Objective: Minimally invasive direct coronary artery bypass (MIDCAB) for revascularization of the left anterior descending artery has become a routine operation. We present our clinical experiences with beating heart MIDCAB surgery performed through partial lower sternotomy (PLS) and retrospectively compare the results of pain perception as well as activities of daily life (ADL) with the conventional full sternotomy. Methods: From January 2009 to August 2012, 197 patients underwent MIDCAB using modified PLS at our hospital. Their mean age was 58.5±10.5 years. 54 (28%) had previous myocardial infarction, 38 (19%) had diabetes mellitus. The visual analog scale (VAS) for pain one, two and three, the ADL score for mobilization were obtained within four days after surgery. 98% of patients were followed-up with both direct visits and questionnaires to assess the major adverse cardiac events (MACE). We performed t-test for comperative data and Kaplan-Meier curves for survival analysis.Results: There was one postoperative death (0.5%) and three conversions to full sternotomy (1.5%). Postoperative angiography was performed in 34 (17.2%) patients, who had some symptoms during the follow-up period of 45 months. The graft patency rate was 96.5% (190 of 197). At follow-up (24.1±11.7 months), survival free of MACE was 91.8±3.1% at 3.5 years. Both the Visual Analog Scale (VAS 35.1±9.6 vs. 57.1±7.8) and the ADL score (80.4±11.8 vs. 36.2±8.6) were significantly higher after the operation in comparison to the matched group of beating heart revascularizations with full sternotomy (p<0.001). Conclusion: This study demonstrates that the MIDCAB using PLS can achieve an effective intermediate-term revascularization and an acceptable clinical outcome. Patients who undergo this procedure are free of major complications and enjoy good quality of life after surgery.

Cystic echinococcosis is an endemic parasitic infestation caused by the larval stage of Echinococcus granulosus. Although infestation of any part of human body can occur, isolated cardiac involvement is uncommon. We present a case of isolated hydatidosis involving the ascending aorta.

A 70-year-old male known with myelodysplastic syndrome (MDS) was admitted with effort angina and fever, which developed into unstable angina. On coronary angiography a critical stenosis of the left main coronary artery and 75% stenosis of the right coronary artery were found. On complete blood count the number of leukocytes was 1600/µl. We administered granulocyte colony-stimulating factor (G-CSF) twice daily to increase the number of leucocytes. After two days the number of leukocytes had increased to 8700/µl. The patient was admitted to the operating room and off-pump coronary artery bypass grafting was performed successfully.

No abstract

Tedavide, aynı seansta sol ana karotid arter bifürkasyonundan sol internal karotid artere uzanan endarterektomi ve 8 mm ringli greft kullanılarak sol karotikosubklavyen baypas yapıldı. Hasta ameliyattan sonra problemsiz olarak dördüncü gün taburcu edildi.Spinning Wheels (çıkrık) sendromu, koroner subklavyen çalma sendromunun değişik bir formu olarak farklı anatomik görünümlerde karşımıza çıkabilir. Proksimal subklavyen arter darlığı ve KABG'nin birlikte bulunması nadir olmasına rağmen, KABG planlanan hastalarda aortik arkın görüntülenmesi olası morbiditeleri önleyebilir. Black aorta in a patient with alkaptonuric ochronosis Alkaptonürik okronozis'li bir hastada siyah aort Alcaptonuria (black urine disease) is a rare inherited genetic disorder of phenylalanine and tyrosine metabolism with hiperpigmentation of skin, sclera, cartilages, degenerative ochronic arthropathies. Other important consequences of alcaptonuric ochronosis are aortic valve stenosis and urinary tract involvement.A 62-year-old male patient with unknown alcaptonuria was admitted to our institution (Fig. 1, Typical dark spots on the sclera and a dark skin lesion and collected urine was black). Echocardiography showed aortic stenosis with a mean gradient of 55 mmHg. Coronary angiography demonstrated 2-Vessel-Disease.Aortotomy revealed typical ochronotic pigmentation of a severely calcified aortic valve and aortic intima. The patient underwent aortic valve replacement with a 25-mm aortic valve prosthesis and the left internal mammarian to the left anterior descending artery and single venous to the right coronary artery bypass grafting (Fig. 2, 3).The postoperative course was uneventful. The patient was discharged on the fifth postoperative day.This extremely rare illness, detected at the time of surgery, has only been described in few papers in the cardiovascular surgery.From the anesthesiologist's point of view, there is a severe risk of difficult airway because of an advanced stiffness of the cervical spine and a reduced mouth opening in these patients.From the surgeon's point of view, there is more risk during cannulation of the ascending aorta, because the discolored aortic lesions are usually more mobile than in other patients. In addition, after opening the aorta and resection of the calcified aortic valve, some black calcium particles can move into the left ventricle cavity and be invisible, so that there is more emboli risk than in other patients.