En tr ABSTRACT Aim: The purpose of this study is to demonstrate the postoperative cardioprotective efficacy of preoperative levosimendan treatment in patients with impaired left ventricular function undergoing coronary by-pass surgery. Materyal and Method: This study was performed prospectively between November 2008 and September 2009 in Eskişehir Osmangazi Univercity Department of Cardiovascular Surgery. Twenty patients with coronary artery disease (CAD) between the ages of 48-78 and ejection fraction (EF) below 40% were included in the study. levosimendan was given to the first group preoperatively(experimental group). Group 2 was the control group. Coronary artery bypass graft (CABG) surgery was performed in all of them. One group received additional levosimendan infusion, preoperatively. Age, comorbidity, cardiopulmonary by-pass (CPB) time, cross clamp (CC) time, patient vessel number, anastomosis number, extubation times, intensive care stay and hospital stay were recorded. Preoperative, postoperative 1st day and postoperative 7th day nt-proBNP values and preoperative and postoperative 15th day ejection fraction (EF) values with echocardiography (ECHO) were measured. The cardioprotective efficacy of the drug was evaluated by comparing the data of the control group and the experimental group. Results: No statistically significant difference was found between the two groups in terms of CPB time, CC time, age, comorbidity, number of sick vessels, number of anastomosis, extubation time, length of stay in intensive care and hospital stay. (P> 0.05). There was no significant difference between the groups in preoperative EF values (P> 0.05). The mean values of EF measurements on the postoperative 15th day were calculated as 39% in the experimental group and 40% in the control group. The increase in EF values was greater in the experimental group. This increase was found to be more significant in the experimental group (P = 0.008). There was a significant difference between the groups in preoperative and postoperative 1st day n-tproBNP values (P <0.05). A significant increase was observed in nt-proBNP values in the groups until the 7th postoperative day. (P 0.05). Conclusion: As a result of this study, it was determined that levosimendan has a positive effect on myocardial protection and contractility in patients with low EF in CABG surgery. Keywords: Levosimendan; coroner by-pass surgery; left ventricle dyusfunction. ÖZ Amaç: Bu çalışmanın amacı koroner by-pass ameliyatı yapılacak, sol ventrikül fonksiyonu bozulmuş hastalarda preoperatif levosimendan tedavisinin postoperatif kardiyoprotektif etkinliğini göstermektir. Gereç ve Yöntem: Bu çalışma Kasım 2008- Eylül 2009 tarihleri arasında, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalında prospektif olarak gerçekleştirildi. Çalışmaya yaşları 48-78 arasında, ejeksiyon fraksiyonu (EF) %40’ın altında koroner arter hastalığı (KAH) olan 20 hasta alındı. Hastalar iki gruba ayrıldı. 1. gruba preoperatif levosimendan verildi (deney grubu). 2. grup kontrol grubuydu. Hepsine koroner arter bypass greft (KABG) cerrahisi uygulandı. Yaş, komorbidite, kardiyopulmoner by-pass (KPB) zamanı, kros klemp (KK) zamanı, hasta damar sayısı, anastomoz sayısı, ekstübasyon süresi, yoğun bakımda ve hastanede kalış süreleri kaydedildi. Preoperatif, postoperatif 1.gün ve postoperatif 7. gün nt-proBNP değerleri ve preoperatif ve postoperatif 15. gün ejeksiyon fraksiyon (EF) değerleri ekokardiyografiyle (EKO) ölçüldü. Kontrol grubu ve deney grubunun verileri karşılaştırılarak ilacın kardiyoprotektif etkinliği değerlendirildi. Bulgular: İki grup arasında komorbidite, KPB zamanı, KK zamanı, yaş, hasta damar sayısı, anastomoz sayısı, ekstübasyon süresi, yoğun bakımda kalış süresi ve hastanede kalış süresi açısından istatistiksel olarak anlamlı farklılık saptanmadı. (P>0,05). Preoperatif ölçülen EF değerlerinde gruplar arasında anlamlı farklılık gözlenmedi (P>0,05). Postoperatif 15. gündeki EF ölçümlerinin ortalama değerleri deney grubunda %39, kontrol grubunda %40 olarak hesaplandı. EF değerlerindeki artış deney grubunda daha fazlaydı. Bu artışın deney grubunda daha anlamlı olduğu tespit edildi (P=0,008). Gruplar arasında preoperatif ve postoperatif 1. gün bakılan nt-proBNP değerleri arasında anlamlı farklılık vardı (P<0,05). Gruplarda nt-proBNP değerlerinde postoperatif 7. güne kadar anlamlı bir artış gözlendi. (P0,05). Sonuç: Bu çalışma sonucunda KABG cerrahisinde düşük EF’li hastalarda levosimendaın myokardiyal koruma ve kontraktilite üzerine olumlu etkinliği olduğu saptandı.

