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Congenital heart disease (CHD) is one of the most specific and yet challenging fields of heart surgery. Apart from the known clinical approaches, including surgery, a significant scale of regenerative therapeutic options is available, which increase the number of cardiomyocytes and restore cardiac function. Although it has been revealed in recent years that mitochondrial transplantation can be used as a promising treatment option in this disease group, there is no clinical evidence for the significance of mitochondrial function in myocardial tissue of patients with CHD regarding cardiac surgery. In this study, mitochondrial morphology and function, myocardial fibrosis, and myocyte atypia were evaluated in myocardial biopsy tissue of pediatric patients with cyanotic and acyanotic CHD, five from each group. After histopathological evaluation of myocardial tissue specimens, mitochondrial morphology and network were analyzed by immunofluorescence staining using an anti-Tom20 antibody, electron transport chain complexes of myocardium were examined by cytochrome c oxidase/succinate dehydrogenase staining, and the amount of ATP was measured by bioluminescence assay. In addition, cardiac markers have been tested to be reviewed as a potential indicator for postoperative follow-up. Myocyte atypia and fibrosis were classified on a scale of 1 to 4. In this study, unlike patients with acyanotic CHD, alterations in mitochondrial network and reduction in ATP production were detected in all pediatric patients with cyanotic CHD. A statistically significant correlation was also determined between mitochondrial dysfunction and cardiac markers. These findings may be assumed as a promising pathway for evaluating the relationship between mitochondrial dysfunction and cyanotic CHD.

Congenital anomalies of the heart and great vessels may lead to localized recurrent pulmonary infections through different mechanisms. Pulmonary artery sling (left pulmonary artery originating from the right pulmonary artery) and Scimitar syndrome are rare causes of wheezing in infants. An 18-month-old female infant with left pulmonary artery sling, Scimitar syndrome, and an anomalous connection of left pulmonary veins to the left atrium was admitted to our clinic. She successfully underwent transcatheter embolization using the Vascular Plug-II on the anomalous systemic arterial supply and repair of pulmonary arterial sling and Scimitar anomaly via a median sternotomy. In conclusion, diagnosis of left pulmonary arterial sling accompanied by abnormalities can be missed in some cases using echocardiography. It may be necessary to conduct more advanced imaging methods before deciding the treatment method to be performed in these patients.

Purpose: The anterior mediastinal masses are composed of neoplasms from many different groups, thymic epithelial tumors (TET) being the most common type. Histologic subtype, tumor stage and completeness of resection are considered to be the most important prognostic factors in thymic malignancies. The aim of this study is to evaluate the association between the preoperative CT characteristics and the histological types, mostly focusing on thymic neoplasms. Methods: Preoperative CT features and pathologic data of 40 patients who underwent surgery due to an anterior mediastinal mass were retrospectively analyzed. Patients are grouped as thymomas, thymic carcinomas and others. Results: CT characteristics such as shape, contour, necrosis, lymph node enlargement, surrounding organization, pathologic invasion pattern, internal density, presence of cystic component, pleural/pericardial effusion and calcification were compared with histologic subtypes. Among these parameters solely pathologic invasion and surrounding organization were statistically different between the groups (p0,05). Conclusion: According to the results of our study, CT imaging has a limited role in predicting stage and malignant potential particularly for thymic neoplasms and anterior mediastinal masses.

Significant advances have been achieved in immunotherapy for the treatment of lung cancer. It is known that tumor cells and cells in the tumor microenvironment express high amounts of programmed cell death ligand 1 (PD-L1). These PD-L1s interact with programmed cell death protein 1 (PD-1), causing immunosuppression. The aim of our study is to examine the correlation between the serum sPD-1 and sPD-L1 levels and clinicopathological characteristics in patients with nonsmall cell lung cancer. We also compared our results with the healthy population (control group).Thirthy-seven nonsmall cell lung cancer (NSCLC) patients who were operated in our clinic were included in our study. The control group included fifteen healthy patients. The sPD-1 and sPD-L1 levels were measured in serum samples by using the ELISA method.The preoperative sPD-1 and sPD-L1 levels were significantly higher in the study group compared to the control group (44.12 ± 22.25 pg/mL vs. 18.54 ± 6.56 pg/mL; p = 0.001 and 26.15 ± 18.03 pg/mL vs. 10.29 ± 3.08 pg/mL; p = 0.001, respectively). There was a statistically significant decline in serum sPD-1 and sPD-L1 levels at the preoperative and postoperative 1st, 7th, and 30th days following surgical resection (44.12 ± 22.25 pg/mL, 37.86 ± 18.02 pg/mL, 36.33 ± 18.36 pg/mL, 34.14 ± 13.71 pg/mL; p = 0.007 and 26.15 ± 18.03 pg/mL, 20.60 ± 15.50 pg/mL, 18.31 ± 14.04 pg/mL, 13.64 ± 10.60 pg/mL; p = 0.001, respectively).There was a positive correlation between the preoperative and postoperative 30th day serum sPD-1 levels and the tumor size (p = 0.031, r = 0.352; p = 0.024, r = 0.371; respectively). We also found a positive correlation between the preoperative and postoperative 30th day serum sPD-L1 levels and pleural invasion (p = 0.001, p = 0.001; respectively), and the N category (p = 0.015, p = 0.013; respectively).We think that sPD-1 and sPD-L1 levels may be used as a potential biomarker for lung cancer screening, prediction of the stage, and besides to detect recurrences and/or metastases following resection in NSCLC following validation with multicenter and larger-scale prospective trials.

