MID TERM RESULTS AFTER OPEN HEART SURGERY IN HEMODIALYSIS PATIENTS AWAITING KIDNEY TRANSPLANT: DOES CARDIOVASCULAR SURGICAL INTERVENTION PRIOR TO TRANSPLANTATION PROLONG SURVIVAL?

The aim of this study was to compare the mid and long term postoperative outcomes between the hemodialysis-dependent patients awaiting kidney transplantat who underwent open heart surgery in our department during the last five years, and those who did not receive a renal transplant, to determine the predictors of mortality, and assess the possible contribution of post heart surgery kidney transplantation to survival. The patients were separated into two groups: those who underwent a transplantation after open heart surgery were included in the Tp+ group, and those who did not in the Tp- group Between June 2008 and December 2012, 127 dialysis dependent patients awaiting kidney transplant and who underwent open heart surgery were separated into two groups. Those who underwent transplantation after open heart surgery were determined as Tp+ (n=33), and those who did not as Tp- (n=94). Both groups were compared with respect to preoperative paramaters including age, sex, diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), obesity, smoking, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), left ventricle ejection fraction (EF), Euroscore; operative parameters including cross clamp time, perfusion time, number of grafts, use of internal mammary artery (IMA); postoperative parameters including revision, blood transfusion, ventilation time, use of inotropic agents, length of stay in the intensive care unit and hospital, and follow up findings. Problems encountered during follow up were recorded. Predictors of mortality were determined and the survival was calculated. Among the preoperative parameters, when compared with the Tp- group, the Tp+ group had significantly lower values in mean age, presence of DM, obesity, PVD, and Euroscore levels, and higher EF values. Assessment of postoperative values showed that blood transfusion requirement and length of hospital stay were significantly lower in the Tp+ group compared to the Tp- group, whereas the length of follow up was significantly higher in the Tp+ group. The use of inotropic agents was significantly higher in the Tp- group. A logistic regression analysis was made to determine the factors affecting mortality. Revision (p=0.013), blood transfusion (p=0.017), ventilation time (p=0.019), and length of stay in the intensive care unit (p=0.009) were found as predictors of mortality. Survival rates at years 1, 2 and 3 were 86.1%, 81%, 77.5% in the Tp- group, and 96.0%, 96.3%, 90.4% in the Tp+ group. Median survival rate was 41.35±2.02 in the Tp- group, and 49.64±1.59 in the Tp+ group which was significantly higher compared to the Tp- group (p=0.048). Chronic renal failure is among the perioperative risk factors for patients undergoing open heart surgery. Transplantation is still an important health issue due to insufficiency of available transplant organs. Patients with chronic renal failure are well known to have higher risks for coronary artery disease. A radical solution of the cardiovascular system problems prior to kidney transplantation seems to have a significant contribution to the post transplant survival.

Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow.

We evaluated the efficiacy of oral diypridamole therapy for the normalization of angiographically determined slow coronary artery flow. Diypridamole, which has dilatator properties on coronary microvessels, proved to be an effective treatment in most patients with slow coronary artery flow.

Left ventricular inflow normal or pseudonormal. A new echocardiographic method: diastolic change of left atrial diameter.

UNLABELLED: Mitral flow Doppler study has been used to evaluate left ventricle (LV) diastolic function. Through its use, greater A wave than E wave, pseudonormal pattern, and restrictive pattern were observed progressively in patients with more LV diastolic dysfunction. Differentiation of normal or pseudonormal mitral flow is very important. In this study, left atrium (LA) diameter change during diastole was used as a new method for the differentiation of normal and pseudonormal mitral flow. METHOD: Sixty-eight patients (30 men, 38 women; mean age 53 +/- 13 years) with echocardiographically determined diastolic dysfunction and 60 healthy volunteers (36 men, 24 women; mean age 49 +/- 12 years) were included in the study. Mitral flow E/A ratio, isovolumetric relaxation time (IVRT), and deceleration time (DT) of E wave were used for determination of the diastolic dysfunction. Thirty of 68 diastolic dysfunction patients had A>E wave, 20 had pseudonormal mitral flow pattern, and 18 had restrictive mitral flow pattern. Left parasternal long-axis echocardiographic window was used for the measurement of LA diameter. Left atrium emptying fraction (LAEF) was defined as ratio of end-diastolic LA diameter to end-systolic diameter. RESULTS: LAEF was found 0.69 +/- 0.01 (mean +/- SE) in the control group, 0.76 +/- 0.01 in the A>E group (P < 0.05, control vs A > E group), 0.83 +/- 0. 05 in the pseudonormal pattern group (P < 0.05, control vs pseudonormal pattern group), and 0.87 +/- 0.01 in the restrictive pattern group (P < 0.001, control vs restrictive pattern group). CONCLUSION: (1) LV diastolic dysfunction reduces the filling of LA content to the LV during diastole; (2) LA diameter changes during diastole as a new and practical method for the differentiation of the normal-pseudonormal mitral flow pattern.

Interventricular septal hydatid cyst.

In this report we describe an unusual case of cardiac echinococcus located in the interventricular septum invaded by a cystic mass. It was demonstrated by using transthoracic echocardiography (TTE) and confirmed with magnetic resonance imaging (MRI). Surgical excision (cystopericystectomy) was performed on the patient as a curative therapy. Early recurrence was observed despite additional medical therapy with albendazole.