Kaan Inan

Bilateral renal artery occlusion due to intraoperative retrograde migration of an abdominal aortic aneurysm endograft

Retrograde (proximal) migration of an abdominal aortic aneurysm endograft is an extremely rare event during endovascular insertion and may lead to occlusion of the bilateral renal arteries and dialysis-dependent renal failure. This case report describes the intraoperative retrograde migration of a bifurcated abdominal aortic endograft during the initial endovascular procedure after deployment of an extender limb graft into the right iliac artery and associated bilateral renal artery occlusion. This was treated with renal artery bypass, and the patient had a favorable outcome.

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.

Hemorrhage Into a Pericardial Cyst and Associated Right Ventricular Compression After Blunt Chest Trauma

Hemorrhage into a pericardial cyst is an extremely rare event after blunt chest injury and may lead to compression of cardiac chambers. Most pericardial cysts develop adjacent to the sternum, at the right or left cardiophrenic angle; therefore a direct blow to the chest may be associated with hemorrhage into a pericardial cyst. Surgical resection is reasonable because hemorrhagic content of cysts may cause failure of percutaneous interventions. The authors present the case of 20-year-old man with a giant hemorrhagic pericardial cyst diagnosed after blunt chest injury, which caused isolated compression of the right ventricle and demonstrates clinical features of this rare pathology.

Mitral Valve Replacement with Bileaflet Preservation for Complex Annular Calcification

Extensive calcification of mitral apparatus may preclude optimal valve repair, thus requiring debridement. We performed mitral valve replacement in a 55-year-old woman with a modified bileaflet preservation technique to avoid complications related to extensive debridement. Posterior transposition of the anterior leaflet as a buttress over the posterior ventricular wall provided extra support for the weakened tissues and covered the decalcified areas, which protected against debris embolism. This technique is safe and reproducible, especially for elderly patients who have complex calcification that requires extensive debridement, enables better preservation of ventricular function, and avoids disruption of the mechanical left ventricular wall.

Left sinus of valsalva aneurysm in an adult with congenital unicuspid aortic valve

Unicuspid aortic valve (UAV) is rare, but well-described congenital malformation in adults. Although aortic root and ascending aortic aneurysms can develop in unicommissural UAV, coexistence with left sinus of Valsalva aneurysm is an unusual event. Surgical correction is necessary to relieve left ventricular outflow tract obstruction associated with aortic stenosis in unicuspid aortic valve, and to decrease the substantial risk of impending rupture of sinus of Valsalva aneurysm.

Interrupted aortic arch associated with aortopulmonary window in a 20 year-old young adult

Interrupted aortic arch (IAA) and aortopulmonary window (APW) are rare but well-described congenital malformations. However, coexistence of these anomalies in young adults is an unusual event. Patients rarely reach adulthood without surgical correction in the neonatal period. The authors describe a 20-year-old patient, who presented with exertional dyspnea and was diagnosed as having IAA and concomitant APW. IAA just distal to the left subclavian artery and a large APW were demonstrated by chest multi-slice computed tomography angiography and cardiac catheterization.

Resection of intrapericardial hibernoma associated with constrictive pericarditis

Hibernoma is a benign soft-tissue tumor, which arises from the remnants of fetal brown adipose tissue. Out of less than 300 cases of hibernoma described to date, pericardial sac is an unusual localization to develop. When the tumor increases in size, this benign pathology can lead to compression of cardiac chambers and cause life-threatening complications in an asymptomatic patient. Here, the authors present the case of a 20-year-old male who underwent an operation for the treatment of constrictive pericarditis, in which an intrapericardial sessile lesion over diaphragmatic surface of pericardial sac was incidentally discovered. The tumor was excised and diagnosed as hibernoma. No recurrence was evident two years after the procedure.

