Background: The aim of this study is to evaluate the microembolic changes related to occlusions of precapillary arterioles in the retina during coronary artery bypass grafting (CABG) surgery using fundus photography, and to examine systemic and operational factors related to occurrent lesions.Methods: Retinal microvascular damage was assessed by color fundus photography one day before CABG surgery, on postoperative day five, and again three months after surgery. In addition to patients’ demographics, diabetes mellitus, hypertension, chronic renal failure, and hypercholesterolemia (LDL level) were examined. Smoking history was recorded. Additionally, each patient’s carotid Doppler results were ranked by four degrees. Data related to the surgery were recorded.Results: No retinal emboli were seen in any patient before surgery. In fundus photographs taken on the fifth day after surgery, retinal precapillary arteriolar occlusions were seen in 20 (28.57%) of the patients. Lesions were observed to have disappeared in the third month after surgery. There was no significant (P > .05) difference in age, sex, diabetes mellitus, HT ratio, tobacco consumption percentage, LDL values, and Doppler USG distribution between the two groups of patients with and without lesions. However, CABG surgery and cross-clamp removal time measured significantly(P < .05) longer in the group with lesions than in the group without lesions.Conclusion: Our results show that retinal microembolism can occur after CABG surgery in association with surgery time and cross-clamp time; however, this does not cause any clinical outcome.

Fonksiyonel olarak genisletilmis politetrafloroetilen (ePTFE) greftler, dusuk aciklik oranlari nedeniyle koroner konduit olarak tercih edilmemektedir. Bu yazida, ePTFE koroner konduit ile 10 yil once ameliyat olan 69 yasinda bir erkek olgu sunuldu. Koroner konduite perkutan girisim sirasinda perforasyon gelismesi uzerine hasta acil ameliyata alindi. Ameliyat sirasinda ePTFE greft varligi saptandi. Bu olgu, ePTFE greftlerinin uzun sureli acik kalabilecegine iliskin bir kanit olusturmaktadir. Ayrica, perkutan girisim uygulanan ePTFE greftlerinde, nativ otolog konduitlere kiyasla, komplikasyon riskinin daha yuksek olabilecegini gostermektedir. Anah tar soz cuk ler: Koroner konduit; genisletilmis politetrafloroetilen greft; aciklik orani. Functionally expanded polytetrafluoroethylene (ePTFE) grafts have not been preferred as a coronary conduit due to their low patency rates. In this article, we report a 69-year-old male case who was operated 10 years ago with an ePTFE coronary conduit. During percutaneous intervention of coronary conduit, perforation was observed and patient was operated immediately. Usage of ePTFE graft was confirmed during surgery. This case report produces an evidence for the long-term patency of ePTFE graft. It also shows a higher complication risk for percutaneous ePTFE grafts compared to the native autologous conduits.

Atrial Septal Defekt is the interatrial defect that occurs in atrial septum that leads to an abnormal shunting. Although it can be seen mostly as an isolated anomaly, it can also appear with major cardiac anomalies. It occurs mostly asymptomatic, however in infantile period congestive heart failure can be seen. The treatment of ASD ranges from medical to surgical treatment. The symptoms and comorbidities help us to evaluate the way of treatment. As can be performed in all ages with less risk and excellent long term results, surgery is the standard treatment. Nowadays, percutaneous transcatheter closure of the defect becomes a popular way of treatment and it seems that it will be the first choice of treatment for suitable cases in near future.