Objectives:In this study, we examined our 38 years of institutional experience with 81 patients operated for primary cardiac tumor.Materials and Methods:Among the 81 patients included, 95% (n=77) had benign tumors and 5% (n=4) had malignant tumors. Benign tumors were myxomas (n=66, 81.5%), rhabdomyomas (n=9, 11.1%) and papillary fibroelastomas (n=2, 2.5). Malignant tumors included angiosarcomas (n=2, 2.5%) and rhabdomyosarcomas (n=2, 2.5%). Common symptoms of admission were dyspnea (49.4%), palpitation (30.9%) and systemic embolization (14.8%). Tumors originated from the left atrium in 61 cases (75.3%), right atrium in 12 cases (14.8%), right ventricle in 5 cases (6.2%) and left ventricle in 3 cases (3.7%). The surgical method was uniatrial in 47 patients (58%). Bilateral atriotomy was performed in 26 patients (32%). The incidence of postoperative complication was 14.8% (n=12).Results:In-hospital (30 day) mortality was 4.9% (n=4). The survival of other benign tumors and malignant tumors were poorer than the patients with myxomas.Conclusion:Surgical resection of primary cardiac tumors with negative margins have excellent long-term survival which are similar to general population.

Background and objectives:Total anomalous pulmonary venous connection is a rare cyanotic CHD that requires surgical repair. An unligated vertical vein after total anomalous pulmonary venous connection surgery may help to decrease the episodes of post-operative pulmonary hypertensive crises, low cardiac output syndrome, and mortality. The aim was to assess long-term outcome and our post-operative transcatheter vertical vein closure experiences in five patients with repaired total anomalous pulmonary venous connection patients.Methods:A retrospective study was conducted in five cases with an unligated vertical vein following repair of supra-cardiac total anomalous pulmonary venous connection at our hospital from 2011 through 2018. Patients characteristics, cardiac catheterisation findings, surgical, and transcatheter procedural details were retrospectively analysed.Results:Transcatheter closure of the unligated vertical vein was technically successful in all the patients. Procedure-related complications were not observed in any of the patients. No long-term complication was found.Conclusions:We suggest that transcatheter closure of the patent vertical vein is an effective and well-tolerated alternative to the surgical approach.

Although stroke is common in infective endocarditis (IE), only 26 cases of thrombectomy have been reported to date for IE-related acute stroke. We report a 40-year-old man who presented with left middle cerebral artery occlusion of unknown cause. Multiple attempts of mechanical aspiration thrombectomy and stentrievers failed to recanalize the artery. Effective revascularization was eventually achieved by placing a self-expanding intracranial stent. Post-procedurally the patient was diagnosed with IE with mitral valve insufficiency, mandating emergent valvular replacement while the patient was still on tirofiban infusion. On follow-up, the patient had a modified Rankin's score of 0, had no recurrent stroke, and the intracranial stent remained patent yet stenosed. Based on the use of a self-expanding intracranial stent in the setting of IE, we discuss the consequences of the fibrotic and inflammatory content of the embolus and the associated high risk of intracranial hemorrhage which complicates clinical decision making.

Objectives: Congenital heart disease (CHD) is one of the most specialized field of heart surgery and compelling approaches such as mitochondrial transplantation is creating promising options. Therapeutic options are available, but lack of data on mitochondrial function in this disease group. Hence, we hypothesized that there is a differential level mitochondrial dysfunction in cyanotic vs acyanotic CHD groups and aimed to indicate any potential pediatric patient group that is suitable for this innovating therapeutic approach. Hence, in this study, mitochondrial morphology and function, myocardial fibrosis, and myocyte atypia were evaluated in myocardial tissue of pediatric patients with cyanotic and acyanotic CHD. Additionally, cardiac enzymes have been reviewed as a potential indicator for postoperative follow-up. Methods: 5 acyanotic CHD and 5 cyanotic CHD patients were included according to clinical parameters of patients. During the open heart surgery, myocardial biopsies (2–3 mm³) were obtained from right atrium. Mitochondrial morphology was evaluated by immunofluorescence staining using anti-Tom20 antibody, electron transport chain complexes of myocardium were examined by histological cytochrome c oxidase/succinate dehydrogenase (COX/SDH) histochemical staining and ATP production was measured. Hematoxylin and eosin, and Masson ’ s trichrome staining were used to determine histopathological changes. In both preoperative and postoperative period, cardiac enzymes of each patient were monitored. Myocyte atypia, and fibrosis were classified on a scale of 1 to 4. All data were analyzed to determine any correlation between all parameters. Results: In the research study, unlike patients with acyanotic CHD, alterations in mitochondrial network and reduction in ATP production were detected in all pediatric patients with cyanotic CHD. These findings may be assumed as an evidence for the relationship between mitochondrial dysfunction and cyanotic CHD. As well as, statistically significant correlation was determined between mitochondrial dysfunction and cardiac enzyme levels. Conclusion: Due to the fact that mitochondrial in myocardium of pediatric patient group with cyanotic CHD were determined, mitochondrial transplantation may be considered as a futuristic therapeutic approach to increase the surgical success in patients with cyanotic CHD. Funding Statement: This work was supported by Hacettepe University Scientific Research Projects Coordination Unit, Project Number: THD-2018-16687 Declaration of Interests: There is no conflict of interest. Ethics Approval Statement: This study protocol was approved by Hacettepe University Faculty of Medicine Ethical Review Board (GO 17/651). Additionally, on behalf of all named authors, I, the Corresponding Author, declare that all experiments were performed in accordance with guidelines, and regulations of Declaration of Helsinki.

