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Biomedical subjects

I Pasaoglu

Publications and source records attributed to I Pasaoglu.

16 recordsLinked to original sources
PubMed2003

A very rare anatomic variation of the left brachiocephalic vein: left retro-aortic brachiocephalic vein with tetralogy of Fallot.

An anomalous course of the left brachiocephalic vein behind the aortic arch was identified in a patient with tetralogy of Fallot. A 6-year-old male patient had been admitted to the hospital with a diagnosis of tetralogy of Fallot and patent foramen ovale. At the beginning of the operation the left brachiocephalic vein could not be found. The pericardium was opened longitudinally and there was no persistent left superior vena cava. After careful examination, the left brachiocephalic vein was found behind the aorta. Especially during open heart surgery this pathology is very important. We conclude that when the left brachiocephalic vein can not be found, the possibility of persistent left superior vena cava and retro-aortic left brachiocephalic vein should be borne in mind.

Aorta, Thoracic↗
PubMed2001

Effect of cardiopulmonary bypass on plasma levels of lipoprotein (a) in hypercholesterolemic patients.

Increments of lipoprotein (a) (Lp (a)) concentration during cardiopulmonary bypass (CPB) have not been justified in the literature yet. We have investigated whether Lp (a) levels remain constant or increase during CPB and if high plasma levels of low density lipoprotein (LDL; containing apolipoprotein (apo) B) in hypercholesterolemic patients affect the assembly of Lp (a) (containing apoB: Apo (a)). In this study, the change in plasma lipid and lipoprotein levels of 40 patients with hypercholesterolemia and 40 patients who have normal cholesterol values were determined and compared during CPB, and in the postoperative early stage. In our study, lipid and lipoproteins, except Lp (a), showed a falling trend and paradoxically, Lp (a) statistically showed a significant rising trend, like the acute phase reactant in two groups (p=0.011 for LDL, p=0.016 for high density lipoprotein (HDL) and p<0.001 for the others, in 80 patients). Concentrations of Lp (a) in plasma increased more sharply in the hypercholesterolemic group than the normocholesterolemic group during CPB. This difference was significant at the 60th minute of cardiopulmonary bypass with a nonparametric test (p<0.05 Mann-Whitney U test). High density lipoprotein values showed more decline in the hypercholesterolemic group patients than in the normocholesterolemic group patients (p<0.05). In conclusion, lipoprotein (a) levels increased more pronounced in patients with hypercholesterolemia during CPB. On the other hand, high LDL levels in hypercholesterolemic patients accelerated Lp(a)formation in the acute phase.

Acute-Phase Proteins↗
PubMed2000

Isolated cardiac metastasis of osteosarcoma.

Osteosarcoma metastasis to the heart caused by tumor thrombosis is very rare. A 7-year-old girl with an osteosarcoma of the right humerus, refused the treatment, at first, then, 1 year later, referred to the hospital with metastasis to the heart. The mass invading the pulmonary arteries was successfully removed with open-heart surgery.

Biopsy, Needle↗
PubMed1995

Coarctation of the aorta in infants and neonates: results and assessment of prognostic variables.

From 1984 until 1994, 75 consecutive patients younger than 12 months of age were operated on for coarctation of the aorta. We retrospectively analyzed predictive factors for morbidity and mortality, and also interaction between surgical procedures and recoarctation. Surgical procedures were as follows: resection with a traditional end-to-end (E-E) anastomosis in 55 patients (73.3%), prosthetic patch aortoplasty (PPA) in 12 patients (16%) and subclavian flap aortoplasty (SFA) in 8 patients (10.7%). Early mortality was 9.33% (7 patients). Logistic regression analysis proved that age at operation, associated anomalies of heart, type of coarctation, aortic arch hypoplasia and pulmonary banding were independent predictors of hospital death. Late mortality occurred in 7 patients (10.3%). Associated anomalies of heart were an independent prognostic factor for late mortality. Actuarial freedom from recoarctation at 1 year was 91% [confidence limits (CL): 82% to 97%] and 5 years were 74% (CL: 67% to 86%). Immediate postrepair gradient was equal after E-E anastomosis and other procedures. We conclude that the treatment of first choice in the management of coarctation of the aorta in infants is E-E anastomosis.

Aortic Coarctation↗
PubMed1993

Changes in the circulating endothelin and atrial natriuretic peptide levels during coronary artery bypass surgery.

