Levent Gökgöz

Psychiatric complications of cardiac surgery postoperative delirium syndrome.

Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.

Preoperative beta-blocker use reduces atrial fibrillation in off-pump coronary bypass surgery.

Background:  Atrial fibrillation (AF) after coronary artery bypass graft surgery constitutes the most common sustained arrhythmia and results in many complications. The purpose of this study was to assess the effects of prophylactic use of beta‐blockers against atrial fibrillation in off‐pump surgery patients in the early postoperative period.

Biochemical and hemodynamic effects of ascorbic acid and alpha-tocopherol in coronary artery surgery.

This study was undertaken to evaluate the effects of alpha-tocopherol and ascorbic acid on markers of myocardial reperfusion injury and myocardial contractile function after coronary artery surgery. Forty-eight patients were divided into 4 groups; 300 mg/day alpha-tocopherol was given orally to the patients in group I for 14 days. In groups II and III, 4 g of ascorbic acid was administered intravenously prior to induction and in the cardioplegic solution, respectively. Group IV was the control group. Blood samples were taken to determine the concentrations of creatine phosphokinase MB isoenzyme, malondialdehyde, uric acid, ascorbic acid and alpha-tocopherol in the perioperative period. Left ventricular functions were determined by means of MUGA scans and echocardiography preoperatively and on the 3rd and 7th days, postoperatively. The changes in serum creatine phosphokinase MB and malondialdehyde were significantly lower in study groups, when compared with the control group. We observed no significant changes in ventricular function, requirement for (+) inotropic agents and the incidence of ventricular arrhythmias among the groups, postoperatively. Biochemical findings are consistent with the free radical hypothesis. But we could not confirm these data with hemodynamic findings. This is probably due to the population of low-risk elective coronary surgery patients in this study.

The effect of selenium added cardioplegia in guinea pigs

1. The aim of the study was to determine the effect of selenium added cardioplegic solutions on postischemic myocardial recovery. 2. The hearts were mounted on Langendorf perfusion apparatus and perfused with Krebs-Henseleit solution. The hearts were arrested by one of the following cardioplegic solutions; (a) K+ 20 mmol/l (control group); (b) K+ 20 mmol/l+selenium 10(-3) mol/l (experimental group). After 20 min of normothermic ischemia the hearts were reperfused by the same buffer. 3. Postischemic percentage changes of heart rate, contractile force and heart work were compared between the groups. 4. Addition of selenium to the cardioplegic solution significantly decreased the postischemic myocardial injury.

Corpus Sterni Reinforcement Improves the Stability of Primary Sternal Closure in High-Risk Patients

PurposeTo compare standard sternal closure techniques with reinforcement longitudinal wire placement in the corpus sterni in high-risk patients undergoing open-heart surgery via median sternotomy.MethodsThe subjects of this study were 71 high-risk patients, 32 (45%) of whom underwent sternal closure by conventional methods (group 1) and 39 (55%) of whom underwent sternal closure with corpus sterni reinforcement. The patients were followed up for a mean period of 90 days.ResultsIn group 2, none of the patients had sternal dehiscence and no revision was required, but in group 1, five (15.5%) patients had sternal dehiscence. This difference was significant between the groups (P = 0.024), but there were no significant differences in mediastinitis and mortality (P > 0.05).ConclusionsOur findings suggest that primary sternal closure with longitudinal wire reinforcement on both sides of the corpus sterni will decrease the risk of infection and improve wound-healing in parallel with a decrease in sternal dehiscence.

The role of selenium added to pulmonary preservation solutions in isolated guinea pig lungs

An experimental comparative study on isolated guinea pig lungs has been undertaken to determine the probable beneficial effects of adding selenium to pulmonary preservation solutions in lung ischemia. The isolated lungs (n = 10 in each group) previously being perfused by oxygenated Krebs-Henseleit solution were put in normothermic ischemic conditions just after the infusion of 30 ml of pulmonary preservation solution (Euro-Collins in the control group, Euro-Collins plus selenium 10(-3) mol in the experiment group). After 3 hours of normothermic ischemia the lungs were reperfused with the same buffer for 20 minutes. Pulmonary artery pressures, tissue malondialdehyde levels, and adenosine deaminase levels of the perfusate were measured before and after the ischemic period and also at the end of reperfusion. An electron microscopic analysis was performed on the lung tissues at the end of the experimental procedure. According to our data, the addition of selenium to pulmonary preservation solution showed a significant protective effect regarding both ischemic and reperfusion injury.

