Halil Basel

Outcomes of De Vega versus biodegradable ring annuloplasty in the surgical treatment of tricuspid regurgitation (mid-term results).

PURPOSE The aim of this study was to compare De Vega semicircular annuloplasty and a new biodegradable ring annuloplasty technique in patients requiring surgical intervention for tricuspid valve disease with concomitant disease of the mitral valve. METHODS Between January 2004 and May 2008, 129 consecutive patients underwent annuloplasty procedures to correct tricuspid valve regurgitation during a concomitant mitral valve operation requiring replacement. Additionally, 24 patients underwent aortic valve replacement (AVR), 11 underwent coronary artery bypass grafting (CABG), 5 underwent AVR plus CABG, 3 underwent mitral valve replacement plus atrial septal defect (ASD) closure, and 2 underwent ASD closure. The patients in this study were assigned to 2 groups: Kalangos ring annuloplasty was performed in 67 patients (group 1), and De Vega semicircular annuloplasty was performed in the remaining 62 patients (group 2). RESULTS Both tricuspid valve repair techniques produced a low rate of complications; however, the number of patients who developed residual tricuspid regurgitation was significantly lower in group 1. CONCLUSION The biodegradable ring annuloplasty technique may be used easily and safely in moderate and severe cases of tricuspid regurgitation; however, larger clinical series are necessary to confirm our promising results.

Basilic vein transposition fistulas versus prosthetic bridge grafts in patients with end-stage renal failure.

BACKGROUND Basilic vein transposition fistulas (BVTFs) and prosthetic bridge grafts (PBGs) provide good vascular access for hemodialysis. To evaluate the patency and complication rates after arteriovenous fistula formation, a concurrent series of patients was reviewed. METHODS Between September 2003 and September 2009, 147 hemodialysis access procedures were performed in 147 consecutive patients at Van Research and Training Hospital and Yuzuncu Yil University Hospital, Van, Turkey. All access procedures were planned on the basis of preoperative duplex scans of arm and forearm veins. Functional patency was defined as the ability to cannulate hemodialysis patients successfully. Primary and secondary cumulative functional patency rates of BVTFs and PBGs were determined with life-table analysis and differences were analyzed with retrospective study. Differences in revision rates, including thrombolysis thrombectomies and operative revisions, were analyzed with the Fisher exact t-test. RESULTS Mean follow-up was 15 months (range, 3-24 months). Risk factors were similar between the two groups. BVTFs had better patency at 15 months. The dialysis access complications were higher in the PBG group versus BVTF group, and the PBG group had a higher infection rate than the BVTF group. CONCLUSION The primary and secondary patency rates were superior in the BVTF group. Our data strongly support the contention that as long as the patient is a candidate for an upper arm BVTF based on anatomical criteria, BVTF always be considered before a PBG.

Repair of ventricle free wall rupture after acute myocardial infarction: a case report

IntroductionAcute myocardial infarction (AMI) may culminate in sudden death by ventricular fibrillation, cardiogenic shock, and cardiac rupture. We present a case of postinfarction rupture treated by direct closure and coronary artery bypass grafting after thrombolytic therapy.Case reportA 67-year-old woman with cardiac risk factors of hypertension, diabetes mellitus, and being post-menopausal was admitted complaining of chest pain and sweating. Thrombolytic therapy with streptokinase was started due to acute myocardial infarction. But, reperfusion criteria were not achieved. Echocardiography revealed a moderate pericardial effusion with mild right chamber collapse and pericardial thrombus. Cardiac catheterization revealed totally occluded left anterior descending (LAD) and circumflex coronary arteries. She was taken to the operating-room immediately. The pericardium was opened and a large amount of blood with thrombus was removed. Her hemodynamic indices improved immediately. There was active bleeding from multiple sites with a 4 mm rupture. Cardiopulmonary bypass was established. Direct closure of rupture was carried out. Reversed autogenous saphenous vein bypass grafts were placed to the LAD and second obtuse margin coronary arteries. Postoperative recovery was uneventful and she was discharged from hospital in good condition. She remained asymptomatic during first year following the surgery.ConclusionThis case demonstrates that left ventricular free wall rupture is not always fatal and that early diagnosis and emergency surgical therapy may be successful. The combination of surgical repair with revascularization should be considered, because 80% of patients who experience LVFWR have multivessel coronary artery disease.

