Cenk Conkbayir

Massive pulmonary thromboembolism after abdominoplasty and liposuction

Pulmonary embolism is a rare complication of abdominoplasty and liposuction that may result in a fatal consequence. A 65-year-old obese woman presented with complaints of shortness of breath, palpitation, and hypotension (90/60 mmHg) seven weeks after abdominoplasty and liposuction. The electrocardiogram showed sinus tachycardia, right axis deviation, and right bundle branch block. The chest X-ray showed atelectatic and focally infiltrated areas, and minimal bilateral pleural effusion. Laboratory findings were normal except for D-dimer level (3500 ng/ml). Echocardiography revealed dilated right heart chambers and a thrombus in the left ventricle. Ejection fraction was normal and pulmonary artery pressure was 50 mmHg. Doppler ultrasound showed no signs of thrombosis. Following the diagnosis of pulmonary thromboembolism, the patient received oxygen therapy and heparin infusion. However, the clinical course did not improve, hemodynamic deterioration continued, and the echocardiographic appearance of the thrombus persisted, so thrombolytic therapy with tissue plasminogen activator was administered, which also resulted in no response. In the end, pulmonary embolectomy was performed and the thrombus was successfully extracted. The patient had an uneventful postoperative course and was discharged on the seventh postoperative day.

Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy

Abstract Aim: Carotid artery stenosis and atrial fibrillation are diseases of the aging patient population. Literature lacks precise anticoagulation treatment protocols for patients with atrial fibrillation following carotid endarterectomy. We present our experiences with anticoagulation strategy in this particular patient population. Patients and methods: Between June 2001–September 2017, 165 patients with chronic or paroxysmal atrial fibrillation out of 1594 cases from three different institutions whom received Coumadin and aspirin and required carotid endarterectomy were reviewed, respectively. Mean age was 63.4 ± 7.9 years. Male/female ratio was 102/63. There were 67 diabetic and 138 hypertensive cases. Results: Patients are followed a mean of 64.4 ± 16.9 months. Early mortality occurred in two patients due to intracranial bleeding and heart failure. Another patient was lost due to intracerebral hemorrhage and 16 other patients died due to various causes in the late follow-up. Three patients required exploration against bleeding. Conclusion: Combination of warfarin with an aim to keep the INR value between 2 and 3, and aspirin at a dosage of 100 mg per day seemed feasible and in our modest patient cohort. Further studies including multicenter larger data are warranted in order to establish a precise anticoagulation treatment protocol for patients with atrial fibrillation after carotid endarterectomy.

The efficiency of O-(beta-hydroxyethyl)-rutosides in reducing the incidence of superficial venous insufficiency in patients with calf muscle pump dysfunction.

Objective We aimed to evaluate the efficiency of O-(beta-Hydroxyethyl)-rutosides (Oxerutin) in reducing the incidence of venous system disease among patients with calf muscle pump dysfunction secondary to immobilization due to lower-limb fractures. Methods A total of 60 patients with lower-limb fractures and immobilized in plaster casts were included in this study randomized into control (n = 30; mean: 30.37 ± 6.03 years; 73.3% males; no treatment) and experiment (n = 30; mean: 31.67 ± 4.76 years; 66.6% males; Oxerutin, 500 mg po q12hr) treatment groups. Doppler ultrasound was performed to evaluate the effect of oxerutin on the alterations in the venous circulation. Results Patients in the control group were determined to be more commonly affected from the below-knee immobilization in terms of venous dysfunction in the great saphenous vein in the below-knee region when compared with the patients in the oxerutin treatment group (46.7 vs. 13.3%, respectively; p = 0.011). Incidence of reflux in the small saphenous vein was more common in the control group during the healing period when compared with the experiment group (40.0 vs. 10.0%, respectively; p = 0.017). None of the patients developed venous thrombosis. Conclusions In conclusion, the impairment of the lower extremity muscle pump should be considered as an important risk factor for venous disease, and should be evaluated. O-(beta-Hydroxyethyl)-rutosides during 6–8 week cast immobilization for a lower limb fracture may be an effective prophylactic regimen in reducing the incidence of reflux in the below-knee superficial veins.

