Letter To The Editor.

We read the letter of F. Rudman et al [Rudman 2017] about our article entitled "Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy" [Colak 2016]. We thank them for their evaluations.

Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy.

BACKGROUND: Mediastinal infection is one of the most serious complications that occurs following open-heart surgery by sternotomy. In the present study, omentoplasty was initially and aggressively used to treat the infection and prevent the recurrence caused by bones in cases of mediastinitis following open-heart surgery at our clinic. METHODS: Among the 3656 patients who underwent surgery at our department of cardiovascular surgery between January 1996 and December 2012, omentoplasty as a treatment for mediastinitis was applied to 19 (0.51%) patients (of which 13 were males) following sternotomy. The cases were revised on the 15th day following the first surgery and/or when there was a suspicion of mediastinal infection. The necrotic skin, subcutaneous tissue, and bone tissue were resected, and all the affected sternal tissues were removed until healthy hemorrhagic areas were reached. RESULTS: The average age of the patients was between 49 and 81 years (mean: 65.7 ± 10.5 years). The mean age of the men was 66.08 ± 12.7 years (age range: 49-81 years) and that of the women was 63.2 ± 6.8 years (age range: 55-71 years). The male to female ratio was 2:1, and in both the male and female groups, the approximate age ranged from 55 and 70 years. In the intraoperative cultures received from wound cases, the most common agent of infection was methicillin-resistant coagulase-negative staphylococci. Purulent leaks from eight patients stopped in approximately 4 days. Purulent leaks from the other 11 patients continued until the 6th day, and thus, medical dressing also continued, after which the leaks stopped on the 15th day. The approximate postoperative hospital stay was 32 days (range: 13-63 days). CONCLUSION: Omentoplasty in heart surgery can be considered an effective method when used to control infection and treat secondary poststernotomy mediastinitis.

Serum fetuin-A and arginase-1 in human obesity model: Is there any interaction between inflammatory status and arginine metabolism?

Obesity is a major risk factor for many chronic metabolic diseases such as inflammation, insulin resistance (IR) and fatty liver injury. It was reported that obesity causes some variations on the serum levels of fetuin-A and is associated with arginine metabolism, especially arginase-1 levels. The aim of our study was to evaluate, the interaction and possible changes of these liver over produced proteins, fetuin-A and arginase-1 levels in obesity-related inflammatory status. Study groups were composed of individuals aged between 19 and 63 (n = 62). The control group included healthy subjects with BMI < 25, obese group included obese patients with BMI > 30 and with no other chronic disease. Biochemical markers were determined by an auto-analyzer. Adiponectin, fetuin-A, arginase-1, asymmetric dimethylarginine (ADMA), arginine, Hexanoyl-lysine (HEL) and leptin levels were measured with commercial ELISA immunoassay kits. Nitrite and nitrate were determined with colorimetric assay kit in serum samples. High sensitive C-reactive protein (hsCRP) levels and liver function enzymes activities were higher in the obese group in respect to the control group. Serum fetuin-A, arginase-1 and leptin levels were increased but adiponectin levels were decreased in obese subjects. Fetuin-A levels showed significant correlations with arginase-1 and HOMA-IR. Consequently, we carried out an investigation about higher serum fetuin-A and arginase-1 levels may have an important role in obesity and obesity-related liver damage.

Effect of curcumin on hepatic heme oxygenase 1 expression in high fat diet fed rats: is there a triangular relationship?

