Anıl Özen

Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be?

Objective Coronary artery bypass grafting (CABG) is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between January 2002 and December 2011, a total of 101 consecutive patients at an age of 80 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ± 2.27 years. Sixty-four (63.4%) were males and 37 (36.6%) were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit (ICU) stay, inotropic support, intra aortic balloon pulsation application, amount of erythrocyte transfusion and fresh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass (CPB) was found to be an independent predictor of mortality (OR: 1.18, 95% CI 1.01−1.38, P = 0.034). The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.

Gangrenous Cecal Volvulus; A Case Report and Review of Literature

Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney’s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney’s syndrome.

Glasgow aneurysm score in predicting outcome after ruptured abdominal aortic aneurysm

Objective To assess the ability of Glasgow Aneurysm Score in predicting postoperative mortality for ruptured aortic aneurysm which may assist in decision making regarding the open surgical repair of an individual patient. Methods A total of 121 patients diagnosed of ruptured abdominal aortic aneurysm who underwent open surgery in our hospital between 1999 and 2013 were included. The Glasgow Aneurysm Score for each patient was graded according to the Glasgow Aneurysm Score (Glasgow Aneurysm Score = age in years + 17 for shock + 7 for myocardial disease + 10 for cerebrovascular disease + 14 for renal disease). The groups were divided as Group 1 (containing the patients who died) and Group 2 (the patients who were discharged). The Glasgow Aneurysm Scores amongst the groups were compared. Results Out of 121 patients, 108 (89.3%) were males and 13 (10.7%) were females. The in-hospital mortality was 48 patients (39.7%). The Glasgow Aneurysm Score was 84.15 ± 15.94 in Group 1 and 75.14 ± 14.67 in Group 2 which revealed significance (p = 0.002). The most appropriate cut-off value for Glasgow Aneurysm Score was determined as 78.5 (AUC = 0.669, p = 0.002, sensitivity: 64.6%, specificity: 60.3%). Glasgow Aneurysm Score value above 78.5 is associated with almost threefold increase in mortality (p = 0.007, OR:2.76, 95% CI 1.30–5.89). In further logistic regression models, Glasgow Aneurysm Score value and preoperative hematocrit values were found to be independent predictors for mortality (p = 0.023 and p = 0.007, respectively). Conclusion Glasgow Aneurysm Score may have a predictive value for outcome of patients with ruptured abdominal aortic aneurysm undergoing open surgical procedure and it appears to be a useful tool in clinical decision-making of an individual patient when integrated with clinical experience.

Surgery for Rheumatic Valve Disease in Pregnancy: What About the Newborn?

BACKGROUND Valvular heart disease constitutes the majority of all causes of cardiac disease in pregnancy. The significant physiological haemodynamic changes of pregnancy may cause serious cardiac problems leading to severe maternal and foetal morbidity and mortality. In this study, we evaluate the effect of maternal rheumatic valvular disease requiring definitive operation concurrent with caesarian delivery on maternal and foetal outcome. METHODS Between 2003 and 2010, a total of nine pregnant women and nine live births were examined. Immediately after caesarean section, the newborns were examined by the neonatologist and transferred to the neonatal intensive care unit. All the mothers were followed routinely with clinical and echocardiographic examinations. RESULTS The age at the time of delivery ranged between 21 and 36 years (median 31 years). Postoperative period of mothers was uneventful and mean hospital stay was 7.56±3.97 days. Birth weight for the newborns was ranged between 1370 and 2900g. Six of the newborns were premature (≤37 weeks). Four newborns were small for gestational age (SGA). There was no mortality in newborns. Hospital stay for the newborns ranged between four and 54 days. CONCLUSIONS Careful follow-up of pregnancies with valvular heart diseases and determining the optimal time of cardiac intervention are the essential issues. We suggest that careful follow-up of both mother and foetus until at least the 28th gestational week, following which combined caesarian section and cardiac surgery can be performed.

Glasgow aneurysm scores in patients undergoing open surgical procedure for aortic aneurysm.

