The purpose of this study is to determine the diagnosis means, the surgical management and the prognosis of patients with intracavitary cardiac hydatid cyst. We report a series of seven patients. The diagnosis was orientated by coexisting pulmonary locations in all patients. Read More
Pancreaticoduodenal arcade aneurysms are rare. Untreated, these lesions enlarge progressively and have the potential for spontaneous rupture. Aneurysmal degeneration of pancreaticoduodenal arcade vessels is known to be associated with celiac artery occlusion, vasculitis, and certain connective tissue disorders. Read More
Background: The development of a saphenous vein graft aneurysm (SVGA) after coronary artery bypass graft surgery is a rare occurrence. There are approximately 60 cases reported in the literature, the majority being single case reports. There is no consensus on the treatment of SVGA. Read More
Angiographies of 384 patients who had coronary artery bypass surgery because of left main coronary artery (LMCA) obstruction during 1970-1989 were reviewed by analysing the pathology, feasibility of surgical angioplasty and survival. Complete LMCA occlusion was found in 2%, proximal ostial stenosis in 9%, mid-shaft stenosis in 24%, circular stenosis in 25% and distal bifurcation stenosis in 40% of the patients. Patients with an ostial stenosis were younger, more often women with less coronary artery disease and less calcified obstructions. Read More
Objective: alpha(1)-adrenoceptor activation confers myocardial protection from ischemic injury. We tested whether norepinephrine mediates delayed cardioprotection against stunning and whether this alters postischemic arrhythmias.
Methods: New Zealand White rabbits were assigned to three groups: Control-group (n=7): no drugs. Read More
We report the case of a 35-year-old female with acute massive right pulmonary embolism, successfully treated by a minimally invasive off-pump pulmonary embolectomy-the first case in the literature implemented via the J-ministernotomy. Read More
Purpose: The aim of this report was to compare polyester vs. bovine pericardial patching during CEA with regards to the incidence of early neurologic events and recurrent stenosis.
Patients And Methods: One hundred and twenty-five consecutive patients with high grade symptomatic (14%) or asymptomatic (86%) carotid artery stenosis (>70%) who underwent 139 CEAs by a single surgeon between January 1997 and April 2001 were retrospectively reviewed. Read More
We have evaluated the safety and efficacy of routine beta-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease. From 1 December 2001 to 31 May 2002, patients received perioperative beta-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. Read More
Endoaneurysmorrhaphy is mostly performed on anterior-septal left ventricular (LV) aneurysms. It may also be applied to posterior aneurysms, which is technically more challenging. Whether the surgical risk is the same, irrespective of the location of the aneurysm, has not been studied before. Read More
Magnetic resonance imaging of the lumen of the carotid artery, or magnetic resonance angiography (MRA) of the carotid, has gone through a long evolutionary period to become a routine imaging modality in many centers. Further improvements are becoming available. There are better gradients available for scanners, high resolution neck surface coils allow improved signal to noise ratios, and contrast agents which have a longer intravascular dwell time are about to be introduced. Read More
The role of radial artery as an arterial conduit for myocardial revascularisation is well established. Minimally invasive approaches for the harvesting of conduits are desirable for clinical and cosmetic reasons. We report our experience with two techniques of endoscopic radial artery harvesting. Read More
The optimum day for discharge after coronary artery bypass graft (CABG) surgery has been subject to some debate yet there has been a steady increase in the number of patients discharged within 5 days of surgery. Delayed discharges may result in the under use of surgical capacity and impact upon patient outcomes. The author conducted a retrospective; correlational study of 333 patients to investigate the variables associated with delayed discharge after CABG. Read More
Unlabelled: Patients with significant risk factors are at increased risk of higher mortality and morbidity (9-16%) after CABG-procedures with cardiopulmonary bypass (CPB). When catheter interventions are not applicable and conventional CABG with CPB are considered to have an unacceptable perioperative risk, these patients (n=35) were scheduled for minimally invasive coronary artery bypass grafting (MIDCAB).
Patients And Methods: The risks leading to exclusion of conventional CABG procedures were: extremely impaired LV-function (EF<20%), severe pulmonary diseases, malignant carcinoma, compromised coagulation system, age >80 years with impaired physical constitution, redo-procedures after complicated initial operation, symptomatic descending thoracic aortic aneurysm, ongoing long-term intensive care treatment with unclear prognosis. Read More
Objective: (1) To evaluate the quality of life (QoL) scores, assessed with SF36 and EuroQol (EQ-5D), of long term survivors after mechanical aortic valve replacement (mAVR); (2) to study the association of QoL with NYHA score, number of major bleeding and thrombo-embolic events and follow-up time; (3) to compare QoL scores of long term mAVR survivors with QoL scores of other populations.
Methods: In total 312 patients had a mAVR between 1964 and 1974 at St. Antonius Hospital Nieuwegein (NL). Read More
The purpose of this study was to investigate the effect of N-acetylcysteine (NAC) on spinal cord ischemia-reperfusion (I-R) in rabbits. Thirty rabbits were divided into five equal groups, group I (sham-operated, no I-R), group II (control, only I-R), group III (I-R+NAC), group IV (I-R+hypothermia), group V (I-R+NAC+hypothermia). Spinal cord ischemia was induced by clamping the aorta both below the left renal artery and above the aortic bifurcation. Read More
Objective: Recent studies have demonstrated that the induction of heat shock protein-72 (HSP72) by different stimuli preserves the heart function after cardioplegic arrest. Based on these findings, we investigated whether intermittent warm blood cardioplegia would induce changes in the myocardial expression of HSP72.