‹skemik kardiyomiyopati, tedavisi zor ve prognozu kotu olan bir hasta grubunu teflkil etmektedir. Son y›llarda atan kalp tekni¤i ile ulafl›lan baflar›l› sonuclar›n, bu grup hastalarda da elde edildi¤i bildirilmektedir. Ancak konvansiyonel yontemlerdeki ciddi geliflmeler, iki grubun birbirine olan ustunlukleri konusundaki tart›flmalar›n devam etmesine neden olmufltur. Bu cal›flmada, her iki grubun erken ve gec donem sonuclar› karfl›laflt›r›lm›flt›r. Cal›flma grubu 2001-2005 y›llar› aras›nda sol ventrikul ejeksiyon fraksiyonu % 30'un alt›nda ve sol ventrikul dilatasyonu olan toplam 25 olguyu kapsamaktad›r. Grup 1 atan kalp, Grup 2 ise kardiyopulmoner by-pass uygulanarak opere edilen olgulardan oluflturulmufltur. Hastane mortalitesi Grup 2'deki tek olgu ile % 4 idi. Hastane ve yo¤un bak›m kal›fl sureleri Grup 1'de daha dufluk bulundu. Gec donemde her iki gruptan 1'er olgu kaybedildi. ‹statistiksel anlaml›l›¤a eriflmemesine ra¤men Grup 2'deki olgular, orta donem takipleri s›ras›nda fonksiyonel kapasite ve angina s›n›fland›rmas› ac›s›ndan daha iyi konumda idiler. ‹skemik kardiyomiyopatili hastalar›n her iki yontemle yap›lan operasyonlar›n›n gerek erken gerekse gec donem sonuclar› tatmin edicidir. Ancak bu cal›flmada, atan kalp tekni¤inin erken donem sonuclar› daha iyi iken, kardiyopulmoner by-pass grubunun gec donem morbiditesi daha dufluk bulundu. Anahtar Kelimeler: Kardiyomyopati, koroner arter bypass, off-pump. Cerrahpafla T›p Derg 2006; 37: 88 - 91 Early and Late Outcomes of Surgical Revascularization Procedures in Ischemic Cardiomyopathy Abstract Management of patients with ischemic cardiomyopathy is rather complicated and also has a poor prognosis. Recently, substantial success rates have also been reported with off-pump technique in these high risk patients. Nevertheless, owing to the great advances that were achieved in traditional myocardial preservation and techniques in the most recent years; a dilemma still remains regarding superiority of these techniques to each other in patients with ischemic cardiomyopathy. Thus, we have compared early and late results of these two techniques in this study. Study group included 25 operated patients who have an left ventricle ejection fraction of less than 30 % and left ventricular dilatation between 2001 and 2005. Groups 1 and 2 included patients that were operated with off pump and cardiopulmonary bypass techniques, respectively. Hospital mortality was 4% with 1 patient dying in Group 2. Durations of intensive care unit and hospital stays were shorter in Group 1. Two patients (1 from each group) died in the late postoperative period. Although midterm comparisons of both functional and angina classifications revealed better results in Group 2 patients, statistical significance wasn't present. Early and late outcomes of surgical revascularization procedures were satisfactory with both techniques in patients with ischemic cardiomyopathy. In this study, short term results seemed better in off pump patients, while late morbidity rate was lower for cardiopulmonary bypass group. KeyWords: Cardiomyopathies, coronary artery bypass, off-pump. Cerrahpasa J Med 2006; 37: 88 - 91

Though perioperative outcome of beating heart surgery have been considered better than conventional methods, late results are still controversial especially in elderly patients. In this clinical trial we have compared early and late results of 71 aged cases operated either by beating or conventional methods. Preoperative risk factors of both groups were comparable except chronic obstructive pulmonary disease. In perioperative parameters, conventional group had statistically significantly longer intensive care and hospital stay days. During late follow-up period mortality rates were comparable but functional capacity of conventional group were better. Perioperative merits and late outcomes of both techniques should be evaluated for decision of operative technique.

