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.
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