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A 45-year-old male patient presented to our clinic with a post-dissectional thoracic aortic aneurysm with the retrograde filling of the false lumen. He previously underwent a Bentall operation and a proximal thoracic endovascular aortic repair. We carried out a bare metal stent implantation concomitant with endograft extension and stent-assisted balloon-induced intimal disruption and relamination procedure consecutively. Although true lumen expansion was achieved, the aneurysmatic dilation of the descending thoracic aorta was kept on expanding due to perfusion of the false lumen by the distal re-entries. Therefore, it was decided to perform a totally false lumen thrombosis by the candy-plug technique. In conclusion, despite being a fatal disease, endovascular treatment of post-dissectional thoracic aortic aneurysm post-dissectional thoracic aortic aneurysm is possible in anatomically suitable patients with a stepwise approach in experienced endovascular centers.

Background and Objectives Coarctation of the aorta in adulthood is generally associated with other cardiovascular disorders requiring surgical management. An extra anatomic bypass grafting from the ascending to descending aorta by posterior pericardial approach via median sternotomy could be a reasonable single stage surgical strategy for these patients. Subjects and Methods Seven male patients aged between 14-41 years underwent an extra anatomic bypass grafting for coarctation repair concomitantly with the surgical management of the associated cardiovascular disorders via median sternotomy. Preoperative mean systolic arterial blood pressure was 161.8±24.5 mmHg, although the patients were under treatment of different combinations of antihypertensive agents. Additional surgical procedures were: aortic valve replacement (n=4), ventricular septal defect (VSD) closure (n=2), ascending aortic replacement (n=3) and Bentall procedure (n=1). None of our patients have been previously diagnosed or operated on for coarctation. Data were evaluated during their hospital stay and in post-operative follow-up. Results The post-operative course was uneventful in all but one patient was re-operated on due to bleeding. There was neither mortality nor significant morbidity during the in-hospital period and all patients were discharged within 5-9 (mean: 6.3±1.5) days. The mean follow up period was 71.83±23 months (range: 23-95 months). Unfortunately one of our patients could not be contacted for a follow up period because of invalid personal data. Conclusion Coarctation of the aorta in adulthood associated with other cardiovascular disorders can be operated on simultaneously via an extra anatomic bypass grafting technique with low morbidity and mortality.

Background In this study, we retrospectively reviewed our experience in a meticulously selected group of patients undergoing redo off-pump coronary artery bypass graft (CABG) surgery from the descending aorta to the circumflex artery (Cx) and its branches. Methods Between January 2001 and October 2013, 32 patients at our hospital underwent redo off-pump CABG from the descending aorta to the Cx and its branches via a left posterolateral thoracotomy. Of these patients, 27 were male (84.3%) and five were female (15.7%), with a mean age of 61.66 ± 8.63 years. All patients had a patent left internal thoracic artery-to-left anterior descending coronary artery (LITA-LAD) anastomosis. Thoracotomy was performed through the fifth intercostal space. The saphenous vein or radial artery was prepared as a graft at the same time as the left posterolateral thoracotomy from the contralateral extremity, without any positional problem. Results The main reasons for surgery in this group of patients were new lesion formation in 19, graft occlusion in six, and both in seven patients. The average operating time was 143.90 ± 36.93 minutes, respiratory assist time was 5.08 ± 1.88 hours, intensive care unit (ICU) stay was 21.3 ± 4.41 hours and hospital stay was 5.06 ± 2.74 days. Thirty-eight bypasses were performed. The follow-up period was 56.17 ± 39.2 months. Six patients were lost in the follow-up period and four patients died. Twenty-two were alive and free of cardiac problems. Conclusion Redo off-pump CABG via a left posterolateral thoracotomy provided a safe and effective surgical approach with lower rates of postoperative morbidity and mortality in patients who required revascularisation of the Cx and its branches.

A cleft sternum is a very rare developmental anomaly. It is caused by failure of fusion of the two lateral mesodermal sternal bars which later form the sternum. Diagnosis of cleft sternum is generally made in the neonatal period, and it is usually associated with other congenital defects. Occasionally, patients with cleft sternum may be reported late in the childhood or even in adulthood. We present the case of an adult patient with sternal cleft diagnosed incidentally in the perioperative period at the time of off-pump coronary artery bypass grafting. No other skeletal or cardiac congenital anomalies had been noted previously in this patient.

JenaValve TM system is a second-generation transcatheter heart valve that provides a successful deployment not only in calcified stenotic aortic valves but also in non-calcified, severe regurgitant aortic valves. We performed a transapical transcatheter aortic valve implantation procedure using this system without any procedure-related complications in a 75-year-old woman with multiple co-morbidity factors, who had both mitral and aortic regurgitation, and low ejection fraction.

