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Objective: The aim of this study is to examine the probability of de-novo fQRS in patients with mild COVID-19 disease, as an indicator of cardiac injury. Methods: Data of 256 patients with normal admission electrocardiography and no comorbidities between 1.12.2020–31.12.2021, were examined retrospectively 6-month after mild COVID-19 disease. Patients were divided into two groups: fQRS+ group (n = 102) and non-fQRS group (n = 154). Relation between fQRS and other electrocardiography, echocardiographic and laboratory findings were investigated. Results: No significant difference was found between the groups among age and gender. Troponin-I and creatine kinase myocardial band values (retrospectively 9.10 ± 1.76 vs 0.74 ± 1.43, 34.05 ± 82.20 vs. 14.68 ± 4.42), COVID-19 IgG levels (45.78 ± 14.82 vs. 36.49 ± 17.68), diastolic dysfunction (39.21% vs. 15.07%), EF value (58.02 ± 1.95 vs. 64.27 ± 3.07), dyspnea (41.17% vs. 6.84%), post-COVID-19 tachycardia syndrome (19.6% vs. 2.74) were more frequent in fQRS+ group compared to non-fQRS group. The EF value was lower in the presence of fQRS in the high lateral leads (57.12 ± 1.99, 58.47 ± 1.79, p:0.018). There was a positive correlation between IgG value and endsystolic diameter, septum thickness and left atrium diameter. In multivariate analysis de-novo fQRS, dyspnea, high troponin and IgG values, diastolic dysfunction, low EF value and left atrial diameter were determined as independent risk factors for post-COVID-19 tachycardia syndrome in follow-up. Conclusion: In COVID-19 disease de-novo fQRS, dyspnea, high IgG and troponin value, left atrial diameter, lower EF value, diastolic dysfunction were associated with post-COVID-19 tachycardia syndrome. The de-novo fQRS in SARS-COV-2 may be a predictor of future more important adverse cardiovascular outcomes and this should alert clinicians.

Coronavirus disease 2019 (COVID-19) is an infection resulting in very high morbidity and mortality rates globally. Limited data are available on the cardiovascular manifestations in these patients. The aim of this study was to analyse the daily troponin I and D-dimer levels and their impact on the need for intensive care and on mortality rates of COVID-19-infected patients.Two-hundred and five patients who were hospitalised between 20 March and 5 May 2020, with a diagnosis of moderate-to-severe COVID-19 pneumonia, were analysed retrospectively. Serum troponin I and D-dimer levels were recorded for at least 10 days after admission.The average age was higher in the group of patients who died compared to the group who were discharged (67.79 ± 14.9 vs 56.87 ± 18.15 years, respectively,We showed that hospitalisations ≥ 9.5 days in duration were related to increased mortality rates. Troponin I and D-dimer follow-up values in the serum were more effective than other inflammatory markers in predicting mortality and the need for intensive care. A high troponin I value should alert the clinician in terms of clinical deterioration.

