Ibrahim Arif Tarhan

Resection of a Right Coronary Artery Aneurysm With Fistula to the Coronary Sinus

We are reporting the successful surgical management of a challenging right coronary artery aneurysm with a giant fistula into the coronary sinus. We performed fistula division, coronary sinus size reduction, and complete resection of the right coronary artery aneurysm with bypass to the posterior descending artery.

Efficacy of physiologic temperature on the spasm of harvested radial artery.

BACKGROUND The potential disadvantage of using the radial artery for coronary artery bypass grafting is its increased tendency to vasospasm. Therefore, different antispastic agents are being used in the perioperative and postoperative period. During the preparation of the radial artery, normal local and systemic temperatures are lost. METHODS We investigated the effects of topical normal saline solution at 20 degrees C (group SI), normal saline solution at 36 degrees C (group SII), diltiazem at 20 degrees C (group DI), and diltiazem at 36 degrees C (group DII) on radial artery free flow. Each group contained 10 patients undergoing coronary bypass surgery. Free flow and local temperature were measured at 3 stages: after the exploration and preparation of the distal 3 cm of the radial artery, after total preparation of the radial artery, and a median of 12 minutes after the pedicle had been sprayed with one of the agents. RESULTS Parallel to the significant decrease of the second local temperatures (P < .001), the second flow of the 4 groups decreased significantly (P < .001). CONCLUSION Hypothermia plays an important role in radial artery vasospasm, and normothermia may be the best perioperative vasodilating agent since the normal radial artery flows were reached with normothermia.

Limb Ischemia Due to Use of Internal Thoracic Artery in Coronary Bypass

Immediately after undergoing coronary bypass grafting using the left internal thoracic artery, a 59-year-old man developed left leg ischemia. Right-to-left femoral artery crossover bypass was performed and the ischemia resolved. A 72-year-old man developed left calf pain 12 days after a similar procedure; peripheral angiography revealed stenosis of the abdominal aorta and distal peripheral arteries, which did not require intervention.

Normothermia is the key for the treatment of internal thoracic artery spasm.

BACKGROUND Free flow of the internal thoracic artery decreases commonly after harvesting because of spasm. Tissue heat loss is inevitable during surgery. The aim of this study was to compare the internal thoracic artery pedicle rewarming method with topical papaverine applications in different thermal conditions. METHODS Patients (n = 120) were organized in to 6 equally sized groups. The effects of topical papaverine application at room temperature, topical heated papaverine (at 37 degrees C) application, internal thoracic artery pedicle storage in normothermic conditions, pedicle storage in normothermic conditions combined with topical papaverine application, and pedicle storage in normothermic conditions combined with topical heated papaverine application were investigated. In the control group, no treatment was applied and the pedicle was stored in room temperature conditions. We measured internal thoracic artery free flows at 3 stages: at the initiation of harvesting, after total harvesting, and after antispasmodic treatment. Durations of the stages were recorded. At each stage hemodynamic parameters, tissue and core temperatures were also monitored. RESULTS Internal thoracic artery pedicle temperature significantly decreased simultaneously with the free flow after the harvesting procedure. Recovery of the physiologic temperature state, provided by storing the internal thoracic artery pedicle in normothermic conditions, improved the flow and increased the efficiency of topically applied papaverine on the vasospasm of the internal thoracic artery. CONCLUSION Topical application of heated papaverine itself does not warm pedicle tissue, but papaverine efficiency increases when the pedicle is stored in normothermic conditions. Preserving internal thoracic artery pedicles in normothermic conditions can be the preferred treatment for spasms.

A case of primary cardiac rhabdomyosarcoma with surgical removal and mitral valve repair.

Primary cardiac tumors are rare. Nearly 25% of primary cardiac tumors are malignant, with rhabdomyosarcoma being the second most common primary sarcoma. Symptoms are variable, and the clinical presentation depends on the location and propagation of the tumor. Transthoracic and transesophageal echocardiography are preliminary tests in diagnosing the disease. Echocardiographic findings should be supported by other imaging methods. In appropriate cases, surgery combined with chemotherapy and radiotherapy is suggested. We present a case of primary cardiac rhabdomyosarcoma with surgical removal and mitral valve repair.

Surgical therapy of pulmonary artery aneurysms: a report of 2 cases.

Pulmonary artery aneurysm is a rare condition that may be acquired rather than congenital. The natural history of pulmonary artery aneurysms is not defined yet, and management is still controversial. We present 2 cases of adult patients with pulmonary artery aneurysms who were treated surgically. We suggest replacement as the surgical strategy.

Ultrasound-accelerated catheter-directed thrombolysis for the management of postpartum deep venous thrombosis.

Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism, which remains an important cause of maternal morbidity and mortality. Although oral or systemic anticoagulation therapy may minimize thrombus propagation, it remains ineffective in removing thrombus burden and consequently does not prevent post‐thrombotic syndrome. A novel technique, ultrasound accelerated catheter directed thrombolysis (UACDT), has been developed to rapidly and completely resolve thrombus. While pregnancy and the postpartum period are generally considered as contraindications for thrombolysis, we demonstrate in this case study the safety and effectiveness of using UACDT to treat symptomatic, postpartum, iliofemoral deep vein thrombosis after only an overnight infusion.

Combined Coronary and Lower Extremity Revascularization with Thoracotomy: A Case Report

Patients with the combination of coronary artery disease and peripheral vascular disease have multiple risk factors and manifest widespread vascular disease. Although indications of combined coronary and femoral revascularization are rare, a combined procedure is useful in selected patients. We report a patient who underwent a successful combined coronary and lower extremity revascularization with anterolateral limited thoracotomy.