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The review of literatUre and
realization of asemptomatic atherosclerotic coronary artery
disease in the patients planned to have coronary artery bypass
operation
Uçar H.İ, Tok M, Doğan Ö.F, Durukan B,
Gürbüz A, Durukan E, Karabay C, Farsak B, Güvener M, Yorgancıoğlu A.C, Doğan
R, Demircin M, Paşaoğlu İ.
Stroke is a devastating complication of
coronary artery bypass surgery. It increases the mortality and morbi-dity of
the operation, and prolongs the length of hospital stay. Functional
disability from the stroke may dramatically reduce the quality of life post-operatively,
and some patients will require permanent institutional care. We conducted a
study to assessed the value of carotid doppler ultrasound examination in the
evaluation of asympthomatic atherosclerotic carotid lesions on the
postoperative cerebrovascular events in cardiac surgical patients.
Fourty four patients who underwent elective
coronary artery surgery were enrolled in this study (mean age = 64±8 years,
median = 63). Preoperative carotid doppler evaluation were perfomed for all
patients who had no signs of atherosclerotic carotid disease.
Eight of the 44 patients had stenotic carotid
artery disease an done of them had stenotic vertebral artery (36 male, 82 %
and 8 female 18 %, mean age, 64±8). Two death (4.5 %) one of them had
carotid artery stenosis and 3 (6.8 %) serebrovascular accedent occured in
the stenotic group early after the surgery. There were one (2.2 %) mild
(20-50 %), five (11.3 %) moderate (50-75 %) and one (2.2 %) severe (% 90)
stenosis. Thirtyfour patients (77.3 %) had intima-media thickness on the
rigth and 35 patients (79.5%) had on the left. Thirty-one patients (70.5 %)
had calcified plaque on the left side and 28 (63.6 %) had on the right
side. There were mild, moderate and severe carotid stenosis one (2.2 %),
five (50-75 %) and one (2.2 %) patients, respectively.
Extra-cerebral carotid stenosis is the most
important predictor of stroke for patients undergoing coronary artery bypass
grafting (CABG). If patients are identified before coronary surgery, they
may benefit from treatment of their carotid disease.
Effects of severity and extent
of coronary artery lesion on heart rate variability
Akgül F, Birand A,
Kudaiberdieva G, Batyraliev T.
Decreased vagal
activity is frequently observed in patients with coronary
artery disease (CAD). The effect of left ventricular
contractility score and extent of CAD on heart rate
variability (HRV) is not well known. That is why, the aim of
this study was to assess the relationship between HRV and
extent and severity of coronary artery lesions. Ninety seven
patients who underwent coronary angiography were assigned to
the study. HRV analysis was accomplished using frequency
domain analysis (Fourier transformation). We assessed the
powers of very low, low, high and very high frequency band
and total power. Parasympathetic component of HRV was
decreased in patients with three vessels disease as compared
with normal subjects and single vessel disease (P<0.05).
HRV was closely related with severity and extent of CAD
(P<0.05). However, no correlation was found between
ventricular contractility score and HRV parameters. In
conclusion, HRV is reduced in CAD being closely related to
severity and extent of coronary artery lesion.
The
role of the troponin T, CK, CK-MB enzyme levels for assessment
of minor myocardial injury and long term prognosis after
sucsessful coronary stent implantation
Kaya G.M, Okyay K, Tulmaç
M, Cemri M, Yalçın R, Çengel A, Dörtlemez Ö.
In this study, we aimed to determine
the importance of the cardiac enzymes (troponin T, creatine kinase and
creatine kinase-myocardiyal band) to predict minor myocardial injury and
long term prognosis in patients who underwent succesful coronary stenting.
Forty seven patients who underwent
succesful coronary stenting in our clinic were prospectively enrolled to the
study. Cardiac enzymes are studied before the procedure, immeditealy after
the procedure and 6 h later. The patients were followed up in hospital for
development of chest pain, electrocardiographic changes, and acute
thrombosis and in long term for development of subacute thrombosis,
myocardial infarction, and death.
Preprocedural
levels of cardiac enzymes were within normal limits. Troponin T levels
increased in two patients after the procedure and in four patient after 6 h.
CK levels was increased in only one patient both after the procedure and
after 6 h. There was no changes in levels pf CK/MB. The patients were
divided in two groups; patients which deve-lopt increase of cardiac enzymes
immeditealy or 6 h later after the procedure constituted group 1 and other
patients constituted group 2. Demographic characteristics and coronary
artery risk factors did not differ statistically between the groups. After
long term follow up of median 44 months more target vessel revascularization
were performed to the patients of group 1 which was not statistically
significant (40.0 % vs 21.4 %; p=0.35).
Troponin T levels increase relatively
more than CK and CK-CK/MB for detecting of minor myocardial injury after
sucsessful coronary stenting. Increase in troponin T levels could also
provide information regarding long term prognosis consisted of target vessel
revascularization, myocardial infarction and death.
Key Words:
Coronary stent implantation, Troponin T, CK, CK-MB, Long term prognosis
Effect of pentoxifylline
on platelet activation during cardiopulmonary bypass for cardiac
surgery
Çağlı K, Kale A, Ulaş M.M, Korkmaz K,
Gedik S, Lafçı G, Bardakçı H, Ayaz S, Şener E, Paç M.
