Surgical treatment of localized dissection of the internal carotid artery.

Dissection of the internal carotid artery is very rare; however, it is diagnosed more frequently with increasing radiographic diagnostic tools. Patients may be completely asymptomatic or may present with symptoms ranging between localized pain to severe cerebral ischemic events. Treatment is usually medical or with interventional radiographic tools. In this report, we present surgical management of internal carotid artery dissection in a 61-year-old female patient.

Effects of Ginkgo biloba extract on spinal cord ischemia-reperfusion injury in rats.

BACKGROUND: We aimed to assess the biochemical and histopathologic effects of Ginkgo biloba extract (EGb) in an ischemia-reperfusion (IR) model of spinal cord ischemia induced by cross-clamping of the infrarenal abdominal aorta. METHODS: A total of 24 Sprague-Dawley rats were divided into 3 groups as group 1: control (sham laparotomy), group 2: IR, and group 3: IR+EGb treatment (IR+T) group. All subjects were euthanized 2 days postsurgery and their spinal cords were removed. Tissue malondialdehyde, superoxide dismutase, glutathione (GSH), and glutathione peroxidase levels were measured, and the spinal cord tissue samples were examined histopathologically. RESULTS: No significant difference was detected in ischemia markers between control, IR, and IR+T groups, with the exception of GSH, which was significantly lower in the IR group. GSH levels in group 1 and group 3 were similar. The group 2 displayed significant ischemic damage to the medulla spinalis. This damage was less pronounced in group 3 compared with group 2 only, but in extent and intensity comparable with the controls. CONCLUSIONS: Although we were not able to demonstrate a uniform effect of EGb on biochemical markers of IR injury, the histopathologic data appear to show a protective effect conferred on the spinal cord tissue by EGb.

Endovascular treatment for primary aortic angiosarcoma to relieve thoracic aortic stenosis.

Aortic aneurysms and stenosis are widely treated with endovascular procedures in the current era. In this report, we present endovascular stent grafting for symptomatic treatment of severe thoracic aortic stenosis caused by an aortic sarcomatoid carcinoma in a 73-year-old female. The peri- and post-operative courses were complicated with tumor embolisms that were managed by both endovascular and surgical measures.

Pressure-controlled mechanical ventilation is more advantageous in the follow-up of patients with chronic obstructive pulmonary disease after open heart surgery.

OBJECTIVE: Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population. PATIENTS AND METHODS: Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups. RESULTS: Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ. CONCLUSION: There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.

Giant Left Anterior Descending Coronary Artery Aneurysm in a Patient with Behçet's Disease.

Coronary artery involvement is quite rare in the course of Behçet's disease. Complications secondary to coronary artery aneurysms, including rupture, dissection, and myocardial ischemia, may be fatal. In young patients without cardiovascular risk factors, systemic inflammatory vasculitis syndromes should be investigated in case of acute coronary syndrome secondary to dilated coronary arteries. In this report, we present our management strategy in a 31-year-old male patient with Bechet's disease.

Bilateral PDA in a patient with VSD and pulmonary atresia.

Patent ductus arteriosus is one of the most common congenital cardiac pathologies, besides patency of ductus may be somewhat vital for various congenital cardiac defects, otherwise death is inevitable. Anatomically, ductus is single and located between the descending aorta and the pulmonary artery. The review of the literature reveals presence of more than one ductus arteriosi in sporadic cases, most commonly associated with aortic arch anomalies. In this report, we present a nine-month-old baby with the diagnosis of ventricular septal defect (VSD), pulmonary atresia (PA), nonconfluent pulmonary arteries, and bilateral patent ductus arteriosi. He underwent a successful pulmonary reconstruction and central-shunt operation with modified aortopulmonary window technique without cardiopulmonary bypass. This is a very rare case with double ductus arteriosi associated with VSD, PA, and nonconfluent pulmonary arteries.

Infrarenal aortic coarctation.

