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Complete arterial
revascularization in obese patients: Short-term results
Nisanoğlu V, Erdil N, Cihan H.B, Aldemir M, Eroğlu B.Ö.T, Battaloğlu B.
Obese patients undergoing CABG are often
thought to have prohibitive perioperative risk with increased morbidity and
mortality. In this study, we compared the short-term results of the
use of the radial artery for complete arterial revascularization with
that of the saphenous vein graft in obese patients.
From September 2001 to February 2006, 1172
adult patients underwent isolated CABG in Inonu University Medical Center,
Department of Cardiovascular Surgery. A retrospective analysis of
prospectively collected data, was performed from all patients. Two hundred
four (17.4%) of these patients was obese. In 135 (66.2%) of these
obese patients, LITA and Saphenous vein graft was used (in some cases RA
graft is used additionally) (group 1). In 69 (33.8%) of these patients,
complete arterial revascularization with unilateral or / and bilateral LİTA
and RA grafts was performed (group 2).
Mean age of the obese
patients was 59.9±9.6. The average number of distal anastomosis per patient
was 2.9±1.3 in group 1 versus 2.9±0.9 (p=0.849) in group 2. There were no
significant differences between two groups according to cross clamp and CPB
time, postoperative ventilation time, days on intensive care, days in
hospital. In post-operative period, no difference was found between two
groups regarding prolonged mechanical ventilation, pharmacologic or mechanic
support, development of arrhythmia, revision for bleeding, wound infection.
In obese patients, early mortality rate was 1.9% with no significant
difference between two groups.
In obese patients, total
arterial revascularization with the internal mammary and radial artery does
not effect short-term results negatively. Taking into account the long-term
advantages of arterial grafts, complete arterial revascularization should be
performed whenever possible.
ExperIence wIth devIce CardIoVIsor In cardIologIcal care
Ryabykina G.V., Sula A.S.,
Shchedrina E.V.
The purpose of this
study to evaluate the sensitivity and specificity of
the CardioVisor device in differentiation of
norm and pathology.
172 patients with
various cardiovascular diseases (87 patients with
coronary heart disease (CHD), 85 patients without CHD (with
arterial hypertension, acquired or congenital heart
diseases, with dilated and hypertrophic cardiomyopathies, as
well as with endocrine and metabolic diseases) were
examined. The control group consisted of 21 healthy
individuals. All the individuals were examined by means of
the CardioVisor device to provide an ECG dispersion
analysis chart. An intermediate pathology rating scale was
used to define the sensitivity and specificity of the device
in differentiation of the" norm" and " pathology" groups.
The device showed a
fairly high sensitivity and specificity (90% and 60%
respectively) in detecting CHD. The CardioVisor device can
help to detect early preclinical stages of cardiac disease.
In terms of
reliability and efficiency the CardioVisor device is
suitable to screening surveys. The device allows one to make
a highly sensitive monitoring of the dynamics of changes in
the myocardial metabolic state during surgical operations,
and in the evaluation of the applied treatment in endocrine
diseases.
Long-term outcome of coronary balloon
angIoplasty In unstable angIna pectorIs
Akgül F, Batyraliev T,
Karben Z, Serçelik A, Vural A, Pershukov I, Besnili F.
Patients with unstable angina pectoris
(UAP) are associated with a higher risk of acute coronary events than that
for stable angina pectoris (SAP). We examined 5-year outcome of 325
consecutive patients (182 with stable and 143 with unstable angina pectoris)
revascularized by balloon angioplasty from September 1998 to December 2001.
Clinical success was lower
and periprocedural complications rate was higher in UAP
patients compared with SAP patients (p<0.05). During 5
year follow-up restenosis and revascularization rate and, incidence of
myocardial infarction were higher in UAP patients compared with SAP patients
(p<0.05). Long-term mortality was similar in
patients with UAP and SAP. In conclusion, UAP patients revascularized
by balloon angioplasty had higher periprocedural complications rate, as well
as restenosis and re-intervention rate. However, survival rate was similar
in UAP and SAP patients.
The effect of clinical characteristics
on bifurcation lesions in patients with coronary artery disease
Taçoy G, Erdem G, Balcıoğlu S, Tavil
Y, Abacı A.
