The creation of an arteriovenous fistula (AVF) is frequently used to achieve easier access for haemodialysis in patients with chronic renal insufficiency. The most frequent late complication of AVFs is aneurysm formation, which carries the risk of spontaneous rupture. This study reports on 18 patients with giant aneurysms that developed on antebrachial AVFs who were operated on over a period of 6 years. Colour duplex ultrasonographic examination of the upper extremity was performed in all but one patient in the preoperative period. Surgical management included resection of the aneurysm and re-establishment of arterial continuity. There were no complications such as infection, ischaemic extremity loss, neurological sequelae or mortality. Colour duplex ultrasonographic examinations after 6 months were all normal. The mean follow-up period was 29.1 months (range 7-50 months). There were no additional vascular complications observed during follow-up. Early surgical intervention is the recommended treatment of choice for giant aneurysm complicating antebrachial AVF.

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Diltiazem infusion which started prior to harvesting provided higher IMA blood flow compared to nitroglycerin infusion. Considering the percentage of increases in flows after resection of distal segment, the most prone part to vasospasm, we assume that a certain amount of spasm occurred in IMA in spite of infusion of study drugs, such that less with diltiazem and more with nitroglycerin. Diltiazem plays more important role than nitroglycerin in the prevention of vasospasm.

A 32-year-old man was urgently referred to our hospital with severe tricuspid insufficiency following a car accident. The completely flail anterior leaflet, due to the rupture of the papillary muscles, was revealed by a two-dimensional transthoracic echocardiography. In the operation, we also detected a tear on the anterior leaflet and the rupture of numerous chordae tendineae of the other leaflets. Valve repair was not considered feasible, therefore the tricuspid valve was replaced with a 31 mm mechanical prosthesis. The patient's recovery from surgery was uneventful, and he was discharged on the seventh postoperative day.Keywords: cardiac injury, tricuspid valve, tricuspid insufficiency Introduction Unfortunately, with the increase in the number of vehicles, traffic accidents have become a serious health problem. Cardiac injuries following chest trauma vary from simple myocardial contusions to severe damage to the intracardiac structures. Traumatic tricuspid valve insufficiency is a rare clinical entity. 1� We present a patient who developed tricuspid insufficiency following blunt chest trauma. Case ReportA traffic accident in August 2011 left a 48-yearold man with thoracic and abdominal trauma, due to his chest hitting the steering wheel. Unfortunately, he was not wearing a seat belt. He was admitted to the state hospital. There, he underwent an urgent splenectomy because of massive bleeding due to splenic rupture. Also, a chest tube was inserted to treat a left-side hemopneumothorax. On the fifteenth day following the accident, he was discharged from the hospital. A few weeks later, he was referred to our hospital with complaints of palpitation, dyspnea on effort, and fatigue. A physical examination revealed hepatomegaly, distention of the juguler veins, peripheral edema and a 3-4/6 systolic murmur on the left lateral sternal border. The cardiac silhouette was enlarged with a chest X-ray. A two-dimensional transthoracic echocardiography showed dilatation of the right atrium (approximately 6.5 cm), and severe tricuspid regurgitation due to papillary muscle rupture (Fig. 1). Coronary angiography revealed normal coronary arteries. On the basis of these findings, the patient was taken to surgery.A cardiopulmonary bypass was performed using aortic and bicaval cannulation. Moderate systemic hypothermia, topical cooling and antegrade cold blood cardioplegia were used for myocardial protection. After the midsternotomy and pericardiotomy, a large amount of haemorrhagic pericardial effusion was evacuated.When the right atrium was opened, the anterior and the posterior papillary muscles were found to be ruptured (Fig. 2). In addition to numerous ruptured chordae tendineae, there was a tear on the anterior leaflet.Valve repair was not suitable for this case, therefore the tricuspid valve was replaced with a 31 mm mechanical prosthesis. A temporary epicardial pacemaker wire was inserted. Sinus rhythm spontaneously resumed. The Case Report Ann Thorac Cardiovasc Surg 2013; 19: 222-224 Online November 15, 2012 doi: 10.5...