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Purpose: Exercise capacity is associated with diastolic function. The aim of our study is to investigate the short term effects of cardiopulmonary rehabilitation and NMES on functional capacity and myocardial tissue doppler (MTD) after coronary artery surgery. Methods: Forty patients with coronary artery bypass graft were randomly divided into two groups: CPR+NMES and CPR. Functional capacity were analyzed through 2 minutes walk test (2MWT) and sit to stand test (SST), left ventricular (LV) diastolic functions were analyzed with MTD and thoracic expansion was analyzed with chest wall measurement on the 2nd and 7th postoperative days. Results: Statistically significant difference was identified between the groups in 2MWT distance (CPR+NMES, Zt*p=0.000*), SST (CPR, Zt*p=0.000*), E’ (CPR+NMES, Zt*p=0.002*), E (CPR+NMES, Zt*p=0.025*), E/E’ (CPR+NMES, Zt*p=0.007*), A (CPR, Zt*p=0.006*) (p

Background: Visceral organ blood circulation is seriously impaired in aortic pathologies especially aortic dissection involving descending thoracic and abdominal aorta. Herein, we aimed to determine the effect of the newly onset renal function impairment on postoperative mortality rates of the patients undergoing EVAR and TEVAR procedures. Methods: Patients who underwent an EVAR / TEVAR procedure in our clinic included in this retrospective study. Patients were divided into two groups according to the presence of renal function impairment. Mortality rates were calculated for the groups. Results: A total of 60 patients who underwent an EVAR/TEVAR procedure between November 2016 and May 2021 included in this study. Group 1 included a number of 48 (80%) patients without postoperative renal dysfunction. Group 2 included a total of 12 (20%) patients with postoperative renal function impairment. The initial analysis of the data revealed significant differences in the age and sex variables of the groups (P=0.038 and P=0.008 respectively). Then propensity score matching was performed to avoid bias in the groups. After propensity score matching Group 1 included 12 (50%) patients without postoperative renal impairment and Group 2 included 12 (50%) patients with postoperative renal dysfunction. There were no significant differences between the groups after propensity matching. Mortality rate was significantly different between the groups which was 1 patient (8.33%) in Group 1 vs 6 (50.00%) patients in Group 2 (P=0.020). Conclusions: Renal functions after EVAR/TEVAR procedures should be carefully monitored because renal impairment is closely related with postoperative mortality. We suggest that more studies with larger patient numbers should be conducted on the relation of renal functions and mortality after regularly performed EVAR/TEVAR procedures.

Objective To determine the efficacy of a sternal wire system in secondary sternal dehiscence after repeat closure of the sternum, following surgical revision after open heart surgery. Study design Case-control study. Place and duration of study Department of Cardiovascular Surgery, Zonguldak Bulent Ecevit University, Zonguldak, Turkey; and Turkey Yuksek Ihtisas Training and Research Hospital, Turkey, from January 2015 to May 2019. Methodology Patients, who underwent open heart surgery with median sternotomy, were included in this retrospective study. The patients were divided into two groups, according to the sternal closure material. The time of the sternal reconstruction surgery, because of sternal dehiscence, fracture, broken sternal wire(s) or cable(s) after the first revision surgery, was noted for each patient. Results A total of 389 patients were identified. Group 1 included 72 (50%) patients whose sternums were closed with a sternal cable system; and Group 2 included 72 (50%) patients whose sternums were closed with conventional steel wires after propensity matching. The duration of cardiopulmonary bypass, number of intra-aortic balloon pumps used, and number of extracorporeal membrane oxygenators used were significantly higher in Group 1 (p = 0.007, p = 0.034, and p = 0.028, respectively). The number of emergency operations was significantly higher in Group 2 (p = 0.021). There was no significant difference in terms of secondary sternal dehiscence between the groups (p = 0.366). Conclusion Application of the sternal wire system in revisional open heart surgery is not more effective than conventional steel wire at preventing secondary sternal dehiscence. Key Words: Sternal dehiscence, Sternal cable, Sternal wire, Open heart surgery, Postoperative revision.

The sternal foramen is an anatomical variation at the lower third of the sternum which carries the risk of life-threatening complications such as pneumothorax. It is usually asymptomatic and can be misinterpreted as an acquired lesion. The sternum is close to the mediastinal structures; the sternal foramen, thus, leaves the lung, heart, and great vessels unprotected during invasive procedures. A 61-year-old male patient was admitted to our emergency department with sudden-onset chest pain. Acute coronary syndrome was diagnosed by the cardiology department. Coronary angiography confirmed the diagnosis of coronary artery disease, and the patient underwent urgent coronary artery bypass grafting. During the exploration, sternotomy was performed with a proper incision. Two sternal images were obtained via the median incision, and a sternal foramen was detected intraoperatively. To the best of our knowledge, this is the first case of sternotomy to undergo open-heart surgery for coronary heart disease and to be diagnosed with the sternal foramen intraoperatively. It is of vital importance that surgeons and interventionists recognize the sternal foramen, which leaves the mediastinal structures unprotected, and take early precautions.

