 (P < .001), preoperative hsCRP (P < .005), and postoperative first day hsCRP (P < 0.001). Preoperative hsCRP levels (P < .002) and postoperative first day IL-6 (P < .001) and hsCRP (P < 0.001) levels were associated with prolonged endotracheal intubation time. Prolonged intensive care unit stay showed significant correlations with elevated levels of preoperative hsCRP (P < 0.002) and postoperative first day IL-6 (P < 0.001) and hsCRP (P < 0.001). There was also statistical significance between the AF+ and AF- groups regarding intensive care unit stay and endotracheal intubation times (P < .001 and P < .001, respectively). Cut-off points for postoperative first day IL-6, preoperative hsCRP, and postoperative first day hsCRP were 46.4 pg/mL (sensitivity = 92.9% and specificity = 80%), 0.46 mg/L (sensitivity = 71% and specificity = 75%), and 17.9 mg/L (sensitivity = 92.9% and specificity = 78%), respectively.Conclusions. Elevated IL-6 and hsCRP levels in patients with postoperative AF suggest inflammatory components have a role of in the pathogenesis of AF.

To examined the pre- and post- operative anti-HSP60 antibodies of serum from patients in preoperative sinus rhythm.We prospectively studied 45 consecutive patients admitted for elective CABG from 2004 to 2005. We randomly selected 10 patients developing AF (study sample [Group A]) and 10 postoperative patients without AF (control [Group B]. The study took place at the Department of Cardiovascular Surgery, Hacettepe University, Ankara, Turkey.Anti-HSP60 IgG value was 27.76 +/- 12.69 absorbance units (AU) in Group A preoperatively and decreased to 13.73 +/- 5.51 AU postoperatively. Controversially, preoperative value of anti-HSP60 IgG was 9.94 +/- 2.92 AU and decreased to 6.72 +/- 1.89 AU, postoperatively in Group B. Statistical analysis showed significant difference regarding preoperative anti-HSP60 IgG levels in Group A compared to Group B, which might be interpreted as an association between postoperative AF and preoperative levels of anti-HSP60 IgG.We provide the first evidence demonstrating the association of pre- and post- operative circulating anti-HSP60 antibodies with postoperative AF. These results suggest that serum HSP60 antibody levels may be a marker for subsequent development of AF.

12th Congress of the European-Association-for-Clinical-Pharmacology-and-Therapeutics -- JUN 27-30, 2015 -- Madrid, SPAIN, WOS: 000384951200256, …, European Assoc Clin Pharmacol & Therapeut

Zellweger Syndrome is a rare autosomal recessive inherited disorder within the spectrum of peroxisome biogenesis disorders. It is a progressive and fatal disorder with multiple congenital anomalies. There may be some challenges for anesthesiologists in patients with Zellweger Syndrome. We report the anesthetic management of an infant with Zellweger Syndrome undergoing closure of patent ductus arteriosus and pulmonary artery banding.

Background The purpose of this study was to define the early and midterm results obtained after the use of edge-to-edge repair with mitral annuloplasty in the setting of Barlow's disease. Methods Between 1998 and 2004, 41 patients having Barlow's disease had an edge-to-edge repair creating a double-lumen mitral valve orifice in our unit. In 38 patients (93%), an annuloplasty band was also inserted. Results Preoperatively, all patients had severe mitral regurgitation (MR), 12 were in New York Heart Association (NYHA) class I, 15 in class II, and 14 in class III. One patient died in hospital (2.4%) and 5 experienced complications (12.5%). There were no late deaths. At follow-up, 2 patients had severe MR and underwent valve replacement, 1 exhibited moderate MR, and 5 had mild MR. Kaplan-Meier 5-year survival, freedom from reoperation and recurrent moderate-severe MR was 97.6% ± 2.4%, 94% ± 4.4%, and 90.6% ± 5.1%, respectively. At latest echocardiographic evaluation (mean 35 ± 12 months) the mean left ventricular end-systolic and end-diastolic diameters, and the mitral valve area decreased ( p = 0.0001) compared with baseline. The mean mitral valve gradient increased ( p = 0.001) without clinical evidence of mitral stenosis whereas ejection fraction did not change. Currently, 35 patients are in NYHA class I and 5 are in class II. Conclusions In the setting of Barlow's disease, use of edge-to-edge repair with mitral annuloplasty is safe and provides lasting restoration of mitral valve competence with measurable hemodynamic and clinical benefits. In our unit, it is the procedure of choice for correction of MR in patients having Barlow's disease.

