Management of extensive venous thrombosis following cardiac surgery in a patient with Behcet's disease.

Behçet's disease is a multisystemic vasculitis of unknown etiology, which is characterized by recurrent urogenital ulceration, cutaneous eruptions, ocular manifestations, arthritis and vasculitis, and its diagnosis is based on clinical criteria. Herein, we report a case of a patient with Behcet's disease, who was successfully managed with anticoagulant and anti-inflammatory therapy for disseminated venous thrombosis leading to pleural effusion, Budd-Chiari syndrome and central nervous system involvement following coronary artery bypass grafting surgery.

Massive ascites due to right heart failure after cardiac transplantation and its treatment: a case report.

Ascites is a common clinical condition during right heart failure. In this short report we have presented a patient with massive ascites due to right heart failure after cardiac transplantation who was previously operated for Ebstein's anomaly and pulmonary stenosis as well as mitral and tricuspid valve repairs. Right heart failure increases the accumulation of ascites which decreases the preload of the heart and cardiac output. Aggressive paracentesis may be a definitive solution for this type of patient.

Our experience in cardiac transplantation in Baskent University.

Recently cardiac transplantation has an important place in treatment of end-stage cardiac failure. In Turkey between 2003 and 2005 at 10 centers 64 cardiac transplantations were performed including five at our facility. Herein we have presented our results. All patients were men of mean age 34.2 +/- 10.7 (17 to 44) years. Upon preoperative echocardiography their mean ejection fraction was 18% +/- 3.27% (17% to 23%). Pulmonary vascular resistance was 4.47 wood unit in one patient and in one case, there was Rh incompatibility between donor and recipient. We used HTK solution for protection of donor hearts. Mean ischemia time was 251.2 +/- 62.7 minutes (155 to 314). Mean aortic clamping time was 84 +/- 4.7 minutes (80 to 90). In all patients we performed a biatrial anastomosis technique. Hemofiltration was used to prevent hemodilution during operation. In the postoperative period four patients had acute renal dysfunction; one, a minor cerebrovascular accident; two, reoperated because of bleeding; one, cholestasis; one, temporary atrio-ventricular block; and one, mediastinitis. Mean follow-up time was 15.6 +/- 19.7 months (2 to 50). Neither early nor late mortality has occurred. All patients are in New York Heart Association class I. In all cases we used triple immunosuppressive therapy. In the follow-up period the mean number of cardiac biopsies per patient was 4.2 +/- 3.03 (2 to 8). Two cases had cardiac catheterization. As a complication of cardiac biopsy, pericardial tamponade developed in one patient; in another one we observed a right ventricular aneursym after cardiac biopsy. Cardiac transplantation was performed with low mortality and morbidity rates in end-stage cardiac failure patients with longer life expectancy and higher life quality. Unfortunately in our country, because of difficulties to find donor hearts, cardiac transplantations were small in number. For better results, we need a larger series.

Low-dose histidine-tryptophan-ketoglutarate solution for myocardial protection.

The effect of histidine-tryptophan-ketoglutarate (HTK) solution for myocardial protection has been shown in experimental and clinical studies using long ischemic times and high dosages. In our study we compared myocardial protection in isolated coronary bypass with a short period of ischemia using low dosage HTK and cold crystalloid cardioplegia. Each group contained 21 coronary artery disease patients. Cardioplegic solutions were administered antegrade in 10 to 15 mL/kg in one shot. This dosage of HTK was lower than that mentioned in the literature. We measured malondialdehyde, lactate, creatine kinase, creatine kinase-MB, and troponin-I levels. Aortic clamping time in the HTK group 33.9 +/- 8.2 minutes, versus 36.2 +/- 11.3 minutes in the crystalloid cardioplegia group (P > .05). Levels of creatine kinase and malondialdehyde were lower in HTK group at 24 hours and 2 minutes, respectively. Lactate levels were lower in the crystalloid cardioplegia group at 2 minutes in the coronary sinus serum sample, but there were no statistically differences among ischemic serum markers in both groups. Only intervals between aortic clamping and cardiac arrest were statistically meaningful (HTK 63.3 +/- 14.7 seconds versus crystalloid cardioplegia 53.6 +/- 15.6 seconds, P = .044). Our study shows that use of low-dose HTK for short clamping time operations is as successful for myocardial protection as crystalloid cardioplegia. Longer times for fibrillation can be explained with the low levels of potassium in HTK solution, but this length did not cause a biochemical or clinical difference.

Predictors and outcomes of minor cerebrovascular events after cardiac surgery: a multivariable analysis of 1346 patients.

AIM: There are no extensive data exist regarding the epidemiology and prognosis of minor cerebrovascular events (MCVE) in adults after cardiac surgery. The aim of this study was to determine perioperative predictors of MCVE and impact on postoperative outcomes after cardiac surgery. METHODS: The database of 1346 adult patients between June 2004-May 2011 were retrospectively analyzed to determine risk factors for postoperative MCVE and prognostic impact in our instution. MCVE was defined as ''a new focal neurologic deficit which appears in the postoperative period''. Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, and discharge status by univariate analyses. Then multivariate logistic regression with forward elimination determined six important denominators of the 24 factors examined on univariate analysis for MCVE. RESULTS: Twenty-six patients suffered a postoperative minor stroke (2%) at a median of 24 hours postoperatively. Head computed tomography was performed in 19 patients (73%) of whom ischemic stroke were identified in 4 (21.05%) patients and pituitary macroadenoma was diagnosed in one patient treated with surgery. Patients who experienced MCVE had no operative mortality and were discharged without any neurological deficit. Multivariable logistic regression analysis identified six risk factors for MCVE: unstable angina pectoris, hyperlipidemia, cerebrovascular accident within two years, EF<50, intra-aortic balloon counterpulsation and higher Euroscore values. CONCLUSION: Unstable angina pectoris, hyperlipidemia, cerebrovascular accident within last two years, EF<50, intra-aortic balon counterpulsation and higher Euroscore values in adults after cardiac surgery are independent predictors of minor stroke as compared with similar predictors of major stroke.