Objective: The aim of this retrospective study is to compare the efficacy of sympathectomy and cilostazol therapy in critical limb ischemia that cannot be revascularized. Material and Method: This study was retrospectively conducted on 30 patients who underwent lumbar sympathectomy (Group 1) and received cilostazol treatment (Group 2) between January 2017 and August 2020. Demographic data, comorbidity, complications, wound healing, walking distance, and pain scale records of the patients were determined by examining the hospital registry system and statistical analysis was performed. Results: In the study, no significant difference was found between the two groups in terms of walking distance and ischemic pain in the statistical analysis of the data before treatment, at the 3rd, 6th, 12th, and 24th months (p> 0.05). However, a statistically significant difference was found between the pre-treatment data and the data at the 3rd, 6th, 12th, and 24th months in both Group 1 and Group 2 in terms of walking distance and ischemic pain (p˂0.001 ). In the time periods followed in both groups, it was observed that there was an increase in walking distance and a decrease in ischemic pain. Conclusion: Cilostazol treatment may be preferred as a good alternative treatment method compared to lumbar sympathectomy in critical leg ischemia. Keywords: Critical leg ischemia; sympathectomy; cilostazol

Background: Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. Diabetes mellitus also is one of the main risk factors for renal dysfunction in coronary artery bypass graft (CABG). In this study, we aimed to compare the early postoperative period results of type 2 diabetes patients taking oral antidiabetics (OAD) or insulin medications, with microalbuminuria and normal creatinine levels after CABG. Methods: Eighty patients with type 2 diabetes and taking OAD or receiving insulin medication all with normal creatinine levels with microalbuminuria were included in this study. Preoperative creatinine values of the patients, albumin levels in spot urine, creatinine levels on the postoperative 3rd day, duration of ventilation, amount of drainage, length of stay in the intensive care unit, length of stay in the hospital, mediastinitis, and mortality rates were recorded. Results: A statistically significant increase in creatinine was found in both taking OAD type 2 diabetes and insulin medication with microalbuminuria. When the two groups were compared with each other, the increase in creatinine levels of the patients using insulin was higher than the patients taking OAD. It also was statistically significant. Conclusion: According to the result of our study, it can be suggested that postoperative creatinine elevation is observed in patients with type 2 diabetes mellitus with microalbuminuria and with normal creatinine levels, either having insulin medication or not. The elevation is higher in patients having insulin medication, while other results are similar, except for impaired renal function.

Infective endocarditis (IE) is rarely seen in children, and it can cause significant morbidity and mortality. Congenital heart disease is a predisposing cardiac condition for IE and has an increasing prevalence. A mycotic aortic aneurysm is a rare disease due to infection and it has been reported that it may be a result of IE. We present a 10‐year‐old boy who was referred to our cardiovascular surgery department due to severe aortic stenosis (AS). Transthoracic echocardiography revealed calcific severe AS and computerized tomography (CT) angiography was performed to better evaluate the ascending aorta. CT angiography demonstrated a saccular aneurysm of the ascending aorta. The underlying pathology was considered as chronic IE on top of congenital AS with an unknown number of cusps. Histologic findings supported our diagnosis and accompanied by a saccular aneurysm. The patient underwent a successful aortic root enlargement, mechanical aortic valve replacement, and ascending aorta repair surgery.

Amaç: Bu çalışmanın amacı açık kalp cerrahisi öncesi 72 saatlik trimetazidin (TMZ) uygulamasının miyokard iskemisi üzerine etkilerini göstermektir.Gereç ve Yöntemler: Bu çalışma, 2009-2010 tarihleri arasında, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalında prospektif olarak gerçekleştirildi. Çalışmaya elektif koroner arter bypass greft operasyonu planlanan, yaşları 43-76 yıl aralığında olan, 12’si erkek, 8 kadın olmak üzere toplam 20 hasta alındı. Hastalar iki gruba ayrıldı. Birinci gruba 72 saat öncesinden başlayarak preoperatif 3x20 mg, oral TMZ verildi (çalışma grubu). İkinci grup kontrol grubuydu. Son 6 hafta içinde miyokard enfarktüsü geçirmiş olan, koroner arter bypass cerrahisine ek kardiyak cerrahi uygulanan, önceden böbrek hastalığı olan, cerrahiden 24 saat önce kardiyak enzim düzeyleri yüksek olan ve hemodinamik açıdan stabil olmayan hastalar çalışma dışı bırakıldı. Yaş, vücut yüzey alanı, cinsiyet, ejeksiyon fraksiyonu, komorbidite, kardiyopulmoner bypass zamanı, kros-klemp zamanı, hasta damar sayısı ve bypass sayıları kaydedildi. Troponin I (TnI) baz değeri için kan numuneleri hasta uyutulmadan hemen önce alındı. Operasyon sırasında kros-klemp kaldırılınca sağ atriyumdan ikinci örnek alındı. Kross-klemp kaldırıldıktan sonra 6., 12. ve 24. saatlerinde TnI için kan örnekleri alındı.Bulgular: Hastalar uyutulmadan hemen önce, kros-klemp kaldırıldıktan hemen sonra ve 6. 12. ve 24. saatlerde bakılan TnI değerleri gruplar arasında karşılaştırıldığında istatistiksel olarak anlamlı bir fark saptanmadı. (sırasıyla, p=0.7734, p=0.3390, p=0.5624, p=0.1296, p=0.1796).Sonuç: Açık kalp cerrahisinde preoperatif kısa süreli TMZ tedavisinin miyokard korunması üzerine bir etkisinin olmadığı tespit edildi.