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Association of tetralogy of Fallot (TOF) with the other intracardiac pathologies such as atrial septal defect (ASD), atrioventricular canal defect or persistent left superior vena cava (PLSVC), absent pulmonary valve are well known pathologies. The associated pathologies require specifi c attention during surgical treatment. In this manuscript, we present management of a four-month-old girl who was diagnosed with TOF and PLSVC but the diagnosis of unroofed coronary sinus was missed in her. Association of unroofed coronary sinus with TOF is a very rare variant of TOF pathology. Souvislost mezi Fallotovou tetralogií (tetralogy of Fallot, TOF) a jinými intrakardiálními patologiemi, jako jsou defekt septa síní (atrial septal defect, ASD), defekt síňokomorového kanálu nebo perzistentní levostranná horní dutá žíla (persistent left superior vena cava, PLSVC) i absence plicní chlopně, je dobře známa. Během chirurgického výkonu vyžadují přidružená onemocnění obzvláštní pozornost. V tomto článku popisujeme léčbu čtyřměsíční dívky s diagnózou TOF a PLSVC, u níž však byl přehlédnut nezastřešený koronární sinus. Nezastřešený koronární sinus se vyskytuje současně s TOF velmi vzácně. more...

Background. The effect of tissue adhesives on coronary grafts in cardiac surgery is a controversial issue. Objective. The aim of this study is to investigate the effect of fibrin glue (FG) applied around the saphenous vein grafts (SVG) in preventing cellular damage resulting from intraluminal pressure increase. Methods. Twenty volunteer patients were included in this ex vivo study. The SVGs remained after coronary artery bypass grafting were connected to the arterial line of the cardiopulmonary bypass circuit. The grafts were divided into two segments and one segment received perivascular FG applied whereas the other part was used plain. SVGs were kept in circulation at 120 mmHg pressure 250 mL/min flow rate for 60 min. The tissues were sent for histopathological examination to determine the endothelial damage. Results. Endothelial damage was more pronounced in the control group when compared with the FG group. In the FG group, no damage was seen in 13 samples and no Type 3 endothelial damage was observe whereas Type 1 injury was detected in seven specimens, Type 2 injury was observed in seven specimens, and Type 3 injury was detected in two specimens in the control group. Conclusion. Perivascular application of FG on the SVG showed a protective effect against endothelial damage resulting from increased intraluminal pressure. Antecedentes. El efecto de los adhesivos tisulares sobre los injertos coronarios en cirugía cardíaca es un tema controvertido. Objetivo. Investigar el efecto del pegamento de fibrina aplicado alrededor de los injertos de vena safena para prevenir el daño celular resultante del aumento de la presión intraluminal. Método. En este estudio ex vivo fueron incluidos 20 pacientes voluntarios. Los injertos de vena safena que quedaron después del injerto de derivación de la arteria coronaria se conectaron a la línea arterial del circuito de derivación cardiopulmonar. Los injertos se dividieron en dos segmentos y a uno de ellos se le aplicó pegamento de fibrina perivascular, mientras que la otra parte se usó sola. Los injertos de vena safena se mantuvieron en circulación a una presión de 120 mmHg y una velocidad de flujo de 250 ml/min durante 60 minutos. Los tejidos se enviaron para examen histopatológico para determinar el daño endotelial. Resultados. El daño endotelial fue más pronunciado en el grupo de control ue en el grupo de pegamento de fibrina. Se observó lesión de tipo 2 en siete muestras del grupo de pegamento de fibrina y lesión de tipo 3 en dos muestras del grupo de control. Conclusiones. La aplicación perivascular de pegamento de fibrina en los injertos de vena safena mostró un efecto protector contra el daño endotelial resultante del aumento de la presión intraluminal. more...

