Mehmet Fatih Ayık

Serum resistin level: as a predictor of atrial fibrillation after coronary artery bypass graft surgery.

AimAtrial fibrillation (AF) is the most common arrhythmia with an incidence of 25–40%, after coronary artery bypass grafting (CABG). Resistin is a newly identified adipocyte-secreted hormone belonging to a cysteine-rich protein family. This study examined the relation of preoperative and postoperative early serum resistin level, which can play an important role as an inflammatory marker to predict AF after CABG. MethodsWe prospectively analyzed 40 consecutive patients (mean age, 59.2+10.3 years; 31 men and nine women) who were undergoing CABG between September and November 2009 at our department. Blood samples were taken to examine quantities of resistin level, the day before surgery and on the 24th hour in the intensive care unit. ResultsThe incidence of AF was 25% (n=10, 2.2+1.1 days, 1.2+0.4 episodes). Preoperative resistin level was higher in the AF group (10.6+3.3 vs. 9.1+4.5 ng/ml, P=0.33), but it was not statistically significant. Postoperative resistin level was significantly higher in the AF group (27.4+8.4 vs. 17.9+9.1 ng/ml, P=0.012) compared with the sinus rhythm group. Resistin levels significantly increased after the surgery in both groups [9.1+4.5 vs. 17.9+9.1 ng/ml, P<0.001 (sinus rhythm group) and 10.6+3.3 vs. 27.4+8.4 ng/ml, P<0.001 (AF group)]. ConclusionPatients with an elevated postoperative resistin level may have high risk for AF after CABG. This intervention targeting inflammation might help reduce the incidence of AF.

Management of Renal Cell Carcinoma with Intracardiac Extension

Abstract  Renal cell carcinoma extended to the right atrium was operated by using cardiopulmonary bypass and deep hypothermic circulatory arrest. Hypothermic circulatory arrest provides bloodless surgical field for tumor thrombus removal and adequate visceral and brain protection. The surgical technique that we used in a patient was reported in light of the literature.

A circumflex coronary artery-to-right atrial fistula in a 10-month-old child : case report

Abstract A coronary fistula (CF) is a rare congenital cardiac anomaly in which there is a connection between the coronary artery and a cardiac chamber or a great vessel. In the paediatric population, a CF is usually asymptomatic. While the circumflex coronary artery (Cx) is the least common source of a CF, the right heart chambers are the most common location of drainage. Herein, we present a symptomatic 10-month-old boy with an atrial septal defect (ASD) in whom we incidentally detected a CF, which stemmed from the Cx and drained to the right atrium. Because the patient was symptomatic and his small size was not appropriate for percutaneous closure of the ASD, surgical closure of the ASD and CF was performed.

Comparison of heart transplantation patients with ischemic and idiopathic dilated cardiomyopathy.

OBJECTIVE We retrospectively analyzed our data to compare preoperative demographic, laboratory, echocardiographic, hemodynamic findings mortality and survival rates of heart transplantation patients with ischemic (ICM) and idiopathic dilated (IDCM) cardiomyopathy. METHODS The data of 144 patients transplanted from February 1998 to January 2011 were analyzed. 38 patients with ischemic ICM and 86 patients with IDCM were compared. RESULTS Recipient age, preoperative creatinine, recipient body mass index, intraoperative cross-clamp time, donor male sex ratio, recipient male sex ratio, hyperlipidemia ratio, and previous nitrate use were significantly higher and left ventricular end systolic diameter significantly lower in patients with ICM. Major causes of death after heart transplantation were infections (31.9%), right ventricle failure (14.8%), and sudden cardiac death (14.8%). Causes of death were not different between the groups. Overall mortality in the entire population was 37.9% (47/124), and it was not different between the groups (39.5% vs 37.2%; P=.48). Early mortality (<30 days) rate was 11.2% (14/124), late mortality rate was 26.6% (33/124), and no statistically significant difference was observed between the groups. Survival analysis showed that ICM patients were not associated with worse survival compared with IDCM (71.1% vs 81.1% after 1 year, 68.1% vs 73.0% at 2 years, and 54.2% vs 62.3% at 5 years; log rank=0.57). Multivariate analysis showed that the only predictor of mortality was preoperative urea level and that heart failure etiology was not a predictor of this end point. CONCLUSIONS Patients with ICM had similar survival and mortality rate compared with IDCM.

Infective endocarditis and spondylodiscitis due to posterior nasal packing in a patient with a bioprosthetic aortic valve.

Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.

Cor triatriatum sinister: a case series.