Introduction: The aim of this study was to retrospectively review patients who were diagnosed with cardiac injury and underwent an emergency surgery. Patients and Methods: Between January 2009 and December 2014, 37 patients diagnosed with cardiac injury were retrospectively evaluated. Patients were evaluated according to the demographics, mean time from admission to surgery, concurrent interventions, type and localization of cardiac injury, and preoperative mean arterial blood pressure. Results: Eight patients who suffered from cardiac arrest underwent emergency surgery by thoracotomy. On admission to emergency service (ES), 22 patients were in shock. In ES, because the hemodynamic situation of six patients worsened despite fluid therapy, they underwent surgery without performing additional tests or imaging. The localization of the injuries were the right ventricle in 19 patients, left ventricle in 15 patients, right atrium in 2 patients, and both the right and left ventricles in 1 patient. In 34 patients, the primary suturing technique was sufficient for repair but two patients were operated on using cardiopulmonary bypass. The mean time from admission to surgery was 3.16 ± 2.37 h. The mean duration of intensive care unit stay was 2.37 ± 2.1 days. On an average, 5.16 ± 4.21 units of packed erythrocyte suspension were transfused. The mortality rate was 37.83% (n= 14). Conclusion: Improvements in emergency interventions, transportation, and availability of echocardiography in the emergency departments have to be more appropriate and efficient for better outcome in the new series., Giriş: Bu çalışmada 2009-2014 yılları arasında acil serviste kardiyak yaralanma tanısı alan ve acil olarak operasyona alınan hastaları literatüre katkı sağlamak amacıyla retrospektif olarak inceledik. Hastalar ve Yöntem: Kliniğimizde Ocak 2009-Aralık 2014 tarihleri arasında acil serviste kardiyak yaralan- ma tanısı alan ve acil olarak operasyona alınan 37 hasta retrospektif olarak incelendi. Hastalar demografik özellikleri, operasyona alınma süresi, ek girişim yapılıp yapılmadığı, yaralanma şekli, kalpte yaralanan bölge, operasyon öncesi arteryel kan basınçları, operasyonun yapılma şekline göre değerlendirildi. Bulgular: Sekiz hasta acil serviste kardiyopulmoner resüsitasyon eşliğinde acil torakotomi ile ameliyata alın- dı. Yirmi iki hastada şok tablosu mevcuttu. Altı hasta sıvı tedavisine rağmen tabloda kötüleşme olması dolayı- sıyla ek tetkik beklenmeden operasyona alındı. Diğer hastalarda ise ekokardiyografi ve bilgisayarlı tomografi sonucunda kardiyak yaralanma olduğu saptanarak operasyona alındı. On dokuz hastada yaralanma sağ ventri- külde, 15 hastada sol ventrikülde, 1 hastada sağ ve sol ventrikülde, 2 hastada ise sağ atriyumdaydı. Otuz dört hastada yaralanmalar primer olarak süturasyon ile onarıldı. Bir hastada mitral kapak replasmanı, 2 hastada ise onarım kardiyopulmoner baypas altında yapıldı. Bir hastada sol internal mammarian arter yaralanması, 2 hastada femoral arter yaralanması ve 1 hastada ise vena kava inferior yaralanması vardı. Beş hastada mide ve ince bağırsak yaralanmaları olduğu için genel cerrahi ile operasyona devam edildi. Hastaların ortalama ameliyata alınma süresi 3.16 ± 2.37 saat olarak bulundu. Ortalama yoğun bakım ünitesinde yatış 2.37 ± 2.1 gün olarak hesaplandı. Hastalarda ortalama olarak 5.6 ± 4.21 ünite eritrosit süspansiyonu kullanıldı. Hastane mortalitesi 14 hasta ile %37.83 idi. Sonuç: Hastane öncesi acil müdahale ve transport imkanlarının gelişmesi, ekokardiyografinin acil servislerde ulaşılabilirliğinin artmasıyla kalp yaralanmalarının daha yüz güldürücü sonuçlarla yeni serilerde karşımıza çıkacağını umut ediyoruz.