Coronary bifurcation
lesions consist of 20-30% of interventional therapeutic
procedures and have a higher rate of clinical and
angiographic restenosis. The effect of clinical
characteristics on bifurcation lesions in patients with
coronary artery disease hadnot been evaluated completely
before. Therefore we aimed to evaluate the effect of
clinical characteristics on coronary artery bifurcation
lesions in this study.
This study
included coronary angiographically evaluated 84 patients who
had a coronary artery disease (CAD). 40 patients who had
coronary arter bifurcation lesions were classified to group
I and 44 patients without bifurcation lesions to group II.
CAD was defined as one or more coronary artery stenoses of
50% or greater and bifurcation lesion was defined as
atherosclerotic plaque that has a propagation from side
branch to main coronary artery
Group I
patients consisted of 72% male, 28% female patients, mean
age was 59±10.3, of whom 20 % had diabetes mellitus (DM),
58% had hypertension (HT), 20 % had smoking habitus, 25% had
family history. Serum Cholesterol 193±41mg/dl, LDL 113±37
mg/dl, HDL 42±9 mg/dl, triglyceride (TG) 157±75 mg/dl were
measured. Group II patients consisted of 80% male, 20%
female patients, mean age was 60.8±9.3, of whom 34 % had
diabetes mellitus (DM), 63% had hypertension (HT), 20 % had
smoking habitus, 30% had family history. Serum Cholesterol
189±42mg/dl, LDL 112±34 mg/dl, HDL 44±9 mg/dl, triglyceride
(TG) 179±100 mg/dl were measured. The clinical
characteristics were
similar between two groups.
Despite
clinical characteristics have an important effect on
atherosclerosis, haemodynamic parameters must be
evaluated in bifurcation lesions.
Slow Coronary Flow Phenomenon and
Its Relation with Positive Arterial Remodeling
Avşar Ö, Değer N, Batyraliev T.
Glagov's positive
remodeling hypothesis for coronary arteries is a well known
fact documented by intravascular ultrasound studies.
Thereby, normal coronary arteries with slow flow may reflect
early stages of atherosclerosis. We aimed to investigate
this hypothesis and relationship of slow coronary flow and
positive arterial remodeling, using B-mode carotid
ultrasound as a surrogate marker of atherosclerosis.
Two hundred
and three patients with normal coronary angiography were
enrolled and separated into two groups as normal (n=106) and
slow flow (n=97) according to corrected TIMI frame counts
(at least in one coronary artery). Common carotid artery
diameters were calculated by high resolution B-mode
ultrasound via computer based software and compared between
two groups.
Inter-adventitial carotid artery diameter was significantly
(p<0,001) higher in slow flow group (6,950±0,884 mm)
compared to normal's (6,354±0,864 mm). Also univariate
analysis revealed that the carotid artery diameter was
signi-ficantly (p<0,01) correlated with corrected TIMI frame
counts of three coronary arteries.
This study
showed that carotid arterial diameter was higher in patients
with slow coronary flow compared to normal flow group. As
this increase in carotid diameter may be associated with
positive remodeling in atherosclerotic process; regarding
the systemic nature of atherosclerosis it may be suggested
that slow coronary flow phenomenon may reflect subclinical
atherosclerosis despite normal coronary lumen in
angiography.
The value of ST segment depression,
Athens QRS Score, Duke Exercise Score and Simple Exercise Score
in exercise stress testing in predicting coronary artery disease
Yuvanç U, Yeşilbursa D,
Şentürk T, Saltan Y, Serdar O.A, Cordan J.
This study was planned to
evaluate the value of ST segment depression and different
scoring methods in predicting the presence and severity of
coronary artery disease. 415 patients who were refered to
our cardiology clinic with chest pain were enrolled in the
study. Exercise stress testing with Bruce protocol and
coronary angiography were performed for all patients. ST
segment changes were investigated, Athens QRS Score, Duke
Score and Simple Exercise Score were calculated. The value
of ST segment depression and different scores were
investigated in predicting the presence and severity of
coronary artery disease.
In 276
patients significant coronary artery disease were detected
while in 139 of them coronary arteries were normal. The
sensitivity and specificity of ST segment depression were %
67 and %75 respectively. The sensitivity and specificity of
Athens QRS Score were %70 and %80; Duke Score %78 and %77;
Simple Exercise Score %80 and %89 respectively. By the ROC
curve analysis, it was demonstrated that; there was no
significant relation with ST segment depression and Athens
QRS Score. For predicting significant coronary artery
disease Duke Exercise Score and Simple Exercise Score were
found to be superior than ST segment depression and Athens
QRS Score.