High fat diet (HFD) is associated with oxidative stress induced fatty liver. Curcumin, an extract of Curcuma longa, has been shown to possess potent antioxidant and hypolipidemic properties. In this study, we investigated the effect of curcumin treatment on hepatic heme oxygenase-1 (HO-1) expression along with pro-oxidant-antioxidant status and lipid accumulation in rats fed an HFD. Male Sprague-Dawley rats were distributed among 4 groups: Group 1, which was fed the control diet (10% of total calories from fat); Group 2, which was fed the HFD (60% of total calories from fat); and groups 3 and 4, which received the HFD supplemented with curcumin and the control diet supplemented with curcumin (1 g/kg diet; w/w), respectively, for 16 weeks. HFD caused increases in hepatic lipid levels, production of reactive oxygen species, and lipid peroxidation. Further, HO-1 expression was significantly decreased. Histopathological examination showed hepatic fat accumulation and slight fibrotic changes. Curcumin treatment reduced hepatic lipids and oxidative stress parameters, and HO-1 expression was significantly increased. These findings suggest that increased HO-1 expression, along with suppressed oxidative stress as well as reduced hepatic fat accumulation and fibrotic changes, contribute to the beneficial effects of curcumin in attenuating the pathogenesis of fatty liver induced metabolic diseases.

Serum asymmetric dimethylarginine and nitric oxide levels in obese postmenopausal women.

BACKGROUND: It has been reported that estrogen deficiency after menopause might cause a decrement in nitric oxide (NO) bioavailability by increasing the level of asymmetric dimethylarginine (ADMA), a major endogenous nitric oxide synthase inhibitor, thus leading to abnormalities in endothelial function. Because NO plays an important role on feeding behavior, ADMA may be involved in the pathogenesis of obesity, too. This cross-sectional study aimed to evaluate the relations of ADMA and NO with the obesity-linked peptides, such as ghrelin, leptin, and adiponectin in postmenopausal women free of hormone replacement therapy. METHODS: Adiponectin, ghrelin, leptin, ADMA, and NO(x) (total nitrite/nitrate) were measured in 22 obese (BMI: 30-47 kg/m(2)) and 19 normal weight (BMI: 21.5-26 kg/m(2)) postmenopausal women.Anthropometric measurements (height, weight, BMI, waist, and hip circumferences) were recorded. Statistics were made by the Mann-Whitney U-test. RESULTS: Ghrelin and adiponectin levels were significantly lower (P<0.001), whereas ADMA and leptin levels were higher in obese women than in normal weight controls (P<0.01 and 0.001, respectively). BMI was correlated negatively with adiponectin and ghrelin and positively with ADMA and leptin levels. No correlation existed between ADMA and NO. CONCLUSION: Estrogen deficiency alone may not cause an increase in ADMA levels unless the women are prone to disturbances in energy homeostasis. In spite of the high ADMA levels, the unaltered NO levels in plasma may be owing to ongoing inflammatory conditions.

Appetite-regulating hormones in chronic kidney disease patients.

OBJECTIVE: Inflammation and loss of appetite is the most common problem in patients with chronic kidney disease (CKD). This comparative cross-sectional study aimed to characterize the changes in circulating levels of ghrelin, obestatin, leptin, all of which have an effect on food intake, and proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) in patients with CKD who were undergoing different treatments. DESIGN AND SETTING: Study participants included 36 patients who had undergone hemodialysis (body mass index [BMI]: 22.3 ± 4.17 kg/m(2)); 41 who had undergone peritoneal dialysis (BMI: 23.5 ± 3.10 kg/m(2)), 30 with early stage CKD (BMI: 24.4 ± 3.32 kg/m(2)), and 31 healthy subjects (24.3 ± 2.14 kg/m(2)). The patients with CKD were kept under a standard diet with restricted salt, potassium, and protein intake. INTERVENTION: Levels of leptin, acylated ghrelin, obestatin, TNF-α, and IL-6 were measured by commercially available enzyme-linked immunosorbent assay kits. Total nitrite/nitrate was analyzed using colorimetric assay kit. RESULTS: Significantly high leptin levels, accompanied by low acylated ghrelin levels, were observed in patients with CKD. Maintenance dialysis did not affect these levels. TNF-α and IL-6 levels were significantly higher in CKD patients than in healthy subjects, the highest being in dialysis patients. Obestatin levels were relatively low in patients who had undergone hemodialysis. CONCLUSION: Low acyl-ghrelin levels, accompanied with high levels of TNF-α and IL-6 may be involved in the loss of appetite and poor nutritional status in CKD patients.