Hypoplastic infrarenal aorta or infrarenal aortic coarctation is an uncommon vascular pathology characterized with diffuse stenosis in the infrarenal abdominal aorta. It is a variant of atherosclerotic occlusive diseases. The exact incidence and etiology are not known. Presenting symptoms are versatile and incidentally most of the patients have severe hypertension with an unidentified mechanism. Here, we report a 49-year-old male patient diagnosed with abdominal aortic coarctation together with the review of the literature. He underwent successful revasvcularization of the lower extremities.

Combined aortic and mitral valve replacement in a child with mucopolysaccharidosis type I: a case report.

Mucopolysaccaridosis syndromes are metabolic disorders that are inherited in an autosomal recessive pattern, and demonstrate cardiovascular involvement that, on rare occasions, results in surgery. The case is presented of a 12-year-old boy with symptoms and signs of congestive heart failure who was referred to the authors' department for severe mitral and aortic valvular stenosis. The patient was shown to have the somatic characteristics of mucopolysaccharidosis, while urinalysis indicated the presence of chondroitin sulfate B. Mitral and aortic valve replacements were carried out, using bileaflet mechanical valves with a standard median sternotomy and cardiopulmonary bypass. A bileaflet preservation technique was adopted during mitral valve replacement to provide better hemodynamics. Severe cardiac involvement in mucopolysaccharidosis requiring cardiac surgery in pediatrics has been rarely documented. A low-profile bileaflet mechanical valve, enabling a larger-sized valve insertion, is preferred in order to avoid patient-prosthesis mismatch during somatic growth of the patient.

Aortoentric fistula following ruptured abdominal aortic aneurysm surgery: aortobifemoral dacron bypass graft is detected by colonoscopy.

Aortoenteric fistula is a dramatic and rare complication, which may occur following abdominal aortic surgery. In this report, we present images of a 65-year-old patient who presented with acute peritonitis two months after aortobifemoral bypass grafting operation with a bifurcated dacron graft. Colonoscopy clearly showed the pathology leading to acute abdomen: Intestinal fistulization of the graft.

Arteriovenous fistula leading to severe tortuosity and aneurysm formation.

Ectasia at the proximal arterial structures is a phenomenon secondary to distal arteriovenous (AV) fistulae and proximal arterial structures must be evaluated carefully prior to an intervention to the lesion especially in long lasting AV fistulae. In this report we present the images of a 58-year-old male patient with a 25-year history of gun shot injury and arteriovenous fistula formation at the femoral region.

Influence of methylprednisolone on levels of neuron-specific enolase in cardiac surgery: a corticosteroid derivative to decrease possible neuronal damage.

BACKGROUND: Cerebral injury is a well-known complication after cardiac surgery with cardiopulmonary bypass (CPB), especially in adult patients. Specific biochemical markers like neuron-specific enolase (NSE) and S-100beta protein were developed previously for early detecting neuronal damage after CPB. Corticosteroids are shown to reduce multisystemic deleterious effects of cardiopulmonary bypass due to their anti-inflammatory characteristics. The aim of this study is to demonstrate the decrease of serum neuron-specific enolase levels in patients who received corticosteroids before CPB. METHODS: Thirty patients scheduled for elective coronary bypass surgery were included in the study. Patients were divided randomly into two groups as the control group (n = 15) who underwent a standard coronary bypass surgery without any additional medication and the study group (n = 15) who received 1 gm of methylprednisolone before CPB. Blood samples for analysis of serum NSE, interleukin-6 (IL-6), and IL-10 were drawn before CPB, 4 and 24 hours after the end of extracorporeal circulation. RESULTS: Serum cytokine and NSE levels were significantly increased after CPB above their normal range in both groups. In the study group, IL-6 and NSE levels were significantly reduced while IL-10 levels were much higher after CPB. High NSE levels significantly correlated with IL-6 levels in the control group. CONCLUSION: The lower levels of NSE in patients who received methylprednisolone may suggest that corticosteroids might be useful in decreasing possible neuronal damage during heart surgery. However, we were not able to demonstrate an adverse neurological outcome.

