Ibrahim Alp

Free-floating tumor thrombus in the left atrium associated with non-small cell lung cancer.

Abstract  A free‐floating tumor thrombus in the left atrium is an unusual metastasis of non‐small cell lung cancer. Surgical resection of free‐floating tumor thrombus prior to adjuvant therapy relieves cardiac symptoms such as exertional dyspnea, and prevents life‐threatening complications including systemic embolization, mitral obstruction, or sudden death.

Blood Cyst of the Right Ventricle Presenting as Recurrent High Fever and Chills in an Adult

Blood cysts are uncommon primary cardiac tumors, frequently encountered in pediatric patients, but extremely rare when found in adults. Due to the considerable risks of embolization and obstruction of the blood flow, surgical removal is preferred. Herein, we report a case of blood cyst of the right ventricle, presenting as recurrent fever and chills in an adult patient.

Four different strategies for repair of aortic coarctation accompanied by cardiac lesions

OBJECTIVES Coarctation accompanied by cardiac lesions is a complex clinical situation due to the presence of two different pathologies that necessitate surgical treatment. An individual strategy, according to the severity of the disease, is important to reduce perioperative mortality and morbidity. METHODS We report here on 25 patients with coarctation accompanied by cardiac lesions who were treated by various surgical approaches. Coarctation and associated disease were treated in 14 patients in a single stage by an ascending-to-descending bypass (n = 11) or by a hybrid procedure (n = 3). The remaining 11 patients underwent a two-stage operation for their treatment. Six of these 11 patients who had coronary artery disease or signs of congestive heart failure were first operated for their cardiac disease, whereas in the remaining five patients, who did not have any congestive signs, coarctation repair was performed first. RESULTS All the patients were male, between the ages of 20 and 24 years, except for one 45-year-old woman. The mean cross-clamp times, cardiopulmonary bypass times and operation times were 52 ± 14.5, 102.3 ± 28.5 and 174 ± 24.8 min in the extra-anatomical bypass group; 29.8 ± 11.7, 55.5 ± 17.6 and 116 ± 22 min in the two-stage groups and 49 ± 19.8, 63 ± 18.7 and 159 ± 21.3 min in the hybrid patients, respectively. One patient who underwent extra-anatomical bypass died on the 14th postoperative day. There were no events during the follow-up period for the other patients. Also, there were no gradients between the extremities and no graft-related complications. CONCLUSIONS As a consequence of the progress in the development of endovascular techniques, hybrid treatment is becoming a more popular option for the treatment of coarctation accompanied by cardiac diseases. Two-stage procedures and extra-anatomical bypass might be alternative techniques if endovascular procedures are contraindicated or failing.

Is the right vertical axillary incision an alternative technique to the submammarian incision for the repair of simple congenital heart defects in female patients

We read with interest the surgical approach of Yan et al. [1] to simple congenital heart defects. The right vertical axillary incision (RVAI) procedure decreased neither cardiopulmonary bypass time nor aortic cross-clamp and hospital stay. The authors claim that they had excellent results, achieving cosmetically satisfactory outcomes in young female patients. Although an objective multiple-choice questionnaire that focused attention on the autoevaluation of the aesthetic result and its psychological influences has been reported previously [2], we could not understand how Yan et al. evaluated patient satisfaction. Meanwhile, it is not stated whether the subgroup analysis was made in terms of age and gender. This approach is recommended for its cosmetic advantages in young female patients, but adult patients in particular, might be dissatisfied regarding the incision of lateral breast tissue. Minithoracotomy with a submammarian incision can be specifically considered a more favourable approach. Contrary to the authors’ comment, breast deformity or asymmetry or any cage deformity will not develop when a careful tissue approximation is performed by the elevation of the breast tissue in young or adult female patients [3, 4]. As stated by the authors, due to poor exposure of the operating field with the RVAI approach, the learning period of this technique will take longer than the other minimally invasive techniques. The conversion of the process into another approach such as an additional surgical incision, can be very difficult, may cause the sacrifice of the internal mammarian artery and may pulmonary complications and increase the magnitude of pain in the postoperative period as well. We fully agree with the authors’ concern about femoral artery stenosis in the future, however, vascular complications such as dissection or stenosis after femoral cannulation is still a debateable topic. Femoral access [5] has been shown to be a safe and preferable option in selected patients and allows limited surgical chest incisions thereby reducing the patient’s surgical trauma. In the preoperative period, Doppler examination of the femoral artery (diameter and quality) can minimize the possible vascular problems and assist in determining the surgical strategy in the young or adult patient. In conclusion, this is a valuable study, and we are grateful to the authors for sharing their experiences. This surgical technique, specialized according to gender, might be performed in male adolescent patients in particular. It might be an alternative to the submammarian incision in female and adult patients.

Coarctation of the aorta associated with left subclavian artery aneurysm: a case report.