Objective: Atherosclerosis is the mainly etiologic factor of coronary artery disease, carotid artery disease and peripheral artery disease. In our study, we aimed to show the presence and effect of Epstein-Barr virus (EBV) on the carotid artery stenosis leading chronic inflammatory process by producing pro-inflammatory cytokines and causing atherosclerosis. Material and methods: Between April 2017 and April 2018, thirty-six patients, who underwent carotid endarterectomy at Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, are included in this study upon their consent. Each voluntary patient was initially recorded for age, sex, height and weight. Among 36 patients included in the study, 58.3% (n = 21) were male and 41.7% (n = 15) were female. The comorbidities such as hypertension, diabetes mellitus were considered. Results: There was not significant difference in EBV (DNA) positivity according to hyperlipidemia presence, sex, and age factors. However, the EBV (DNA) positivity was higher in the patients with co-morbidities such as hypertension and diabetes mellitus; no significant difference was detected. EBV (DNA) positivity in patients with bilateral carotid artery stenosis was 42.1% and it was 0% in patients without bilateral carotid artery stenosis (p: 0,002). The EBV (DNA) positivity was significantly higher in patients with bilateral carotid artery stenosis Conclusion: We believe that our significantly high EBV (DNA) rates in the patients with bilateral carotid artery stenosis may encourage the studies that claim the role of viral etiology on atherosclerosis, however, further studies are needed. more...

Atrial fibrillation (AF) is diagnosed with the electrocardiogram, which is the gold standard in clinics. However, sufficient arrhythmia monitoring takes a long time, and many of the tests are made in only a few seconds, which can lead arrhythmia to be missed. Here, we propose a combined method to detect the effects of AF on atrial tissue. We characterize tissues obtained from patients with or without AF by scanning acoustic microscopy (SAM) and by Raman spectroscopy (RS) to construct a mechano-chemical profile. We classify the Raman spectral measurements of the tissue samples with an unsupervised clustering method, k-means and compare their chemical properties. Besides, we utilize scanning acoustic microscopy to compare and determine differences in acoustic impedance maps of the groups. We compared the clinical outcomes with our findings using a neural network classification for Raman measurements and ANOVA for SAM measurements. Consequently, we show that the stiffness profiles of the tissues, corresponding to the patients with chronic AF, without AF or who experienced postoperative AF, are in agreement with the lipid-collagen profiles obtained by the Raman spectral characterization. more...

Background: It has been shown that interleukin-35 (IL-35) subunits are strongly expressed in atherosclerotic plaques in humans. Therefore, it is considered to play a role in atherosclerosis. Objectives: In this study, IL-35 levels were compared with the control group in patients with stable coronary artery disease (CAD), and the association between IL-35 levels and the lesion type, lesion severity and extension was investigated with the Gensini score (GS) and the Syntax score (SS) in the patient group. Methods: Sixty patients (18 female and 42 male) with CAD diagnosed by coronary angiography, who presented with typical chest pain and positive noninvasive cardiac stress test, and 46 patients (18 female and 28 male) with normal coronary lumenogram, were included in this study. Gensini and Syntax scores were calculated in the patient group, and these values were compared with IL-35 levels. Non-normally distributed variables were analyzed by the Mann-Whitney U test, whereas normally distributed parameters were assessed by Student’s t-test. The difference between categorical variables were evaluated by the Chi-square or Fisher test. P-values more...

OBJECTIVE: Cardiovascular diseases are responsible for the majority of deaths on a global scale. Atherosclerosis is the main risk factor for cardiovascular disorders and represents a complex phenomenon associated with endothelial dysfunction and inflammation. Statins, especially atorvastatin (ATV) and pitavastatin (PTV), are common agents used to control ongoing atherosclerotic events in the body to minimize cardiovascular disease-based deaths. MATERIALS AND METHODS: The present study aimed at comparing the efficacy of ATV and PTV in a cell line model of inflammation. Human saphenous vein cells were treated with TNF-alpha to mimic atherosclerotic conditions, and the cells were divided into 7 groups, including control, DMSO, TNF-alpha (10 ng/mL-6 hours), ATV (50 μM/24 hours), PTV (2 μM/24 hours), ATV (50 μM/24 hours)+TNF-alpha (10 ng/ mL-6 hours) and PTV (2 μM/24 hours)+TNF-alpha (10 ng/mL-6 hours). The expression levels of 20 proinflammatory cytokines and chemokines were investigated in these groups using a human atherosclerosis antibody array. RESULTS: Possible pathway interactions were determined by STRING and PANTHER analyses. Comparison with the effect of ATV indicated that PTV reduced the levels of 4 proinflammatory cytokines: CCL11, CSF2, CCL20, and TGFB1 (p more...