Isolated partial anomalous pulmonary venous connection of the left lung.

Isolated partial anomalous pulmonary venous connection (PAPVC) of the entire left lung is a rare congenital anomaly with incidental diagnosis and vague symptoms, if any, until late adulthood. If left untreated, PAPVC may result in severe right ventricular failure and pulmonary vascular disease. We present the case of a 34-year-old woman with isolated PAPVC of the entire left lung. The patient underwent operation with a side-to-side left atrio-vertical vein anastomosis while on cardiopulmonary bypass and under cardioplegic arrest. She was discharged without complications and with a gradient of 2 mm Hg across the anastomosis. Left-sided PAPVC can be repaired with minimal morbidity and mortality. Surgical correction is warranted when patients are symptomatic or show evidence of right-sided overload due to unpredictability of the natural course. Recent data demonstrate that both on-pump and off-pump surgical procedures produce excellent long-term outcomes when performed without persisting gradients.

Off-pump total cavopulmonary connection in a patient with hypoplastic right pulmonary artery and right lung secondary to kyphoscoliosis.

The last-stage palliation of patients with single ventricle physiology hearts is Fontan procedure and its modifications that can be performed with or without cardiopulmonary bypass in the current era. Pulmonary vasculature and status of the lungs are critically important for the success of the operation. In this report, we present a 10-year-old patient with single ventricle heart and severely hypoplastic unilateral pulmonary artery and respective lung due to kyphoscoliosis who underwent extracardiac Fontan procedure without cardiopulmonary bypass, successfully.

Endovascular treatment of thoracic aortic pathologies in patients with aortoiliac occlusive disease.

Today, with the increasing experience and advances in graft technology, endovascular grafting is applied nearly to all levels of the aorta for the treatment of various aortic pathologies. The major route of the stent graft deployment is from the femoral region through the iliac arteries. Since both aneurysms and arterial occlusive diseases share atherosclerosis as the common ancestor of etiology, some patients may poses both aneurysms and stenosis together. These stenotic changes occurring in the iliac and femoral arteries may complicate the passage of the stent graft system. In this report, we sought to evaluate an alternative novel route of graft system application for endovascular treatment of thoracic aortic aneurysms.

Rastelli and Norwood combination for the treatment of type I truncus arteriosus and hypoplastic aortic arch: a case report.

Although truncus arteriosus is often treated with low mortality and morbidity rates, truncal valve patency and aortic arch and coronary artery anomalies are factors that can contribute to a worse outcome. In this report, we present our experience with the combination of Rastelli and Norwood procedures for the treatment of Type I truncus arteriosus that was complicated by a hypoplastic aortic arch.

Visceral artery aneurysms.

OBJECTIVE: Visceral artery aneurysms are rare vascular malformations and the literature lacks satisfactory general information about the pathology. The aim of this study was to review our experiences in the diagnosis and treatment of visceral artery aneurysms. MATERIALS AND METHODS: We retrospectively reviewed data on 10 patients who were diagnosed with visceral artery aneurysms at our institution between June 2002 and September 2005. All available clinical, pathologic, and postoperative data were reviewed and analyzed for postoperative outcome. RESULTS: Four splenic artery aneurysms, 2 hepatic artery aneurysms, 5 renal artery aneurysms, 1 superior mesenteric artery aneurysm, and 1 inferior mesenteric artery aneurysm (13 total visceral artery aneurysms) were diagnosed in 10 patients. All the patients were treated except 1 patient with bilateral renal artery aneurysms. One patient required emergent surgical treatment due to splenic artery aneurysm rupture. Only 1 patient underwent endovascular treatment (ie, coil embolization for a superior mesenteric artery aneurysm); otherwise all the patients were treated surgically on an elective basis. Surgical treatment modalities included ligation with exclusion in 4 patients (2 splenic artery aneurysms, 1 renal artery aneurysm, 1 hepatic artery aneurysm) and resection with revascularization in 4 patients (1 splenic artery aneurysm, 2 renal artery aneurysms, 1 hepatic artery aneurysm, 1 inferior mesenteric artery aneurysm). Histopathologic examination of the vascular materials revealed major atherosclerotic changes except one that showed inflammatory vasculitic changes. One patient required bleeding revision, and mortality did not occur in any of the patients. CONCLUSIONS: Visceral artery aneurysms are rare and potentially life-threatening vascular disorders. The number of cases diagnosed every year increases because of advanced radiologic diagnostic methods and screening programs. Careful consideration and early management of these malformations can be life saving.

