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Objective: Atheromatous plaques in the ascending aorta are major risk factors for strokes caused by macroembolization after coronary artery surgery. Detection of plaque formations and changes in the surgical strategy are very important. This study was planned to compare value direct palpation and multislice computerized tomography to establish aortic plaques and to establish clinical predictors of aortic calcification. Methods: Fifty-four patients who underwent coronary bypass surgery were included in this prospective and diagnostic study. Proximal portion of each patient's aorta was evaluated with multislice computerized tomography and was compared with direct palpation. The efficacy of intraoperative palpation to predict calcifications was studied with ROC analysis and the predictors of aortic plaque formation were analyzed using logistic regression analysis. Results: Atheromatous plaques were detected with palpation in four patients (7.4%), and with multislice tomography in six patients (11.1%). The aortic instrumentation was changed in two patients (3.7%) and strategy was changed in one patient 1.8%). According to the ROC analysis, when multislice computerized tomography was taken as the reference, intraoperative direct palpation was 67% sensitive and 100% specific to predict aortic plaques. Logistic regression analysis of the risk factors showed that the older age was the only significant risk factor (OR-1.3, 95% CI -1.114-1.568, p=0.001) for plaque formation in the aorta. Neither stroke nor other neurological disorders have been observed during the study. Conclusions: It can be stated that multislice computerized tomography is more effective to show aortic plaques, but it is not sufficient. Multislice tomography may give additional information about the ascending aorta and the opportunity to visualize the aortic arch. It can be preferred in patients with aortic aneurysm or dissection. [ABSTRACT FROM AUTHOR]

Background: While minimally invasive procedures are being used in cardiac surgery, experience with minimally invasive proximal aortic surgery has been limited to certain centers., Methods: Between January 2010 and March 2015, 54 patients with an upper "J" hemi-sternotomy and 75 patients with a conventional sternotomy due to proximal aortic pathology were included in this study. Forty-five patients from the "J" hemi-sternotomy group were matched with 45 patients from the conventional sternotomy group with respect to age, sex, ejection fraction, diabetes, hypertension, smoking history and operative type. Perioperative variables were in-hospital mortality, surgery for revision, amount of blood loss, requirement for blood transfusion, cardiopulmonary bypass (CPB), aortic cross-clamp and unilateral cerebral protection times, duration of ventilation, and length of intensive care unit (ICU) and total hospital stay., Results: Patients were between 21-76 years with a mean age of 58.14 ± 11.06 years; 73.3% (n = 66) were male and 26.7% (n = 24) were female. Of all the cases included, 36.7% (n = 33) had isolated ascending aortic replacement, 41.1% (n = 37) had concomitant aortic valve replacement and ascending aortic replacement, and 22.2% (n = 20) had a Bentall procedure. Statistically, the amount of bleeding (P = .026), length of ventilation (P = .001), ICU (P = .001) and total hospital stay (P = .004) in the "J" hemi-sternotomy group were all found to be significantly lower than those in the conventional group., Conclusions: Minimally invasive techniques like an upper "J" hemi-sternotomy can be safely performed without prolonging the aortic clamp time, and with less blood loss, less ventilatory support, and shorter ICU and total hospital stays when compared to conventional methods.

We report a 59-year old patient with a double J ureteral catheter displaced out of the ureter through the inferior vena cava and right ventricle. The catheter was removed successfully under cardiopulmonary bypass., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Paget's disease of the sternum is rare. In patients with sternal Paget's disease, sternotomy, and harvesting of internal mammary arteries may reveal problems because of a thickened sternum and substernal adhesions. Saphenous vein graft or other arterial grafts may be used. Especially in younger patients who received saphenous vein graft, a repeat revascularization operation, because of earlier saphenous vein graft degeneration, may be needed in subsequent years. During the repeat operation, opening and reclosing the chest will still be a major problem. In appropriate patients, an operation through a thoracotomy or noninvasive balloon and/or stent techniques may be good choices.