Ahmet Dolapoglu

Giant Right Coronary Artery Aneurysm Associated with a Fistula Draining into the Superior Vena Cava

Giant coronary artery aneurysm associated with a coronary-cameral fistula is an uncommon condition. Such aneurysms are usually associated with other cardiac diseases, such as coronary atherosclerosis, and therefore might augment myocardial ischemia in adults. The main indications for surgical intervention are severe coexisting coronary artery disease, evidence of embolization, and aneurysmal enlargement or rupture. We describe a large right coronary artery aneurysm and a coronary-cameral fistula that drained into the superior vena cava. The surgical repair was successful.

Management of a Mycotic Thoracoabdominal Aortic Aneurysm Involving the Celiac Artery

A mycotic aneurysm that also involves the visceral arteries is a life-threatening condition. Surgical management typically consists of débridement and in situ repair with a Dacron graft and reimplantation of the involved visceral branches. We report a rare case of a mycotic saccular thoracoabdominal aortic aneurysm involving the celiac artery, with Streptococcus pneumoniae as the responsible organism. Successful repair of the aneurysm and concomitant revascularization of the celiac artery were achieved.

Can Septic Condition or Stroke Impact on the Procalcitonin Level Along With Mesenteric Ischemia After Cardiac Surgery

M IS C E L L A N E O U S the included studies. With regard to median survival, Figure 2 plots differences in median survival between the two procedures. No “assessment” or statistical comparison is made among studies, which would require inclusion of sample size, as the authors suggest. This figure is simply a visual aid to show how many studies favor pleurectomy with decortication and extrapleural pneumonectomy. The Allen study to which Cao and associates refer is an outdated study that was an invited paper and not part of a rigorous peer-reviewed journal process. We would recommend comparing results with those of more current studies that use immunohistochemistry for diagnosis, a TNM staging system, computed tomography, and modern surgical techniques.

Venous thromboembolism in heart transplantation: Should we consider genetic predisposition?

Ironman triathlon performance preand post-heart transplant Mark J. Haykowsky, PhD, Kenneth J. Riess, PhD, and Christian A. Schneider, MD From the Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Health Sciences, Northern Alberta Institute of Technology, Edmonton, Alberta, Canada; and the Department of Cardiology, PAN Klinik, Faculty of Medicine, University of Cologne, Cologne, Germany

Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.

Intraoperative Transesophageal Echocardiography Accurately Identifies Sinus of Valsalva Aneurysm in a 27-Year-Old Man

A 27-year-old man was referred for elective surgical removal of a right atrial mass. He had a history of dyspnea and mild chest discomfort on exertion. Four years earlier, he had undergone neck surgery to remove a swollen lymph node; it was benign and had not recurred. Recent cardiac magnetic resonance (CMR) images showed a 2 × 2 × 2-cm right atrial mass immediately inferior to the noncoronary sinus of Valsalva. The mass had a smooth, well-defined margin and was not attached to the interatrial septum (Fig. 1). Sensing a possible change in diagnosis, we performed intraoperative transesophageal echocardiography (TEE) via probe before making a median sternotomy. Compared with the preoperative CMR findings, TEE showed a sinus of Valsalva aneurysm (SVA) arising from the noncoronary cusp (Fig. 2), and no fistula between the aneurysmal sac and the cardiac chambers (Fig. 3). Aortic valve function and that of the other coronary sinuses were normal. After excising the aneurysmal sac, we repaired the resulting defect in the aortic wall in the usual fashion, placing a pericardial patch through an aortotomy (Fig. 4). Postoperatively, TEE showed normal aortic valve function and no regurgitation.

Left Ventricular Aneurysm Repair with Endoaneurysmorrhaphy Technique: An Assessment of Two Different Ventriculotomy Closure Methods.

BACKGROUND Left ventricular aneurysm is a serious mechanical complication of myocardial infarction and has an incidence of 10-35% after myocardial infarction. Ventricular aneurysm in patients with angina, heart failure, and ventricular arrhythmia should be surgically treated. Endoaneurysmorrhaphy is one of the repair techniques that results in better left ventricular geometry and function. After this surgical procedure the ventriculotomy is repaired either with Teflon felt strips or by direct suture of the epicardium. METHODS In this study, we described the postoperative early outcomes of two ventriculotomy closing techniques such as Teflon felt versus direct closure after aneurysm repair. This retrospective study included a total of 73 patients (mean age > 70 years) with left ventricular aneurysm, who underwent endoaneurysmorrhaphy repair between 1997 and 2009. All selected patients were divided into two groups according to the ventriculotomy closure technique either by Teflon felt or direct by epicardial closure. The pre-, intra-, and postoperative results of these patients were analyzed accordingly. RESULTS The postoperative early mortality rate and postoperative bleeding were not significantly different between the Teflon felt and primary closure groups (P = .246 and P = .371 respectively), but postoperative arrhythmias were significantly higher in the Teflon felt repair group (P = .049). CONCLUSION Endoaneurysmorrhaphy is a better surgical technique in left ventricle aneurysm to restore the internal contour and preserve the surface anatomy of the ventricle. The ventriculotomy closure can be performed with two different approaches, including Teflon felt strips or by direct suture of the epicardium. Based on this studys findings, two repair techniques have similar impact on the early outcomes. However, with overall outcomes with respect to Teflon felt repair, direct closure of the ventriculotomy after endoaneurysmorrhaphy was superior.