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Öztan G, Bozbuğa N, İşsever H, Oğuz F, Canıaz İ, Yazıksız N, Ertan M, Alpagut İU. Comparative Analysis of Transcriptome Profiles in Patients with Thromboangiitis Obliterans. Genes (Basel) 2023; 15:19. [PMID: 38275601 PMCID: PMC10815726 DOI: 10.3390/genes15010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Thromboangiitis obliterans (TAO) causes vascular insufficiency due to chronic inflammation and abrupt thrombosis of the medium and small arteries of the extremities. In our study, we aimed to determine biomarkers for the diagnosis of TAO by evaluating 15 male TAO patients with Shinoya diagnostic criteria and 5 healthy controls who did not have TAO-related symptoms in their family histories. METHODS The Clariom D Affymetrix platform was used to conduct microarray analysis on total RNA extracted from whole blood. A total of 477 genes (FC ≤ 5 or >5) common to the fifteen patient and five control samples were selected using comparative microarray analysis; among them, 79 genes were upregulated and 398 genes were downregulated. RESULTS According to FC ≤ 10 or >10, in the same TAO patient and control group, 13 genes out of 28 were upregulated, whereas 15 genes were downregulated. The 11 key genes identified according to their mean log2FC values were PLP2, RPL27A, CCL4, FMNL1, EGR1, EIF4A1, RPL9, LAMP2, RNF149, EIF4G2, and DGKZ. The genes were ranked according to their relative expression as follows: FMNL1 > RNF149 > RPL27A > EIF4G2 > EIF4A1 > LAMP2 > EGR1 > PLP2 > DGKZ > RPL9 > CCL4. Using protein-protein interaction network analysis, RPL9, RPL27A, and RPL32 were found to be closely related to EIF4G2 and EIF4A1. The Reactome pathway found pathways linked to 28 genes. These pathways included the immune system, cellular responses to stress, cytokine signaling in the immune system, and signaling by ROBO receptors. CONCLUSIONS By figuring out the protein expression levels of the genes that have been found to explain how TAO disease works at the molecular level, it will be possible to figure out how well these chosen transcripts can diagnose and predict the disease.
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Affiliation(s)
- Gözde Öztan
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey;
| | - Nilgün Bozbuğa
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - Halim İşsever
- Department of Public Health, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey;
| | - Fatma Oğuz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey;
| | - İrem Canıaz
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - Nilgün Yazıksız
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - Melike Ertan
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - İbrahim Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
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Arslan A, Yanartaş M, Taş S, Bozbuğa N, Yıldızeli B. The Effect of Perioperative Fluid Management and Operative Modifications on Mortality and Morbidity in Patients Undergoing Pulmonary Endarterectomy. Braz J Cardiovasc Surg 2023; 38:22-28. [PMID: 36897820 PMCID: PMC10010723 DOI: 10.21470/1678-9741-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease treated with pulmonary endarterectomy. Our study aims to reveal the differences in liquid modalities and operation modifications, which can affect the patients' mortality and morbidity. METHODS One hundred twenty-five patients who were diagnosed with CTEPH and underwent pulmonary thromboendarterectomy (PTE) at our center between February 2011 and September 2013 were included in this retrospective study with prospective observation. They were in New York Heart Association functional class II, III, or IV, and mean pulmonary artery pressure was > 40 mmHg. There were two groups, the crystalloid (Group 1) and colloid (Group 2) liquid groups, depending on the treatment fluids. P-value < 0.05 was considered statistically significant. RESULTS Although the two different fluid types did not show a significant difference in mortality between groups, fluid balance sheets significantly affected the intragroup mortality rate. Negative fluid balance significantly decreased mortality in Group 1 (P<0.01). There was no difference in mortality in positive or negative fluid balance in Group 2 (P>0.05). Mean duration of stay in the intensive care unit (ICU) for Group 1 was 6.2 days and for Group 2 was 5.4 days (P>0.05). Readmission rate to the ICU for respiratory or non-respiratory reasons was 8.3% (n=4) in Group 1 and 11.7% (n=9) in Group 2 (P>0.05). CONCLUSION Changes in fluid management have an etiological significance on possible complications in patient follow-up. We believe that as new approaches are reported, the number of comorbid events will decrease.