Background/aim: Cardiopulmonary bypass (CPB)-associated acute kidney injury (AKI) is a common situation and rapid diagnosis and risk classification are important in the prevention and management of AKI. Changes in serum creatinine (SCr) levels in the current consensus criteria do not allow clinicians to diagnose CPB-associated AKI until 48 h after surgery. Materials and methods: We conducted a prospective single center study involving 57 patients who underwent cardiac surgery with CBP to compare serum beta-trace protein (BTP), neutrophil gelatinase-associated lipocalin-2 (NGAL), and cystatin C (CysC) levels with SCr for early diagnosis of CPB associated AKI. We defined AKI according to KDIGO criteria. Results: AKI was diagnosed in 24 (42.1%) patients. Mean duration of postoperative intensive care unit stay was 4.79 (± 6.12) days for the AKI+ group and 2.15 (± 0.56) days for the AKI- group. The average length of hospital stay was 8.13 (± 5.75) days for the AKI+ group and 7.21 (± 3.68) days for the AKI- group, which was significantly longer in the AKI+ group (P < 0.001, P = 0.011). Unlike other biomarkers, a significant increase in postoperative CysC levels was always found in patients with AKI during follow-up when compared to patients in whom AKI did not develop (P < 0.001). Conclusion: Increase in serum CysC levels showed a significant positive correlation with increase in SCr levels. We have not seen this correlation between other biomarkers and SCr. According to our study, serum CysC was a reliable biomarker that may aid in the early detection and follow-up of AKI after cardiac surgery.

Objective: We aimed to evaluate congenital heart disease (CHD) cases according to EUROCAT subgroup classification that were diagnosed during the prenatal period in our center.Methods: CHDs ...

Takayasu arteritis is a disease that results in the granulomatous inflammation of large vessel walls. Takayasu arteritis is generally observed in young females during the second or third decades of life. This disease is treated by the revascularization of the affected organs either by surgery or by endovascular interventions. In this study, we present a case where renal autotransplantation was performed on a lady with an autologous saphenous vein graft subsequent to numerous previous endovascular interventions for her solitary kidney due to Takayasu arteritis-induced renal artery stenosis. The patient was prevented from becoming dialysis dependent through this surgical intervention. Renal autotransplantation is the choice of treatment, especially for those in whom endovascular interventions have failed. Patient management must include the partnership of an experienced vascular surgeon, transplant urologist, rheumatologist, nephrologist and radiologist.

Cardiac resynchronization therapy is a promising therapeutic option for patients with end-stage heart failure. The preferred method for left ventricular lead implantation is the percutaneous access through the coronary sinus. However, this technique may impose certain technical difficulties due to suboptimal lead positioning. In such cases, a video-assisted thoracoscopic epicardial approach may be a good alternative. To date, video-assisted left ventricular epicardial lead implantation from two or three port incisions have been described. Herein, we present the first successful left ventricular epicardial lead implantation through a simplified single-port video-assisted thoracoscopy technique in Turkey.

Background: Arterial aneurysmatic lesions are one of the unique features of Behcet’s disease (BD). However, it is difficult to determine which BD patients will develop an aneurysm. Objectives: In this study, we aimed to determine the differences between BD patients with and without an arterial aneurysm. Methods: Data of the 23 BD patients with an arterial aneurysm was published as an abstract in 2013 (1). We retrospectively reviewed the medical records of 441 patients with BD according to International Study Group (ISG) criteria between January 2013 and June 2018. Totally, we determined 45 BD patients with an arterial aneurysm. Six patients with isolated carotid and/or cranial arterial aneurysms who were followed by other clinics excluded from the analysis. Overall, 39 BD patients with an extracranial and extra carotidal aneurysm included in the study. Data regarding demographic features, clinical, laboratory and vascular imaging findings were collected. Results: A total of 39 BD patients (Male: 76.9%) with an arterial aneurysm were analyzed in this study. Mean age, mean age of diagnosis and a median follow-up of patients were 40.9±11.0 years, 29.7±7.7 and 71.8 (2-186) months, respectively. The mean age at the onset of the arterial aneurysm was 36.1±11.5 years. The median time lag between the onset of BD and detection of an aneurysm was 63.6 (0-482) months. The prevalence of male patients in BD with aneurysms, without aneurysms and only mucocutaneous were 76.9%, 52.3%, and 34.3%, respectively. Comparison of BD patients with and without an aneurysm shown in table 1. In multivariate analysis, having a venous thrombosis was the sole risk factor for the development of arterial aneurysm (OR 10.53, 95% CI 1.53-72.71) (Table). Distribution of aneurysms was shown in the figure. At the first diagnosis, a median number of the aneurysm was 1 (1-4), the median diameter of an aneurysm was 39 mm (10-80) and 16 (41%) patients had more than one aneurysm. Type of the firstly detected aneurysm was as follows; 38.5% saccular, 17.9% fusiform, 15.4% pseudoaneurysm and 2.6% dissecting aneurysms. Aneurysm type was not known in 25.6% of patients. The first diagnostic finding was an aneurysmal symptom in the 25% of BD patients. Conclusion: Aneurysm was the diagnostic symptom in 25% of BD patients with an aneurysms. The median time lag between the onset of BD and detection of an aneurysm was almost 5 years. In aneurysmal BD, there is male sex dominance and having venous thrombosis is the most important risk factor. Although pulmonary arteries have an important role in the BD course, the involvement of the aorta and iliac arteries can be seen frequently. References [1] Kalyoncu U, et al. Ann Rheum Dis 2013;72 (abs) Disclosure of Interests: Berkan Armagan: None declared, Ertugrul Cagri Bolek: None declared, Alper Sari: None declared, Gozde Kubra Yardimci: None declared, Bayram Farisogullari: None declared, Emre Bilgin: None declared, Fatma Gonca Eldem: None declared, Levent Kilic: None declared, Omer Karadag: None declared, Bora Peynircioglu: None declared, Barbaros Erhan Cil: None declared, Metin Demircin: None declared, Ali Akdogan: None declared, Sule Apras Bilgen: None declared, Ali Ihsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim

