Denyan Mansuroglu

Endovascular stenting of mid-aortic syndrome due to Takayasu arteritis

Abstract Introduction–patients: Takayasu arteritis may involve various parts of the aorta and its major branches. It leads to occlusive or aneurysmal disease of the vessel. It can be treated either with surgery or percutaneous intervention. We report a successful endovascular treatment of stenosis of the descending thoracic and abdominal aorta in a 19-year-old female. Methods–results–conclusions: Self-expandable nitinol stent was deployed and adequate opening of the aorta was obtained in this patient. Long-term durability of endovascular approach is a matter of debate. We also reviewed the sufficiency of endovascular treatment versus surgery.

Severe Hypokalemia Probably Associated With Sertraline Use

Objective: To report a case of ventricular fibrillation caused by severe hypokalemia probably associated with sertraline use. Case Summary: A 48-year-old male patient experienced ventricular fibrillation and cardiac arrest 2 hours after an uneventful coronary angiography procedure, which revealed normal, unobstructed coronary arteries. Blood chemistry was immediately obtained, revealing a very low potassium (K+) level of 2.44 mEq/L. Other blood electrolytes, including magnesium, ECG, and corrected QT intervals, were all within normal limits. A thorough search for an etiology of hypokalemia, including adrenal gland causes, herbal product consumption, and toxic exposure, did not reveal any identifiable cause. This led us to consider the only drug he was on—sertraline 50 mg per day—as the possible culprit. Discussion: There has been no clear identification of severe hypokalemia associated with sertraline use in the literature. However, there have been a considerable number of self-reported cases of hypokalemia in patients on sertraline therapy. Scoring according to the Naranjo adverse drug reaction scale revealed a probable relationship between severe hypokalemia and sertraline use in our patient. No clear pathogenic mechanism for the effect of sertraline on serum K equilibrium is known. However, considering the number of self-reported incidences and this case report, the effect of sertraline on serum K levels warrants consideration. Conclusions: This is the first documented case report of severe hypokalemia probably associated with sertraline use.

Gastrointestinal complications after open heart surgery: incidence and determinants of risk factors.

Acute mesenteric ischemia is a rare but serious complication of open heart surgery. Between January 2009 and January 2012, 1360 adult patients underwent open heart surgery with cardiopulmonary bypass at our institution; 29 patients presented gastrointestinal complications. Eight patients developed acute mesenteric ischemia and all of them died. Significant predictors of the complication were New York Heart Association functional class III/IV, history of extensive atherosclerosis and chronic renal failure, acute renal failure following surgery, low cardiac output, use of 2 or more vasoconstrictor drugs, prolonged mechanical ventilation, and multiorgan failure. Atherosclerosis is a multisystemic disease that affects several organs. Radiologic evaluation of mesenteric arterial system should be performed in high-risk patient populations. Perioperative percutaneous and open vascular procedures will reduce the risk of acute mesenteric ischemia that may develop after cardiac surgery and consequent morbidity and mortality rates.

Images in InterventionNative Aortic Valve Thrombosis Leading to ST-Segment Elevation Myocardial Infarction

A 54-year-old male patient with no history of left bundle branch block was admitted to the emergency department with chest pain lasting for 1 h. Electrocardiography demonstrated newly developed left bundle branch block indicating ST-segment elevation myocardial infarction. He was immediately taken

Timing of coronary artery bypass surgery in patients with non-ST-segment elevation myocardial infarction and postoperative outcomes.

Introduction The aim of the study was to assess whether a cardiac troponin T (cTnT) level 1 ng/ml or below threshold is safe and to evaluate mid-term follow-up results in stable patients with non-ST-segment elevation after acute myocardial infarction. Material and methods Among cTnT positive patients who presented to the emergency unit with chest pain and received coronary angiography, 100 patients who underwent isolated coronary artery bypass grafting (CABG) constituted the study group (group 1). The same number of patients (n = 100) who were cTnT negative and underwent an isolated CABG operation under elective conditions were selected as the control group (group 2). Results Among preoperative criteria, group 1 had significantly higher smoking rates (74% vs. 41%, p = 0.0001), and significantly lower ejection fraction values (47.1 ±8.25, 54.69 ±8.73, p = 0.0001). There were no significant differences between the groups with respect to operative parameters. Postoperative follow-up periods were significantly longer in group 1 (23.25 ±14 vs. 17.55 ±7.95 months, p = 0.001). Average waiting time for cTnT to drop below the 1 ng/ml threshold value was 5.73 ±2.95 (1–12) days. Intra-aortic balloon pump use in Groups 1 and 2 was 3% and 1%, respectively. There were no hospital mortalities in either group. Mortality rates at mid term were 6% in both groups. Conclusions This study compared two groups positive and negative for preoperative cTnT. The findings show that it is safe to wait until cTnT levels decrease to the 1 ng/ml threshold value in cTnT positive patients having a stable course. This waiting period is not very long, which is significant with respect to potential complications.

Giant aortic pseudoaneurysm presented with acute coronary syndrome by compressing the coronary arterial system.

A 36-year-old man was presented with acute coronary syndrome. He had a history of an aortic valve replacement (AVR) operation 7 years ago and a redo AVR because of the aortic prosthesis dehiscence 6 months ago. Coronary angiography revealed a severe stenosis in the left anterior descending artery (LAD) ( Panel A , see Supplementary data online, Video S1 ). The other coronary arteries were normal. A bare-metal stent was implanted in the LAD; 2 months after discharging, the patient was admitted with …

Concomittant Coronary Revascularization and Resection of a Cardiac Tumor

Ischemic cardiac diseases are the leading causes of mortality in the developed and developing regions of the world. Although vascular problems may accompany coronary artery disease, association of primary cardiac tumors with ischemic heart disease and the treatment of the combination are rarely reported in the literature. This report presents a male patient who successfully underwent concomitant coronary artery bypass grafting with resection of right atrial myxoma. In this report, we present a case of ischemic heart disease and myxoma treated successfully in the same surgical session.