Aim: We present our subclavian artery revascularization experiences in the patients with thoracic aortic aneurysm who underwent hybrid repair. Materail and Methods: Between May 2015-December 2018,4 patients underwent TEVAR procedure following axilloaxillary bypass grafting.The mean age of the patients was 72.5 +/- 3.01 years.One patient was female and 3 patients were male.Patients had thoracic aortic aneurysms including the left subclavian artery or aberrant right subclavian artery. Results: All patients underwent endovascular stent graft repair following axilloaxillary bypass grafting in the same day.Mortality did not occur in the perioperative period.One patient had graft infection at 8th month of the operation and the graft was removed.He was lost due to pneumonia following the operation.The control computed tomographies of the other 3 patients revealed patent grafts together with successful endovascular interventions and they have been following uneventfully a mean of 27 +/- 6.2 months (range:24-32,median:29). Conclusion: The risk of stroke,spinal cord ischemia, and upper extremity ischemia are found higher in the patients who underwent coverage of the left subclavian artery without revascularization.The axilloaxillary bypass grafting may be performed in the patients with high risk to prevent carotid artery manipulation and clamping during carotid-subclavian bypass with long term promising patency rates. Objetivo: Presentamos nuestras experiencias de revascularización de la arteria subclavia en los pacientes con aneurisma de aorta torácica sometidos a reparación híbrida. Material y métodos: entre mayo de 2015 y diciembre de 2018, 4 pacientes fueron sometidos a TEVAR después de un injerto de derivación axiloaxilar. La edad media de los pacientes fue 72,5 ± 3,01 años. Un paciente era mujer y 3 pacientes eran varones. Los pacientes tenían aneurismas de la aorta torácica incluyendo el arteria subclavia izquierda o arteria subclavia derecha aberrante. Resultados: Todos los pacientes fueron sometidos a reparación endovascular con endoprótesis vascular en el mismo día después de un bypass axiloaxilar, no hubo mortalidad en el perioperatorio, un paciente presentó infección del injerto a los 8 meses de la operación y se retiró el injerto, se perdió por neumonía Las tomografías computarizadas de control de los otros 3 pacientes revelaron injertos permeables junto con intervenciones endovasculares exitosas y han estado siguiendo sin incidentes una media de 27 ± 6,2 meses (rango: 24-32, mediana: 29). Conclusión: El riesgo de ictus, isquemia medular e isquemia de la extremidad superior es mayor en los pacientes sometidos a cobertura de la arteria subclavia izquierda sin revascularización; en los pacientes con alto riesgo se puede realizar un bypass axiloaxilar para prevenir la manipulación de la arteria carótida. y pinzamiento durante la derivación carótido-subclavia con tasas de permeabilidad prometedoras a largo plazo. more...

