Mustafa Paç

Primary Cardiac Myxomas: Clinical Experience and Surgical Results in 67 Patients

Abstract  Background: Primary cardiac tumors are rarely seen and have an incidence of 0.3% of all open‐cardiac operations. Among those, myxoma is the most common cardiac tumor. There are only a few reports of such tumors from Turkey. Methods and Results: We report our experience with 67 patients with primary cardiac myxoma operated on at our institute between December 1990 and October 2006. The study group comprised 22.38% males and 77.61% females with a mean age of 46.29 (±18.29) years. The predominant symptoms were dyspnea and palpitation. In addition, 3 patients presented with peripheral embolism with impending limb ischemia that necessitated emergency embolectomy. Echocardiography was generally enough for the demonstration of the myxomas. Two sporadic myxomas (%2.98) and one familial myxomas (1.49%) presented with recurrence. There were three (4.47%) hospital mortalities. Two patients (2.27%), with preoperative decompensation, died after tumor resection, from progressive low cardiac output. One patient, with preoperative massive pulmonary embolus, died two days after operation, from right ventricle insufficient. Conclusion: In conclusion, we herein summarized surgical results with primary cardiac myxomas. Surgical excision of primary cardiac myxomas tends to show excellent results after surgical excision.

Neurochemical markers during selective cerebral perfusion via the right brachial artery

Unilateral selective cerebral perfusion through right brachial artery is one of the cerebral protection methods for aortic arch repair. The purpose of this study is to determine whether cerebral perfusion through contra-lateral hemisphere is adequate or not. Seventeen consecutive patients underwent aortic arch repair using low flow antegrade selective cerebral perfusion (ASCP) through right brachial artery under moderate hypothermia. We measured S100beta and neuron-specific enolase (NSE) levels, venous O(2) saturation, lactate, and glucose from both left and right jugular vein blood samples before, during and following ASCP and cardiopulmonary bypass. There was no operative mortality or neurological complication in these patients. No significant differences were observed in S100beta and NSE levels, venous saturation, glucose and lactate between the blood samples which were gathered from both jugular veins, statistically. This technique, as far as biochemical markers are concerned, seems to provide adequate perfusion for both right and left cerebral hemispheres.

Thoracic aortic aneurysms after blunt trauma

BACKGROUND Aortic injury after blunt trauma that is missed during the first admission will soon be seen as a chronic aneurysm. The objective of this study is to show the importance of the diagnosis and appropriate treatment of these aneurysms. METHODS Between 2009 and 2012, 8 patients (mean age, 50±31 years) diagnosed with chronic traumatic aortic aneurysm were treated with either thoracic endovascular aortic repair (TEVAR) or conventional surgery 20 years on average after the trauma. RESULTS Treatments included TEVAR in four patients, conventional surgery in two patients, and hybrid intervention in one patient. One patient died postoperatively. One patient had an endoleak requiring a repeat TEVAR, which was successful. Brachial embolectomy was performed after placing the endovascular stent. No paraplegia or lower extremity ischemia was seen. One patient died preoperatively due to rupture of the aneurysm. CONCLUSION Chronic traumatic aortic aneurysms may cause general symptoms years after a blunt trauma. Aortic injury must always be considered in the assessment and follow-up of trauma patients.

Buerger's disease in eastern Anatolia

Thromboangiitis obliterans (TAO) is very frequent in eastern Anatolia. In a ten-year period 204 Buerger’s disease patients were diagnosed in Atatürk University Research Hospital. The patients were 18 to 45 years old (mean 28.4 years). Of these patients 185 were chronic smokers, 124 were from a lower socioeconomic level, and 137 were living in a cold climate. Cryoglobulin was positive in 48 patients.The diagnosis was established by physical examination, Doppler ultrasonography, angiography, and pathologic examination.Bilateral lumbar sympathectomy was done in 127 cases, unilateral lumbar sympathectomy in 49. Bilateral thoracic and lumbar sympathectomy was done in 10 cases. In 103 cases digital ulcers were detected. Ankle-brachial indexes increased by 0.1–0.2 by the fourth day after sympathectomies, and skin temperature increased by 2–3 °C.In 72 patients complete wound healing was achieved; 21 patients had one finger amputation, and 10 patients have undergone major amputations.

The Classic ‘T on P’ Phenomenon

C ongenital long QT syndrome (LQTS) is a genetic channelopathy with variable penetrance characterised by abnormally prolonged ventricular repolarisation with an increased propensity to syncope and polymorphous ventricular tachycardia, which may lead to ventricular fibrillation and sudden cardiac death. Electrocardiography is the primary important step in the diagnosis of LQTS but electrocardiogram (ECG) findings may be easily ignored. We present an asymptomatic two-month-old infant with peculiar ECG features with ‘T on P’ phenomenon caused by a homozygous mutation in the KCNQ1 gene. Implantable cardioverter-defibrillator implantation is an effective therapy and can apply to small children successfully.

Glasgow aneurysm scores in patients undergoing open surgical procedure for aortic aneurysm.

