Alper Sami Kunt

Balloon occlusion of the descending aorta in the treatment of severe post‐partum haemorrhage

The current case report presents a patient with life-threatening post-partum haemorrhage who was treated successfully with arterial balloon occlusion of the descending aorta, using an intra-aortic balloon pump without counterpulsation. This appears to be the first report of the use of this procedure in the treatment of post-partum haemorrhage. The literature is reviewed and the usefulness of the procedure discussed.

Coronary endarterectomy with beating heart in patients with diffuse atheromatous coronary artery disease and poor ventricular function: early and midterm results.

BACKGROUND In this study, we retrospectively reviewed our experience with off-pump coronary artery bypass grafting and coronary artery endarterectomy in patients with severely reduced left ventricular function and diffuse atheromatous coronary artery disease to evaluate the early and midterm results. METHODS Between July 1998 and March 2004, 42 patients underwent off-pump myocardial revascularization with coronary artery endarterectomy. The mean age (+/-SD) for the 28 male and 14 female patients was 59 +/- 10.2 years. Twenty-seven patients (64.2%) had experienced a previous myocardial infarction, and 11 (26.2%) had undergone an operation on an emergency basis. All patients had an ejection fraction of less than 30%. The left anterior descending coronary artery was the most endarterectomized vessel (75% of patients). RESULTS There were 5 early deaths (11%). Twenty-five (67.6%) of the surviving patients were symptom free, and 8 were in Canadian Cardiovascular Society classes II to IV. The ejection fraction improved after the operation in the 30 patients (71.42%) who underwent echocardiographic control and coronary angiography. The 28.4-month patency rate of the endarterectomized coronary arteries was 89%. The patency rates were 93.3% for the left internal thoracic artery-left anterior descending coronary artery and 88.8% for the right coronary artery. CONCLUSION The results of this study show increased operative mortality and morbidity in patients requiring coronary artery endarterectomy. However, the early results and particularly the midterm survival rates, clinical status, and continued graft patency justify off-pump coronary artery endarterectomy in patients with severely depressed left ventricular function and diffuse coronary artery disease. Many of these patients have disease that would otherwise be inoperable.

Decrease of Total Antioxidative Capacity in Developed Low Cardiac Output Syndrome

Background. It has been known that cardiac surgery induces an oxidative stress. The persistent oxidative stress during reperfusion may lead to depressed myocardial function resulting in low cardiac output syndrome (LCOS) necessitating inotropic or intra-aortic balloon counterpulsation support. Total antioxidant capacity (TAC) is a measurement of oxidative stress in tissues. The purpose of this study was to examine the TAC differences during coronary artery bypass graft (CABG) operation in patients who have developed LCOS and who have not. Material and Methods. Seventy-nine patients were enrolled in the study. Central venous blood samples were obtained immediately before surgery, during operation, and at the end of surgery to assess TAC. Clinical data regarding patient demographics and operative outcomes were prospectively collected and entered into our clinical database. Results. LCOS developed in 8 patients (10.12%). The TAC has decreased sharply in the LCOS patients compared with those who did not develop LCOS (P < 0.001) during operation. In addition, the receiver operating characteristic (ROC) area was 0.879. Conclusion. TAC has decreased during operation in a significant proportion of patients undergoing isolated CABG, and this is more prominent and serious and might be an independent variable in patients who have developed LCOS. This may be related to intraoperative misadventure or inadequate myocardial antioxidative protection. Routine measurement of the TAC during operation may provide information for assessment of the LCOS development.

Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

BACKGROUND Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. CASE In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. RESULTS During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. CONCLUSION Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

Ringless alfieri mitral valve repair for significant ischemic mitral regurgitation with coronary artery bypass grafting.

BACKGROUND Ischemic mitral regurgitation (IMR) is associated with diminished survival prospects. Ringless edge-to-edge mitral valve repair is usually performed in association with coronary artery bypass grafting (CABG). In this report, we present our early results for ringless edge-to-edge repair and concomitant CABG. METHODS Between January 2011 and June 2012, 17 patients underwent ringless edge-to-edge mitral valve repair. The cause was ischemic in all patients. A double-orifice repair was done in all patients. Complete coronary revascularization was routinely added in all cases. RESULTS There were no hospital and late deaths. Low cardiac output developed in 5 patients (29.41%) and was treated with inotropic agents. Two of these patients required intraaortic balloon pump support. Atrial fibrillation and ventricular arrhythmia developed in 5 (29.41%) of the patients, and all of them converted to sinus rhythm with antiarrhythmic agents. The mean (SD) stays in the intensive care unit and the hospital were 2.83 ± 1.29 days and 7.74 ± 2.14 days, respectively. As of the latest follow-up, all patients were in New York Heart Association class I or II. There was no recurrent mitral valve regurgitation or valve-related complications. CONCLUSIONS Alfieri mitral valve repair is associated with lower risks of mortality, postoperative stroke, and prolonged intensive care unit and hospital stays. Alfieri mitral valve repair and concomitant CABG surgery can be performed in patients with IMR.

Brucella Endocarditis Affecting the Mitral Valve

Brucellosis is still prevalent in Mediterranean and Middle East countries and Brucella endocarditis is a rare and often fatal complication. We describe a case of Brucella endocarditis in a 23-year-old male who required mitral valve replacement after successful antibacterial treatment.

Proximal Obstruction of Left Subclavian Artery after Coronary Artery Bypass Surgery

ASIAN CARDIOVASCULAR & THORACIC ANNALS 328 1998, VOL. 6, NO. 4 PROXIMAL OBSTRUCTION OF LEFT SUBCLAVIAN ARTERY AFTER CORONARY ARTERY BYPASS SURGERY A patient who had coronary artery bypass grafting in 1986 and angioplasty in 1993 was admitted to our hospital recently with chest pain and dyspnea of 5 months duration. Blood pressure in the right upper extremity was 120/70 mm Hg, while it was 70/40 mm Hg in the left. Angiography indicated total occlusion of the right coronary and circumflex arteries. The left internal thoracic artery (ITA) was patent but the left subclavian artery showed delayed filling and subclavian steal (Figure 1). The left subclavian artery was explored via an incision through the left supraclavicular space. The left subclavian artery and the left external carotid artery were snared proximally and distally and a 6-mm polytetrafluoroethylene graft was anastomosed end-to-side between the carotid artery and the subclavian artery, close to the origin of the left internal thoracic artery. In the postoperative period, the left arm arterial blood pressure reached 110/65 mm Hg. Angiography showed that the graft was patent with good filling of the left internal thoracic artery (Figure 2). The patient was discharged in good condition on the 3rd postoperative day with anticoagulant therapy. He was symptom-free at the 6-month follow-up.