As a
conclusion it was demonstrated that; estimating exercise
scores with ST segment evaluation may provide additional
gains in detecting coronary artery disease. The sensitivity
and specificity of Simple Score which patients
characteristics were into account was found to be superior
than other scores.
ClInIcal Impact of drug-elutIng
coronary stents: RevIew
Jamgyrchiev S, Fetcer
D.V., Pershukov I.V., Ozgul S, Batyraliev T.
Percutaneous
transluminal coronary angioplasty (PTCA) was first
successfully performed by Andreas Gruentzig in 1977.
However, the disadvantage of PTCA is high restenosis rate,
which can range from 25 to 50% depending on the vessel
diameter, lesion location and length, presence of diabetes
mellitus and other factors. In 1993 two completed randomized
trials demonstrated advantages of stenting compared with
balloon angioplasty. BENESTENT and STRESS trials documented
significant reduction in restenosis rates after
Palmaz-Schatz stent placement. However, although much lower
restenosis rates have been demonstrated after stenting
compared to PTCA, they are still considerable and range from
20 to 30%. Some authors believed that pharmacotherapy with
oral antiproliferative and immunosuppressive agents could
become an efficient and cheap way to prevent restenosis. ,
systemic administration of rapamycin did not reduce in-stent
neointimal proliferation, and the rate of restenosis
exceeded the mean frequency of restenosis after conventional
stenting.
Delivery of
a therapeutic agent with stents proved to be a more
justified approach. Using a stent platform for drug delivery
can be called an ideal option, drug-eluting stents
demonstrate high efficacy and safety. They have been
successfully used in clinical practice allowing significant
reduction of neointimal hyperplasia and restenosis rates
while showing the same MACE rates as bare metal stents.
New types of
DES are expected in the market, which will lead to increased
competition and reduce their cost.
Türel B, Coşkun Ş, Comart
E, Yavuzcan UB, Aygün H.
Atrial fibrillation is
a rhythm disorder whose prevalance is increasing in
accordance with the aging population. The most important
disadvantage of atrial fibrillation for the public health is
thromboembolism because of the thrombogenic milieu that it
creates. Left atrial appendage is the origin of nearly all
of left atrial clots in atrial fibrillation. Warfarin usage
which is the only proven prophylaxis method against
thromboembolism, is handicapped because of the need for
frequent prothrombin time monitoring and widespread
pharmacologic and food interactions. Percutaneous and
surgical left atrial appendage closure interventions are put
forward to cope with this situation. Percutaneous left
atrial appendage closure technics which are considered a new
frontier for interventional cardiology are reviewed in this
article.
Key Words:
Left atrial appendage, Atrial fibrillation, Stroke
SItus Inversus totalIs and corrected transposItIon of the great
vessels in a 50 year old woman
Serçelik A, Mavi A, Karben
Z, Batyraliev T, Gümüşburun E, Demirbaş Ö.
Situs inversus totalis
refers to a mirror-image reversal of the normal position of
the internal organs. Congenitally corrected
transposition of the great arteries characterized by
atrioventricular and ventriculoarterial discordance.
Congenitally corrected transposition of the great arteries
is very singular if it is associated with situs inversus
totalis.
In this case report, a
50 years old woman with situs inversus totalis and
congenitally corrected transposition of the great arteries
has been presented. The recognition of these anomalies is
extremely important because these anomalies may disturb the
surgical procedure for the concurrent disease in situs
inversus totalis and congenitally corrected transposition of
the great arteries. Therefore, recognition of anomalies with
this patient may be useful for cardiac surgeon.
Key Words:
Situs inversus totalis, Congenitally corrected transposition
of the great arteries
The current practice
of interventional cardiology has been revolutionized by the
advent of drug-eluting stents, which have been shown to
reduce the incidence of adverse events. However
bifurcation lesions are always problematic due to high
procedural and complication rates. A number of percutaneous
stenting techniques have been proposed for optimal treatment
of bifurcation lesions but the most favourable
interventional approach remains controversial. In this case
report which a new technique called TABAS (Three Angle
Bifurcation Angioplasty and Stenting) is sugessted as an
alternative to the T-technique and Crush technique.
