Abdulmecit Kantarci

An isolated single L-II type coronary artery anomaly: A rare coronary anomaly.

The incidence of congenital artery anomalies is 0.2-1.4%, and most are benign. Single coronary artery (SCA) anomalies are very rare. The right coronary artery (RCA) originating from the left coronary system is one such SCA anomaly, and the risk of sudden cardiac death (SCD) increases if it courses between the pulmonary artery and aorta and coexists with other congenital heart diseases. Additionally, coursing of the RCA between the great vessels increases the risk of atherosclerosis. We herein present the case of a 57 year-old man who was admitted to our cardiology outpatient clinic and diagnosed with an SCA anomaly in which the RCA arose from the left main coronary artery (LMCA) and coursed between the pulmonary artery and aorta. However a critical stenosis was not detected in imaging techniques, and myocardial perfusion scintigraphic evidence of ischaemia was found in a small area. Therefore, he was managed with conservative medical therapy.

The prevalence of coronary artery anomalies with coronary computed tomography

BACKGROUND/AIM In this study, the aim is to investigate the prevalence of various coronary artery anomalies (CAAs), evaluated by 256-detector row coronary computed tomography (CCT), within the Turkish population. MATERIALS AND METHODS We included 2973 patients who had received CCT. The high take-off right coronary artery (RCA) and left coronary artery (LCA), the RCA arising from the left sinus (LS), the LCA arising from the right sinus (RS), the circumflex artery (CX) arising from the RS, the single coronary ostium originating from the RS, the CX arising from the RCA, and the RCA arising from the pulmonary artery were evaluated. RESULTS Seventy-nine patients (2.65%) were diagnosed with CAAs. The frequency of high take-off of the RCA, LCA, and both was 0.1%, 0.67%, and 0.06%, respectively. Frequency of separate ostium of the left anterior descending artery and CX was 0.67%. The frequency of RCA originating from the LS, CX originating from the RS, LCA originating from the RS, LCA and RCA originating from the pulmonary artery, and CX originating from the RCA was 0.50%, 0.10%, 0.23%, 0.03%, and 0.20%, respectively. CONCLUSION In this study, CCT was demonstrated to be a high-quality imaging modality for the detection of CAAs.

How to close open choledochotomy: primary closure, primary closurewith T-tube drainage, or choledochoduodenostomy?

BACKGROUND/AIM Although common bile duct stones are generally treated endoscopically, surgery is required if endoscopic removal is impossible. The aim of this study was to compare the surgical options in such patients. MATERIALS AND METHODS A total of 282 patients with common bile duct stones underwent open choledochotomy; primary closure was applied in 48 (17.0%), primary closure with T-tube drainage in 81 (28.7%), and choledochoduodenostomy in 153 (54.3%) patients. RESULTS Postoperative complications were seen in 8 (16.7%) patients in the primary closure, 33 (40.7%) patients in the primary closure with T-drainage, and 37 (24.2%) patients in the choledochoduodenostomy group. No significant differences were observed among the groups (P > 0.05). The mean postoperative hospital stays in the primary closure, primary closure with T-tube drainage, and choledochoduodenostomy groups were 5.5, 13.5, and 8.9 days, respectively. The mean postoperative hospitalization was significantly shorter in the primary closure group than in the other groups (P < 0.05). CONCLUSION Primary closure is a safe and feasible method in selected patients.

A Rare Congenital Anomaly: Interrupted Aortic Arch and Giant Ascending Aortic Aneurysm in a Young Male

Interrupted aortic arch (IAA) is a rare congenital cardiac defect defined as complete loss of luminal and anatomical continuity between the ascending and descending segments of the aorta. Very few patients can reach adult age without surgical correction. These cases showed diagnosis of the nearly asymptomatic Type A IAA with aortography and multislice computed tomography (MSCT). A 27-year-old male patient was applied to the internal medicine department with complaint of fatigue. They heard a diastolic murmur on the aortic focus and referred the patient to our cardiology polyclinic. Physical examination showed reguler heart beat with blood pressures of 150/90 mm Hg in the right arm, 140/90 mm Hg in the left arm, 100/60 mm Hg in the right limb and 100/60 mm Hg in the left limb, and there was a diastolic murmur prominently on the aortic fo-cus. Electrocardiogram was in sinus rhytm and normal. His chest ro-entgenogram (anteroposterior) showed a dilated aortic root. When we made echocardiography, we saw bicuspit aortic valve with moderate aortic regurgitation and dilatation of the ascending aorta (70 mm). Then an attemp to perform aortography via femoral artery fa-iled because the aortic arch was not able to go through. When we gave contrast, we saw that the aortic arch was interrupted. Aortography via the right brachial artery showed a giant ascending aortic aneurysm (70 mm), severe aortic regurgitation, interruption of the aortic arch distal to the left subclavian artery (Fig. 1, arrow) and prominent collateral circulation (Fig. 2, arrows). After aortography, the patient underwent a MSCT. MSCT confirmed the diagnosis of the IAA distal to the orgin of the left subclavian artery and measured the ascending aorta as 75 mm (Fig. 3, arrow). The patient was referred to an experienced surgeon on adult congenital heart diseases, but was denied surgery due to lack of symptoms. In this case, a rare congenital anomaly was detected with transcatheter aortography and MSCT diagnostic techniques, which complement each other. Fig. 1 Fig. 2 Fig. 3