OBJECTIVE As a highly rare congenital defect, cor triatriatum sinister represents only 0.1% of congenital cardiac anomalies. Depending on the degree of obstruction and the accompanying symptoms, cor triatriatum can be diagnosed at any age. This case series described 5 patients with cor triatriatum sinister who underwent operation. METHODS Five patients with cor triatriatum sinister were seen at our institution between 2007 and 2013. The demographic characteristics and surgical results of these patients are outlined in this retrospective review. RESULTS The surgical approach consists of left or right atriotomy, excision of the obstructing membrane, and repair of the associated intracardiac anomalies. After an uneventful postoperative hospital stay, all patients were discharged 5-10 days postoperatively. There were no instances of recurrent constriction after surgical treatment of the cor triatriatum membrane. Patients were followed up for a median of 4 years and were symptom free. CONCLUSION In the surgical management of this easily and fully treatable congenital cardiac anomaly, it is difficult to determine which atriotomy approach is comparatively more advantageous. However, in the management of cor triatriatum sinister, priority should be given to confirmation of the diagnosis and full resection of the membrane. Thus, the surgeon should not hesitate to perform additional incisions if deemed necessary.

Right Anterolateral Thoracotomy in the Repair of Atrial Septal Defect: Effect on Breast Development

The aim of this study was to assess the cosmetic results and the impact on the breast development of a right anterolateral thoracotomy (RALT) in pre‐pubertal children who underwent RALT for correction of atrial septal defects.

Clinical and hemodynamic features of Eisenmenger syndrome patients at the time of first admission: a tertiary referral-center experience

OBJECTIVE In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed. METHODS The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6 ± 9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission. RESULTS The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9 ± 33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112 ± 6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV1 (forced expiratory volume), FEV1/FVC values were respectively, 3.1 ± 0.4, 2.5 ± 0.4 L and 76.7 ± 3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 ± 1.0 ml / kg/min and VE/VCO2 rate was 53.9 ± 3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low. CONCLUSION The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters.

Association Between Resistin Level and Renal Function in Patients Undergoing Coronary Artery Bypass Graft Surgery

Aim The purpose of this study was to evaluate the association between resistin levels and renal function in patients undergoing coronary artery bypass graft (CABG) surgery. Methods Thirty-seven consecutive patients (mean ± SD, age 60 ± 10 years, 29 (78%) male) undergoing CABG surgery at our department were enrolled into our study. Blood samples were taken to examine quantities of resistin level and other blood parameters the day before surgery. The patients were categorized into 2 groups: lower resistin level (group 1) or higher resistin level (group 2) according to the median value of 9 ng/mL. Results Mean ± SD resistin level, glomerular filtration rate (GFR), and urea and creatinine levels were 9.5 ± 4.2 ng/mL, 78 ± 25 mL/min per 1.73 m2, 42 ± 14 mg/dL, and 1.08 ± 0.2 mg/dL, respectively. Resistin showed significant correlation with serum levels of urea (r = 0.448l P = 0.005), creatinine (r = 0.367; P = 0.026), inverse correlation with GFR (r = −0.398; P = 0.015), statin usage (r = −0.393; P = 0.016), and β-blocker usage (r = −0.365; P = 0.026). In the multivariate logistic regression model, only GFR (odds ratio, 0.960; 95 confidence interval, 0.928-0.993; P = 0.018) remained independently associated with higher resistin levels after adjustment of other potential confounders in patients undergoing CABG surgery. According to the receiver operating characteristics curve analysis, the optimal cutoff value of GFR to predict higher resistin levels was found as 91 mL/min or less per 1.73 m2, with 100% sensitivity and 61.1% specificity. Conclusion The present study demonstrated that a lower glomerular filtration rate was associated with higher circulating resistin levels, independent of coronary heart disease risk factors in patients undergoing CABG surgery.

[Preoperative and intraoperative risk factors affecting mortality after heart transplantation: a single-center experience].

OBJECTIVE We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center. METHODS Data of 123 patients (mean age 40.6±14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1±14.6, 58 male) and 50 patients who died (Group 2, mean age 42.6±12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis. RESULTS Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7±63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3±27.7 vs 126.9±42.1 min, p=0.05), pre-operative creatinine clearance (81.0±31.5 vs 67.2±33.0 ml/min, p=0.02), urea (45.2±18.6 vs 57.8±35.2 mg/dl, p=0.02), and creatinine (1.01±0.25 vs 1.17±0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21±5.16 vs 12.50±8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regression analysis revealed that preoperative creatinine clearance (OR 0.989, 95% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 0.992 1.249, p=0.045) were the independent predictors of mortality. CONCLUSION Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation.