Search

Objective: Our aim in this study is to investigate the relationship between mortality and morbidity of phosphorylcholine coated oxygenator circuit used in heart-lung machine in congenital open heart surgery operations. Materials and Methods: The study was conducted in Dr. Sami Ulus Child Diseases Training and Research Hospital Cardiovascular Surgery Clinic between 2008-2009. 30 congenital heart patients were included. The patients were divided into 2 groups of 15 people. In one of the groups, a phosphorylcholine coated oxygenator circuit was used in the heart lung machine (Group P). In the other group, a standard oxygenator circuit was used (Group C).Congenital heart surgery was performed for 19 Ventricular Septal Defects (VSD), 5 Secundum Atrial Septal Defects (ASD), 3 Primum ASD, 2 Mitral insufficiency and 1 Discret subaortic membrane. Extubation times, intensive care and discharge times, 24-hour drainage follow-up, inotropic drug use, blood and fresh frozen plasma (FFP) transfusion amount, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase-MB, urea, blood urea nitrogen, creatinine, white cell number of platelets, lactate dehydrogenase, albumin, total protein, C-reactive protein, prothrombin time, partial thromboplastin time, fibrinogen, D-dimer, C5a and elastase levels were compared perioperatively. Results: In the study, it was determined that the discharge time was shorter in Group P. It was found that the increase in d-dimer values with fibrinogen was less in Group P. These were found to be statistically significant (p 0.05). There was no mortality in either group. Conclusion: In this study, phosphorylcholine-coated oxygenator did not significantly reduce the inflammatory response during cardiopulmonary by-pass (CPB). There was no difference between the two groups in terms of morbitidity and mortality.However, the fact that fibrinogen values, which are the acute phase reactants, are lower than the control group and the increase in d-dimer values remain limited may be important in terms of hemocompatibility of the phosphorylcholine coated circuit.

Giriş ve Amaç: Periferik arter hastalıklarının tedavisinde konvansiyonel cerrahi yaklaşımlara ek olarak endovasküler tedavi yöntemi giderek daha fazla kullanılmaktadır. Bu çalışma, periferik arter hastalığında kullandığımız endovasküler tedavi yöntemlerini değerlendirmeyi amaçlamaktadır.Gereç ve Yöntemler: Endovasküler yöntemle tedavi edilen hastaların yirmi dördü retrospektif olarak analiz edildi. Hastaların 19’ unda aralıklı klodikasyon, 4'ünde istirahat ağrısı, bilateral popliteal arter anevrizması olan bir hastada da, diz eklemlerinin arkasında ağrı vardı. Yirmi hasta erkek ve 4'ü kadındı. Yaş ortalaması 55,26± 10,95 (38-81) yıl idi. Fontaine Evrelendirmesi’ ne göre klinik değerlendirme yapıldı. Hastalar ayak bileği-brachial arter indeksi (ABI), bilateral alt ekstremite arteriogramları ve Doppler muayeneleri ile işleme alındı. Endovasküler tedavi uygulanan hastaların 10’ unda TASCII-A, 5'inde TASCII-B ve 9’ unda da TASCII-C lezyonları vardı. Tüm hastalar arteriyel doopler taraması ile takip edildi.Bulgular: Onbir hastaya Bioabsorbable stent kondu. Üç hastaya balon anjiyoplasti yapıldı. Üç hastada nitinol stent uygulandı. Altı hastaya subintimal ilerlenip gerçek lümende balon anjiyoplasti yapıldı. Bilateral popliteal ve sağ anterior tibial arter anevrizması olan 1 hastaya kaplı stent greft ile anevrizma onarımı yapıldı. Olguların %100'ünde hemodinamik başarı sağlandı. Preoperatif 0,67±0,13 (0,4-0,95) ve bir yıl sonra 0,94±0,07 (0,8-1) ABI analizi istatistiksel olarak anlamlı bulundu (p, Objective: Methods of endovascular therapy have been increasingly used in addition to conventional surgical approaches in the treatment of peripheral arterial diseases. This study aims to evaluate to the endovascular treatment methods that we use in patients with peripheral arterial disease.Materials and Methods: We retrospectively analyzed twenty-four of patients were treated with endovascular method. Nineteen of the patients had intermittent claudication, 4 had rest pain and one patient with bilateral popliteal artery aneurysms had pain at the back of bilateral knee joints. Twenty patients were male and 4 were female. The mean age was was 55,26± 10,95( 38-81) years. Evaluations included clinical assesment according to Fontaine stages. Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Ten of the patients who underwent endovascular therapy had a lesion in TASCII-A group, 5 had a TASCII-B lesion, and TASCII-C lesions were present in 9 patients. All patients were followed prospectively with arterial duplex scan.Results: Bioabsorbable stent was implanted in 11 patients. Balloon angioplasty was performed in 3 patients. A self-expandable nitinol stent was deployed in 3 patients. Subintimal balloon angioplasty was performed in 6 patients. An aneurysm repair was performed with stent graft in 1 patient who had bilateral popliteal and right anterior tibial artery aneurysms. Initial technical and hemodynamic success was achieved in 100% of cases. Preoperative 0,67±0,13 (0,4-0,95) and after one year later 0,94±0,07 (0,8-1) analysis for ABI revealed statistically significant (p