Aneurysm of the left subclavian artery (LSA) in association with coarctation of the aorta (CoAo) is a rare phenomenon, especially in the younger population. A 19-year-old male patient was admitted for lower extremity varices and diagnosed to have severe CoAo and a 45-mm LSA aneurysm after digital subtraction angiography following detection of nonpalpable lower extremity pulses on physical examination. Corrective surgery was performed from a left posterolateral thoracotomy through the 4th intercostal space, and a discrete ring-like coarctation tissue was observed in the aorta just below the level of the LSA orifice. Complete excision of the coarctation tissue was followed by aortoplasty with a Dacron patch. Additionally, the subclavian aneurysm was completely excised and a 10-mm Dacron tube graft interposition was performed. Prompt diagnosis and surgical treatment in particularly hypertensive patients precludes significant mortality and morbidity following a possible rupture.

Aortic rupture due to pseudocoarctation caused by migrated stent graft

Migration of the stent graft is one of the complications of the endovascular aneurysm repair. Sometimes migration might cause fracture of the stent graft. This fracture might be viewed like a coarctation in the computerized tomographic examinations. In this situation, intraluminal aortic pressure of the proximal segment of the aorta will increase and might cause aortic rupture. Herein, we are presenting surgical treatment of the aortic rupture of the aorta, caused by the pseudocarctation of the migrated stent graft 6-year after the endovascular stent graft repair of the abdominal aortic aneurysm.

Long-term results of the single-patch repair technique for sinus venosus atrial septal defects.

BACKGROUND Anomalous pulmonary venous drainage commonly accompanies sinus venosus atrial septal defects (SVASDs). Many techniques have been reported for avoiding postoperative complications, such as narrowing of the superior vena cava (SVC) or the pulmonary system, and arrhythmia. We perform a single V-Y pericardial patch plasty repair technique for SVASDs. The purpose of this study is to report on the long-term results of this surgical technique. METHODS We retrospectively analyzed patients who had a diagnosis of ASD and who underwent their operations between 2000 and 2010 at the Gulhane Military Medical Academy Haydarpasa Training Hospital. Thirty-nine of the patients had an anomalous pulmonary return, and the single pericardial patch technique had been performed in 32 of these patients. RESULTS The mean (±SD) postoperative extubation time was 5 ± 1.6 hours. The mean drainage volume was 384 ± 137 mL. All patients were discharged from the hospital at a mean of 4.6 ± 1.1 days after their operation and were prescribed anticoagulants for 3 months. No perioperative or late-term mortality was observed. Patients were followed up for 6 months to 2 years. There were no residual shunts and no stenosis-related findings in the pulmonary venous system or the SVC. CONCLUSION Use of the single pericardial patch plasty technique might lower complication rates in patients with SVASD, especially those who have not completed their growth.

Coronary artery bypass grafting following simultaneous treatment of abdominal aortic aneurysm and peripheral arterial disease.

Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).

Reversed C Sternotomy versus Conventional Sternotomy in Cardiac Surgery

BACKGROUND In this study, cardiac surgery with minimally invasive reversed C sternotomy was compared with conventional sternotomy in patients undergoing valve replacement or septal defect repair. METHODS In this prospective randomized study, 35 patients were assigned into one of two groups for elective cardiac surgery under general anesthesia: Group A (reversed C sternotomy group) and Group B (conventional sternotomy group). Intraoperative variables, intubation time, postoperative drainage volume, pulmonary function tests, sleep quality and quality of life, and requirement for blood transfusion were compared. RESULTS A significant difference between the two groups was found in blood transfusion requirement, extubation time, and drainage volume. Forced expiratory volume in one second and functional vital capacity were significantly lower in Group B than in Group A at postoperative Month 1. Total sleep component score of Pittsburg Sleep Quality Index in Group B patients was significantly worse at postoperative Month 1. Postoperative assessment of quality of life (physical and mental) also showed a significant difference between the two groups. CONCLUSION These preliminary findings suggest that creating an access point without compromising the integrity of the sternum seems to be an advantageous and appropriate technique for suitable patients undergoing cardiac surgery.

Comparison of conventional technique and ultrasonographic mapping in saphenous vein harvesting.

BACKGROUND Saphenous vein mapping provides accurate identification of the graft diameter, location of the harvest side, and quality of graft and also led to a selective leg skin incision. In this article, we aimed to compare patients who underwent coronary artery bypass graft (CABG) surgery with or without vein mapping. METHODS Patients who underwent CABG surgery with saphenous vein grafts (SVG) between January 2005 and January 2010 in our service were analyzed retrospectively. One hundred seventy-eight 178 SVGs were harvested with classical methods (Group A), and 136 SVGs were harvested after Doppler ultrasonography (USG) mapping (Group B). RESULTS In Group A, 6.7% of patients needed additional incisions for graft harvesting than planned before CABG surgery due to unsuitable vein grafts. In Group B, SVGs were harvested from left lower extremity in 16 patients, and the saphenous vein was not suitable for grafting in 1 patient due to Doppler examination. In the postoperative period, complications at the incision site were reduced in Group B. CONCLUSION Preoperative vein mapping for harvesting SVGs is an effective method in reducing wound site complications, hospital stay, and hospital costs and in increasing patient comfort and satisfaction.