The plasma galectin-3 level has high specificity and sensitivity for predicting postoperative atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: Postoperative new-onset atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) surgery. This study aimed to determine the utility of the preoperative netrin-1 and galectin-3 levels for predicting POAF following CABG surgery, as well as that of postoperative serial measurement for assessing these markers' patterns of expression. PATIENTS AND METHODS: This prospective cohort study included 50 patients that underwent CABG surgery. The plasma netrin-1 and galectin-3 levels were measured via enzyme-linked immunosorbent assay (ELISA) before surgery (baseline) and at 6, 12, and 24 h after surgery. The patients were divided into two groups according to the occurrence of POAF; the POAF (+) group and the POAF (-) group. RESULTS: In total, 26 patients developed POAF, whereas 24 remained in sinus rhythm. Baseline galectin-3 levels were higher in the POAF (+) group than in the POAF (-) group (30.7 ± 10.1 pg mL-1 and 15.7 ± 3.6 pg mL-1, respectively). The post-CABG surgery galectin-3 level increased in both the POAF (+) and POAF (-) groups at 6 h (46.2 ± 26.3 pg mL-1 and 24.9 ± 5.9 pg mL-1, respectively), 12 h (45.2 ± 24.1 pg mL-1 and 26.6 ± 9.3 pg mL-1, respectively), and 24 h (54.2 ± 33.5 pg mL-1and 28.6 ± 7.7 pg mL-1, respectively). The plasma netrin-1 level did not differ between groups at baseline or at 6, 12, and 24 h post CABG surgery. CONCLUSIONS: Whereas netrin-1 does not appear to have any utility as a marker for the development of POAF in CABG surgery patients, the plasma galectin-3 level has high specificity and sensitivity for predicting POAF following CABG surgery and could be considered a marker for predicting POAF.

The effects of dexmedetomidine on human internal mammary artery and saphenous vein grafts under hypothermia and normothermia.

OBJECTIVES: The purpose of this study was to determine the effects of hypothermia and normothermia on the isolated human saphenous vein (SV) and internal mammary artery (IMA) responses to dexmedetomidine. METHODS: The response of human IMA and SV strips with (E+) and without (E-) endothelium subjected to cumulative concentrations of (10-9, 0-6 M) dexmedetomidine were recorded at 37 °C and at 28 °C. OnE-way ANOVA was used for analysis. A p < 0.05 was considered significant. RESULTS: At 37˚C dexmedetomidine resulted in similar significant concentration-dependent contractions in both E+ and E- SV strips (p < 0.05). At 37 °C dexmedetomidine resulted in significant concentration-dependent contractions in E+ IMA strips, these contractions were significantly lower at all concentrations of dexmedetomidine in E- compared to E+ IMA strips (p < 0.05). When results between similar groups of SV and IMA strips were compared, the contractions were significantly higher in the IMA strips in E+ and E- at 37 °C and also E- 28 °C groups compared to SV (p < 0.05). CONCLUSION: In conclusion, dexmedetomidine causes in vitro vasoconstriction in human IMA and SV grafts. These contractions are greater in IMA compared to SV grafts. Endothelium-derived pathways are possibly involved in the contractile responses of IMA. Moderate hypothermia augments vasoconstriction in SV grafts (Fig. 3, Ref. 27).

Prospective ECG-gated high-pitch dual-source cardiac CT angiography in the diagnosis of congenital cardiovascular abnormalities: Radiation dose and diagnostic efficacy in a pediatric population.

