Mustafa Kurkluoglu

Detachment and dislocation of thermoreactive clips from sternum in late postoperative period due to misuse

Median sternotomy is the most common method of access to the heart and great vessels in cardiac surgical procedures. However, particularly in obese and diabetic patients, complications such as dehiscence, osteomyelitis, mediastinitis and superficial wound infection or fistula formation may be encountered. To overcome these complications, some alternative surgical techniques and surgical equipment are designed for sternal closure. Nitinol thermoreactive clips is one of them. In this study, we report a patient with detachment of thermoreactive clips from sternum in the late postoperative period due to wrong measurement of distance between intercostal spaces.

A rare complication after coronary artery bypass graft surgery: Ogilvie's syndrome.

Gastrointestinal (GI) complications occur in less than 2% of patients undergoing open-heart surgery. Acute colonic pseudo-obstruction, known as Ogilvies syndrome, is also a rare complication encountered in 0.046% of patients undergoing coronary artery bypass graft surgery. It is characterised by massive colonic dilatation without mechanical obstruction in patients with underlying medical or surgical conditions. In this report we describe a patient who suffered from acute renal failure requiring haemodialysis, and subsequently Ogilvies syndrome, which was treated with high-dose neostigmine.

Carotid Intima-Media Thickness: A Novel Inflammatory Marker Which Should Not Be Assessed Alone!

No abstract available

A novel point for warfarin usage in ACCP Guidelines, 2012 and its importance for quality of anticoagulation. Commentary on the article by Dr. Ciurus et al. (Kardiochir Torakochir Pol 2015; 12 (4): 334-340)

We have read with great interest the article about the factors affecting the quality of anticoagulation with warfarin by Ciurus et al. [1]. The authors implicate the importance of predictors of controlling the anticoagulation. They aim to assess the quality of anticoagulant therapy in patients on warfarin and evaluate the factors affecting its deterioration. We thank the authors for their well-designed study. Regarding the current guidelines concerning anticoagulant therapy, we detected some contradictory and overlooked points that should be highlighted. We want to make some contributions to the report by Ciurus et al. [1] about the warfarin usage introduction update and education change according to current guidelines. n nDespite the presentation of new anticoagulants, vitamin K antagonists (VKA) still maintain their importance in clinical administration [2]. Unfortunately, this wide use of VKA is still associated with a wide spectrum of complications. Particular concerns have been raised regarding prevention of these complications. As one of them, the Ciurus et al. emphasized that maximizing the time in the optimum therapeutic range has great importance for avoiding adverse clinical outcomes [1]. To attain this goal, controlling the patient-specific factors such as adherence to the therapeutic plan, appropriate dosing, and reliable international normalized ratio (INR) control are very important. Among such patient-related factors, the feeding habit of the patients is a special issue. Many doctors and patients remember the wide VKA interaction food list containing dietary vitamin K. It has been a frequent practice to limit or alter dietary habits of the patients according to those food lists. But this clinical advice has been changed by the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines, 2012 [3]. n nIt is suggested in the abovementioned document that limitations of diet deteriorate the therapeutic INR levels. Because most people have long-lasting dietary habits, which are very difficult to change, attempts to change any dietary habit may result in uncontrolled alterations of oral vitamin K intake, resulting in difficulties sustaining the therapeutic INR levels. The ACCP guidelines recommend that “A consistent intake of vitamin K-containing foods is advisable, but neither specific restrictions nor additions seem necessary in patients with stable anticoagulant control. Patients should be informed of possible changes in INR, in particular in response to the use of dietary supplements or herbs, or alcohol used chronically or ingested in large quantities.” n nThe authors reported that, “The participants were informed about the diet limitations required in order to improve the effectiveness of the anticoagulant therapy.” Although this suggestion is valid for attaining a therapeutic level, it is very difficult to maintain this level in therapeutic doses. That is why we think the ACCP guidelines made a modification on warfarin use in 2012, which we cannot see in the previous guidelines from 2008 [4]. We also agree with the suggestion that the patient should be informed about the food and drug interactions but no suggestion should be made on limiting dietary intake, in order to maintain therapeutic INR levels.

Left atrial appendage mass: is it always a thrombus?

Myxoma is the most common benign tumor of the heart, but it is very rare for it to originate from the left atrial appendage. Distinguishing between a mass, a thrombus, and a tumor in the body of the left atrium with preoperative transthoracic or transesophageal echocardiography is very difficult, even more so in patients with mitral valve disease and chronic atrial fibrillation. A 50-year-old male patient was admitted for surgery with the diagnosis of mitral stenosis and chronic atrial fibrillation. Transesophageal echocardiography demonstrated a mass attached to the wall of the left atrial appendage. Histopathological examination of the mass showed an image compatible with a myxoma. We hereby describe a case of a left atrial appendage myxoma mimicking a left atrial appendage thrombus.

A Combination of Persistent Left Superior Vena Cava and Subaortic Discrete Membrane

A persistent left superior vena cava is the most common congenital anomaly in volving the systemic veins. It occurs in approximately 0.5% of the general population and 3% to 10% of patients with other cardiovascular abnormalities including atrial septal defect, ventricular septal defect, bicuspid aortic valve, coarctation of aorta, and cor-triatriatum. A discrete subaortic membrane is a rare cause of subaortic stenosis in adult. It may present as in an isolated form as fibrous or fibromuscular ring below the aortic valve or in association with other congenital anomalies. This is the case of a persistent left vena cava superior associated with a subaortic discrete membrane.

Effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits

OBJECTIVESnWe investigated the effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits.nnnSTUDY DESIGNnEighteen New Zealand male rabbits were randomized into two groups, as drug (Group B) and non-drug (Group A). The right carotid artery of all the subjects was transected and anastomosed end-to-end with 10/0 polypropylene suture. The left carotid artery was left intact. Group B subjects received 30 mg/kg/day oral bosentan for 21 days, starting 3 days before the operation. Group A subjects did not receive any medication. After 28 days, the anastomoses site and the contralateral control site were removed, and samples were investigated histomorphometrically.nnnRESULTSnSignificant intimal hyperplasia was observed at all anastomoses compared to the non-anastomotic left side. Bosentan decreased significantly the intimal area [Group A: 48.3 µm(2) (37.1 µm(2)-65.7 µm(2)), Group B: 31.4 µm(2) (12.2 µm(2)-63.2 µm(2)), (p=0.04)] and intima/media area ratio [Group A: 0.49 (0.13-0.74), Group B: 0.22 (0.09-0.37), (p=0.024)] compared to the non-drug group.nnnCONCLUSIONnAccording to our investigation, bosentan decreased the intimal hyperplasia developed in a rabbit carotid artery model. Further investigations are needed to support the potential clinical utilization of bosentan after vascular interventions.

Contents Vol. 124, 2013

No abstract available

Sternal abscess overlying giant aortic pseudoaneurysm developed after Bentall procedure

Aortic pseudoaneurysms are one of the most important complications to be encountered in cardiac surgery. Recently, the aortic pseudoaneurysms have been diagnosed by contrast enhanced computerized tomography. It has high specificity and sensitivity rates. Late postoperative sternal abscesses are rarely seen after open heart surgery. Thorax computerized tomography scan revealed abscess extending from subcutaneous tissue to the medullar component of sternum, overlying retrosternal giant aortic pseudoaneurysms. This article presents the case of a patient, who had undergone Bentall procedure three years ago due to type I aortic dissection and later presented in our cardiovascular surgery department with a sternal mass. Pam Med J 2013;6(1):33-36