Circumflex coronary artery revascularization at the proximal atrioventricular groove.

Proximal circumflex coronary artery in the atrioventricular groove usually has large diameters. Arterial diameters in this region vary from 2.5 to 5 mm. Revascularization of this part of the circumflex artery allows good distal anastomosis configuration and better long-term patency rate.

Repair of Gerbode defect and aortic neocuspidization by using bovine pericardium in aortic valve endocarditis.

Aortic valve endocarditis may be destructive and cause an acquired Gerbode-type defect. The use of biological material in the closure of the Gerbode defect and reconstruction of the aortic valve is essential for both early and long-term survival. Herein, we present a 62-year-old male patient whose Gerbode defect was repaired with bovine pericardium. Additionally, the aortic valve was reconstructed by using bovine pericardium with Ozaki neocuspidization technique.

Inflammatory Myofibroblastic Tumor Invading the Left Atrium: Report of a Rare Case.

Inflammatory myofibroblastic tumors (IMTs) of the lung are rare solid tumors and usually affect children and young adults. We describe an unusual form of an IMT of the left lower lobe invading the left atrium. A 9-year-old male patient with recurrent cough was referred for an evaluation of left-lung pneumonia. Transthoracic needle biopsy was performed, and the histopathological examination showed mixed inflammatory cells. Accordingly, an IMT was considered. Left lower lobectomy was performed. A portion of the tumor invading the left atrium was resected together with the intact atrial wall. The postoperative period was uneventful, and the patient was discharged on the sixth postoperative day.

Chronic Otitis Media Resulting in Aortic Valve Replacement: A Case Report.

The bicuspid aortic valve is known to be the most common congenital cardiac malformation, with an approximate incidence rate of 1-2% in the general population. Most patients are unaware of the disease until the onset of infective endocarditis, which is a life-threatening complication that may affect a heart valve or other cardiac structures at the site of endothelial damage. A 22-year-old man presented to our internal medicine clinic with a complaint of acute onset dyspnea and fatigue. His body temperature was 38 (°)C. A diastolic murmur was detected at the right sternal border. Two-dimensional transthoracic echocardiography revealed severe aortic insufficiency, and two-dimensional transesophageal echocardiography showed that the aortic valve was bicuspid. There was also a flail lesion extending the left ventricular outflow tract, resulting in pathological coaptation and severe aortic insufficiency. The patient was referred to our cardiovascular department for surgery. We herein present this case of a bicuspid aortic valve complicated by infective endocarditis due to the underlying disease of chronic otitis media related to a rare pathogen: Alloiococcus otitidis. The patient underwent a successful aortic valve replacement surgery due to aortic insufficiency following infective endocarditis. He was discharged on the 16(th) postoperative day in good condition.

Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery. METHODS: There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD. RESULTS: There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality. CONCLUSION: The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.

[Effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits]. / Tavsan karotis arterlerinde yapilan anastomozlarda bosentanin intima hiperplazisi üzerine olan etkisi.

OBJECTIVES: We investigated the effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits. STUDY DESIGN: Eighteen New Zealand male rabbits were randomized into two groups, as drug (Group B) and non-drug (Group A). The right carotid artery of all the subjects was transected and anastomosed end-to-end with 10/0 polypropylene suture. The left carotid artery was left intact. Group B subjects received 30 mg/kg/day oral bosentan for 21 days, starting 3 days before the operation. Group A subjects did not receive any medication. After 28 days, the anastomoses site and the contralateral control site were removed, and samples were investigated histomorphometrically. RESULTS: Significant intimal hyperplasia was observed at all anastomoses compared to the non-anastomotic left side. Bosentan decreased significantly the intimal area [Group A: 48.3 µm(2) (37.1 µm(2)-65.7 µm(2)), Group B: 31.4 µm(2) (12.2 µm(2)-63.2 µm(2)), (p=0.04)] and intima/media area ratio [Group A: 0.49 (0.13-0.74), Group B: 0.22 (0.09-0.37), (p=0.024)] compared to the non-drug group. CONCLUSION: According to our investigation, bosentan decreased the intimal hyperplasia developed in a rabbit carotid artery model. Further investigations are needed to support the potential clinical utilization of bosentan after vascular interventions.

