Effects of Cilostazol on the Myocardium in an Obese Wistar Rat Model of Ischemia-Reperfusion Injury.

OBJECTIVES: This study aims to determine the protective effect of cilostazol on myocardium in obese Wistar rats with induced ischemia-reperfusion injury (IRI). METHODS: Four groups with 10 Wistar rats were included: 1] Sham Group: IRI was not established in normal weight-Wistar rats. 2] Control Group: IRI but no cilostazol in normal weight-Wistar rats. 3] Cilostazol in normal weight-Wistar rats: IRI and cilostazol was administered. 4] Cilostazol in obese- Wistar rats: IRI and cilostazol was administered. RESULTS: Tissue adenosine triphosphate (ATP) levels were significantly higher and superoxide dismutase (SOD) levels significantly lower in the control group than in the sham group and normal weight cilostazol group (p=0.024 and p=0.003). Fibrinogen levels were 198 mg/dL in the sham group, 204 mg/dL in the control group, and 187 mg/dL in the normal-weight cilostazol group (p=0.046). Additionally, plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in the control group (p=0.047). The level of ATP was significantly lower in the normal-weight cilostazol group than in the obese group (104 vs 131.2 nmol/g protein, p=0.043). PAI-1 level was 2.4 ng/mL in the normal weight cilostazol group and 3.7 ng/mL in the obese cilostazol group (p=0.029). Normal-weight Wistar rats with cilostazol had significantly better histologic outcomes than the control group and obese Wistar rats (p=0.001 and p=0.001). CONCLUSION: Cilostazol has a protective effect on myocardial cells in IRI models by decreasing inflammation. The protective role of cilostazol was reduced in obese Wistar rats compared with normal-weight Wistar rats.

Optimal cutoff value of carotid stump pressure for determining the need for a carotid shunt in carotid artery endarterectomy.

OBJECTIVE: This study was conducted to identify the diagnostic value of carotid stump pressure for determining the need for a carotid artery shunt in patients undergoing carotid artery endarterectomy. MATERIALS AND METHODS: Carotid stump pressure was prospectively measured in all carotid artery endarterectomies performed under local anesthesia between January 2020 and April 2022. The shunt was selectively used when neurological symptoms appeared after carotid cross-clamping. Carotid stump pressure was compared between patients who needed shunting and those who did not. Demographic and clinical characteristics, hematological and biochemical parameters, and carotid stump pressure of the patients with and without shunts were statistically compared. To determine the optimal cutoff value and diagnostic performance of carotid stump pressure for identifying the patients who need a shunt, receiver operating characteristic analysis was performed. RESULTS: Overall, 102 patients (61 men and 41 women) who underwent carotid artery endarterectomy under local anesthesia were included, with an age range of 51-88 years. A carotid artery shunt was used in 16 (8 men and 8 women) patients. The carotid stump pressure values of the patients with a shunt were lower than those without a shunt (median (min-max): 42 (20-55) vs 51 (20-104), p < 0.0006). In the receiver operating characteristic curve analysis performed to determine the need for a shunt, the optimal cutoff value of carotid stump pressure was ≤48 mmHg, sensitivity was 93.8%, and specificity was 61.6% (area under the curve: 0.773, p < 0.0001). CONCLUSION: Carotid stump pressure has sufficient diagnostic power to determine the need for a shunt, but it cannot be used alone in the clinical setting. Instead, it can be used in combination with other neurological monitoring methods.

The Evaluation of YouTube™ English Videos' Quality About Coronary Artery Bypass Grafting.

Objectives: The aim of the study was to clarify the reliability and quality of English videos about Coronary artery bypass grafting on YouTubeTM. Methods: The study was performed between July 16 and July 30. A cardiovascular surgeon searched for terms including "coronary artery disease," "coronary artery treatment," "coronary artery bypass" and "coronary artery bypass surgery," in YouTubeTM. All videos were classified into two groups according to the source who uploaded the video as professional videos and non-professional videos. Video characteristics including duration of video on YouTube™, length of video, and view numbers for each video were recorded. Moreover, the numbers of "comments," "likes," and "dislikes" were noted. Furthermore, the target audience of the videos (professional health care worker and patients) was analyzed, DISCERN score and Global quality score (GQS) were calculated for each video. Results: Totally, 812 videos were divided into two groups according to upload sources; 448 videos were categorized as professional videos and 364 videos were categorized as non-professional videos. The mean number of views was 3220.5 for professional videos and 2216.5 for non-professional videos (p=0.001). In addition, the mean "like" numbers and mean comment numbers were significantly higher for professional videos (p=0.001 and p=0.001). The mean DISCERN score was 2.6 for professional videos and 1.5 for non-professional videos (p=0.001). Similarly, the mean GSQ was significantly higher for professional videos (3.5 vs. 2.5, p=0.001). Conclusion: YouTube™ videos which are shared by professional healthcare workers have better quality and reliability with significantly higher DISCERN score and GQS.

