Type A aortic dissection is an infrequent occurrence following open-cardiac surgery, and the development of paraplegia as a complication is even rarer. This case report presents a unique instance of Type A aortic dissection in a patient who experienced paraplegia subsequent to undergoing coronary artery bypass grafting and mitral valve replacement. The causes of paraplegia after aortic dissection are diverse, with cerebrovascular diseases and spinal cord ischemia being uncommon contributors. Despite its rarity, paraplegia in this context carries substantial mortality and morbidity risks. This case emphasizes the importance of considering such complications in the postoperative management of cardiac surgery patients, highlighting the need for vigilance and early intervention.
Objective: The primary aim of this study was to determine the effect of postoperative practices on pain in patients undergoing open and closed heart surgery. The secondary aim was to determine the activities that patients had difficulty in performing during pain. Material and Methods: This prospective and descriptive study was conducted in a cardiovascular surgery clinic between September 2022 and July 2023. The sample calculation was carried out according to the simple random sampling method with 65 patients in the open heart surgery patient group according to the Power (G-power) analysis, and 57 of the 79 patients in the closed heart surgery patient group between these dates were reached. Personal information in the research data form and 16 questions determining pain levels. Pain levels during the postoperative procedures on the 1st day (dressing, getting out of bed, walking, coughing) and 3rd day (chest tube/drain and pacing wire removal) were asked and recorded. Results: The mean ages of the patients in the open and closed cardiac surgery groups were 61.5±8.4 and 45.5±12.8 years, respectively (p=0.015<0.05). Coronary artery bypass graft was performed in 75.4% of open operations and septal defect in 36.8% of closed operations. Pain measurements during dressing (p=0.017<0.05) and pacing wire removal (p=0.001<0.05) were significantly different in patients who underwent open surgery. The pain experienced by patients in both groups during chest tube withdrawal was found to be severe. Conclusion: It was determined that there was a significant difference in the pain experienced in open and closed surgeries after cardiac surgery.
Objective: Cardiac syndrome X (CSX) is used to define patients with ischemic chest pain and normal coronary arteries, as revealed by angiography. The etiology of CSX may be associated with extensive coronary microvascular endothelial dysfunction, inflammation, and oxidative stress. We aimed to simultaneously investigate the relationships of serum vitamin D levels with oxidative stress, atherogenic index of plasma (AIP) and systemic inflammation marker C-reactive protein (CRP) to albumin ratio in CSX patients. Material and Methods: The present study group included 52 consecutive symptomatic patients diagnosed with CSX and 42 healthy controls. Serum total cholesterol, high-density lipoprotein (HDL), triglyceride, vitamin D, CRP, serum advanced oxidation protein product, and Ferric reducing ability of plasma levels were measured. The CRP/albumin ratio was determined. The AIP was calculated as log (triglyceride/HDL-C). Results: Patients with CSX had decreased vitamin D levels [11.2 (IQR: 6.3) ng/mL vs. 14.8 (IQR: 6.4) ng/mL; p=0.05] and higher CRP/albumin ratios [1.42 (0.84) vs. 1.01 (0.36); p=0.01] and similar AIP (0.11±0.30 vs. 0.14±0.29; p=0.76) compared to the control group. There was a weak negative correlation between vitamin D and CRP/albumin ratio (r=-0.23, p=0.03) levels. Conclusion: The reduction of vitamin D levels and systemic inflammation may play a role in the development of CSX.
Objective: Few studies have shown that certain myocardial repolarization markers from surface electrocardiogram (ECG) are associated with ascending aortic (AA) dilatation (AAD). We aimed to investigate the association between 12-lead surface ECG markers and AAD. Material and Methods: Consecutive patients without active complaints, who were admitted to the outpatient clinic for routine control, were included in the study. Transthoracic echocardiography (TTE) was performed to measure AA diameter. ECG markers, including QRS duration, TP-e interval, QTc interval, and frontal QRS-T angle were calculated. Patients were divided into two groups based on their AA diameter: those with an AA diameter ≥40 mm [AAD (+)] and those with an AA diameter <40 mm [AAD (-)]. Statistical analysis was performed to compare the two groups using a p value <0.05 as statistically significant. Results: Among the 251 patients, 31 (12.3%) had AAD. Patients with AAD had a significantly higher rate of coronary artery disease (CAD) history. Fragmented QRS, pathological Qwaves, longer P-maximum, P-minimum, P-dispersion, QRS duration, Tp-e duration, R peak time, and increased frontal QRS-T angle were more common in the AAD(+) group (all p<0.05). Correlation analysis revealed a significant correlation between the frontal QRS-T angle and AAD (R=0.379, p<0.001). In multivariate logistic regression analysis, AAD showed an independent association with the frontal QRS-T angle (OR: 3.886, 95% CI: 1.270-11.893, p=0.017) and history of CAD (OR: 10.689, 95% CI: 2.151- 53.121, p=0.004). Conclusion: AAD was independently associated with a CAD history and frontal QRS-T angle.
