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AIM: The logistic clinical SYNTAX score (log CSS) is a combined risk scoring system including clinical and anatomic parameters; it has been found to be effective for the prediction of mortality in patients with ST-elevation myocardial infarction (STEMI). Coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction is still debated. In the present study, we aimed to evaluate the utility of log CSS to stratify the risk of in-hospital mortality in acute STEMI patients undergoing emergent CABG for primary revascularization. METHOD: In total, 88 consecutive patients with acute STEMI, who did not qualify for primary percutaneous coronary intervention and required emergent CABG were included in our study. Nine of 88 patients died during hospitalization. The study population was divided into two groups as in-hospital survivors and non-survivors. Log CSS and SYNTAX score (SS) were calculated for both groups and two groups were compared in terms of demographics, preoperative, intraoperative, postoperative characteristics, SS and log CSS. RESULTS: Log CSS was found to be an independent predictor of in-hospital mortality, log CSS > 10.5 had 89% sensitivity, 81% specificity (area under the curve: 0.927; 95% confidence interval: 0.855-0.993). Moreover, peak troponin level was an independent predictor of in-hospital mortality. Glucose level, cardiopulmonary resuscitation before operation, glomerular filtration rate, left ventricular ejection fraction, and Killip class were significantly associated with in-hospital mortality. CONCLUSION: Log CSS may improve the accuracy of risk assessment in patients who are undergoing emergent CABG for primary revascularization of STEMI.
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Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Ponte de Artéria Coronária , Mortalidade Hospitalar , Humanos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
BACKGROUND: Neutrophil to lymphocyte ratio (NLR) is a prognostic predictor in a wide range of cardiovascular disease. Acute aortic dissection (AD) is an uncommon but fatal cardiovascular disease. In this study, we investigated both prognostic factors in patients with AD and whether NLR can be a predictor for mortality. Methods: We analyzed retrospectively the data of 57 patients with AD who had undergone emergent surgery in our hospital and included 128 consecutive patients with chest pain admitted to the emergency room as a control group. Also, patients who were operated on due to aortic dissection as another subgroup were compared to NLR values. Baseline clinical features, cardiovascular risk factors, and surgical and laboratory parameters were obtained from the hospital database. Results: Patients with AD had higher NLR than the control group (1.7 ± 0.5 versus 7.6 ± 3.3, P < .001). In the AD group, 15 deaths occurred and non-survivors had significantly higher NLR, compared to survivors (11.6 ± 2.4 versus 6.6 ± 2.3, P < .001). In multivariate analysis, high NLR (odds ratio [OR] 1.913, 95% CI 1.030-1.081, P = .04) and cross-clamp time (OR 1.265, 95% CI 1.003-1.596, P = .04) were determined as independent predictors of in-hospital mortality. In receiver operating characteristics curve analyses, the NLR > 9.3 predicted the mortality in AD with a specificity of 91% and a sensitivity of 86% (P < .001). CONCLUSION: This study shows that high NLR can be used as a marker for prognosis in short-term mortality of patient with AD. Additionally, increased lactate level in perioperative period, prolonged cardiopulmonary bypass time, and additional cardiac procedures are strong independent predictors of short-term mortality in patients with acute AD.
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Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Dissecção Aórtica/diagnóstico , Linfócitos/patologia , Neutrófilos/patologia , Medição de Risco , Procedimentos Cirúrgicos Vasculares/métodos , Dissecção Aórtica/sangue , Dissecção Aórtica/mortalidade , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/mortalidade , Biomarcadores/sangue , Ecocardiografia , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios X , Turquia/epidemiologiaRESUMO
INTRODUCTION: The inflammatory process has been reported to be associated with aortic dissection (AD) from the development to the prognosis. The aim of the study was to investigate a relationship between the neutrophil to lymphocyte ratio (NLR) and in-hospital outcomes in patients with acute aortic dissection (AAD) who underwent surgical repair. METHODS: One hundred and eighty-four patients who were admitted with the diagnosis of type A AAD who underwent surgical repair at two large tertiary hospitals. According to their NLR, 91 patients had high NLR (>6.0) and 93 patients had low NLR (⩽6.0). RESULTS: The frequency of major bleeding, hospital-related infection, multi-organ dysfunction and mortality in hospital were higher in the high NLR group compared to the low NLR group. NLR, WBC count and operation duration were found to be independent predictors for in-hospital mortality. CONCLUSIONS: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.