Management of patients with ischemic cardiomyopathy is rather complicated and also has a poor prognosis. Recently, substantial success rates have also been reported with off-pump technique in these high risk patients. Nevertheless, owing to the great advances that were achieved in traditional myocardial preservation and cardiopulmonary bypass techniques in the most recent years; a dilemma still remains regarding superiority of these techniques to each other in patients with ischemic cardiomyopathy. Thus, we have compared early and late results of these two techniques in this study. Study group included 25 operated patients who have an left ventricle ejection fraction of less than 30 % and left ventricular dilatation between 2001 and 2005. Groups 1 and 2 included patients that were operated with "off pump" and "cardiopulmonary bypass" techniques, respectively. Hospital mortality was 4% with 1 patient dying in Group 2. Durations of intensive care unit and hospital stays were shorter in Group 1. Two patients (1 from each group) died in the late postoperative period. Although midterm comparisons of both functional and angina classifications revealed better results in Group 2 patients, statistical significance wasn't present. Early and late outcomes of surgical revascularization procedures were satisfactory with both techniques in patients with ischemic cardiomyopathy. In this study, short term results seemed better in "off pump" patients, while late morbidity rate was lower for "cardiopulmonary bypass" group.

Fibrosing mediastinitis is an uncommon benign disorder characterized by proliferation of dense fibrous tissue within the mediastinum. Affected patients are typically young and present with signs and symptoms related to obstruction of vital mediastinal structures, such as central systemic veins, the esophagus, airways, and pulmonary arteries or veins. The precise cause and pathogenesis of fibrosing mediastinitis in most cases is unknown, and links to infectious and noninfectious causes remain speculative. We present a case of severe symptomatic SVC syndrome as a result of fibrosing mediastinitis, which were treated successfully using a polytetrafluorethylene (PTFE) graft.

AIM The aim of this study was to translate the VEINES-QOL/Sym questionnaire into Turkish, which is used mainly in Western European countries, and to study its reliability and validity. METHODS Standard "forward-backward" translation method was used to translate the questionnaire. The internal consistency was assessed with Cronbach's α, test-retest reliability was assessed with the intraclass correlation and Spearman-Brown coefficients. Validity was examined by correlation of VEINES-QOL/Sym with SF-36, Venous Clinical Severity (VCSS), and Venous Disability Scores (VDS). RESULTS Out of 100 patients included (mean age 41.9 ± 12.5 years; 32% male, 68% female), 30 were given the questionnaire twice with 24-hour intervals for test-retest; a final completion rate of 99.2% was achieved. The Cronbach's α was 0.914. The Spearman-Brown coefficients and the intraclass correlation coefficients were 0.994, 0.988 and 0.966, 0.933 for VQOL and VSym scores, respectively. For the total quality of life and for several domains the correlations between VEINES-QOL/Sym and SF-36 were high, and significant. Inverse and significant correlations were observed with VCSS. CONCLUSION Conclusively, the Turkish version of VEINSES-QOL/Sym questionnaire is reliable and valid; thus, it is highly recommended to use Turkish version of VEINSES-QOL/Sym to evaluate the quality of life and symptoms of patients with venous insufficiency in Turkey.

Background: In this study, we described the survival rates of patients who underwent myocardial revascularization for acute left main coronary artery occlusion.Methods: Thirty-two consecutive patients who underwent surgical revascularization for acute left main coronary artery occlusion (26 males, 8 females; mean age 62.9 +/- 10.9 years; range 34 to 82 years) were included in this study. The preoperative clinical and demographic variables and postoperative follow-ups were collected retrospectively to detect predictors of outcome and risk-adjusted survival rates of the patients.Results: Early mortality was 37.5% with 12 patients. Early mortality rate was found significantly higher in patients above 65 years of age [OR 4.667 (1.0-21.65)] and patients with retrograde collateralization from the right coronary artery [OR 4.667 (1.01-21.65)]. Female gender [OR 1.889 (0.31-11.34)], diabetes mellitus [OR 2.692 (0.45-15.87)], hypertension [OR 1.615 (0.32-7.98)] and intraaortic balloon pump usage [OR 4.500 (0.67-29.80)] were not found as significant risk factors for early mortality (p>0.05).Conclusion: Although the early mortality rate is high, surgical revascularization is still the standard treatment approach in patients with acute left main coronary artery occlusion. In patients with hemodynamic instability and without good collateral flow from right coronary artery, percutaneous intervention may be performed as a bridge to surgery.