Amaç: İskemik kalp hastalığına bağlı gelişen mitral yetmezlik, halen operatif mortalitesi yüksek seyirli bir hastalıktır. Cerrahi prosedür olarak halen bir fikir birliği sağlanmamıştır. Bu çalışmada İskemik Mitral Yetmezlikte (İMY), mitral kapak replasmanı (MVR) ve tamir sonuçlarının karşılaştırılarak, birbirlerine üstünlüklerini ortaya koymak amaçlanmıştır. Materyal ve Metod: 2007 ve 2011 yılları arasında Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde, İMY nedeniyle opere edilen 36 hasta incelenmiştir. Hastaların (38.9%) kadın, 22’si (61.1%) erkekti. 20 hastaya MVR, 16 hastaya mitral rekonstrüksiyon yapıldı. Her iki grupta bütün vakalarda koroner bypass mevcuttu. Hastalarda preoperatif risk faktörleri, mitral yetersizliğin derecesi, sol ventrikül ejeksiyon fraksiyonları, pre-postoperatif fonksiyonel klasifikasyonları, aort kros klemp ve kardiyopulmoner bypass süreleri, yoğun bakım ve hastane kalış süreleri belirlendi. Bulgular: MVR yapılan grupta preoperatif diyastolik çap ve kontrol diyastolik çap arasında anlamlı olarak fark saptanmıştır (p=0.016). Bu grupta diyastolik çaptaki düzelme tamir grubuna göre istatistiksel olarak daha iyi çıkmıştır. Ayrıca preoperatif fonksiyonel kapasite (FK) ve kontrol FK arasında, düzelme yönünde anlamlı fark bulunmuştur (p=0.008). Erken dönem mortalite görülen hastalar incelendiğinde MVR yapılan grupta 6 hasta, tamir grubunda 5 hasta exitus oldu. Mortalite görülen 11 hasta ile sağ kalan hastalar preoperatif ejeksiyon fraksiyonu (EF) yönünden karşılaştırıldığında anlamlı bir fark bulunmamıştır. (p=0.986) Sonuç: İMY‘de öncelikle mitral tamir önerilse de, son zamanlarda bazı çalışmalarda da önerildiği gibi, MVR yapılması mitral yetmezliğin tam giderilmesini sağlayıp, reoperasyon riskini azaltmaktadır.

Aortic aneurysm rupture is still a life threateningsituation despite the advancements in cardiovascular surgery field. Today,endovascular treatment is an option for these patients. In the case of anaortic rupture, urgent evaluation of the patient and planning the patientspecific treatment are crucial. Herein, we represent two cases who survivedafter successful treatments of aortic ruptures., Aorticaneurysm rupture is still a life threatening situation despite theadvancements in cardiovascular surgery field. Today, endovasculartreatment is an option for these patients. In the case of an aorticrupture, urgent evaluation of the patient and planning the patientspecific treatment are crucial. Herein, we represent two cases whosurvived after successful treatments of aortic ruptures.

Anthracosis is an occupational disease which is caused by long-term inhalation of coal and rock dust. We present a case of epicardial anthracosis in a patient who underwent coronary artery bypass graft surgery for coronary artery disease. This is the first case of anthracosis related to the heart in the literature to the best of our knowledge. This case report emphasizes the systemic dissemination of inorganic particles such as carbon in the human body. © 2018 Wiley Periodicals, Inc.

Aim: Tricuspid valve diseases are generally affected from rheumatismal diseases and it emerges by regurgitation. In our study, we aimed to search both the situation and importance of Tricuspid Annular Plane Systolic Excursion (TAPSE) score during the follow-up of patients who had undergone tricuspid valve replacement. Material and Method: Between the years of 2011-2013, the patients who were done tricuspid valve replacement have been evaluated retrospectively. Our group was made up of re-operated patients and the ones that were operated for the first time. TAPSE score, clinical classification of New York Heart Association (NYHA), Mean Pulmonary Artery Pressure (MPAP), ejection fractions, echocardiographic measure parameters were checked and their correlations with clinical conditions, were evaluated. Results: During the follow-up of these patients post operatively, functional capacity (before the operation 3.31±0.63; 1.83±0.83), TAPSE score (pre-operation 17.38±3.15mm; 12.53±4.8mm), MPAP (pre-operation 35,53±14,72 mmHg; 30.3±11.2 mmHg) values were evaluated. In the values of NYHA and MPAP, marked clinical improvement was detected in parallel with clinical situation; the decline in score of TAPSE was observed contrary to clinical and the other parameters. Discussion: Although the TAPSE score is important in defining the mortality and morbidity before the operation, we observed that it is no such of an importance in the follow-up of patients who had tricuspid valve replacement. We think that, for the follow-up of these patients who had tricuspid valve replacement, clinic condition and other parameters should be in the forefront, however the score should be evaluated in the background.

Amac: Bu calismada, mekanik kalp kapagi disfonksiyonu olan hastalardaki genetik polimorfizmler arastirildi. Ca­lis­ma­pla­ni:­Ocak 1994 Aralik 2004 tarihleri arasinda mekanik kalp kapagi disfonksiyonu nedeni ile yeniden ameliyat edilen hastalarin olusturdugu 18 hasta (grup 1), normal fonksiyonel olan ve mekanik kalp kapagi replasmani yapilmis, uluslararasi normallestirilmis oran (INR) duzeyleri dusuk olan 15 hasta (grup 2) ve 50 saglikli kisi (grup 3) olmak uzere, toplam 83 hasta calismaya dahil edildi. Faktor V Leiden, protrombin, interlokin (IL-6) ve tumor nekroz faktor alfa (TNF-a) polimorfizmleri tespit edilerek, mekanik kalp kapagi disfonksiyonu ile olan muhtemel iliskileri arastirildi. Bul gu lar: Interlokin-6 polimorfizmi sonuclari, grup 1 ve grup 3 karsilastirildiginda anlamli olarak farkli bulundu (p

