Cengiz Bolcal

A mitral-aortic intervalvular fibrosa false aneurysm in a patient without overt heart disease.

False aneurysms originating from mitral-aortic intervalvular fibrosa are clinically very rare. A 22-year-old male patient without overt heart disease was admitted to the cardiology department of the Gulhane Military Academy of Medicine, Ankara, Turkey, with a false aneurysm located between the left ventricular outflow tract and the anterior left atrium. The false aneurysm was repaired at the Department of Cardiovascular Surgery, and the patient was discharged 10 days after the surgery.

Combination sedoanalgesia with remifentanil and propofol versus remifentanil and midazolam for elective cardioversion after coronary artery bypass grafting

Postoperative atrial fibrillation (AF) occurs in up to 50% of cardiac surgery patients and represents the most common postoperative arrhythmic complication. Elective cardioversion, a short but painful procedure, remains an option for patients who do not convert to sinus rhythm with medical therapy. Combinations of remifentanil (a potent analgesic with a short elimination time) with propofol (a hypnotic agent) or midazolam (a sedative agent) produce a synergistic interaction. This study was undertaken to compare these combinations in terms of effectiveness and pain relief when given as sedoanalgesia for elective cardioversion. In this prospective, randomized trial, 60 adult patients with postoperative AF after coronary artery bypass grafting were given a single dose of propofol 1 mg/kg combined with remifentanil 0.1 μg/kg (group 1), or midazolam 0.05 mg/kg combined with remifentanil 0.1 μg/kg (group 2). Cardiorespiratory parameters were monitored and recorded. Demographic data were similar (P>.05) and sufficient sedoanalgesia and successful cardioversion were achieved in both groups. Hemodynamic parameters revealed no significant differences between groups (P>.05); however, induction time, time to eye opening, recuperation time, and time to full recovery of psychomotor function were faster in group 1 than in group 2 (P<.05). The remifentanil/propofol combination provided sufficient analgesia, satisfactory hemodynamic stability, and mild respiratory depression, along with faster recovery and discharge times from the intensive care unit.

Is there a role for surgery in the management of isolated secundum atrial septal defect in adults

Summary Objectives The aim of this retrospective study was to compare the short-term outcomes of surgical versus transcatheter closure of secundum atrial septal defect (ASD) in adults. Methods From January 2008 to October 2012, 229 patients aged 18 years and older with significant isolated secundum ASDs were admitted to our hospital. We focused only on objective data obtained from their medical records. We collected and compared a total of 163 patients with isolated secundum ASD, who were treated with device occlusion or surgical closure, and had no missing data. Postoperative outcomes, rhythm disturbances, residual ASD, infection rates and length of hospital stay were compared. Results Complete follow-up data were available for 42 (46%) patients in the device group and for 121 (87%) in the surgery group. Complete closure was observed in 41 of the 42 patients (97.6%) in the device group (p = 0.258) and in all 121 in the surgery group (100 %) (p > 0.05). There were no mortalities. The mean length of hospital stay in the device group was 1.92 ± 0.43 days and in the surgery group 7.14 ± 0.14 days (p < 0.01). Conclusions The transcatheter approach for closure of ASDs is an effective and safe treatment option when performed for certain indications. Broadening the spectrum of indications may cause some adverse events. Surgical treatment remains a good alternative for all patients with ASDs and can be performed safely in order not to increase procedure-related complications.

Concomitance of varicoceles and chronic venous insufficiency in young males

Introduction: The aim of this article was to evaluate the concomitance of symptomatic varicose veins and varicoceles in a young male patient group. Method: The study was conducted as a prospective, multicentre study in the cardiovascular outpatient clinics of two major military hospitals. The data of 1500 young male patients with symptomatic venous insufficiency were recorded regarding symptomatic varicoceles. Results: The median age of the patients was 21.2 ± 1.3 years. Symptomatic varicocele was a concomitant finding in 46.0% of the patients. In patients with chronic venous insufficiency, higher body mass index, high levels of smoking, standing occupation, positive family history, longer duration of symptoms and constipation were found as potential factors for concomitant varicocele in both univariate and multivariate analysis. A statistically significant, moderately positive correlation was found between grades of venous reflux in saphenofemoral junction and varicocele (Spearmans rho correlation r = 0.637, P <0.001). Conclusion: With the observation that varicoceles may be concomitant in nearly half of patients with venous insufficiency, it is thought that just a simple question in history taking may help these patients to be diagnosed and get treated for this potential cause of infertility.

