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Objective: Intraoperative coronary angiography has always been favoured by cardiac surgeons. Thermal coronary angiography (TCA) is a useful method for intraoperative control of graft patency. It detects heat differences between tissues, provides easy-to-interpret angiographic images and even measures the flow of the grafts quantitatively. Methods: Between January 2000 and January 2002, TCA has been used in scheduled coronary bypass operations. Upon completion of each distal anastomosis, the perfusion of the distal arterial tree from the graft was evaluated with a thermal camera. Results: TCA was applied to 1401 patients, mean age 60.97 ^ 9.61 years, who underwent simple coronary artery bypass grafting (CABG) procedures. A total of 4105 thermal images were obtained including 2161 venous, 1355 single internal thoracic artery (ITA), 56 bilateral ITA and 477 radial artery grafts. Image quality was not sufficient in 34 grafts (1.57%) due to either deep intramyocardial vessels or excessive epicardial fat tissue. Technical failures in three ITA anastomoses were detected and revised before the cross-clamp was removed. Flow-restricting lesions distal to the anastomosis on the left anterior descending artery (LAD) in nine patients were managed with a secondary distal bypass graft (five patients) or plaque splitting and anastomotic revision (four patients). Endarterectomy was combined in seven patients since the graft flow and the distal visualization was not satisfactory, although the anastomoses were performed on a good lumen. Angiographically undetected diagonal arteries were revascularized in 11 patients with totally occluded LAD vessels. Conclusion: Thermal imaging provides decisive coronary angiographies, and detects the perfusion area and flow of the implanted graft. It allows real-time detection of technical failures, reveals unexpected occluding plaques or any kind of flow-restricting lesions, and gives the chance of refinement of the anastomosis during the arrest period. We believe that the thermal imaging technique is a safe, noninvasive and feasible method to document the quality of the myocardial revascularization intraoperatively. q 2003 Elsevier B.V. All rights reserved.

Objective: Bleeding complications have been a major concern in certain thoracic surgery operations, especially decortication and pulmonary resection for inflammatory pulmonary infection. Prevention of plasminogen activation and fibrinolysis by aprotinin administration has been shown to reduce perioperative bleeding during operations associated with high blood consumption. Methods: Use of blood products (packed red cells, whole blood), chest tube drainage, analgesic requirement, chest tube duration for the patients undergoing major thoracic operations were recorded. In a double blind randomized fashion, patients were assigned to two groups receiving aprotinin (n ¼ 51) at a loading dose of 10 6 kallikrein inhibitory units (KIU) followed by an infusion of the same dose during chest closure or receiving placebo (n ¼ 52). On a daily basis, red-cell percentages of total fluid from drainage bottles were recorded and using the blood hematocrit level of the patient of the day before, the corrected value for the patient’s blood volume equivalent of daily drainage was calculated. Results: There was a significant reduction in perioperative use of donor blood (0.98 ^ 0.92 vs. 0.45 ^ 0.32 unit; P ¼ 0:0026), and total chest tube drainage (corrected value for the corresponding blood volume) (28.2 ^ 36.9 vs. 76.9 ^ 53.3 ml, P ¼ 0:0004) (mean ^ standard deviation) in the aprotinin group. However, aprotinin did not reduce postoperative transfusion or decrease in hematocrit level due to thoracic operations. In high transfusion-risk thoracic surgery patients (patients who underwent decortication, pulmonary resection for inflammatory lung disease and chest wall resection), the perioperative transfusion was only 0.50 ^ 1.08 units in aprotinin group, compared with 1.94 ^ 0.52 units in control group (P ¼ 0:003). Postoperative transfusion was also reduced in aprotinin administrated group (0.53 ^ 0.56 vs. 1.38 ^ 0.97 units; P ¼ 0:02). The mean total blood loss was decreased to nearly one third of the blood loss of the control group (41 ^ 28 ml vs. 121 ^ 68 ml; P ¼ 0:001). Conclusion: Aprotinin significantly reduced perioperative transfusion requirement and postoperative bleeding during major thoracic operations. Aprotinin decreased perioperative transfusion needs. Moreover, patients who were at risk of greater blood loss during and after certain thoracic operations had a greater potential to benefit from prophylactic perioperative aprotinin treatment. q 2001 Elsevier Science B.V. All rights reserved.