Background: Arterial aneurysms are one of the unique features of Behcet’s disease (BD). Although arterial aneurysms are relatively rare, they carry risk of rupture and have poor prognosis. Objectives: To evaluate the medical and interventional therapies and long-term outcomes of BD patients with extracranial arterial aneurysms. Methods: We retrospectively reviewed the medical records of 441 BD patients according to ISG criteria between 2013 and 2018 at the Hacettepe University Vasculitis Center (HUVAC). We determined 45 BD patients with an arterial aneurysm. Six patients with isolated carotid and/or cranial arterial aneurysms who were followed by other clinics excluded from the analysis. Overall, 39 BD patients with an extracranial and extra carotidal aneurysm included in the study. Data regarding demographic characteristics, clinical, laboratory and vascular imaging findings, history of medical treatments and outcomes were collected. Vascular intervention of patients were grouped as surgery or endovascular intervention. Radiological response after vascular intervention divided into 3 groups as regression, stable and progression according to radiological evaluation. Regression was defined as a decrease or disappearance of the aneurysm. Stable was defined as no change in the aneurysm diameter. Progression was defined as an increase in diameter of a previous aneurysm or occurrence of a new vascular event. We colligated the stable and regression groups and compared with the progression group. Relapse was defined the progression of the aneurysm which underwent an intervention. Results: A total of 39 BD patients (Male, 80%) with an arterial aneurysm were analyzed in this study. Mean age and mean age of diagnosis patients were 40.9±11.0 and 29.7±7.7 years, respectively. The clinical features of BD was as follows; oral ulcer 100%, genital ulcer 80.6%, acneiform lesion 47.2%, erythema nodosum 33.3%, pathergy positivity 34.5%, arthritis 27.8%, fever 24.3%, uveitis 34.5%, neurological involvement 30.6% and, gastrointestinal involvement 7.7%. Distribution of arterial aneurysms were 5.1% subclavian, 5.1% coronary artery & cardiac, 38.8% pulmonary, 10.3% thoracic aorta, 33.3% abdominal aorta, 5.1% renal, 25.6% iliac and 12.8% femoral. Induction and maintenance treatments are shown in figure 1. In our cohort, 25 (64%) patients needed a vascular intervention, including 9 (23%) open operations and 16 (41%) endovascular interventions. Of 7 (18%) patients had to perform an urgent open operation or endovascular intervention but we didn’t find any relation between the progression of an aneurysm and urgent intervention. First induction treatment options and prognosis of arterial aneurysms shown in figure 2. At median 71.8 months follow up, 7 (18%) patient died in the BD aneurysm group. The rate of progression of the aneurysm was 20% in BD patients with pulmonary artery involvement and 64% in BD patients with aortic and its branch involvement (p=0.038). In the absence of medical induction treatment, 5 patients had progression, 1 had regression and 1 had no follow-up. Conclusion: Arterial aneurysms in BD have poor prognosis and high mortality. Glucocorticoids, cyclophosphamide and interferon-α are the most preferred treatments for induction and maintenance therapy for aneurysm of the BD. Approximately 2/3 of the patients required a vascular intervention. Clinical and radiological progression was more prominent in the aorta and its branches. As expected, there is more progression in interventional procedures without medical treatment. Disclosure of Interests: Berkan-Armagan: None declared, Ertugrul Cagri Bolek: None declared, Alper Sari: None declared, Gozde Kubra Yardimci: None declared, Bayram Farisogullari: None declared, Emre Bilgin: None declared, Fatma Gonca Eldem: None declared, Levent Kilic: None declared, Omer Karadag: None declared, Bora Peynircioglu: None declared, Barbaros Erhan Cil: None declared, Metin Demircin: None declared, Ali Akdogan: None declared, Sule Apras Bilgen: None declared, Ali Ihsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim

Kumbasar U, Aypar E, Karagoz T, Demircin M, Dogan R. Pulmonary thromboendarterectomy in pediatric patients: Report of three cases. Turk J Pediatr 2018; 60: 604-607. Chronic thromboembolic pulmonary hypertension (CTEPH), which occurs due to impartial resolution of the pulmonary thrombus, is a rare type of pulmonary hypertension. However, most patients have an excellent long-term survival following pulmonary thromboendarterectomy (PTE). Pulmonary emboli and associated CTEPH is unusual in the pediatric population and is mostly reveals an underlying thrombophilic state. PTE is also recognized as the best therapeutic option in this subgroup of patients. In this case series, we report three young patients who had successfully undergone PTE due to pulmonary emboli and associated CTEPH.