Objective: The aim of this study is to assess the prevalence of intramyocardial left anterior descending artery (IMLAD) and evaluate the early and mid-term outcomes in patients undergoing coronary artery bypass graft (CABG) procedures. Material and Methods: A retrospective analysis of 349 surgical reports of consecutive CABG procedures performed between January 2014 and October 2022 was conducted. Patients with IMLAD were matched with patients with epicardial left anterior descending artery (LAD) according to age, gender, and date of operation. A comparison between two groups was performed and follow-up data were obtained. Results: IMLAD was detected in 40 patients out of 349. The prevalence was 11.5%, and the median age was 56.5 years. There were 28 (70%) males. There were no statistically significant differences between the groups in terms of preoperative comorbidities, postoperative morbidities, reoperation rate for bleeding, mortality rates, and length of stay in the intensive care unit and the hospital. The cross-clamp and cardiopulmonary bypass times were comparable in both groups (p=0.350 and 0.765, respectively). The median follow-up time was 42 months (range 7-92 months) in the IMLAD group and 42.5 months (range 5-94 months) in the matched control group. Survival rates and freedom from reintervention rates were similar between the groups (p=0.368 and p=0.465, respectively). Conclusion: This study highlights the feasibility of performing surgeries involving IMLAD. Patients with IMLAD exhibited comparable early and mid-term clinical outcomes following CABG procedures compared to those with epicardial LAD.
Kist hidatik, Echinococcus granulosus paraziti tarafından oluşturulan ve en sık karaciğer ve akciğeri tutan hayvan kökenli bir enfeksiyondur. Kalpte lokalize hidatid kistler çok nadir olup, tüm hidatik kistlerin yaklaşık %0,5-2'si kadardır. Hastalık asemptomatik olabildiği gibi ani ölüme dahi yol açabilmektedir. Bu nedenle asemptomatik hastalarda bile erken cerrahi tedavi önerilmektedir. Kronik herhangi bir hastalığı olmayan 18 yaşındaki bir hasta göğüs ağrısı nedeniyle tetkik edilirken, fark edilen kardiyak kist hidatik vakasında kist içeriğinin aniden perikarda boşalarak taşikardi ve hipotansiyon tablosuyla başlayan ve sonrasında tamponad tablosuna ilerleyen olgumuz görüntüler eşliğinde sunulmuştur. Vakanın takiplerinde albendazol tedavisinin 6 aya uzatılmasının kistin tekrar oluşumunun engellemesine katkıda bulunduğu değerlendirilmiştir.
Objective: Chronic inflammation in obesity is the main factor that increases insulin resistance by causing changes in insulin sensitivity. Our study aimed to investigate the relationship between insulin resistance and C-reactive protein (CRP), uric acid, and fibrinogen levels in different body mass indexes (BMI). Material and Methods: In our study, patients who applied to our hospital with the complaint of overweight in 2021-2022 were retrospectively analyzed, and 149 women aged 20 and over were included in the study. Glucose, uric acid, total cholesterol, high-density lipoprotein cholesterol, lowdensity lipoprotein cholesterol, triglyceride (TG), CRP, insulin, fibrinogen results, which were measured simultaneously with the height and weight measurements of the patients, were obtained from the laboratory information system. Results: The patients included in the study were 25 normal weight, 56 overweight, 53 obese and 15 morbidly obese according to BMI. The uric acid and TG levels of the overweight group were found to be significantly higher than the normal group (respectively; p=0.012, p=0.031), the CRP level of the morbidly obese group was found to be significantly higher than the normal, overweight, and obese groups (respectively; p<0.001, p<0.001, p=0.006). A significant positive correlation was found between Homeostatic Model Assessment for Insulin Resistance and CRP and uric acid (respectively; r=0.219, p=0.009; r=0.353, p<0,001). Conclusion: We think that uric acid levels in the early stage of obesity and CRP levels in the advanced stage may be a guide for insulin resistance and obesity-related diseases.