Background To assess the applicability of the Glasgow aneurysm score (GAS) in patients with aortic aneurysm undergoing an elective open surgical procedure in our hospital. Materials and methods A total of 105 patients undergoing elective open surgical procedure between January 2006 and June 2012 were evaluated retrospectively. Glasgow aneurysm score (GAS) was calculated as age+7 points for myocardial disease, +10 points for cerebrovascular disease, and +14 points for renal disease. The best cut-off value for GAS was determined using the ROC curve analysis. Results The hospital mortality rate was 3.8% (4 patients). GAS was significantly lower in patients who survived the operation (76.05 ± 14.71 vs. 92.0 ± 10.8 respectively, p = 0.031). The ICU stay was also significantly lower in patients who survived the operation (2.37 ± 5.23) compared to the nonsurvivors (25.67 ± 13.80, p = 0.001). No significant difference was observed regarding age, duration of hospital stay, and aortic diameter. The area under the ROC curve was 0.818 and for a 100% sensitivity rate, the cut-off value for GAS was 77.5 with a 58.4% specificity rate (p = 0.031). All patients with a GAS < 77.5 were alive after surgery. Conclusion The GAS appears to be a reliable clinical predictor for in hospital mortality following elective repair of abdominal aortic aneurysm following open surgical procedure.

Two cases of Noonan syndrome: aortic coarctation causing a giant aneurysm of the descending aorta.

◆ A 16-year-old girl was referred with the diagnosis of Noonan syndrome. She underwent surgical closure of a patent ductus arteriosus when she was 10 months old. On physical examination, there was a grade 2/6 systolic murmur on the lower left sternal border. Echocardiographic examination revealed aneurysmal dilatation of the descending aorta (Fig. A). Computed tomography demonstrated a large fusiMustafa Paç# Ayşe Esin Kibar Mehmet Burhan Oflaz Feyza Ayşenur Paç

Mitral Valve Replacement in “Complex” Mitral Insufficiency: An Unusual Case of an Isolated Hammock Mitral Valve

Abstract  The hammock mitral valve is a rare congenital abnormality resulting in mitral regurgitation or stenosis, with incidences ranging from 0% to 12% in pediatric surgical series. It is difficult to correct this condition by reconstructive techniques. We describe here an alone hammock valve without any cardiac malformation in a five‐year‐old patient who underwent mitral valve replacement.

Is Tricuspid Annular Plane Systolic Excursion (TAPSE) Predictor for out Patients with LVAD Right Ventricular Failure in lvad Patients with Preoperative Low Value TAPSE on Mild-term Follow Up

Purpose Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices (LVAD) in patients with refractory heart failure. There are some predictors such as Michigan and Penn Risk scores, CVP/PCWP, RVSWI and INTERMACS profiles for early postoperative RV failure in LVAD implantation. We analyzed readmission due to right ventricular failure in LVAD patient with preoperative low values for tricuspid annular plane systolic excursion (TAPSE) on mild-term follow up. Methods From June 2013 to October 2017, 61 patients who had discharged successfully underwent LVAD implantation at our department. Patients were divided into two groups according to the preoperative TAPSE. Group A (n = 24) was TAPSE of ⩽12 mm and Group B (n= 37) was TAPSE of >12 mm. Statistical methods for the analysis of recurrent events with a terminal event were performed to evaluate readmission due to RVF. Demographics and outcomes were compared between these two groups. Results Of sixty-one patients, mean age was 42.3 ± 13.7 (19-67) years, 20% were women, mean follow up time were 663.6 ± 391 (92-1571) days, median TAPSE was 13 (6-20) mm, dilated cardiomyopathy 62,2%, fourteen (23%) patients were performed heart transplantation, readmission due to RVF was 11% (in group A 2 patients, in group B 5 patients), there was no difference between the two groups with regard to compared RVF on mild term follow up (p:0,53). Two (28,5%) patients patients died due to pump thrombosis after RVF event, a patient was performed heart transplantation, four (57%) patients is followed with medical treatment on out of hospital. A patient died due to pump thrombosis in grup B. Conclusion Right ventricular (RV) dysfunction following implantation of a LVAD is a serious condition and is associated with increased mortality. We use some scores and predictors such as TAPSE for early postoperative RVF but the absolute there are needed new predictors for RVF with LVAD patients who out of hospital on long term follow up.

A new heart surgery clinic: Open Heart Surgery Outcomes at Karabuk Training and Research Hospital: Assessment of the first year -

This study aims to assess the one-year outcomes of open heart surgeries performed at the recently established Cardiovascular Surgery Clinic of Karabuk Training and Research Hospital. A total of 71 consecutive patients (60 males, 11 females; mean age 63.7±9.3 years; range 42 to 84 years) who underwent open heart surgery were evaluated retrospectively from 21 January 2016 to 21 January 2017. The most common comorbidity was hypertension (64.8%), followed by smoking (61.9%), chronic obstructive pulmonary disease (54.9%), and diabetes mellitus (40.6%). Mean length of stay at the intensive care unit was 3.4±2.9 days, and mean length of stay at the hospital was 10.4±6.9 days. In-hospital mortality occurred in a total of seven patients (9.9%). Early mortality (within the first 30 days) was seen in four (5.6%) patients. We believe our mortality and morbidity rates are acceptable despite the disadvantages of being a recently established center and the presence of multiple comorbid factors of patients. Although our clinic is a new center founded in Karabuk province, it is planned to become an important center in the future in terms of heart surgery through the increasing number and variety of surgeries.