Penetrating cardiac injuries are one of the most lethal types of trauma. Early diagnosis, appropriate approach in the emergency department (ED), early resuscitation and immediate surgical intervention are essential in the management of penetrating cardiac injuries. In this study we retrospectively evaluated five patients with penetrating cardiac injuries in a 1-year period before an open heart surgery center was set up in our hospital; and we aimed to underline the importance of an appropriate and early surgical intervention without cardiopulmonary by-pass on survival. Median age of our patients was 26 years (range, 17-42 years) and all of the patients were males. Two patients were presented as cardiac arrest and they could not be survived. Three of our patients presented to our ED with cardiogenic shock and all of them recovered after the operation. Right ventricle injury was determined in two patients and both of them survived after the operation. In 3 patients, left ventricle injury was observed and 2 of them died. While 3 patients presented with gunshot injury, 2 of them presented with sharp object injury. One patient in each group was died. Three patients recovered without any complications, however 2 patients- one before operation and 1 during operation- died (survival rate: 3/5). Those 3 patients did not develop any major stationary sequela with normal LVEF in the follow-up at first and third., Penetran kalp yaralanmaları, travma çeşitleri arasında en öldürücü olanlardır. Penetran kalp yaralanmalarına uygun yaklaşımda erken tanı, acil serviste (AS) doğru müdahale, erken resüsitasyon ve acil cerrahi müdahale önemlidir. Biz bu çalışmamızda hastanemizde açık kalp cerrahisi yapılmaya başlanmasından önceki 1 yıl içerisinde, penetran kardiyak yaralanma ile AS'ye getirilen beş hastayı retrospektif olarak inceledik ve kardiyopulmoner by-pass yapılamadığı durumlarda bile, erken ve doğru cerrahi müdahalenin sağkalım üzerine olan önemini vurgulamayı amaçladık. Çalışmaya alınan hastaların ortalama yaşı 26 (17-42) yıl idi ve tümü erkekti. İki hasta AS'ye kardiyak arrest olarak getirilmişti ve bu hastalar kurtarılamadı. Üç hasta ise AS'ye kardiyojenik şok ile getirildi ve bu hastaların tümü ameliyat sonrası iyileşti. İki hastada sağ ventrikül yaralanması tespit edildi ve bu hastaların her ikisi de operasyon sonrası hayatta kaldı. Üç hastada sol ventrikül yaralanması saptandı ve bu hastaların 2'si öldü. Üç hasta ateşli silah ile yaralanırken, 2 hasta kesici alet ile yaralanmıştı. Her iki grupta birer hasta öldü. Üç hasta herhangi bir komplikasyon olmadan taburcu edildi. İki hasta, biri operasyon öncesi ve biri operasyon sırasında olmak üzere öldü (sağkalım oranı: 3/5). Bu 3 hastanın yapılan birinci ve üçüncü ay kontrollerinde sol ventrikül ejeksiyon fraksiyonları normal olarak hesaplandı ve herhangi bir major sekel oluşturan komplikasyon gelişmedi.

Secundum atrial sepal defect and patent ductus arteriosus are the most frequently encountered congenital heart diseases. They are treated with percutaneous modalities with high success rates and low morbidity and mortality rates. Peri-procedural complications may occur in the early period or in late follow-up. The most striking feature when complications occur is the high mortality rates observed when surgical treatment is required. Here we report one case with patent ductus arteriosus surgically treated due to broken coil and two cases of atrial septal defect directed to surgery one in the early (with the suspicion of device embolization during the procedure) and one in the late post-procedure period (residual shunt) of device closure. First two patients were directed to emergent surgery, whereas the last one underwent elective surgery. Coil was removed in the case with ductus. There was no embolus due to the device in the second case and defect was closed with a patch. The device was removed and patch closure of the defect was performed in the third case. We believe that, these percutaneous modalities should be employed in centers where cardiac surgical back-up is available., Sekundum atrial septal defekt ve patent duktus arteriozus en sık karşılaşılan konjenital kalp hastalıklarıdır. Bu patolojiler, perktütan girişimlerle yüksek başarı, düşük morbidite ve mortalite oranları ile tedavi edilmektedir. Periprosedürel komplikasyonlar erken dönemde ya da geç takip sırasında oluşabilmektedir. Bu komplikasyonlar oluştuğunda cerrahi tedavi gerekli ise yüksek mortalite oranları ile karşılaşılmaktadır. Biz burada kırılmış 'coil' sebebiyle cerrahi uygulanan bir patent duktus arteriozus vakası ve biri erken (işlem sırasında cihaz embolisi şüphesi), diğeri geç dönemde (rezidü kaçak) komplike olmuş cihaz ile kapatılmış iki atriyal septal defekt vakasını bildiriyoruz. İlk iki hasta acil şartlarda, diğeri ise elektif olarak opere edilmiştir. Duktus vakasında 'coil' çıkarılmıştır. İkinci vakada cihaz embolisi saptanmamış, defekt yama ile kapatılmıştır. Üçüncü vakada ise cihaz çıkartılmış, yama ile defekt kapatılmştır. Biz perkütan girişimlerin, kalp cerrahisi desteğinin sağlanabildiği merkezlerde yapılması gerekliliğine inanıyoruz.

