Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous vein.

AIM: The problem of varicose veins in the lower leg is a common disease and associated with long-term morbidity. It has usually been treated using high ligation with stripping and endovenous ablation surgery of the great saphenous vein. The aim of this paper is to report our own series of patients treated by ultrasound guided catheter directed foam sclerotherapy for the chemical ablation of great saphenous vein. METHODS: The study involved 108 legs with symptomatic varicose veins (C2-4) secondary to great saphenous vein insufficiency. The great saphenous vein was accessed at knee level. With the method of Tessari sclerosant foam was made (2 mL 3% polidocanol and 8 mL air) and delivered along the great saphenous vein while the catheter was withdrawn. At two and fifty two weeks after treatment the patients were evaluated. RESULTS: Catheter-directed foam sclerotheraphy was successfully performed in all of the patients. Venous Clinic Severity Score was reduced significantly (P<0.05). Eighty nine percent of the GSV were completely occluded, 4% were partly occluded and 7% were recanalized. No serious side-effects occurred. CONCLUSION: Catheter-directed foam sclerotheraphy is a safe, simple and minimally invasive procedure. Patient satisfaction was good and the occlusion rate is promising after a single treatment.

Preoperative NT-proBNP levels: a reliable parameter to estimate postoperative atrial fibrillation in coronary artery bypass patients.

BACKGROUND: Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass grafting (CABG). This study was designed to evaluate whether the levels of preoperative and postoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) are predictors of postoperative paroxysmal atrial fibrillation in patients who undergo coronary artery bypass surgery. METHODS: A total of 117 patients were prospectively evaluated for new-onset AF after coronary operation. Plasma NT-proBNP values in all patients were measured at five different time points. RESULTS: AF occurred during the hospitalization period in 33 patients (28.2 %). Significantly higher NT-proBNP levels in the preoperative examination were recorded in patients who developed AF postoperatively compared with patients without postoperative AF (329.36 ± 82.93 vs. 230.67 ± 59.93 pg/ml, P < 0.05). Although we detected some higher values in the other group of patients with AF (at T1, T2, T3, T4), the difference was not statistically significant compared to the normal rhythm group. CONCLUSION: The main finding of the current study is a positive correlation between high levels of preoperative NT-proBNP and the risk of new-onset AF after CABG surgery.

Right ventricular outflow obstruction of the patient with biventricular non-compaction.

We present a case of a 16-year-old girl who underwent infundibular myectomy for right ventricular outflow tract obstruction complicated by biventricular non-compaction. The pathogenesis of this condition remains unknown. In pediatric patients non-compaction cardiomyopathy is associated with other cardiac abnormalities and carries a high mortality as a result of heart failure. In view of her improved cardiac performance after operation, we believe that a cardiac repair procedure should be performed based on the usual indications if left ventricular function is preserved.

Protection of saphenous vein graft from arterial pressure: an experimental study.

BACKGROUND: Reoperations for bypass surgery increase the need for new grafts. We investigated early changes in both the normal human saphenous vein and in ectatic varicose veins externally supported by PTFE (polytetrafluoroethylene) graft and exposed to arterial pressure in an IN VITRO non-pulsatile flow model. MATERIAL AND METHODS: A total of 24 saphenous vein pieces (11 of them normal, the other 13 with varicosities) with a length of 6 centimeters were divided into equal parts; half of these parts were wrapped in PTFE grafts. All vein parts were placed in a perfusion circuit. Tissue biopsies were obtained from the vein segments. Light and electron microscopy examinations were performed, and endothelial continuity, elastic laminate continuity, medial connective tissue uniformity, medial smooth muscle uniformity, and adventitial connective tissue uniformity parameters were identified. RESULTS: All parameters in the PTFE protected vein groups were better. The fewest morphological changes among all four groups were detected in the vein walls from normal veins with PTFE protection. There was no significant difference in endothelial continuity and adventitial connective tissue uniformity between the normal vein group and the varicose vein group with PTFE protection. CONCLUSIONS: It is suggested that supporting vein grafts externally with PTFE sufficiently protects the vein walls against damage from exposure to arterial pressure. If varicose veins are used as arterial grafts, supporting them with PTFE may be useful because of the good protection of endothelial and medial connective tissues, resulting in similar parameters to those of normal vein walls.

