Mustafa Kemal Demirag

Late-term results of mitral valve replacement with St. Jude medical® mechanical valve prosthesis : Samsun experience

Background and aim of the study— We have reported the short- and long-term results of mitral valve replacement in this article. Methods — Mitral valve replacement was conducted in 276 patients in our clinic between January 1989 and March 2005.The youngest patient was 4 years old and the oldest patient was 74 years old. Mean age was 40.08±1.06 y. Of these patients, 41.3% were men and 58.7% were women.The reason for operation was mitral stenosis in 96 patients (34.78%), mitral insufficiency in 78 patients (29.26%) and mitral stenosis plus mitral insufficiency in 102 patients (36.96%).The aetiology of mitral valve lesions was acute rheumatic fever in 208 patients (75.36%).The aetiology of mitral valve lesions was degenerative in 37 patients (13.41%), ischaemic in 23 patients (8.33%) and congenital in 8 patients (2.9%). Results — In the 5, 10 and 15-year periods, the actual survival rates were 87.64%±2.02%, 83.35%±2.38% and 68.19%±5.63%, respectively. Thromboembolism was observed in 38 patients (13.77%).The rates of actual freedom from thromboembolism in the 5, 10 and 15-year periods were 93.08%±1.53%, 88.48%±1.99% and 81.06%±3.43%, respectively. Of the 276 patients who had been observed for 15 years, 5 had (1.81%) valvular thrombosis. The rates of actual freedom from valvular thrombosis in the 5, 10 and 15-year periods were 98.89%±0.64%, 98.04%±0.87% and 98.04%±0.87%, respectively. In the 15-year period, 23 patients (8.33%) had haemorrhage due to anti-coagulation.The rates of actual freedom from haemorrhage due to anti-coagulation in the 5, 10 and 15-year periods were 95.64%±1.23%, 93.40%±1.56% and 87.73%±2.96%, respectively. Seven patients (2.54%) had prosthetic valvular endocarditis. The rates of actual freedom from endocarditis in the 5, 10 and 15-year periods were 98.51%±0.74%, 97.60%±0.97% and 97.01%±1.13%, respectively. Nine patients (3.27%) were re-operated. The rates of actual freedom from re-operation in the 5, 10 and 15-year periods were 97.45%±0.95%, 96.58%±1.12% and 96.58%±1.12%, respectively. Conclusions — St. Jude Medical® mechanical valve prosthesis has been the valve of choice in our clinic owing to its excellent haemodynamic properties and low rates of complication.

Surgical treatment of posterior nutcracker syndrome presented with hyperaldosteronism

Posterior nutcracker syndrome is caused by the compression of left renal vein between the abdominal aorta and the vertebral body. Most seen symptoms are haematuria, left flank pain, abdominal pain and varicocele. The nutcracker syndrome may lead to left renal vein thrombosis due to blood congestion within compression of the vessel. Both endovascular and open surgical interventions can relieve symptoms; however, traditional surgical repair is still considered as the gold standard. Here, we present the surgical treatment of a 36-year old female with complaints of hypertension, hyperaldosteronism and diagnosed with posterior nutcracker syndrome.

Gunshot Injury to the Groin: Management of Patients with Life-Threatening Condition Gunshot Injury to the Groin

Gunshot injuries have become increasingly common in Turkey. Patients with gunshot arterial injuries to the groin admitted to the emergency department present with rapidly expanding hematoma, absent distal pulse, bruit over the artery, ischemic limb, unrecordable blood pressure, confused status, tachycardia, tachypnea, and pulsatile external bleeding (1). Prompt restoration of the circulation is mandatory to avoid death and ischemia. Although vascular injuries are not uncommon, femoral vascular injuries are the most common, accounting for approximately 70% of all peripheral vascular injuries. Vascular injuries were common during war, constituting 2%–5% of all injuries (2). Amputation rate was 50% in the World War II and reduced to less than 10% during the Vietnam War (3).

Surgical Treatment of Inferior Pancreaticoduodenal Artery Aneurysm with Common Hepatic Artery Revascularization

Pancreaticoduodenal artery aneurysms (PDAAs) are rarely seen among the visceral artery aneurysms (<2%). PDAA is mostly asymptomatic but can be presented with abdominal pain. Embolization can be applied safely with a high success rate; however, in some conditions such as when embolization fails or accompanying celiac axis occlusion, open surgery can be performed. We report the successful management of a patient with PDAA and occlusion of the celiac axis with uneventful short- and mid-term follow-up.