An interesting finding: What is the relation between aortic enlargement and COVID-19?

BACKGROUND: We aim to compare the diameters of ascending aorta in COVID-19 patients and COVID-19-free individuals referred to our pandemic hospital. METHODS: The medical records and thorax tomographies of patients admitted to the "pandemic central" state hospital with symptoms of COVID-19 were observed between April 2020 and May 2020 in this case-control study. The first group consisted of patients diagnosed with COVID-19, and the second group consisted of patients without the disease. The diameter of the ascending aorta is measured via tomography and compared to each other. The most causative risk factors for aortic enlargements underwent a multivariate regression analysis. RESULTS: Charts of 156 patients (104 COVID-19 positives, 52 COVID-19 negatives) were reviewed. There was a statistical difference (p: .01) between the mean aortic diameter of COVID-19 patients (39 mm) and COVID-free patients (32.5 mm) even though comorbid factors and patient characteristics were similar in the two groups at the time of hospital admission. The regression analysis result demonstrates that COVID-19 (leading factor), age, and coronary artery disease were the most significant factors associated with increasing aortic dimensions. (p: .001, B: 5.3/, p: .02, B: 3.36/, p: .002, B: 0.13/, R square: 40.2%). CONCLUSION: This study shows that the mean aortic diameter of COVID-19 patients is larger than non-COVID-19 patients with similar comorbidities referred to a pandemic hospital. COVID-19, age, and coronary artery disease are the most influential factors that affect the aortic diameter, and the COVID-19 was the leading factor.

Infective endocarditis caused by Chaetomium globosum.

Chaetomium globosum is a dematiaceous, filamentous fungus belonging to the large genus saprobic ascomycetes and is rarely involved in human infection. We present the case of a 25-year-old man undergoing tricuspid valve replacement due to recurrent prosthetic ring endocarditis. Initially, it was considered culture-negative endocarditis; however, the diagnosis of Chaetomium globosum could only be provided by DNA isolation of the mold isolate grown in culture and the valve tissue samples taken from the patient. This report describes the first documented tricuspid endocarditis caused by Chaetomium species and discusses the importance of molecular tools to enhance the diagnostic process in culture-negative endocarditis, especially for fastidious and nonculturable microorganisms.

The Evaluation of Cardiovascular Surgery-Associated Google Search Trends During COVID-19 Waves.

Objectives: The aim of the study was to clarify public interest about cardiovascular disease during the COVID-19 pandemic using Google Trends (GT). Methods: The study was performed between November 20 and December 1, 2021. A total of 21 keywords related to cardiovascular surgery were selected. Public attention to all selected keywords was analyzed by GT with using the filters "web search," "all categories," and "Turkey." In Turkey, three COVID-19 waves (between March 12, 2020, and May 8, 2020, November 24, 2020, and January 20, 2021, and March 20, 2021, and May 16, 2021) were experienced since the beginning of the pandemic. To analyze public attention to cardiovascular surgery during the COVID-19 waves, 8-week periods during the COVID-19 waves were compared with the same times in the past 4 years (2016-2019). Results: Comparisons of March 12-May 8 2020 and the same period between 2016 and 2019 showed that total public interest about cardiovascular surgery was significantly decreased (-28.7%, p=0.001). The comparison of the second COVID-19 wave (November 24, 2020-January 20, 2021 versus November 24-January 20, 2016-2019) revealed that public interest about cardiovascular surgery was significantly lower in the COVID-19 era (-22.2%, p=0.001). Comparison of the third COVID-19 wave and the same periods in the previous 4 years demonstrated that public interest about cardiovascular disease was significantly lower in the COVID-19 era (-8.5%, p=0.001). In contrast, the term coronary angiography was searched significantly more during the third wave of COVID-19 in comparison to the same periods between 2016 and 2019 (17.9%, p=0.015). Conclusion: Our study demonstrated that public interest in cardiovascular diseases was significantly decreased in all waves of the COVID-19 pandemic. However, interest in only the term coronary angiography was significantly increased in the third wave of pandemic.

Biochemical Factors Affecting Thrombosis Development in Permanent Tunneled Hemodialysis Catheter.

