Hakan Ceyran

Surgical treatment of vasculo-Behçet's disease. A review of patients with concomitant multiple aneurysms and venous lesions.

Background: Vascular complications can be seen in patients with Behcet’s disease. Arterial and venous complications may be found separately or concomitantly in patients. Patients and methods: Out of 29 patients with vasculo-Behcet’s disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 ± 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. Results: We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed ...BACKGROUND Vascular complications can be seen in patients with Behçets disease. Arterial and venous complications may be found separately or concomitantly in patients. PATIENTS AND METHODS Out of 29 patients with vasculo-Behçets disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 +/- 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. RESULTS We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed in two patients who had anastomotic aneurysms and graft occlusion without disabling ischemia. Venous pathologies were treated by medical therapy. The patients were followed up between 1 to 8 years. One of the patients with iliac artery aneurysm died due to gastrointestinal bleeding 15 months after the operation. CONCLUSIONS In conclusion, when an aneurysm has been found in a patient with Behçets disease, the patient should be scanned for possible multiple aneurysms and venous lesions since they might be found together. Surgical treatment, when feasible, should be performed in cases with Behçet aneurysms because of a high risk of rupture. However, the possibility of an anastomotic aneurysm developing after surgery should also be kept in mind.

The Effect of High Dose Melatonin on Cardiac Ischemia-reperfusion Injury.

Purpose Melatonin, the most potent scavenger of toxic free radicals, has been found to be effective in protecting against pathological states due to the release of reactive oxygen species. This study was performed to establish the effect of high dose melatonin on protection against ischemia-reperfusion (I/R) injury in rat hearts. Materials and Methods Forty male Sprague-Dawley rats were used in this study. They were separated into four groups of ten rats each. A left coronary artery occlusion was induced in the rats by ligating the artery for 20 minutes and then releasing the ligation (reperfusion) afterwards. The control group was Group A. Group B was subjected to myocardial ischemia-reperfusion without any treatment, while Group C underwent myocardial ischemia-reperfusion with a melatonin treatment before the ischemia. Group D was subjected to myocardial ischemia-reperfusion with a melatonin treatment before the reperfusion. After 20 minutes of reperfusion, blood samples were obtained from each group for biochemical studies, and the animals were sacrificed for histological and, immunohistochemical examinations of the myocardial tissue. Results We found that the cardiac troponin T(cTn-T) levels were significantly increased in Group B when all groups were compared. In the Group C rats treated with melatonin, the cTn-T values were significantly lower than those in Groups B and D. In addition, malondialdehyde (MDA) and antioxidant enzymes including, superoxide dismutase (SOD) and myeloperoxidase (MPO) were lower than those in Group B in the melatonin treated groups. The differences were statistically significant (p < 0.05). Histopathologic and immunohistopathologic studies also supported the effectiveness of melatonin. Conclusion Our study suggests that high dose melatonin, appears to offer protection against cardiac ischemia-reperfusion injuries in rats by scavenging the free radicals and could have a potential clinical use in the management of myocardial ischemia.

Carnitine levels in patients with chronic rheumatic heart disease.

OBJECTIVE Carnitine, a small aminoacid derivative plays a major role in fatty acid oxidation. Myocardial carnitine deficiency may cause malfunction of the heart. Rheumatic valvular heart disease can be associated with myocardial dysfunction. We have investigated myocardial and plasma-free carnitine levels in patients with chronic rheumatic heart disease. MATERIAL AND METHODS Eleven patients with chronic rheumatic heart disease requiring valve replacement were selected for study. Ten patients with no cardiac failure, myocardial wall motion abnormalities and myocardial infarction and for whom coronary bypass surgery was planned were selected as the control group. Carnitine levels of myocardial tissue obtained from the right atrium and plasma during the operation were evaluated using spectrophotometric method. Myocardial-free carnitine levels expressed as mumol/g (dry weight) were determined according to Ceberblad and Lindstedt technique. RESULTS Myocardial-free carnitine levels in patients were found to be 0.72 +/- 0.37 mumol/g (dry weight) in comparison with 1.44 +/- 1.03 mumol/g (dry weight) in the control group. Myocardial-free carnitine levels in patients were statistically decreased when compared to control group. Plasma-free carnitine levels in patients were 80.91 +/- 28.22 mumol/L and 89.52 +/- 48.21 mumol/L in the control group, respectively. There was no significant difference between plasma-free carnitine levels of the groups. CONCLUSION In our study, myocardial-free carnitine levels were decreased while plasma-free carnitine levels were normal in patient with chronic rheumatic heart disease.

Myxomas Causing Coronary Emboli Resulting in Acute Myocardial Infarction

A 26-year-old female presented with chest pain, numbness in the legs, and electrocardiographic signs of left ventricular aneurysm and recent myocardial infarction. Transesophageal echocardiography detected a mass in each atria. Angiography demonstrated normal coronary arteries, a left ventricular aneurysm, and an apical thrombus. At surgery, myxomas were excised from both atria and the aneurysm was plicated, followed by peripheral embolectomy. The patient made a good recovery.

A rare cause of peripheral arterial embolism: ruptured cardiac hydatid cyst.

