Tetralogy of fallot and absence of left pulmonary artery.

Unilateral absence of the pulmonary artery is a rare congenital lesion usually caused by backward displacement of the conical artery of the truncus arteriosus. The purpose of this report is to describe and discuss the treatment of an 8-year-old patient who presented with cyanosis and was diagnosed with tetralogy of Fallot together with an absence of the left pulmonary artery and major aortopulmonary collateral arteries.

Effects of calcium dobesilate and diosmin-hesperidin on apoptosis of venous wall in primary varicose veins.

BACKGROUND: Evaluation of the therapeutic effects of calcium dobesilate and diosmin-hesperidin through regulation of apoptosis. PATIENTS AND METHODS: 56 Patients were divided into four groups; Group 1 consisted of patients (n = 18) with the recent diagnosis of primary varicose disorder who have never used medications, Group 2 consisted of patients (n = 14) who have used diosmin-hesperidin for at least six weeks prior to the operation, Group 3 consisted of patients (n = 14) who have used calcium dobesilate for at least six weeks prior to the operation and finally Group 4 (Control group) consisted of normal saphenous vein biopsies (n = 10). All biopsies were stained with Hematoxylin and Eosin. Tissue samples from 56 patients were immunohistochemically stained with antibodies of anti-bcl-2, anti-bax and anti-p53. Apoptosis was evaluated by TUNEL method. RESULTS: There were no statistically significant differences among the groups in respect to gender distribution and smoking status. Immunohistochemical evaluation of apoptosis related proteins revealed a statistically significant difference between Group 4 and the other groups with respect to the apoptag staining on venous wall (p = 0.026). There were significant differences in the presence of bcl-2 protein expression between groups 4 and Group 1 (p = 0.0002) and between Group 1 and Group 3 (p = 0.023). CONCLUSIONS: Our study highlights the significance of apoptosis in varicose disorders and suggests that calcium dobesilate, which is used in the treatment of varicose veins, could be of benefit by regulating apoptosis.

Giant aneurysm of left anterior descending coronary artery treated by surgical off-pump therapy.

Coronary artery aneurysms may predispose to acute thrombosis, embolisation and myocardial ischaemia or rupture with subsequent tamponade and/or sudden death. The optimal therapy for patients with coronary artery aneurysm is unknown, and controversy persists regarding the use of medical or surgical modalities. There is no doubt that surgical therapy is reserved for cases with large aneurysms or with myocardial ischaemia due to significant associated coronary artery stenoses. We discuss here the surgical management of a case with coronary artery aneurysm and concomitant coronary artery disease. Although the beating heart technique of myocardial revascularisation and repair of coronary artery aneurysm without cardiopulmonary bypass is not suitable for all patients, it should be considered for those high-risk patients who have impaired left ventricular function or who are at high risk for pulmonary or neurological complications.

The role of taurine added to pulmonary reperfusion solutions in isolated guinea pig lungs.

An experimental comparative study on isolated guinea pig-lungs has been undertaken to determine the probable beneficial effects of adding taurine to pulmonary reperfusion solutions in lung ischemia-reperfusion. 20 guinea pigs were used. The isolated lungs (n = 10 in each group) previously being perfused by oxygenated Krebs-Henseleit solution were put in normothermic ischemic conditions. After 3 hours of normothermic ischemia the lungs were reperfused (with Krebs-Henseleit solution in the control group, Krebs-Henseleit solution plus taurine 10(-2) M in the experiment group) for 20 minutes. Pulmonary artery pressures, tissue malondialdehyde (MDA) and glutathione (GSH) levels were measured before and after the ischemic period and also at the end of reperfusion. Malondialdehyde and glutathione levels of the pefusate were measured before ischemic period and at the end of reperfusion. An electron microscopic analysis was performed on the lung tissues before and after the ischemic period and also at the end of reperfusion. Decreased pulmonary artery pressure, tissue perfusate MDA levels and increased perfusate GSH levels were observed in taurine added group. Electron microscopic evaluation supported our findings indicating preservation of lamellar bodies of type II pneumocytes. It is concluded that taurine may play an important role in protecting tissue against ischemia-reperfusion injury by functioning as an antioxidant.

Biochemical and hemodynamic effects of ascorbic acid and alpha-tocopherol in coronary artery surgery.