Combined Surgical Approach to Multiple Giant Coronary Artery Aneurysms

Multiple giant coronary artery aneurysms are rare but can develop in the presence of an underlying atherosclerotic vessel disease. Nevertheless, there is no consensus on the ideal surgical treatment or on operative procedures, including aneurysm resection, ligation, distal bypass, and graft interposition. We present the case of a 72-year-old woman with a history of multiple arterial aneurysms who was admitted to the emergency clinic with sudden-onset chest pain and dyspnea. The patients diagnosis was ischemic heart disease and multiple giant coronary artery aneurysms involving the left anterior descending coronary artery and the proximal and distal segments of the right coronary artery. We present a combined surgical approach to multiple giant coronary artery aneurysms associated with atherosclerosis.

The Effects of Lipid-Lowering Therapy on Graft Patency in Coronary Bypass Surgery Patients

BACKGROUND Our aim was to investigate the effects of lipid-lowering treatment (LLT) on graft patency in coronary artery bypass grafting (CABG) patients. METHODS A total of 209 CABG patients (95 men, 45%) with a total cholesterol level above 200 mg/dL and a low-density lipoprotein level above 100 mg/dL were included. Patients were divided into 2 groups on the basis of administration of LLT after CABG: group 1 received LLT after the operation (those patients undergoing operations after 1998, n = 102, 49% male) and group 2 did not receive LLT after the operation (those patients undergoing operations between 1992 and 1998, n = 107, 42% male). Median duration of follow-up was 5.2 years. Follow-up angiography could be obtained in 108 (52%) patients (56 in group 1, 52 in group 2). RESULTS There was a 42% reduction in ischemic events and deaths in group 1, and 60% of these patients had a symptom-free or event-free period for 6 years. The 5-year graft patency for left internal mammary artery-to-left anterior descending artery grafts in group 1 was 95%, and the corresponding figure was 90% in group 2. Right coronary artery-to-saphenous vein graft patency was 66% for group 1 and 30% for group 2. Circumflex artery-to-saphenous vein patency rate was 59% for group 1 and 53% for group 2. A higher graft patency was found in group 1 as a whole. CONCLUSION Results of this retrospective study support the fact that LLT provides a higher graft patency for CABG patients.

Pulmonary Vascular Protective Mechanisms in Adult Patients with an Isolated Large Ventricular Septal Defect: A 21-Year Experience

Abstract  Background: Ventricular septal defects (VSDs) are one of the most common congenital heart defects in adults. In adult patients with an anatomically large VSD and relatively preserved pulmonary vascular system, several pulmonary flow‐limiting cardiac morphologic alterations (PFMA) are encountered. Patients: Ninety‐eight male patients (mean age 22.5 ± 2 years) operated for an anatomically large VSD in our institution were retrospectively reviewed. PFMA in patients with an anatomically large but functionally mild‐to‐moderate VSD (when ratio of pulmonary to systemic flow (Qp/Qs) < 2.2 and ratio of pulmonary to systemic vascular resistance (Rp/Rs) < 0.3) were recorded. Results: Thirty patients (31.2%) revealed a mild‐to‐moderate VSD in functional severity. Five PFMA were encountered in these patients: (1) ostium (os) infundibulum (n = 10, 33.3%), (2) aneurysm of the membranous septum (AMS) (n = 10, 33.3%), (3) systolic bulging of the conal septum toward the right ventricular outflow tract (n = 6, 20%), (4) prolapse of the aortic cusps (n = 2, 6.7%), and (5) attachment of the tricuspid septal leaflet to the septal crest (n = 2, 6.7%). Double‐chambered right ventricle was encountered in four patients with os infundibulum and classic tetralogy‐type septal malalignment in one patient with aortic cusp prolapse. Concurrent to VSD repair, resection of the os infundibulum and the AMS and aortic valve repair were performed. Conclusion: Presence of a large VSD and relatively preserved pulmonary vascular system in adults is associated with several PFMA. Preoperative awareness and concurrent surgical treatment of these alterations seem to be crucial to improve the expected benefit of surgical repair of VSD in this subgroup of the patients.