One of the important unfavorable events that occur during the course of the cardiac hydatid cyst is rupture of the cyst and embolism of the germinative membrane. Peripheral arterial embolism of this germinative membrane is uncommon but is a potential risk due to the nature of the disease. Ruptured cardiac hydatid cyst should be suspected in young patients who have a peripheral arterial embolism and come from sheep-raising areas and/or if they have a suspected embolectomy material resembling germinative membrane. Following the embolectomy and reconstruction of the circulation in the involved extremity, ruptured cardiac hydatid cyst should be diagnosed immediately and excision of the cardiac cyst should be performed as quickly as possible. In this case report, we present two patients who had lower extremity embolism originating from the ruptured cardiac hydatid cyst and were operated on for cardiac cyst excision.One of the important unfavorable events that occur during the course of the cardiac hydatid cyst is rupture of the cyst and embolism of the germinative membrane. Peripheral arterial embolism of this germinative membrane is uncommon but is a potential risk due to the nature of the disease. Ruptured cardiac hydatid cyst should be suspected in young patients who have a peripheral arterial embolism and come from sheep-raising areas and/or if they have a suspected embolectomy material resembling germinative membrane. Following the embolectomy and reconstruction of the circulation in the involved extremity, ruptured cardiac hydatid cyst should be diagnosed immediately and excision of the cardiac cyst should be performed as quickly as possible. In this case report, we present two patients who had lower extremity embolism originating from the ruptured cardiac hydatid cyst and were operated on for cardiac cyst excision.

Transapical aortic balloon valvuloplasty in a 6-year-old child with unsuccessful retrograde approach

Severely stenotic aortic valves can be treated by percutaneous techniques. However, in rare conditions it could not be possible because of vascular access and valvular passage problems due to small and eccentric orifice. Hybrid approach to balloon aortic valvuloplasty may be considered an alternative to surgery. Here, we present a case of a patient with severe aortic stenosis who has had two failed attempts of percutaneous intervention.

Newborn with an Intracardiac Mass Generated Secondary to Umbilical Vein Catheterization

Umbilical vein catheterization is a routine procedure of neonatal intensive care units, and only rare complications associated with catheter malposition have been described in the literature. We herein present an infant boy (28 days old, 4 kg) with an intracardiac mass diagnosed after umbilical vein catheterization. The patient was referred to our clinic with a diagnosis of catheter migration and thrombosis, but this could not be confirmed during surgery. Pathological analysis of the excised intracardiac mass revealed nonbacterial thrombotic endocarditis. Our case confirms the essentiality of controlling the location of the umbilical venous catheter after its insertion.

Mitral Balloon Valvuloplasty in a Child by Hybrid Approach

Rheumatic fever is the main etiology for valvular heart diseases in children. Valvular insufficiencies are frequent, and development of disease at an earlier age results in severe valvular damage. In this report we present a 9-year-old child with rheumatic heart disease who was admitted to our clinic with hemoptysis and haematemesis caused by mitral stenosis (MS) resulting in pulmonary venous hypertension. The child was treated with mitral balloon valvuloplasty by hybrid approach. Percutaneous mitral balloon valvuloplasty is used for management of MS in adults, but it is less frequently used in children because of its high rate of complications. Because of the severity of disease with which this patient presented, as well as her younger age and lower weight, we preferred to use the hybrid approach, and the results were favorable. In conclusion, in patients with special conditions, hybrid mitral valvuloplasty through the right upper pulmonary vein should be considered when managing children with similar conditions.

Brucella Endocarditis Affecting the Mitral Valve

Brucellosis is still prevalent in Mediterranean and Middle East countries and Brucella endocarditis is a rare and often fatal complication. We describe a case of Brucella endocarditis in a 23-year-old male who required mitral valve replacement after successful antibacterial treatment.

Proximal Obstruction of Left Subclavian Artery after Coronary Artery Bypass Surgery

ASIAN CARDIOVASCULAR & THORACIC ANNALS 328 1998, VOL. 6, NO. 4 PROXIMAL OBSTRUCTION OF LEFT SUBCLAVIAN ARTERY AFTER CORONARY ARTERY BYPASS SURGERY A patient who had coronary artery bypass grafting in 1986 and angioplasty in 1993 was admitted to our hospital recently with chest pain and dyspnea of 5 months duration. Blood pressure in the right upper extremity was 120/70 mm Hg, while it was 70/40 mm Hg in the left. Angiography indicated total occlusion of the right coronary and circumflex arteries. The left internal thoracic artery (ITA) was patent but the left subclavian artery showed delayed filling and subclavian steal (Figure 1). The left subclavian artery was explored via an incision through the left supraclavicular space. The left subclavian artery and the left external carotid artery were snared proximally and distally and a 6-mm polytetrafluoroethylene graft was anastomosed end-to-side between the carotid artery and the subclavian artery, close to the origin of the left internal thoracic artery. In the postoperative period, the left arm arterial blood pressure reached 110/65 mm Hg. Angiography showed that the graft was patent with good filling of the left internal thoracic artery (Figure 2). The patient was discharged in good condition on the 3rd postoperative day with anticoagulant therapy. He was symptom-free at the 6-month follow-up.