Preservation of the native mitral valve provides important advantages over valve replacement. The aim of this study was to evaluate the effect of training for mitral valve repair on the outcome.Between 1997 and 2004, 471 patients underwent mitral valve repair procedures in a single firm. Of these procedures, 300 (64%) were performed by a consultant (TJS) (consultant group) and 171 (36%) by trainees supervised by the same consultant (trainees group).Atrial fibrillation was more prevalent in the consultant group (p = 0.02) but there were no significant differences in the demographics, etiology of mitral regurgitation, and other comorbidity between the groups. Posterior leaflet prolapse was more prevalent in the trainees group (p0.0001) and anterior leaflet prolapse (p0.0001), bileaflet prolapse (p = 0.003), and Barlow's syndrome (p = 0.0003) in the consultant group. The consultant performed a higher proportion of concomitant coronary artery bypass grafting (p = 0.04), aortic valve replacement (p = 0.02), procedures, and nonelective cases (p = 0.03) with shorter bypass (p = 0.01) and ischemic times (p = 0.0004) than trainees. The complication rate was similar in the two groups (26% vs 22%), but the consultant had a higher operative mortality than the trainees (5% vs 0.6%) (p = 0.01). A similar proportion in the two groups exhibited recurrent mitral regurgitation (8% vs 9%). Kaplan-Meier five-year freedom from reoperation (95.6 +/- 1.6 vs 95.7 +/- 2.2%) (p = 0.7) and survival (82 +/- 4% vs 88 +/- 4%) (p = 0.09) were similar in the two groups.With appropriate patient selection, cardiothoracic trainees can be taught mitral valve repair surgery without a negative effect on the early or late outcome.

This study was planned to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications and to compare early clinical outcomes of coronary artery bypass surgery in diabetics with nondiabetics in a single center. A total of 1090 adults who underwent coronary artery surgery in a five year period were included in a retrospective cohort study based on available chart review. Of 1090 patients, 400 had type II diabetes mellitus. Intraoperative and postoperative blood glucose levels in diabetic group were manipulated by means of a continuous insulin infusion. Data of pre- and postoperative blood glucose levels were evaluated with respect to postoperative infection risk for diabetics. Risks of early mortality, cerebrovascular accident, and postoperative infection in diabetic patients were compared with the nondiabetic group. High preoperative mean glucose levels were the main risk factor for the development of postoperative infection (p = 0.012 and p = 0.028 for the mean glucose levels 1 and 2 days before operation, respectively). For diabetic group, of 400 patients 20 (5%) were diagnosed to have postoperative infection (superficial sternal wound in 3 (0.75%), donor site infection in 4 (1%), mediastinitis in 5 (1.25%), urinary tract infection in 6 (1.5%), and lung infection in 2 (0.5%) patients). The diabetic group had significantly higher prevalence of mediastinitis, donor site infection, urinary tract infection and total infection (p values were 0.048, 0.013, 0.009, and 0.044, respectively). Early mortality was higher among diabetics than in nondiabetics (1.73% vs 3%, p = 0.048) but the risk of cerebrovascular accident in diabetics was not greater than in nondiabetics in early period. In patients with diabetes who undergo coronary artery bypass surgery, preoperative hyperglycemia is an independent predictor of short-term infectious complications and total length of stay in hospital.

One of the serious potential complications of complex congenital heart defect (CHD) is bacterial endocarditis. Right sided endocarditis accounts for 5-10% of all cases of infective endocarditis, with the tricuspid valve more frequently affected than the pulmonary valve. Pulmonary artery involvement in bacterial endocarditis is very rare, but when it exists it is almost always associated with endocarditis of the pulmonary valve: isolated pulmonary artery vegetations have not previously been reported before.A 6-year-old boy with atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta (CA), persistent ductus arteriosus (PDA) and pulmonary hypertension, who had been operated for closure of PDA, correction of CA and pulmonary artery banding, was readmitted with bacterial endocarditis. In surgery, the VSD was closed with a Dacron patch using interrupted pledget buttressed sutures, and the ASD was closed using primary sutures. After debanding, while pulmonary arteriotomy was performed for patch angioplasty, we observed that the entire pulmonary artery trunk, right and left pulmonary artery branches, were filled with a solid mass, which was successfully treated by surgical excision.With ongoing improvements in diagnostic tools, especially in echocardiography, antibiotic therapy and surgery, CHD can now be treated successfully in early infancy or childhood.

Catheter fracture is a well-known complication of placement of plastic catheters. We introduce the fracture of a peripheral intravenous cannula after re-insertion of the guide needle during intravenous cannulation inside the blood vessel. Peripheral venous cannulation was attempted with an 18G cannula in a patient for anesthesia induction undergoing endovenous laser ablation. Under sterile conditions the broken piece of the cannula was removed from the vein with a surgical incision and the skin was sutured.

A 43-year-old woman with critical stenosis of the left main stem was managed with saphenous vein angioplasty using BioGlue. She developed severe myocardial ischemia postoperatively, probably due to external compression exerted on the patch by the adhesive material, and required emergency coronary artery bypass grafting.