Methods: Forty patients scheduled for aortocoronary bypass were randomly assigned to receive either cold or warm intermittent blood cardioplegia. Read More
Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70-74 years old; in Group 2 patients aged 75-79 years old; and in Group 3 patients aged 80 years old or older. An isolated AVR was performed in 289 patients (63%), concomitant coronary artery bypass graft (CABG) in 168 patients (36. Read More
The aim of this study is to determine if surgical repair of coarctation in adults improves systemic hypertension. The charts of 23 consecutive patients (age range 13-36 years, mean 23.6+/-7) who underwent repair of aortic coarctation at the Atatürk University, Aziziye Hospital, between 1986 and 2000 were reviewed. Read More
Purpose: Recurrent carotid stenosis following standard longitudinal carotid endarterectomy (s- CEA), with and without patch angioplasty, effects the durability of the procedure and can lead to reintervention. The purpose of this study is to evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) in women.
Methods: The records of all patients undergoing elective carotid endarterectomy (CEA) for symptomatic and asymptomatic high-grade carotid stenosis over a 5-year period from July 1994 to June 1999 were reviewed. Read More
Purpose: To study early changes in venous hemodynamics in stripping operation with preservation of the calf saphenous veins.
Patients And Methods: From October 1999 to December 2000, 110 extremities of 73 patients were treated for primary varicose veins. Based on preoperative ascending venography, 40 extremities underwent the groin-to-knee stripping of the GSV, 20 underwent the proximal division of the LSV, and 50 received combinations of both surgeries. Read More
Purpose: Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population.
Methods: From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age <80, Group II: > or =80 years. Read More
Abdominal aortic aneurysm (AAA) repair is a complex surgical procedure and is commonly performed in a variety of practice settings across the United States. The quality of surgical care is neither ideal nor uniform across medical centers with documented variation in both utilization and outcomes. Recent data document that screening, though effective in reducing AAA-related deaths, may have only small contributions to population mortality. Read More
Fibrin sealants are prepared from fibrinogen, thrombin and sometimes also factor XIII that have been purified from human plasma. Bovine aprotinin is also included in some preparations. Each of these components has the potential to carry blood-borne pathogens, albeit at a very low frequency. Read More
Fibrin sealants have many different uses across a broad range of surgeries, where they have proved successful in controlling bleeding, providing suture support and tissue sealing. The action of all fibrin sealants depends on the thrombin-catalyzed formation of a fibrin clot. However, neither the purity nor the concentration of the main components of fibrin sealants (thrombin and fibrinogen) is uniform across all commercial products and this will affect performance. Read More
Factor XIII has a well-established role in natural coagulation and clot stabilization. It is often added back to fibrin sealants that are used in a wide range of surgical settings to achieve successful hemostasis, tissue adhesion and wound healing. Factor XIII is the final enzyme to be activated in the blood coagulation cascade. Read More
Fibrin sealants are used in a wide range of surgeries, primarily as hemostatic agents, but also to assist tissue sealing and wound healing. While all fibrin sealants contain fibrinogen and thrombin, they differ in their final composition. This affects the properties of the resulting fibrin clot and may influence their use in different surgical procedures. Read More
We describe a new method of aortoventriculoplasty in a patient with calcified mitral stenosis, aortic valvular stenosis, severe left ventricular outflow tract obstruction, and aneurysm of the ascending aorta. This complex pathology was successfully treated with replacement of both the valves and a tubular dacron graft. The proximal end of the dacron tube was tailored as a patch for the repair of the ventricular septum and the aortic root, and the distal end was anastomosed to the distal ascending aorta. Read More
Background: A common postoperative complication after CABG with internal mammary artery (IMA) harvest is the evolution of a pleural effusion. Our aim was to see if the intra-operative insertion of a Bellovac drain to the pleural cavity, with drainage continuing for 4-days post operation, eliminates the complication of pleural effusion.
Methods: Using our computerised audit database, 500 consecutive patients were identified who had undergone CABG including at least one internal mammary graft by a single consultant at Blackpool Victoria Hospital. Read More
We report the case of a 70-year-old man who underwent off-pump coronary artery bypass grafting 15-years after left pneumonectomy. He had significant two-vessel coronary artery disease. Comorbidities included poor ventricular function and impaired respiratory function. Read More
Background: The Off-Pump Coronary Artery Bypass (OPCAB) technique is becoming more popular in many cardiac units throughout the world. This relatively new technique has prompted surgeons and anaesthetists to review and modify the routine approach to Coronary Artery Bypass Surgery (CABG). In this study we reviewed and analysed the outcome of an integrated anaesthetic and surgical peri-operative approach that allowed routine use of OPCAB and avoided the use of cardiopulmonary bypass (CPB). Read More
Introduction: It was the purpose of our study to assess the validity of EuroSCORE (European system for cardiac operative risk evaluation) in our patient population.
Materials And Methods: Between March 1999 and August 2001, information on risk factors and mortality was collected for 1123 consecutive adult patients undergoing heart surgery with cardiopulmonary bypass. EuroSCORE was used for risk stratification. Read More
Purpose Of The Study: To investigate the haemodynamic properties of a direct endovascular aortic shunt to maintain distal aortic perfusion as an alternative of a distal shunt (left-left-, Gott shunt) in thoracic aortic aneurysm repair.
Methods: A shunt was developed and tested in an in vitro model which should be capable of transporting a flow of 3-4 L/min with a decrease in blood pressure < 20 mmHg. Thereupon the shunt was tested in an in vivo experiment in six pigs to assess the possibility of its use with normal distal blood pressure. Read More