Ali Yener

Horseshoe lung with left lung hypoplasia.

Horseshoe lung is an uncommon congenital malformation in which the bases of the right and the left lungs are fused to each other by a narrow isthmus posterior to the cardiac apex. So far 22 cases have been described: most of these were associated with right lung hypoplasia and the scimitar syndrome. A horseshoe lung anomaly with left lung hypoplasia is described.

Corpus Sterni Reinforcement Improves the Stability of Primary Sternal Closure in High-Risk Patients

PurposeTo compare standard sternal closure techniques with reinforcement longitudinal wire placement in the corpus sterni in high-risk patients undergoing open-heart surgery via median sternotomy.MethodsThe subjects of this study were 71 high-risk patients, 32 (45%) of whom underwent sternal closure by conventional methods (group 1) and 39 (55%) of whom underwent sternal closure with corpus sterni reinforcement. The patients were followed up for a mean period of 90 days.ResultsIn group 2, none of the patients had sternal dehiscence and no revision was required, but in group 1, five (15.5%) patients had sternal dehiscence. This difference was significant between the groups (P = 0.024), but there were no significant differences in mediastinitis and mortality (P > 0.05).ConclusionsOur findings suggest that primary sternal closure with longitudinal wire reinforcement on both sides of the corpus sterni will decrease the risk of infection and improve wound-healing in parallel with a decrease in sternal dehiscence.

Effects of VEGF and MSCs on vascular regeneration in a trauma model in rats.

In the human body, vascular injuries that are caused by trauma, vessel lumen stenosis, and occlusions are often irreversible and can lead to sequelae formation as the vessels cannot reproduce fast enough. To solve this problem, the blood flow must be returned to the region as fast as possible. The adipose tissue contains progenitor cells with angiogenic potential and can be used to resolve the issue.

Another cause of chest pain: Coronary artery—Pulmonary artery fistulae

This report describes three patients with coronary artery fistula from proximal left anterior descending artery to the pulmonary artery. Retrospective analysis of 2756 adults undergoing coronary arteriography for evaluation of angina pectoris between July 1988 and January 2000 revealed coronary artery fistulae in three patients: one male (46 years old) and two females (45 and 53 years old). No murmur was audible in any patient. There was no associated significant coronary artery disease. The feeder arteries to the fistulae for all three patients were left anterior descending coronary artery. One of the patients underwent cardiopulmonary bypass and the fistulae was ligated, due to very strong angina. The diagnosis is mostly incidental during routine coronary arteriography. We concluded that the coronary artery-pulmonary artery fistula might be a cause of angina without audible murmur and may sometimes need surgical ligation.

The dose-dependent effects of L-carnitine in myocardial protection in normothermic ischemia

L-Carnitine has been shown to improve the post-ischemic recovery of myocardial function and metabolic measurements that are reduced in the course of ischemia and reperfusion of the heart. In this study we used 40 male guinea-pigs in order to determine if the effect of L-carnitine which is used in the protection of the post-ischemic reperfused heart, is dose-dependent or not. All harvested hearts were perfused for 30 min on modified Langendorf apparatus with oxygenized Krebs-Henseleit solution. After this period, in (n = 10), 5 mmol and 10 mmol (group B, n = 10) of L-carnitine were added into a Krebs-Henseleit solution. After 20 min, perfusion was complete and the hearts were then exposed to normothermic ischemia for 20 minutes. Following the ischemia, hearts were reperfused with the same solutions for 30 min. In group C (n = 10), 10 mmol of L-carnitine was added into the solution at the post-ischemic reperfusion step. In the control group, the same procedures were performed without using L-carnitine. Matching was done according to the contractile force of the heart rate and the levels of malondialdehyde and adenosine deaminase. When 10 mmol L-carnitine was added into the perfusion solutions at the pre-ischemic period, the best results were obtained and myocardial damage was much less than the control group. The protective effects of L-carnitine in normothermic ischemia is dose-dependent and it must be given at the pre-ischemic period.

New technique to enlarge the aortic annulus

A new technique is described to enlarge the aortic annulus and the supraaortic area by using the anterior mitral leaflet. This technique is used when it is necessary to replace both the aortic and mitral valves.

Dipyridamole induced myocardial recovery after global ischemia

1. An experimental comparative study on isolated guinea pig hearts was carried out to determine the effect of dipyridamole added to the reperfusion solution on myocardial recovery after global ischemia. 2. After 20 min of normothermic ischemia two groups of solutions: (1) Krebs solution; (2) Krebs + dipyridamole 20 micrograms/l (10 experiments in each group) were used for reperfusion. 3. Postischemic myocardial functions (heart rate, ventricular contractility, heart work) and tissue enzymes (CPK-MB, LDH) were compared with their preischemic values. 4. Addition of dipyridamole 20 micrograms/l to reperfusion solution improved postischemic myocardial functions and decreased myocardial injury.

Magnesium decreases cardiac injury in patients undergoing coronary artery bypass surgery

Background The calcium-channel blocking effect of magnesium might have protective effects in patients undergoing cardiopulmonary bypass surgery. We assessed the effects of magnesium on hearts undergoing coronary artery bypass surgery with intermittent warm blood hyperkalemic cardioplegia in the antegrade fashion. Patients and Methods Twenty patients undergoing coronary bypass surgery were randomly divided into two groups, a control group who received intermittent antegrade warm blood hyperkalemic cardioplegia for myocardial protection, and a study group who received the same solution with the addition of magnesium to the cardioplegia. Extracellular substrates (creatinine Phosphokinase, creatinine phosphokinase-MB group, lactate dehydrogenase, c-reactive protein, and cardiac troponin I were measured preoperatively and postoperatively. Results There were significant differences in the post-operative concentrations of creatinine phosphokinase, creatinine phosphokinase-MB group, c-reactive protein, and lactate dehydrogenase after cardiopulmonary bypass (P<0.001 ) in the study group compared with the control subjects. Cardiac troponin I levels were also significantly lower in the study group after cardiopulmonary bypass (P<0.005). Conclusions Our study indicates that if magnesium is added to intermittent antegrade warm blood hyperkalemic cardioplegia, blood levels of many markers of cardiac myocardial injury after cardiopulmonary bypass are lowered. This finding may have implications for myocardial protection.

Giant Benign Fibrous Tumor of the Pleura in a Pregnant Woman : Report of a Case

Abstract.While most pleural neoplasms are malignant and associated with asbestos exposure, benign tumors may also occur. Benign fibrous tumors of the pleura are rare and, unless diagnosed and resected early, they may reach an enormous size and cause severe symptoms. We report the case of a pregnant woman with a giant benign fibrous tumor localized in the pleura.

Temporary Blindness Due to Sodium Nitroprusside Overdosage in a Postoperative Patient: an Unusual Adverse Effect

Sodium nitroprusside dihydrate (SNP) is a powerful and easily managed vasodilator which is administered by intravenous infusion following appropriate dilution. Although it was first used in 1951 for treating hypertensive crises in adults, its use in children for this indication was first reported in 1969. 1 Since this report, it has been widely used in various cardiovascular and other disorders amenable to hypotensive therapy. The drug must be used carefully because it has some undesirable effects like fatigue, syncope, and shock due to rapid fall in blood pressure. Also, if the drug is administered in high dosage, symptoms of cyanide (CN) poisoning may appear. 2 Symptoms and signs of nitroprusside toxicity in children have been underemphasized in the medical literature. In this article, a child is presented who had temporary blindness due to SNP intoxication in the postoperative period after correction of coarctation of the aorta.