OBJECTIVES: In the present study, we aimed to deterimine the dose-related effects of ticagrelor, the first reversible inhibitor of the P2Y(12) receptor, found in smooth muscle cells as well as platelets, during neointimal hyperplasia in a rabbit carotid anastomosis model. METHODS: This study was an experimental, prospective, randomized controlled study including 20 New Zealand white female rabbits (6-months old; weighing 2300 +/- 300 g). Under general anaesthesia, the rabbits underwent transection of the right carotid artery and subsequent anastomosis of both ends. The study animals were divided into the following 4 groups: T1 (ticagrelor 5 mg/kg, orally, daily), T2 (ticagrelor 10 mg/kg, orally, daily), T3 (ticagrelor 20 mg/kg, orally, daily) and control (no ticagrelor treatment). The single oral doses were administered in phosphate-buffered saline. The control group received sterile phosphate-buffered saline (2 ml/kg/day, orally) for 3 weeks postoperatively. At the end of the study, the animals were killed, and the anastomosed segment of the right carotid artery and part of the left carotid artery were excised from each animal. Antibodies against transforming growth factor-beta were used in staining of arterial sections, which was followed by histomorphological and immunohistochemical studies. RESULTS: The median intimal thickness (2.0 +/- 0.14 m left vs 73.4 +/- 35.8 m anastomosed right arteries; P

Amac: Bu calismada dogustan kalp cerrahisinde kardiyopulmoner baypas (KPB) sirasinda lokosit filtrasyonunun enflamatuvar reaksiyonlar uzerine olan etkisi arastirildi. Ca­lis­ma­ pla­ni:­ Calismada KPB sirasinda oksijenator sonrasinda lokosit filtresinin arteriyel hatta baglandigi hastalar grup 1’i (n=15), kontroller ise grup 2’yi (n=15) olusturdu. Hastalar yas, cinsiyet, dogustan kalp hastaligi, toplam KPB suresi, aortik kros klemp suresi, mekanik ventilasyon suresi, yogun bakim unitesi (YBU) ve hastane kalis suresi, 24 saatlik gogus drenaj miktari takibi, inotropik ilac kullanimi, toplam kan transfuzyon miktari ve ameliyat sonrasi komplikasyonlar acisindan ayrintili olarak degerlendirildi. Elastaz ve kompleman (C5a) icin alinan kan ornekleri ameliyat sirasinda induksiyondan sonra sternotomi oncesi, KPB’ye gecmeden once, protamin sonrasi, ameliyat sonrasi birinci saatte YBU’de ve ameliyat sonrasi 24. saatte alindi. Tam kan sayimi, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), kreatinfosfokinaz MB (CKMB), kan ure azotu (BUN) ve kreatinin duzeyi icin ameliyat oncesi ve ameliyat sonrasi birinci ve 24. saatlerde kan ornekleri alindi. Bul gu lar: Hastanede yatis suresi grup 2’de grup 1’e gore daha uzun bulundu (sirasiyla 6.5±1.8’e karsin 9.7±5.1 gun, p=0.015). C5a degerleri her iki grupta da uc, dort ve besinci periyotlarda istatistiksel anlamli olmayan artislar gosterdi (sirasiyla 0.5±0.2’ye karsin 0.6±0.2; p=0.361 ve 0.4±0.1’e karsin 0.4±0.0; p=0.144 ve 2.1±6.6’ya karsin 0.4±0.1; p=0.298). Gruplar arasinda ALT, AST, CKMB ve lokosit sayisi icin yapilan alt grup analizinde istatistiksel anlamli farklilik (p

