E Celik

Surgery for false aneurysm developing after type A acute aortic dissection

Aortic false aneurysm is life-threatening with high morbidity and mortality rates. Surgical treatment varies according to the pathologic process, infection status, and site of origin of the aneurysm. We presented a case of false aneurysm of the ascending aorta, developing after type A acute aortic dissection repair. The operation was performed with the use of deep hypothermia and circulatory arrest to avoid massive uncontrollable hemorrhage.

Our double valve replacement strategy in a case with pectus carinatum deformity

Background Pectus carinatum is a deformity of the chest characterized by a protrusion of the sternum and ribs. It develops as a result of an overgrowth of cartilage causing the sternum to protrude forward. It is detected most commonly during pubertal growth spurt. Methods Our case was a 63-year-old male. An elective umbilical hernia repair was being planned. During the investigations due to shortness of breath, transthoracic echocardiography (TTE) revealed severe aortic and mitral regurgitation. Left ventricular end-diastolic and end-systolic diameters were measured as 72 and 48 mm, respectively. Left and right atrial diameters were measured as 56 and 55 mm, respectively. Pulmonary arterial pressure was calculated as 35 mm Hg and left ventricular ejection fraction was identified as 60%. Coronary angiography detected no significant stenoses and confirmed aortic and mitral regurgitation with an ejection fraction of 50%. Our case was consulted with Department of Pulmonary Diseases due to dyspnea and moderate pectus carinatum. Fibrotic lesions and pleural thickenings in the upper zones of both hemithoraces were interpreted as sequelae of tuberculosis. Pulmonary function tests were normal. Elective open heart surgery was planned. Results After standard median sternotomy, aortic valve was replaced with 23 mm St. Jude mechanical valve and mitral valve was replaced with 31 mm St. Jude mechanical valve. Left atrial appendix was sutured internally due to atrial fibrillation to avoid embolization and posterior leaflet of the mitral valve was preserved. Postoperative period was event-free. Conclusions Most cases with pectus carinatum are asymptomatic as in our case. Psychological and cosmetic disturbances may be observed as well as respiratory tract infections and exertional dyspnea. We think that technically challenging correction surgery should be avoided if patients are asymptomatic, particularly after completion of calcification process of the bony structures.

Predictors of intra-aortic balloon pump insertion in coronary surgery and mid-term results.

Background We aimed to investigate the preoperative, operative, and postoperative factors affecting intra-aortic balloon pump (IABP) insertion in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). We also investigated factors affecting morbidity, mortality, and survival in patients with IABP support. Methods Between January 2002 and December 2009, 1,657 patients underwent isolated CABG in İzmir Katip Celebi University Atatürk Training and Research Hospital. The number of patients requiring support with IABP was 134 (8.1%). Results In a multivariate logistic regression analysis, prolonged cardiopulmonary bypass time and prolonged operation time were independent predictive factors of IABP insertion. The postoperative mortality rate was 35.8% and 1% in patients with and without IABP support, respectively (p=0.000). Postoperative renal insufficiency, prolonged ventilatory support, and postoperative atrial fibrillation were independent predictive factors of postoperative mortality in patients with IABP support. The mean follow-up time was 38.55±22.70 months and 48.78±25.20 months in patients with and without IABP support, respectively. The follow-up mortality rate was 3% (n=4) and 5.3% (n=78) in patients with and without IABP support, respectively. Conclusion The patients with IABP support had a higher postoperative mortality rate and a longer length of intensive care unit and hospital stay. The mid-term survival was good for patients surviving the early postoperative period.

Effects of smoking habit and diagnosed COPD on intensive care unit stay length of surgically treated coronary artery and obstructive peripheral arterial disease patients

Results There were 47 COPD patients in 868 patients who underwent surgery for coronary artery disease. In addition, 490 patients were active smoker and 378 were not using tobacco products. Mean Intensive care unit stay for COPD patients was 4,81 day and 3,06 day for patients without COPD. This difference was significant (p < 0.05).There were 31 COPD patients in 268 patients who underwent surgery for peripheral arterial disease. In this group, 172 patients were active smoker and 96 were not smoking. Mean Intensive care unit stay for COPD patients was significantly longer in COPD group (p < 0.05).

