A. Yüksel Bozer

Atrial fibrillation after coronary artery bypass surgery: predictors and the role of MgSO4 replacement.

Abstract Background: Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. The aim of the study was to identify factors associated with atrial fibrillation (AF) and to determine the efficacy of postoperative magnesium sulphate (MgSO4) replacement on the incidence of AF after coronary artery bypass grafting (CABG) operation. Methods: Fifty patients undergoing CABG were studied prespectively. Consenting patients with good left ventricular function and without any documented arrhythmias were randomly divided into two groups of 25 patients each in a double‐blind fashion. The clinical characteristics of both groups were similar. In the study group, 200 mEq MgSO4 was given for the first 5 postoperative days, in the control group, placebo was given instead of MgSO4. Results: Five (20%) patients in the control group and one (4%) patient in the MgSO4 group experienced AF. There was no significant relationship between the development of AF and the following variables: age; sex; diabetes mellitus; hypertension; previous myocardial infarction; smoking; extension of coronary artery disease; aortic cross‐clamp time; number of grafts; cardiopulmonary bypass time; postoperative pericarditis; and anemia. Conclusion: The use of MgSO4 in early postoperative period is effective in reducing the incidence of AF after CABG in patients with good ventricular function.

Blood cyst of the pulmonary valve causing pulmonic valve stenosis

B lood cysts of the heart valves are frequently seen as a postmortem finding on the atrioventricular valves of infants aged 16 months. They are usually small, rounded, pinpoint to pinhead nodules on the submarginal part of the atrial surface of the CUSPS,~,~ but are also seen less often on the ventricular surfaces of the semilunar valves2 Although these cysts seem to disappear after 6 months of age, rare cases have been described in children and adults.M We describe a child who underwent successful1 surgical excision of a blood cyst from the pulmonary valve. A lo-year-old girl was referred because of suspected pulmonary stenosis. At the age of 8 years, a precordial murmur was observed. There were no symptoms of cardiac dysfunction. She looked healthy. Physical examination was normal except for the heart. There was a palpable systolic thrill, and palpable pulmonary valve closure in the second left intercostal space. An opening click of the pulmonary valve and a grade 3 to 416 systolic ejection murmur was heard at the same area. A pulmonic second sound was accentuated ana’ relativelyhed splitting was established. The electrocardiogram showed a frontal QRS axis of loo”, and a mild right ventricular hypertrophy. Posteroanterior x-ray projection demonstrated moderate prominence of the pulmonary trunk. Two-dimensional echocardiography revealed an abrupt pressure gradient between the pulmonary artery and right ventricle of 68 mm Hg. Cardiac catheterization confirmed the diagnosis. Pulmonary balloon valvuloplasty reduced the gradient to 41 mm Hg. On the cineangiogram, there was a persistent, rounded, sharply demarcated filling defect in the pulmonary trunk, slightly below the valve (Figure 1). The cineangiocardiogram also showed mild pulmonary stenosis and poststenotic dilatation of the main pulmonary artery. On June 17, 1992, open heart surgery was peformed. At operation, the pulmonary artery was seen to be greatly dilated ana! a systolic thrill was palpated over the pulmonary trunk. A longitudinal incision was made and a dark red-colored, lobulated cystic mass measuring I .5 X 1 X 0.8 cm was seen (Figure 2). The valve cusps were normal. The cyst originated from the left posterior pulmonary valve leaflet. The cyst was removed by sharp dissection at its base. During the excision the cyst was opened and bloody fluid flowed out. The basilar layer of the cyst at its base was not removed from the ventricular suface of the cusp. The excised cyst was ovoid and lobulated, and measured I .5 X 1 X 0.9 cm. The wall of the cyst was 0.1 to 0.2 cm in thickness, and lined with a single layer of cuboidal cells overlying an eosinophilic, relatively hypocellular stroma. After operation, no murmur was heard, and on subsequent examination no gradient

The Effect of Extracorporeal Circulation on Serotonin Metabolism

Abstract Serotonin metabolism during extracorporeal circulation was investigated in 11 patients who had undergone open-heart operations by detection of 5-hydroxyindoleacetic acid (5-HIAA) in the urine. The amount of 5-HIAA excreted was found to be significantly higher during operation as compared with preoperative control values. In the postoperative period no significant rise in 5-HIAA excretion was observed. The role of serotonin as a mediator in postoperative complications is discussed.

Traumatic Aorto-Esophageal Fistula: A Case Report

The patient, a 44-year-old man, was hospitalized with clinical findings of dysphagia, fever, chest pain, and hematemesis. He had developed dysphagia and chest pain upon swallowing a lamb bone during a meal about 9 days before. On the same day the bone was observed on the esophagograms taken (Figure 1). Laryngoscopy performed to remove it was unsuccessful. He developed hematemesis on the following day and 7 days after the incident it was about 100 cc again. Three days later fever was added to his clinical condition. After taking antibiotics for 6 days, the patient was referred to the clinic.