Mitral valve replacement (MVR) in patients with severe mitral regurgitation and poor ventricle has a high mortality and morbidity. For such patients if mitral valve repair is not possible MVR can be performed with partial or complete protection of the mitral leaflets. Herein we report 2 patients with severe mitral regurgitation and poor ventricle (EF 20%– 25%). MVR was performed by complete protection of the both anterior and posterior mitral leaflets and using the on-pump beating heart technique.Levosemindan was administered to one of the patients on induction of anesthesia. Weaning from cardiopulpunary bypass was uneventful for the both patients. The postoperative course of the 2 patients was uneventful and they were discharged on the 5th and 6th days.

A 57-year old male patient presented to the outpatient clinic with swelling in his left wrist causing pain and numbness in his fingers. The patient had undergone multiple cardiovascular angiographic interventions in the past. The first diagnosis was thrombosed radial artery pseudoaneurysm. The intraoperative diagnosis was the volar ganglion cyst. In this report, we emphasize the importance of the complications after transradial arterial catheterizations and present our experience. [Hand Microsurg 2019; 8(1.000): 59-62]

Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases.

BACKGROUND The aim of this study was to assess the efficacy and applicability of on-pump beating heart aortic valve replacement with retrograde coronary sinus (CS) warm blood perfusion. METHODS The prospective study included 14 consecutive patients who underwent aortic valve replacement with mechanical prosthesis using retrograde CS perfusion. The operative variables and early outcome of this procedure are presented. RESULTS Retrograde CS perfusion and venting the heart from the pulmonary vein provided good visualization of the operative field and performance of the operations without any difficulty. Partial oxygen pressures of CS perfusion blood and the returning blood from the coronary ostia were 288.5 +/- 34.4 and 39.6 +/- 4.6 mmHg, respectively. Postoperative peak creatine kinase-MB and troponin T values were mean 77.0 +/- 63.6 IU/L and mean 0.8 +/- 0.7 ng/mL, respectively. No mortality or major complication was observed and all the patients were discharged from the hospital in good condition. CONCLUSIONS On-pump beating heart aortic valve replacement with retrograde CS warm blood perfusion is a good surgical option, and has the advantage of maintaining physiologic condition of the heart throughout the procedure.

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

BACKGROUND There are few reports on postoperative late cardiac tamponade with surgical therapy in the literature. METHODS Hospital records of 87 patients with postoperative late cardiac tamponade who had undergone cardiac surgery between January 1999 and December 2003 were evaluated retrospectively. RESULTS Out of 8400 patients who had undergone cardiac surgery, 87 patients (1 %) had postoperative late cardiac tamponade. The incidence was 0.1 % for patients with coronary artery bypass grafting and 3.4 % for those with heart valve replacement ( p < 0.01). Subxiphoid midline incision was carried out in 67 patients (77 %). Conversion to re-sternotomy was required in 8 patients due to either ineffective drainage (5 patients, 7.5 %) or laceration and bleeding (3 patients, 4.5 %). Re-sternotomy was undertaken in 20 patients with no complication. Early death occurred in 3 patients with subxiphoid drainage (3.5 %), two of which were related to bleeding. Out of 84 patients who survived, 10 patients had recurrent cardiac tamponade, 5 of which required surgical drainage (6 %). CONCLUSIONS Bleeding due to dense adhesions between the epicardium and the sternum may be encountered during subxiphoid drainage for postoperative late cardiac tamponade and lead to a 3 % mortality rate.

Vascular complications of Behçet’s disease include occlusion of vessels and arterial aneurysm formation, which is prone to rupture. Early type II endoleak repair following an endovascular stent-graft procedure for a ruptured descending aortic aneurysm in a 31-year-old man with Behçet’s disease is described. Endovascular stent-grafts provide an important alternative in complicated cases, but the possibility of endoleak should be born in mind.

Objectives: The performance of small-diameter (3–5-mm) vascular grafts still poses a challenge in the field of vascular surgery. We present here our preliminary experience with implanting unique small-sized polycarbonate urethane vascular grafts in 7 dogs. Material and Methods: Each animal was implanted with 4 interposition grafts, 2 femoral and 2 carotid. No anti-thrombotic medication was administered. Doppler sonography was performed at 3-month intervals to examine for patency and flow characteristics. Animals were sacrificed electively at 3, 6 and 12 months. Results: At 3 months, all grafts were patent. After 6 months, 3 grafts occluded and at 1 year a further 6 grafts occluded. Hence 9 of 28 grafts occluded (67.9% patency). During the study, no correlation could be established between flow velocity or resistance index and occlusion. Histopathology showed intimal hyperplasia to be the cause of occlusion. Conclusions: Compared to literature data on small-diameter grafts in the same position, ADIAM’s Biomechanical grafts performed clearly better. Compliance data suggest a correlation between elastic compliance and patency.