The vascular actions and mechanisms of taurine were investigated in the isolated human radial artery (RA). RA rings were suspended in isolated organ baths and tension was recorded isometrically. First, a precontraction was achieved by adding potassium chloride (KCl, 45 mM) or serotonin (5-hydroxytryptamine, 5-HT, 30 µM) to organ baths. When the precontractions were stable, taurine (20, 40, 80 mM) was added cumulatively. Antagonistic effect of taurine on calcium chloride (10 µM to 10 mM)-induced contractions was investigated. Taurine-induced relaxations were also tested in the presence of the K+ channel inhibitors tetraethylammonium (1 mM), glibenclamide (10 µM) and 4-aminopyridine (1 mM). Taurine did not affect the basal tone but inhibited the contraction induced by 5-HT and KCl. Calcium chloride-induced contractions were significantly inhibited in the presence of taurine (20, 40, 80 mM) (p

Department of Cardiac Surgery, Guven Hospital, Ankara, Turkey* Corresponding author. Department of Cardiac Surgery, Guven Hospital. Simsek sok. No: 29, Kavaklidere, Ankara, Turkey. Tel: +90-312-4572490;Fax: +90-532-3158616; e-mail: ibrahimduvan@hotmail.com (I. Duvan).Received 24 February 2012; received in revised form 21 March 2012; accepted 30 March 2012

Minimally invasive direct coronary artery bypass (MIDCAB) surgery in the awake patient with epidural anesthesia had been previously reported. However, there is no prospective randomized study comparing MIDCAB surgery with epidural anesthesia versus general anesthesia.The study was conducted as a prospective and randomized study. Between January 2002 and May 2003, 76 patients were randomly assigned into either MIDCAB under general anesthesia (GA Group) or MIDCAB under epidural anesthesia (EA Group). The EA Group patients did not receive concomitant general anesthesia and they were conscious throughout the procedure. All patients had a left internal thoracic artery to left anterior descending coronary artery bypass using the same MIDCAB techniques. There were 42 patients in the GA Group and 34 patients in the EA Group. For statistical analysis, unpaired t-test for independent samples was used for comparison of continuous variables, and Pearson Chi-Square test was used for comparison of discrete variables.The demographic characteristics of the groups were similar. There was no mortality or major morbidity in both groups. The EA Group patients had lower arterial oxygen saturations (93.3+/- 3.2% versus 97.4+/- 1.3%, p0.001) and higher partial carbon dioxide pressures (45.8+/- 3.6 mmHg versus 41.5+/- 2.5 mmHg, p0.001), but these were not clinically significant. The EA Group patients had significantly less intensive care unit (ICU) (5.5+/- 6.5 hours versus 18.2+/- 4.8 hours, p0.001) and hospital stay periods (31.4+/- 20.7 hours versus 58.6+/- 17.9 hours, p0.001), as well as significantly less postoperative pain (visual analog score 1.06+/-0.6 versus 2.3+/-0.6, p0.001) and blood loss (184.2+/- 169.0 ml versus 371.7+/- 315.3 ml, p0.001). There was no any difference in regard to patient satisfaction after the procedure between the two groups. Long -term results were equally satisfactory in both groups.It can be concluded that, similar surgical results can be achieved by MIDCAB surgery with general or epidural anesthesia. Although epidural anesthesia has no impact on the degree of patient satisfaction after the procedure, it yields significantly shorter ICU and hospital stay periods, which may result in more efficient use of hospital resources.

Off-pump coronary artery bypass grafting can not be performed without adequate stabilization and exposure techniques. Although most of the commercially available systems provide effective stabilization and exposure, their use were generally deemed time consuming and cumbersome. Achieving the same and even better results with simple traction sutures has led to the abandonment of commercially available systems. Although not a primary concern, the radial suture traction technique is also extremely cost efficient.

Hydatid disease (HD) is a parasitic infection caused by larvae of Echinococcus granulosus. HD may affect almost any part of the body. Cardiac involvement in HD is uncommon, constituting only 0.5-2% of all cases of hydatidosis. Here, we present a 29-year-old male patient with a right ventricular hydatid cyst treated surgically. Surgery still remains the treatment of choice in the management of HD. We also believe that routine echocardiographic screening may be useful in endemic regions where the infestation is common.

Maneuvers during coronary artery bypass (CAB) operations like cannulation, cross or partial clamping of ascending or arcus aorta must be avoided in the existence of significantly atherosclerotic plaques. If these maneuvers are performed, atherosclerotic plaques will be prone to be the reason of the atheroembolic complications due to debris dislocation. We present a simple, effective, and protective technique for constructing proximal anastomoses during off-pump CAB operations to prevent patients from devastating atheroembolic complications either cerebral or systemic.

Electrical injury is the passage of electrical current through the body. Although it is relatively uncommon, it still carries high risk of morbidity and mortality. In the heart, the most common sequelae after electrical injury are myocardial contusion and arrhythmias. We present a 25-year-old male patient with severe aortic regurgitation and 5 cm dilatation of the ascending aorta admitted due to the complaints of increasing chest pain, palpitation and dyspnea and had a high-voltage electric injury 10 days priorly.