Baran Ugurlu

Effect of left ventricular volume on results of coronary artery bypass grafting

After coronary artery bypass grafting, our patients with ischemic cardiomyopathy and significant left ventricular (LV) dilation demonstrated an improvement in angina symptoms, acceptable operative and medium-term survival, a trend toward improvement in LV ejection fraction, and a significant reduction in LV chamber size. Our results suggest that patients with ischemic cardiomyopathy and LV dilation should not be excluded from surgical revascularization based on ventricular size alone.

Cervical Aortic Arch A Case Report

Cervical aortic arch is a rare type of aortic arch anomaly that is presumed to result from persistence of the third aortic arch and regression of the normal fourth arch. Most of the patients with this anomaly are asymptomatic, but symptoms of dysphagia and respira tory distress due to the compression by the vascular ring have been reported. Other findings such as a supraclavicular pulsatile mass, blood pressure discrepancies between the upper limbs, and loss of femoral or opposite-upper-limb pulses with compression of the cervical mass may also be present. In this article a twenty-two-year-old woman with symptomatic cervical aortic arch is presented. The patient had a left cervical pulsatile mass and elevated blood pressure on her right upper limb and was treated surgically with reanastomosis of the aorta.

A Multicentre Study of Abdominal Aorta Diameters in a Turkish Population

The aim of this study was to determine the normal values for aortic diameters and the prevalence of aortic dilatation in a mixed Turkish population. Between March 1998 and May 2000, patients who were undergoing abdominal ultrasonography examination for pathologies not involving the aorta, in three different cities, were enrolled into the study prospectively. The anterior posterior aortic diameters were measured at the subdiaphragmatic and aortic bifurcation levels using ultrasonography. A total of 596 patients were included (302 females, 294 males). The mean age was 48 ± 16 years (range, 6–88 years). The mean aortic diameter in the whole group was 19.0 ± 3.9 mm (10–45 mm) at the subdiaphragmatic level and 15.7 ± 3.6 mm (9–65 mm) at the aortic bifurcation level. The mean subdiaphragmatic aortic diameter was 18 ± 3 mm in females and 19 ± 4 mm in males. The mean aortic diameters at the bifurcation level was 15 ± 3 mm in females and 16 ± 4 mm in males. An aortic bifurcation diameter < 30 mm was encountered in 0.67% of the population. This ratio increased to 1.8% in patients over 55 years of age, regardless of sex. A subdiaphragmatic aorta diameter above 30 mm was observed in 1.2% of the population. In patients over the age of 55 years, this ratio increased to 2.7% (3.6% in males and 1.9% in females). In this national study, the subdiaphragmatic aortic diameters were similar to mean values reported in the world literature. The mean aortic bifurcation diameters were generally lower when compared with the literature, which may be due to difficulties in standardization of the measurements. Aneurysmal dilatation rates in this study also conform to those reported in studies conducted in other countries. Considering the significant number of patients with aneurysmal dilatation of the aorta in the elderly population, we believe it would be prudent to evaluate the aorta in all patients undergoing abdominal ultrasonographic examination.

Dissection of the ascending aorta due to metastatic carcinoma

The association of aortic dissection with a malignancy is a rare finding and previous reports are usually those of primary aortic sarcomas. In this report we present a case with typical ascending aorta dissection associated with metastatic carcinoma originating from the lungs. The metastatic infiltration of the vasovasorum of the aorta by carcinoma cells may have caused aortic dissection by decreasing medial strength and integrity. This is a mechanism of aortic dissection that we have not encountered in previous reports.

Stroke and Myxoma

Cardiac myxoma was detected by transthoracic echocardiography in 8 patients (aged 11 to 64 years) who were admitted between 1991 and 1999 with stroke or transient ischemic attacks, representing 80% of the total myxoma cases treated in this period. All patients underwent surgery and the myxomas were successfully removed. There were no recurrences during a mean follow-up of 3.1 years. In the presence of unexplained transient ischemic attack, cerebral infarction, or syncope, this relatively rare cardiac lesion should be suspected and investigated by transthoracic echocardiography.

