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AIM: To determine the association of monocyte count-to-high-density lipoprotein (HDL)-cholesterol ratio, a recently emerged inflammatory marker, with abdominal aortic aneurysm (AAA) size. PATIENTS & METHODS: A total of 120 asymptomatic AAA subjects (99 male, mean age: 67.1 ± 10.2 years) were enrolled into the study. All data were compared between patients with low and high admission monocyte/HDL ratio. Multivariate linear regression analysis was performed to study the relationship between different variables and AAA size. RESULTS: Compared to patients with below-median monocyte/HDL ratio, aneurysm diameter was significantly higher in above-median monocyte/HDL ratio group (54.3 ± 10.6 mm vs 62.0 ± 12.4 mm, p < 0.001, respectively). Hypertension, coronary artery disease, monocyte/HDL ratio and C-reactive protein were independently associated with AAA diameter. CONCLUSION: Monocyte/HDL ratio is independently associated with AAA size.

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OBJECTIVE: The aim of this study was to examine the effects of positive inotropic drugs, including adrenaline, dopamine, and dobutamine on thyroid hormone levels following open heart surgery. METHODS: We analyzed free thyroid hormones (FT3 and FT4) and thyroid-stimulating hormones (TSH) in 200 consecutive patients undergoing open heart surgery. Patients were divided into 5 groups according to the inotropic drug administration as follows: Group A (n = 46) received dopamine alone; Group B (n = 40), dopamine and dobutamine; Group C (n = 36), dopamine, dobutamine, and adrenaline; Group D (n = 32), adrenaline alone; and Group E (n = 46), placebo. Procedural factors affecting thyroid hormones were recorded and included cardiopulmonary bypass (CPB) time, cross-clamping time, degree of hypothermia, and the duration and doses of positive inotropic drugs. Blood samples for hormone assays were collected before initiation of inotropic drug therapy (baseline) and postoperatively at 24, 72, and 120 hours after drug therapy. RESULTS: FT3, FT4, and TSH levels at baseline were similar in all groups. Although there was a trend showing very slight increases in thyroid hormone levels from baseline to the 24th, 72nd, and 120th postoperative hours after drug therapy, these changes were not significant, and there were also no significant differences between the groups. There was also no significant statistical difference in CPB time, cross-clamping time, degree of hypothermia, and duration and doses of positive inotropic drugs between groups. CONCLUSION: Although thyroid hormone levels were affected by positive inotropic drug usage after open heart surgery, this effect was not significant and thyroid hormone levels remained within normal ranges.

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Pulmonary endarterectomy is the treatment of choice in suitable patients who have chronic thromboembolic pulmonary hypertension. The most common surgical technique involves the use of deep hypothermic circulatory arrest. Herein, we describe a modified aortic clamping technique with selective antegrade cerebral perfusion, performed with moderate hypothermia but without circulatory arrest. This technique avoids the adverse effects of deep hypothermic circulatory arrest and also establishes a bloodless surgical field. We achieved good surgical results and acceptable long-term outcomes in 3 patients with use of this technique, which we recommend as a feasible alternative to the standard operative practice.

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Many mechanical complications associated with insertion, maintenance, and removal of the hemodialysis catheters have been reported in the literature. A 47-year-old man was consulted to our hospital because of an entrapped hemodialysis catheter guidewire. Computed tomographic scan revealed that the right subclavian vein was perforated by the guidewire and the wire was knotted over itself, one loop inside the vein and two loops in the extravascular site. Guidewire is pulled out from a 3-cm incision over the wire loops lateral to the right sternocleidomastoid muscle. He was discharged home on postoperative day 2 without any complication. Our suggestion is that any abnormal resistance should be immediately evaluated for the presence of any potential knots using the most appropriate imaging technique.

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We describe a simple method to repair anterior mitral leaflets with elongated chordae, using chordal shortening and transfer techniques on the same segment. With this method, optimal elongated chordae shortening is determined easily, and shortened chordae are supported by the transferred chordae.

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PURPOSE: To investigate the diagnostic accuracy and limitations of 16-slice multidetector computed tomography (MDCT) in the detection of significant ( > 50%) stenosis of coronary artery bypass grafts (CABG) and native coronary arteries. MATERIALS AND METHODS: One hundred two patients with 236 grafts were investigated by 16-slice MDCT. Native coronary arteries were also investigated. The image quality was assessed in terms of artifact, and the evaluable segments were screened for the presence of occlusion and significant ( > 50%) stenosis. MDCT results were compared with conventional coronary angiography. RESULTS: The evaluability of MDCT was 90.4% for CABG and 71.2% for native coronary arteries. The most frequent causes of nonevaluable segments were motion artifact in venous grafts, metallic clip artifact in arterial grafts, and severe calcification in native coronary arteries. MDCT correctly diagnosed all of the 46 occluded grafts. The sensitivity, specificity, and the positive and negative predictive value of MDCT for the detection of significant CABG stenoses were 91.4%, 98.5%, 84.2%, and 99.2%, respectively. Including nonevaluable segments in the analysis, overall sensitivity was 84.2%. For the evaluation of native coronary arteries, MDCT had a sensitivity of 82.1% and a specificity of 75.3%, but evaluability was only 71.2%, resulting in overall sensitivity of 62.1%. CONCLUSION: Use of 16-slice MDCT angiography allows very accurate evaluation of CABG patency and has high diagnostic accuracy in detecting graft stenoses. But evaluation of native coronary artery stenosis is limited, particularly in patients with advanced coronary artery disease with severe calcification.