This study was undertaken to evaluate the effects of alpha-tocopherol and ascorbic acid on markers of myocardial reperfusion injury and myocardial contractile function after coronary artery surgery. Forty-eight patients were divided into 4 groups; 300 mg/day alpha-tocopherol was given orally to the patients in group I for 14 days. In groups II and III, 4g of ascorbic acid was administered intravenously prior to induction and in the cardioplegic solution, respectively. Group IV was the control group. Blood samples were taken to determine the concentrations of creatine phosphokinase MB isoenzyme, malondialdehyde, uric acid, ascorbic acid and alpha-tocopherol in the perioperative period. Left ventricular functions were determined by means of MUGA scans and echocardiography preoperatively and on the 3rd and 7th days, postoperatively. The changes in serum creatine phosphokinase MB and malondialdehyde were significantly lower in study groups. when compared with the control group. We observed no significant changes in ventricular function, requirement for (+) inotropic agents and the incidence of ventricular arrhythmias among the groups, postoperatively. Biochemical findings are consistent with the free radical hypothesis. But we could not confirm these data with hemodynamic findings. This is probably due to the population of low-risk elective coronary surgery patients in this study.

Long-term effects of combined iliac dilatation and distal arterial surgery.

PURPOSE: When standard aortofemoral surgical procedure is combined with lower extremity vascular surgery, problems related with the hospital stay, morbidity, mortality and the cost of treatment will exist. The number of reports relating to combined iliac artery PTA and distal bypass surgery is limited. After the development of stenting procedures, the results of arterial system plasty have much more improved. This report reviews our preliminary experience with iliac artery angioplasty with distal bypass procedures. PATIENTS AND METHODS: A total of 41 patients have undergone combined iliac artery dilatation and distal arterial revascularization. Angioplastic procedures were performed in the angiography suite and distal surgery was carried out at the same day or the day after. Of all patients, 29 underwent percutaneous transluminal angioplasty (PTA) and 12 underwent combined PTA and stent placement. Ipsilateral femoropopliteal bypass was performed as a distal revascularization procedure in all patients. RESULTS: Mean systolic iliac artery pressure gradients improved from 34.7+/-8.6 mmHg to 3.9+/-3.2 mmHg after angioplastic procedures (P < 0.0001). Six patients needed reangioplasty because of restenosis in the follow-up period. Thrombectomy was performed on 1 patient in the early postoperative period and re-do femoropopliteal bypass was performed on two patients in the 2nd and 23rd months. Three minor wound infections were successfully treated with antibiotics and local care. Mean follow-up was 21.4 months (range 1-48 months). By life-table analyses, the overall 4-year cumulative primary patency of combined procedures was 78.1%. CONCLUSION: The results show that the combined procedure is a suitable method for the treatment of patients with multiple stenotic lesions at the iliac and distal arterial levels. We believe that the combined use of PTA and distal vascular surgery by an experienced surgical team will give beneficial results and a highly satisfactory outcome in this group of patients.

Eight year experience with the CarboMedics bileaflet valvular prosthesis.

Two hundred and two patients (97 female and 105 male; mean age: 45. 5+/-9 years) received CarboMedics bileaflet valves during a period of eight years. Ninety-one patients received mitral, 72 aortic and 39 aortic+mitral valve prosthesis. Tricuspid plasty and coronary artery bypass surgery were the concomitant operations in 17 and 12 patients, respectively. The mean follow-up period was 24.7 months and the ratio was 91%. Overall operative mortality was 3.96% (8 patients); 2.78% for aortic valve replacement (AVR), 3.29% for mitral valve replacement (MVR) and 7.7% for double valve replacement (DVR). The late mortality rate was 2.89% for AVR, 2.2% for MVR and 8. 3% for DVR. The main cause of mortality was low cardiac output. The overall survival rate was 91.5% in 2 years. The actuarial freedom from thromboembolism in 2 years was 97% for AVR, 95% for MVR and 84% for DVR. No mortality due to heamorrhagic events was observed. CarboMedics prosthetic heart valves may be used satisfactorily with a low incidence of valve-related morbidity and mortality.

Bland-White-Garland syndrome in an adult. Case report and review of diagnostic and predictive strategies.

In a 27-year-old man with Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery), comparison was made between conventional diagnostic techniques and radionuclide imaging for selection of surgical procedure and evaluating the outcome. Dynamic 99mTc imaging exactly located the left coronary artery orifice, which was not seen on angiography, thereby determining the surgical approach, and 123I study revealed that, despite absence of symptoms, the adrenergic activity of the heart was globally diminished, with limited response to revascularization.

Psychiatric complications of cardiac surgery postoperative delirium syndrome.

Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.

Mitral and aortic valve replacement using fresh unstented pulmonary and aortic homografts.