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Affiliation(s)
- Akın Arslan
- Department of Cardiovascular Surgery, Sakarya Research and Training Hospital, Sakarya, Turkey
| | - Mehmed Yanartaş
- Department of Cardiovascular Surgery, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Serpil Taş
- Department of Cardiovascular Surgery, Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Nilgün Bozbuğa
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Bedrettin Yıldızeli
- Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
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Kirali K, Omeroğlu SN, Uzun K, Erentuğ V, Bozbuğa N, Eren E, Balkanay M, Alp M, Yakut C. Evolution of Repaired and Non-Repaired Tricuspid Regurgitation in Rheumatic Mitral Valve Surgery without Severe Pulmonary Hypertension. Asian Cardiovasc Thorac Ann 2016; 12:239-45. [PMID: 15353464 DOI: 10.1177/021849230401200313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the usefulness of repairing significant tricuspid regurgitation (≥ grade 2) without severe pulmonary hypertension (≤ 50 mm Hg). Between 1993 and June 2001, 88 consecutive patients were operated on for rheumatic mitral valve disease associated with significant tricuspid regurgitation and without severe pulmonary hypertension. The severity of the tricuspid valve disease was assessed by echocardiography. Sixty-three patients had severe (≥ grade 3) tricuspid regurgitation (Group I), and 25 patients had moderate (grade 2) tricuspid regurgitation (Group II). There was no hospital mortality. six patients died during follow-up. The overall actuarial survival rate for 8 years was 92.1% ± 3.1%. Cox proportional hazard regression analysis showed that age ( p = 0.006) and pulmonary complication ( p = 0.01) were associated with increased late mortality. Freedom from death was similar in both groups at 8 years (93.1% ± 3.3% versus 88% ± 8%, p = 0.7). Severe postoperative tricuspid regurgitation (≥ grade 3), caused by the failure of tricuspid repair or leaving the valve untouched, impaired long-term survival after surgery, and actuarial survival was 96.1% ± 2.7% and 83% ± 7.8% at 7 years ( p = 0.048), respectively. Severe tricuspid regurgitation, functional or organic, should be corrected at the time of mitral valve surgery, whereas untouched functional moderate tricuspid regurgitation improves after mitral valve surgery.
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Affiliation(s)
- Kaan Kirali
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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4
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Alp BN, Bozbuğa N, Alp M. Risk factors for retinal arteriolar emboli in coronary artery disease. J Int Med Res 2009; 37:1301-10. [PMID: 19930835 DOI: 10.1177/147323000903700505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study determined the prevalence of retinal arteriolar emboli risk factors in 148 patients (86 males) diagnosed with coronary artery disease who required coronary artery bypass graft surgery (mean +/- SD age 59.1 +/- 12.9 years). The prevalence of smoking was 50.7%, hypertension was 49.3%, diabetes mellitus was 27.0% and obesity was 31.1%. Retinal arteriolar emboli were detected using binocular indirect ophthalmoscopy of both eyes. They were found in 10 patients (6.8%) and identified as the cholesterol type. Patients were divided according to their baseline low-density lipoprotein cholesterol (LDL-C) serum level; retinal arteriolar emboli were significantly more frequent in patients with LDL-C levels > 100 mg/dl. These results demonstrate that the prevalence of hypercholesterolaemia and high LDL-C were increased in patients with retinal arteriolar emboli. Identification and treatment of modifiable risk factors, such as high LDL-C and hypercholesterolaemia, might be beneficial in these individuals.
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Affiliation(s)
- B N Alp
- Department of Health Education Faculty, Marmara University, Istanbul, Turkey
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Abstract
Transient cortical blindness is rarely encountered after angiography of native coronary arteries or bypass grafts. This paper reports a case of transient cortical blindness that occurred 72 h after coronary angiography in a 56-year old patient. This was the patient's fourth exposure to contrast medium. Neurological examination demonstrated cortical blindness and the absence of any focal neurological deficit. A non-contrast-enhanced computed tomographic scan of the brain revealed bilateral contrast enhancement in the occipital lobes and no evidence of cerebral haemorrhage, and magnetic resonance imaging of the brain showed no pathology. Sight returned spontaneously within 4 days and his vision gradually improved. A search of the current literature for reported cases of transient cortical blindness suggested that this is a rarely encountered complication of coronary angiography.