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The hammock mitral valve is a rare congenital abnormality resulting in mitral regurgitation or stenosis, with incidences ranging from 0% to 12% in pediatric surgical series. It is difficult to correct this condition by reconstructive techniques. We describe here an alone hammock valve without any cardiac malformation in a five-year-old patient who underwent mitral valve replacement.

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BACKGROUND: To evaluate whether ambroxol administered orally during the perioperative period has a protective effect against postoperative pulmonary dysfunction in on-pump coronary artery bypass surgery. METHODS: Fifty younger patients without known pulmonary disease were randomly assigned into 2 groups. In ambroxol group (n = 25), patients were given ambroxol for a week before and after the elective coronary artery bypass grafting. In control group (n = 25), placebo was given. Groups were compared with respect to pulmonary function tests (PFTs), lecithin/sphingomyelin (L/S) ratio in the bronchoalveolar lavage fluid, arterial blood gases, and incidence of perioperative morbidity. PFTs were performed before medication and repeated on the postoperative seventh day. Bronchoalveolar lavage fluid was obtained just before cardiopulmonary bypass and within the first postoperative hour. Room air arterial blood gases were checked before and 2 days after the operation. RESULTS: Postoperative lecithin/sphingomyelins were significantly lower than the preoperative values in both groups, but differences between the groups in either preoperative or postoperative measurements were not significant. Although preoperative PaO2 in both groups was similar, it was significantly lower in control group on postoperative second day (62.4 +/- 7.1 vs. 55.2 +/- 6.4 mm Hg, P < 0.05). In either groups, postoperative forced vital capacity and forced expiratory volume in 1 second were significantly lower than preoperative values with a more prominent decrease in control group. Perioperative morbidity was similar. CONCLUSIONS: In on-pump coronary artery bypass grafting, ambroxol improves postoperative PFTs and PaO2 levels without any significant clinical implication, and it exerts these effects possibly in ways other than surfactant modulation.

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Substernal goiter can cause extrathoracic upper airway obstruction. Since cardiopulmonary bypass results in a systemic inflammatory response syndrome characterized by an increase in capillary permeability and edematous changes in many tissues including the thyroid gland, an existing nonobstructive substernal goiter may become obstructive postoperatively. We describe the case of a patient with an asymptomatic substernal goiter who required urgent thyroidectomy for tracheal obstruction after elective coronary artery bypass grafting. To the best of our knowledge, ours is the 1st such case reported in the English-language medical literature. This case illustrates that, in cases of acute postoperative respiratory failure after open heart surgery, tracheal obstruction caused by enlarged substernal goiter should be considered in the differential diagnosis.

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BACKGROUND: Inflammation plays a pivotal role in the pathogenesis of organ dysfunction after cardiopulmonary bypass (CPB). The aim of this study was to investigate whether pentoxifylline (PTX) has effects on the inflammatory process and leukocytes in cardiac surgery patients undergoing CPB. MATERIAL AND METHODS: A double-blind, prospective, randomized, placebo-controlled study was undertaken to assess the effect of PTX on leukocyte counts, tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and C-reactive protein (CRP) levels in 60 patients undergoing CPB for elective coronary artery bypass grafting. In 30 patients, 200 mg of PTX was added to 500 mL NaCl and perfused for 180 min after induction of anaesthesia and also 100 mg of PTX was added to the warm cardioplegic solution; another 30 patients received saline solution as placebo. RESULTS: All measurements were performed before PTX infusion (T0), after induction of anaesthesia (T1), 30 min after weaning from CPB (T2), and 6 hours (T3) and 24 hours postoperatively (T4). PTX did not change the percentage of eosinophils, basophils, neutrophils, monocytes, or lymphocytes, or CRP levels. In the control group, however, total leukocyte count and IL-6 level at T3 and T4 period were significantly higher than the study group. The progressive increment in TNF-alpha level observed at each period was also significantly prominent in the control group. CONCLUSION: CPB-related whole body inflammatory response could be partially inhibited by intraoperative PTX administration. This effect of PTX would be helpful in preventing the well-known complications of CPB-induced systemic inflammation.

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