The use of prosthetic valves carries a high incidence of complications including thromboembolism, hemolysis, infection, impaired hemodynamic function and mechanical failure. Unstented homograft valves provide a good quality of life, particularly in terms of a reasonable freedom from these complications. This paper presents the first simultaneous replacement of the mitral and aortic valves using fresh unstented pulmonary and aortic homografts collected from the same donor. We believe that this technique will be especially useful in developing countries facing financial difficulties and problems with patient education.

The role of selenium added to pulmonary preservation solutions in isolated guinea pig lungs.

An experimental comparative study on isolated guinea pig lungs has been undertaken to determine the probable beneficial effects of adding selenium to pulmonary preservation solutions in lung ischemia. The isolated lungs (n = 10 in each group) previously being perfused by oxygenated Krebs-Henseleit solution were put in normothermic ischemic conditions just after the infusion of 30 ml of pulmonary preservation solution (Euro-Collins in the control group, Euro-Collins plus selenium 10(-3) mol in the experiment group). After 3 hours of normothermic ischemia the lungs were reperfused with the same buffer for 20 minutes. Pulmonary artery pressures, tissue malondialdehyde levels, and adenosine deaminase levels of the perfusate were measured before and after the ischemic period and also at the end of reperfusion. An electron microscopic analysis was performed on the lung tissues at the end of the experimental procedure. According to our data, the addition of selenium to pulmonary preservation solution showed a significant protective effect regarding both ischemic and reperfusion injury.

The effect of selenium added cardioplegia in guinea pigs.

1. The aim of the study was to determine the effect of selenium added cardioplegic solutions on postischemic myocardial recovery. 2. The hearts were mounted on Langendorf perfusion apparatus and perfused with Krebs-Henseleit solution. The hearts were arrested by one of the following cardioplegic solutions; (a) K+ 20 mmol/l (control group); (b) K+ 20 mmol/l+selenium 10(-3) mol/l (experimental group). After 20 min of normothermic ischemia the hearts were reperfused by the same buffer. 3. Postischemic percentage changes of heart rate, contractile force and heart work were compared between the groups. 4. Addition of selenium to the cardioplegic solution significantly decreased the postischemic myocardial injury.

The effects of thyroid hormones on the heart following global ischemia. A clinical and experimental study.

Cardiopulmonary bypass is associated with a reduction in plasma thyroid hormone concentrations in patients undergoing cardiac surgery. However, studies of the effects of cardiopulmonary bypass on thyroid function are limited and many studies report conflicting data concerning only the period of cardiopulmonary bypass. In this study, we tried to clinically determine the effects of cardiopulmonary bypass on concentrations of thyroid hormones by comprehensive thyroid function tests in 10 patients before and after surgery, and observed the benefits of triiodothyronine supplementation after global ischemia on myocardial function experimentally in guinea pigs. In patients undergoing surgery, concentrations of total triiodothyronine and free triiodothyronine decreased progressively on the institution of cardiopulmonary bypass and remained below normal levels until 24 hours postoperatively. In the guinea pig hearts studied in a Langendorf perfusion apparatus, T3 supplementation enhanced percentage recovery of ventricular contractile force, heart work and heart rate with respect to other groups receiving no T3 supplementation or T3 supplementation without any ischemic interval.

An unusual foreign body swallowed by a newborn causing respiratory distress.

Swallowed and inhaled foreign bodies in children under 5 years of age are common and considered serious causes of morbidity and mortality. However such occurrence is uncommon in infants and newborns. The current report deals with a strange object lodged in the oesophagus of a 20-day-old male newborn.

Effect of right atrial appendicectomy on the release of atrial natriuretic peptide in humans.

The present study evaluated the effect of right atrial appendicectomy on the release of atrial natriuretic peptide (ANP) and subsequent changes in postoperative haemodynamics in 20 men undergoing coronary artery bypass graft surgery. The right atrial appendix was removed in ten patients and saved in ten. Serum ANP, sodium levels and urinary sodium excretion were measured before and on days 1, 7 and 30 after surgery. Haemodynamic parameters were monitored before surgery and on day 30. Serum ANP levels fell significantly in patients undergoing appendicectomy (P < 0.05); haemodynamic parameters were unchanged. Hence, appendicectomy reduced serum ANP levels in the short term, though these tended to rise again with time; cardiac function was not affected by lowered levels of serum ANP. Consequently, saving the appendix in right atrial appendicectomy improves natriuresis and may decrease diuretic requirement.