Pleura preservation during coronary operation does not have any beneficial effect on respiratory functions.

AIM: According to some reports the destruction the integrity of the pleura during acute myocardial infarction (AMI) harvesting during coronary surgery may also impair respiratory function in the postoperative period. The purpose of this study was to evaluate the influence of preserved integrity of pleura on respiratory function in patients undergoing coronary artery bypass grafting (CABG). METHODS: One hundred and forty-three patients who had on-pump-CABG operation with pedunculated LIMA graft were divided to 2 groups. The first group is the study group that pleura opened (group OP; N=69), and the other group is that their pleura protected (group C, N=74). All patients were evaluated with using respiratory function test parameters (functional vital capacity [FVC], force expiratory volume %-at the 1st second [FEV1%] in the preoperative period and on the 7th postoperative day). Respiratory problems, blood drainage amounts and used blood products in the postoperative period were measured. RESULTS: Preoperative FVC values were not different between the two groups (3.08+/-0.5 in group C and 3.37+/-0.7 L in OP group) (P>0.05). On the VII postoperative day this parameter did not show any significant difference between the groups (2.80+/-0.6 in group C and 2.75+/-0.5 liter in OP group) (P>0.05). Preoperative FEV1% values did not show any difference (77.6+/-4.6% and 76.0+/-2.7% in OP and C groups respectively. There was no significant difference between the postoperative FEV1% values (71.8+/-5.1% and 73.4+/-6.3% respectively) (P>0.05). Patients with protected pleura had significantly lower blood drainage and whole blood unit transfusion (P<0.05). CONCLUSIONS: Preservation of the pleural integrity during LIMA harvesting significantly reduces postoperative bleeding but not affects pulmonary functions.

Subfascial endoscopic perforator surgery ameliorates the symptoms of chronic venous ulcer (C6) patients.

AIM: Chronic venous insufficiency and the development of venous ulceration, as a result of this condition affects quality of life. In order to avoid skin changes and allow for quick remedy, subfacial endoscopic perforator surgery (SEPS) has been suggested and gained some popularity. The purpose of this study was to assess the healing rate of venous ulcers in patients undergoing SEPS. METHODS: The SEPS procedure by using two ports was applied in 20 patients with active venous ulceration (CEAP-C6). The results were evaluated by Doppler findings, Venous Disability Score (VDS) and Venous Clinical Severity Score (VCSS) before and after the operation. Patients with prior deep vein thrombosis were excluded from this study. RESULTS: The ulcers healed in all patients. Significant clinical improvement according to VDS and VCSS values was obtained in all patients after the procedures. There was no mortality or any other major complication during the follow up period. CONCLUSION: The advantages of using two-port, video-controlled SEPS procedure may provide freedom from the skin complications that can be seen after Linton operation with quick and sustainable ulcer healing.

Congenitally corrected transposition of the great arteries plus dextrocardia operated with an unusual operative technique.

We describe a case of congenitally corrected transposition of the great arteries plus dextrocardia and normal anatomical abdominal viscera. Systemic (tricuspid) valve replacement was performed due to moderately severe valve regurgitation. An unusual operative technique was used because of the patient's rare morphology. On cardiopulmonary bypass, the systemic valve was approached via a left atriotomy anterior to the left pulmonary veins, whereby the surgeon was positioned on the patient's left side. As the surgeon had excellent exposure from the opposite side of the table, he was able to perform a tricuspid valve replacement through the left atrium. Our aim is to share our limited experience of such cardiac morphology, which may oblige the surgeon to be positioned on the left side of the table to perform systemic valve surgery.