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A 37-year-old male patient was referred to our clinic due to refractory right-sided heart failure. Physical examination showed generalised oedema in lower extremities bilaterally, ascites and hepat...

Background: In this study, we present the outcomes of 53 patients with concomitant coronary artery disease and ischemic mitral regurgitation (IMR)who underwent coronary bypass grafting (CABG) plus mitral repair (flexible posterior band annuloplasty). Materials and Methods: A total of 53 patients with concomitant ischemic mitral regurgitation and coronary artery disease underwent CABG plus posterior mitral band annuloplasty between June 2008 and June 2015. Flexible Duran AnCore® annuloplasty band (Medtronic) was used in all patients. Transesophageal echocardiography (TEE) was intraoperatively performed in all patients. A transthoracic (TTE) follow-up examination was performed at postoperative months 1, 3, 6, and 12. Results: The average cross-clamp and cardiopulmonary bypass times were 85.11 ± 5.79 and 105.98 ± 6.14 minutes, respectively. Postoperatively, there was an improvement in the grade of mitral regurgitation from 3.8 to 0.7 and in the NYHA class from 3.1 ± 0.5 to 0.5 ± 0.6 (both P < .001). In addition, statistically significant reductions in LVEDD, LVESD, and PAP were observed (P < .001). Ejection fraction rose from 39 ± 10% to 45 ± 8% (P < .01). Early mortality rate was 7.5% (n = 4). Mean follow-up was at 16 months. Late mortality occurred in one patient. During the follow-up period, reoperation was required in 2 patients. Only 2 parameters, redo surgery (P = .030) and IABP use (P = .021), were found related to mortality (P < .001). Cox regression analysis showed that redo surgery and postoperative bleeding increased mortality by 14.731 times (odds ratio: 14.731; 95% confidence interval [CI]: 1.530-141.852) and 23.839 times (odds ratio: 23.839; 95% CI: 1.478-348.641). Discussion: In patients with IMR, mitral band annuloplasty performed in conjunction with CABG was associated with an increase in functional capacity and ejection fraction as well as a reduction in LVEDD and LVESD. This approach represents a feasible alternative with low mortality and prevents future development of mitral regurgitation and the need for redo surgery.

In congenital heart surgery, especially after Tetralogy of Fallot (TOF), problems from the right ventricular outflow tract may lead to serious complications as morbidity and mortality. To resolve these problems by reoperating using cardiopulmonary bypass (CPB) with valves or conduits is affecting surgical morbidity and mortality rates. The ability of a newly developed Shelhigh Pulmonic Valved Injectable No-React-Treated Conduit (NR 4000-PA MIS Shelhigh Inc., Union, NJ, USA) to be implanted into a beating heart provides great advantages for both patient and surgeon. Early results of the first application in our clinic are presented in this article.

A 57-year-old man who had aortic insufficiency with mild dilatation (36 mm) of the ascending aorta but no evidence of aortic wall degeneration, developed acute dissection of the ascending aorta 6 months after aortic valve replacement. He underwent successful Dacron graft replacement of the ascending aorta.

The incidence of bacterial endocarditis and valvular involvement is rare in the childhood period. If the patient is unresponsive to medical treatment and some complications occur, early surgical treatment is indicated. Debridement of vegetation combined with valve repair techniques sparing the native valve is the ideal surgical procedure instead of replacement, especially for children. Annuloplasty is the key step during valve repair procedures. On the other hand, absence of appropriate sized annuloplasty rings on the market for this group of patients is the main problem. Nondegradable annuloplasty rings might lead to stenosis as the child grows. Thus, biodegradable tissue engineered materials are new solutions for such patients since the fibrous tissue induced by implanted ring grows with time. We describe a pediatric patient with Brucella endocarditis at the mitral position who was treated successfully with valve repair using a biodegradable annuloplasty ring (Kalangos Biodegradable Ring).

Prevention of retained foreign bodies in the pericardial cavity is critical for patient safety. We report a patient with a bulldog clamp that was forgotten during a coronary artery bypass operation 8 years ago, which was detected by chance and removed.

Objective: Purulent pericarditis is a rare disease that is being conventionally managed with intravenous antibiotics and pericardial drainage. In our study, we used intrapericardial fibrinolytic treatment together with pericardiocentesis and antibiotic therapy. We evaluated the role of intrapericardial fibrinolytic treatment in nine purulent pericarditis patients. Methods: Six children and three adult patients with purulent pericarditis, aged between 5 and 50 years, were treated with intrapericardial fibrinolysis by streptokinase. Intrapericardial drainage catheter was placed into the subxyphoidal localization under local anaesthesia and echocardiography guidance, streptokinase was infused into the pericardial sac as the fibrinolytic agent. Results: Repeat echocardiograms showed no reaccumulation of pericardial effusions, pericardial thickening or constrictions. No patients had systemic bleeding, arrhytmias, or hypotension. There was one death which was due to sepsis and congestive heart failure. Conclusion: We believe that early pericardial drainage and intrapericardial fibrinolysis appears to be safe and effective in the treatment of purulent pericarditis. q 2002 Elsevier Science B.V. All rights reserved.