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Affiliation(s)
- B N Alp
- Department of Health, Education Faculty, Marmara University, Istanbul, Turkey
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Erdoğan HB, Bozbuğa N, Kayalar N, Erentuğ V, Omeroğlu SN, Kirali K, Ipek G, Akinci E, Yakut C. Long-Term Outcome After Total Correction of Tetralogy of Fallot in Adolescent and Adult Age. J Card Surg 2005; 20:119-23. [PMID: 15725134 DOI: 10.1111/j.0886-0440.2005.200374df.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although most patients with tetralogy of Fallot (TOF) undergo radical repair during infancy and childhood, patients remaining undiagnosed and untreated until adulthood can still be treated. These patients have either a previous palliative or natural collateral circulation to the lung or a mild form of right ventricular outflow tract (RVOT) obstruction. The aim of this study is to analyze the perioperative and long-term results of radical corrective procedures in patients who reached adult ages. Two hundred and seven patients with TOF underwent complete correction between 1985-and 2002, 64 (30.9%) of whom were aged 14 years or more. The mean age at corrective repair for this group was 20.6 +/- 7.5 years (range 14 to 49 years). Only two patients had previous modified Blalock-Taussig shunts. In 44 patients (68.7%) besides infundibular resection, a transannular gluteraldehyde-treated pericardial patch was used to reconstruct right ventricular outflow tract (RVOT). Only infundibular patching was used in 15 patients (23.4%) and infundibular muscular resection with primary closure of right ventricle was performed in five patients (7.8%). Hospital mortality was 3.1% with two patients. Four patients (6.2%) underwent reoperation because of recurrent ventricular septal defect (VSD) with/without residual obstruction or pulmonary regurgitation. All survivors were in NYHA class I (42) or II (17). Late mortality was recorded in two patients and 16-year actuarial survival was 89.2%+/- 4.9%. The significant negative predictors of late survival determined by univariate analysis were reoperation <0.018) and associated cardiac anomalies <0.011). Multivariate analysis showed that there was no negative predictor of late-term mortality. Corrective procedures in adult patients with TOF can be performed successfully compared to patients who underwent operation during infancy and childhood.
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Affiliation(s)
- Hasan Basri Erdoğan
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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7
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Abstract
From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi-organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow-up.
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Affiliation(s)
- Vedat Erentuğ
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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8
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Abstract
Coronary artery disease remains a major cause of mortality and morbidity with systemic lupus erythematosus (SLE). We report two cases of coronary artery bypass grafting (CABG) associated with SLE. The first patient (a 45-year-old woman) underwent CABG operation for left main and two-vessel coronary disease using cardiopulmonary bypass. Successful CABG was done using off-pump technique in the second patient (a 39-year-old woman) under hemodialysis therapy. Both patients showed good postoperative outcome without complications.
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Affiliation(s)
- Nilgün Bozbuğa
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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9
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Abstract
A 36-year-old male had coronary heart disease with a 12-year history of muscular weakness in his bilateral lower extremities and gait disturbance characterized by classical features of gastrocnemius and peroneal muscular atrophy. This is a clinical report of the first case of Charcot-Marie-Tooth disease (type 2) associated with the left main coronary artery disease requiring bypass surgery with cardiopulmonary bypass. The surgical procedure and postoperative course were uneventful. The patient was followed for 18 months postoperatively.