Entrapped Cardiac Thrombus and Fatal Right Heart Failure due to Massive Pulmonary Emboli

The prevalence of patent foramen ovale (PFO) in the general population is 25-30%however, paradoxical embolism is rarely seen. Entrapped cardiac thrombus (impendingparadoxical embolism) is defined as embolus that project through the patent foramen ovale(PFO) thus biatrial embolism and paradoxical embolism are rarely seen in alives. Completeremoval of the thrombus by surgery reduces the risk of embolization. Emergency surgery isindicated for biatrial thrombus, entrappedcardiacthrombusandmassivePEwithhemodynamiccompromise. We present the management of a 41 year old male with entrappedcardiac thrombus and fatal right heart failure due to massive pulmonary emboli

Isolated Tricuspid Valve Infective Endocarditis: A Rare Entity

Tricuspid valve (TV) infective endocarditis (IE) is an uncommon issue. Isolated TVIE accounts for approximately 5% to 36% of all IE. Staphylococcus aureus (60% to 90%) is the most common microbiological pathogen. Most of the patients can be successfully treated with medical therapy however; surgery is preferred for patients in whom medical therapy has failed. Successful surgical treatment should include radical debridement of the infected tissues and the restoration of the valve function. We report the surgical management of a 32-year-old female who was presented with tricuspid valve endocarditis with unknown predisposing factors.

Closed Femoral Shaft Fracture Associated With Superficial Femoral Artery Thrombosis in a Child

Femur fractures are common in pediatric population. However, traumatic vascular injuries secondary to femoral shaft fractures were rarely reported in the literature. Major signs of the vascular injury are including pulselessness, enlarging pulsatile haematoma, bruit, thrill, haemorrhage and acute ischemia. Vascular injury may present even if in the presence of the distal pulses of the limb. We report a case of 5 year old child who presented with superficial femoral artery thrombosis due to proximal femoral shaft fracture. We emphasize the significance of suspicion of vascular injuries associated with femoral shaft fractures in pediatric population and the influence of the current research on the future studies.

Right Ventricular Free Wall Perforation without Tamponade: A Rare Complication of Permanent Pacemaker Lead Placement

Cardiac pacemakers are placed on the right and left ventricles to provide stimulations for myocard muscle contractions. During the course of life, the pacemaker leads sway with the heart during each heartbeat. Therefore, not only abrasion but also degeneration may occur on the myocardium and the pericardium. Hence, lead displacement is a frequently seen complication . Fatal results may be seen because of ventricular perforation. Perforation of the atrial and ventricular myocardium are mostly seen. Until the ventricular lead tip goes out of ventricle cavity about 3 mm, it is usually not noticeable by imaging techniques. Cardiac tamponade is a rare phenomenon but if it occurs, it is usually seen within Received 27/08/2016 Accepted 04/11/2016 Published 05/11/2016

Acute thrombotic occlusion of infrarenal abdominal aorta: A case report

Acute abdominal aortic occlusion is a rare phenomenon that requires rapid diagnosis and intervention. Patients are presented with severe pain and ischemia of the bilateral lower limbs with paresthesia or paraplegia. Acute occlusion can occur via de novo thrombus formation on an atherosclerotic aortic plaque and embolization of a central thrombus. Here we present a case with acute infrarenal abdominal aortic occlusion. Correspondence to: Serkan Burc Deser, 19 Mayis University, Medical Faculty, Department of Cardiovascular Surgery, 55139 Samsun, Turkey, Tel: 00 90 (362) 312 19 19/2615; Fax: 00 90 (362) 457 60 91; E-mail: sbd983@yahoo.com

Surgical Treatment of Stent Restenosis after Long Segment Placement into theSuperficial Femoral Artery

Endovascular stent placement is taking place of the bypass surgery in patients with peripheral arterial disease, over the last decade. However, patency of the long segment stents, below knee disease, advenced age, absence of distal runoff, diabetes and chronic renal disease are still challenging. Surgical bypass for the superficial femoral artery occlusive disease to the below the knee stenosis by using autologous vein graft has still good results. Here we present a 55 year old male who had long segment superficial femoral artery atherosclerotic disease. He had a history of long segment endovascular stent placement. We extracted the restenotic stent and performed bypass with PTFE graft to the below the knee.