Cardiopulmonary bypass
(CPB)-induced pathophysiologic reactions affect the
functionality of platelets which may contribute to
endothelial injury and tissue edema. The aim of this study
is to investigate the effect of intraoperative
pentoxifylline use on platelet functions and its clinical
significance.
This study was
undertaken to assess the effect of pentoxifylline (PTX) on
total platelet count, platelet factor 4 (PF4) and mean
platelet volume (MPV) level, and platelet morphology in
peripheral blood smear in twenty patients undergoing CPB for
elective coronary artery bypass grafting (CABG). All
measurements were performed after induction of anesthesia
(T1), 30th minutes after the weaning of CPB (T2), at 6th
hours (T3) and 24th hours of postoperative period (T4). In
10 patients, 200 mg of PTX was added to 500 ml 0,9% NaCl and
perfused at 180 minutes after induction of anesthesia and
also 100 mg of PTX was added to warm cardioplegic solution;
another 10 patients received 500 ml 0,9% NaCl as placebo.
Total platelet count
at T4 was within the normal range in two groups, however,
it was significantly lower in the PTX group. In both groups,
an increase in PF4 levels was observed at every point and
the difference between two groups regarding the PF4 level
at T3 point is significant. MPV value did not differ
between groups at any point.
Intraoperative use of PTX could partially inhibit CPB-induced
platelet activation but its clinical importance like
decrease in hemorrhagic complications and need for
transfusion could not be demonstrated.
Primary percutaneous
coronary intervention (PCI), when performed by an
experienced team in a timely fashion, is a better
reperfusion therapy than thrombolysis in patients who have
acute myocardial infarction with ST- segment elevation.
Stent implantation is associated with an improvement in both
early and late outcomes, as compared with balloon
angioplasty alone, predominantly as a result of a reduction
in target-vessel revascularization. Drug-eluting stents
significantly reduce the risks of both restenosis and target-vessel
revascularization after elective PCI, as compared with
uncoated stents. Whether drug-eluting stents are also
beneficial in the setting of primary PCI has been studied
in several recent studies but a definite final conclusion
has not been reached. In this review, the role of drug
eluting stents in patients with ST- segment elevation
myocardial infarction has been discussed in the light of
latest data.
Antiphospholipid syndrome (APS)
is a systemic autoimmune patholology characterized with
arterial and venous thrombosis, recurrent fetal death and
thrombocytopenia in association with positive laboratory
tests for antiphospholipid antibodies in the form of Lupus
Anticoagulant or anticardiolipin antibodies. Patients with
APS are prone to excessive morbidity and mortality after
cardiac surgery because of their hypercoagulable state.
These constitutes a group of high risk patients to whom
meticulous care should be given in all stages of the surgery
through the diagnosis and anticoagulation during
intraoperative and postoperative period. The risks related
with APS in cardiac surgical patients, current diagnosis,
intraoperative and postoperative management are summarized
in this review.
Key Words: Antiphospholipid syndrome, Heart surgery
Aortic dissection resulting from
vein graft proximal anastomosis
Cingöz F, Günay C,
Karabacak K, Demirkılıç U, Tatar H.
Aortic
dissection that is a rare complication after cardiac surgery
can be mortal. It has been occasionally repor-ted that may
originate from aortic or cardioplegic cannulation points.
Furthermore, side clamp may be assumed to induce intimal
tear which occurs performing the proximal anastomosis on the
aorta. The patient who was admitted to our clinic with
aortic dissection symptoms and signs. In his history, He
had been performed aortocoronary bypass surgery using safen
vein graft 5 years ago. The patient was operated on under
CPB support and was performed Dacron tube graft
interposition at ascending aorta, aorta-coronary by-pass (Ao-LAD,
Ao-RCA). In this study, this case will be discussed under
literature knowledge.
Iatrogenic aortic dissection in a
patient who has rigth arcus aorta and origin anomaly of aberrant
left subclavian artery: Endovascular therapy and coronary artery
bypas surgery
Serter T.F, Tok M, Uçar
İ.H, Çil B, Farsak B, Yorgancıoğlu A.C.
Cardiac
catheterization is not only a diagnostic tool but also a
means of treatment of cardiac diseases. Catheter-induced
aortic dissection is a very rare but serious complication
of diagnostic cardiac angiography. A 70-year-old man was
admitted to the hospital with chest pain. Conventional
angiography showed coronary artery disease with right arcus
aorta, aberrant left subclavian artery and origin anomaly of
four major supraaortic vessels, which were leaving the arcus
separately and also aberrant left subclavian artery and
dissection of thoracic aorta beginning from origin of the
aberrant left subclavian artery. Iatrogenic dissection of
arcus aorta was treated with an endovascular stent graft
were placed in the thoracic aorta. After endovascular stent
graft off-pump coronary artery by-pass grafting was
performed.
Key Words: Right arcus aorta, Aberrant left
subclavian artery, Iatrogenik aortic dissection,
Endovascular stent graft, Coronary bypass surgery
In this case report, a
patient who is presented whit rigth valsalva sınüs anevrizm
is ruptured to the rigth atrium and also develop abdominal
pain. The valsalva sınüs anevrizm ruptures generally develop
whit chest pain and dispnea. But, atypical symtoms are seen
in this case.
Key Words: Rupture of valsalva sınüs anevrizm, Aorta-atrial
fistüla
