Celalettin Gunay

Tissue levels of adiponectin, tumour necrosis factor-alpha, soluble intercellular adhesion molecule-1 and heart-type fatty acid-binding protein in human coronary atherosclerotic plaques

Background  There is little information available about any link between the levels of adiponectin, intercellular adhesion molecule‐1 (ICAM‐1), tumour necrosis factor‐α (TNF‐α) and heart‐type fatty acid‐binding protein (H‐FABP) in coronary atherosclerotic plaque specimens.

Surgical approach to ascending aorta in bicuspid aortic valve.

Abstract Objective: Former studies have pointed out that hemodynamic stress imposed by associated valvular disease is the primary factor in the development of ascending aorta dilatation. At present, intrinsic wall pathology is blamed for dilatation and aneurysm formation in bicuspid aortic valve (BAV). Materials and Methods: Aortic valve replacement (AVR) was performed on 78 adult patients with BAV. Patients were divided into two groups. Group I(n = 27)underwent only AVR. Group II(n = 51)underwent AVR and additional ascending aorta procedures such as Shawl‐Lapel aortoplasty(n = 12)and tailoring aortoplasty(n = 9). Dacron wrapping was performed after both techniques were done. Ascending aorta replacement was done on 11 patients by using composite graft. Supracoronary graft replacement was performed in 3 patients after AVR. Results: Ascending aorta diameter increment was 1.25 mm/year in normotensive and 2.80 mm/ year in hypertensive patients. Ascending aorta aneurysm (diameter > 55 mm) developed in eight patients in the postoperative period in group I. Ascending aorta dilatation did not develop in group II patients. Mean survival time ± standard error (SE) was 128 ± 11 and 99 ± 4 months and survival possibility was 77.78% and 92.16%. Freedom from reoperation was 65.4% and 95.9% in 8 years in group I and group II, respectively. Conclusion: Aortic wrapping with or without aortoplasty has a beneficial effect not only in dilated ascending aorta but also in all nondilated BAV patients with normal‐sized aortic diameter. Ascending aorta wrapping in BAV patients preserves the endothelial lining and prevents further dilatation, aneurysm formation, and dissection.(J Card Surg 2003;18:173‐180)

The results of radial artery Y-graft for complete arterial revascularization

OBJECTIVE Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma in complete arterial coronary artery bypass grafting (CABG). Using sequential grafting techniques, CABG is possible with only two arterial grafts in multi-vessel coronary artery disease (CAD). However, sequential grafting may not be convenient for all circumstances and sometimes surgical technique may be challenging. We present our experience in the use of radial artery (RA) Y-graft on a routine basis. METHODS Between January 1996 and November 2001, 127 patients (aged 63+/-8 years) with the diagnosis of multi-vessel disease underwent complete arterial revascularization using left internal mammarian artery (LIMA) and RA. Left ventricular ejection fraction ranged from 23 to 65% (mean 51+/-11%). Triple-vessel disease was present in 73.2% of patients. We used the division technique of RA during harvesting and formation of one or more composite Y-grafts of the RA itself to allow end-side rather than sequential anastomoses without any significant decrease the usable conduit length. The results of this technique were compared with the data of patients (n=109) who underwent completely arterial CABG with the use of the multiple arterial grafts in the same period. RESULTS LIMA was anastomosed to the left anterior descending coronary artery (LAD) system in all patients. Two to four (mean 2.8+/-0.6) anastomoses were performed with RA Y-graft per patient. Proximal end of the radial graft was anastomosed to LIMA (60.6%) or aorta (39.4%). Mean operating time was 185 (45 min; bypass time, 68+/-23 min; and cross-clamp time, 49+/-17 min). Perioperative intraaortic balloon pump was necessary in five patients (3.9%). There was no operative mortality or morbidity. During the follow-up period of 2-30 months, none of the patients had any complication. Postoperative coronary angiography in 54 patients (42.5%) documented excellent early patency rates (LIMA 100%, and RA 98.1%). CONCLUSIONS We believe that keeping our technique in their armamentarium will be useful for cardiac surgeons as an alternative method during complete arterial revascularization. This approach allows for complete arterial revascularization in multi-vessel CAD using only single IMA and RA grafts with excellent early results.