OBJECTIVES In this study, we aimed to evaluate the early and mid-term outcomes of surgery for renovascular hypertension (RVH) at our institution, within the last 13 years. METHODS We retrospectively reviewed 19 patients who underwent surgery for RVH, between 2005 and 2017. The age at operation, clinical characteristics, cause of arterial stenosis, diagnostic workup, surgical management and outcomes during the follow-up were analysed. The continuous variables were expressed as mean ± standard deviation. RESULTS Twelve female and 7 male patients underwent surgery for RVH. Their mean age was 17.07 ± 11.9 years (range 4–42 years). Nine patients had renal arterial stenosis, and 10 patients had midaortic syndrome (MAS). Aortorenal bypass with the saphenous vein was performed in 6 patients with renal arterial stenosis and 1 patient with MAS. An isolated thoracic aorta-abdominal aortic bypass was performed in 1 patient with MAS, and thoracic aorta-abdominal aortic bypass combined with unilateral aortarenal bypass was performed in 9 patients with MAS. The other surgical procedures performed were 2 autotransplantations and 2 unilateral nephrectomies. Among the patients with MAS, 4 underwent reoperation. The mean follow-up duration was 45.58 ± 32.7 months. Hypertension was cured in 3 patients and improved in 14 patients. The postoperative follow-up creatinine levels were similar to preoperative creatinine levels. All bypasses were patent on mid-term follow-up. One patient who underwent aortorenal bypass died 14 months postoperatively. CONCLUSIONS Surgical management is a suitable option for patients with RVH, who were unresponsive to medical and/or endovascular management. Surgical methods are safe and effective in children and young adults with RVH.

Gestasyonel Trofoblastik Neoplaziler (GTN) plasenta dokusundan köken alırlar ve erken vasküler invazyon yaptıklarından sıklıkla metastaz yaparlar. Beyin metastazı nadir görülür. Metastatik GTN'nin taranmasında 18-florodeoksiglukoz pozitron emisyon tomografisinin (FDG-PET) etkinliği konusunda veriler yetersizdir. Bu olgu sunumunda, eş zamanlı akciğer ve beyin metastazı olan ve beyin metastazının FDG-PET ile saptanama- dığı bir GTN olgusunu sunuyoruz., Gestational trophoblastic neoplasms (GTN) originate from placental tissue and usually metastasizes because of its propensity for early vascular invasion. Intracranial metastases are relatively uncommon. There are limited data on the efficacy of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the eva- luation of metastatic GTN. We present a case of GTN with simultaneous pulmonary and cranial metastases in which the cranial metasteses were undetectable with positron emission tomography (PET) scan.

Background & objectives: Oxidative stress can cause many diseases and increases the risk of post-operative complications in children with congenital heart disease. For these reasons, this study was aimed to investigate the differences between cyanotic and acyanotic paediatric patients who underwent heart surgery with markers of oxidative stress. Methods: Eighty five patients were included in the study. The samples taken before the surgery and within the first 24 h after the surgery were evaluated for haemoglobin (Hb), leukocytes, uric acid, glutathione (GSH), malondialdehyde and total antioxidant capacity. Cyanotic, acyanotic, hyperoxygenated, normo-oxygenated, cardiac surgery with or without cardiopulmonary bypass (CPB) comparisons were made. Results: Positive correlation was found between age and pre-operative total antioxidant status values. Cyanotic and acyanotic patients did not have different antioxidant reserve capacities preoperatively. Although pre-operative thiobarbituric acid reactive substances (TBARS) levels were significantly lower in cyanotic patients, post-operative levels were higher. TBARS levels increased and GSH levels reduced postoperatively. The level of oxygenation did not cause a significant difference on markers of oxidative stress. The duration of CPB did not have negative effects on oxidative stress. Interpretation & conclusions: Cyanotic and younger patients were found to be more vulnerable to oxidative stress. The increased levels of TBARS and the decreased levels of GSH could be the indicators of oxidative damage depending on many factors such as surgery, CPB, ischaemia/reperfusion, inflammation, iron overload and oxygenation. The level of oxygenation does not cause a noticeable difference in oxidative stress. CPB causes oxidative stress, but if it is conducted appropriately, the duration of CPB does not cause a significant negative impact on oxidative stress.

An unoperated 45-year-old man with double-inlet single left ventricle, transposed great arteries, ventricular septal defect, and pulmonary stenosis presented with mitral and pulmonary valvular vegetations unresponsive to antibiotic therapy. The initial diagnosis was made with echocardiography, and the morphology was delineated with computed tomography and magnetic resonance imaging. The patient underwent mitral valve replacement with a mechanical valve and pulmonary valve vegetectomy. He recovered well and he is currently well two years after the operation.