Giriş: Karotis arter hastalığı inmenin başlıca nedenlerinden biridir ve ciddi morbidite ve mortaliteye neden olmaktadır. Operasyon sırasında uygulanan anestezi tekniklerinin birbirine üstünlüğü tartışmalıdır. Biz bu yazıda rejyonel anestezi altında opere ettiğimiz hastaların sonuçlarını paylaşmayı amaçladık. Gereç ve yöntem: Ocak 2010 – Aralık 2018 yılları arasında 360 hastada 412 karotisendarterektomi operasyonu uygulanmıştır. Tüm operasyonlar servikal blok tekniği ile uygulanan rejyonel anestezi altında gerçekleştirilmiştir. Hastalar retrospektif olarak demografik özellikler, shunt kullanımı, operasyon süresi, peroperatif nörolojik olay, morbidite, mortalite, hastanede kalış süresi, reeksplorasyon gereksinimi, restenoz, kan ve kan ürünleri ihtiyacı açısından irdelenmiştir. Bulgular: Hastaların 112’si kadın, 248’i erkekti. 328 hasta geçmişte ya da aktif olarak sigara kullanıcısıydı. 246 hastada diabetesmellitus, 280 hastada hipertansiyon, 312 hastada hiperlipidemi mevcuttu. 290 hastada koroner arter hastalığı öyküsü vardı.Hiçbir hastada operasyon sırasında genel anesteziye geçme ihtiyacı olmadı, mortalite veya nörolojik olay gelişmedi. 27 hastada klemp testini tolere edememesi nedeniyle shunt kullanımı gerekti. 2 hasta erken dönemde kaybedildi. 2 hastaya hematom nedeniyle eksplorasyon gerekti. Hiçbir hastada major nörolojik olay gelişmedi. Sonuç: Rejyonel anestezi uyanık hastada anlık nörolojik muayeneye olanak vermesi, operasyon süresi, hastanede yatış zamanı, kan ve kan ürünü kullanımını azaltması gibi avantajları ile birlikte karotisendarterektomisinde önemli rol oynamaktadır. Introduction: Carotid artery disease is one of the most important etiologic factors of the stroke and causes serious mortality and morbidity. The superiority of anesthesia techniques applied during the operation is controversial. We aimed to presentour results of the patients who underwent operation with regionalanethesia. MaterialandMethod: Between January 2010-December 2018, 412 carotid endarterectomy operations were performed among 360 patients. All operations were performed under regional anethesia applied with cervical block technique. The patients are examined retrospectively according to demographic features, shunt usage, operation time, peroperative neurological event, morbidity, mortality, hospital stay, reexploration requirement, restenosis, blood and blood products requirement. Results: 112 patients were female, 248 patients were male.328 patients were active or exsmoker. 246 patients had diabetes mellitus, 280 patients had hypertension, 312 patients had hyperlipidemia. 290 patients had diagnosis of coronary artery disease. In any patient, the general anesthesia requirement were needed during the operation, mortality or neurological event did not ocur. 27 patients required shunt due to crossclampin tolerance. 2 patients were lost in early followup. 2 patients required reexploration due to hematoma. Major neurological event did not ocur in any patient. Conclusion: Regional anesthesia has an important role in carotidendarterectomy with advantages of providing instant neurological examination and decreasing operation time, hospital stay and blood and blood product usage. more...

We read with interest the manuscript of Megaly et al.[1] in which the authors presented a challenging treatment of an ascending aortic pseudoaneurysm with endovascular stent grafting. However, we would like to comment on the paper with an alternative treatment option. more...

Objective: The aim of this study was to evaluate the long-term results of patients who underwent thoracic stent grafting. Material and Method: We retrospectively evaluated 25 patients with a mean age of 67.1 (20-82) with thoracic aortic pathology treated with a stent graft or the hybrid method (endovascular intervention after surgery) in our clinic. Results: 23 patients were treated electively and 2 of them were treated urgently. Type 1A endoleak was observed in 5 patients in control imaging. Additional intervention was performed in 3 of these patients. In one patient, the endoleak spontaneously regressed during follow-up. One patient died on the 6th postoperative day due to MI. A total of 7 patients underwent hybrid procedures. One of the debranching patients developed major complications during endovascular procedure. In the type B dissection patients, neurological complications were observed during post-procedure controls in 1 of the 7 patients who underwent hybrid intervention. Conclusion: Endovascular thoracic stent grafting is performed with high technical success and survival rates in thoracic aortic pathologies. Hybrid intervention is preferred in patients with non-suitable anatomy for TEVAR alone., Amaç: Bu çalışmada, torasik stent greft uygulanmış hastaların uzun dönem sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde sadece stent greft ile ya da hibrid yöntem (cerrahi sonrası endovasküler girişim) ile tedavi edilmiş torasik aort patolojili, yaş ortalaması 67,1 (20-82) olan 25 hastayı retrospektif olarak değerlendirdik. Bulgular: Hastalardan 23’ü elektif olarak tedavi edilirken, 2’si acil olarak işleme alınmıştır. Kontrol görüntülemelerde 5 hastada tip 1A endoleak izlenmiştir. Bu hastalardan 3’üne ek girişim uygulanmıştır. Hastalardan birisinde endoleak takip sırasında kendiliğinden regrese olmuştur. 1 hastada ise post-op 6. günde MI nedeniyle ex olmuştur. Toplam 7 hastada hibrid işlem uygulanmıştır. Debranching uygulanan hastalardan bir tanesinde endovasküler işlem sırasında majör komplikasyon gelişmiştir. Hibrid girişim uygulanan 7 hastadan 1’i olan tip B diseksiyon hastasında işlem sonrası kontroller sırasında nörolojik komplikasyon izlenmiştir. Sonuç: Endovasküler torakal stent greft işlemi torakal aort patolojilerinde yüksek teknik başarı ve sağ kalım oranları ile uygulanmaktadır. Tek başına TEVAR’a uygun olmayan anatomiye sahip hastalarda hibrid girişim tercih edilmektedir. more...