We report a 51year-old male patient admitted to our emergency department because of sudden abdominal pain, hypotension, and dyspnea. On physical examination, abdominal tenderness was observed, primarily in the lower abdomen. Hemoglobin was 8.5g/dl and hematocrit was 26%. Renal function was within normal limits. Ruptured giant left IIIAA ( diameter 11 cm ) with massive hematoma on the left side of retroperitoneal space and extensive left kidney ( diameter 26x18x20 cm ) hydronephrosis ( Figure 1a,1b ) was detected with contrast-enhanced computed tomography (CT). The patient been consulted to the urology department at the same time and decided left nephrectomy for left kidney hydronephrosis. The patient was immediately taken to operation room due to hemodynamic instability. Proximal control was obtained by percutaneous endoaortic balloon occlusion catheter. The aneurismal sac was reached after midline laparotomy (figure 2). Ligation was performed to both the proximal and distal neck of aneurismal sac. After this procedure aneursimal sac was opened and drained. Concomitantly nephrectomy was performed. The postoperative follow up was uneventful. Symptoms of ischemic colon and claudicating were not observed and renal function tests were impaired. The patient was discharged on day 7 postoperatively. At 6 months postoperative, the patient remained well.

JenaValve TM system is a second-generation transcatheter heart valve that provides a successful deployment not only in calcified stenotic aortic valves but also in non-calcified, severe regurgitant aortic valves. We performed a transapical transcatheter aortic valve implantation procedure using this system without any procedure-related complications in a 75-year-old woman with multiple co-morbidity factors, who had both mitral and aortic regurgitation, and low ejection fraction.

Giriş: İleri yaş diyabetik hastalarda koroner arter cerrahisine bağlı perioperatif mortalite ve morbidite riski mevcuttur. Çalışmamızda yaşlı (Grup I) ve ileri yaş (Grup II) diyabetik hasta gruplarında atan kalpte koroner arter cerrahisinin risk faktörlerini ve sonuçlarını karşılaştırmayı amaçladık.Gereç ve Yöntem: Bu çalışma hastanemizde geriye dönük olarak izole atan kalpte koroner cerrahisi yapılan 37 diyabetik hasta yaş gruplarına göre 65 yaş ve üzeri olanlar alındı. Çalışmaya 65 - 75 yaş arasında 25 hasta ve 76 yaş ve üzerinde 12 hasta dahil edildi. Grupların preoperatif ve operatif özellikleri ile ameliyat sonrası sonuçları karşılaştırıldı.Bulgular: Yaşlı hastalar, ileri yaşlı grubunda olan hastalarla karşılaştırıldığında; ortalama arteryel anastomoz sayısı (p=0.045), vücut kitle indeksi (P=0.001), sigara kullanımı (p=0.027) ve ACE inhibitörü kullanımı (p=0.027) istatistiksel olarak yüksek bulundu. İleri yaşlı grubunda ise ortalama venöz anastomoz sayısı (1.5±0.61 vs 2.25±0.75, p= 0.008) istatistiksel olarak anlamlı bulundu.Sonuç: Her iki grupta da beklenenden daha uzun yaşam süreleri nedeniyle koroner arter cerrahisi sıklığı artmaktadır. Her iki grupta da atan kalpte koroner arter cerrahisinin daha faydalı bir yöntem olarak önermekteyiz., Increased risk for perioperative morbidity and mortality after beating heart coronary artery bypass grafting(CABG) in diabetic octogenarians (Group II) and elderly (Group I) can be in question. We aimed to compare the risk factors and the results of off-pump CABG between diabetic elderly and octogenarian groups .Methods- This study retrospectively enrolled 37 diabetic patients with an age equal to or greater than 65 years who underwent isolated OPCAB at our department . Twenty-five patients were between 65 and 75 years of age while 12 patients had an age equal to or greater than 76 years. Each study group was assessed for preoperative properties, operative characteristics, and postoperative outcomes. Results-Elderly patients had a significantly higher mean number of arterial anastomoses (p=0.045), body mass index (BMI) (P=0.001), number of smoking subjects (p=0.027), and number of subjects using ACE inhibitors (P=0.027) compared to the octogenarians. Octogenarians had a significantly greater mean number of venous grafts (1.5±0.61 vs 2.25±0.75, p= 0.008).Conclusions-People of advanced age have been increasingly operated with CABG operation as persons 80 years old or older live longer than previously expected. Off-pump CABG was a beneficial surgical coronary revascularization method for both elderly and octogenarian patients

