Bingür Sönmez

Acute Gastrointestinal Complications after Open Heart Surgery

Retrospective analysis revealed that 24 of 4401 adult patients (0.5%) developed severe gastrointestinal complications after open heart surgery during a 3-year period from January 1995. There were 4 women (17%) and 20 men (83%). Mean age was 61.7 ± 2.02 years. Gastrointestinal bleeding (33.3%), mesenteric ischemia (20.8%), pancreatitis (20.8%), hepatic dysfunction (16.7%), and cholecystitis (16.7%) were the most common complications. Mortality was 41.7% (10 patients). During the same period, mortality in the patients who did not develop gastrointestinal complications was 1.89% (p < 0.0001). Emergency basis, reoperation, combined operations, peripheral vascular disease, diabetes mellitus, chronic lung disease, and impaired left ventricle function were found to be risk factors for the development of postoperative gastrointestinal complications.

Influence of Cardiovascular Risk Factors on the Outcome of Coronary Artery Bypass Surgery

AbstractPurpose. To assess the impact of gender, age, and other cardiovascular risk factors on the outcomes of patients undergoing coronary artery bypass grafting (CABG). Methods. A total of 5 067 consecutive patients undergoing isolated CABG between 1995 and 2000 were divided into the age groups: 25–49 years, 50–59 years, 60–69 years, and 70–84 years. Data on patient age, gender, smoking, serum cholesterol, blood pressure, body mass index, diabetes, family history, morbid obesity, and renal failure were retrospectively analyzed. Results. The percentage of women aged >60 years undergoing CABG was higher than the percentage of men aged >60 years (45.6% vs 36.6%). Most of the cardiovascular risk factors, except for smoking, were favorable in women (P < 0.001). The in-hospital mortality was 2.0% in women and 1.7% in men (P = 0.409). CABG was performed on significantly more men than women, accounting for 80.7% and 19.3% of the 5 067 patients, respectively (P < 0.001). However, the incidence increased remarkably in women aged >60 years. Conclusions. The risks of CABG may vary to some degree in accordance with the major cardiovascular risk factors. The risk of operative mortality was independent of gender in this study.

The hazardous effects of alveolar hypocapnia on lung mechanics during weaning from cardiopulmonary bypass

The bronchoconstrictive effects of alveolar hypocapnia during weaning from cardiopulmonary bypass (CPB) were investigated in patients undergoing elective coronary artery revascularization. Thirty patients were randomly assigned into two equal groups. In both groups, mechanical ventilation was initiated for 3 min prior to weaning from CPB with the venous pressure low. This kept the pulmonary vascular bed empty, resulting in alveolar hypocapnia (ETCO2 < 2 kPa). Peak airway pressure (P peak) and plateau pressures (P plateau) were recorded. In group 1, 5% CO2 was added to the inspiratory gas mixture and the ETCO2 allowed to rise (ETCO2 > 3.3 kPa). The ventilation pressure measurements were recorded again after 3 min stabilization. In group 2, the venous pressure was increased to allow the pulmonary venous bed to fill and the ventilation pressures recorded after a 3 min period of stabilization. In group 1, the ventilatory pressures dropped significantly (p < 0.001) when the alveolar hypocapnia was reversed with added CO2 (P peak 19.71 ± 5.7 to 12.31 ± 2.8 cmH2O and P plateau 13.15 ± 3.28 to 9.15 ± 2.23 cmH2O). In group 2, a similar effect was achieved by allowing filling of the pulmonary vascular bed (P peak 17.46 ± 4.72 to 11.92 ± 3.03 cmH2O and P plateau 13.93 ± 4.10 to 9.37 ± 3.00 cmH2O). These results suggest that filling the pulmonary vascular bed prior to initiating ventilation, when weaning from CPB, prevents the otherwise deleterious effects of alveolar hypocapnia, resulting in raised bronchomotor tonus and raised airway pressures.

Retroperitoneal hematoma due to an arteriovenous malformation originating from the femoral artery.

A 56-year-old female patient with ARDS (Acute Respiratory Distress Syndrome) was followed in the ICU (Intensive Care Unit). On the 10th day, she experienced an acute decrease in hemoglobin. Computerized tomography (CT) of the abdomen revealed a retroperitoneal hematoma (Fig. A). The hemorrhage was controlled after medical therapy at first, but two days later, another decrease in blood count and an increase in the size of the hematoma occurred. CT angiography demonstrated an arteriovenous malformation between the right femoral artery and the inferior epigastric vein (Fig. B). The patient was decided to undergo surgery. The hematoma was evacuated, the abnormal vessel originating from the femoral artery was ligated, and the probable bleeding sites from the dilated veins in the retroperitoneal area were controlled. Retroperitoneal hematoma due to an arteriovenous malformation originating from the femoral artery Femoral arterden kaynaklanan bir arteriyovenöz malformasyon nedeniyle gelişen retroperitoneal hematom