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Dissecção Aórtica/sangue , Dissecção Aórtica/mortalidade , Linfócitos/patologia , Neutrófilos/patologia , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Estudos Retrospectivos , Turquia/epidemiologiaRESUMO
BACKGROUND: In this study, the relationship between patency of saphenous vein (SV) graft and different sizes of aorta wall punches was investigated during the follow-up period after coronary artery bypass graft surgery. We also evaluated the other possible factors affecting SV graft patency. METHODS: This study consisted of 266 consecutive and symptomatic patients with postoperative angiography. The primary endpoint was at least one saphenous graft failure observed from coronary computed tomography angiography (cCTA) and/or invasive angiography after surgery. Groups were created as SV occluded and patent group. Survival curves of patients in groups were estimated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS: Cox-regression analysis demonstrated influence of older age (P = .023) and Diabetes Mellitus (DM) (P = .002) on SV graft failure. However, increasing ejection fraction (P = .011) was a protective factor against SV graft failure. There was no significant difference between the two groups in terms of usage rate of the punches with different diameters (P = .296). CONCLUSION: The incidence of SV graft patency does not seem to increase in patients whose 4.8-mm aortic punch was used during proximal anastomosis compared to the reference group in which a punch of 4.0 mm was used. Also, the final proximal anastomosis graft size that was measured using cCTA was similar between patients with 4.8-mm punch and patients with 4-mm punch. Results from this study could help to determine which size for aortosaphenous anastomosis is clinically optimal.
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Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Sobrevivência de Enxerto , Veia Safena/transplante , Adulto , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Rejeição de Enxerto/diagnóstico por imagem , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Veia Safena/diagnóstico por imagem , Resultado do TratamentoRESUMO
Objective: It has been shown that clonal mutations occur in hematopoietic stem cells with advancing age and increase the risk of death due to atherosclerotic vascular diseases, similarly to myeloproliferative neoplasms. Endothelial cells (ECs) and hematopoietic stem cells develop from common stem cells called hemangioblasts in the early embryonic period. However, the presence of hemangioblasts in the postnatal period is controversial. In this study, JAK2 gene variants were examined in patients with atherosclerotic carotid disease and without any hematological malignancies. Materials and Methods: Ten consecutive patients (8 men and 2 women) with symptomatic atherosclerotic carotid stenosis were included in this study. ECs (CD31+CD45-) were separated from tissue samples taken by carotid endarterectomy. JAK2 variants were examined in ECs, peripheral blood mononuclear cells, and oral epithelial cells of the patients with next-generation sequencing. Results: The median age of the patients was 74 (range: 58-80) years and the median body mass index value was 24.44 (range: 18.42-30.85) kg/m2. Smoking history was present in 50%, hypertension in 80%, diabetes in 70%, and ischemic heart disease in 70% of the cases. The JAK2V617F mutation was detected in the peripheral blood mononuclear cells of 3 of the 10 patients, and 2 patients also had the JAK2V617F mutation in their ECs. The JAK2V617F mutation was not found in the oral epithelial cells of any of the patients. Conclusion: In this study, for the first time in the literature, we showed that the JAK2V617F mutation was found somatically in both peripheral blood cells and ECs in patients with atherosclerosis. This finding may support that ECs and hematopoietic cells originate from a common clone or that somatic mutations can be transmitted to ECs by other mechanisms. Examining the molecular and functional changes caused by the JAK2V617F mutation in ECs may help open a new avenue for treating atherosclerosis.
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Células Endoteliais , Janus Quinase 2 , Mutação , Humanos , Janus Quinase 2/genética , Masculino , Feminino , Células Endoteliais/patologia , Células Endoteliais/metabolismo , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/genética , Doenças das Artérias Carótidas/patologia , Leucócitos Mononucleares/metabolismo , Aterosclerose/genéticaRESUMO
BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.
