Osman Tansel Darçin

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.

Mini-dose pump-prime aprotinin inhibited enhanced fibrinolytic activity and reduced blood loss and transfusion requirements after coronary artery bypass surgery.

Objectives: Low-dose aprotinin in the pump during cardiopulmonary bypass (CPB) has been shown to improve postoperative hemostasis and platelet preservation. This investigation was undertaken to evaluate the effects of mini-dose pump prime only aprotinin (70 mg) on the hemostatic parameters and blood transfusion requirements in patients undergoing on-pump coronary artery bypass surgery (CABG).Materials and Methods: We studied 86 patients who underwent CABG. Forty patients received mini-dose aprotinin (500.000 KIU [70 mg] in the pump), and a control group of 46 did not. D-dimer level, full blood count, postoperative blood loss, and transfusion requirements were analyzed before, after one hour operation and first day after operation.Results: Twenty-four-hour postoperative blood loss was significantly reduced in the aprotinin group (188± 51.5 ml vs. 818± 243.5 ml, [mean ± standard deviation] p < 0.01). Patients in the aprotinin group also received significantly less banked blood posoperatively than the control group (1.20 ± 0.52 vs. 3.33 ± 1.13 Units/per patient (p < 0.04). One hour after operation, and 24 hours after operation D-dimer level was significantly reduced in the aprotinin group (p < 0.008 and p < 0.017, respectively).Conclusions: Mini dose pump-prime aprotinin reduces postoperative blood loss, transfusion requirements and yet confers hemostatic improvement through reduced fibrinolysis in patients undergoing routine coronary artery bypass grafting.

Coronary endarterectomy with beating heart in patients with diffuse atheromatous coronary artery disease and poor ventricular function: early and midterm results.

BACKGROUND In this study, we retrospectively reviewed our experience with off-pump coronary artery bypass grafting and coronary artery endarterectomy in patients with severely reduced left ventricular function and diffuse atheromatous coronary artery disease to evaluate the early and midterm results. METHODS Between July 1998 and March 2004, 42 patients underwent off-pump myocardial revascularization with coronary artery endarterectomy. The mean age (+/-SD) for the 28 male and 14 female patients was 59 +/- 10.2 years. Twenty-seven patients (64.2%) had experienced a previous myocardial infarction, and 11 (26.2%) had undergone an operation on an emergency basis. All patients had an ejection fraction of less than 30%. The left anterior descending coronary artery was the most endarterectomized vessel (75% of patients). RESULTS There were 5 early deaths (11%). Twenty-five (67.6%) of the surviving patients were symptom free, and 8 were in Canadian Cardiovascular Society classes II to IV. The ejection fraction improved after the operation in the 30 patients (71.42%) who underwent echocardiographic control and coronary angiography. The 28.4-month patency rate of the endarterectomized coronary arteries was 89%. The patency rates were 93.3% for the left internal thoracic artery-left anterior descending coronary artery and 88.8% for the right coronary artery. CONCLUSION The results of this study show increased operative mortality and morbidity in patients requiring coronary artery endarterectomy. However, the early results and particularly the midterm survival rates, clinical status, and continued graft patency justify off-pump coronary artery endarterectomy in patients with severely depressed left ventricular function and diffuse coronary artery disease. Many of these patients have disease that would otherwise be inoperable.

Coronary artery bypass surgery in high-risk patients

BackgroundIn high-risk coronary artery bypass patients; off-pump versus on-pump surgical strategies still remain a matter of debate, regarding which method results in a lower incidence of perioperative mortality and morbidity. We describe our experience in the treatment of high-risk coronary artery patients and compare patients assigned to on-pump and off-pump surgery.MethodsFrom March 2002 to July 2004, 86 patients with EuroSCOREs > 5 underwent myocardial revascularization with or without cardiopulmonary bypass. Patients were assigned to off-pump surgery (40) or on-pump surgery (46) based on coronary anatomy coupled with the likelihood of achieving complete revascularization.ResultsThose patients undergoing off-pump surgery had significantly poorer left ventricular function than those undergoing on-pump surgery (28.6 ± 5.8% vs. 40.5 ± 7.4%, respectively, p < 0.05) and also had higher Euroscore values (7.26 ± 1.4 vs. 12.1 ± 1.8, respectively, p < 0.05). Differences between the two groups were nonsignificant with regard to number of grafts per patient, mean duration of surgery, anesthesia and operating room time, length of stay intensive care unit (ICU) and rate of postoperative atrial fibrillationConclusionUtilization of off-pump coronary artery bypass graft (CABG) does not confer significant clinical advantages in all high-risk patients. This review suggest that off-pump coronary revascularization may represent an alternative approach for treatment of patients with Euroscore ≥ 10 and left ventricular function ≤ 30%.

