Mehmet Ates

Preserved Pleural Integrity Provides Better Respiratory Function and Pain Score after Coronary Surgery

Abstract  Background and Aim: Patients undergoing surgical procedures through median sternotomy have reduced pulmonary function in the postoperative period. Our study was designed to evaluate the effect of pleural integrity in terms of respiratory functions and pain score after coronary bypass procedures. Methods: In a randomized, prospective study we evaluated 320 patients in two groups. Group I (n = 160) patients were the patients whose pleural cavity was intact while internal mammary artery (IMA) harvesting, and in group II (n = 160) the pleural cavity of the patients was opened. They matched in terms of postoperative respiratory functions and pain score. Results: FEV1 (%) and FEV1/FVC levels at the postoperative fifth day were significantly lower in group II (I = 71.5 ± 4.9 vs. II = 63.5 ± 8.3 and I = 24.1 vs. II = 22.1), respectively (p < 0.05). The rate of postoperative pleural effusions and atelectasis at the postoperative fifth day were significantly higher in group II (I = 35%, 15% vs. II = 48%, 35%), respectively (p < 0.05). The pain score was higher in group II at postoperative fifth day. Conclusions: All patients undergoing cardiac surgery suffer deterioration in pulmonary functions. Pleurotomy seems to compound this with increased rates of atelectasis and pleural effusions. Moreover, preserving pleural integrity provides beneficial effects on pain score after coronary operations especially in the early postoperative period.

Blood pressure changes after aortic coarctation surgery performed in adulthood.

Abstract  Objective: The aim of this study was to assess the effect of aortic coarctation surgery in adult patients on arterial blood pressure in the early postoperative period. Methods: Ninety‐three adult patients (61 male, 32 female) aged 15–43 years who had operation since 1962 for aortic coarctation in Siyami Ersek Cardiovascular Surgery Center were retrospectively evaluated. Tube graft interposition was done in 31 patients; resection and end‐to‐end anastomosis were performed in 32 patients; 24 patients had undergone pathchplasty; and 6 patients by‐pass shunting performed. The effect of surgery on the blood pressure was investigated. Results: The mean systolic and diastolic blood pressure significantly reduced after operation (systolic 193.6 ± 33.7 mmHg vs 147.4 ± 22.0 mmHg, diastolic 99.8 ± 17.9 mmHg vs 82.0 ± 10.8 mmHg). From 93 patients (all with hypertension) 54 (58%) became normotensive after operation according to VIth Joint National Committee classification. The number of normotensive patients after operation was 28 (of 37) for 15–19 years age group, 14 (of 23) for the 20–24 years age group, 4 (of 16) for 25–29 years age group, 6 (of 11) for 30–34 years age group, and 2 (of 6) for the over 35 years old age group. Conclusion: The diastolic and systolic blood pressures reduce significantly in the adult patients operated for aortic coarctation. On the other hand, persistent hypertension seemed to increase in the older age groups in spite of the surgery.

‘Acquired’ left ventricular to right atrial shunt after mitral valve replacement: Detection by transthoracic colour Doppler echocardiography

Left ventricular to right atrial communications are rare types of ventricular septal defects usually of congenital origin. A case of an iatrogenic shunt between the left ventricle and the right atrium as a rare complication of mitral valve replacement is reported.

Massive Right Atrial Myxoma Causing Right Ventricular Inflow Obstruction: An Unusual Presentation of Myxoma

Abstract  We describe a case of a massive right atrial myxoma, causing right ventricular inflow obstruction. The tumor was detected by echocardiography and resected along with a section of the tricuspid septal leaflet, followed by primary repair, resulting in relief of her symptoms. (J Card Surg 2010;25:293‐295)

The effect of the keyhole technique on diabetic patients undergoing autologous brachiobasilic transposition of an arteriovenous fistula.

PURPOSE Our aim was to investigate the efficiency of the keyhole transposed brachiobasilic technique in patients with diabetes mellitus and compare the effect of different arteriovenous fistula techniques on the development of complications. MATERIALS AND METHODS Thirty-eight diabetic, chronic renal failure patients (group 1) had transposed brachiobasilic arteriovenous fistula creations, and 49 diabetic patients (group 2) had other types of fistula creations and histories of multiple fistula attempts. The 2 groups were compared for age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, arteriovenous fistula patency, and possible complications. RESULTS The 2 groups were not different statistically regarding the demographic data including age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, and mean operation time. The median follow-up after surgery in both groups was 8 months. The primary patency in group 1 was 97.4% in the early period (6 weeks after surgery) and 94.7% in the late period (mean duration of 8 months after surgery). In the second group, these rates were 73% and 62%, respectively (P < .05). The secondary patency rates were 84.2% in group 1 and 53% in group 2 (P < .05). In group 2, the primary and secondary patencies of brachiocephalic and radiocephalic fistulas were significantly lower than the patencies of group 1. The incidence of complications was significantly less in group 1 than in group 2 (P < .05). CONCLUSION Although the groups were small in size, the success rate with the keyhole transposed brachiobasilic technique in patients with diabetes was extremely gratifying, and this report can be considered to document the first attempt of a hemodialysis-access procedure.

Does Atherosclerotic Aortic Plaque Detected by Telecardiography Indicate an Increased Risk of Coronary Artery Disease

OBJECTIVE The purpose of this study was to determine the cause of aortic arch calcification and to evaluate its prognostic value as an indicator of cardiovascular disease and its severity. METHODS AND RESULTS The study was conducted prospectively among 1027 patients who underwent a coronary angiography in our hospital between April 2002 and September 2002 for suspected coronary artery disease. All chest x-rays were reviewed by a radiologist, who categorized aortic arch calcifications by their presence or absence. The patients were stratified according to age (< or =50, 51-64, and > or =65 years) to eliminate the influence of age on aortic arch calcification. Coronary lesions were considered either single-vessel or multivessel disease. Univariate analysis revealed significant correlation with age (r = 0.37; P < .001), presence of hypertension (r = 0.14; P < .001), smoking (r = -0.10; P = .001), presence of coronary artery disease (r = 0.10; P = .001), and the existence of multi-vessel disease (r = 0.09; P = .006). Multivariate analysis disclosed significant association with age and hypertension and no association with smoking, coronary artery disease, and other risk factors. CONCLUSION The aortic arch calcifications observed on plain chest x-rays are usually age related, and both aortic arch calcifications and coronary artery disease are strongly associated with age. The presence of aortic calcification on chest x-rays was not an indicator of the presence and extent of coronary artery disease.

HUGE LEFT ATRIUM

Left atrium dilates and hypertrophies in mitral stenosis cases. Occasionally left atrium reaches to extreme sizes. In giant left atrium cases, mitral stenosis may be the sole pathology or it may be accompanied by mitral insufficiency, or it may present as mixed mitral disease where mitral stenosis dominate. Transthoracic echocardiography is the easiest and cheapest method for the diagnosis and follow-up of the disease. Transesophageal echocardiography performed during the operation helps the surgical team in evaluating the effectiveness of artificial valves (1).