Management of carotid body tumors and familial paragangliomas: review of 30 years' experience.

BACKGROUND: Carotid body tumors (CBTs), especially familial paragangliomas, are rare benign neoplasms, accounting for <0.5% of all tumors; and they are the most common extra-adrenal paraganglioma. METHODS: In this study, CBTs were clinically suspected in 31 patients but diagnosed by histopathology in 28 between 1977 and 2007 at our department. All but one was operated upon. The ages of the 30 surgically treated patients ranged 17-73 years. A mass in the neck was the common symptom in all patients. Two of the 28 patients with CBTs had a familial paraganglioma history of CBT. RESULTS: Twenty-eight of these 30 surgically treated patients had confirmed CBT by histopathology; the diagnoses of other two patients were neurofibroma in one and tuberculosis lymphadenitis in one. These two patients were excluded from the study. CBTs were resected without a shunt procedure. UltraCision was used in five patients for tumor resection; the surgical results of these patients were excellent (easy dissection, minimal hemorrhage and time operation). Twenty patients underwent total resection, six had resection and saphenous vein interposition, one had partial resection, and one had carotid artery ligation with no resultant neurological deficit. One case of hypoglossal paralysis and one benign recurrence were detected. No mortality or malignant course was observed. CONCLUSION: CBTs are infrequent neoplasms; their surgical treatment is highly dependent on the ability and experience of the surgeon. The diagnostic and therapeutic relevance reside in making a timely diagnosis to propose a surgical treatment aimed at preventing complications and neurological damage. Surgical resection is usually definitive therapy for these lesions.

Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography- or Echocardiography - Guided Percutaneous Catheter Drainage Methods.

OBJECTIVE: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. METHODS: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. RESULTS: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. CONCLUSION: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Effect of dietary curcumin and capsaicin on testicular and hepatic oxidant-antioxidant status in rats fed a high-fat diet.

This study investigated the effects of curcumin and capsaicin on testicular and hepatic oxidant-antioxidant status in rats fed a high-fat diet (HFD). Male Sprague-Dawley rats were divided into 5 groups (8 rats per group). The control group was fed a normal control diet (standard laboratory chow), the HFD group was fed HFD (60% of total calories from fat), the HFD+CUR group received HFD supplemented with curcumin (1.5 g curcumin/kg HFD), the HFD+CAP group was given HFD supplemented with capsaicin (0.15 g capsaicin/kg HFD), and the HFD+CUR+CAP group received HFD supplemented with curcumin and capsaicin for 16 weeks. Hepatic and testicular thiobarbituric acid reactive substances (TBARS), reactive oxygen species (ROS), glutathione (GSH) levels, glutathione transferase activity, and Cu-Zn superoxide dismutase, glutathione peroxidase, and catalase protein expression and enzyme activities were measured. Protein expression was determined by Western blotting. GSH levels and antioxidant enzyme activities were measured with colorimetric methods. HFD slightly increased hepatic and testicular oxidative stress parameters. GSH levels did not change between groups. TBARS and ROS levels were significantly reduced in the HFD+CUR+CAP group compared with the HFD group. Liver and testis antioxidant enzyme activities and expression increased significantly with combined capsaicin and curcumin treatment. Curcumin and capsaicin treatment attenuated testicular and hepatic oxidative stress and enhanced the antioxidant defense system. The combination of capsaicin and curcumin with HFD seems to have some remarkable and beneficial effects on testicular oxidative damage in the fatty liver rat model.

Dietary curcumin and capsaicin: Relationship with hepatic oxidative stress and apoptosis in rats fed a high fat diet.