An experimental study was designed to search the effectiveness of retrograde cerebral perfusion which is presently used as cerebral protection method for the surgery of arcus aorta. Twelve dogs were subjected to the study. Six of them were remained in total circulatory arrest at 20 °C for 60 min. Retrograde cerebral perfusion was done again at 20 °C for 1 h for the other six dogs. Tumor necrosis factor (TNF). P-selectin, Intracelluler Adhesion Molecule (ICAM), Creatine Phosphokinase (CPK-BB) and tissue Adenosine triphosphate (ATP) levels were measured, before the cardiopulmonary bypass at 37 °C and during perfusion period at 5, 60 min and 4 h. Tissue ATP level for retrograde cerebral perfusion group was 3.99±0.7 mcmol/g tissue and 2.8610.1 mcmol/g tissue for total circulatory arrest group at fourth hour (p ICAM (Intracelluler Adhesion Molecule) level was higher in total circulatory arrest group (18.751±3.6 ng/ml) when compared to retrograde cerebral perfusion group (8.75±1.8 ng/ml) (p All parameters showed that retrograde cerebral perfusion preserved the brain functions better comparing with total circulatory arrest. The time necessary for aortic surgery may be provided by the retrograde cerebral perfusion technique.

Introduction: Surgical site infection (SSI) is a serious complication after cardiac surgery; skin preparation is an important step in the prevention of wound contamination with skin flora. In this study, two different skin preparation strategies (standard povidine iodine cleaning plus plain adhesive drape and microbial sealant (InteguSeal, Kimberly-Clark Health Care, Roswell, GA, USA) were compared in cardiac surgery patients. Methodology: This prospective study included 96 cardiac surgery patients randomized to either a standard plain adhesive drape (28 patients, control group) or a microbial sealant (68 patients, study group). Bacterial isolates were obtained from the wounds in the operating room before the skin incision and after the surgical procedure had ended. Results: Microorganisms were isolated from 38 patients (39.6%) in the study population. Twenty-seven of these patients were from the microbial sealant group and 11 were from the plain adhesive drape group. No postoperative wound infection was encountered in either group. No statistically significant differences between the two groups regarding the number of patients with microorganism isolation (p = 0.974) or postoperative leukocyte counts and neutrophil granulocyte percentages were observed. Conclusions: Regarding SSI after cardiac surgery, microbial sealant is equivalent to the standard skin preparation strategy applied with povidine iodine cleaning and a plain adhesive drape.

Ten dogs underwent 60 minutes of aortic occlusion; 5 received enoximone 10 μg·kg−1·min−1 and the other 5 served as controls. Distal and proximal aortic pressures were measured during the procedure. Neurological status was assessed after 72 hours. Spinal cord specimens were taken for electron microscopy. During aortic occlusion, cerebrospinal fluid pressure was 17 ± 3 mm Hg in the control group and 14 ± 4 mm Hg in the enoximone group, while distal aortic pressure was 15 ± 4 mm Hg in the control group compared to 47 ± 6 mm Hg in the enoximone group (p < 0.001). Four dogs in the control group suffered paraplegia but there was no paraplegia in the enoximone group (p < 0.01). Electron microscopy scores indicated significantly less ultrastructural damage (p < 0.01) in the enoximone group (2.73 ± 0.79) than in the control group (7.67 ± 0.89). It was concluded that enoximone was effective in reducing the risk of spinal cord injury during aortic crossclamping.

Aortic root surgery has traditionally been performed with an arrested and cooled heart using cardioplegia. A new technique of myocardial protection was utilized in the treatment of ascending aortic aneurysm with severe aortic valve regurgitation requiring aortic root replacement with the Cabrol technique. Retrograde and antegrade perfusion of the heart with blood allowed the surgical operation to be performed safely while the heart was beating and eliminated the ischemic reperfusion injury which occurs during cardioplegic arrest and reinstitution of blood perfusion after removal of the aortic cross-clamping required in traditional techniques.

Repair of post infarction posterior ventricular septal defect has generally been performed with a ventriculotomy through the infarcted zone. This approach has a significant mortality and morbidity due to haemorrhage, extension of infarction or further compromise of ventricular function secondary to suture placement. We present a case with delayed repair of a post infarction posterior septal defect using a right atrial approach, where no discrete infarct or other abnormality of the free ventricular wall was found.

Background: Postoperative pulmonary dysfunction following cardiopulmonary bypass (CPB) usually develops secondary to the inflammatory process with contact activation, hypothermia, operative trauma, general anesthesia, atelectasis, pain, and pulmonary ischemia/reperfusion due to crossclamping. The aim of the present study was to evaluate the effects of an on-pump, normothermic, and beating-heart technique and of low-volume ventilation on lung injury.Methods: We compared the results for 20 patients who underwent operations with an on-pump, normothermic, and beating-heart technique of mitral valve surgery with low-volume ventilation (group 1) with the results for 23 patients who underwent their operations with an on-pump, hypothermic cardiacarrest technique (group 2). In both groups, blood samples were collected from the right superior pulmonary vein, and inflammation and oxidative stress markers (malondialdehyde, lactic acid, platelet-activating factor, and myeloperoxidase) were studied.Results: Malondialdehyde, myeloperoxidase, and lactate values were significantly lower in group 1 than in group 2 just before the termination of CPB (P < .05). We observed no differences between the 2 groups with regard to values for platelet-activating factor.Conclusions: Inflammation and oxidative stress markers were lower in the group of patients who underwent beating-heart valve surgery with low-volume ventilation. These results reflect less of an ischemic insult and lower inflammation compared with the results for the patients who underwent conventional operations.