Pneumopericardium is defined as air between the leaves of the pericardium, which is usually self-limited. In tension pneumopericardium, however, rapid fluid resuscitation and haemodynamic monitoring followed by pericardial fenestration and drainage should be performed. A 49-year-old male falling from height was brought to the emergency room. On chest X-ray in supine position, a deep sulcus sign and subcutaneous emphysema with multiple rib fractures were detected. At computerized tomography, pericardial free air, right pneumothorax and subcutaneous emphysema were detected. A tube thoracostomy was applied to the patient. During follow-up with cardiac enzymes in the intensive care unit, no tension pneumopericardium developed, and subcutaneous emphysema regressed. A control computerized tomography scan showed a complete regression in the pneumopericardium on the tenth day.

Corresponding author: Suleyman Surer, M.D. Bursa Yuksek Ihtisas Egitim ve Arastirma Hastanesi Kalp ve Damar Cerrahisi Klinigi, 16330 Yildirim, Bursa, Turkey. Tel: +90 505 494 08 28 e-mail: drsuleyman1@hotmail.com Invasive cardiac interventions have an important role in development of lower extremity arterial pseudoaneurysms. A 27-year-old male patient presented with the complaint of difficulty in walking following the discharge from the hospital after a successful emergent percutaneous transluminal coronary angioplasty and stent implantation for acute myocardial infarction in a cardiology clinic. Arterial Doppler ultrasonography showed a 90 mm of pseudoaneurysm in the right external iliac artery. Closure of aneurysm by compression and thrombin injection under ultrasonographic guidance was planned, but failed. Aorto-femoral bypass was performed eventually.

[Cukurova Med J 2015; 40(Suppl 1): 167-169]

Cardiac hydatid cyst is a rare condition, and the location of a hydatid cyst in the interventricular septum is exceptional. A 54-year-old female was admitted to our hospital with complaints of chest pain, shortness of breath and malaise. Transthoracic echocardiography defined a cystic mass lesion of 50 × 59 mm originating from apex of the heart protruding into and compressing the interventricular septum. The cyst was excised surgically and the patient was discharged on the 8th postoperative day without symptoms. In our case, localization of the cystic mass was within interventricular septum which is an uncommon site. It limited both ventricular volumes significantly. In addition, this cyst was extensively protruding to the right ventricular epicardium.

Background. Intra-aortic balloon pump (IABP) is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases.Methods. This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum.Results. The procedure was successfully performed in all the patients. The mean duration of IABP support was54.0±13.4hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft.Conclusions. This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.