Supraclavicular control of patent internal thoracic artery graft flow during aortic valve replacement

BACKGROUND The mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery (LITA) is significant. The risk of LITA injury and inadequate myocardial preservation during the cross-clamp period may cause myocardial pump failure. METHODS A total of 43 patients with a patent LITA graft underwent AVR. The patients were divided into the two groups. Group 1 included 19 patients who underwent AVR with deep hypothermia (20 degrees C) without LITA clamping. Group 2 included 24 patients in whom LITA flow was controlled through supraclavicular occlusion and AVR performed with moderate hypothermia (28 degrees C). RESULTS Average cardiopulmonary bypass time (CPB) time was 118.79 +/- 20.36 minutes in group 1 and 102.67 +/- 9.66 minutes in group 2 (p = 0.006). Average cross-clamp time was 53.79 +/- 7.26 minutes in group 1 and 49.63 +/- 6.7 minutes in group 2 (p = 0.022). Inotropic support was required in 12 patients in group 1 and 4 patients in group 2 (p = 0.002). Average intensive care unit stay was 4.68 +/- 2.24 days in group 1 and 2.29 +/- 0.46 days in group 2 (p < 0.001). Average hospital stay was 11.84 +/- 2.91 days in group 1 and 8.04 +/- 2.38 days in group 2 (p < 0.001). Mortality due to myocardial failure developed in 4 patients in group 1 but in none of the patients in group 2 (p = 0.02). CONCLUSIONS Proximal control of LITA flow by extrathoracic supraclavicular occlusion reduces the incidence of myocardial failure due to nonhomogenous cardioplegia delivery to the anterior wall of the heart, resulting in improved myocardial protection and the elimination of the need for deep hypothermia.

Surgical Treatment of Coronary Artery Fistulas: 15 Years' Experience

We report our experience of surgical treatment of coronary artery fistula and focus on the electrocardiographic changes that may be seen postoperatively. Between 1988 and 2003, cardiac operations were carried out on 9,487 patients, of whom 21 had a coronary artery fistula. The mean age of these 21 patients was 36.8 ± 4.9 years. The fistula originated from the right coronary artery in 9 cases and from the left side in 12. The fistulous connection was to the right ventricle in 5 patients, to the right atrium in 6, to the pulmonary artery in 8, and to the coronary sinus in 2. There was no operative mortality. Two patients (10%) had nonspecific electrocardiographic changes during the postoperative period. Repeat coronary angiography revealed normal coronary anatomy in both, and their electrocardiograms normalized within 2 months. Patients suspected to have myocardial ischemia related to the surgical procedure, with ST segment depression or T wave abnormalities on the electrocardiogram, should undergo repeat angiography to eliminate the possibility of coronary artery damage.

Mitral valve replacement with bileaflet preservation: a modified technique.

We present a modified bileaflet preserving mitral valve replacement technique to eliminate left ventricular outflow tract obstruction and larger size prosthesis implantation. Mitral anterior leaflet was incised from the middle of leaflet to mitral annulus. Pletgetted sutures were firstly bitten from mitral annulus and then passed from the bottom to the tip of anterior leaflet. These sutures were anchored to prosthesis. Bileaflet prosthesis was put down into the annulus and sutures were ligated on the strut of prosthesis. Posterior leaflet was also preserved. Excessive anterior leaflet tissue was attached to left atrium wall by deeply bitten sutures.

Huge Right Atrial Myxoma Causing Fixed Tricuspid Stenosis with Constitutional Symptoms

Abstract  Nonspecific constitutional symptoms are reported mostly in patients with left‐atrial myxomas, which occur five times as often as its right‐atrial counterpart. We present huge right‐atrial myxoma, which obstructs tricuspid orifice with nonspecific constitutional symptoms without any pulmonary embolism attack. (J Card Surg 2003;18:550‐553)

True aneurysm formation in axillofemoral bypass with a reinforced ePTFE graft-a case report.

Since improvement in reinforced expanded polytetrafluoroethylene (ePTFE) grafts, true aneurysm and pseudoaneurysm formation have become relatively rare complications after axillofemoral reconstruction. This is a case report of a true aneurysm of an axillofemoral graft. The true aneurysm occurred 29 months after insertion of a reinforced ePTFE graft for aortoiliac occlusive disease. A mid-graft true aneurysm was identified during examinations without any trauma history. Continuous long-term follow-up is recommended for these reinforced ePTFE grafts because of rare aneurysm formation, preferably using duplex ultrasonography.

Beta blockers for the prevention of atrial fibrillation after coronary artery bypass surgery: Carvedilol versus metoprolol

Although all beta blockers appear to be effective in the prevention of postoperative atrial fibrillation (AF) following coronary artery bypass surgery (CABG), carvedilol was found to be much more effective than metoprolol in this respect as the current study clearly delineated. We believe that the ongoing COMPACT trial will answer the question of whether or not carvedilol is more superior than metoprolol to prevent postoperative AF in patients undergoing CABG.

Extended use of radial artery with Y-graft technique for complete arterial revascularization.

One of the biggest problems encountered during complete arterial revascularization is difficulty obtaining sufficient graft length to perform multiple distal anastomoses. We describe a technique of dividing the radial artery during harvest and forming one or more composite Y-grafts to allow end-to-side rather than sequential anastomoses without substantially decreasing usable conduit length. This approach has merit and may be helpful in some patients who require complex arterial grafting.