Objectives: The present study aimed to compare the results of beating heart technique and conventional mitral valve surgery (MVS). Methods: Three hundred and nineteen patients who underwent MVS between April 2005 and December 2006 were enrolled in the study. While 125 patients underwent beating heart MVS (group 1), the conventional approach was used for 194 patients (group 2). Of those patients who underwent beating heart MVS, 75 underwent MVS without cross-clamping the aorta. Coronary sinus retroperfusion was used during surgery in the remaining 50 patients. The right anterolateral thoracotomy was performed in nine out of the 29 patients requiring re-operation, while resternotomy was performed in 20. Results: No significant differences were shown between the groups in the preoperative period in terms of the Parsonnet mortality score, Ontario mortality score, and length of intensive care stay. However, there were significant differences with respect to EuroSCORE risk score, EuroSCORE mortality, and Parsonnet risk score, and length of hospital stay according to Ontario risk scoring. It was established that the patients in group 1 had a shorter length of hospital stay [group 1: six days (range, 4-37 days); group 2: 10 days (range, 4-62 days)]. Group 1 was observed to have shorter time periods when the groups were compared regarding operative time [group 1: 130 min (range, 100-270 min); group 2: 240 min (range, 100-360 min)], cross-clamping (XCL) time [group 1: 27.5 min (range, 3-99 min); group 2: 60.5 min (range, 30-163 min)], and cardiopulmonary bypass time [group 1: 57 min (range, 22-150 min); group 2: 90 min (range, 39-388 min)]. There were also significant differences in favor of group 1 in terms of postoperative need for inotropic support wgroup 1: 26 patients (16%); group 2: 68 patients (35%) x. Although there were no statistically significant differences in the groups in terms of mortality rates according to the Parsonnet scoring system, with the exception of the moderate risk group, it was noted that the mortality rates in the beating heart group were lower. Conclusions: This study concluded that beating heart MVS can be performed successfully, particularly for patients at higher risk which will lead to increased morbidity and mortality in postoperative period. (C) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Background and aim Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. Various strategies have been developed to prevent ischemic reperfusion injury. The aim of this study was to assess the efficacy and applicability of the on-pump beating heart mitral valve surgery without cross-clamping the aorta in order to prevent reperfusion injury. Methods The prospective study (between April 2005 and December 2006) included 88 consecutive patients who underwent mitral valve surgery. The operations were carried out on a beating heart using normothermic cardiopulmonary bypass without cross-clamping the aorta, therefore perfusing the heart antegradely through the aortic root. Venting the heart from the aorta and the pulmonary vein provided adequate visualization of the operative field. Results Seventy-eight patients (88.6%) underwent mitral valve replacement and 10 patients (11.3%) underwent mitral valve repair with this technique. Concomitant surgery was required in 29 patients (32.9%). Twenty-five patients (28.4%) had also undergone previous open heart surgery. Mean cardiopulmonary bypass time was 57.4 +/- 18.4 minutes. Mean duration of ventilation was 12.2 +/- 3.5 hours, mean intensive care unit stay was 1.3 +/- 1.6 days, and mean hospital stay was 6.9 +/- 4.5 days. One-year survival was 96.6% for all causes of mortality. Conclusions In this study, we showed that on-pump beating heart operations without cross-clamping is an acceptable surgical choice for mitral valve disease. Complication rates are low and perioperative mortality is lower than that generally reported with conventional technique.

Background and Aim: Postoperative neurologic deficit is the most devastating complication after surgical thoracic aorta repair. Cerebrospinal fluid drainage and some medications are used for spinal cord protection during and after the operation. Methods: A 25-year-old patient applied to our clinic with a traumatic descending aortic aneurysm. We performed a surgical repair for the aneurysm but could not achieve to place a lumbar catheter to provide cerebrospinal fluid drainage. Levosimendan was chosen for spinal cord ischemic preconditioning because of its vasodilatory effects. Results: Postoperative course was uneventful. Hemodynamic and neurologic complication was not observed, and the patient was discharged from the hospital in the postoperative 5th day. Conclusions: Levosimendan can be used for preconditioning and spinal cord protection from ischemic injury during descending aorta repair. We clearly benefit from the vasodilator peculiarity of the drug for improving spinal cord perfusion.