Background To assess the applicability of the Glasgow aneurysm score (GAS) in patients with aortic aneurysm undergoing an elective open surgical procedure in our hospital. Materials and methods A total of 105 patients undergoing elective open surgical procedure between January 2006 and June 2012 were evaluated retrospectively. Glasgow aneurysm score (GAS) was calculated as age+7 points for myocardial disease, +10 points for cerebrovascular disease, and +14 points for renal disease. The best cut-off value for GAS was determined using the ROC curve analysis. Results The hospital mortality rate was 3.8% (4 patients). GAS was significantly lower in patients who survived the operation (76.05 ± 14.71 vs. 92.0 ± 10.8 respectively, p = 0.031). The ICU stay was also significantly lower in patients who survived the operation (2.37 ± 5.23) compared to the nonsurvivors (25.67 ± 13.80, p = 0.001). No significant difference was observed regarding age, duration of hospital stay, and aortic diameter. The area under the ROC curve was 0.818 and for a 100% sensitivity rate, the cut-off value for GAS was 77.5 with a 58.4% specificity rate (p = 0.031). All patients with a GAS < 77.5 were alive after surgery. Conclusion The GAS appears to be a reliable clinical predictor for in hospital mortality following elective repair of abdominal aortic aneurysm following open surgical procedure.

Assessment of Radial Artery Graft Patency in Symptomatic Patients.

BACKGROUND The purpose of this study is to evaluate the patency of radial artery (RA) grafts consistent with the target vessel characteristics. METHODS Between October 2001 and January 2012, 83 symptomatic patients or patients with positive ischemic test results underwent coronary angiography following coronary artery bypass grafting. Of these, 68 patients with 81 RA grafts at a mean 49.2 ± 31.9 months (range, 1-137 months) were evaluated. According to the location and degree of proximal stenosis, 5-year graft patency was determined by Kaplan-Meier analysis. The relationships between RA graft patency and degree of proximal stenosis, target vessel location, and inflow characteristics of grafts were assessed by means of Cox proportional hazard models. RESULTS Mean age of the patients was 56.4 ± 10.2 years. The period between the operation and postoperative coronary angiography was 49.2 ± 31.9 months (range, 1-137 months; median, 48.8 months). There was no impact on RA patency with regard to preoperative characteristics of the patients. RA patency was higher for left coronary system compared with right system (p = 0.038; 85.5 vs. 65.4%). In addition, patency rate was statistically higher for the proximal stenosis ≥ 90% (odds ratio, 3.65; 95% confidence interval, 1.20-11.07; p = 0.018). Kaplan-Meier patency analysis showed a patency of RA as 79.2% at 5 years. CONCLUSION RA graft patency differs with degree of preoperative native coronary artery stenosis and location of target vessel. RA grafts to not severely stenosed (< 90%) coronary system and to the right coronary territory carry a remarkably high risk of graft failure.

Subclinical cardiac disease in ankylosing spondylitis

To investigate aortic stiffness and subclinical left ventricular systolic dysfunction in ankylosing spondylitis (AS) patients.

A Very Rare Complication of Trans-Radial Cardiac Catheterization: Radial Artery Pseudoaneurysm: Case Report

A 42-year-old male underwent diagnostic coronary angiography prior to the surgical procedure. Catheterization was performed with the standard heparin regimen (5000 IU IV bolus only once). Hemostatic parameters were normal prior to surgery. Mechanical aortic valve replacement and ascending aorta graft interposition were performed. The patient was on warfarin therapy along with low molecular weight heparin (LMWH) following surgery. A Very Rare Complication of Trans-Radial Cardiac Catheterization: Radial Artery Pseudoaneurysm: Case Report

Early type II endoleak repair after endovascular therapy in Behcet's disease.

Vascular complications of Behçet’s disease include occlusion of vessels and arterial aneurysm formation, which is prone to rupture. Early type II endoleak repair following an endovascular stent-graft procedure for a ruptured descending aortic aneurysm in a 31-year-old man with Behçet’s disease is described. Endovascular stent-grafts provide an important alternative in complicated cases, but the possibility of endoleak should be born in mind.

Cavernous Hemangioma of the Right Atrium: A Very Rare Case of Complete Atrioventricular Block

![Figure][1] [![Graphic][3] ][3] A 54-year-old previously healthy man had been having dizziness for months. Electrocardiography exhibited complete atrioventricular (AV) block and ventricular rate of 50 beats/min (A) . Echocardiography showed a 2.4 × 2.5 cm right atrial mass with