Surgical repair of aneurysm of arteriovenous fistula in patients with chronic renal failure.

THE AIM OF THE STUDY: The aim of the study was to show the efficacy and results of aneurysm reconstruction that was developed for relieving the patients from pain and mass effects and to give an early hemodialysis option. MATERIAL AND METHODS: Medical records were retrospectively screened over a period of 17 years to identify patients diagnosed with and surgically treated for aneurysm of an AV fistula. Twenty-eight patients were included in this study. The mean average age was 44 ± 3 years (31-60). Seventeen (60.7%) patients were female. Twenty-two (78.5%) patients had hypertension and 9 (32.1%) patients had diabetes mellitus. Aneurysm was examined by using ultrasonography to reveal the flow dynamics. The aneurysm was resected and an appropriate sized graft was interposed under local anesthesia. The same vein was dissected and anastomosed over the graft in an end-to-side fashion. RESULTS: Mean aneurysm diameter was 40 ± 12 mm. All aneurysm tissues and thrombotic materials were removed from the surgical field. Mean graft length was 37 ± 11 mm. Three (10.7%) patients need surgical revision because of postoperative bleeding. Dermal necrosis occurred in 1 (3.5%) patient. Infection was noted in 1 (3.5%) patient. Vascular access was started from the reconstructed venous area 2 or 4 days later in all patients. The patency rate was 100% in three years. CONCLUSIONS: Surgical reconstruction of the arteriovenous fistula aneurysm can be safely performed in hemodialysis patients with low complication rates. It gives early vascular access with high patency rates. All patients are relieved from pain and distended mass effect.

Carotid intima-media thickness in patients with slow coronary flow and its association with neutrophil-to-lymphocyte ratio: a preliminary report.

BACKGROUND: The slow coronary flow (SCF) is characterized by angiographically normal or near-normal coronary arteries with delayed progression of the contrast agent into distal vasculature. We aimed to investigate neutrophil-to-lymphocyte (N/L) ratio and the carotid intima-media thickness (CIMT) value in patients with SCF compared to patients with newly diagnosed coronary artery disease (CAD) and normal patients. MATERIALS AND METHODS: We enrolled 60 consecutive patients with SCF, 68 patients with CAD, and 72 normal patients. The association between thrombolysis in myocardial infarction frame count, CIMT, and N/L ratio and other clinical and laboratory parameters were evaluated. RESULTS: The N/L ratio was significantly higher not only in patients with SCF but also in patients with CAD, compared to those of controls. The N/L ratio was positively and moderately correlated with CIMT in the whole study population. CONCLUSIONS: The NL ratio is significantly associated with reduced coronary blood flow, and elevated N/L ratio might be an independent predictor for the presence of SCF.

Taurine attenuates lung ischemia-reperfusion injury after lung transplantation in rats.

PURPOSE: Taurine, the major intracellular free amino acid found in high concentrations in mammalian cells, is known to be an endogenous antioxidant and a membrane-stabilizing agent. It was hypothesized that taurine may be effective in reducing ischemia-reperfusion injury after lung transplantation and an experimental study was conducted in a rat model. METHODS: The number of Sprague-Dawley rats used in the study was 35. Animals were randomized into five groups of 7 rats each, including control, donor I, donor II, ischemia-reperfusion injury, and treatment groups. All animals were exposed to the same experimental conditions in the preoperative period. Rats were fixed in a supine position after the induction. After the rats were shaved, a left pneumonectomy was performed following sternotomy in control, donor I, and donor II groups. The harvested grafts in donor I and donor II groups were transplanted to the rats of the ischemia-reperfusion group and treatment group, respectively. However, taurine was administered intraperitoneally for 3 days before the harvesting procedure in donor II. All harvested lungs were kept in a Euro-Collins solution at +4 °C for 24 h in a half-inflated manner. After harvesting and transplantation, lungs were sampled for histopathological and biochemical analysis. RESULTS: Malondialdehyde and superoxide dismutase, glutathione peroxidase, and catalase levels were lower in the treatment group than the other groups (p < 0.05). Histopathological findings were better in treatment group than the ischemia-reperfusion group (p < 0.05). CONCLUSION: It was demonstrated that donor treatment with taurine resulted in preservation of transplanted lung tissue in respect to histopathological and biochemical findings.