MInImaly InvasIve saphenous veIn harvestIng
preserves endothelIal cell functIon In human saphenous veIn grafts
Kaplan S, Bisleri G, Morgan J.A, Akman H.O, Çobanoğlu
A, Öz M.C.
The
saphenous vein is the most commonly used conduit for coronary artery
bypass surgery. During conventional surgery, considerable damage to the
vein endothelium may occur during harvesting and this may play an
important role in early and late human saphenous graft (HSVG) failure.
The aim of this study was to compare endothelial function of HSVG,
harvested by means of endoscopic or conventional technique, with respect
to the leukocyte-endothelial cell adhesion molecule (LECAM) and
inducible nitric oxide synthase (INOS-2) expression, and cyclic
guanosine monophosphate (cGMP) level.
Segments of 10 saphenous veins
were harvested from 10 different patients undergoing coronary artery
bypass grafting (CABG) surgery either with the conventional (Group A)
or endoscopic (Group B) techniques. Samples were taken from segments
that were stripped of surrounding tissue but not distended. HSVG
specimens were stored in heparinized blood for 1 h at room temperature.
Specimens were analyzed by Western blotting to quantify intercellular
adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1
(VCAM-1), and inducible nitric oxide synthase-2 (INOS-2) expression, as
well as tissue cGMP levels.
Measured intensity of ICAM-1
bands (Group A= 2483±295 vs. Group B=1718±307, p=0.007) and VCAM-1 bands
(Group A=1138±247 vs. Group B= 703±162, p= 0.013) on Western Blotting
were significantly lower in endoscopically harvested vessels as compared
with conventionally harvested vessels. In contrast, INOS-2 expression
(Group A=296±86 vs. Group B= 531±215, p=0.034) and saphenous vein tissue
cGMP levels (Group A=1.03±0.31 pmol/ml vs. Group B=2.02±0.53 pmol/ml,
p<0.001) were significantly higher in endoscopically harvested vessels
as compared with conventionally harvested vessels.
Decreasing leukocyte endothelial cell adhesion molecule expression and
increasing INOS-2 expression and cGMP level are important to prevent
vascular endothelial cell injury and atherosclerotic process in the
vessels, and to improve HSVG patency after implantation. These findings
suggest that minimally invasive harvesting technique, in addition to
previous favorable reports on pain, wound complications, costs, low
morbidity and earlier hospital discharge, improves vascular homeostasis
and provides a better endothelial cell function and integrity in
saphenous vein grafts when compared with the open harvesting technique.
The effects of anabolIc
androgenIc steroIds on vascular structure and endothelIal functIon
Şahin T, Baytuğan Z.N, Ağaçdiken A, Kozdağ G, Ural D,
Kahraman G, Kılıç T, Bildirici U, Komşuoğlu B.
Anabolic
androgenic steroids (AAS) to increase muscular strenght and body mass
have been used widespread and uncotrolled among athletes. It has known
that these drugs have hepatotoxic, virilisation and pro-atherogenic
adverse effects. Endothelial dysfunction has been shown as an early sign
of atherogenesis. The purpose of this study was to investigate the
effects of anabolic androgenic steroids on vascular structure and
endothelial functions among body builders.
Fourty five (mean age 30.6±6.9 years) healthy,
volunteer men, making body building for more than one year were studied.
Twenty two body builders (mean age 31.7±6.8 years) who have taken AAS
regularly and exercised in the past six months were formed group I and
twenty three body builders ( mean age 29.5±6.9 years) only exercised
regularly formed group II. Twenty one healthy men with a similar age
group having a sedantery life style and don't exercise regularly formed
a control group. Endothelial functions in the brachial artery and
carotid intima-media thickness can be assessed.