BACKGROUND: Apoptosis plays a major role in fatty liver disease. High-fat diets are related to the onset of fatty liver disease and hepatic oxidant-antioxidant imbalance. Curcumin and capsaicin are somewhat beneficial in reducing hepatic triglycerides; this is most likely because they are known to downregulate reactive oxygen species (ROS) and apoptosis. OBJECTIVES: The aim of this study was to investigate the effects of curcumin and capsaicin on apoptosis through the oxidative effect in an animal model of fatty liver disease. MATERIAL AND METHODS: Male Sprague Dawley rats were fed a normal control diet, a high-fat diet (HFD; 60% of total calories from fat), a HFD+curcumin (1.5 g curcumin/kg HFD), a HFD+capsaicin (0.15 g capsaicin/kg HFD), or a HFD+curcumin+capsaicin (1.5 g curcumin and 0.15 g capsaicin/kg HFD). Liver lysate levels of BAX, Bcl-2 and caspase-3 were determined via immunoblotting. Caspase-3 activity was measured with a colorimetric caspase-3 measurement kit. Total antioxidant status (TAS) and total oxidant status (TOS) were assayed using commercial kits. The generation of hepatic ROS was measured with fluorimetry. Fragmentation of DNA was detected using the TUNEL method. RESULTS: High-fat diet caused increased expression of BAX and caspase-3, as well as increased TOS and caspase-3 activity, but decreased expression of Bcl-2. HFD+curcumin+capsaicin caused decreased BAX, caspase-3, TOS, and ROS levels as compared to HFD, but increased TAS and Bcl-2. A HFD +curcumin+capsaicin also decreased the number of TUNEL-positive cells. CONCLUSIONS: These results suggest that supplementation with curcumin and capsaicin balances the hepatic oxidant-antioxidant status and may have a protective role in the apoptotic process in an HFD-induced fatty liver model.

Surgical Management of Aortic Coarctation from Infant to Adult.

OBJECTIVE: In the present study, we aimed to retrospectively investigate the early and late results of different surgical treatment techniques applied in different age groups with coarctation of the aorta (CoA). MATERIALS AND METHODS: Between January 2007 and February 2017, 26 patients (12 males, 14 females; mean age: 12.2±12.4 years; range: 29 days-34 years) who underwent surgery with the diagnosis of CoA were evaluated. Overall, 11 of these patients (42.3%) were in the infantile period, whereas 15 patients (57.7%) aged between 6 and 34 years. Resection and end-to-end anastomosis were performed in 13 patients (50%). Bypass grafting was performed in six patients (23.1%), and patch plasty was performed in seven patients (26.9%). RESULTS: A patient (3.8%) who was operated on during the infantile period died early, whereas another patient (3.8%) died 2 years after the surgery. Recoarctation was detected in two patients. A patient underwent balloon dilatation, whereas another patient underwent balloon dilatation and stenting. In patients who underwent re-section and end-to-end anastomosis based on postoperative echocardiography results during follow-up, a lower statistically significant gradient was observed compared with the preoperative period. Despite the decrease in the left ventricular systolic diameter (LVSD) and the increase in the ejection fraction (EF) the decrease in LVSD and increase in EF were not statistically significant. In patients who underwent patch plasty or graft interposition, the low values of the gradient and left ventricular diastolic diameter in the postoperative follow-up were statistically significant. However, the decrease in LVSD and increase in EF were not statistically significant. CONCLUSIONS: Our clinical experience suggests that repairing with resection and end-to-end anastomosis is a more appropriate treatment option during the infancy, whereas patch plasty or bypass grafting may be preferred in advanced ages.

Intraoperative transit-time flow measurement in on-pump coronary artery bypass graft surgery: Single center experience.