Objective: Bicuspid aortic valve (BAV), which is the one of the most common congenital heart malformation and seen approximately 1-2% of the general population. It has been shown that BAV is associated aortic valve dysfunction (aortic stenosis, aortic regurgitation or both) and increased risk for bacterial endocarditis from adult to the advanced ages. In this study, we aimed to determine the frequency of BAV disease in the asymptomatic young population who is applied to the health board. Material and Methods: 5,490 subjects who were consulted to the cardiology outpatient by health board were systematically analyzed from our hospital database system and 15 patients with BAV were identified. The frequency of BAV and aortic valve measurments were recorded. Patients with previous aortic valve intervention were excluded from the study. Results: Fifteen patients with BAV were identified (0.3%), all patients were newly diagnosed during screening at the health board. Mean age of the BAV subjects was 23.4±2.45 years. Two of them were female (13.3%) and thirteen of them (86.7%) were male. Aortic insufficiency was the most common pathology, mild in 11 (73.3%), and moderate in 2 (13.3%) cases. Only 2 (13.3%) patients had aortic dilatation. Aortic stenosis was not detected. Conclusion: Prevalence of BAV in asymptomatic young adults was lower than the literature.
Objective: The impact of the coronavirus pandemic on various sectors was widespread, with a notable influence on the education system. This study was designed to assess the impact of deep vein thrombosis (DVT) education in a virtual classroom setting on the knowledge, attitude, and practices of students enrolled in the vocational school of health services amid the coronavirus pandemic. Material and Methods: Conducted as a semi-experimental design with a single-group pre-test-post-test structure, the study involved students from a state university's vocational school of health services (n=90). Participants underwent DVT training, and their knowledge, attitude, and practices were measured before and after the training. Data collection took place from April 20 to June 20, 2022, utilizing a DVT knowledge, attitudes, and practices information form developed by the researchers. Descriptive data were assessed using numbers, percentages, mean, and standard deviation, while the McNemar chi-square test and student t-test were employed for variable comparisons. Results: Of the participants, 74.4% were female, with a mean age of 20.32±2.8 years, and 64.5% were enrolled in the first aid and emergency aid program. 87.9% found the online training to be sufficient. Statistically significant differences were observed between pre-test and post-test scores (p<0.05). Conclusion: The virtual classroom education on DVT was found satisfactory by the majority of students, resulting in an evident improvement in their knowledge, attitude, and practices.
Iatrogenic arteriovenous fistulas (AVF), which are increasing in the literature with the increase of surgical closed vascular interventions in diagnosis and treatment, are rare but have fatal complications. AVF may present with congestive heart failure symptoms, cardio-pulmonary symptoms, and leg edema immediately after the operation or over the years, depending on the size of the fistula. Diagnosis can be made by imaging examinations such as Doppler ultrasonography, computed tomography, or magnetic resonance angiography in patients with suspected AVF. The endovascular stentgrafting approach seems to be more popular in eligible patients due to surgical treatment's high morbidity and mortality rates. We aimed to report a rare case of iliac arteriovenous fistula that developed after a laparoscopic intervention due to ovarian cyst rupture and successfully grafted with an endovascular covered stent.
Objective: Transcatheter aortic valve implantation (TAVI) offers an alternative to surgery for patients with symptomatic severe aortic stenosis. Currently, the most commonly used valves for clinical use are the Balloon-expandable Edwards SAPIEN and Self-expandable CoreValve Revalving valves. The aim of our study is to compare these valve types used in TAVI procedures performed in our center and to determine the predictors of complications. Material and Methods: 96 patients who underwent TAVI in our center were included in our study. Pre-procedural clinical, laboratory and echocardiographic data of patients who underwent TAVI were reviewed retrospectively. Results: Complications developed in 31 (32.3%) of the patients. Total complications were found to be higher in patients with balloon-expandable valve (18 vs. 13, p=0.036, respectively). In patients who developed complications, hemoglobin and hematocrit values at the time of admission to the hospital were found to be significantly lower, and C-reactive protein was found to be high. Among the echocardiographic findings at admission, the aortic valve area was found to be narrower and the maximum and mean gradient was higher in patients with complications. Conclusion: In our study, a lower complication rate was observed in self-expandable valves. Some independent markers of TAVI-specific complications and mortality were identified. Examination of new predictors and development of a TAVI-specific scoring system may be considered in future prospective controlled studies.