Clinical and morphological phenotype of geleophysic dysplasia

Abstract Geleophysic dysplasia (GD) is a rare, recessively inherited lysosomal storage disorder of unknown origin with a progressive course. A 9-year-old Turkish boy born to consanguineous parents with findings typical of GD is reported. Cardiac abnormalities included mitral and aortic stenosis with aortic insufficiency. There was persistent hypo-uricacidaemia, severe pulmonary hypertension and tricuspid insufficiency. He required aortic and mitral valve replacement but, unfortunately, died of a severe pulmonary infection in the post-operative period. The condition has to be differentiated from lysosomal storage disorders such as mucopolysaccharidosis.

Pleural flap for treating perigraft leak after a modified blalock-taussig shunt

Plasa oozing through the graft after a modified Blalock-Taussig shunt is a troublesome complication. We encountered a massive leak following a modified Blalock-Taussig shunt in a 2 1/2 year-old-girl which required reexploration. The leak was treated by wrapping the polytetrafluoroethylene shunt with the parietal pleura flap harvested from the adjacent chest wall. The patient had an uneventful recovery. Covering of the polytetrafluoroethylene shunt with parietal pleura appears to stop plasma leak through the graft following a modified Blalock-Taussig shunt.

Long-Term Oral Ciprofloxacin in the Treatment of Prosthetic Valve Endocarditis due to Pseudomonas Aeruginosa

Prosthetic valve endocarditis caused by Pseudomonas aeruginosa is refractory to medical treatment alone and early valve replacement is necessary. We describe a 40-year-old patient in whom endocarditis developed in the early postoperative period, and reoperation was not considered feasible. Ciprofloxacin was administered orally in order to suppress bacteremia for 36 months. Long-term oral ciprofloxacin may provide an opportunity in the treatment of prosthetic valve endocarditis caused by Ps. aeruginosa in patients who are unfavorable candidates for reoperation.

The effects of levosimendan and dobutamine in experimental bupivacaine-induced cardiotoxicity

BackgroundAccidental intravenous exposure to bupivacaine is highly cardiotoxic and may lead to death. Positive inotropic agents are usually utilized in resuscitative efforts. We have compared the efficacy of levosimendan, a novel inotropic agent, with dobutamine and their combination in a rat model of bupivacaine intoxication.MethodsTwenty-eight male Wistar albino rats weighing between 250-300 g were divided into these four groups: control (C), levosimendan (L), dobutamine (D) and dobutamine+levosimendan (D+L). Bupivacaine was administered at a dose of 3 mg/kg/min until cardiac arrest occurred or for 120 min. ECG, heart rate, blood pressure, arterial blood gases, and end tidal CO2 levels were monitored. Levosimendan was administered as a bolus of 12 μg/kg for 10 min and continued as an infusion at 0.3 μg/kg/min. Dobutamine was infused at a dose of 3 μg/kg/min. The time required for a 50% and 75% decrease in heart rate and blood pressure with a total time to cardiac arrest and bupivacaine dose for obtaining cardiac arrest were analyzed.ResultsTime periods for heart rate reductions of 50% and 75% were significantly longer in groups L (903, 1198 s), D (984, 1542 s) and L+D (1705, 3152 s) compared with the control group (345, 538 s p < 0.001). Median times to mean blood pressure reductions of 50% and 75% were 399 - 504 s in the control group, 1005 -1204 s in group L, 685 - 1009 s in group D and 1544- 2982 s in group L+D, and the difference was significant compared with the control group. Median time duration to asystole was 703 s in the control group compared with 1385 s in group L, 1789 s in group D and 3557 s in group L+D. Time to cardiac arrest was significantly higher in all 3 study groups. It was also significantly higher in the L+D group compared with both groups L and D separately.ConclusionA combination of dobutamine with levosimendan significantly increased survival times in this bupivacaine-induced toxicity rat model compared with the control, levosimendan, and dobutamine groups.

Concomitant carotid and popliteal artery aneurysms in a patient with Behçet's syndrome. A case report

Behçets syndrome is a multisystem disorder of unknown etiology with a worldwide distribution. It is considered a systemic vasculitis affecting the skin, joints, eyes, gastrointestinal tract, neural tissue, and blood vessels. About 30% of the patients have vascular involvement, mainly as venous thrombosis, but aneurysms of the aorta, peripheral, and pulmonary arteries have also been reported. The authors present a patient with Behçets syndrome who had aneurysms both of the popliteal artery and the carotid artery treated surgically.