BACKGROUND: This study aims to evaluate the effects of graft dysfunction detected by intraoperative transit-time flow measurement on the outcomes of on-pump coronary artery bypass graft surgery. METHODS: A total of 1,240 patients (856 males, 384 females; mean age 57.4±12.1 years; range, 47 to 74 years), who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy performed by the same surgical team, were reviewed retrospectively. With the introduction of transit-time flow measurement into practice at our clinic in 2006, all patients regularly underwent transit-time flow measurement during surgery in order to evaluate the graft patency. Interpretation of the data obtained using the transit-time flow measurement in patients who underwent surgery has directed our decision as to whether to perform graft revision. Patients were evaluated for early- and late-period mortality/ morbidity, perioperative and postoperative myocardial infarction, and intraaortic balloon requirement. RESULTS: A total of 3,596 grafts in the perioperative period was evaluated using transit-time flow measurement. Anastomosis/graft revision, new anastomosis/patch plasty to distal native artery or free left internal mammary artery graft was performed in 146 grafts of 143 patients in whom transittime flow measurement showed insufficient patency. Four of six patients who developed peri/postoperative myocardial infarction were found to have perioperative hypotension, ST elevation, and wall motion abnormality on transesophageal echocardiography before closure of the sternum. The flow was corrected by extending the short length of the grafts with insufficient flow after transit-time flow measurement and it was recorded that transit-time flow measurements were at normal values at these four grafts. Two patients developed acute myocardial infarction in the postoperative period and stent was applied in one vessel of each patient; however, one of these patients died. Sixteen patients were inserted intraaortic balloon pump, four of which being in the preoperative period. Revision surgery was performed due to bleeding in 56 patients and sternal infection in 12 patients. Of all patients, 28 (2.3%) died in the early postoperative period. CONCLUSION: We believe that transit-time flow measurement may be an important tool in evaluating graft function and contribute to eliminate the causes of graft failure during surgery.

Surgical treatment with wrapping of the moderately-dilated ascending aorta.

BACKGROUND: The aim of this study is to present early and mid results associated with the treatment of dilatation of the ascending aorta using the wrapping technique. METHODS: A total of 54 patients (16 males, 38 females; mean age 56.9±12.7 years; range 21 to 77 years) who were subjected to the wrapping technique due to dilatation of the ascending aorta between January 2010 and Fabruary 2017 were retrospectively analyzed. The Dacron grafts were used in all patients. Wrapping was performed in all patients in combination with the other cardiac surgical procedures. Wrapping was performed with aortoplasty in 32 patients and as an isolated procedure in 22 patients. Preoperative clinical findings, concomitant cardiac procedures, intraoperative parameters, postoperative early and long-term outcomes were evaluated. The ascending aorta and descending aorta diameters, ejection fraction, left ventricle end-diastolic and end-systolic diameters were measured using a computed tomography scan and/or transthoracic echocardiography after surgery, and was compared with the preoperative values. RESULTS: The median follow-up was 3.8 (range, 1 to 7) years. No intraoperative complication associated with the wrapping procedure was reported in any of the patients. One patient died during the early postoperative period. Relapse-free intra-arterial fibrinolysis was used to correct postoperative cerebral infarct in one patient without any sequelae. Revision surgery was required in two patients due to bleeding and in another two patients due to sternal dehiscence. A postoperative decrease in the aortic diameter and an increase in the ejection fraction were found to be statistically significant. Findings such as sinus of Valsalva and distal aortic dilation, rupture, pseudoaneurysm, and graft mobilization were not observed during follow-up. CONCLUSION: Our study results show that the wrapping techniques may be safely performed in patients with moderate dilatation of the aorta who do not require replacement of the ascending aorta.

Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms.

OBJECTIVE: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. METHODS: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). RESULTS: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). CONCLUSION: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

The impact of intraoperative transit time flow measurement on the results of on-pump coronary surgery.

OBJECTIVE: The purpose of this study is to evaluate the effect of detection of graft dysfunction by intraoperative transit time flow measurement (TTFM) on the surgical results of on-pump coronary artery bypass grafting. METHODS: Two hundred patients undergoing on-pump isolate coronary artery bypass grafting via median sternotomy performed by the same surgical team were included into the study. TTFM was routinely performed for assessment of graft patency during operation after a transit time flow meter became available in our center in February 2006. The last 100 consecutive patients before this date formed the control group (Group A), and the first 100 consecutive patients after this date formed the study group (Group B). Interpretation of the values obtained using the TTFM in Group B patients has allowed us to reach a decision whether or not to revise a graft. Preoperative and postoperative variables of the two groups were compared. RESULTS: The clinical features of control and study groups were comparable. We assessed patency of 303 grafts using TTFM. Revision was required for nine grafts in nine patients based on unsatisfactory TTFM findings. Incidences of overall mortality (p<0.05), peri- or postoperative myocardial infarction (p<0.05) and intraaortic balloon pump insertion (p<0.05) were significantly lower in Group B than Group A. CONCLUSIONS: We believe that TTFM seems to be a crucial tool for deciding if a graft is well-functioning or not, and it allows for improvement of graft failure during operation. Our results suggest that detection of graft dysfunction intraoperatively by TTFM improves the surgical outcome.