To evaluate the behavior of circulating endothelin and atrial natriuretic peptide (ANP) during coronary artery bypass graft (CABG) surgery, blood samples from patients with coronary artery disease (n = 8) were investigated before, during and after operation. Plasma levels of endothelin and ANP were determined using the radioimmunoassay method. Baseline plasma levels were compared to those of normal volunteers (n = 6). Left ventricular function at rest and as a response to isometric exercise was evaluated using radionuclide ventriculography before and after coronary bypass surgery. The mean endothelin value was found to be within normal limits, however the mean ANP value was slightly higher than control. Patients had significantly improved left ventricular systolic and diastolic function after surgery. The mean endothelin level was higher than initial values immediately after extra-corporeal circulation and returned to initial values in two hours. However, ANP values were increased and remained higher than initial values. Baseline endothelin values were negatively correlated with systolic function parameters, whereas endothelin and heart rate had a positive correlation before extra-corporeal circulation. Coronary artery bypass graft surgery may cause an increase in the circulating endothelin level either due to endothelial injury or due to myocardial ischemia and hypothermia. Following surgery, increased endothelin levels returned to normal values immediately.

Aldosterone↗
PubMed1990

Detection of right-sided endocarditis in children with congenital heart disease by two-dimensional echocardiography.

Right-sided endocarditis is rare in children. Since the clinical picture is nonspecific and the frequency of sterile blood cultures is high, the clinical and laboratory diagnosis is difficult. Recent reports suggest that echocardiography is a useful method to detect the presence of right-sided endocarditis. We studied 8 patients with congenital heart disease and right-sided endocarditis detected by two-dimensional echocardiography. All the patients were shown to have one or more vegetations in the two-dimensional echocardiographic examination. The 4 patients who did not respond to antibiotic therapy underwent elective cardiac surgery. One of these patients additionally had recurrent emboli to the lungs. Another of these 4 patients died during surgery due to myocardial failure. Apart from these 4 cases, urgent surgical intervention had to be carried out in 2 cases because of very large vegetative masses. Surgical confirmation of the diagnosis was available in all 6 cases. According to these results, we can conclude that two-dimensional echocardiography assumes a specific diagnostic role in cases with right-sided endocarditis.

Child↗
PubMed1990

Myocardial metabolism during fixed-rate pulsatile left ventricular bypass.

Fixed-rate pulsatile cardiopulmonary bypass may improve subendocardial perfusion during ventricular fibrillation and has been employed during intermittent aortic cross-clamping. Variable-rate pulsatile left heart bypass that is governed by venous inflow and is asynchronous to the electrical activity of the heart is currently used in clinical practice. To study the effect of fixed-rate pulsation on myocardial metabolism during left heart bypass, six adult pigs underwent alternating periods of pulsatile (PLS) and nonpulsatile (NPLS) centrifugal pump left atrial-to-aortic bypass in randomized block design. Coronary sinus, aortic, and bypass circuit flows were recorded. Oxygen content and lactate concentration of coronary sinus and aortic blood were measured. Pulsatility index and pulse power index during pulsatile bypass were 4.4 and 4.7 (cycles/s)2, respectively. Percent bypass was maximal at a mean pulsation rate of 41.3 and averaged 92.2 and 91.3 for PLS and NPLS, respectively. Myocardial oxygen consumption per minute was reduced 14.3% during NPLS but was unchanged during PLS compared to control (CTRL). Percent lactate extraction was significantly lower than CTRL during NPLS only. Competition for inflow with the ejecting heart appeared to limit circuit pulsation rate and pulse power index. Fixed-rate pulsation is ineffective in reducing myocardial metabolism and should be avoided in left heart bypass.

Animals↗
PubMed1988

Quantitation of absolute flow in coronary artery bypass grafts using digital subtraction angiography.

Coronary angiography defines the location and size of obstructive lesions, but does not assess their physiological significance. To assess a new method to measure the blood-flow waveform, reversed saphenous vein grafts from the left subclavian artery to the left anterior descending coronary artery were placed in five mongrel dogs. Contrast material was injected selectively into the vein graft while obtaining fluoroscopic images from AP and 45 degrees LAO projections. Blood flow was measured under baseline, low-flow, and hyperemic conditions using an electromagnetic flow probe (EM). Seventeen radiographic determinations of mean blood flow (range 18-130 ml/min) were linearly correlated to simultaneous EM measurements (r = 0.91 and 0.88, respectively). Contrast material injections changed EM flow measurements by an average of 35%, which though large, is less than with other radiographic methods. The computed blood-flow waveforms had a time resolution of 1/30 sec and were in good agreement with EM waveforms measured simultaneously. Clinical application of this radiographic method for determining the blood-flow waveform may allow early prediction of coronary artery bypass graft closure.

Angiography↗
PubMedDate not supplied

Atrial fibrillation after coronary artery bypass surgery: predictors and the role of MgSO4 replacement.