Surgical strategy in a patient with combined infective endocarditis of pseudomonas putida and metisiline sensitive staphylococcus, complicated with splenic infarction cerebral abscess.

Infective endocarditis, which is described as malignant disease of infections, has several complications increasing morbidity and mortality like splenic infarct and cerebral abscess.

Role of LDL level over hospital stay length of surgically treated coronary artery and obstructive peripheral arterial disease patients

Atherosclerosis is the most common and most important risk factor for cardiovascular diseases.

Comparison of amount of postoperative use of blood and blood products between patients receiving and not receiving salicylate before coronary surgery

Results There was no significant difference between groups that underwent on-pump coronary bypass surgery in terms of mean units of blood and blood products used (p > 0.05). The percentage of blood product use was 54.5% in salicylate receivers and 55.6% in non-receivers. There was no significant difference between groups of patients that underwent off-pump beating heart coronary surgery in terms of amount of blood and blood product used (p > 0.05). The percentage of blood product use was 37.5% in salicylate receivers and 50% in non-receivers in this group of patients (p > 0.05). Conclusions When the amount blood and blood products used was investigated for patients undergoing either on-pump or off-pump coronary bypass in terms of salicylate use, no significant difference was detected between groups.

Importance of urgent surgical treatment in a patient having massive pericardial effusion with end-stage renal disease

Results Subxiphoid pericardial drainage was performed under local anesthesia. Pericardial fluid of 1000 ml was drained. A pericardial drainage tube was inserted at surgery and removed after 5 days. A 2 x 3 cm2 biopsy specimen was taken under direct vision from the lower aspect of anterior pericardium. Sample of the drained fluid was collected for microbiological culture and cytological analysis. Microorganism cultured no from pericardial fluid. The pericardial biopsy specimen was negative for malignancy. He has uremic pericardial effusion. There was no complication and surgery-related death. After hospital discharge, patient was followed with physical examinations and echocardiogram.

Morbidity, mortality and mid-term follow-up in patients developing renal insufficiency after on-pump and off-pump coronary surgery.

Results Age, diabetes, preoperative renal insufficiency, and prolonged cardiopulmonary bypass time (CPB) were the independent predictive factors of postoperative renal insufficiency in patients undergoing on-pump coronary revascularization. Postoperative mortality rate was 12.5% (no = 1) and 47.4% (n = 27) in patients with postoperative renal insufficiency undergoing off-pump and onpump coronary revascularization, respectively (P = 0.124). Mean follow-up was 47.00 ± 23.08 months and 44.97 ± 20.96 months in patients with postoperative renal insufficiency undergoing off-pump and on-pump coronary revascularization, respectively. In follow-up, mortality rate was 37.5% (no = 3) and 12.5% (n = 7) in patients with postoperative renal insufficiency undergoing off-pump and on-pump coronary revascularization, respectively (P = 0.098). Diabetes and reoperation for bleeding were the independent predictive factors of survival in patients with postoperative renal insufficiency undergoing on-pump coronary revascularization.

Comparison of patients receiving salicylate before coronary artery surgery with patients not receiving in terms of postoperative mortality rates

Methods Sixty one patients that underwent coronary bypass surgery between January 2011 and December 2011 at our clinic were investigated retrospectively. Sixty one (80.3%) of them were operated on under cardiopulmonary bypass and 12 (19.7%) were operated on beating heart. Thirty (49.2%) of them were receivers of 100 mg enteric coated salicylate and 31 (50.8%) were non-receivers, divided into 2 groups. The mean age of salicylate receivers was 61.33 years whereas it was 57.71 years in the non-receivers.