Background: This study aims to investigate the effects of combined and individual use of pericardial closure, expanded polytetrafluoroethylene membrane and resorbable adhesion barrier (REPEL-CV (R)) on pericardial adhesions on a rabbit model. Methods: Thirty rabbits were randomly assigned to six groups: control, pericardium, expanded polytetrafluoroethylene, resorbable membrane, expanded polytetrafluoroethylene + resorbable membrane, and pericardium + resorbable membrane. At the postoperative five weeks, the tenacity of the adhesions was evaluated using a qualitative grading system, and histological specimens were examined. Results: Resorbable membrane group had significantly lower tenacity scores, compared to the control, pericardium, and expanded polytetrafluoroethylene groups (p

Chylous fistula is a serious complication of neck dissection. The use of somatostatin after neck surgery, has been described in literature. Because of the absence of definitive guidelines, reporting of our experience in three cases may guide the surgeons to overcome this life threatening complication. We descibe three cases who underwent neck dissection. While two of them had high output (>1000 mL/day), one had a low output (250 mL/ day) chyle leakage, after neck dissection. After it was noticed in earlier days, conservative management was started immediately. While Somatostatin was started after the re-exploration in two, it was started due to the failure of conservative treatment for low output leakage in one. All of the chyleous fistulas were healed within less than two weeks. We think that somatostatin may be considered as an effective treatment in low output chyle fistulas which the leakage continues after conservative treatment; however in high output chyle fistulas, somatostatin should be used in patients due to lack of control of leakage after ligation of thoracic ductus in revision Somatostatin treatment was discussed in the light of the current literature.

Background This study was performed to investigate the pre-existing histologic alterations at the time of complete repair in patients with tetralogy of Fallot (TOF) and evaluate their effects on the early postoperative outcomes. Methods Fourteen patients, seven with acyanotic TOF (SO2 > 90, group I) and seven with cyanotic TOF (SO2

Objectives We evaluated the clinical outcome and factors affecting survival in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC). Methods Between 1990 and 2007, 28 patients with RCC and tumor thrombus extending into IVC underwent radical nephrectomy and thrombectomy. Patient data were reviewed retrospectively to evaluate the demographics, clinical presentation, surgical approach, pathological features, clinical outcomes, and survival. Results Twenty-eight patients with a mean age of 52.7 years were operated. Thrombus level was infrahepatic in 15 patients (54%), intrahepatic in 3 patients (10%), suprahepatic in 3 patients (10%), supradiaphragmatic in 2 patients (8%), and intracardiac in 5 patients (18%). All patients with intracardiac thrombi underwent cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). The mean tumor size was 98.21 mm. Four patients had distant metastases and 3 patients had lymph node involvement. Pathological examination revealed RCC of clear cell type in 26 patients, papillary in 1 and chromophobe in 1 patient. At a mean follow-up of 36.4 months, 16 patients were still alive while 8 patients died due to disease progression and 2 patients died of other causes. Two patients died of pulmonary emboli in the early postoperative period. Lymph node involvement, distant metastases, hypercalcemia, and sarcomatoid component were found to be factors affecting overall survival significantly. Level of tumor thrombus and Fuhrman grade did not affect survival. Conclusions Radical nephrectomy and tumor thrombectomy is currently known to be the most effective method in patients with RCC and tumor thrombus extending into IVC. Factors affecting survival are the ones related to tumor biology. Tumor thrombus level does not affect the prognosis.

Nephrotic syndrome represents a form of acquired thrombophilia thereby causing increased risk of thrombosis. In patients with nephrotic syndrome both venous and arterial thrombosis can occur; however, intracardiac thrombus is among the rarest reported in the literature. In this case report, we present a 10.5-yr-old boy with right atrial thrombosis and an acute rejection episode after renal transplantation due to end stage renal disease caused by focal segmental glomerulosclerosis manifested by nephrotic syndrome. The clinical course was successfully managed with surgical removal of thrombus, institution of anticoagulant as well as antirejection therapy. This report draws attention to the risks that could be associated with thrombosis in renal recipients with congenital or acquired thrombophilias and emphasizes the importance of identifying risk factors for thrombosis in these patients.

Background. Open heart surgery still involving major bleeding continues to be a major challenge after cardiac surgery and is also a significant cause of morbidity and mortality. Most hemostatic factors are intercorrelated with postoperative bleeding, and fibrinogen seems the most fundamental hemostatic risk factor for open heart surgery. Methods. The study included 97 patients who underwent elective coronary artery surgery (78 men and 19 women; mean age, 60.9 ± 10.3). Preoperative blood samples were obtained and preoprative quantitative determination of plasma fibrinogen levels were measured by the clotting method of Clauss using the fibrinogen kit. Patients were operated on by the same team and the same tecnique. The total amount of drainage blood from chest tubes was recorded after termination of operation. Results. There were statistical significance between the f ibrinogen levels and the drainage (r = –0.897, P < .001). Chest drainage was a mean of 972 mL (range, 240-2445 mL) in the first 48 hours after sternotomy closure. Fibrinogen level and relation to age was statistically significant (P = .015). There was no statisticaly significance between fibrinogen levels and gender (male gender = 400.7 ± 123.0 versus female gender = 395.6 ± 148.1; P = .877) and between drainage and gender (male gender = 968.2 ± 538.5 versus female gender = 990.0 ± 554.7; P = .876). Two patients (2%) died early after the surgery. There were no significant differences between the postoperative bleeding and cardiopulmonary bypass time (P = .648) or cross-clamp time (P = .974). Conclusions. The results of this study suggested that low preoperative fibrinogen level appears to be a useful diagnostic marker to assess the activity of the coagulation system, and that its preoperative level may serve as a potential risk factor for postoperative bleeding after coronary artery bypass surgery.

