Hasan Berat Cihan

On-pump Coronary Artery Bypass Surgery in High-risk Patients Aged Over 65 Years (EuroSCORE 6 or More): Impact on Early Outcomes

The results of on-pump coronary artery bypass graft (CABG) surgery in 166 high-risk elderly patients (EuroSCORE 6 or more; over age 65 years [mean 71.8 years]) were compared with 176 low-risk elderly patients (EuroSCORE below 6; over age 65 years [mean 68.8 years]). There was no significant difference in hospital mortality or number of grafts between the two groups. Rates of inotropic agent use, intra-aortic balloon pump insertion and atrial fibrillation, and the duration of intensive care unit and hospital stay were significantly higher in high-risk than low-risk patients. There were no significant differences in the incidence of major complications between the two groups. The results suggest that, in selected patients, on-pump CABG can be safely performed in high-risk patients over 65 years old with no effect on mortality.

Pseudoaneurysm of high origin ulnar artery after penetrating trauma.

High origin ulnar artery from the brachial artery is rare and lies superficially in the forearm. Its reported frequency ranges from 0.17% to 2%. Pseudoaneurysms of peripheral arteries are very rare, and mostly these are the result of penetrating injuries. Here, we report a case pseudoaneurysm of high origin ulnar artery from the brachial artery and its surgical approach method.

Late traumatic aneurysm of the right atrium.

Cardiac injuries caused by blunt trauma constitute an important proportion of all cardiac injuries. The diagnosis of myocardial injury caused by blunt trauma can be challenging in the setting of additional multiple lesions. Blunt trauma to the chest complicated with myocardial contusion constitutes 3% to 9.4% of all blunt trauma cases. The incidence of cardiac trauma has been reported to be 16% in autopsy series after blunt trauma to the chest. Myocardial contusion comprises all cardiac abnormalities after nonpenetrating trauma, including dysrhythmias, myocardial rupture, myocardial infarction, congestive cardiac failure, valvular disruption, tamponade, and thromboembolic events. Late complications of contusion to the heart caused by blunt trauma include ventricular aneurysm and chronic constrictive pericarditis. Traumatic right atrial aneurysm after blunt chest trauma is rarely seen. The case presented here demonstrates the successful management of a patient with posttraumatic aneurysm of the right atrium.

Pre-Operative Trans-Thoracic Doppler Ultrasonography Evaluation and Intra-Operative Manual Evaluation of the Left Internal Thoracic Artery in Patients with Type 2 Diabetes with Coronary Artery Disease

Patients with coronary artery disease, with (n = 25) and without (n = 59) type 2 diabetes, who were scheduled to undergo coronary artery bypass grafting were enrolled in this prospective study. The left internal thoracic artery (LITA) was assessed for graft suitability before surgery by trans-thoracic Doppler ultrasonography and during surgery by manual measurement. Significant differences were seen between pre-operative and intra-operative LITA blood flow rates and LITA diameters, and the values of each at the two time points showed significant correlation, suggesting that pre-operative measurements largely related to intra-operative conditions. The pre-operative and intra-operative LITA blood flow rates and LITA diameters were not significantly different between patients with and without type 2 diabetes. Pre-operative LITA blood flow was monophasic in three patients without diabetes and the LITA grafts of these patients were deemed unsuitable for implantation during surgery. It is concluded that type 2 diabetes does not seem to have a negative effect on the suitability of LITA grafts. In addition, trans-thoracic Doppler ultrasonography is an easy, cost-effective, reproducible and non-invasive examination method, which may help in the evaluation of LIMA function and contribute to graft selection.