PURPOSE: The goal of this study was to investigate the radiation dose and diagnostic efficacy of cardiac computed tomography angiography (CCTA) using prospective ECG-gated high-pitch dual-source computed tomography (DSCT) in the diagnosis of congenital cardiovascular abnormalities in pediatric population. MATERIALS AND METHODS: One hundred five pediatric patients who were clinically diagnosed with congenital heart disease with suspected extracardiac vascular abnormalities were included in the study. All CCTAs were performed on a 128×2-section DSCT scanner. CCTA findings were compared with surgical and/or conventional cardiac angiography findings. Dose-length product (DLP) and effective doses (ED) were calculated for each patient. Patients were divided into 4 groups by age, and ED and DLP values were compared among groups. The image quality was evaluated using a five-point scale. RESULTS: CCTA showed 173 abnormalities in 105 patients. There were 2 patients with false positive and 3 with false negative findings. The sensitivity and specificity of CCTA were 98.3% and 99.9%, respectively. The positive predictive value and negative predictive value of CCT were 98.9% and 99.9%, respectively. The average DLP and ED values were 15.6±9.6 (SD) mGy.cm and 0.34±0.10 (SD) mSv, respectively. The mean image quality score was 4.8±0.5 (SD) in all patients. The inter-observer agreement for the image quality scores was good (κ=0.80). CONCLUSION: CCTA is an excellent imaging modality for evaluation of cardiovascular abnormalities and provides excellent image quality with very low radiation exposure when low-dose prospective ECG-triggered high-pitch DSCT is used.

Unexpected malignant pericardial mesothelioma presenting as pericardial constriction.

Pericardial mesothelioma is a rare and highly aggressive and lethal cardiac tumour. A 25-year-old male patient who was complaining of fever, night sweats, shortness of breath and palpitations after an upper respiratory system infection was admitted in May 2008. He had a history of 12 years exposure to asbestos. When the patient was referred to our hospital in June 2008, his complaints of palpitations and shortness of breath were continuing. He had oedema of legs and a venous swelling on his neck. The echocardiography showed pericardial effusion and pericardial thickening which were also found on the CT. Through median sternotomy a pericardectomy and tumor resection were performed. Histological and immunohistochemical findings lead to the diagnosis of malignant pericardial mesothelioma. In conclusion, there is still not a radical therapy for primary pericardial mesothelioma. Surgery is done to prevent cardiac tamponade and relieves constriction (Fig. 1, Ref. 12).

Surgical management of left main coronary artery aneurysm.

Aneurysmal dilatation of coronary arteries is characterized by abnormal dilatation of a localized or diffuse segment of the coronary arterial tree. Left main coronary artery aneurysms are rare coronary anatomic abnormalities. They rarely involve the left main coronary artery. Different strategies have been adopted, where the coronary artery aneurysms have been left as such, resected partially, isolated, reconstructed, ligated with a simultaneous bypass with internal mammary artery, or treated with vein grafts. We report a case of a successful ligation of aneurysm of the left main coronary artery and three simultaneous coronary artery bypass procedures (Fig. 1, Ref. 15).

Characteristics of venous insufficiency in western Turkey: VEYT-I study.

OBJECTIVES: Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. METHOD: Randomized patients who applied to a health-care centre were included in this study. The Tübingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. RESULTS: A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 ± 9.4. CONCLUSION: The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

Mitral valve repair for active culture positive infective endocarditis.

OBJECTIVE: To describe the clinical and echocardiographic outcome after mitral valve (MV) repair for active culture positive infective MV endocarditis. PATIENTS AND METHODS: Between 1996 and 2004, 36 patients (mean (SD) age 53 (18) years) with positive blood culture up to three weeks before surgery (or positive culture of material removed at operation) and intraoperative evidence of endocarditis underwent MV repair. Staphylococci and streptococci were the most common pathogens. All patients had moderate or severe mitral regurgitation (MR). Mean New York Heart Association (NYHA) class was 2.3 (1.0). Follow up was complete (mean 38 (19) months). RESULTS: Operative mortality was 2.8% (one patient). At follow up, endocarditis has not recurred. One patient developed severe recurrent MR and underwent valve replacement and one patient had moderate MR. There were two late deaths, both non-cardiac. Kaplan-Meier five year freedom from recurrent moderate to severe MR, freedom from repeat operation, and survival were 94 (4)%, 97 (3)%, and 93 (5)%, respectively. At the most recent review the mean NYHA class was 1.17 (0.3) (p < 0.0001). At the latest echocardiographic evaluation, left atrial diameters, left ventricular end diastolic diameter, and MV diameter were significantly reduced (p < 0.05) compared with preoperative values. CONCLUSIONS: MV repair for active culture positive endocarditis is associated with low operative mortality and provides satisfactory freedom from recurrent infection, freedom from repeat operation, and survival. Hence, every effort should be made to repair infected MVs and valves should be replaced only when repair is not possible.

