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Buyukbayrak F.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | Uyar I.,Akut Cardiovascular Hospital | Aksoy E.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | Gunay D.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | And 3 more authors.
Turkish Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Background: This study aims to evaluate the diagnostic specificity and sensitivity of transthoracic echocardiography (TTE) for the diagnosis of cardiac tamponade after cardiac surgery. Methods: Of 2,300 patients who underwent open heart surgery between January 2010 and September 2012, 118 (39 males, 79 females; mean age: 55.4±15.2 years; range 19 to 80 years) who required a revision surgery for bleeding and/or cardiac tamponade were retrospectively analyzed. Data of TTE were available in 73 patients. Diagnostic specificity and sensitivity of the TTE and clinical parameters including hypotension, oliguria, and metabolic acidosis were estimated with respect to surgical confirmation. Sensitivity and specifity rates were compared using the Cochrane Q test and McNemar test. Results: The mean and median time from the first operation were 12.0±11.7 and nine days, respectively (0 to 62 days). Overall mortality occurred in 28 patients (38.4%). Among patients with surgically confirmed tamponade, TTE showed 64.5% sensitivity, whereas hypotension was present in 92.0%, oliguria in 80.6% and metabolic acidosis in 45.1% (p<0.001). Among patients with unconfirmed tamponade, TTE showed 90.9% specificity, whereas hypotension was present in 54.5% patients, oliguria in 81.8% and metabolic acidosis in 45.4% (p=0.07). Specificity rates showed constancy with time, while sensitivity rates tended to increase after seven days. Conclusion: Transthoracic echocardiography plays an important role in the evaluation of postoperative hemodynamic impairment. However, its high false negativity rate for diagnosis of cardiac tamponade should be kept in mind to prevent further delay in patients with high clinical suspicion.


Sismanoglu M.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | Tas S.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | Tuncer E.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | Adademir T.,Kartal Kosuyolu Yuksek Ihtisas Yuksek Ihtisas Training and Research Hospital | And 4 more authors.
Turkish Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Background: In this study, we report early and late results of surgical treatment of aortic valve endocarditis with aortic annular involvement. Methods: B etween D ecember 1 985 a nd J anuary 2011, 42 consecutive patients (32 males, 10 females; mean age 39.0±13.3 years; range 16 to 67 years) were retrospectively analyzed in terms of surgical findings and operative procedures. The blood cultures were positive in 25 patients (59.5%) and the most commonly identified microorganism was streptococcus (n=15, 35.7%). Fourteen patients (33.3%) had a medical history of previous cardiac surgery and 13 (31.0%) had prosthetic valve endocarditis. The mean duration of follow-up were 7.9±4.4 years (range 0.1 to 18.2 years). Results: All patients underwent a total of 64 surgical procedures. The most commonly performed procedure was aortic valve replacement with 26 patients (61.9%), followed by aortic root replacement in 15 (35.7%) and primary repair of periprosthetic leakage in one patient (2.4%). Nine patients (21.4%) had concomitant procedures for the mitral valve. In-hospital mortality was seen in nine patients (21.4%). Postoperatively seven patients had (16.7%) low cardiac output, six had (14.3%) heart block, however, only two of them required permanent pacemaker. The actuarial survival rates at one, five and 10 years were 80.0±6.3%, 69.9±7.3% and 64.9±8.3%, respectively. Conclusion: Although surgery for aortic valve endocarditis with annular involvement has high in-hospital mortality rate, long-term survival is satisfactory for surviving patients.

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