Cardiac hydatidosis is a rare but potentially life-threatening infestation. Cardiac hydatid cysts generally occur in the left ventricle; followed by the atria, the free wall of the right ventricle, the pericardium and the interventricular septum. Herein, we report a 17-year-old girl with a giant left ventricle cyst who was previously treated by interventional methods for liver and lung hydatid cysts. The cardiac cyst was removed with cardiopulmonary bypass support.

TOF repair can be performed with low morbidity and mortality in many centers. However, some patients can experience a prolonged, troublesome postoperative recovery, associated with higher inotopic scores, extended duration of ventilation, longer intensive care and hospital stays. Underlying pathophysiologic explanation for this concept can be defined as combined myocyte injury and fibrosis in right ventricle of patients with TOF that occurred in response to chronic hypoxia and volume overload, even before corrective surgery.

Introduction. Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurysm, embolus, or arteriovenous fistula may be seen in the pediatric age group. The most common etiologies defined for arterial complications are peripheral arterial puncture performed for a routine arterial blood gas analysis, arterial catheters placed for invasive monitorization of children, or catheterization performed for diagnostic purposes through the peripheral arterial system, most commonly the femoral artery.Materials and Methods. Nine children with peripheral arterial complications, whose ages varied between 2 months and 2.5 years, were enrolled in this study. All patients were treated surgically. Following physical examination, Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography were used as diagnostic tools. We studied thrombophilic panels preoperatively. Six patients had brachial artery pseudoaneurysms that developed accidentally during venipuncture, I had a brachial arteriovenous fistula that developed after an accidental brachial artery puncture during routine peripheral blood analysis. In the remaining 2 patients, peripheral arterial embolic events were detected. One had a left brachial arterial embolus and the other had a sudden onset right femoral artery embolus that was detected via diagnostic interventions.Results. No morbidity such as amputation, extremity loss, or mortality occurred due to the arterial events or surgery. All patients were discharged from the hospital in good clinical condition. In all patients, follow-up at 3 or 6 months revealed palpable peripheral artery pulsations of the ulnar and radial arteries at wrist level.Conclusion. Because the incidence of peripheral arterial complications is relatively low in children compared to adults, the diagnostic and therapeutic approaches are extrapolated from the adult guidelines. We proposed that early diagnosis and surgical approach prevented the complications from further developing in the affected extremity in these particular cases.

Background. Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system, leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins, or by surgical trauma. Proinflammatory cytokines, such as tumor necrosis factor (TNF)-?, interleukin (IL)-6, and IL-8, play an important role in the inflammatory processes after CPB and may induce cardiac and lung dysfunction. This study examined the association of the increased release of TNF-? with increased myocardial and lung injury after CPB and its effect on postoperative morbidity. Methods. Twenty patients undergoing elective coronary artery bypass grafting (CABG) were included in the study. Four intervals of blood samples were obtaind and assayed for TNF-?, white blood cells, C-reactive protein, and erythrocyte sedimentation rate. Results. All patients were similar with regards to preoperative and intraoperative characteristics, and clinical outcomes were comparable. Plasma levels of TNF-? rose more than 20 pg/mL during and after standard CPB in 13 patients (group 1), whereas the plasma levels were less than 20 pg/mL in the remaining 7 patients (group 2) after CPB. The patients of the first group had increased mediastinal bleeding and prolonged intubation time compared to the other group. Conclusion. Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare, but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-? and white blood cell level, C-reactive protein, and erythrocyte sedimentation rate after the operation, but in patients with a high level of TNF-? (more than 20 pg/mL), increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-? after open heart surgery; however, the specific level of TNF-? was first described as 20 pg/mL in this study.

A unique case of superoinferior ventricles, left atrial isomerism, concordant atrioventricular connection, and discordant ventriculoarterial connection is described. The associated anomalies were azygous vein continuation, large subpulmonary and apical ventricular septal defects, and left ventricular outflow tract obstruction (pulmonary stenosis). The diagnosis was mostly made by fetal echocardiography and the superoinferior location of the ventricles was confirmed by postnatal echocardiography. Fetal and postnatal echocardiography facilitated the precise morphologic diagnosis and segmental analysis of this defect.

Cardiopulmonary bypass (CPB) is a technique which is commonly performed without any problem in cardiac surgery. CPB can also be used in patients with a tumoral mass adherent to the great vessels, in patients with critically narrowed airway, if cross-table intubation of the distal trachea is not feasible and in patients necessitating re-do surgery with extensive adhesions because it allows extensive mobilization of the heart and great vessels without compromising their function. It also allowed the central pulmonary artery to be controlled without comprising oxygenation and complete resection of a tumor localized in the A-P window. Herein we report such patients operated with CPB without any problem.

