Mehmet Taşar

Behcet's disease and cardiovascular involvement: our experience of asymptomatic Behcet's patients.

Summary Abstract Behcet’s syndrome is a systemic inflammatory disease associated with vasculitis, and arterial, venous and cardiac disorders. Thirty-eight Behcet’s disease patients were examined prospectively with echocardiography, ultrasonography and computed tomography, and coagulation parameters were determined. Deep venous insufficiency was found in 16 patients, venous thrombosis in seven, one patient had iliac artery stenosis, three had carotid arterial intimal proliferation, two patients had aortic annulus dilatation, six had aortic valve insufficiency, and three had mitral valve insufficiency. None had coagulation defects. To decrease morbidity and mortality rates, a multidisciplinary approach is important for early diagnosis of cardiovascular involvement in Behcet’s disease.

Surgical Repair of Lower Extremity Vascular Injuries in Children: Two Cases

The use of percutaneous devices is commonplace for the treatment of many congenital heart defects. However, there are some situations where procedure-related complications are encountered and surgical help is required to ameliorate this issue. Vascular injury due to transcatheter intervention is a significant and challenging complication and occasionally requires surgical approach. In this case report, we aimed to present successful surgical management of vascular injuries associated with percutaneous interventions in children.

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

AIM The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT). MATERIALS AND METHODS We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patients anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded. RESULTS The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups. CONCLUSION Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

Regional cervical plexus blockage for carotid endarterectomy in patients with cardiovascular risk factors.

BACKGROUND Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. METHODS We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. RESULTS Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. CONCLUSION Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients

Introduction Determining operative mortality risk is mandatory for adult cardiac surgery. Patients should be informed about the operative risk before surgery. There are some risk scoring systems that compare and standardize the results of the operations. These scoring systems needed to be updated recently, which resulted in the development of EuroSCORE II. In this study, we aimed to validate EuroSCORE II by comparing it with the original EuroSCORE risk scoring system in a group of high-risk octogenarian patients who underwent coronary artery bypass grafting (CABG). Material and methods The present study included only high-risk octogenarian patients who underwent isolated coronary artery bypass grafting in our center between January 2000 and January 2010. Redo procedures and concomitant procedures were excluded. We compared observed mortality with expected mortality predicted by EuroSCORE (logistic) and EuroSCORE II scoring systems. Results We considered 105 CABG operations performed in octogenarian patients between January 2000 and January 2010. The mean age of the patients was 81.43 ± 2.21 years (80-89 years). Thirty-nine (37.1%) of them were female. The two scales showed good discriminative capacity in the global patient sample, with the AUC (area under the curve) being higher for EuroSCORE II (AUC 0.772, 95% CI: 0.673-0.872). The goodness of fit was good for both scales. Conclusions We conclude that EuroSCORE II has better AUC (area under the ROC curve) compared to the original EuroSCORE, but both scales showed good discriminative capacity and goodness of fit in octogenarian patients undergoing isolated coronary artery bypass grafting.

Coronary artery bypass grafting in a Behçet's disease patient : online article - case report

Behçets syndrome is a chronic, multisystemic, inflammatory, vasculitic disorder characterised by oral aphta, ocular lesions, genital ulcers and the involvement of other systems. Although vascular involvement is seen frequently, coronary artery disease is extremely rare in Behçets disease and it is generally treated with invasive or conservative procedures. In this case, we aimed to present a successful bypass grafting of three vessels using cardiopulmonary bypass in a patient with Behçets disease.

Rapidly Progressive Dyspnea after Coronary Arterial Bypass Grafting with Bilateral Internal Mammary Artery: Report of a Case

Diffuse alveolar haemorrhage (DAH) is defined as bleeding into alveolar spaces, and it is caused by the disruption of the alveolar-capillary basement membrane. While various diseases are associated with the development of DAH, we describe a rare case of alveolar haemorrhage after a full arterial revascularisation procedure via bilateral internal mammary arteries.

Surgical Treatment of Isolated Interrupted Aortic Arch in a Young Female Diagnosed during Pregnancy

Interrupted aortic arch (IAA) is a very rare pathology characterized by luminal discontinuity between ascending and descending aorta. IAA is commonly treated in pediatric ages, but the surgery is rarely used for adult patients. In this case report, we aimed to present a successful surgery in a young woman in whom IAA was diagnosed during pregnancy.

Trends in mechanical aortic valve replacement surgery in a large, multi-surgeon, single hospital practice

Introduction In recent decades, new high-performance prostheses have been invented for use with small aortic annuli, and they have helped avoid patient prosthesis mismatch (PPM) without the need for aortic annular enlargement. The purpose of this study is to examine the trends in mechanical aortic valve replacement surgery in a large, multi-surgeon, single hospital practice. Material and methods Between January 1999 and January 2008, 1337 consecutive patients underwent aortic valve replacement (AVR) with or without concomitant aortic annulus enlargement. Patients with aortic dissections and patients undergoing Bentall and Ross procedures were excluded from the analysis. Patients were grouped according to the used aortic valve size. The data were collected and analyzed retrospectively. Results The mean age of the subjects was 54.37 ± 17.35 (range: 10-84), and 881 of them were men (65.8%). The number of aortic root enlargement procedures decreased over the years (p < 0.05); particularly, the decline of the Nicks procedures was statistically significant (p < 0.05). In 2008, the most frequently used valve size was 23, which stands in contrast with the smaller size preferred in 1999 (p < 0.05). The primary pathophysiology leading to aortic valve replacement, i.e. aortic stenosis, did not change over the years (p > 0.05). Although the use of combined surgery increased in time, there was no statistical relationship with any increase in mortality rates (p > 0.05). Conclusions This study showed that avoiding the procedure of aortic root enlargement and implanting high-performance prostheses with larger valves is safe.