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Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Sistema de Registros , Cateterismo Cardíaco/efeitos adversosRESUMO
Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut's modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.
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Aorta Torácica , Implante de Prótese Vascular , Humanos , Aorta Torácica/cirurgia , Aorta/cirurgia , Reoperação , Valva Aórtica/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologiaRESUMO
Trace elements are essential micronutrients that take part in most antioxidant reactions in the body. In this study, we evaluated the levels of copper, chromium, manganese, selenium, magnesium, zinc, iron, and silicon in adult patients who undergone isolated on-pump coronary artery bypass with the occurrence of postoperative atrial fibrillation, transient renal injury, transient liver injury, and rate of wound infection; 51 adult patients (41 men, 10 women) underwent isolated coronary artery bypass grafting (CABG) under cardiopulmonary bypass. The mean age was 61,9 ± 8,0 years (range 45-82 years). Blood samples were collected preoperatively, postoperative first hour, postoperative first day, and fifth postoperative day for element analysis. Serum levels were determined by an Inductive Coupled Plasma Optical Emission Spectrometer (ICAP 6000). Serum copper, zinc, and selenium values, typically known as strong antioxidant elements in the body, decreased significantly during the first hour and first day of postoperative period compared to the preoperative period (p < 0.05). Also, postoperative atrial fibrillation, transient renal injury, transient liver injury, and rate of wound infection were observed to increase with the decrease in levels of trace elements (p < 0.05). The levels of these elements were observed to return to normal levels during the fifth postoperative day. The levels of trace elements decrease significantly after on-pump coronary artery bypass surgery. Our study results suggest that this could be one of the predisposing factors for increased postoperative atrial fibrillation, transient kidney injury, transient renal injury, and increased rate of wound infections for patients undergoing on-pump coronary artery bypass grafting.
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Fibrilação Atrial , Selênio , Oligoelementos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antioxidantes , Cobre , Ponte de Artéria Coronária/métodos , Morbidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Fatores de Risco , ZincoRESUMO
Right ventricular (RV) function is a determining factor for clinical outcomes in patients undergoing tricuspid valve surgery (TVS). Our aim was to investigate the importance of the function of the right ventricular outflow tract (RVOT), which is an important anatomical region of the RV, in patients underwent TVS. 104 patients who underwent TVS were analyzed retrospectively. Patients with previous cardiac surgery, congenital heart disease, or heart failure were excluded. The parasternal short-axis view at the level of the aortic root was used to measure RVOT dimensions and RVOT fractional shortening (RVOT-FS). The effect of RVOT diameter and function on major adverse cardiac events (MACE) after TVS was investigated. In our study, MACE, consisting of pacemaker implantation, acute kidney injury, postoperative atrial fibrillation and mortality, was developed at 44 (42.3%) patients.We compared the predictive performances of RVOT end-systolic (RVOTs) diameter, RVOT end-diastolic (RVOTd) diameter, RVOT-FS and RV diameters in prediction of MACE. The model including the RVOTs had higher AUC, R2 and likelihood ratio X2 values (0.775, 0.287 and 25.0, respectively) than RVOTd (0.770, 0.279 and 24.2, respectively) and RVOT-FS (0.750, 0.215 and 18.1, respectively). RVOT diameters showed better performance in predicting MACE than RV diameters. Moreover, there was statistically significant association between RVOTs, RVOTd and MACE (p value were 0.014 and 0.027, respectively), while no association between RVOT-FS and MACE (p value was 0.177). In summary, we determined that the RVOT diameters are important predictors for the in-hospital clinical outcomes of patients who underwent TVS.
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OBJECTIVE: Atrial ï¬brillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial ï¬brillation has been described previously. We aimed to evaluate the prognostic inï¬uence of small airway function on predicting postoperative atrial ï¬brillation undergoing isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial ï¬brillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory ï¬ow (forced expiratory ï¬ow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups. RESULTS: The frequency of postoperative atrial ï¬brillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity % [80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory ï¬ow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were signiï¬cantly lower in postoperative atrial ï¬brillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory ï¬ow 25%-75% were found to be independent predictors of postoperative atrial ï¬brillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory ï¬ow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial ï¬brillation with 63.8% sensitivity and 70.1% speciï¬city. CONCLUSION: Our study demonstrated that small airway obstruction, as indicated by forced expiratory ï¬ow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial ï¬brillation in patients undergoing isolated CABG.
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Fibrilação Atrial , Humanos , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda , Ponte de Artéria CoronáriaRESUMO
Background: In this study, we aimed to examine the effect of novel coronavirus 2019 disease (COVID-19) on the healing process of patients undergoing open-heart surgery. Methods: Between October 2020 and May 2021, a total of in 22 patients (14 males, 8 females; mean age: 60±15 years; range, 18 to 82 years) who developed COVID-19 within the first 30 days after open-heart surgery were retrospectively analyzed. Since the study was conducted in the pre-vaccination period, all of the patients were unvaccinated. Demographic, operative, and laboratory data of the patients were analyzed, and morbidity and mortality rates were evaluated. Results: Postoperative COVID-19 infection occurred in 22 of 1,171 patients who underwent open-heart surgery. Pneumonia developed in 14 (64%) patients and mechanical ventilation support was required in 50% (n=7) of them. Mortality was seen in eight (36%) patients. Only procalcitonin level (p=0.003) and age (p=0.005) had significant effects on survival. Conclusion: Postoperative COVID-19 infection is associated with high pneumonia and mortality rates in unvaccinated patients. Protocols that can prevent false polymerase chain reaction negativity and early contamination can be life-saving.
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INTRODUCTION: Infective endocarditis is a disease that progresses with morbidity and mortality, afecting 3-10 out of 100,000 people per year. We conducted this study to review the early outcomes of surgical treatment of infective endocarditis. METHODS: In this retrospective study, 122 patients who underwent cardiac surgery for infective endocarditis in our clinic between November 2009 and December 2020 were evaluated. Patients were divided into two groups according to in-hospital mortality. Demographic, echocardiographic, laboratory, operative, and postoperative data of the groups were compared. RESULTS: Between November 3, 2009, and December 7, 2020, 122 patients were operated for infective endocarditis in our hospital. Emergency surgery was performed in nine (7.3%) patients. In-hospital mortality occurred in 23 (18.9%) patients, and 99 (81.1%) patients were discharged. In-hospital mortality was related with older age, presence of periannular abscess, New York Heart Association class 3 or 4 symptoms, low albumin level, high alanine aminotransferase level, and longer cross-clamping time (P<0.05 for all). CONCLUSION: The presence of paravalvular abscess was the most important prognostic factor in patients operated for infective endocarditis.
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Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Humanos , Abscesso/cirurgia , Estudos Retrospectivos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Endocardite/cirurgia , Mortalidade HospitalarRESUMO
OBJECTIVE: Coronary artery bypass graft (CABG) surgery as a primary treatment for acute ST-elevation myocardial infarction (STEMI) is still debated. This study aimed to evaluate the predictors of long-term mortality in STEMI patients undergoing emergent CABG. To the best of our knowledge, this is the first study to evaluate the long-term mortality predictors in patients with STEMI revascularized by primary CABG. METHODS: This retrospective study included 88 consecutive patients with STEMI, who did not qualify for primary percutaneous intervention and required emergent CABG between 2010 and 2017. The study population was divided into the following 2 groups: survivors and nonsurvivors. The 2 groups were compared in terms of demographics, preoperative, intraoperative, and postoperative characteristics. RESULTS: 23 of the 88 patients, died during the median 92.8 (69.0-105.1) months of follow-up. Data were evaluated with univariate and multivariate analyses. Killip class (p<0.001) was found to be an independent predictor of long-term all-cause mortality in patients with STEMI revascularized by CABG, and mortality rates increased significantly as Killip class increased (log-rank test, p<0.001). Moreover, age (p=0.044) was found to be an independent predictor of long-term mortality. Left ventricular ejection fraction, glomerular filtration rate, glucose levels, and left anterior descending artery to the left internal mammary artery graft usage (p=0.001, p=0.009, p<0.001, and p=0.039, respectively) were significantly associated with long-term all-cause mortality for our study population. CONCLUSION: Killip class was found to be an independent predictor of long-term all-cause mortality in patients with STEMI who underwent emergent CABG. The patients' admission status may give valuable information about long-term mortality.