We read with great interest the presentation by Lindblom et al. [1] regarding an aneurysm of the left internal mammary artery (IMA), which is a rare and potentially devastating pathology. The case presented has diagnostic challenges and a spontaneous rupture resulting in life-threatening bleeding. The authors suggested the importance of the careful interpretation of radiological findings and the significance of multidisciplinary collaboration between radiologist and clinician. We fully agree with their implications regarding this unusual scenario and would also like to add a short comment on this topic. Mediastinal masses may present a challenge in diagnosis. A mediastinal mass is sometimes detected during routine screens by chest radiography. Mediastinal masses generally originate from the thymus, thyroid, parathyroid, and lymph glands. Vascular pathologies are among the most important causes for mediastinal masses and should always be excluded [2-4]. Vascular lesions include aneurysms of the thoracic aorta, the brachiocephalic artery, the IMA, the intercostal artery, the innominate vein, the superior vena cava, the azygos vein, and the internal mammary vein [2]. True IMA aneurysms are uncommon clinical entities. They are associated with atherosclerotic disease, hereditary connective tissue disorder, fibromuscular dysplasia, type 1 neurofibrinomatosis, vasculitis, and idiopathic causes. Whildhirt and associates[2] reported a case with an atherosclerotic aneurysm of the right IMA, which is a rare cause of a mediastinal mass. Iatrogenic pseudoaneurysms after sternotomy arise from a variety of vessels including the coronary artery, saphenous vein graft(SVG), the intercostal arteries and the IMA. Pseudoaneurysm of the IMA after sternotomy is extremely rare. It may result from central venous catheterization, pacemaker lead implantation, local infection, and trauma to the branches of IMA by steel wires, or may be spontaneous. Iatrogenic IMA pseudoaneurysm may present as an asymptomatic mediastinal mass. However, a high index of suspicion is important in the diagnosis of pseudoaneurysms of the IMA, especially in a haemodynamically unstable patient after sternotomy [3]. Almassi [4] presented a case of an aneurysm of the internal mammary vein presenting as an enlarging anterior mediastinal mass. Diagnosis of internal mammary vein aneurysm can be established by contrast computed tomography scan of the chest with image acquisition in the venous phase. This vascular pathology should be considered in the differential diagnosis of mediastinal masses[4]. Aneurysm of saphenous vein graft(SVG) may also present as a mediastinal mass and is a rare but potentially fatal complication of coronary artery bypass grafting(CABG). Many factors may actually play a role in the development of SVG aneurysm. This aneurysm may be located anywhere along the graft[5]. A computed tomographic scan with intravenous contrast, magnetic resonance imaging and echocardiography is helpful in identifying the consistency, vascularity, and patency of the SVG aneurysm [5]. Coronary angiography also demonstrates the vascular nature of this lesion and can detect other lesions in the native coronary artery. In a patient who has undergone CABG, the appearance of a mediastinal mass on a chest radiography should raise the suspicion of an SVG aneurysm [5]. We think that patients presenting with a mediastinal mass should always be evaluated first for the existence of these vascular abnormalities. Conflict of interest: none declared

Vasoplegic syndrome (VS) or vasodilatory shock frequently occurs after cardiac surgery, particularly with cardiopulmonary bypass(CPB). It is often associated with high morbidity and mortality, especially if it is resistant to intravascular volume expansion and conventional vasoconstrictive drugs [1]. This complication is similar to septic shock and characterized by severe and persistent hypotension, decreased systemic vascular resistance (SVR), normal or increased cardiac output (CO), low intra-cardiac filling pressures, and the necessity for high-dose catecholamines. Until today, the aetiology of VS is not fully understood. However, this syndrome is thought to be caused by the inflammatory-mediated dysregulation of endothelium homeostasis and subsequent endothelial dysfunction, including endothelial cell activation, endothelial permeability augmentation, coagulation defects, production of different regulators, and vascular tone disorders [1]. We read with great interest the paper by Kortekaas et al [2]. The authors report that pre-existing endothelial cell activation, reflected by higher baseline von Willebrand factor pro-peptide and soluble P-selectin levels is a predisposing factor for VS after mitral valve surgery. They also conclude that this activation may have resulted in desensibilization of endothelium in patients with VS. We would like to add some comments on possible agents for the management of VS VS is attributed to a combination of endothelial injury, arginine-vasopressin system dysfunction, and the release of vasodilatory inflammatory mediators[1]. Although these markers may be useful for the identification of patients at increased risk of developing VS, effective treatment strategies for this syndrome are currently lacking. The choice of vasoconstrictive agents for VS is a matter of controversy. To maintain adequate haemodynamics for VS, the conventional treatment based on fluid resuscitation and catecholamine drugs is ineffective in a subset of patients with profound vasodilatation[1]. Arginine vasopressin (AVP) and methylene blue (MB) may be used as additional rescue or a preventative treatment for VS [1, 3]. AVP is well-known to treat norepinephrine-resistant vasodilatation but may be associated rebound hypotension after discontinuation [3,4]. AVP significantly increases mean arterial pressure (MAP) and SVR, and results in a marked decrease in norepinephrine doses [1]. Tayama and associates [3] treated postoperative refractory low SVR hypotension concomitant with pulmonary hypertension by AVP. They reported that exogenous AVP normalized SVR and increased MAP. They also observed that AVP enhanced urine output and improved respiratory function. Noto and co-workers [4] reported that they treated six patients with terlipressin (TP; 1 mg bolus), a synthetic analogue of AVP for post-CPB refractory vasodilatory hypotension. In these patients, the authors suggested that exogenous TP administration normalized SVR and increased MAP with a minimum effect on pulmonary pressure. MB, an inhibitor of nitric oxide synthase and guanylate cyclase, seems to be a possible effective therapeutical option and to improve outcomes in patients with catecholamine-resistant VS after cardiac surgery [1, 5]. In a prospective observational study, Leyh and colleagues [5] tested the effect of MB (2 mg/kg over 20 minutes) in 54 patients with norepinephrine-resistant VS. In this study, MAP increased and norepinephrine dose decreased 1 hour after MB administration. These changes were accompanied by a significant decrease in CO. Finally, we think that further studies are necessary to find the most appropriate possible therapeutic agents for VS. Conflict of interest: none declared