Background: Increased experience and improvements in technology seem to have encouraged the use of percutaneous interventions for left main coronary artery (LMCA) occlusions. There is no consensus, however, and the data are inadequate on whether surgery or percutaneous procedures should be the intervention of choice for critical occlusions.Methods: From January 2002 to December 2006, 108 patients with unprotected LMCA stenosis >80% were treated at our center. Eighty-three patients (77%) underwent bypass grafting and 20 (18%) underwent percutaneous intervention for the purpose of myocardial revascularization. We analyzed parameters demonstrated as risk factors for myocardial revascularization and their predicted effects on outcome.Results: Five patients (5%) died following emergency cardiopulmonary resuscitation before any intervention was performed. The early survival rate was 84.1% in the coronary bypass group and 63% in the percutaneous intervention group. The mean (+/- SD) survival time was 55.7 +/- 2.6 months in the bypass group and 7.6 +/- 1.3 months in the percutaneous group. The late-survival rate was also significantly higher in the bypass group. The mean late-survival time was 44.5 +/- 3.6 months in the bypass group and 2.3 +/- 0.8 months in the percutaneous group.Conclusion: Although emergency percutaneous interventions are lifesaving in some cases, these results clearly demonstrate that coronary bypass grafting should be the intervention of choice for myocardial revascularization in patients with critical LMCA occlusion.

Abstract The objective of this study was to perform a cultural adaptation and define the validity of the Turkish version of the Intermittent Claudication Questionnaire (ICQ) in order to provide a practical instrument for the evaluation of the impact of intermittent claudication (IC) on patients’ quality of life and response to therapy. A standard ‘forward–backward’ translation method was used to translate the questionnaire into Turkish. Reliability was assessed by internal consistency of the questionnaire reporting Cronbach’s α coefficient, test–retest reliability that was assessed with the intraclass correlation between instrument scores over time and with the Spearman–Brown coefficient as a variant of split-half reliability. Validity was examined by correlation of the ICQ with the scores of the SF-36 and its eight domains. Eighty-four patients (mean age, 60.7 ± 7.3 years; male, 57%) were given the ICQ and a final completion rate of 98.8% (83 patients) was reached. The mean total ICQ score was 39.1 ± 21.8 (SD) (0–100) for the first application of the questionnaire. Thirty patients out of the eligible 83 completed the questionnaire at two time points with a 1-day interval. For the retest, the total ICQ score was 40.6 ± 26.1 (4.7–97.2). The total SF-36 score of all the study patients was 33.8 ± 20.7 (3.0–81.0). Cronbach’s α was 0.95; the Spearman–Brown coefficient was 0.92; and the intraclass correlation coefficient for the two measurements was 0.91. For the total score and for the scores of domains except the emotional role domain, the correlations were high and all the correlations were statistically significant. In conclusion, the Turkish version of the ICQ, which is a disease-specific, self-administered, and practical instrument, is reliable and valid. We recommend its use to assess the effect of IC on the quality of life of patients in clinical trials and in daily clinical practice.

OBJECTIVES:Unilateral antegrade cerebral perfusion can be performed with minimal manipulations to arch arteries, but whether it provides adequate brain perfusion remains unclear. Some authors believe that this technique can be inadequate without deep hypothermia. We investigated the reliability of unilateral cerebral perfusion at 22 degrees C hypothermia and the advantages of avoiding deep hypothermia.METHODS:Study participants were 55 patients who underwent surgery with unilateral cerebral perfusion. Patients were divided into 2 groups; 18 patients underwent surgery at 16 degrees C hypothermia (group I) and 37 patients at 22 degrees C hypothermia (group II). The mean age of the patients was 59 +/- 10 years in group I and 55 +/- 14 years in group II. Supracoronary ascending aorta replacement was performed in 25 and hemiarch replacement in 15 patients. Nine patients underwent surgery for a Bentall procedure. Total arch replacement was performed in 4 patients and total thoracic aorta replacement in 2 patients.RESULTS:The hospital mortality was 11% in group I and 5.4% in group II (P = .59). Transient neurologic deficits were not detected in any of the patients. The rate of permanent neurologic deficits was 5.9% in group I and 2.8% in group II (P = .54). Although mean aortic cross-clamp and antegrade cerebral perfusion times were not significantly different, mean cardiopulmonary bypass time was longer in group I than group II (174 +/- 38 vs 142 +/- 37 minutes, P = .005). Postoperative bleeding, blood product usage, serum creatinine and hepatic enzyme level changes, inotrope usage, and arrhythmia occurrence were not different between the 2 groups. Mean mechanical ventilation time was longer in group I than group II (24 +/- 17 vs 16 +/- 6 hours, P = .02).CONCLUSIONS:Unilateral antegrade cerebral perfusion at 22 degrees C systemic hypothermia appears to be safe and reliable for brain protection. Advantages of this technique are avoidance of deep hypothermia and reduced cardiopulmonary bypass and mechanical ventilation times in patients undergoing aortic surgery.