Treatment of chronic atrial fibrillation with intraoperative radiofrequency ablation is gaining more acceptance in patients with rheumatic valve disease. This article reports a case of fatal atrio-esophageal fistula after radiofrequency ablation in a patient with rheumatic mitral and aortic valve disease with chronic atrial fibrillation.

Tuberculous pseudoaneurysm of the aorta is a rare disease that is uniformly fatal if not treated properly. The authors present a case of a recurrent tuberculous false aneurysm of the descending thoracic aorta that was treated surgically with excision and primary repair of the lesion. To their knowledge, this is the first reported case of recurrent disease after a successful surgical treatment.

A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure.

Endovascular treatment of aortic aneurysms is getting popular in our country due to its less invasive nature and shortened hospital stay. The initial experience with endovascular stent-graft implantation procedures to treat abdominal aortic aneurysms and their results were evaluated retrospectively in this study.Eight patients with abdominal aortic aneurysms were treated with endovascular stent grafts. Seven patients were male and 1 was female with the mean age of 63.13+/-9.23 (48-72) years. Six patients were considered not proper for conventional surgical treatment.The procedure was converted to conventional surgery in one patient due to traumatic rupture of the iliac artery during the intervention. Type I endoleak was detected in 1 patient in the first month and was treated successfully by balloon dilatation of the proximal neck. Type II endoleak in two patients resolved spontaneously in the postoperative follow-up. No mortality was occurred. The mean intensive care unit stay was 24.57+/-10.37 (20-48) hours, mean hospital stay was 4.00+/-1.83 (3-8) days, and mean use of blood and blood products was 456.25+/-722.81 ml, excluding the patient treated by conventional surgery. The mean follow-up period was 9.36+/-3.75 (4-15) months.Endovascular treatment of abdominal aortic aneurysms is a good therapeutic alternative with low morbidity even in complicated cases. More studies are needed to enlighten the safety, effectiveness and durability of this therapeutic modality.

Recurrence of ductal patency is a rarely encountered complication in surgical repair of patent ductus arteriosus (PDA). An adult patient with ductal recurrency underwent closure of ductus by using cardiopulmonary bypass via transpulmonary approach. She had significant improvement of symptoms and no residual shunt or pseudoneurysm seven months after surgery. (J Card Surg 2003; 18:17-19)

Repetitive procedures usually take place in the natural course of coronary heart disease. The aim of this study was to evaluate the risk factors, which affect coronary bypass reoperations, and to compare them with the postoperative results of the coronary first operations and the reoperations.Between January 1995 and January 2000, coronary reoperations were performed in 104 cases (Coronary reoperations group) by the same surgical team. Ninety-nine of them were the first, 3 were the second and 2 were the third reoperations in this group. At the same period of time, 3609 patients underwent coronary bypass procedure as the first operation (Coronary 1. operation group). Eighty-seven patients were male (83.65%), 17 were female (16.35%) and the mean age was 60.82 +/- 9.49 in reoperation group; while among 2916 patients 2223 were male (80.8%), 693 were female (19.2%) and the mean age was 60.37 +/- 9.58 in the first operation group.Incidence of prolonged ventilation (p = 0.0001), renal dysfunction requiring dialysis (p = 0.01), need for intraaortic balloon pump (p = 0.0001) and prolonged intensive care unit (p = 0.01) and hospital stay (p = 0.01) were significantly higher in reoperation group. The mortality rate was 9.62% in the reoperation group while it was 2.2% in the first operation group (p = 0.0001).The high morbidity and mortality of coronary bypass reoperations can be reduced to acceptable levels accordingly with early therapy prior to ventricular dysfunction and clinical deterioration that will improve the outcome in these patients.

Development of a fistula between the main renal vessels after nephrectomy has heretofore been a rare occurrence, but its increasing frequency would seem to result from increased interest in detection of this fistula. The authors present a rare case of arteriovenous fistula following partial nephrectomy. Renal hyper tension following nephrectomy, also quite rare, developed in this case.