Traditional single patch versus the "Australian" technique for repair of complete atrioventricular canal defects.

PurposeA variety of operative techniques has been used to repair complete atrioventricular (AV) canal defects and satisfactory outcomes after single patch repairs have been reported. We report our comparative results of repairing complete AV canal defects between 1998 and 2006 using the traditional single patch and the “Australian” techniques.MethodsFourteen patients underwent traditional AV canal repair with the single patch technique (Group 1) and 11 patients underwent repair with the “Australian” technique (Group 2). All patients were examined with preoperative echocardiography and cardiac catheterization, and were followed up with echocardiography to evaluate AV valve and ventricular function.ResultsThere were two early postoperative deaths in Group 1 and one in Group 2. One patient from each group had moderate left AV valve regurgitation postoperatively, but none from either group had left ventricular outflow obstruction.ConclusionsThe “Australian” technique is a simpler method requiring shorter aortic cross-clamping and total bypass times with good clinical and functional results. The early postoperative results are as encouraging as those achieved by the traditional single patch technique; however, long-term follow-up results are required to establish the efficacy of this simplified technique.

The dose-dependent effects of L-carnitine in myocardial protection in normothermic ischemia

L-Carnitine has been shown to improve the post-ischemic recovery of myocardial function and metabolic measurements that are reduced in the course of ischemia and reperfusion of the heart. In this study we used 40 male guinea-pigs in order to determine if the effect of L-carnitine which is used in the protection of the post-ischemic reperfused heart, is dose-dependent or not. All harvested hearts were perfused for 30 min on modified Langendorf apparatus with oxygenized Krebs-Henseleit solution. After this period, in (n = 10), 5 mmol and 10 mmol (group B, n = 10) of L-carnitine were added into a Krebs-Henseleit solution. After 20 min, perfusion was complete and the hearts were then exposed to normothermic ischemia for 20 minutes. Following the ischemia, hearts were reperfused with the same solutions for 30 min. In group C (n = 10), 10 mmol of L-carnitine was added into the solution at the post-ischemic reperfusion step. In the control group, the same procedures were performed without using L-carnitine. Matching was done according to the contractile force of the heart rate and the levels of malondialdehyde and adenosine deaminase. When 10 mmol L-carnitine was added into the perfusion solutions at the pre-ischemic period, the best results were obtained and myocardial damage was much less than the control group. The protective effects of L-carnitine in normothermic ischemia is dose-dependent and it must be given at the pre-ischemic period.

Dipyridamole induced myocardial recovery after global ischemia

1. An experimental comparative study on isolated guinea pig hearts was carried out to determine the effect of dipyridamole added to the reperfusion solution on myocardial recovery after global ischemia. 2. After 20 min of normothermic ischemia two groups of solutions: (1) Krebs solution; (2) Krebs + dipyridamole 20 micrograms/l (10 experiments in each group) were used for reperfusion. 3. Postischemic myocardial functions (heart rate, ventricular contractility, heart work) and tissue enzymes (CPK-MB, LDH) were compared with their preischemic values. 4. Addition of dipyridamole 20 micrograms/l to reperfusion solution improved postischemic myocardial functions and decreased myocardial injury.

Bland-White-Garland Syndrome in an Adult: Case Report and Review of Diagnostic and Predictive Strategies

In a 27-year-old man with Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery), comparison was made between conventional diagnostic techniques and radionuclide imaging for selection of surgical procedure and evaluating the outcome. Dynamic 99mTc imaging exactly located the left coronary artery orifice, which was not seen on angiography, thereby determining the surgical approach, and 123I study revealed that, despite absence of symptoms, the adrenergic activity of the heart was globally diminished, with limited response to revascularization.