Background: Off-pump coronary surgery is an established method of less invasive cardiac surgery. We compared our early results in patents with 1-vessel disease who underwent surgery with full sternotomy with off-pump coronary artery bypass (OPCAB) or a left anterior minithoracotomy with minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass.Methods: From July 2003 to June 2006, 54 patients with single-vessel disease of the left anterior descending artery who underwent surgery performed by the same surgical team were included in this prospective study. Of these patients, 27 underwent MIDCAB through an anterolateral minithoracotomy, and 27 had OPCAB through a full sternotomy. Patients were selected for the surgical groups on the basis of general condition, anatomical aspects, type of coronary lesions, comorbidities, and patient preferences. Demographic, operative, and postoperative data were collected prospectively.Results: Demographic data, Canadian Cardiovascular Society Classification, and comorbidities were identical for both groups. There were no cases of operative mortality, early graft insufficiency, myocardial infarction, cerebrovascular accident, or conversion to cardiopulmonary bypass in either group. Durations of mechanical ventilation and total hospital stay were shorter in the MIDCAB group, 6.8 +/- 3.0 hours vs 8.3 +/- 1.6 hours and 4.5 +/- 0.7 days vs 5.2 +/- 1.4 days (P=.03 and P=.03), respectively. Atrial fibrillation was seen in 2 patients in each group; all were returned to sinus rhythm by medical therapy.Conclusion: Although MIDCAB grafting is a challenging technique, it may be safely performed on selected patients with low postoperative mortality and morbidity.

T he high-risk potential for neurological dysfunction following coronary artery bypass grafting (CABG) in patients with concomitant carotid stenosis has always been a challenge. Many surgeons advocate combined CABG with carotid endarterectomy (CEA). However, clinical experience with the concomitant approach is conflicting. 1 Patients with bilaterally diseased carotid artery have a more challenging group. Sixty-five patients underwent both CABG and unilateral CEA (group I) or isolated CABG (group II) was enrolled for this study at Siyami Ersek Thoracic and Cardiovascular Surgery. This retrospective study was initiated with the approval of the institutional review board. All patients had severe bilateral carotid artery disease (CAD) defined as a 50-99% stenosis in conjunction with a >50% stenosis or occlusion in the contralateral carotid artery. Demographic characteristics were comparable between 2 groups. Only a small group of patients (15.5%) had symptomatic carotid artery disease in the whole group. All patients scheduled for CABG underwent carotid color-flow duplex ultrasound examination when a history of transient ischemic attacks, cerebral vascular accidents was present or asymptomatic bruits on physical examination or with an age of >65 years. We excluded patients with previous CABG, concomitant valve replacement, and any other associated procedure or lesions in external carotid artery. We performed CEA procedures either with locoregional anesthesia (6 cases) or general anesthesia (24 cases). The side with symptoms or greater stenosis was generally performed first. We used intraoperative caroted shunt in 2 patients and carotid patch in 2. Coronary artery bypass grafting was performed after completion of the carotid operation. Cerebral protection for our patients during cardiopulmonary bypass included hypothermia and high perfusion flows and pressures. Intermittent tepid blood cardioplegic arrest was primarily used for myocardial protection. Proximal anastomoses were performed during partial aortic cross clamp period. Operative and postoperative data are given in Table 1. There were 2 deaths (5.7%) and no stroke in group II and 2 deaths (6.6%) and 4 strokes (13.3%) in group I (p=0.87 and p=0.026). Both deaths in group I were cardiac related. One patient died on the 4th postoperative day due to cardiac arrest and the second died due to low cardiac output syndrome on the 8th postoperative day. Two patients in group II died on the 8th and 34th day postoperative due to multiorgan failure and both patients had neurological and cardiac related complications. Three out of 4 strokes in group I emerged in the early postoperatvie awakening period. The fourth …