An atypically localized atrial myxoma: a case report.

Atypical cardiac myxomas are rare occurrences and may present with a variety of clinical manifestations depending on the location and morphology. A 46-year-old woman had a 4 x 3 x 2-cm myxoma originating from the superior wall of the left atrium, found by echocardiography and multislice tomography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a narrow-base stalk originating from the right wall of the left atrium in between the right upper and lower pulmonary vein. The patient recovered without complication and was discharged 6 days after the operation. At 1-year follow-up, echocardiography revealed normal cardiac function without reccurence in terms of mass. Although up to 80% of myxomas are localized in the left atrium, of which 75% involve in the interatrial septum, it should not be forgotten that myxomas can appear in an atypical localization, as occurred in our case.

The effect of surgical treatment for secundum atrial septal defect in patients more than 30 years old.

BACKGROUND: We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect. METHODS: We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation. RESULTS: The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period. CONCLUSION: Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.

Endovascular Stent Graft Repair of Localized Acute Aortic Intramural Hematoma: A Case Report and Literature Review.

Aortic intramural hematoma (IMH) is a variant of acute aortic syndrome, which can be life-threatening. Ascending aorta IMHs, particularly accompanied by penetrating aortic ulcer (PAU), can cause dissection, rupture, and cardiac tamponade. Therefore, early surgical treatment is recommended for IMHs of the ascending aorta. Herein, we present the case of a 60-year-old male patient who was on warfarin sodium treatment and in whom an IMH localized to the arcus aorta was detected incidentally via computed tomography, with the suspicion of pulmonary embolism, and an endovascular stent graft was inserted into the arcus aorta. This case highlights the importance of following ulcerated aortic plaques and suggests that IMH can be successfully treated with endovascular stent grafting.

One of the most frequent vascular diseases in northeastern of Turkey: Thromboangiitis obliterans or Buerger's disease (experience with 344 cases).

PURPOSE: This is a retrospective clinical study on adult patients treated surgically for Buerger's disease in our region. METHODS: In our clinic, 344 patients with Buerger's disease were surgically treated between 1980 and 2004. The major complaints included foot coldness in 312 (90.6%) patients, color changes in 290 (84.3%), rest pain in 160 (46.5%), claudication in 166 (48.2%) and necrotic ulcers in 185 (53.1%). Lumbar sympathectomy was made in 278 (80.2%) patients, thoracic sympathectomy in 7 (2.2%), thoracic and lumbar sympathectomy in 12 (3.6%), lumbar sympathectomy and femoropopliteal or femorotibial bypass in 30 (9%), and femoropopliteal or femorotibial bypass in 17 (5%). RESULTS: Color changes were improved in 230 (79.3%) patients, food coldness were decreased in 288 (92.3%) and rest pains were improved in 43 (26.8%). Intermittent claudications decreased in 132 of 166 patients. Necrotic ulcers healed in 30 of 185 patients. Amputation was made totally in 155 (53%) patients in 10 years. CONCLUSIONS: As a nonatherosclerotic, segmental, inflammatory disease, Buerger's disease is casually related to tobacco use. The main goal is to discontinue the use of tobacco. Sympathectomy may be helpful in healing the ulcers and decreasing the symptoms. Vascular reconstruction is rarely possible for patients with Buerger's disease due to segmental involvement and distal nature of the disease.

The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery.

Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74) underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90%) were in NYHA class III; 34 (85%) patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.