The aim of this study was to investigate the response of heart to stress according to the size of the prosthetic valve in patients who had undergone mitral valve replacement by using dobutamine stress echocardiography (DSE) and to evaluate the relationship between the size of the prosthetic valve and cardiac recovery-remodeling process.Thirty-nine patients, who had undergone mitral valve replacement were compared in terms of left ventricular diameters, systolic functions and cardiac mass indexes in order to investigate the effect of the mechanical valve size on postoperative cardiac remodeling in this longitudinal study. They were divided into three groups according to their valve size: Group 1 (valve size29 mm, n=11), Group 2 (valve size=29 mm, n=11) and Group 3 (valve size29 mm, n=17). Statistical analysis was performed using Chi-square and one-way ANOVA tests to determine the statistical differences between the groups. The repeated measurements of two-way ANOVA test was used to analyze effects during long-term follow-up.Only Group 1 patients achieved a significant decrease in terms of left ventricular mass index and end-diastolic diameter (138.3+/-29.7 g/m2 vs 86.6+/-15.6 g/m2 and 5.1+/-0.5 cm vs. 4.4+/-0.4 cm, p0.05). Group 3 patients' left ventricular ejection fraction become worse after the operation (64.0+/-5.6% vs. 55.9+/-6.5%, p0.05). Maximum and mean pressure gradients across the mitral prosthesis as well as pulmonary artery pressure were significantly increased in all groups during DSE. Maximum gradients increased from 14.2+/-4.6 to 20.7+/-7.5 mmHg in Group 1 (p0.05), 11.6+/-4.7 to 16.2+/-6.8 mmHg in Group 2 (p0.05), and 10.6+/-3.1 to 20.8+/-12.7 mmHg in Group 3 (p0.05). Isovolumic relaxation time decreased in all groups following the dobutamine infusion, as expected, but this decline was not significant in Group 3.A worsening in left ventricular systolic function was observed in large- sized valve prosthesis group. Only the patients who had undergone MVR with small-sized valve prosthesis achieved a decrease in cardiac mass index and preservation of the systolic function. The echocardiographically determined differences and mass index that appeared after the operation may point out that, the effect of the operation on cardiac remodeling can be related with the ventricular size.

The study aim was to investigate the effect of blood glucose level on atherosclerotic lesion distribution and the contribution to the operative mortality/morbidity in diabetic patients who underwent coronary artery bypass grafting (CABG).Between 1986-2003, a total of 2095 patients with diabetes mellitus underwent CABG. The analysis was carried out retrospectively from the clinical records. The patients were divided into four groups according to the blood glucose levels that were obtained when they first applied to hospital; Group 1 (492 patients with blood glucose120 mg/dl), group 2 (1112 patients with blood glucose - 120-200 mg/dl, group 3 (261 patients with blood glucose 201-250 mg/dl) and group 4 (230 patients with blood glucose250 mg/dl). One way ANOVA test was used for the statistical analysis of continuous variables and Chi-square test was used for analyzing the categorical variables.Emergent operation rate due to acute ischemia gradually increased from Group 1 to Group 4 and reached 6.6% in Group 4 (p=0.005). Operation time and the duration of cardiopulmonary bypass and cross clamp were significantly longer in patients with high blood glucose levels (p0.05). Necessity for inotropic drug administration postoperatively (p0.05) and mechanical support (p0.05) were significantly higher also. The hospital mortality in group 3 was 9.6% and in group 4 was 11.3% (p=0.09). No statistically significant difference was found in terms of morbidity between the groups (p0.05). The multi-vessel coronary artery disease was more common in groups with high blood glucose level (p0.05). As the blood glucose level raised, patients were more frequently (p0.05) confronted with distal left anterior descending artery, middle circumflex artery and right coronary artery lesions.Uncontrolled blood glucose level not only increased the perioperative complications but also the incidence of middle and distal coronary artery lesions. It is necessary to diagnose and aggressively treat the high blood glucose level especially before the CABG.

The periods of ischemia and reperfusion represent different characteristics by lack of oxygen and reoxygenation. The aim of this experimental spinal cord injury model was to investigate whether resveratrol has protective effects during ischemia or reperfusion and the mechanism of the protection by using N-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthase. Rabbits were divided into seven groups according to the time of administration of resveratrol or L-NAME (RI and RR, resveratrol during ischemia or reperfusion; IL and RL, L-NAME during ischemia or reperfusion; RILR, resveratrol during ischemia and L-NAME during reperfusion; LIRR, L-NAME during ischemia and resveratrol during reperfusion; control group). After neurologic evaluation at the twenty-fourth hour of reperfusion, lumbar spinal cords were removed for electron microscopic evaluation, immunohistochemical staining for apoptosis, and malondialdehyde (MDA) and myeloperoxidase (MPO) measurements. The RILR group had the best functional recovery, with a mean 3.6 Tarlov score (P < 0.05), and showed near normal electron microscopic findings (scores of 7.6 +/- 0.9 for the control group and 3.9 +/- 2.9 for the RILR group, P < 0.05). MPO and MDA levels were decreased in all groups compared with the control group, but only the decrement in the RILR group reached statistical significance. Immunohistochemical analysis showed that the groups including resveratrol and L-NAME together had the best staining for apoptosis. Resveratrol exhibits important protection by means of neurologic outcome, histopathologic analysis, and biochemical analysis, especially when used in during ischemia followed by L-NAME administration during reperfusion. Also, resveratrol protects against apoptosis, especially when combined with L-NAME.

Primary aortoduodenal fistulas are among the rare causes of gastrointestinal hemorrhage and are defined as communications between the native abdominal aorta and the duodenum. The mortality rate is very high if undiagnosed and untreated. Two male patients, 61- and 76-years-old, were admitted to the emergency unit at different times with the chief complaints of abdominal pain, gastrointestinal hemorrhage and pulsatile mass in their abdomen. The first case experienced sudden massive upper gastrointestinal bleeding while being prepared for an emergency operation in the intensive care unit, and cardiac arrest developed within a few minutes. After resuscitation and successful surgical operation, the patient woke up without any neurological defect or sequelae and was extubated at the 9th postoperative hour. The second patient, who had been wounded by gun shot 30 years previously was admitted to the hospital because of simple gastrointestinal hemorrhage. A para-aortic pseudo-aneurysm connected with the duodenum was diagnosed by computed tomography. After successful surgical operation, the patient was discharged. In this report, a case of ruptured primary aortic aneurysm and another case of para-aortic pseudo-aneurysm connected with the duodenum, both of which were treated successfully by surgical operation, are presented.