Management of traumatic popliteal vein injuries

PURPOSE The aim of this study was to evaluate different repair methods of popliteal vein injuries, and to assess the relationship between early patency and surgical outcome. METHODS Thirty patients with popliteal vein injuries underwent surgical repair procedure at our hospital from March 2000 to April 2010. Patients who were haemodynamically unstable and those with massive bleeding from limb wounds were taken directly to the operating room. Stable patients underwent preoperative colour-flow duplex ultrasonography (CFDU). RESULTS Our study group consisted of 26 males and 4 females, ranging in age from 17 to 60 years with a mean age of 25.3 ± 5.9 years. The mechanism of trauma was penetrating in 27 patients and blunt in the remaining 3 patients. Treatment included primary venous repair in 11 cases, end-to-end anastomosis in 8, interposition vein graft in 10, and interposition polytetrafluoroethylene (PTFE) graft in 1. There were 26 patients with associated arterial injury, of which 4 cases had primary repair, 9 had end-to-end anastomosis, 11 had saphenous vein graft interposition, and 2 had PTFE graft interposition. Associated bone fracture was seen in 6 patients. There were no deaths. One patient required a below-knee amputation. Postoperative CFDU revealed thrombosed venous repair in 7 cases without any sequelae. CONCLUSION Popliteal venous injuries can be repaired with minimal downside and a good early patency rate. Additionally, transient venous patency allows for establishment of venous and lymphatic collateralisation. Alternatively, venous ligation should be considered only in unstable patients who refuse blood transfusion (Jehovahs witnesses). In these victims, adjuvant management may be required such as the use of fasciotomy and anticoagulation treatment.

Single coronary artery anomaly causing ischemic mitral insufficiency

Single coronary artery anomaly is rarely seen, and although it can present with sudden death, chest pain, arrhythmia, myocardial infarction, or congestive heart failure, it can also be asymptomatic. We describe the case of a 58-year-old man with single coronary artery anomaly in whom the coronary artery stemmed from the left coronary sinus and caused ischemic mitral insufficiency due to left anterior descending artery stenosis. He underwent successful mitral valve repair and coronary bypass.

Ischaemic mitral regurgitation: The effects of ring annuloplasty and suture annuloplasty repair techniques on left ventricular re-remodeling

Objective: To examine the mid-term results of patients on whom a coronary revascularization as well as a mitral ring and suture annuloplasty have been performed due to coronary artery disease (CAD) and ischaemic mitral regurgitation (IMR). Methodology: Totally 73 patients on whom a revascularization and a mitral valve repair due to CAD and IMR had been performed in our clinic between 2000-2008 were included in the study. Patients were divided into two groups one of which included 38 patients (52.05%) on whom a coronary artery bypass graft (CABG) and a ring annuloplasty on the mitral valve had been performed (Group 1) and the other one 35 patients (47.95%) on whom only suture annuloplasty as well as a CABG had been performed (Group 2). The study was planned retrospectively and study data have been obtained by screening the hospital registries retrospectively. In the mid-term, patients were invited for a check and their intragroup and intergroup echocardiographic parameters and functional capacities were assessed statistically. Results: In pre-operational and post-operational intragroup assessment in terms of echocardiographic findings; although LVEDD, LVESD, EDV, PAP and the degree of recurrent MR have been decreased in both groups, the decrease in LVESD and PAP and the low degree of recurrent MR were statistically significant in Group 1 patients (p=0.047, p=0.023, p=0.01, respectively). When the mid-term intergroup echocardiograpic findings were assessed; PAP and recurrent MR have been determined statistically lower in Group 1 patients (p=0.005, p=0.08, respectively). The length of intensive care unit stay, length of hospitalization and length of detachment from respiratory support were statistically significantly longer in ring annuloplasty performed group (p=0.012, p=0.033, p=0.029, respectively). Conclusions: In moderate to severe IMR patients, a positive contribution can be provided to ventricular remodeling by a ring annuloplasty through a significant decrease in left ventricular diameter and a low recurrent MR and PAP.