Methods The Ethics Committee approved the study protocol. The contractile response of human IMA (n=6) and SV strips (n = 6) with and without endothelium, suspended in organ baths, bubbled with 95% O2 + 5% CO2 which were subjected to cumulative concentrations of 10-9 – 10-6 M dexmedetomidine were recorded at 37oC and at 28oC. The results were expressed as percentage of maximum contraction to phenylephrine. Statistical Analysis: Contractions induced by dexmedetomidine were expressed as a percentage of phenylephrine induced response. Results are expressed as means ± SD. Student’t test was used for analysis between in groups and results between these groups were determined by unpaired test. A p value of < 0.05 was considered significant.

ContextAlthough left atrial radiofrequency ablation (RFA) is increasingly used for the treatment of chronic atrial fibrillation during mitral valve surgery, its efficacy to restore sinus rhythm and any resulting benefits have not been examined in the context of an adequately powered randomized trial.ObjectiveTo determine whether intraoperative RFA of the left atrium increases the long-term restoration of sinus rhythm and improves exercise capacity.Design, Setting, and PatientsRandomized, double-blind trial performed in a single UK tertiary referral center with enrollment between December 2001 and November 2003. A total of 101 patients referred for mitral valve surgery with at least 6 months’ history of uninterrupted atrial fibrillation were assessed for eligibility; 97 were enrolled. Patients were followed up for 12 months.InterventionPatients were randomly assigned to undergo mitral valve surgery and RFA of the left atrium (n = 49) or mitral valve surgery alone (controls; n = 48).Main Outcome MeasuresThe primary outcome measure was presence of sinus rhythm at 12 months; secondary measures were patient functional status and exercise capacity (assessed by shuttle-walk test), left atrial contractility, and left atrial and left ventricular dimension and function and plasma levels of B-type natriuretic peptide.ResultsAt 12 months, sinus rhythm was present in 20 (44.4%) of 45 RFA patients and in 2 (4.5%) of 44 controls (rate ratio, 9.8; 95% CI, 2.4-86.3; P

Noncompaction of the ventricular myocardium is a rare disorder that represents numerous prominent trabeculations and intratrabecular recesses in the ventricles. It is believed to represent not only an arrest in endomyocardial morphogenesis but also an unclassified cardiomyopathy. The pathology has been almost invariably associated with other congenital cardiac malformations. A female patient with noncompaction of the myocardium of both ventricles and congenitally corrected transposition of the great arteries (cTGA), situs inver-sus totalis, and atrial and ventricular septal defects is described. When she was 7 days old a permanent pacemaker was implanted because of complete heart block. Prazosin (Minipress), an a -receptor blocker, was administered, and the cardiac ejection fraction showed a striking increase from 20% to 42%. Despite careful and regular follow-up evaluations, the general condition of the patient slowly worsened. Five months after surgery she died of hepatorenal failure and low cardiac output. This case report is thought to be the first description of congenital complete heart block, cTGA, and situs inversus totalis with noncompaction of the myocardium of both ventricles.

Chlamydia pneumoniae and Helicobacter pylori can cause persistent infections of the respiratory and gastrointestinal tract, respectively. It has been suggested that persistent infection of arteries with these bacteria can contribute to the development of atherosclerosis. The aims of this study were to determine the presence of C. pneumoniae and H. pylori DNA in atherosclerotic plaque samples by PCR and to evaluate the correlation between clinical status and DNA positivity of these bacteria. Eighty-five consecutive patients (mean age, 59 ± 10; 75 male, 10 female) undergoing coronary artery bypass grafting, carotid endarterectomy, and surgery of the abdominal aorta for atherosclerotic obstructive lesions were included in the study. Forty-six endarterectomy specimens from the atherosclerotic lesions and 39 specimens from healthy regions of the ascending aorta, which were accepted as the control group, were excised. The presence of microorganism DNA in endarterectomy specimens was assessed by PCR. C. pneumoniae DNA was found in 12 (26%) of 46 endarterectomy specimens and none of the healthy vascular-wall specimens ( P < 0.001), while H. pylori DNA was found in 17 (37%) of 46 endarterectomy specimens and none of the controls ( P < 0.001). Either C. pneumoniae or H. pylori DNA was positive in 23 (50%) of 46 patients and none of the controls ( P < 0.001). Six of the atherosclerotic lesions showed coexistence of both of the microorganism DNAs. The presence of C. pneumoniae and H. pylori DNA in a considerable number of atherosclerotic plaques but their absence in healthy vascular wall supports the idea that they may have a role in the development of atherosclerosis, especially in countries where infection is prevalent and where conventional risk factors fail to explain the high prevalence of atherosclerotic vascular disease.