Unrecognized indication for robot-assisted cardiac surgery: Patients with acute psychotic disorders

Abstract Patients with acute psychotic disorders are often considered as inappropriate candidates for cardiac surgery as well as for other surgical interventions. Post-operative care and patient compliance, which are the main problems associated with such patients, are the most important issues for conventional cardiac surgery. Robot-assisted cardiac surgery may be a new solution in this respect. In this report we aimed to present our acute psychotic patient with serious mitral insufficiency secondary to huge atrial myxoma, treated with robotic cardiac surgery.

Platelet indices may be correlated with severity of vasospastic disorders.

Background Vasospastic disorders are common worldwide. In daily practice, routine blood samples are used for several investigations. In this study we aimed to determine the possible correlations between lymphocyte count, platelet indices, and the severity of vasospastic disorders. Material/Methods Data of 102 patients admitted to our department with vasospastic disorder symptomatology were retrospectively collected. Demographic data, symptoms, and blood test results were recorded. Patients were divided into 2 groups according to their rewarming time, which is determined by the cold stimulation test. Group 1 consisted of patients with rewarming time below 20 min and Group 2 consisted of patients with rewarming time above 21 min. Demographic data and blood test results were compared between groups. Results were analyzed with the SPSS for Mac 20.0 package program. Results There was no statistically significant difference between the groups in demographic variables and symptomatology. In Group 2, mean platelet volume (MPV) and platelet distribution width (PDW) were higher than in Group 1, which was statistically significant (8.87±0.74 vs. 8.38±0.78, p=0.001 and 15.91±1.92 vs. 14.7±1.99, p=0.002, respectively). Similar to MPV and PDW, lymphocyte count was also higher in Group 2 than in Group 1 (2.28±0.65 vs. 1.90±0.68, p=0.002). Conclusions Diagnosis and grading the severity of VD is challenging, but it can be supported by the presence of increased PDW, MPV, and lymphocyte count.

Primary and secondary lymphoedema in male patients with oedema in lower limbs

Objective: The purpose of this prospective study was to evaluate patients with clinically diagnosed lymphoedema of the lower extremities. The proportions of primary and secondary lymphoedema, the possible aetiologic factors and the concomitance of chronic venous diseases and lymphoedema were focused on. Method: The male patients who attended our outpatient clinic during 2000 and 2004 were evaluated. In all, 160 male patients with 5 cm circumference difference at calf level between two lower extremities or with clinically diagnosed bilateral leg oedema were enrolled. All patients underwent duplex venous ultrasonography and lymphoscintigraphy. Venography was performed in 12 patients with normal lymphoscintigraphy and ultrasonography. Results: The age distribution was between 20 and 54 years (mean ± SD; 22.9 ± 4.3). Among 160 patients, 70.0% had lymphoedema, while 7.5% had chronic venous insufficiency, 3.75% chronic deep venous thrombosis, 7.5% concomitant venous disease and lymphatic obstruction, and 7.5% idiopathic oedema. In the last 3.75% the pathology was Klippel–Trenaunay syndrome. Of the primary lymphoedema patients (16.25%), 18 were praecox, six tarda and two were congenital types. Conclusion: In young male patients, the causes of secondary lymphoedema are lymphadenectomy, neoplastic metastasis, cellulitis, lymphangitis, etc. Further techniques confirmed the clinical diagnosis of lymphoedema in 77.5% (sum of lymphoedema and concomitant disease) of all patients. With these findings lymphoedema can be diagnosed clinically, and further diagnostic techniques can be reserved unless treatment is effective.