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Affiliation(s)
- Vedat Erentuğ
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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10
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Erentuğ V, Bozbuğa N, Izgi A, Eren E, Kirali K, Balkanay M, Ipek G, Akinci E, Alp M, Yakut C. [Traumatic vascular complications due to intraaortic balloon pump support]. ULUS TRAVMA ACIL CER 2004; 10:28-33. [PMID: 14752683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The use of an intraaortic balloon pump (IABP) catheter was retrospectively evaluated in terms of risk factors, insertion techniques, and complications in patients with low cardiac output. METHODS A total of 1036 patients (804 males, 232 females; mean age 53.4 years; range 16 to 75 years) received IABP support from 1985 to March 2002. Of these, 789 patients (76.1%) underwent open heart surgery, 247 patients (23.8%) developed low cardiac output during medical treatment. Insertion of IABP was performed via the femoral artery either percutaneously by the Seldinger technique in 897 patients (86.6%), or by direct surgical exposure in 88 patients (8.5%). Open surgical IABP insertion was performed through an 8 mm Dacron graft placed with an end-to-side anastomosis to the common femoral artery (88 patients) or to the ascending aorta (23 patients). RESULTS The overall mortality rate was 35.1% (364 patients). Vascular complications were associated with IABP in 104 patients (10%), of which 57 patients (5.5%) required surgical treatment. Major complications were aortic arch dissection in two patients and paraplegia in two patients. Vascular complications tended to increase with female gender, older age, diabetes, and peripheral vascular disease. The mean duration of IABP support in the presence of vascular complications was 7.8 days (range 5 hours to 77 days). CONCLUSION Application of unsheathed IABP and proper evaluation of peripheral circulation seem to decrease the incidence of vascular complications.
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Affiliation(s)
- Vedat Erentuğ
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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11
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Erentuğ V, Bozbuğa N, Omeroğlu SN, Ardal H, Eren E, Güçlü M, Güzelmeriç F, Kirali K, Akinci E, Yakut C. Rupture of Abdominal Aortic Aneurysms in Behçet's Disease. Ann Vasc Surg 2003; 17:682-5. [PMID: 14738093 DOI: 10.1007/s10016-003-0076-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Behget's disease is a systemic disease of unknown etiology with a chronic relapsing course,characterized by oral aphtous, genital ulcers, ocular lesions, and occasionally vasculitis. Major asymptomatic vascular complications should always be considered in patients with Behget'sdisease. We present the surgical treatment of two male Behget's patients of 41 and 30 years of age with ruptured infrarenal abdominal aortic aneurysms. The urgent repairs of ruptured abdominal aortic aneurysms were performed successfully in both patients. Because Behget's disease is usually seen at young ages, vascular assessment should also be done routinely for early diagnosis and therapy, which can be life-saving.
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Affiliation(s)
- Vedat Erentuğ
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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12
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Abstract
The rare cardiac anomaly of atresia of the coronary sinus ostium with a large communication between the coronary sinus and the left atrium was discovered during a mitral valve replacement operation in a 44-year-old woman.
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Affiliation(s)
- Nilgün Bozbuğa
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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13
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Erentuğ V, Bozbuğa N, Mansuroğlu D, Erdoğan HB, Mataraci I, Kirali K, Akinci E, Yakut C. [Surgical treatment of peripheral vascular injuries after cardiac catheterization]. Anadolu Kardiyol Derg 2003; 3:216-20. [PMID: 12967886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Diagnostic and therapeutic cardiac interventions have being performed in expanding numbers during last years. Forty-two cases with peripheral vascular injuries requiring surgical therapy after 64.911 cardiac interventions in our center between 1985 and 2002 were evaluated retrospectively. METHODS Thirty-three of vascular injuries (78.6%) occurred after angiography/catheterization, and the remaining vascular injuries (21.4%) occurred after angioplasty/stent procedures. There were 12 female (28.6%) and 30 male (71.4%). The mean age was 51.3+/-4.1 years. The localization of the arterial injuries were femoral region in 37 cases (88.1%) and brachial region in 5 cases (11.9%). The complications were recorded as arterial thrombosis in 19 cases, pseudoaneurysm in 14 cases, hematoma in 5 cases, arteriovenous fistula in 2 cases, deformed stent stuck in 2 cases. Arterial injuries were treated by performing embolectomy in 16 cases, embolectomy and saphenous patch plasty in 3 cases, resection of pseudoaneurysm and PTFE patch plasty in 1 case, draining of hematoma and primary repair in 5 cases, primary repair of femoral arteriovenous fistula in 2 cases and removal of the deformed stent from femoral artery in 2 cases. RESULTS The incidence of vascular complications was significantly higher in brachial interventions when compared with femoral interventions (p<0.0001). The postoperative morbidity was found as 14.3% in our cases. CONCLUSION The early diagnosis and treatment are very important in peripheral vascular complications after cardiac interventions; otherwise, delay can cause loss of related extremity.