Surgery on varicose veins in the early ottoman period performed by Şerefeddin Sabuncuoğlu

AbstractŞerefeddin Sabuncuoğlu, a pioneer of surgery, is known to be the author of first illustrated surgery textbook, Cerrahiyyetu’l Haniyye (Imperial Surgery), which was written in Turkish in 1465 AD at the age of 80 years. The purpose of this article is to describe his contributions to varicose vein surgery. In addition to vascular surgery, Şerefeddin Sabuncuoğlu was interested in a wide range of surgical specialities including thoracic surgery, general surgery, pediatric surgery, ophthalmology, orthopedic surgery, urologic surgery, and obstetrics and gynecology. His book was the first illustrated textbook of surgery in the Turkish medical literature, containing color illustrations of surgical procedures, incisions, and instruments. The book has been known of for only the past 60 years. There are 137 different medical observations and recommendations in Cerrahiyyetu’l Haniyye, along with translated passages from the works of Ebu Kasim-ul Zahravi (Albucasis), Al-Tasrif (Textbook of Surgery), including Sabuncuoğlu’s additional original contributions. In chapter 90 of the book, Sabuncuoğlu describes lower extremity varices and their surgical treatment and provides a few color illustrations. Although not recognized and rewarded in his time, Şerefeddin Sabuncuoğlu was a great surgeon in Turkish-Islamic medical history. This review demonstrates that his textbook, Cerrahiyyetu’l Haniyye, was the first illustrated textbook including various surgical procedures, incisions, and instruments of varicose vein surgery.

Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

BACKGROUND Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. CASE In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. RESULTS During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. CONCLUSION Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

Hybrid endovascular repair of thoracoabdominal aorta: early results.

BACKGROUND Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure. METHODS From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter. RESULTS All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination. CONCLUSION Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.

Successful Treatment of Traumatic Late Rupture of Thoracic Aorta: Case Report

trauma die at the scene of injury or before reaching the operating room.1-3 Those who survive usually have a contained aortic rupture and require mostly emergent intervention to control mediastinal hemorrhage. Actually, ruptured thoracic aortic aneurysm is more common in older patients and has a high early postoperative mortality, ranging from 24%4 to 42,1%.5 In this subgroup of elderly patients, mortality has been reported as 50% when operation was performed on the emergency basis.6 In this setting, endovascular stent grafting is a less invasive treatment for descending aortic pathologies and may be considered as an alternative to conventional surgical repair.

Oral Anticoagulant Therapy May Prevent Mortality in Peripheral Vascular Surgery

ABS TRACT Objective: Atherosclerotic peripheral arterial disease is associated with an increased risk of myocardial infarction, stroke, and death from cardiovascular causes. Antiplatelet drugs protect from major cardiovascular events, but the role of oral anticoagulant agents is unclear in the prevention of cardiovascular complications in patients with peripheral arterial disease. Material and Methods: We assigned patients with peripheral arterial disease treated surgically. According to the medical treatment in postoperative and follow-up periods, the patients were divided into two groups: Anticoagulant therapy [patients receiving oral anticoagulant agents with a target international normalized ratio (INR)=2.0-3.0, n=78] and the patients not receiving oral anticoagulant agents (n=56). In both groups, medical treatment was combined with antiplatelet therapy in some patients. The primary outcome was death and secondary outcome was limb amputation. Results: A total of 134 patients were treated surgically. The mean follow-up period was 30 months. Revision due to bleeding, occlusion of the graft, embolism of non-treated arteries, myocardial infarction and stroke occurred in 6 patients receiving anticoagulant therapy (7.69%) and in 5 patients not receiving anticoagulant therapy (8.92%, p=0.48). Death and limb amputation occurred only in patients not receiving anticoagulant therapy (12.5%, p=0.02 and 5.4%, p=0.071). Conclusion: In patients with peripheral arterial disease treated surgically, the oral anticoagulant therapy may be effective for preventing death.