Recent data regarding the performance of mechanical prostheses in patients agedor =65 years are scant. Hence, the outcome of mechanical prosthesis implantation in this age group has been retrospectively evaluated.Between January 1990 and October 2002, 253 patients (163 males, 90 females) agedor =65 years (mean age 68.2 years) underwent aortic valve replacement (AVR) and/or mitral valve replacement (MVR) at the authors' institution.Among the patients, 94 (37.2%) had MVR, 137 (54.1%) had AVR, and 22 (8.7%) had MVR+AVR. In total, 99 patients (39.1%) had concomitant coronary artery bypass grafting (CABG). The early mortality rate was 11.1%; that for patients agedor =70 years was greater than that for patients aged 65-69 years (14.5% versus 9.6%, p0.001). The overall actuarial survival was 91.3 +/- 2.4% at 5 years, 81.1 +/- 4.1% at 8 years, and 73.8 +/- 6.3% at 10 years. Actuarial survival for patients with isolated AVR and MVR at 10 years was 84.7 +/- 6.0% and 61.4 +/- 18.8%, respectively. Actuarial survival at 10 years for patients with isolated valve replacement was 76.1 +/- 8.1%, and 68.7 +/- 10.2% for patients with concomitant CABG (p = 0.680). Actuarial survival at 10 years was 81.3 +/- 6.9% for patients aged 65-69 years, and 50.3 +/- 11.0% for patients agedor =70 years (p = 0.001). Freedom from a major thromboembolic event was 99.4 +/- 0.7% at five years and 86.3 +/- 6.0% at 10 years, while freedom from hemorrhage was 90.4 +/- 2.6% and 70.3 +/- 6.8%, respectively.Mechanical prostheses can be used in patients agedor =65 years, with favorable results. However, on the basis of the present findings, patients agedor =70 years have a reduced early and late survival.

Structural bioprosthetic valve degeneration is the most prominent drawback of these valves. The durability of bioprosthetic valve is less with mitral than aortic ones. Herein we present a case who had undergone a bioprosthetic mitral valve replacement 21 years ago when he was 31 years old. Echocardiography showed 3 degree mitral regurgitation with gradient 23/12 mmgh, systolic pulmonary artery pressure (SPAP) 48mmgh, left atrium diameter was 8 cm and 3 degree tricuspid regurgitation. The bioprosthetic valve in mitral position was replaced with No.29 st Jude mechanical valve and Tricuspid valve Devege annuloplasty was performed. The postoperative period was uneventful.

The study aim was to investigate the long-term efficacy of closed mitral valvotomy (CMV).Data obtained over a 36-year period from 1,134 patients who underwent CMV were analyzed. The analysis was carried out retrospectively from hospital records, with follow up examinations being conducted mainly at the outpatient clinic.In-hospital mortality (or = 30 days after surgery) was 0.4% (n = 5, all closed procedures). Cardiac failure was the main cause of early death, and postoperative peripheral embolism occurred in five cases (0.5%). Freedom from thromboembolism was 99.0 +/- 0.5% at 36 years. Operative results were satisfactory in most patients, and severe mitral incompetence was seen only in three cases. Post-valvotomy mitral regurgitation occurred in 88 patients (7.7%) during the first year after CMV. Reoperation was performed in 500 patients (44.1%). The mean interval between CMV and reoperation was 141.1 +/- 80.8 months (range: 1-436 months). Fourteen patients were reoperated on for mitral regurgitation, 485 for mitral restenosis, and five for mixed mitral valve disease (stenosis and regurgitation). Freedom from reoperation after CMV was 81.4 +/- 1.3% at 10 years, 16.4 +/- 2.1% at 20 years, 3.1 +/- 1.2% at 20 years, and 0% at 36 years. Cox regression analysis indicated that impaired functional capacity, reduced mitral valve area, gradual increase in left atrial diameter and postoperative mitral insufficiency increased the reoperation rate after CMV.When compared with percutaneous balloon or surgical open valvotomy, CMV represents a satisfactory technique in terms of simplicity, high efficacy and lower cost.

Objective: This study was planned to investigate if there is any difference in terms of the muscle force between the distal and proximal segments of the latissimus dorsi muscle.Subjects and Methods: An implantable mock circulation system was placed around the latissimus dorsi muscle. The wrapping procedure around the implantable mock circulation was performed by using two different latissimus dorsi muscle segments. In group 1, the very proximal and in group 2, very distal part of the latissimus dorsi were wrapped. The main differences is the blood supply to the distal part of the latissimus dorsi that was interrupted during dissection. During the stimulation period which lasted 120 minutes, the pressure developed in this system and adenosine triphosphate (ATP) levels were measured.Results: The stimulation at 20 Hz did not result in any change in pressure and metabolic data. When it was switched to 43 and 85 Hz, ATP levels decreased with a resultant drop in pressure in group 2. However ATP levels were 15.9±2.2 μmol/gr and 14.8±2.5 μmol/gr in group 1, 12.0±1.4 μmol/gr and 6.1±1.2 μmol/gr in group 2 at 43 and 85 Hz respectively (p