Objective. Carotid endarterectomy (CEA) reduces disabling or fatal stroke risk in patients with significant carotid stenosis. The aim of this study was to compare the results of CEA performed under general anesthesia (GA) or local anesthesia (LA) in patients with symptomatic severe carotid artery stenosis. Method. We retrospectively collected the data on 64 patients who underwent CEA under GA (47 patients) and LA (17 patients) at our hospital from January 2010 to January 2014. All clinical, demographics, preoperative risk factors and postoperative data were compared for postoperative results. Surgical indications, techniques, and complications were also compared. Results. The groups were similar for age, gender and preoperative risk factors. There were no significant differences in death (GA: 4.2% vs. LA: 0%; p =1.0), stroke (GA: 4.2% vs. LA: 0%; p=1.0), death/ stroke rate (GA: 2.1% vs. LA: 0%; p=1.0), nerve injury (GA: 2.1% vs. LA: 5.8%; p=0.464), saphenous vein patch closure (GA: 83% vs. LA: 59%; p=0.051), shunt rate (GA: 8.5% vs. LA: 6 %; p=1.0), hospital stay (GA: 8.2±5.7 day vs. LA: 6.2±2.9 day, p=0.275), hematoma rate (GA: 0 %vs. LA: 5.8%; p =0.266) and transient ischemic attack rate (GA: 4.2% vs. LA: 0%; p=1.0) between the two techniques. Mortality occurred in two patients (both in the GA group) due to stroke and myocardial infarction. Conclusion. Carotid endarterectomy performed safely under general or local anesthesia is associated with low morbidity and mortality rates. Local anesthesia can be a safe option for evaluating the better neurological status during operation.

Free-floating thrombus (FFT) of the carotid artery is an exceptional medical condition with a currently unclarified pathophysiology. Approximately 150 cases have been described and published in the literature throughout the world so far. Thus, no definite management strategies have been established yet. In this paper, a symptomatic case of an FFT inside the common carotid artery presented with a history of slurred speech, and right sided hemiplegia was reported. After the diagnosis of a mobile thrombus within the origin of the left common carotid artery, the patient was placed on anticoagulation. As the medical therapy failed, carotid thromboendarterectomy was performed.