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Affiliation(s)
- Vedat Erentuğ
- Koşuyolu Heart Education and Research Hospital, Istanbul.
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Erentuğ V, Bozbuğa N, Erdoğan HB, Mataraci I, Akinci E. A right atrial thrombus mimicking cardiac tumor after atrial septal defect closure operation. Anadolu Kardiyol Derg 2003; 3:288. [PMID: 12967905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Vedat Erentuğ
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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Abstract
BACKGROUND Brucella endocarditis (BE) is a lethal complication of human brucellosis, which is rarely seen and hardly described. METHODS In the present report, six successfully treated cases of BE involving three native aortic valves, two native mitral-aortic valves, and a mitral bioprosthesis are described. The diagnosis of BE was based on clinical features, high brucella serologic titers, and positive blood cultures. Although the blood cultures were positive in all patients, all the resected valve materials and tissue cultures were negative. The patients received rifampicin, streptomycin, and doxycycline (in 3 patients), rifampicin, tetracycline, and cotrimoxazole (in 2 patients), and rifampicin, doxycycline, and cotrimoxazole (in 1 patient). Infected native valves and bioprosthesis were replaced by mechanical valves. RESULTS There was no early or late mortality. No recurrent infection developed after management with a combination of antibiotherapy lasting 6 months postoperatively during a mean follow-up of 47 months (range 20 to 84 months). CONCLUSIONS This report suggests that the combination of valve replacement and antibiotic therapy produces successful results in the treatment of BE.
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Affiliation(s)
- C Keleş
- Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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Abstract
BACKGROUND Pulmonary dysfunction is still a major problem in coronary artery bypass grafting (CABG). The purpose of this randomized study was to determine the effect of different CABG techniques on pulmonary function. METHODS Fifty eight patients with severe obstructive pulmonary disease had elective isolated coronary surgery. The surgical methods for the patients with chronic obstructive pulmonary disease (COPD) were standard CABG in 18 patients (group 1), beating heart surgery in 19 patients (group 2), and minimally invasive direct coronary artery bypass grafting (MIDCABG) in 21 patients (group 3). RESULTS The earliest extubation time was from group 3 (p < 0.001). The average stay in the intensive care unit was significantly longer in group 1 (2.6 +/- 1.5 days) than in groups 2 (1.4 +/- 0.8 days) and 3 (1.1 +/- 0.8 days) (p < 0.05). The most prevalent respiratory morbidity was atelectasis that developed in 6 patients from group 1, in 2 patients from group 2, and in 3 patients from group 3. Forced expiratory volumes in 1 second (FEV1) obtained in the second postoperative month were significantly lower than preoperative values only in group 1 (p < 0.05). Forced vital capacity (FVC) values were significantly lower than the preoperative values in all three groups (p < 0.05). CONCLUSIONS Off-pump bypass surgical procedures are more advantageous than on-pump methods for patients with COPD. These patients can be operated on using the beating heart technique or by using MIDCABG to prevent side effects of CPB on pulmonary function and effects of sternotomy.