Cardiac myxomas are the most common primary benign tumors of the heart and appears particularly in the left atrium. Myxomas exhibit a wide spectrum of symptoms from asymptomatic to very serious according to the localisation of the tumours. Only 5% of these tumours occur in the right and left ventricles. We report an unusual case of a 21-year-old woman with a leukemia in remission, in whom routine transthorasic echocardiographic examination demonstrated an incidental left ventricular mass. The patient underwent successful resection of the left ventricular mass under cardiopulmonary bypass through the left atrial approach. Histopathologic examination was diagnostic for myxoma. In this case, the presentation of the mass was atypical for two reasons: the tumour was a cardiac myxoma in the left ventricular localisation and in a patient with leukemia in remission.

altında yapılan operasyonlar sırasında ciddi kanama riski taşır. Yakın zamanda kanama geçirmiş hastalarda da cerrahi tedavi mutlak zorunlu ise uygun medikasyon altında ilk 2 hafta içinde operasyonun güvenle planlanabileceği görüşündeyiz

A 78-year-old woman with a history of hypertension and end-stage renal disease was admitted to our hospital for routine control. On physical examination, blood pressure was 145/90 mmHg and pulse rate was 100 beats/min. The electrocardiogram revealed sinus tachycardia and laboratory findings were unremarkable except for kidney function tests. Transthoracic echocardiography (TTE) revealed normal left ventricular systolic functions with moderate concentric hypertrophy. The apical four-chamber view revealed a spherical cavitylike mass of diameter of 3.5 cm adjacent to the left atrioventricular groove (Fig 1a). Subsequently, transesophageal echocardiography (TEE) was performed in order to identify the cystic mass, which contained thrombotic material (Fig 1b). Enhanced computed tomography (CT) angiography showed a giant, partially-thrombotic coronary artery aneurysm (CAA) (Fig 1c). Diagnostic coronary angiography confirmed the giant CAA (27x42 mm in size) arising from the proximal segment of the circumflex coronary artery (Fig 1d). Covered stent implantation was offered promptly, but refused by the patient. Presently, she is under conservative treatment with warfarin and follow-up observation. CAA is defined as a dilatation of the coronary artery that is more than 1.5 times the diameter of normal adjacent segments. Giant CAAs are extremely rare anatomic occurrences. Although there is no uniform definition, they are variously defined as more than 20 to 50 mm in size. Etiological factors include atherosclerosis, Kawasaki disease, congenital malformations, chest trauma, connective tissue diseases, autoimmune diseases and coronary interventions. Although the present patient was asymptomatic, a giant CAA may cause coronary artery rupture, thromboembolism or haemodynamic problems related to compression. A variety of imaging techniques have been used to view giant CAAs. Although noninvasive imaging methods including echocardiography, computed tomography, and magnetic resonance imaging can detect some CAAs, coronary angiography remains the gold standard and provides important information on the size, shape, location, and number of aneurysms. 210

