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A 32-year-old male presented with pain in the left lower extremity while walking and a pulsatile mass on the backside below the left knee level. Aneurysmal dilatation was reported in the popliteal artery in the magnetic resonance angiographic examination. Following the surgical resection of the sac and revascularization, fungal fibers were detected in the histopathological examination and microbiological evaluation of the specimen. Considering the potential etiology, a detailed cardiac assessment was carried out in asymptomatic patient. On echocardiographic evaluation significant vegetation on the anterior leaflet of the mitral valve and severe mitral insufficiency were detected. With appropriate anti-fungal treatment and successful surgical management complete recovery was achieved. [ABSTRACT FROM AUTHOR]

Pacemaker implantation in patients with tricuspid prosthesis is a challenging situation. It is not possible to pass the pacing lead through tricuspid valve in these patients. Therefore, ventricular pacing can be achieved either epicardial or endocardial left ventricular stimulation. For epicardial pacing, lead implantation can be done transvenously via coronary sinus or surgically. In this paper, we present a patient who had complete atrioventricular block (CAVB) following tricuspid valve prosthesis implantation and treated with epicardial pacing via coronary sinus. In patients who develop CAVB after tricuspid valve replacement, can be treated with permanent pacemaker implantation via CS. This technique enables a minimally invasive approach and effective stimulus in patients with inaccessible right ventricle because of the presence of prosthetic tricuspid valve. [ABSTRACT FROM AUTHOR]

Background: PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation. Methods: This retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23-27 weeks) and less than 1000 grams (489-970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery. Results: No surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86-238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems. Conclusions: Bed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA. [ABSTRACT FROM AUTHOR]

A 51-year-old man was referred to our institution for dyspnea on exertion and non-productive cough, of three-month history. A silent inferior myocardial infarction was detected incidentally on an ECG that manifested itself as inferior Q waves. Two-dimensional transthoracic echocardiography demonstrated a second large cardiac chamber (6x5 cm) adjacent to the inferior-basal left ventricle wall, with a narrow neck and to-and-fro signals during Doppler US evaluation. Ventriculography showed a pseudoaneurysm, like an hourglass, on the inferior wall of the left ventricle which was approximately 6x5 cm in diameter. Coronary angiography showed triple vessel disease with total occlusion of the circumflex coronary artery. These findings were consistent with left ventricular pseudoaneurysm resulting from an old inferior myocardial infarction. After diagnosis of left ventricular pseudoaneurysm and concomitant coronary artery disease, surgery was recommended. He underwent coronary artery bypass surgery including the repair of the pseudoaneurysm. But, unfortunately the patient died in during the operation. This case illustrates that pseudoaneurysm can develop after silent myocardial infarction with nonspecific symptoms. In addition, if false aneurysm invades adjacent organs such as lungs, then the risk of surgical mortality increases. [ABSTRACT FROM AUTHOR]

In this study we analyzed the surgical outcomes of reconstruction of the diffusely diseased left anterior descending artery (LAD) with saphenous vein patch, and by left internal thoracic artery (LITA) grafting on to the patch during on-pump coronary artery bypass surgery. Between 2009 and 2014, 21 patients (mean age 65.1 years) underwent vein patch angioplasty combined with left internal thoracic artery bypass. Five of them (24.8%) had a history of myocardial infarction, and 2 patients (9.5%) had unstable angina and 1 patient (4.8%) acute anteroseptal myocardial infarction. Twelve patients (54.0%) were Canadian Cardiovascular Society class III or IV, and 10 patients (48.0%) were New York Heart Association class III or IV. The mean number of distal anastomoses per patient was 3.24±0.62. The mean length of vein patch was 4.14±0.82 cm. The 30-day mortality rate was 4.8% (n=1). There were 3 late cardiac-related deaths observed at postoperaticve 2., 11., and 40. month The actual survival was 90.0% at 2, and 81.0% at five years. Follow-up angiogram (15 patients, 71.4%) revealed patent LITA graft in 93.3% of the patients. Long segmental LAD reconstruction with autologous saphenous vein patch without endarterectomy, provides alternative approach with acceptable long-term results to the patients who have diffusely diseased coronary arteries. [ABSTRACT FROM AUTHOR]

• Chaetomium species is widespread worldwide and rarely cause infection in human. • This is the first reported case of endocarditis caused by Chaetomium species. • Mortality is high for invasive Chaetomium infections. • Molecular tools are used to confirm the diagnosis in Chaetomium infections. • Appropriate treatment for Chaetomium infections is unknown. Chaetomium globosum is a dematiaceous, filamentous fungus belonging to the large genus saprobic ascomycetes and is rarely involved in human infection. We present the case of a 25-year-old man undergoing tricuspid valve replacement due to recurrent prosthetic ring endocarditis. Initially, it was considered culture-negative endocarditis; however, the diagnosis of Chaetomium globosum could only be provided by DNA isolation of the mold isolate grown in culture and the valve tissue samples taken from the patient. This report describes the first documented tricuspid endocarditis caused by Chaetomium species and discusses the importance of molecular tools to enhance the diagnostic process in culture-negative endocarditis, especially for fastidious and nonculturable microorganisms. [ABSTRACT FROM AUTHOR]