Giant Left Anterior Descending Coronary Artery Aneurysm in a Patient with Behçet's Disease

ABSTRACT Coronary artery involvement is quite rare in the course of Behçet's disease. Complications secondary to coronary artery aneurysms, including rupture, dissection, and myocardial ischemia, may be fatal. In young patients without cardiovascular risk factors, systemic inflammatory vasculitis syndromes should be investigated in case of acute coronary syndrome secondary to dilated coronary arteries. In this report, we present our management strategy in a 31-year-old male patient with Bechet's disease.

Endovascular Stent Grafting for Aortic Arch Aneurysm in Aortoiliac Occlusive Disease following Aortic Arch Debranching and Aortobifemoral Reconstruction.

Treatment of thoracic aortic aneurysms constitutes high mortality and morbidity rates despite improvements in surgery, anesthesia, and technology. Endovascular stent grafting may be an alternative therapy with lower risks when compared with conventional techniques. However, sometimes the branches of the aortic arch may require transport to the proximal segments prior to successful thoracic aortic endovascular stent grafting. Atherosclerosis is accounted among the etiology of both aneurysms and occlusive diseases that can coexist in the same patient. In these situations stent grafting may even be more complicated. In this report, we present the treatment of a 92-year-old patient with aortic arch aneurysm and proximal descending aortic aneurysm. For successful thoracic endovascular stent grafting, the patient needed an alternative route other than the native femoral and iliac arteries for the deployment of the stent graft. In addition, debranching of left carotid and subclavian arteries from the aortic arch was also required for successful exclusion of the thoracic aneurysm.

Over 14 years of experience with cardiac myxomas.

Atrial myxomas are the most commonly encountered tumours of the heart and can present at different ages with different clinical symptoms. They are one of the curable tumours of the heart. Appropriate surgical treatment and surgery must be performed with great precautions in order to prevent fatal systemic embolizations. In this retrospective study we will present our experience of 14 years, between 1990 and 2004, in 27 patients who had been operated for cardiac myxomas. Diagnosis of the myxomas were made by echocardiography in all cases. Surgical approach to the tumour was biatrial in nine, left atrial in II, and transseptal in seven patients. Associated procedures included coronary artery bypass grafting in one, mitral valve repair with tricuspid annuloplasty in two patients, mitral valve replacement in one and bilateral femoral embolectomy in one patient. One hospital mortality occurred as a result of multiorgan failure in a patient with peripheral embolization. None of the patients required recurrent operation, however, mitral valve insufficiency was surgically corrected in one patient.

Endoluminal stenting of mycotic saccular aneurysm at the aortic arch.

Endovascular grafts have been widely used for the treatment of aneurysms since the early 1990s. They are preferred especially for use in patients in whom conventional surgical methods carry high risks of death and morbidity. Increasing operator experience and technical refinements in endovascular grafting have enabled these procedures to be performed even in critical segments of the aorta, such as the thoracic and arch levels. In this report, we present the case of a patient who was treated successfully with an endovascular graft for a mycotic saccular aneurysm located just below the left subclavian artery.