research Amaç: Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi'nde yeni uygulanmaya başlanan kalp cerrahisi sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kasım 2012 ile Kasım 2013 tarihleri arasında 110 açık kalp ameliyatı gerçekleştirildi. 10 hasta (%9.1) ST elevasyonlu miyokard enfarktüsü nedeniyle acil olarak ameliyata alındı. 31'i (%29.2) atan kalpte ve 75'i (%70.8) kardiyopulmoner baypas ile olmak üzere toplam 106 hastaya koroner arter baypas greftleme yapılırken, 1 mitral onarım, 1 Bentall prosedürü, 1 triküspit kapak onarımı, 1 mitral kapak replasmanı, 1 root genişletmeyle birlikte aort kapak replasmanı ve 1 suprakoroner greft implantasyonu uygulandı. Bulgular: Bir (%0.9) hastada hastane mortalitesi görüldü. İkili antiagregan kullanmakta olan 4 (%3.6) hastaya ameliyat günü içerisinde kanama nedeniyle revizyon yapıldı. 3 (%2.7) hastada morbidite yaşandı. 11 (%10) hastada atriyal fibrilasyon gözlendi ve amiadoron tedavisi ile normal sinüs ritmi sağlandı. 5 (%4.5) hastada intraaortik balon pompası kullanıldı. Tartışma: Yaygın bir kırsal nüfusa hizmet veren Hitit Üniversitesi Çorum Eğitim ve Araştırma Hastanesi'nde yeni kurulan kalp cerrahisi merkezi düşük mortalite ve morbiditeyle hizmet vermektedir. Aim: We aimed to assess the clinical outcomes of our department of cardiac surgery which was newly introduced in Hitit University Corum Education and Research Hospital. Material and Method: Between November 2012 and November 2013, a total of 110 open-heart surgeries were performed. Ten out of these (9.1%) were emergency operations for acute ST elevation myocardial infarction Off-pump technique was used in 31 (29.2%) patients and cardiopulmonary bypass was used in 75 (70.8%). A total of 106 patients received coronary artery bypass grafting, 1 received mitral reconstruction,1 received Bentall procedure, 1 received tricuspid valve repair, 1 received mitral valve replacement, 1 received aortic valve replacement with aortic root enlargement and 1 received aortic supracoronary graft replacement. Results: Hospital mortality occurred in 1 (0.9%) patient. Four patients (3.6%) who were on dual antiaggregants underwent a revision for bleeding on the day of the operation. Morbidities occurred in 3 (2.7%) patients. Atrial fibrillation occurred in 11 (10%) patients and the normal sinus rhythm was achieved by amiodarone. Intraaortic balloon counterpulsation was used in 5 (4.5%) patients. Discussion: The newly introduced cardiac surgery department of the Hitit University Corum Education and Research Hospital, which provides tertiary care to a wide rural community, serves with low morbidity and mortality.

Background. Wound infection after median sternotomy for cardiac or thoracic surgery is a serious complication, and there is a lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis treated with longitudinally affixed titanium plates on sternal halves. Methods. The technique was composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. The series included 21 patients who developed sternal non-union resulting from mediastinitis. Mobilization of muscular flaps was performed in 8 cases. This technique also consists of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Antibiotherapy based on culture and sensitivity data continued for 4 to 7 weeks. Results. Twenty patients achieved complete wound healing without further operative intervention or major complication. Nineteen patients treated with this technique survived. One patient died from sepsis after developing residual focus of chondritis and undergoing wide resection of cartilage, and 1 patient died from complications of severe stroke. Conclusion. We had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.

A 65 year old woman was admitted to our hospital with dyspne. She had a medical history of hypertension. Her blood presure was 156/107 mmHg under medication. Physical examination and routine blood tests were normal. The electrocardiogram showed sinus rhythm. Standard anteroposterior chest radiography (Figure 1A) showed a widened mediastinum so a thoracic aortic aneurysm (TAA) was suspected. Transthoracic echocardiography showed normal left ventricular systolic function and also a 36x33 mm saccular aortic aneurysm with intraluminal thrombus which had extended to the lesser curvature of aorta with a narrow neck (11 mm) was seen from the suprasternal view (Figure 1B). For a more accurate assessment, we performed computed tomography angiogram of the thoracic aorta. It demonstrated that a saccular aneurysm of the mid inner curvature of aortic arch with some thrombotic material inside the aneurysm (Figures 1C, 1D). The rest of the aorta was not dilated. She had no history of severe chest or back pain, hoarseness and trauma. The patient and her family were informed about the recommended surgical and endovascular repair options if needed. The patient was initially managed conservatively with aggressive antihypertensive therapy