BACKGROUND: Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. The aim of the study was to identify factors associated with atrial fibrillation (AF) and to determine the efficacy of postoperative magnesium sulphate (MgSO4) replacement on the incidence of AF after coronary artery bypass grafting (CABG) operation. METHODS: Fifty patients undergoing CABG were studied prospectively. Consenting patients with good left ventricular function and without any documented arrhythmias were randomly divided into two groups of 25 patients each in a double-blind fashion. The clinical characteristics of both groups were similar. In the study group, 200 mEq MgSO4 was given for the first 5 postoperative days, in the control group, placebo was given instead of MgSO4. RESULTS: Five (20%) patients in the control group and one (4%) patient in the MgSO4 group experienced AF. There was no significant relationship between the development of AF and the following variables: age; sex; diabetes mellitus; hypertension; previous myocardial infarction; smoking; extension of coronary artery disease; aortic cross-clamp time; number of grafts; cardiopulmonary bypass time; postoperative pericarditis; and anemia. CONCLUSION: The use of MgSO4 in early postoperative period is effective in reducing the incidence of AF after CABG in patients with good ventricular function.

Atrial Fibrillation↗
PubMedDate not supplied

Improved heart preservation with UW preservation solution.

Despite the good clinical results obtained with the current heart preservation techniques, these methods need to be improved. The UW solution has provided excellent preservation for the pancreas, kidney, and liver after extended cold ischemic storage times. We have tested the ability of the UW solution to store hearts for 5 and 12 hours and compared the results with those obtained from hearts preserved by either Stanford or modified Collins' solutions. Three groups of five canine hearts each underwent 5 hours, and three groups of five canine hearts underwent 12 hours of ischemia at 4 degrees C. Then the hearts were reperfused in an isolated working canine heart preparation. Those hearts preserved for 5 hours had nearly normal ventricular function and adenosine triphosphate contents and were able to maintain normal tissue electrolyte concentration and water contents. After 12 hours of storage time only adenosine triphosphate contents were similar among the groups. Hearts preserved with the UW solution rapidly recovered, reaching nearly normal left ventricular function by 60 minutes of reperfusion; hearts preserved by the modified Collins' solution recovered more slowly, but function was good after 120 minutes of reperfusion. Hearts preserved by the Stanford solution never attained adequate function. The three groups of hearts preserved for 12 hours did not differ in their ability to utilize lactate or in their rates of oxygen utilization. Tissue water and sodium contents were considerably lower in the hearts preserved with the UW solution after 150 minutes of reperfusion compared with hearts stored in the modified Collins' or Stanford solutions. Hearts stored 12 hours in the UW solution under cold ischemic conditions recovered left ventricular function rapidly after reperfusion with normal blood, utilized lactate and oxygen at normal rates, and were able to regulate tissue water and sodium contents to nearly normal levels. Because of the superior preservation obtained by the UW solution, the solution deserves further evaluation for possible future use in clinical heart transplant programs.

Adenine Nucleotides↗
PubMedDate not supplied

Significance of the whole blood activated clotting time in cardiopulmonary bypass.

Recent publications have described a poor correlation between whole blood activated clotting time (WBACT) values and plasma heparin levels during cardiopulmonary bypass (CPB). A prospective, controlled study was undertaken to investigate the variables which may influence the WBACT in this situation. Antithrombin III levels over a range of 35-93 u/dl did not influence either the WBACT value or plasma heparin level. However, reduced platelet function following infusion of prostacyclin (10 ng/kg/min prior to CPB and 20 ng/kg/min thereafter); platelet number (range 63-287 X 10(9)/l) and packed cell volume (range 16-30%) were found to correlate with the WBACT. It is concluded that in addition to the circulating plasma heparin level, the wide variations in platelet number, platelet function and packed cell volume which are frequently observed during cardiopulmonary bypass may also influence the WBACT value.

Adult↗
PubMedDate not supplied

The incidence and management of coronary ostial stenosis.

Coronary ostial stenosis in the absence of more peripheral coronary artery disease was present in four patients (0.093%) of 4298 angiograms performed on patients with coronary artery disease. Case reports of four patients undergoing coronary artery bypass graft surgery for isolated coronary ostial stenosis are presented and surgical techniques discussed. Three patients were young females (mean age 31 years). It is suggested that coronary ostial stenosis is a rare variant of coronary artery disease, more common in young women.

Adult↗
PubMedDate not supplied

A simple management of mediastinitis.

Between January 1, 1986 and December 31, 1993, 6940 open heart procedures were performed via median sternotomy at Hacettepe University Medical Center. Mediastinitis developed in 55 patients (0.79%). Twenty-four were children. All were reoperated for treatment of mediastinitis. Following radical debridment 17 were irrigated with dilute povidone-iodine solution after primary reclosure (Group A), the remaining 38 were simply reclosed while leaving just drains in the mediastinum (Group B). Hospital mortality was 17.65% in Group A and 15.79% in Group B. Time of hospitalization after treatment in living patients was 17.6 days in Group A and 16.3 days in Group B. A mortality of 15.79% is an acceptable result which shows early radical debridment and drainage of the mediastinum is the most important cornerstone of the treatment of mediastinitis and is mostly enough with proper systemic antibiotic therapy.

Adolescent↗