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Affiliation(s)
- M Güler
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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Keleş C, Sişmanoğlu M, Bozbuğa N, Erdoğan HB, Akinci E, Ipek G, Yakut C. A cardiac hydatid cyst involving the basal interventricular septum causing biventricular outflow tract obstruction. Thorac Cardiovasc Surg 2000; 48:377-9. [PMID: 11145411 DOI: 10.1055/s-2000-8343] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We report a case of a 37-year-old sheep-raising man with a cardiac hydatid cyst involving the basal interventricular septum causing biventricular outflow obstruction. He suffered from multi-organ hydatidosis and underwent cerebral hydatid cyst extirpation and right nephrectomy for renal echinococcosis. The diagnosis of the cyst was obtained by echocardiography and magnetic resonance imaging. The diagnosis was confirmed by positive hemagglutination test. He was operated on for cardiac hydatid cyst using enucleation and capitonnage procedure under extracorporeal circulation. The morbidity was complete atrioventricular block, necessitating VDD pacemaker implantation. This was followed by medical treatment with albendazole (400 mg/day).
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Affiliation(s)
- C Keleş
- Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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18
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Akinci E, Işik O, Tekümit H, Dağlar B, Bozbuğa N, Oğuş NT, Balkanay M, Gürbüz A, Berki T, Yakut C. Three ventriculoplasty techniques applied to three left-ventricular pseudoaneurysms in the same patient. Tex Heart Inst J 1999; 26:87-9. [PMID: 10217473 PMCID: PMC325601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A 59-year-old male patient underwent surgery for triple-vessel coronary artery disease and left-ventricular aneurysm in 1994. Four months after coronary artery bypass grafting and classical left-ventricular aneurysmectomy (with Teflon felt strips), a left-ventricular pseudoaneurysm developed due to infection, and this was treated surgically with an autologous glutaraldehyde-treated pericardium patch over which an omental pedicle graft was placed. Two months later, under emergent conditions, re-repair was performed with a diaphragmatic pericardial pedicle graft due to pseudoaneurysm reformation and rupture. A 3rd repair was required in a 3rd episode 8 months later. Sternocostal resection enabled implantation of the left pectoralis major muscle into the ventricular defect. Six months after the last surgical intervention, the patient died of cerebral malignancy. Pseudoaneurysm reformation, however, had not been observed. To our knowledge, our case is the 1st reported in the literature in which there have been 3 or more different operative techniques applied to 3 or more distinct episodes of pseudoaneurysm formation secondary to post-aneurysmectomy infection. We propose that pectoral muscle flaps be strongly considered as a material for re-repair of left-ventricular aneurysms.
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Affiliation(s)
- E Akinci
- The Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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Abstract
OBJECTIVE Recently, closed mitral commissurotomy (CMC) has been reexplored due to the concepts of less invasive valvular surgery. The feasibility of closed mitral commissurotomy via port access or limited thoracotomy by aid transesophageal echocardiography (TEE) was investigated in this clinical study. METHODS Between August 1996 and April 1998, 42 patients (32 women, ten men with a mean age of 36.2+/-7.8 years) underwent less invasive CMC at the Kosuyolu Heart and Research Hospital. CMC procedure were done through a limited (12-16 cm) thoracotomy incision in 23 patients, a very limited or mini thoracotomy incision (7-8 cm) in 11 patients and port access by aid TEE in eight patients. Preoperative mean mitral valve area was calculated as 1.19+/-0.13 cm2 and mean mitral valve gradient was measured as 14.8+/-3.2 mmHg. TEE provided information about the mitral valve anatomy and functions during the procedure in all patients. RESULTS Commissurotomy was successfully performed in all patients. In eight patients, a Tubbs dilator was inserted via port access at the 6th intercostal space from a 3-cm incision. Incision by guidance of TEE and CMC could be performed without thoracotomy in five patients. In three patients of the port access group, a very limited thoracotomy was required to perform CMC by digital guidance. Postoperative mean MVA was 2.37+/-0.29 cm2, minimal mitral gradient was 5.3+/-1.7 mmHg. In eleven patients, minimal mitral regurgitation was observed. The operations and postoperative period were free of complications in all patients. Following an average 12+/-2.8 h intensive care unit period, all patients were discharged after an average of 3.4+/-0.8 days of hospitalization. CONCLUSION Limited thoracotomy has less detrimental structural effects in patients. Port access by aid TEE approach to CMC may offer less invasiveness, lower cost effectiveness and be an alternative to percutaneous balloon mitral valvotomy.
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Affiliation(s)
- E Akinci
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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