Successful treatment of a 20-year nonhealing venous leg ulcer in a patient with systemic lupus erythematosus

Corresponding author: Assoc. Prof. Cenk Eray Yildiz Department of Cardiovascular Surgery Institute of Cardiology Istanbul University Haseki Cad. No: 29/31, 34304 Fatih Istanbul, Turkey Phone: +90 212 459 2000, +90 532 383 8804 Fax: +90 212 459 2069 E-mail: ceyildiz@hotmail.com 1 Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey 2 Department of Cardiology, Faculty of Medicine, Near East University, Nicosia, Cyprus 3 Department of Cardiovascular Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey 4 Department of Cardiovascular Surgery, Private Clinic, Izmit, Kocaeli, Turkey 5 Department of Cardiovascular Surgery, Medical Faculty, Istanbul University, Istanbul, Turkey

The Relationship Between Grade of Ischemia, Success of Reperfusion, and Type of Thrombolytic Regimen

Background This study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI). Material/Methods We enrolled 229 consecutive patients with diagnosis of STEMI and receiving TT. Patients were divided into 2 groups – grade 2 ischemia (GI2) and grade 3 ischemia (GI3) – according to initial electrocardiogram (ECG). As TT, fibrin-specific (tissue plasminogen activator (t-PA)) or non-fibrin-specific (streptokinase (SKZ)) regimens were used. Successful reperfusion was defined as >50% resolution of the maximal ST segment on 90-min ECG. We tried to evaluate whether the grade of ischemia could predict the success of reperfusion and if there were any differences in terms of successful reperfusion between different thrombolytic regimens. Results The successful reperfusion rate was significantly higher in GI2 than GI3 (82.4% vs. 64.4% respectively, p=0.002). The success rate was lowest at anterior GI3 (55.8%). Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061). In addition, in multivariate analysis, GI and infarct localization were found as independent predictors for successful reperfusion with TT (p=0.006 and p=0.042, respectively). Conclusions In the current study, we found that GI2 is an independent predictor for successful reperfusion in STEMI treated with TT. Fibrin specific regime should be preferred in anterior GI3.

Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access.

We appreciate the fluency of the original article by Uzun et al. (1) entitled “Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access,” which was recently published in Anatol J Cardiol 2014; 14: 542-6.” The authors divided the study population in two groups, those who used autogenous saphenous grafts and those who used PTFE. Although the investigators used saphenous grafts in both the upper arm and forearm, they used PTFE only in the upper arm. It is known that using the same autogenous grafts in different parts of the extremities could cause distinct long term patency. There are considerable peculiarities among the use of autogenously grafts in different regions in terms of infection, steal syndrome, and heart failure (2). In addition, some studies have reported that different autogenous grafts could cause different results even when used in same region (3). In the aforementioned study, although the investigators used autogenous saphenous grafts mostly in the distal part of the upper extremity, they used PTFE mostly in the proximal part of the upper extremity. To our knowledge, this factor could affect the grafts in terms of patency and infection risk. Generally, same regions were used among the studies in the literature; these studies compared different kinds of grafts (4). We want to understand the opinion of the authors regarding this.

Multivessel disease in a patient taken to the catheter laboratory with acute myocardial infarction and cardiogenic shock

A 56-year-old male patient was admitted to the emergency room with sudden onset chest pain with concomitant dyspnea and cold diaphoresis. In his past medical history, he had old myocardial infarctions and a coronary bypass operation 5 years ago. His blood pressure was 80/60 mm Hg, and his heart rate was 105 beats/minute. There were rales in the middle and basal part of the lung. In his admission electrocardiogram (ECG), incomplete left bundle brunch block, ST-segment depression in V3-6, and ST-segment elevation with pathologic Q wave in the inferior leads were seen (Fig. 1). He was taken to the catheter laboratory immediately, and a coronary angiogram was performed. In his coronary angiography, all of the native coronary arteries and saphenous grafts were occluded; only the left internal mammary artery (LIMA)-to-left anterior descending artery (LAD) graft was working, but the distal LAD was not seen after the anastomosis (Fig. 2, Video 1).