A simple technique to reduce tension on coronary button anastomosis in aortic root surgery.

The permanency of the coronary ostial anastomosis is an important predictor of morbidity in aortic root surgery. We introduced a technique to reduce coronary reimplantation-related complications in aortic surgery. We believe that plicating the folds of the graft at both sides of the coronary ostial anastomosis reduces the tension on the suture line and may be advantageous to avoid pseudoaneurysm formation, detachment of the coronary button from the graft, distortion of the coronary geometry, or bleeding from the suture line.

Direct approach to hydatid cyst of the interventricular septum.

A 37-year-old woman who had undergone an operation for hydatid cyst of the liver 10 years earlier decided to have a check-up for echinococcosis, because she had not been seen by a clinician for 4 years. The case is of particular interest not only because it enabled a rare preliminary diagnosis of cardiac echinococcosis by simple electrocardiographic analysis, but also because our technique of excision appears to be one never before reported in connection with interventricular hydatid cysts. In such an instance, we recommend a direct approach (if possible) through the interventricular septum without entering the cardiac chambers, in order to avoid dissemination; and we recommend enucleation of the germinative membrane without capitonnage, to avoid impairment of the atrioventricular conduction pathway or of myocardial contraction.

Surgical approaches in left anterior descending artery in-stent stenosis.

Background: In-stent stenosis remains the major disadvantage of coronary interventions. Extensive applications of the intracardiac devices especially involving long segments of coronary arteries have resulted in an increase in the number of cases of in-stent stenosis. That may require aggressive surgical approaches.

Effects of minimal dose aprotinin on blood loss and fibrinolytic system-complement activation in coronary artery bypass grafting surgery.

Background: To determine whether 500,000 KIU aprotinin is effective to reduce blood loss in coronary artery bypass grafting (CABG) and to evaluate the effects of this regimen on hematologic parameters.

Methods: Forty-four patients scheduled for primary CABG were randomly assigned to the aprotinin (n = 24) or control group (n = 20). In aprotinin group, aprotinin was administered in two equal doses (before skin incision and added to the pump prime).

[Effects of combined mitral valve replacement and radiofrequency atrial ablation in chronic atrial fibrillation].

Objective: The aim of the study is to find out the efficacy of radiofrequency catheter atrial ablation (RF) simultaneously done with mitral valve replacement (MVR) surgery in patients having rheumatic mitral valve disease with chronic atrial fibrillation and to evaluate the short-term postoperative results.

Methods: Seventeen patients underwent MVR surgery, and intraoperative RF procedures were done simultaneously with MVR to eight of these patients, whereas remaining nine of them were assigned to control group. Patients were assessed preoperatively, at time of discharge, and 1st, 6th and 12th months controls.

Acute renal failure following open heart surgery: risk factors and prognosis.

Background: Acute renal failure (ARF) development after cardiac surgery carries high mortality and morbidity.

Methods: Out of 14437 consecutive patients undergoing open-heart surgery between January 1991 and May 2001, 168 (1.16%) developed postoperative ARF mandating hemodialysis.

Does delayed correction interfere with pulmonary functions and exercise tolerance in patients with tetralogy of fallot?

Study Objectives: To assess exercise tolerance and determine the distinct role of cardiac, respiratory, or peripheral factors on it after delayed surgical repair in patients with tetralogy of Fallot.

Design: The aerobic exercise capacity of 15 adult patients (mean [+/- SD] age, 21 +/- 6; age range, 9 to 30 years) undergoing successful total correction at a mean age of 12 +/- 5 years (patients) was compared to healthy, matched control subjects by using right ventricle echocardiography, resting spirometry, and cardiopulmonary exercise tests at a mean postoperative time of 7.5 +/- 4.

Arch repair with unilateral antegrade cerebral perfusion.

Objective: Several antegrade cerebral perfusion techniques with differing neurological outcomes are employed for aortic arch repair. This study demonstrates the clinical results of aortic arch repair with unilateral cerebral perfusion via the right brachial artery.

Methods: Between January 1996 and March 2004, 181 patients underwent aortic arch repair via the right upper brachial artery with the use of low-flow (8-10 ml/kg per min) antegrade selective cerebral perfusion under moderate hypothermia (26 degrees C).

The intraoperative effect of pentoxifylline on the inflammatory process and leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass.

Background: Inflammation plays a pivotal role in the pathogenesis of organ dysfunction after cardiopulmonary bypass (CPB). The aim of this study was to investigate whether pentoxifylline (PTX) has effects on the inflammatory process and leukocytes in cardiac surgery patients undergoing CPB.

