ObjectiveThe aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes.MethodsTwenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted.ResultsA total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation.ConclusionThe decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.

Patients over age of 70 years, with a left atrial diameter over 60 mm, reoperated due to endocarditis and mechanical valve thrombosis, should be reevaluated for risk assessment while giving the decision of optimal operation timing. Especially patients with left ventricular hypertrophy and decreased myocardial reservoirs, efficient myocardial protection during the operation had an important role.

Unilateral ACP with systemic hypothermia at 22 degrees C is safe and has satisfactory clinical results. Establishing ACP via cannulation of the right axillary artery is fast and simple. The presence of fewer cannulas in the operation field provides an operative condition as convenient as the deep hypothermic circulatory arrest technique.

SummaryMiller–Fisher syndrome (MFS) is an uncommon neurological disorder that is considered a variant of the Guillain–Barre syndrome (GBS). It is clinically defined by a triad of symptoms, namely ataxia, areflexia and ophthalmoplegia. These acute inflammatory polyradiculopathic syndromes can be triggered by viral infections, major surgery, pregnancy or vaccination. While the overall incidence of GBS is 1.2–2.3 per 100 000 per year, MFS is a relatively rare disorder. Only six cases of GBS after cardiac surgery have been reported, and to our knowledge, we describe the first case of MFS after coronary artery bypass surgery. Although cardiac surgery with cardiopulmonary bypass may increase the incidence of MFS and GBS, the pathological mechanism is unclear. Cardiac surgery may be a trigger for the immune-mediated response and may cause devastating complications. It is also important to be alert to de novo autoimmune and unexpected neurological disorders such as MFS after coronary bypass surgery.

Carotid body paragangliomas were diagnosed by Doppler ultrasound, carotid artery angiography, and cranial computed tomography in a 35-year-old man with a mass in the neck and hearing loss, and in a 42-year-old man with headache, syncope, and a mass in the neck. They underwent successful surgical excision.

Objectives We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients. Methods This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm2/m2 for men and PMI < 4.0 cm2/m2 for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients. Results The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, p < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, p = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, p = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, p = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia. Conclusions Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.

Bu çalışmada, kardiyak troponin I'nın koroner arter baypas greftleme sonrası yüksek riskli atriyal fibrilasyon gelişimini öngörebilme özelliği değerlendirildi. Ça lış ma pla nı: Eylül 2013-Kasım 2013 tarihleri arasında, hemodinamik olarak stabil ve ameliyat öncesi sinüs ritminde olan, elektif ve izole koroner arter baypas greftleme yapılan 74 ardışık hasta (65 erkek, 9 kadın; ort. yaş 62.1±9.5 yıl; dağılım 44-75 yıl) çalışmaya alındı. Kardiyak troponin I düzeylerini ölçmek için kan örnekleri, prospektif olarak ameliyattan bir gün önce ve bir sonraki gün alındı. Atriyal fibrilasyon elektrokardiyografi ile taburculuğa kadar her gün ve gerektiğinde kaydedildi. Hastalar, atriyal fibrilasyon grubu ve sinüs ritim grubu olmak üzere iki gruba ayrıldı. Bul gu lar: Atriyal fibrilasyon 15 hastada (%20) tespit edildi. Atriyal fibrilasyon grubu ve sinüs ritim grubunun ortalama yaşları arasında anlamlı bir fark yoktu (p= 0.114). İki grup arasında kros-klemp süresi ve kardiyopulmoner baypas pompa süresi açısından anlamlı bir fark gözlenmedi (sırasıyla, p= 0.861, p= 0.468). Hipertansiyon, hiperlipidemi ve diabetes mellitus insidansı açısından gruplar arasında anlamlı bir fark yoktu (sırasıyla p= 0.225, p= 0.385, p= 0.318). Hastanede ve yoğun bakım ünitesinde yatış süresi açısından da iki grup arasında anlamlı bir fark yoktu (sırasıyla, p= 0.929, p= 0.186). Ameliyat öncesi ve ameliyat sonrası kardiyak troponin I düzeyleri, ameliyat sonrası atriyal fibrilasyon gelişimi ile ilişkili bulunmadı (sırasıyla, p= 0.763, p= 0.336). So nuç:Çalışma sonuçlarımız, koroner arter baypas cerrahisi yapılan hastalarda ameliyat sonrası atriyal fibrilasyon gelişimi için kardiyak troponin I'nın kesin bir öngördürücü olmadığını göstermektedir. Anah tar söz cük ler: Atriyal fibrilasyon; koroner arter baypas greftleme; troponin I.

Behçet's disease is a chronic systemic inflammatory disorder associated with recurrent oral and genital ulcers and iritis. Vascular lesions are encountered in 7%-29% of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare. We describe a surgically treated case of Behçet's disease in a 28-year-old man who presented with a rapidly enlarging left common carotid artery aneurysm.