Background: Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents.Methods: We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch.Results: The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months.Conclusions: CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques. [ABSTRACT FROM AUTHOR]

The rare combination of tetralogy of Fallot (TOF), absent pulmonary valve syndrome (APVS), and absent left pulmonary artery (ALPA) is reviewed herein. Children with TOF with APVS and ALPA should be closely monitored, even if they are asymptomatic or mildly symptomatic, and should undergo elective surgery at the end of infancy. doi: 10.1111/jocs.12461 (J Card Surg 2015;30:104-107) [ABSTRACT FROM AUTHOR]

Keywords: atrial septal defect; myxoma; surgery EN atrial septal defect myxoma surgery 707 708 2 01/28/21 20210201 NES 210201 A 47-year-old woman was referred to the cardiology clinic because of dyspnea. During transesophageal echocardiography, a pedunculated, highly mobile left atrial mass approximately 0.9 cm in diameter, originating from the interatrial septum, was noticed along with atrial septal defect (Figure 1A,B). Atrial septal defect, myxoma, surgery. [Extracted from the article]

Background Atheromatous plaques of the ascending aorta are one of the most important risk factors for postoperative mortality and morbidity in coronary artery bypass grafting (CABG). We have retrospectively analyzed the results of proximal anastomoses constructed on the innominate artery in patients with calcific atheromatous plaques (CAP) in their ascending aorta detected intraoperatively. Patients and Methods This study is a retrospective review of 16 consecutive patients who underwent CABG operations and had CAP on their ascending aorta between November 2006 and June 2009. The atheromatous lesions were detected intraoperatively and the operation plan was changed to off-pump surgery. All the proximal anastomoses were made on the innominate artery, left internal thoracic artery (LITA) or the other saphenous vein grafts (SVG). Thirteen patients were male and three were female with a mean age of 63.7 ± 5.3 (ranged, 53-71) years. Results A total of 56 distal anastomoses (3.5 per patient) and 25 proximal anastomoses on the innominate artery were performed. Of the 16 patients, seven (43.7%) had received a sequential SVG; two (12.5%) patients, sequential LITA graft; and one (6.25%) patient sequential SVG and LITA graft. One of the proximal anastomoses was performed on the SVG in four patients (25%) and on the LITA graft in one patient (6.2%). One patient (6.2%) died due to cerebrovascular morbidity. No other complications were observed. Conclusions The innominate artery is an alternative site for proximal anastomoses in patients with calcific atheromatous aorta. doi: 10.1111/jocs.12112 (J Card Surg 2013;28:228-232) [ABSTRACT FROM AUTHOR]

Background: Cerebral injury is a well-known complication after cardiac surgery with cardiopulmonary bypass (CPB), especially in adult patients. Specific biochemical markers like neuron-specific enolase (NSE) and S-100β protein were developed previously for early detecting neuronal damage after CPB. Corticosteroids are shown to reduce multisystemic deleterious effects of cardiopulmonary bypass due to their anti-inflammatory characteristics. The aim of this study is to demonstrate the decrease of serum neuron-specific enolase levels in patients who received corticosteroids before CPB. Methods: Thirty patients scheduled for elective coronary bypass surgery were included in the study. Patients were divided randomly into two groups as the control group (n = 15) who underwent a standard coronary bypass surgery without any additional medication and the study group (n = 15) who received 1 gm of methylprednisolone before CPB. Blood samples for analysis of serum NSE, interleukin-6 (IL-6), and IL-10 were drawn before CPB, 4 and 24 hours after the end of extracorporeal circulation. Results: Serum cytokine and NSE levels were significantly increased after CPB above their normal range in both groups. In the study group, IL-6 and NSE levels were significantly reduced while IL-10 levels were much higher after CPB. High NSE levels significantly correlated with IL-6 levels in the control group. Conclusion: The lower levels of NSE in patients who received methylprednisolone may suggest that corticosteroids might be useful in decreasing possible neuronal damage during heart surgery. However, we were not able to demonstrate an adverse neurological outcome. [ABSTRACT FROM AUTHOR]

Post-transfusion purpura (PTP) is a rare disorder characterized by severe thrombocytopenia developing after a blood component transfusion. Ninety percent of the reported cases are women. In this article, we present a case of PTP in a male patient who underwent coronary artery bypass grafting and discuss its management. doi: 10.1111/jocs.12462 (J Card Surg 2015;30:253-255) [ABSTRACT FROM AUTHOR]

Background: PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation.Methods: This retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23-27 weeks) and less than 1000 grams (489-970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery.Results: No surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86-238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems.Conclusions: Bed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of mediastinal parathyroid adenoma and the use of indocyanine green angiography during surgery. The patient, a 55-year-old female, presented with symptoms of hyperparathyroidism and underwent sternotomy with intraoperative indocyanine green angiography. The procedure allowed for visualization and removal of the enlarged parathyroid tissue, as well as the detection of thymic tissue involvement. The use of indocyanine green angiography was found to be beneficial in reducing operation time, guiding surgical orientation, and preventing persistent hyperparathyroidism. [Extracted from the article]