BACKGROUND: It is critical to clarify the biochemical factors associated with thrombosis development following tunneled dialysis catheter (TDC) insertion. METHODS: The study involved retrospective analysis of charts of patients hospitalized for permanent TDC placement between 2013 and 2020 in a tertiary academic center. Patients undergoing a hemodialysis schedule with permanent TDC for more than three months were included in the study. To determine predictive factors associated with thrombosis development in permanent TDC, patients were assigned to one of two groups, according to the extent of thrombosis. The groups were compared in terms of demographic characteristics, blood test values, complication and length of follow-up period. RESULTS: A total of 350 patients (204 female, 146 male) were enrolled into the study. In patients with thrombosis the mean BMI was found significantly higher (p = 0.001) and presence of diabetes mellitus was significantly common (p = 0.014). Patients with thrombosis had significantly higher D-dimer (6.5 vs. 2.4 µg/mL, p = 0.001) and procalcitonin levels (4.1 vs. 1.4 ng/mL, p = 0.001). Additionally, patients with thrombosis had a significantly higher rate of infective complications (p = 0.014). Logistic regression analysis revealed that BMI > 30 kg/m2 and infective complications increased thrombosis risk 3.842 and 3.104 times (p = 0.004 and p = 0.038, respectively). Additionally, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were significantly associated with the development of thrombosis (p = 0.001 and p = 0.007). CONCLUSIONS: The present study demonstrated that the presence of infection, higher BMI > 30 kg/m2, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were found to increase the incidence of thrombosis.

Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency.

BACKGROUND: In the present retrospective, single-center study, we evaluated the long-term effectiveness and reliability of endovenous laser ablation (EVLA), endovenous n-butyl cyanoacrylate (NBCA) application, and radiofrequency ablation (RFA) in the management of chronic venous insufficiency (CVI). METHODS: The medical records of patients who had undergone EVLA, NBCA, or RFA for CVI from January 1, 2014 to January 1, 2017 were reviewed. The medical records included data on sex, age, body mass index, American Society of Anesthesiologists score, and symptoms at admission. The great saphenous vein diameter, CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification, and venous clinical severity score were also recorded. All the patients were followed up with physical examinations and color Doppler ultrasound scan at the first week and 6 and 12 months after treatment. After 12 months, the follow-up examinations were performed annually. RESULTS: A total of 232 patients who had undergone lower limb CVI surgical treatment (EVLA, n = 77; NBCA, n = 73; RFA, n = 82). The mean follow-up time was 67.5 ± 4.7 months. The procedure duration was significantly shorter for the NBCA group (13.5 minutes) vs that for the EVLA (31.7 minutes) and RFA (27.9 minutes) groups (P = .001). The pain score was highest in the EVLA group (P = .001). The EVLA group had also experienced a significantly greater incidence of complications and a longer time to return to daily activities (P = .001). The post hoc analysis revealed comparable occlusion success among the three groups on the first postoperative day and at 6, 12, and 24 months postoperatively. However, significantly better occlusion rates were found for RFA vs EVLA at 3 and 5 years of follow-up (P = .024 and P = .011, respectively). The success of NBCA and RFA was similar at 3 and 5 years of follow-up (P = .123 and P = .330, respectively). CONCLUSIONS: The outcomes showed similar early postoperative occlusion success among all three CVI treatment techniques. However, RFA resulted in a significantly higher success rate compared with EVLA at 3 and 5 years of follow-up. Additionally, the NBCA and RFA procedures achieved comparable long-term success. However, EVLA was associated with significantly greater complication rates and pain scores and a longer time to return to daily activities. The NBCA procedure had a significantly shorter operation time compared with the other procedures.

Assessment of the Modified CHA2DS2VASc Risk Score in Predicting Mortality in Patients Hospitalized With COVID-19.

Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high-risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. A total of 694 patients were retrospectively analyzed and divided into 3 groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n = 289); group 2, score 2-3 (n = 231) and group 3, score ≥4 (n = 174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p <0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and neutrophil-lymphocyte ratio were independent predictors of in-hospital mortality (p = 0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In receiver operating characteristic analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality was 0.70 and 0.64, respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test = 3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.

Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams.

BACKGROUND: PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation. METHODS: This retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23-27 weeks) and less than 1000 grams (489-970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery. RESULTS: No surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86-238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems. CONCLUSIONS: Bed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Detected by Echocardiography in an Asymptomatic Young Athlete.