Amaç: Araştırma, koroner arter baypas greft (KABG) uygulanacak hastalarda ameliyat öncesi anksiyete görülme prevalansının ve yorgunluk düzeyinin belirlenmesi amacıyla tanımlayıcı kesitsel olarak yapıldı. Gereç ve Yöntemler: Araştırmaya 1 Nisan 2019-1 Nisan 2020 tarihleri arasında KABG uygulanacak 116 hasta alındı. Veriler kişisel bilgi formu, Durumluk-Sürekli Kaygı Envanteri ve Çok Boyutlu Yorgunluk [Multidimensional Assessment of Fatigue (MAF)] Ölçeği ile toplandı. Verilerin analizinde Mann-Whitney U, Kruskal-Wallis ve Spearman korelasyon testleri kullanıldı. Bulgular: Çalışmada bireylerin ameliyat öncesi anksiyete düzeyinin 44,94±1,36 olduğu, %64,7'sinin orta-yüksek düzeyde anksiyete yaşadığı ve MAF Ölçeği total skorunun 35,12±6,99 olduğu belirlendi. Bekâr, çalışmayan ve uyku kalitesini kötü olarak değerlendiren bireylerin ameliyat öncesi anksiyete düzeyinin, kadın, bekâr, sigara-alkol kullanan, çalışan ve uyku kalitesini kötü olarak değerlendiren bireylerde ise yorgunluk düzeyinin istatistiksel olarak anlamlı düzeyde daha yüksek olduğu bulundu. Çalışmada ayrıca ameliyat öncesi anksiyete ile yorgunluk alt boyutları ve total yorgunluk düzeyi arasında pozitif yönlü orta düzeyde anlamlı ilişki olduğu belirlendi (p<0,05). Sonuç: KABG geçiren hastaların çoğunluğunun ameliyat öncesi anksiyete yaşadığı, ameliyat öncesi anksiyete düzeyi arttıkça yorgunluk düzeyinin de arttığı belirlendi. Bu nedenle kardiyak cerrahi hastaları ameliyat öncesi dönemde holistik açıdan değerlendirilmeli ve ameliyat öncesi anksiyete ve yorgunluk düzeylerinin azaltılmasına yönelik kanıta dayalı hemşirelik girişimleri uygulanmalıdır.
Objective: In recent years, coronavirus disease-2019 (COVID-19) has been the primary health problem and because of the virus affinity to endothelial cells, it has become an important reason of vascular problems and cardiac injury. After mild COVID-19 infection, patients frequently attend cardiology clinics with cardiac symptoms and their primary cardiac tests are mostly normal. In this study we aimed to analyze if two-dimensional speckle tracking echocardiography shows any difference between symptomatic and asymptomatic post-COVID19 patients when transthoracic echocardiography parameters are normal. Material and Methods: In this retrospective single center study, 2,741 transthoracic echocardiography records were assessed and 108 post-COVID-19 patients were detected and divided into symptomatic and asymptomatic patient groups and left ventricular global longitudinal strain (LV-GLS) values were compared. Results: The number of patients with normal LV-GLS values were equal in the groups and there were 4 patients whose values were borderline in the asymptomatic group, while there was none in the symptomatic group. The number of patients with impaired GLS values in the symptomatic group were higher than the asymptomatic group (15 vs 4 patients) and the difference was statistically different (p=0.008). The average LV-GLS values were -18.88±2.50 in the asymptomatic group and -17.40±3.68 in symptomatic group but the difference was not statistically significant (p=0.098). Conclusion: More symptomatic patients than the asymptomatic ones have impaired LV-GLS values according to the results of this study. Even if it is not statistically significant, the mean LV-GLS values are also reduced in symptomatic patients after mild COVID-19 infection.