To evaluate the effects of intravenous magnesium sulfate (Mg(2)SO(4)) administration on ischemia-reperfusion injury of the spinal cord.Sixteen rabbits were randomly assigned to the control (group I, 8 rabbits) and the study group (group II, 8 rabbits). The abdominal aorta was clamped for a period of 30 min followed by a reperfusion period of 60 min. The animals in group II received 0.25 ml/kg/h Mg(2)SO(4) intravenous infusion (15% Mg(2)SO(4)) throughout this procedure. The animals were then observed for 24 h after which their neurological states were evaluated and tissue samples obtained from the spinal cord were examined with electron microscopy.Aortic pressure distal to the cross-clamp during the occlusion period was 9 +/- 3 mm Hg in group I and 19 +/- 6 mm Hg in group II. All animals in group I were paraplegic at the end of the study. In group II the neurological outcome of 1 animal was poor while the other 7 animals were neurologically in a good condition. Electron microscopic examinations of the spinal cord tissues of group I revealed severe injury but the ultrastructure was well preserved in group II.Intravenous Mg(2)SO(4) administration may have protective effects on the ischemia-reperfusion injury of the spinal cord. We propose that Mg(2)SO(4) may be an additional protective pharmacological agent in thoracal and thoracoabdominal aortic surgery.

BACKGROUND The protective effect of coronary sinus retroperfusion in cases of ischaemic myocardium is clearly known. It restores the blood flow to the ischaemic tissue, reduces the infarct size, and improves the left ventricular pump function. METHODS In this study, we investigated the effects of coronary sinus retroperfusion with the addition of magnesium sulphate on myocardial haemodynamics. A total of sixteen animals were entered into the study and divided equally into four groups: group I, control group, left anterior descending (LAD) coronary artery occlusion only; group II, LAD artery occlusion and Mg SO infusion; group III, LAD occlusion and retrograde coronary sinus perfusion; and group IV, LAD occlusion, retrograde coronary sinus perfusion and Mg SO infusion.(4) (4) RESULTS Haemodynamic measurements were obtained throughout the study, at baseline, during the first and third hour of occlusion, and in the second, fourth and sixth hour of reperfusion. Although, the cardiac index was decreased in all groups, in the second hour of reperfusion it was significantly higher in groups III and IV compared to the control group. In the second hour of reperfusion cardiac index values were 56 +/- 5 and 63 +/- 6 ml/kg per min in groups III and IV respectively (P < 0.05) and as time passed this incremental change in groups III and IV became more apparent. In the fourth hour of reperfusion, group II showed significantly higher values than the control group. Group IV had higher values compared to group III at the fourth and sixth hours post-reperfusion. In general there were significant differences between groups II, III and IV at four and six hours post-reperfusion. The first derivative of pressure measured over time-the dP/dt value-was higher in groups III and IV compared to the control group in the first hour of occlusion (being 1650 +/- 55 and 1700 +/- 35 in groups III and IV respectively, and 1420 +/- 45 in the control group) and these differences continued throughout the occlusion and the reperfusion periods (P < 0.05). Group IV had the highest left ventricular stroke work index (LVSWI) values compared to the other groups in various pulmonary capillary wedge pressure (PCWP) measurements (P < 0.05). It was 0.78 g.m/kg at the 20 mmHg PCWP. CONCLUSIONS Magnesium, if administered in an antegrade direction had only a limited effect, whereas magnesium-enriched retrograde coronary sinus perfusions appeared to significantly protect the ischaemic myocardium against the hazardous effects of ischaemic reperfusion injury.

Introduction: Tricuspid heart valve is mostly affected by rheumatic diseases and is usually seen with mitral valve involvement. It is important to known the intervention time and route and the factors that determine mortality and morbidity. Tricuspid Annular Plane Systolic Excursion (TAPSE) is a scoring system which is performed by non-invasive doppler echocardiography and is used to determine the right ventricule function. Materials and Methods: Tricuspid valve replacement was done to 9 patients with mechanical heart valves who were operated before for the rheumatic heart valve disease. (5 bioprothesis and 4 mechanical valves). All patients were female. They all had ascites with an exercise capacity class III-IV preoperatively. Preand post-operative TAPSE scores, mean pulmonary pressures (PAP) and ejection fractions were measured. Only one patient deceased because of heart failure. (TAPSE:1.6 CM, PAB:30mmHg). Functional capacity was I-II in her outpatient control. Discussion: Tricuspid heart valve is mostly affected by rheumatic diseases and is usually seen with mitral valve involvement. Stenosis and/or regurgitation can be seen but regurgitation is the most common presentation. Severe tricuspid regurgitation which was diagnosed by echocardiography in the follow-up of patients who were previously operated because of mitral valve regurgitation, causes 50%mortality in 5 years, whereas, it was not detected any mortality in patients with moderate regurgitation. Operative mortality was 20% in a study with a 15 patients who were operated because of rheumatic heart disease. At the same study half of the patients were class III-IV according to New York Heart Association (NYHA) classification. In our study operative mortality was found 11.11 with a preoperative NYHA class III-IV and postoperative class I-II. Any of the patients has no ascites in postoperative outpatient controls. In patients who were following up for pulmonary artery hypertension, prognosis was better with TAPSE scores ≥2.0 than TAPSE scores ≤2.0 who did not have any significant difference in their mean pulmonary artery pressures. TAPSE is an important determinant of cardiac index. TAPSE