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Ponte de Artéria Coronária/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Adulto , Fatores Etários , Idoso , Análise de Variância , Causas de Morte , Ponte de Artéria Coronária/métodos , Emergências , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
A 17-year-old female patient with a history of surgery for primary femoral and metastatic lung osteosarcoma was admitted to our clinic with palpitations. Upon evaluation, a metastatic osteosarcoma in the left ventricle was diagnosed. Based on the collaborative decision of the oncology and cardiovascular surgery clinics, surgery was performed and the patient was discharged without any problems. According to the recommendation of the oncology clinic, chemotherapy was postponed for 6 months after surgery. Five months postoperatively, however, she had a recurrence with 2 tumors. Based on the collaborative decision, chemotherapy was initiated and in 2 months the size of the recurrent tumors had diminished. The patient is still under the care of the oncology and cardiovascular surgery clinics and continuing her chemotherapy regimen. Osteosarcomas have a high mortality. Metastatic tumors of the heart are not common. The location of the metastasis and the characteristics of the primary tumor determine the treatment modality. In some previously published reports, various treatment choices have been described. In the present case report, we present a rare case with metastatic cardiac osteosarcoma.
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Neoplasias Ósseas/patologia , Fêmur , Neoplasias Cardíacas/secundário , Recidiva Local de Neoplasia , Osteossarcoma/secundário , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Terapia Combinada , Diagnóstico Diferencial , Ecocardiografia , Feminino , Seguimentos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/terapia , Ventrículos do Coração , Humanos , Imageamento por Ressonância Magnética , Osteossarcoma/diagnóstico , Osteossarcoma/terapia , Tomografia Computadorizada por Raios XRESUMO
The cardiac involvement of hydatid cyst, which is rarely seen, with the location of asymptomatic huge cyst in the interventricular septum (IVS) is an extraordinary condition. We report an isolated cardiac hydatid cyst located in the IVS in an 18-year-old man diagnosed incidentally by transthoracic echocardiography. Cardiac magnetic resonance imaging confirmed a mass lesion of 47×74 mm in diameter located at the base of IVS. The cystic content and its germinative membrane were resected and the cavity was applicated under cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged on the 6th postoperative day, with oral albendazole therapy.
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Equinococose , Septo Interventricular , Adolescente , Albendazol , Ecocardiografia , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
AIM: In this study, we aimed to investigate the superiority of right pericardial window (RPW) versus posterior pericardial drain placing for the parameters of pericardial effusion and the postoperative complications at the patients who has undergone cardiac surgery. MATERIALS AND METHODS: Between July and September 2018, 120 adult patients (mean age 50.30 ± 14.61) who underwent cardiac surgery without the necessity of opening the pleura were included in the study. In Group 1, the RPW was opened (n = 60), and Group 2 posterior pericardial drainage tube was placed without RPW (n = 60). Risk factors and postoperative complication were evaluated and compared between the Groups. RESULTS: Cardiac tamponade occurrence was not significantly different between the Groups (Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative transthoracic echocardiographic controls revealed significant pericardial effusion in Group 2 (6.90 mm ± 13.02 mm) compared to Group 1 (2.30 mm ± 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 ± 0.26 in Group 1 and 0.88 ± 0.36 in Group 2 (p = 0.022). A significant decrease in glomerular filtration rate was observed in Group 2 (102.7 ± 24.5 and 91.2 ± 28, p = 0.019). Postoperative acute renal failure was significantly higher in Group 2 compared to Group 1 (p < 0.001). Postoperative new onset atrial fibrillation occurred in 4 patients in Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit stay was 36.00 ± 22.31 h in Group 1 and 53.60 ± 59.50 h in Group 2 (p = 0.034). Development of pneumothorax, pneumonia and pleural effusion were not statistically different between the Groups (p = 0.079, 0.171, 0.509). CONCLUSION: RPW application is more effective on preventing postoperative complications in cardiac surgery instead of placing drains in posterior pericardium.