The anomalous origin of the coronary artery from the pulmonary artery (ALCAPA) is the most common congenital coronary artery anomaly. Up to 90% of patients die during the first year of life. It is unusual for an ALCAPA patient to survive to adulthood. We present a case of an asymptomatic young athlete with ALCAPA, in which the diagnosis was established by echocardiography during pre-participation physical evaluation. The patient underwent surgical closure of the left main coronary artery ostium through the inside of the main pulmonary artery and coronary artery bypass grafting. He was discharged after 6 days and remained well during follow-up visits. We emphasize the importance of echocardiographic examination during pre-participation cardiovascular screening in young athletic populations to avoid sudden death related to ALCAPA.

Surgical Revascularization of the Left Anterior Descending Artery with Multiple Failed Overlapping Stents.

BACKGROUND: Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents. METHODS: We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch. RESULTS: The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months. CONCLUSIONS: CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques.

A giant circumflex coronary artery aneurysm with a fistula into the coronary sinus: case report.

Coronary artery fistulas are a rare clinical entity in cardiac anomalies, and in a significant portion of patients, the fistulas are accompanied by coronary aneurysm formation. In this article, we present a giant circumflex coronary artery aneurysm with a fistula into the coronary sinus.

Pretreatment with methylprednisolone improves myocardial protection during on-pump coronary artery bypass surgery.

BACKGROUND: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). METHODS: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. RESULTS: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001). CONCLUSIONS: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.

Simultaneous occurrence of a large asymptomatic prolapsing left atrial myxoma with a cutaneous squamous cell carcinoma.

Synchronous myxoma of the heart and other malignancies are extremely rare. We report a case of a 64-year-old man who had a large left atrial myxoma that obstructed the mitral valve, as well as an unrelated, coexistent cutaneous squamous cell carcinoma in the sacral area. During the preoperative evaluation for non-cardiac surgery, the tumor was diagnosed coincidentally by echocardiographic examination. Echocardiography findings were consistent with a large left atrial myxoma originating from the posterior wall and prolapsing into the left ventricular cavity through the mitral valve, causing mitral stenosis. The mass was successfully completely excised. Histologic examination of the mass confirmed the diagnosis of cardiac myxoma. We report a casual echocardiographic finding of a left atrial myxoma that obstructed the mitral valve outflow tract, and an unrelated, synchronous cutaneous squamous cell carcinoma in the sacral area.

Absence of left pulmonary artery in tetralogy of Fallot with absent pulmonary valve syndrome.

The rare combination of tetralogy of Fallot (TOF), absent pulmonary valve syndrome (APVS), and absent left pulmonary artery (ALPA) is reviewed herein. Children with TOF with APVS and ALPA should be closely monitored, even if they are asymptomatic or mildly symptomatic, and should undergo elective surgery at the end of infancy.

Five-year follow up of Konno aortoventriculoplasty for repeat aortic valve replacement in an adult patient.

Konno aortoventriculoplasty (AVP) is performed for various types of left ventricular outflow tract obstruction. We report on a 32-year-old woman who had undergone double valve replacement five years earlier. She presented with increased interventricular septum thickness, small aortic root and gradient across the aortic mechanical valve. We performed Konno AVP with repeat aortic valve replacement (AVR). The control echocardiography showed no significant residual gradient. Konno AVP with repeat AVR may be safely performed with satisfactory results.

Endovascular treatment of abdominal aortic aneurysm in a 26-year-old man. A case report and 10-year follow-up.

We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-year follow-up. A young patient presenting with an abdominal aortic aneurysm is extremely rare, and data describing this population are limited. Open aneurysm repair (OAR) is the treatment of choice in these patients. However, since its introduction, endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. The long-term durability and late complications after EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. Our good long-term outcome will help to support the use of EVAR as a reasonable alternative to OAR in young patients with suitable anatomic findings.

Aspergillus flavus endocarditis of the native mitral valve in a bone marrow transplant patient.

BACKGROUND: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous drug use are the risk factors for developing infection. CASE REPORT: We report a case of Aspergillus flavus native mitral valve endocarditis in a patient who had allogeneic stem cell transplantation in the past due to myelodysplastic syndrome. CONCLUSIONS: Although it is rare and there is limited experience available with the diagnosis and treatment, early recognition and therapeutic intervention with systemic antifungal therapy and aggressive surgical intervention are critical to prevent further complications that may eventually lead to death. In addition, better novel diagnostic tools are needed to facilitate more accurate identification of patients with invasive Aspergillus and to permit earlier initiation of antifungal treatment.