Acar Tokcan

Intravenous leiomyomatosis extending into the right ventricle after subtotal hysterectomy

A case of intravenous leiomyomatosis with extension into the right ventricle is described. A tumor in the inferior vena cava was detected three years after a subtotal hysterectomy had been performed for a myomatous uterus but was misdiagnosed as a thrombus. The tumor enlarged and intruded into the right ventricle for which she underwent surgery. The correct diagnosis was made during the surgery, therefore a two-stage resection was planned. Surgical resection is the best treatment for intracardiac extension of intravenous leiomyoma. We recommend iliac venotomy to remove the ilio-caval portion of the tumor in both stages of operations.

A rare presentation of cardiac hydatid cyst: stroke and acute aortic occlusion.

Cardiac involvement in hydatid disease is uncommon. We report a case of a surgically treated ruptured left ventricular hydatid cyst, which presented with acute stroke and was later complicated by distal aortic embolism due to perioperative dislodgement of the germinative membrane.

Effects on Reperfusion Injury of Adding Diltiazem to Tepid Blood Cardioplegia

BACKGROUND Although the present techniques of myocardial preservation for limiting ischemia/reperfusion injury in open heart operations yield excellent results for most patients, certain subgroups of patients with advanced coronary artery disease present a challenge in terms of intraoperative safety. METHODS In a prospective, randomized, controlled study, we assessed the myocardial protective effects of a total dose of 150 +/- 150 = 300 microg/kg diltiazem added to induction and terminal (reperfusion) doses of tepid blood cardioplegia. We determined the myocardial morphological (ultrastructural) and enzymatic (serum assays for the cardiospecific isoenzyme of creatine kinase [CK-MB]) changes and functional recovery (atrioventricular [AV]-node recovery time and postoperative need for inotropic support) in patients undergoing elective coronary artery bypass operations. The determinations were made with respect to values for control patients, who received the same cardioplegia but without the addition of diltiazem. RESULTS The mean isoenzyme CK-MB levels and semiquantitative ultrastructural score values of the diltiazem group were significantly less than those of the control group. Although AV-node recovery time was significantly prolonged (P < .05), this factor did not have major clinical impact. CONCLUSIONS We concluded that the addition of 150 +/- 150 microg/kg diltiazem to the induction and terminal doses of tepid cardioplegia enhanced myocardial protection in elective aortocoronary bypass surgery in high-risk patients and presented no significant additional operative risk.

Electromechanical Effects of Protamine and Verapamil in Rat Papillary Muscle

The electromechanical effects of protamine sulfate and the calcium channel blocker verapamil on rat cardiac and skeletal muscles were studied using isolated left ventricular papillary muscle and phrenic nerve-hemidiaphragm preparations. Protamine produced significant decreases in isometric force in the cardiac tissue and contracture developed at concentrations of 40 and 80 mg·L−1. Isometric force also decreased significantly with verapamil at concentrations of 0.757 and 7.57 mg·L−1. Both drugs caused significant decreases in the contractile force of hemidiaphragm muscle when the tissue was stimulated indirectly. Protamine and verapamil caused the resting membrane potential and the amplitude of the action potential to decrease in cardiac tissue and overshoot failed to develop with 80 mg·L−1 of protamine or 7.57 mg·L−1 of verapamil. These bioelectrical changes developed in a dose-dependent manner. It was concluded that protamine had a similar effect to that of calcium channel blockers and it may act through a reduction of cellular calcium. This effect on cardiac tissue may be mediated through the sarcolemmal ion pumps or channels, leading to changes in calcium homeostasis.

Cerebral Circulation via Right Vertebral Artery in Takayasu's Arteritis

A 42-year-old woman had left fronto-orbital aching and amaurosis for 6 months. Fluorescein angiography of the left eye showed vasculitis. Aortography revealed total occlusion of both subclavian arteries, both carotid arteries, and the left vertebral artery, with serious narrowing of the abdominal aorta. The right vertebral artery was spared. Blood flow in the middle and anterior cerebral arteries was normal in spin-echo and phase-contrast magnetic resonance studies. Immuno-histochemical findings indicated Takayasus arteritis.

Angina Pectoris Due to Severe Muscular Bridge in Hypertrophic Cardiomyopathy

We report the case of a 39-year-old male with hypertrophic cardiomyopathy who complained of angina pectoris. The patient was treated with a beta blocker and a calcium antagonist without effect. Myocardial scintigraphy revealed anterior ischemia. Cardiac catheterization and ventriculography revealed severe systolic narrowing of the left anterior descending coronary artery and no significant pressure gradient across the left ventricular outflow tract. Myotomy was performed on a muscular bridge over the left anterior descending coronary artery and the patients angina was relieved. In young patients with hypertrophic cardiomyopathy who develop angina refractory to medical therapy, a coexisting muscular bridge should be sought.

Aortic regurgitation in Behçet's disease with aortitis and myxoid degeneration of the aortic valve leaflets

A case of Behçets disease (BD) associated with aortic regurgitation (AR) is presented. The patient had all four major criteria of BD. He also had AR complicated by pulmonary edema and heart failure. He was medically treated for his hemodynamic status after which he had an aortic valve replacement operation. The histopathological examination of the aortic wall revealed lymphocytic vasculitis of vasovasorum and fibrous thickening, and myxoid degeneration was observed in the aortic leaflets.