We read with great interest the paper by Singh et al [1]. They described surgical treatment including proximal ligation and plication of the aneurysm with coronary artery bypass grafting in a series of 4 cases of coronary artery aneurysm (CAA) from a single centre. We would like to congratulate the authors for bringing such a rare entity to our attention. We would also like to add a short comment on this topic. Coronary artery dilatation is an exceptional and frequently unrecognized incidental finding in patients with coronary artery disease [2]. At present there is no uniform definition of this pathology. Coronary artery ectasia (CAE) and CAA are characterized by an abnormal dilatation of the coronary artery. They are used interchangeably for the condition. CAE may be classified into four types on basis of the extent of coronary artery involvement: Type I - diffuse ectasia of two or three vessels; Type II - diffuse ectasia in one vessel and localised disease (ie, aneurysm) in another; Type III - diffuse ectasia in one vessel only, and; Type IV - localised or segmental involvement (CAA) only [3]. This classification may have prognostic implications, with the worst outcomes in types I and II [2]. CAA may be classified in three different ways on the basis of the composition of the vessel wall (true aneurysms or pseudoaneurysms), the morphologic structure (saccular or fusiform aneurysms), and size (e.g., large or giant aneurysms) [2]. The various factors contributing to CAA formation include atherosclerosis, congenital malformations, Kawasaki disease, percutaneous coronary interventions, inflammatory arterial diseases (polyarteritis nodosa, systemic lupus erythematosus, Takayasu's arteritis), infectious causes (endocarditis, syphilis, candidosis, Lyme borreliosis), chest traumas, vasculitis (eg, Behcet disease), connective tissue disorders (Marfan's syndrome, Ehlers Danlos syndrome, scleroderma), primary cardiac lymphoma and primary hyperaldosteronism [2]. CAE is used to describe diffuse dilatation (>1.5 times the normal diameter) of the coronary arteries that involves 50% or more of the length of the vessel. However, CAA is defined as a localized dilatation that exceeds the diameter of normal adjacent coronary artery segments, or the diameter of the patient's largest coronary vessel by 1.5 times. Herein, coronary artery involment is less than 50% of the total length of the vessel [2]. A giant aneurysm is defined as one where the maximal vessel diameter exceeds 20 mm in adults or 8 mm in children. In adults, the reported diameter of giant CAAs varies from 50 to 150 mm. Giant CAAs are rare, with a reported prevalence of 0.02% [4]. Potential complications include rupture (subsequent cardiac tamponade), thrombosis, embolization, dissection, mechanical obstruction, and erosion into surrounding structures. In these patients, surgery should be considered as a means to avoid complications [5]. Conflict of interest: none declared

Coronary artery ectasia (CAE) is detected in approximately 1-5% of all coronary angiography procedures. Coronary artery dilatation is only rarely diagnosed or cannot be recognized generally. There is no consensus regarding the definition of this rare anomaly. A 75-year old female who is a hypertansive and hyperlipidemia with a history of chronic stable angina despite full medical therapy. She was admitted on intensive care unit this time because of a typical chest pain that did not alleviate with sublingual nitroglycerin. Coronary angiography revealed mainly of the diffuse ectasia of three coronary artery and rheumatic heart valve disease. She underwent aortic and mitral replacement and a three-vessel bypass. Her postoperative course was well and she was discharged on the postoperative day 7 th. The patient is doing well on follow-up with no recurrence of symptoms.

Venous aneurysms are rare entities observed in neck, thorax, extremity, and abdominal veins. Although the exact etiology is unknown, trauma to vessel wall, inflammation, congenital anomalies, and local degenerative changes are implicated. Venous aneurysms may be thrombosed and lead to thromboembolic events, acute pulmonary embolism, and death. Resection of the aneurysm is the general preferred approach. We present a 56-year-old male with swelling in left inguinal region and symptoms of chronic venous insufficiency. Diag - nostic workup revealed an aneurysm in left accessory saphenous vein. It was resected under local anesthesia. The patient was discharged without any complications.

Objective: Diabetes mellitus is recognized as a risk factor for mortality and morbidity after coronary bypass grafting. We aimed to determine the association between preoperative hemoglobin HbA1c and AF after isolated off-pump coronary bypass grafting (OPCAB). Methods: The seventy-two diabetic patients undergoing isolated off-pump coronary bypass grafting were retrospectively analyzed for AF. They were divided into; Low (4.8–5.4%), Medium (5.5–8%) and High (8.1–11.5%) groups. The three groups were compared with respect to demographic, echocardiographic, intraoperative and postoperative clinical characteristics correlation. Results: Three patients died during postoperative period. AF occurred in 12 patients (16.6%) after surgery. The incidence of postoperative AF was 15.3% in the lower, 4.4% middle and 57.1% upper group. There was statistically significant correlation between preoperative HbA1C and preoperative stroke, preoperative MI history, Left atrial (LA) size, preoperative levosimendan, preoperative clopidogrel, postoperative AF, postoperative dopamine and dobutamine use, IABP, duration of extubation time, 24-hour chest tube drainage, duration of ICU and hospital mortality. Univariate logistic regression analysis showed significant correlation between postoperative AF and variables like preoperative HbA1c levels, LVEF