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Drenagem/efeitos adversos , Drenagem/métodos , Derrame Pericárdico/prevenção & controle , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Adulto , Idoso , Fibrilação Atrial/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Tamponamento Cardíaco/etiologia , Creatinina/sangue , Ecocardiografia , Feminino , Taxa de Filtração Glomerular , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Pericárdio/cirurgia , Complicações Pós-Operatórias/etiologia , Período Pós-OperatórioRESUMO
Isolated sinus of Valsalva aneurysm is a rare congenital pathology associated with a life-threatening course when untreated. In this article, we report a 60-year-old male patient with an isolated aneurysm of right sinus of Valsalva treated by modified Bentall procedure. The patient with cardiac symptoms applied to our clinic for further evaluation. Enhanced computed tomographic angiography and transthoracic echocardiography revealed an isolated aneurysm of right sinus of Valsalva. An optimal management for the condition is not clear, while early surgical intervention is recommended due to potentially life-threatening complications.
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OBJECTIVES: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. METHODS: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. RESULTS: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). CONCLUSION: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.
Assuntos
Plaquetas/fisiologia , Ponte de Artéria Coronária/efeitos adversos , Veia Safena/transplante , Grau de Desobstrução Vascular/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/etiologia , Ecocardiografia , Feminino , Testes Hematológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Curva ROC , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Veia Safena/fisiopatologia , Estatísticas não Paramétricas , Falha de TratamentoRESUMO
BACKGROUND: The measurement of cardiac markers is still the gold standard for diagnosing myocardial infarction (MI), but there is always a transition period between the time of infarction and when a marker can be measured in the blood. Therefore, clinicians are shifting their focus to the identification of potential new analytes capable of predicting MIs before the standard cardiac markers increase. In this study, we tested whether measurement of the concentration of soluble intercellular adhesion molecule 1 (sICAM-1) in plasma can be used for this purpose. MATERIALS AND METHODS: In this prospective study, we included 60 male patients who had a left main coronary artery lesion or a left main equivalent and who underwent elective (group I, n = 20), urgent (group II, n = 20), or emergent (group III, n = 20) coronary artery bypass grafting (CABG). We excluded patients who had increased cardiac markers at admission, and drew blood samples for sICAM-1 measurements from other patients immediately after coronary angiography evaluations. We divided the patients into 3 groups according to their clinical characteristics and cardiac marker levels. Only patients with increased cardiac markers underwent emergent CABG (group III). We measured sICAM-1 concentrations immediately after coronary angiography and measured creatine kinase MB (CK-MB) and cardiac troponin I (cTnI) just before CABG. We then evaluated the results for correlations. RESULTS: CK-MB, cTnI, and sICAM-1 levels were significantly higher in group III than in groups I and II (P < .05 for all). Our analysis for correlations between the sICAM-1 level and cardiac marker levels revealed no significant correlations in group I (CK-MB, r = 0.241 [P = .15]; cTnI, r = -0.107 [P = .32]) and group II (CK-MB, r = -0.202 [P = .19]; cTnI, r = 0.606 [P = .002]), but our analysis did reveal highly significant correlations in group III (CK-MB, r = 0.584 [P = .003]; cTnI, r = 0.605 [P = .002]). CONCLUSION: Measuring the plasma concentration of sICAM-1 before the concentrations of cardiac markers increase in patients with MI may provide clinicians with faster and reliable data for deciding on and administering the most appropriate procedures and/or therapies.
Assuntos
Molécula 1 de Adesão Intercelular/sangue , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Idoso , Biomarcadores/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
We represent a case of asymptomatic isolated chronic ascending aortic dissection that lasted for 15 years in which a patient was only followed up with medical therapy that saved him from early surgical intervention.