Right coronary artery originating from the distal left circumflex artery, evaluation using three imaging techniques.

An isolated single coronary artery is extremely rare, with an incidence of 0.024% to 0.066% in the general population (1), and many patients with coronary artery anomalies are asymptomatic. However, some of these anomalies can lead to sudden death. In this report, we describe a rare case using three different imaging methods.

Açık Kalp Cerrahisinden Sonra Derin Sternum Yara İnfeksiyonunda Negatif Basınçlı Yara Tedavisinin Rolü

Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A) and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B) between January 2006 and January 2010.

Periferik arterlerin yalancı ve gerçek anevrizmalarındaki deneyimlerimiz

Ozet Amac. Son yillarda tani ve tedavi amacli invaziv metotlarin yaygin kullanimi nedeniyle pseudo anevrizma olgulari artmistir. Bu calismamizin amaci, klinigimizde opere edilen periferik arter gercek ve pseudo anevrizma olgularinin preoperatif ozelliklerinin, cerrahi tedavi sonuclarinin retrospektif olarak degerlendirilmesidir. Yontem . Klinigimizde 1999-2008 yillari arasinda periferik arter anevrizmasi saptanan 35 olgu retrospektif olarak incelendi. Bulgular. Akut ve kronik olmak uzere toplam 12 (%34,3) olguda ekstremite iskemisi mevcuttu. Gercek anevrizma 12 (%34,3) (1 olguda birden fazla anevrizma), psodoanevrizma ise 23 (%65,7) olguda tespit edildi. Etiyolojide gercek anevrizmalarda en sik ateroskleroz, psodoanevrizmalarda ise iyatrojenik nedenler saptandi. 26 (%74,2) olguda anevrizmanin en sik yerlestigi bolge femoral ve popliteal arterler olup en sik uygulanan cerrahi yontemin psodo anevrizmada primer tamir, gercek anevrizmada ise anevrizmektomi ile birlikte safen ven veya sentetik greft interpozisyonu idi. Sonuclar . Toplam 1 (%2,9) gercek anevrizmada 8 saatlik bir iskemi nedeniyle alt ekstremite parmaklarinda amputasyon gerekti. Elektif cerrahi onarimin, bu komplikasyonun tedavisini kolaylastirdigi gorulmustur. Komplikasyon gelisimi, yapilacak mudahalelerin basari sansini azaltacagi icin asemptomatik bile olsa periferik anevrizmalar mutlaka cerrahi olarak tedavi edilmelidir. Anahtar sozcukler : Periferik arter, anevrizma, anevrizmektomi Abstract Aim. Peripheral arterial aneurysms are frequently encountered due to increased incidence of arteriosclerosis and common use of invasive methods for the diagnostic and therapeutic purposes. The aim of this report is to evaluate preoperative features of peripheral arterial aneurisms operated at our clinic and their surgical results retrospectively. Methods. 35 peripheral arterial aneurysm cases diagnosed and operated at our clinic between the years of 1999-2008 and they were retrospectively evaluated. Results. Acute and chronic ischemia of the extremities were determined in 12 cases (34.3%). True aneurysms were seen in 12 (34.3%) cases (more than one aneurysm in one case). Pseudo-aneurysms were seen in 23 (65.7%) cases. Frequent causes for true and pseudo-aneurysms were arteriosclerosis and iatrogenic factors. Frequent localization of the 26 (74.2%) aneurysms were the femoral and popliteal arteries. It was noted that, aneurysmectomy combined with interposition of sapheneous vein or synthetic graft was the most commonly applied surgical method in patients with true anevrisms. Conclusions. In one true anevrism (2.9%), amputation of the lower extremity toes was required due to ischemia more than eight hours. It is suggested that peripheral aneurysms (even asymptomatic cases) must be surgically treated since they may cause serious complications. Keywords : Peripheral artery, aneurysm, aneurysmectomy v