Ismail Haberal

Does Pulmonary Artery Venting Decrease the Incidence of Postoperative Atrial Fibrillation after Conventional Aortocoronary Bypass Surgery

OBJECTIVES In this study, we tested the hypothesis that pulmonary artery venting would decrease the incidence of atrial fibrillation after coronary artery bypass surgery. METHODS This prospective study included 301 patients who underwent complete myocardial revascularization with cardiopulmonary bypass in our department during a 2-year period. The patients were randomly divided into 2 groups: group I included 151 patients who underwent aortic root venting and group II included 150 patients who underwent pulmonary arterial venting for decompression of the left heart. Pre-, peri-, and postoperative risk factors for atrial fibrillation were assessed in both groups. RESULTS The mean age was similar in the 2 groups. The mean number of anastomoses was significantly higher in group I (2.8 ± 0.8) than in group II (2.4 ± 0.8) (P = 0.001). The mean cross-clamp time was 42.7 ± 17.4 minutes in group I and 54.1 ± 23.8 minutes in group II (P = 0.001). The mean cardiopulmonary bypass time was 66.4 ± 46.1 minutes in group I and 77.4 ± 28.6 minutes in group II (P = 0.08). The incidence of atrial fibrillation was 14.5% (n = 21) in group I and 6.5% (n = 10) in group II (P = 0.02). Multivariate regression analysis showed that pulmonary artery venting decreased the postoperative incidence of atrial fibrillation by 17.6%. CONCLUSIONS Pulmonary arterial venting may be used as an alternative to aortic root venting during on-pump coronary bypass surgery, especially in patients at high risk of postoperative atrial fibrillation.

Presence of Aggregatibacter actinomycetemcomitans in saliva and cardiac tissue samples of children with congenital heart disease

Aim: The purpose of this study was to analyze the presence of Aggregatibacter actinomycetemcomitans in saliva and cardiac tissue samples of children requiring cardiac surgery in Istanbul, Turkey. Subjects and Methods: Twenty-five patients (mean age: 6.24 ± 2.93) undergoing surgery for congenital heart defects (CHDs) and an age/gender-matched control group of 25 healthy children were enrolled in the study. Saliva samples were collected from all children; plaque index (PI) and gingival index (GI) were also determined. In CHD group, cardiac tissue samples were received during surgery. All samples were evaluated for the presence of A. actinomycetemcomitans and its highly leukotoxic JP2 clonal strains using polymerase chain reaction. The findings were analyzed by Mann–Whitney U, Chi-square, and Fishers exact tests. Results: No significant differences were found in PI and GI values between the groups. A. actinomycetemcomitans was not detected in cardiac tissue samples. A. actinomycetemcomitans in saliva was detected in 2 (8%) of the CHD and 5 (20%) of the control children (p > 0.05). A. actinomycetemcomitans JP2 clonal strains were determined from 1 (4%) of the control group while it was not determined from the samples of the CHD group. Conclusions: Early colonization of A. actinomycetemcomitans in oral cavities could be assessed as a risk marker for periodontal disease. Periodontal pathogens may enter bloodstream through bacteremia; thus, the presence of periodontal pathogens in the oral cavity of children should be assessed as a risk marker for cardiac diseases in older ages.

Left ventricular posterior wall rupture contained by posterolateral pseudo-aneurysm with calcified thrombus

Presently described is case of left ventricular (LV) posterior wall rupture contained by posterolateral pseudoaneurysm with calcified thrombus. A 63-year-old male was admitted to coronary intensive care unit with acute pulmonary edema and required mechanical ventilation for 2 days. He had undergone coronary angiography with diagnosis of unstable angina 1 year prior, and drug-eluting stent had been implanted for 90% stenosis of proximal left anterior descending artery (LAD). Chest radiography revealed enlarged mediastinal and cardiac silhouette. Computed tomography scan of the chest displayed LV posterior wall rupture contained by posterolateral pseudoaneurysm with calcified thrombus (Figure A, B, arrows). Transthoracic echocardiogram showed dilated, hypokinetic LV with inferoposterior hypokinesia and confirmed pseudoaneurysm 7.1x4.7 cm in size at widest diameter and with neck length of 4 cm, extending from posterolateral to anterolateral wall (Figure C and supplementary video 1*). Coronary angiography revealed double vessel disease with significant stenosis diagonal LAD and total occlusion in the proximal left circumflex artery (Supplemental video 2 and 3*). Patient underwent open-heart surgery. Dor technique was used for endo-exclusion of pseudoaneurysm with endopatch. Rupture was repaired with pericardial patch and polypropylene running suture. Coronary artery bypass grafting was performed, and procedure was completed without complications (Figure D-G and supplementary video 4*). Unfortunately, the next day, the patient died due to malignant arrhythmia and severe bleeding. 104

Combined transdiaphragmatic off-pump and minimally invasive coronary artery bypass with right gastroepiploic artery and abdominal aortic aneurysm repair

Patient: Male, 74 Final Diagnosis: Abdominal aortic aneurysm (AAA) Symptoms: Palpable abdominal mass Medication: — Clinical Procedure: Abdominal aortic aneurysm repair Specialty: Surgery Objective: Rare disease Background: Coronary artery disease is common in elderly patients with abdominal aortic aneurysms. Here we report a case of the combination of surgical repair for abdominal aortic aneurysm and off-pump and minimally invasive coronary artery bypass surgery. Case Report: A 74-year-old man who presented at our clinic with chest pain was diagnosed with an abdominal aortic aneurysm. His medical history included right coronary artery stenting. Physical examination revealed a pulsatile abdominal mass on the left side and palpable peripheral pulses. Computed tomography scans showed an infrarenal abdominal aneurysm with a 61-mm enlargement. Coronary angiography revealed 80% stenosis in the stent within the right coronary artery and 20% stenosis in the left main coronary artery. The patient underwent elective coronary artery bypass grafting and abdominal aortic aneurysm repair. Abdominal aortic aneurysm repair and transdiaphragmatic off-pump and minimal invasive coronary artery bypass grafting with right gastroepiploic artery were performed simultaneously in a single surgery. Conclusions: We report this case to emphasize the safety and effectiveness of transdiaphragmatic off-pump and minimally invasive coronary artery bypass surgery with abdominal aortic aneurysm repair. This combined approach shortens hospital stay and decreases cost.