The relationship between angiotensin-converting enzyme (ACE) gene polymorphism and type I aortic dissection was examined in 205 unrelated hypertensives. A total of 94 patients underwent emergency repair due to type I aortic dissection, confirmed by computed tomography, and the remaining 111 were controls. Polymerase chain reaction was used to confirm that ACE gene polymorphism was due to insertion (I) or deletion (D) of a 287 base pair (bp) DNA sequence within intron 16. The genotype distribution and allele frequency of ACE I/D polymorphism between patients and controls were not statistically significant. When the frequency of at least one D allele carrier (DD or ID genotype) was compared with the II homozygous genotype, there was also no significant difference between the study groups. The findings revealed no association between ACE I/D polymorphism and aortic dissection. We conclude that I/D mutation of the ACE gene does not seem to be a risk factor for aortic dissection.

Objective: Posterior ventricular rupture is a rare and fatal complication of mitral valve surgery. This study is designed to define the risk factors for left ventricular rupture after mitral valve replacement and, especially, to find out if posterior leaflet preservation is protective for posterior ventricular rupture. Methods: Between January 1996 and March 2007, 2560 patients underwent mitral valve replacement operation in our hospital. Risk factors for posterior ventricular rupture were studied with chi(2), and logistic regression analysis. Results: The surgery was complicated with posterior ventricular rupture in 23 (0.8%) of 2560 patients. Nineteen patients (82.6%) were female, four patients (17.4%) were mate. Mean age of the patients in this group was 60 +/- 10. Mortality rate of the patients with posterior ventricular rupture was 86% (20 patients). Twelve patients with posterior ventricular rupture were at the age of 60 and older. Age of 60 and above was found as a highly significant risk factor for posterior ventricular rupture (OR 4.53, 95% Cl 1.98-10.38, p < 0.001). Posterior leaflet was preserved in 513 patients (20%) and posterior ventricular rupture did not occur in these patients. Resection of posterior leaflet was also found as a highly significant risk factor (p = 0.008) for posterior ventricular rupture. Reoperation was performed in 372 patients and posterior ventricular rupture occurred in 7 of them. Reoperation was also found as a significant risk factor (OR 2.563, 95% Cl 1.03-6.34, p = 0.042) for posterior ventricular rupture. Conclusions: Extreme annular traction and aggressive decalcification should be avoided during mitral valve resection. Posterior leaflet of the mitral. valve should be preserved, especially in the older age group to prevent posterior ventricular rupture. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Open repair is considered the first choice for the treatment of chronic aortic transection. These patients are usually very young and they have a low risk of mortality and morbidity for surgery. However, spinal cord injury and local complications such as phrenic nerve injury and lung lacerations are still major problems in open repair, while they are very uncommon in endovascular repair. Additionally, the mid-term results of endovascular repair for aortic transections are excellent. In this paper, we present three patients with chronic transection who were treated with endovascular repair. Patients were evaluated by CT scan and were appropriate candidates for endovascular repair. Vailant thoracic endografts were used and a technically successful repair was achieved in all patients. Mid-term follow-up has been completed and there is no evidence of endoleak or stent graft migration. In conclusion, we recommend endovascular repair for chronic aortic transection in anatomically suitable patients. The long-term results will demonstrate whether it is a definitive treatment or not.