Objective: Literature does not contain a standard procedure about anticoagulant therapy aimed at patients with atrial fibrillation and carotid artery stenosis following carotid endarterectomy. In this paper, we present our therapy modality at these patients in our clinic. Material and Method: The study includes 424 patients and 498 carotid endarterectomy operations performed by two surgeons with the same technique between June 2010 and December 2017. Fourty-five patients had chronic or paroxysmal atrial fibrillation. Therefore, the patients were receiving Coumadin and aspirin. The median age was 63.4±7.9. There were 27 female and 18 male patients. Thirty seven patients were hypertensive and 17 patients were diabetic. Nine patients underwent bilateral carotid endarterectomy operations. Thirty three patients were symptomatic. Eleven patients had coronary artery disease and 5 patients had cardiac valvular pathologies. Results: The whole carotid endarterectomy operations were performed under locoregional anesthesia. Early mortality occured in one patient because of hypertensive intracranial bleeding. The median follow up period was 68.4±19.2 months. One patient was lost due to aging and co-morbid factors and one patient was lost due to malignancy in late follow up period. Three patients required revisions for hematoma at incision region but an active bleeding focus could not be detected. There was no re-stenosis in any patient during follow-up. Conclusion: The large and multi-centered studies are needed for the anticoagulant therapy protocol for the patients with atrial fibrillation following carotid endarterectomy. We prefer combination of warfarin, providing INR value between 2-3, and 100 mg aspirin per day at our patients as therapy modality., Amaç: Karotis arter stenozu ve atriyal fibrilasyonun birarada görüldüğü hasta grubunda karotis endarterektomi sonrası antikoagülan tedavi protokolü ile ilgili standart bir prosedür bulunmamaktadır. Bu hasta grubunda kliniğimizde uyguladığımız tedavi stratejimizi sunmaktayız. Gereç ve Yöntem: Çalışma Haziran 2010 - Aralık 2017 arasında karotis endarterektomisi operasyonunu gerçekleştiren 2 cerrahın verilerinin toplandığı 424 hastayı ve 498 karotis endarterektomisi işlemini içermektedir. Bu hastaların 45’inde kronik veya paroksismal atriyal fibrilasyon mevcuttu. Hastalar warfarin ve aspirin tedavisi almaktaydı. Ortalama yaş 63,4±7,9 idi. Hastalardan 27’si kadın 18’i erkekti. 37 hastada hipertansiyon, 17 hastada diyabetes mellitus mevcuttu. Hastaların 9’una bilateral karotis arter stenozu nedeniyle cerrahi işlem uygulandı. 33 hasta semptomatikti. 11 hastada koroner arter hastalığı, 5 hastada kardiyak valvuler patoloji mevcuttu. Bulgular: Hastaların tamamında lokorejyonel anestezi ile karotis endarterektomisi yapıldı. Erken mortalite 1 hastada hipertansif intrakraniyal kanama sebebiyle gerçekleşti. Hastaları ortalama takip süresi 68,4±19,2 ay idi. Takiplerde 1 hastada komorbid faktörlere bağlı sebepler, 1 hastada malignite nedeniyle geç dönemde mortalite gerçekleşti. Hastaların 3’ünde insizyon böl gesinde hematom nedeniyle revizyon gerekti; fakat eksplorasyonda aktif kanama odağı tespit edilemedi. Hiçbir hastada takipleri sırasında restenoz saptanmadı. Tartışma: Atriyal fibrilasyonu olan hastalarda karotis endarterektomi sonrası antikoagülan tedavi protokolü açısından daha geniş ve çok merkezli çalışmalara gereksinim vardır. Biz hastalarımızda INR değerini 2-3 arasında tutacak şekilde warfarin tedavisi ile günlük 100 mg aspirin kombinasyonunu tedavi stratejisi olarak uygulamayı tercih ettik. more...

