Erkan Kuralay

The injury of Brachiocephalic arteries due to thyroid fine needle aspiration biopsy is rare. Carotid artery dissection after thyroid fine needle aspiration biopsy was reported in limited numbers in the current literature. We present localized common carotid artery dissection just above the carotid-subclavian bifurcation. Our case report concerns the proper standard carotid artery dissection after the fine needle aspiration biopsy procedure.

Objective Antegrade cardioplegia may cause maldistribution in patients with multivessel coronary artery disease. Surgically bypassing large epicardial vessels before the cross-clamp and then administering cardioplegia from both the aortic root and the anastomosed grafts significantly prevent maldistribution and provide better cardiac protection. Methods This study included 80 patients, all older than 70 years with an ejection fraction between 25 and 35%. Patients were equally divided into two groups. Distal anastomoses to some of large epicardial coronary arteries were performed before the cross-clamp was placed. Grafted veins were attached to multi-perfusion set ports. Then, cross-clamping was performed, and the multi-perfusion set was disconnected from the aortic cannula and attached to the cardioplegia route. Antegrade cardioplegia was administered to both the aortic root and saphenous vein grafts. After all distal anastomoses were completed, the cross-clamp was removed, and the multi-perfusion set was connected to the aortic cannula again. Conventional coronary bypass techniques were used in group 2 patients. Results Inotropic agents were administered in 12 patients in group 1 and 29 patients in group 2 (p < 0.001). The average troponin I value in coronary sinus blood was 1.05 ± 0.8 ng/mL in group 1 and 3.12 ± 0.7 ng/mL in group 2 (p < 0.001). The average lactate value in coronary sinus blood was 1.15 ± 0.55 mmol/L in group 1 and 3.7 ± 2.4 mmol/L in group 2 (p < 0.001). Six patients died in the early postoperative period in group 2 (p = 0.028). Conclusion The current technique considerably reduces cross-clamping time and allows better distribution of the cardioplegic solution, preserving myocardium. Reduced coronary sinus lactate and troponin I levels also indicate better myocardial protection.

Proximal circumflex coronary artery in the atrioventricular groove usually has large diameters. Arterial diameters in this region vary from 2.5 to 5 mm. Revascularization of this part of the circumflex artery allows good distal anastomosis configuration and better long-term patency rate.

Background: Right ventricle (RV) dysfunction after a coronary artery bypass grafting procedure is a challenge that adversely affects RV filling pressure and contraction. This study sought to determine whether additional bypass of an RV branch would lessen RV dysfunction. Methods: Patients with severe right coronary artery (RCA) stenosis were divided into 2 groups. Group 1 patients (n = 50) had a single distal bypass on the RCA. Group 2 patients (n = 50) had both distal RCA and additional bypass on the RV branch of the RCA. Right ventricular function was examined by echocardiogram by measuring transannular plane systolic excursion, fractional area change, tissue Doppler S-wave velocity, and inferior vena cava diameter. Results: Transannular plane systolic excursion and fractional area change measurements rapidly decreased below the cutoff in both groups, but group 2 patient values reached normal limits at 90 days. Tissue Doppler S-wave velocity reached the normal limit in 7 days. Inotropic agents were required in 11 patients in group 1 and 2 patients in group 2 (P = .013). The mean (SD) intensive care unit stay was 2.11 (1.12) days and 1.45 (0.71) days (P = .033), and the hospital stay was 7.32 (1.44) days and 6.22 (0.45) days in groups 1 and 2, respectively (P = .027). Conclusion: The data in this study suggest that an additional graft on the RV branch of the RCA (eg, conus, marginal, any good runoff vessels on the RV) prevents severe RV dysfunction and allows for rapid recovery of RV dysfunction after off-pump coronary surgery.

Mitral annuloplasty is an integral part of mitral valve repair. Several types of techniques have been described for mitral annuloplasty. The autologous pericardium is used for mitral annuloplasty to allow mitral annular flexibility. Complete mitral ring annuloplasty is done using a D-shaped bovine pericardium. Classical annuloplasty sizers are utilized for the sizing and shaping of bovine pericardium. Biological material covers all parts of the mitral annulus and allows annular flexibility.

In this article, we present two cases with mesenteric ischemia. Both patients had three occluded splanchnic arteries. Superior mesenteric artery and celiac artery were revascularized antegradely by using bifurcated Dacron® grafts. The main body of the bifurcated graft (7/14) was anastomosed to the supraceliac abdominal aorta. Then, the small branch of the grafts was anastomosed to the common hepatic artery or celiac artery. Superior mesenteric artery part of the Dacron® grafts was passed behind the pancreas and anastomosed to the superior mesenteric artery in an end-to-side fashion by using the Taylor patch technique. Inferior mesenteric artery was mobilized in both patients and anastomosed to the left iliac artery in an end-to-side fashion.

Aortic valve endocarditis may be destructive and cause an acquired Gerbode-type defect. The use of biological material in the closure of the Gerbode defect and reconstruction of the aortic valve is essential for both early and long-term survival. Herein, we present a 62-year-old male patient whose Gerbode defect was repaired with bovine pericardium. Additionally, the aortic valve was reconstructed by using bovine pericardium with Ozaki neocuspidization technique.

Clamp-induced internal carotid artery dissection can develop during carotid endarterectomy surgery. If it is not noticed, serious complications such as acute occlusion of the carotid artery in the early period and false aneurysm formation in the late period may develop. Inadequate back-flow and circumferential halo around the distal internal carotid artery may the predictor of injury during carotid artery surgery.

Aim: Emergency conversion to on-pump during coronary surgery is known to increase morbidity and mortality in patients undergoing off-pump coronary surgery. We aimed to investigate the relation between the anatomical position of the heart and the incidence of conversion to on-pump coronary surgery. Material and Methods: Four hundred patients, who underwent off-pump three-vessel coronary surgery during June 2010 and February 2020. The angle between the left anterior descending (LAD) artery and the left arm of the sternal retractor was used to identify the anatomical position of the heart intraoperatively after pericardiotomy. Patients were categorized as having either transvers (Position Angle> 45°, n:200) or vertical (Position Angle <45°, n:200) heart. Results: The conversion rate was 8.75% (35/400) in our study. Thirty-three of patients with transverse heart patients converted to on-pump surgery (16.5%), whereas the two patients(1%) in patients with vertical heart. The length of intensive care unit stay was longer in patients with conversion compared to the patients with no conversion (3.17±1.10 days and 1.11±0.11 days, respectively) (p=0.001). Inotropic support and blood transfusion requirements were higher in converted patients. The mortality rate was 14.2% in converted patients while non-converted patients had no mortality (p<0.001). Conclusion: Conversion from off to on-pump during coronary surgery may cause high incidence of morbidity and mortality. Probable causes responsible for conversion should be predicted before making a decision for off-pump surgery. Anatomically transverse position of the heart may be considered as a potential predictor of conversion.