A rare vascular malformation, Klippel-Trenaunay syndrome. Report of a case with deep vein agenesis and review of the literature.

The Klippel-Trenaunay syndrome (KTS) is a rare anomaly characterized by naevus, soft tissue hypertrophy and varicosities which is mainly unknown etiology. Associated deep venous system abnormalities have been reported with KTS. Here, a 4-year-old-boy with KTS was reported, because of the associated popliteal vein, common femoral vein with its deep and superficial branches, and external iliac vein agenesis. The originality of the presented case is that we have never observed such a case before.

Simultaneous bilateral carotid endarterectomy: our first experience.

UNLABELLED: Indications for and against bilateral carotid surgery as a simultaneous or a staged procedure and patient selection criteria for simultaneous bilateral carotid endarterectomies (SBCE) are discussed. METHODS: Six patients who underwent 12 SBCE (group A) were compared with 20 patients who underwent 40 bilateral staged endarterectomies (group B). The indications and surgical management were similar and the accompanying risk factors were comparable in both groups. A shunt or patch was not used and the occlusion time was 12.5+/-2'. Total occlusion time in the SBCE was 25+/-2.5'. RESULTS: The results are comparable in both groups. In the SBCE group no major neurological complications were noted except for a transient hypoglossal paresis. In group B a case with transient ischemic attack (TIA) was noted; however no mortality, myocardial infarct, respiratory problems or permanent damage of the central nerves were observed in either groups. CONCLUSION: Although our number of patients was not satisfactory to yield a conclusion, our results, together with that of the international literature were encouraging for SBCE. SBCE can be safely performed, in experienced hands with a better preoperative assessment of the function of the circle of Willis in association with meticulous surgical technique and proper patient selection.

Detection of Chlamydia pneumoniae and Helicobacter pylori DNA in human atherosclerotic plaques by PCR.

Chlamydia pneumoniae and Helicobacter pylori can cause persistent infections of the respiratory and gastrointestinal tract, respectively. It has been suggested that persistent infection of arteries with these bacteria can contribute to the development of atherosclerosis. The aims of this study were to determine the presence of C. pneumoniae and H. pylori DNA in atherosclerotic plaque samples by PCR and to evaluate the correlation between clinical status and DNA positivity of these bacteria. Eighty-five consecutive patients (mean age, 59 +/- 10; 75 male, 10 female) undergoing coronary artery bypass grafting, carotid endarterectomy, and surgery of the abdominal aorta for atherosclerotic obstructive lesions were included in the study. Forty-six endarterectomy specimens from the atherosclerotic lesions and 39 specimens from healthy regions of the ascending aorta, which were accepted as the control group, were excised. The presence of microorganism DNA in endarterectomy specimens was assessed by PCR. C. pneumoniae DNA was found in 12 (26%) of 46 endarterectomy specimens and none of the healthy vascular-wall specimens (P < 0.001), while H. pylori DNA was found in 17 (37%) of 46 endarterectomy specimens and none of the controls (P < 0.001). Either C. pneumoniae or H. pylori DNA was positive in 23 (50%) of 46 patients and none of the controls (P < 0. 001). Six of the atherosclerotic lesions showed coexistence of both of the microorganism DNAs. The presence of C. pneumoniae and H. pylori DNA in a considerable number of atherosclerotic plaques but their absence in healthy vascular wall supports the idea that they may have a role in the development of atherosclerosis, especially in countries where infection is prevalent and where conventional risk factors fail to explain the high prevalence of atherosclerotic vascular disease.