Davit Saba

Venous lesions in Behçet's disease

OBJECTIVES Review of venous lesions in Behçets disease (BD). DESIGN Retrospective study. SETTING University Hospital, Turkey. MATERIALS AND METHODS One hundred and twenty nine patients with BD diagnosed and treated in our hospital during the last 10 years were reviewed. Fifty-two patients with 54 vascular lesions of Behçets disease were identified. MAIN RESULTS The incidence of isolated venous lesions in BD was 26%. Venous lesions developed after the initial diagnosis of BD in all patients within 10 years. Thirty-four (63%) of the 54 vascular lesions were venous and 15 (28%) were arterial. In 5 (9%) patients, both arterial and venous lesions were present. Deep vein thrombosis was the most frequent lesion (76%), followed by superficial thrombophlebitis (10%), superior vena cava thrombosis (10%) and inferior vena cava thrombosis (2%) and varicose veins (2%). CONCLUSIONS Venous lesions are not rare and affect the prognosis of BD. For this reason, venous lesions of BD should always be sought at follow-up of patients with BD.

Fatal haemoptysis due to pulmonary artery aneurysm in Behçet's disease

Behgets disease (BD) was described by the Turkish dermatologist, Hulusi Behget, in 1937.1 The main symptoms of the disease vary according to the affected organs such as skin, mucosa, eyes, joints, gastrointestinal tract, vascular system and nervous system. 2 For many years, the known vascular complications of BD have been attributed to thrombophlebitis. However, several reports have been published in recent years relating to cases with aneurysm and arterial occlusion. 3-1~ The aetiology is still unknown; however, vasculitic changes are common in all involved organs, z8 Pulmonary artery aneurysm (PAA) is uncommon in patients with BD. PAA may be bilateral 4 and may also rupture causing sudden death due to massive haemorrhage or haemoptysis from an arteriobronchial fistula. s The incidence of vascular involvement in our 183 cases with BD was 28.4% (52 cases) in the last 15 years, PAA was observed in four (2.2%) patients who are reported in this paper. eral perihilar well-circumscribed round opacities (Fig. 1). Computerised tomography (CT) of the thorax showed bilateral PAA (Fig. 2), verified at pulmonary angiography. Bronchoscopy revealed significant bleeding from the left lower lobe bronchus. Because of increased bleeding, the patient was urgently taken to theatre. Although a left lower obectomy was carried out, the patient died due to massive haemoptysis on the third postoperative day. A post mortem study was

Off-pump bypass grafting in patients with significant left main coronary artery stenosis

The aim of this study was to investigate and determine whether patients with significant (≧%50) left main coronary artery stenosis could undergo coronary bypass on the beating heart and compare the results to those obtained using the conventional method. Prospectively collected data of patients with significant left main coronary artery disease who had undergone coronary bypass on the beating heart (group A, n = 100) or with the conventional method (group B, n = 100) were evaluated retrospectively. EuroSCORE values, preoperative and operative details, postoperative morbidity and mortality, and early results were compared. Groups were similar in terms of EuroSCORE, demographics, and preoperative variables. Number of distal anastomoses per patient was 3.1 ± 0.9 in the beating heart group while it was 3.3 ± 0.9 in the conventional group (P = 0.09). Patients operated on with the conventional method had higher levels of peak creatine kinase-myocardial band, blood and blood product transfusions, and inotropic requirements, while mechanical ventilation times and hospital stay were longer. The incidence of postoperative atrial fibrillation, mediastinitis, and intra-aortic balloon usage were comparable between the groups. There was no neurological complication in group A whereas five major neurological complications (three transient ischemic attacks, two strokes) occurred in group B (P = 0.06). Thirty-day mortality occurred in one patient in the beating heart group whereas five early deaths were observed in the conventional group (P = 0.21). In significant left main coronary artery stenosis coronary bypass on the beating heart is a safe and effective alternative to the conventional method with the same or better early results. The long-term results need to be evaluated.

Single-stage repair of adult aortic coarctation and concomitant cardiovascular pathologies: a new alternative surgical approach

BackgroundCoarctation of the aorta in the adulthood is sometimes associated with additional cardiovascular pathologies that require intervention. Ideal approach in such patients is uncertain. Anatomic left-sided short aortic bypass from the arcus aorta to descending aorta via median sternotomy allows simultaneuos repair of both complex aortic coarctation and concomitant cardiac operation.MaterialsFour adult patients were underwent Anatomic left-sided short aortic bypass operation for complex aortic coarctation through median sternotomy using deep hypothermic circulatory arrest. Concomitant cardiac operations were Bentall procedure for annuloaortic ectasia in one patient, coronary artery bypass grafting for three vessel disease in two patient, and patch closure of ventricular septal defect in one patient.ResultsAll patients survived the operation and were alive with patent bypass at a mean follow-up of 36 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia.ConclusionWe conclude that single-stage repair of adult aortic coarctation with concomitant cardiovascular lesions can be performed safely using this newest technique.

Postoperative outcomes after off-pump coronary artery bypass grafting in EuroSCORE low- and high-risk women.

BACKGROUND Many previous studies have reported that women who undergo coronary artery bypass grafting have higher perioperative morbidity and mortality rates than men. The use of off-pump coronary artery bypass grafting (OPCAB) has been suggested to decrease morbidity and mortality because the deleterious effects of cardiopulmonary bypass, particularly in high-risk patients, are avoided. The reduction in unwanted postoperative complications in women undergoing OPCAB surgery has not been extensively investigated. The aim of this retrospective study was to compare perioperative rates of morbidity and mortality and follow-up events after OPCAB in female patients assessed as high- or low-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS The study included 377 adult female patients who underwent elective primary isolated OPCAB. The study patients were divided into 2 groups based on the Additive EuroSCORE: low-risk patients (group I, n = 301, EuroSCORE < 6) and high-risk patients (group II, n = 76, EuroSCORE > or = 6). RESULTS Patient ages were 60.1 +/- 7.77 years in group I and 69.3 +/- 5.51 years in group II (P <.001). Compared to group I patients, group II patients had significantly higher Additive EuroSCORE (P <.001), predicted mortality rate (Logistic EuroSCORE) (P <.001), and Canada angina classification (P <.001) and higher rates of preoperative myocardial infarction (P <.001), peripheral vascular disease (P <.001), carotid artery disease (P <.005), and hypertension (P <.05). Occurrence of postoperative arrhythmia and mortality were significantly higher (P <.05) in group II. The observed mortality rate in group I was 1%, which was 41% of the predicted mortality rate (Logistic EuroSCORE) of 2.42 +/- 0.76. The observed mortality rate in group II was 5.3%, which was 79% of the predicted rate (6.74 +/- 2.89), but the difference was not significant (P = .2). Intensive care unit length of stay (P <.01) and ventilation times (P <.05) were longer for group II than group I, and the incidence of conversion to cardiopulmonary bypass was 1.6% versus 5.3%, respectively, in groups I and II (P = .08). CONCLUSION These results indicate that OPCAB surgery is safe and seems to be an effective surgical technique for lowering rates of morbidity and mortality in high- and low-risk female patients.

Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

Objective We aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery. Methods We retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections. Results Forty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up. Conclusion Although myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.