Material And Methods: A double-blind, prospective, randomized, placebo-controlled study was undertaken to assess the effect of PTX on leukocyte counts, tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C-reactive protein (CRP) levels in 60 patients undergoing CPB for elective coronary artery bypass grafting.

Off-pump, in situ internal thoracic artery grafting: a durable treatment for single-vessel coronary artery disease.

Background: The value of off-pump in situ left internal thoracic artery to left anterior descending coronary artery bypass grafting in single-vessel coronary artery disease was assessed by long-term angiographic and clinical data.

Methods: One-hundred three randomly selected patients (87 male, 16 female; mean age, 57.4 +/- 10.

Off-pump coronary artery bypass grafting: long term angiographic results.

Objective: Although short-term results of off-pump coronary artery bypass grafting are well documented, late postoperative data are still scarce. This report provides an analysis of late postoperative control angiograms.

Methods: 265 patients (231 males, 34 females; mean age: 54 +/- 10) underwent postoperative angiographic control, after an average postoperative period of 4.

Risk factors for stroke following coronary artery bypass operations.

Background: Although the overall complication rates have been decreased significantly in recent years, stroke rates still remain high in patients undergoing coronary bypass operations. This study is designed to evaluate the risk factors for stroke in patients who had undergone coronary artery bypass surgery in an 8-year period in our clinic.

Methods: Between 1995 and 2003, 8547 coronary artery operations under cardiopulmonary bypass were performed.

Assessment of cerebral blood flow with transcranial Doppler in right brachial artery perfusion patients.

Background: Antegrade selective cerebral perfusion as a method of cerebral protection during the correction of aortic arch aneurysms and dissections is considered as a safe method for cerebral protection. There are still some questions remaining to be answered; such as whether cerebral perfusion through contralateral hemisphere is adequate.

Method: Fifteen consecutive patients (mean age of 53 +/- 3.

Neurocognitive functions after aortic arch repair with right brachial artery perfusion.

Background: Satisfactory neurologic outcome following aortic arch repair through right brachial artery perfusion is well established. However, how neurocognitive functions are affected following selective cerebral perfusion, still needs to be elucidated.

Methods: In a period between April 2002 and March 2003, 22 patients (19 male, 3 female, with a mean age of 46.

Comparison of pulsatile and non-pulsatile cardiopulmonary bypass in patients with chronic obstructive pulmonary disease.

Background: Patients with chronic obstructive pulmonary disease have an increased risk of mortality and morbidity after open-heart surgery. This is mostly due to a dysfunction of the pulmonary system during and after non-pulsatile cardiopulmonary bypass. The purpose of this study was to compare the pulsatile and non-pulsatile blood flows during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease.

Repair of the aortic arch with left unilateral selective cerebral perfusion.

A 67-year-old woman who presented with chest and back pain was diagnosed with an aneurysm of the ascending aorta. Coronary angiography and aortography were performed via the right brachial artery, which was complicated by axillary artery dissection. At surgery, despite our clinical experience of using the right upper brachial artery for arterial cannulation, right femoral artery cannulation was performed to establish cardiopulmonary bypass (CPB) as the dissection was extending to the brachiocephalic artery.

[Reexploration for bleeding and tamponade in intensive care unit following open heart surgery].

Objective: Following open-heart surgery some patients can need reexploration in the intensive care unit due to bleeding or pericardial tamponade. This study evaluates the impact of reexploration in the intensive care unit (ICU) on morbidity and mortality rates.

Methods: Between January 1990 and January 2002 overall 18,578 open heart surgery procedures were performed in our clinic and among them 570 (3%) patients required reexploration due to bleeding or pericardial tamponade.

Comparison of changes in diastolic functions after aortic valve replacement with freestyle stentless porcine xenografts in patients with restrictive and nonrestrictive physiology.

In this study, the effect of valve replacement on diastolic parameters was evaluated preoperatively and postoperatively at 3, 6, and 12 months by comparing diastolic parameters in patients after aortic valve replacement with freestyle stentless porcine xenografts for aortic stenosis. Depending on deceleration time (DT) and isovolumetric relaxation time (IVRT) with preoperative echocardiographic assessment, patients were divided into two groups: restrictive physiology (DT < or = 150 msec and IVRT < 100 msec, 20 patients), and nonrestrictive physiology (DT > 150 msec and IVRT > or = 100 msec, 27 patients). Although left ventricular mass index significantly decreased in both groups, improvement in DT, IVRT, and ejection fraction occurred only in patients with restrictive physiology.

Dynamic cardiomyoplasty as a biomechanic bridge to heart transplantation.

We report a heart transplantation that was done 4 years after a dynamic cardiomyoplasty operation. The patient was a 42-year-old man. Radionucleide ventriculography with technetium 99 m revealed an ejection fraction of 18%.