The basal diameters of the
brachial artery are measured most widely in group I and most narrowly in
group III. Although the difference between group I and III was
significant (p=0.01), we did not found difference between other
groups.As the diameters measured after reactive hyperemia and
sublingual nitrate administration compared, there were not any
difference between groups (p> 0.05). The persantages of changes of flow
mediated diameters in respect to basal diameters are in group I %9± 2,
in group II % 11± 3, in group III % 14± 3 and the difference between
groups were significant (p= 0.009, p< 0.001, p= 0.006).The persantage
of changes after the nitrat induced dilation in respect to basal
diameter measured in group I %11±2, in group II % 14±4, in group III
% 18±3 and there was a statistically significant difference
(respectively p=0.002, p<0.001, p< 0.001). As the right and left
common carotid artery maximum and mean intima-media thickness compared,
there were not any difference both right and left carotid artery maximum
diameter. Both of the carotid arteries mean intima-media thickness in
group I and III were different (p=0.05). We did not found difference
between other groups.
In young healthy men intense
body building exercises and AAS's disturb the endothelial dependent and
independent vasodilatation. Especially excesivve and uncontrolled use of
anabolic-androgenic steroids resuls in intima-media thickness increment.
Coronary angiography is the clinical gold standart
for diagnosis of coronary artery disease. Because it is an invasive
procedure with potentially serious risks, it should be performed only by
well-trained individuals. Physicians who perform coronary angiography
must possess all the necessary fundamental technical aspects of
catheterization. In this review, we will discuss the possible wrong
actions performed unwillingly during an anjiography, and their
consequences.
DIagnosIs, treatment and
IndIcatIons of aortIc InsuffIcIency
Sağ S, Güllülü S
There have been several significant advances in our
understanding of aortic valve disease over the past year. Acute aortic
insufficiency can now be diagnosed rapidly and accurately thanks to
Doppler echocardiography. An emergency operation is recommended by most
authors in the case of acute aortic leakage due to the major risk or
mortality resulting from pulmonary edema, ventricular arrhythmias,
electromechanical dissociation or cardiogenic shock. The management of
patients with chronic aortic insufficiency is an important clinical
problem someway still open. Patients who have asymptomatic aortic
valvular disease with normal systolic ventricular function need careful
follow-up, because aortic insufficiency is potentially
life-threatening. Medical therapy may be helpful for long-term
management of patients with chronic aortic insufficiency, but valve
replacement should be done before heart failure or refractory left
ventricular dilatation develops. Definitely the management of patients
with chronic aortic insufficiency consists mainly in the definition of
the right time to surgery with the lowest risk and the greatest benefit.
Key Words: Aortic
Insufficiency, Echocardiography, Indications for operation
A Case of rIght coronary artery to pulmonary veIn fIstula
Çelik T, Kurşaklıoğlu H, İyisoy A, Turhan H, Yüksel
Ç, Işık E.
Coronary artery fistula is an abnormal communication
between an epicardial coronary artery and cardiac chambers, major
vessels or other structures. Although acquired coronary artery-pulmonary
vein fistula has been reported in the literature no congenital coronary
artery-pulmonary vein fistula case has been reported up to now. In this
case report we described a case of congenital coronary-pulmonary vein
fistula causing coronary steal syndrome.
BIoprosthetIc valve
ImplantatIon for the InfectIve endocardItIs wIth abscess formatIon
localIzed on the aortIc valve and root causIng severe aortIc
regurgItatIon
Demiralp E, Ulusoy R.E, Cebeci B.S, Özmen N, Yılmaz
A.T, Kırılmaz A.
We
would like to present a 22-year-old man with native bicuspid aortic
valve endocarditis with a vegetation localized on the ventricular face
of the aortic coronary cusp complicated with paravalvular abscess and
severe aortic regurgitation, which hemoculture yielded a coagulase
negative staphylococcus pretreated with vancomycin for twelve days
following a Benthall procedure with freestyle aortic root replacement
and an aortic mechanical valve implantation (No:23 St.Jude) with left
anterior descending to aortocoronary saphein vein bypass surgery.
Antibiotic therapy was lasted to two months postoperatively and the
patients is still doing well for the past one year.
Although the surgical
intervention is a challenging procedure due to its high mortality risk
in acute native valve endocarditis, pretreatment with antibiatics
following bioprosthetic valve and aortic root implantation for
uncontrolled native aortic valve infective endocarditis with aortic root
destruction can be choice for treatment.