factPresentation Penetran kalp yaralanmaları, travma çeşitleri arasında en öldürücü olanlardır. Penetran kalp yaralanmalarına uygun yaklaşımda erken tanı, acil serviste (AS) doğru müdahale, erken resüsitasyon ve acil cerrahi müdahale önemlidir. Biz bu çalışmamızda hastanemizde açık kalp cerrahisi yapılmaya başlanmasından önceki 1 yıl içerisinde, penetran kardiyak yaralanma ile AS’ye getirilen beş hastayı retrospektif olarak inceledik ve kardiyopulmoner by-pass yapılamadığı durumlarda bile, erken ve doğru cerrahi müdahalenin sağkalım üzerine olan önemini vurgulamayı amaçladık. Çalışmaya alınan hastaların ortalama yaşı 26 (17-42) yıl idi ve tümü erkekti. İki hasta AS’ye kardiyak arrest olarak getirilmişti ve bu hastalar kurtarılamadı. Üç hasta ise AS’ye kardiyojenik şok ile getirildi ve bu hastaların tümü ameliyat sonrası iyileşti. İki hastada sağ ventrikül yaralanması tespit edildi ve bu hastaların her ikisi de operasyon sonrası hayatta kaldı. Üç hastada sol ventrikül yaralanması saptandı ve bu hastaların 2’si öldü. Üç hasta ateşli silah ile yaralanırken, 2 hasta kesici alet ile yaralanmıştı. Her iki grupta birer hasta öldü. Üç hasta herhangi bir komplikasyon olmadan taburcu edildi. İki hasta, biri operasyon öncesi ve biri operasyon sırasında olmak üzere öldü (sağkalım oranı: 3/5). Bu 3 hastanın yapılan birinci ve üçüncü ay kontrollerinde sol ventrikül ejeksiyon fraksiyonları normal olarak hesaplandı ve herhangi bir major sekel oluşturan komplikasyon gelişmedi. Penetrating cardiac injuries are one of the most lethal types of trauma. Early diagnosis, appropriate approach in the emergency department (ED), early resuscitation and immediate surgical intervention are essential in the management of penetrating cardiac injuries. In this study we retrospectively evaluated five patients with penetrating cardiac injuries in a 1-year period before an open heart surgery center was set up in our hospital; and we aimed to underline the importance of an appropriate and early surgical intervention without cardiopulmonary by-pass on survival. Median age of our patients was 26 years (range, 17-42 years) and all of the patients were males. Two patients were presented as cardiac arrest and they could not be survived. Three of our patients presented to our ED with cardiogenic shock and all of them recovered after the operation. Right ventricle injury was determined in two patients and both of them survived after the operation. In 3 patients, left ventricle injury was observed and 2 of them died. While 3 patients presented with gunshot injury, 2 of them presented with sharp object injury. One patient in each group was died. Three patients recovered without any complications, however 2 patients- one before operation and 1 during operation- died (survival rate: 3/5). Those 3 patients did not develop any major stationary sequela with normal LVEF in the follow-up at first and third.

Gastrointestinal complications after open-heart surgery are rare. Many preoperative, intraoperative, and postoperative factors may predispose patients to these complications or cause them. Our patient was a 64-year-old woman who underwent aortic valve replacement due to aortic stenosis. Free intra-abdominal hemorrhage occurred on the 2nd postoperative day. During exploratory laparotomy, it was determined that the hemorrhage was from a vein near the falciform ligament of the liver and from a bleeding laceration of the splenic capsule. The complication was repaired surgically. To our knowledge, intra-abdominal hemorrhage of both liver and spleen after open-heart surgery has never been reported before, even in large patient series. We report the case and present our ideas regarding the cause of the bleeding.

The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle, as the anterolateral muscle has dual blood supply, whereas the posteromedial papillary muscle has a single blood supply. We present a a 49 years old male patient who has presented with chest pain and dyspnoea. A transesophageal echocardiogram was performed which showed that the mitral valve was normal in thickness with a flail anterior leaflet not coapting with the posterior leaflet due to the coronary artery disease. The patient underwent a mitral valve replacement and left anterior coronary artery and obtuse marginal bypass grafting.

Deep venous thrombosis is frequently seen in lower extremities. However, when seen in the iliac level, mass effect of an underlying pathology must be considered. In this report, we present two cases with upper region deep venous thrombosis, which had underlying pathologies of appendicitis and non-Hodgkin lymphoma. Keywords: Deep venous thrombosis, Etiology, Emergency department