Erhan Kansiz

Single-institutional 22 years experience on cardiac myxomas.

Myxomas are the most common benign tumors of the heart. This study presents single-institutional 22 years experience on cardiac myxomas. The records of 9756 consecutive cases of open heart surgery between 1985 and 2007 revealed 0.23% myxoma. Age ranged between 12 and 77 years and male to female ratio was 7:17. Myxomas originated from the left atrium (15 patients), mitral valve (3 patients), right atrium (2 patients), right atrium and right ventricle (2 patients), right ventricle (1 patient), and left ventricle (1 patient). Three patients were operated for multiple myxomas. Myxomas were resected through right atriotomy, right atriotomy and pulmonary arteriotomy, left atriotomy, biatrial approach, or left ventriculotomy depending on the tumor location. Mean follow-up time was 11.5 years. Mortality occurred in 6 patients (1 early, 5 late deaths). No myxoma recurrence was detected. Myxomas should be resected leaving no remnant mass, without delay when they are diagnosed.

Amino Terminal Pro-B-Type Natriuretic Peptide and Late Left Ventricular Reverse Remodeling in Coronary Artery Bypass Grafting Patients with Low Ejection Fraction

ABS TRACT Ob jec ti ve: Left ven tri cu lar re mo de ling ac ce le ra tes the co ur se of car di ac fa i lu re by aggra va ting ven tri cu lar dysfunc ti on fol lo wing myo car di al in farc ti on. Thus, pre dic ti on and pre ven ti on of left ven tri cu lar re mo de ling is cru ci al. The aim of this study was to eva lu a te the pre dic ti ve va lu e of pe ri o pe ra ti ve plas ma NT-proBNP le vels for pos to pe ra ti ve left ven tri cu lar re ver se re mo de ling and ejec ti on frac ti on in pa ti ents who un der went co ro nary ar tery bypass graf ting. Ma te ri al and Met hods: Forty pa ti ents with myo car di al in farc ti on inprevious thre e months we re en rol led in the study. All pa ti ents with mo de ra te left ven tri cu lar dysfunc ti on (EF ≤40%) un der went on pump co ro nary ar tery bypass graf ting (CABG) ope ra ti on. Pa ti ents’ pre o pe ra ti ve left ven tric le vo lu mes and in de xes, ejec ti on frac ti ons, and NT-proBNP le vels we re com pa red to the pos to pe ra ti ve va lu es. Results: Pre o pe ra ti ve NT-proBNP le vels we re sig ni fi cantly re la ted to pre o pe ra ti ve and pos to pe ra ti ve ejec ti on frac ti ons, and pos to pe ra ti ve left ven tri cu lar re ver se re mo de ling (p= 0.037, p= 0.033, p= 0.014, res pec ti vely). Conc lu si on: The pre o pe ra ti ve N-ter mi nal proBNP may help to as sess the pos to pe ra ti ve ejec ti on frac ti on and ven tri cu lar re mo de ling. Ami no ter mi nal proBNP is a sa fe, ava i lab le and ef fec ti ve to ol to pre dict the pos to pe ra ti ve func ti o nal and struc tu ral chan ges of the left ven tric le.

Sequence variations of NKX2-5 and HAND1 genes in patients with atrial isomerism.

OBJECTIVE Atrial isomerism is a congenital disorder, which is characterized by lateralization defects in normally asymmetrical developing organs like the heart. Atrial isomerism is supposed to be caused by molecular defects during early development. The NKX2-5 is a cardiac specific transcription factor, which initiates and regulates downstream transcriptional cascades of cardiogenesis. The HAND1 is another transcription factor expressed in the heart, and it is characterized by an asymmetrical pattern of expression. In this study, we aimed to test whether mutations in NKX2-5 and HAND1 genes play a role in the etiology of atrial isomerism. METHODS This case-control study consisted of 70 patients who underwent surgical treatment for congenital heart defects including atrial isomerism, 80 healthy subjects (HAND1 gene) and 40 healthy subjects (NKX2-5 gene). All exons and exon-intron boundaries of NKX2-5 and HAND1 genes were analyzed by SSCP, and suspected samples were sequenced for mutation analysis. Digestion with appropriate restriction enzymes was performed for analysis of known mutations and polymorphisms. The frequencies of the alleles and the genotypes were compared among patient and control groups using the Chi-square and the Fisher tests when appropriate. RESULTS In intronic region of HAND1 gene, we identified a C>G substitution both in patients and controls. Frequency of mutant allele (11, 42%) was found higher (p=0.046) in patient group than that of the control group (2.5%). Association between atrial isomerism and genotypes with mutant allele was found borderline significant (p=0.054). In NKX2-5 gene, we identified heterozygous Q170X (Gln170ter) mutation in one patient. We did not found any correlation between defined sequence variations and clinical properties of the patients. CONCLUSION Our results suggest that mutations or sequence variations in HAND1 or NKX2-5 genes may play role in etiology or pathogenesis of atrial isomerism.

Left Atriotomy versus Right Atriotomy Trans-Septal Approach for Left Atrial Myxoma

The biatrial approach has been the classic means of access for left atrial myxoma resection. Increased surgical experience led cardiac surgeons to favour the uniatrial approach to reduce incisions and achieve adequate exposure. In this study, two unilateral surgical approaches were compared in 18 consecutive left atrial myxoma cases. Patients were divided into two groups according to the surgical approach: left atriotomy (group 1, n = 9) and right atriotomy trans-septal approach (group 2, n = 9). Comparison criteria included pre- and post-operative functional capacity, cardiac rhythm, left ventricular ejection fraction, pulmonary artery pressure, left atrial dimensions, cardiopulmonary bypass time, aortic cross-clamp time, drainage over 48 h postoperatively, units of blood transfused, extubation time and length of stay in the intensive care unit and hospital. No significant between-group difference was observed in any criteria except aortic cross-clamp time, which was significantly longer in group 2 than in group 1. No recurrence of myxoma occurred in either group for the 15 patients followed up. Right atrial trans-septal incision appears to be as safe and effective as the left atriotomy approach for left atrial myxoma resection.