Amaç: Pediyatrik kardiyak anestezist tarafından ultrasonun yaygın olarak kullanılması ile zaman ve malzeme tasarrufu ile birlikte başarılı girişim sayısı artmış, komplikasyonlarda da azalma olmuştur. Bu çalışmada, çocuklara 2 farklı yöntem olan anatomik tarif (AT) ve Ultrasonografi (US) eşliğinde perkutan santral venöz kateter (SVK) takılması yöntemlerini karşılaştırdık. Yöntem: On kilogramın altında, toplam 293 olgu, rastgele, retrospektif olarak; AT (n=151) ve US (n=142) eşliğinde kateterizasyon yapılanlar olarak 2 gruba ayrıldı. SVK sağ/sol internal juguler ven (İJ), sağ/sol femoral ven (FV) ve sağ/sol subklaviyen venden (SKV) takıldı. Karşılaştırılan parametreler: demografik veriler, kateterin takıldığı yer, girişim sayısı, işlemi bitirme süresi, cerrahi kateter takılma sayısı, komplikasyonlar idi. Bulgular: Grupların demografik verileri; yaş (1 gün- 4.5 yaş), ağırlık (560 g-10 kg), boy (23-103 cm) ve cinsiyetleri arasında fark yoktu (p>0,05). SVK takıldığı yerler sırası ile % olarak: sağ İJ/sol İJ/sağ FV/ sol FV/ sağ SKV / cerrahi femoral ven/sağ atriyum; AT de 82/6/6/2/2/2, US’de 89/9/1/0/0/0 (p more...

Development anomalies of the aortic arch and its major branches are rare congenitalcardiovascular disorders. In this article, we present aberrant left subclavian arteryassociated with right aortic arch. more...

Atriyal septal defekt erişkinde en sık rastlanan doğumsal kalp anomalilerinden biridir. Minimal invaziv cerrahi tekniklerdeki gelişmeler, seçilmiş uygun vakaların bu yöntemle daha yaygın olarak tedavi edilmesini artırmıştır. Sağ anterior torakotomi ile minimal invaziv olarak atriyal septal defekt onarımı güvenilir sonuçları, yüksek hasta memnuniyeti nedeniyle özellikle genç bayan hastalarda ilk sıralarda tercih edilecek yöntemlerden biridir. Biz bu yazıda yaklaşık 3 yıl önce silikon meme protezi ameliyatı olan hastada uyguladığımız minimal invaziv teknik ile sinüs venozus defekti onarımını anlatmaktayız. Mevcut kompleks atrial septal defekt ve cerrahi alanda silikon meme protezi bulunmasına rağmen sağ anterolateral mini torakotomi yaklaşımı sayesinde uygulanan tedavi başarılı ve kozmetik olarak sorunsuz olmuştur. Atrial septal defect is one of the most common congenital cardiac anomalies in adulthood. Advances in minimally invasive surgical approaches result in an increased use of these techniques in selected patients. Atrial septal defect closure with minimal invasive surgery through right anterior thoracotomy is one of the first chosen treatment methods with reliable results and high patient satisfaction especially in young ladies. In this paper, we present the repair of sinus venosus defect with minimal invasive methods in a patient whom underwent breast reconstruction using a silicone prosthesis three years ago. The operation through right anterolateral minithoracotomy approach was successful and cosmetically uneventful even in the presence of a complex atrial septal defect and the silicone breast prosthesis in the surgical area. more...