The modified Blalock-Taussig shunt is the most commonly performed systemic to pulmonary artery shunt in children with cyanotic heart disease. Nowadays the approach has shifted from palliative procedures to earlier total correction. But modified Blalock-Taussig shunt is still a lifesaving procedure in cases with severe hypoplastic pulmonary arteries and concomittant coronary artery anomalies which disallow total correction. Here, we present a case with tetralogy of Fallot, mirror image aorta, right aortic arch and coronary artery anomaly. An intrapericardial left subclavian to left pulmonary artery shunt, which is a very rare entity, was performed with sternotomy. [J Contemp Med 2012; 2(3.000): 185-187]

Presentation of an interrupted aortic arch (IAA) in adulthood is extremely rare. Nonhemorrhagic stroke has not been reported previously in any adult with IAA. We, herein, describe a formerly asymptomatic 52-year-old male presenting with recurrent vertebrobasilar circulation ischemic strokes resulting from accelerated atherosclerotic arteriopathy secondary to IAA associated upper body hypertension. Surgical correction of IAA led to treatment of hypertension and cessation of ischemic attacks together with regression of collateral arterial networks as shown by computer tomography angiography.

The modified Blalock-Taussig shunt is the most commonly performed systemic to pulmonary artery shunt in children with cyanotic heart disease. Nowadays the approach has shifted from palliative procedures to earlier total correction. But modified Blalock-Taussig shunt is still a lifesaving procedure in cases with severe hypoplastic pulmonary arteries and concomittant coronary artery anomalies which disallow total correction. Here, we present a case with tetralogy of Fallot, mirror image aorta, right aortic arch and coronary artery anomaly. An intrapericardial left subclavian to left pulmonary artery shunt, which is a very rare entity, was performed with sternotomy., Modifiye Blalock-Taussig şant siyanotik kalp hastalıklarında en sık kullanılan sistemik pulmoner arter şantıdır. Günümüzde yaklaşım palyatif prosedürlerden, erken tüm düzeltmeye kaymıştır. Ancak modifiye Blalock-Taussig şant halen tüm düzeltmeye engel olan koroner arter anomalili ciddi hipoplastik arterli olgularda hayat kurtarıcı bir prosedürdür. Biz, burada Fallot tetralojili, sağ arkus aorta, ayna görüntüsü aortalı ve koroner arter anomalili bir hastayı sunuyoruz. Bu hastaya sternotomi ile nadir bir yaklaşım olan intraperikardiyal sol subklavyen-pulmoner arter şantı yapılmıştır.

The effect of aprotinin, a protease inhibitor, on myocardial interleukin-8 (IL-8) production after ischemia-reperfusion injury was investigated. Twenty patients who had elective coronary artery bypass grafting were included in this study. Patients were randomly divided into two groups (n = 10 in each). Group A patients received high dose aprotinin (20,000 IU/kg as pretreatment followed by 7500 IU/kg for 6 h) and Group B patients received normal saline as a control. Serum IL-8 levels after the termination of cardiopulmonary bypass (CPB) showed a significant improvement in aprotinin treated group compared to control group (70 +/- 42.6 vs 360.71 +/- 87.9 ng/ml) (P0.005). Levels were also significantly higher at post-operative 24th hour in patients who did not received aprotinin (340.16 +/- 92.10 vs 96.13 +/- 34.33 ng/ml). However at post-operative 48th hour levels were again higher in control (untreated) group, but the difference was not statistically significant (78.8 +/- 34.4 vs 42.8 +/- 9.29 ng/ml). Aprotinin prevented the IL-8 release from myocytes in ischemia-reperfusion injury. The mechanism is highly dependent on anti-protease activity of aprotinin.

Gorham-Stout syndrome is a rare disease and most often recognized in children and young adults. Chylothorax is a serious complication of Gorham-Stout syndrome. The treatment of either Gorham-Stout syndrome or chylothorax is still a dilemma. We described a 9-year-old girl with Gorham-Stout syndrome and chylothorax who was admitted to our hospital because of dyspnea, orthopnea, and bone pain, and treated with interferon alpha-2b.

Subxiphoid pericardiotomy was the primary treatment in 305 patients with pericardial effusion from January 1984 to June 1996. There were 198 males and 107 females, ages ranged from 15 days to 75 years. The procedure was carried out with local anesthesia and sedation in 263 (86.2%) patients and under general anesthesia in 42 (13.8%). Median drainage was 975.25 ± 48.46 mL in 264 patients with benign effusion and 1131.25 ± 97.48 mL in 41 (13.4%) with malignant disease; cytology was positive in 14 of 38 (36.8%) and pericardial biopsy showed cancer in 12 of 36 (33.3%). Intraoperative complications in 22 patients (7.2%) included cardiac arrest in 12 (3.9%) of whom, 7 (2.3%) died. Overall 30-day mortality was 16.3%; it was 46.3% (19/41) in malignant cases versus 11.7% (31/264) in cases of benign effusion. Follow-up of 234 (91.8%) hospital survivors for 18 ± 3.62 months (range, 2 to 54 months) showed recurrent pericardial effusion needing further intervention in 31 (13.2%) of whom, 8 had cancer and 23 had benign disease. Median survival in benign cases was more than 107 days versus 56 days in malignant cases. Because of its acceptable mortality and morbidity, subxiphoid pericardiotomy is recommend as an initial procedure.

Noonan sendromu farklı kardiyakanomalilerin de eşlik ettiği nadir görülen bir hastalıktır. Sunulan olgudaNoonan sendromlu bir hastada kardiyak anomalilerin daha önce bildirilmemiş birkombinasyonu bildirilmiştir. Eşlik eden kardiyak anomaliler atriyal septaldefekt, atriyal fibrilasyon ve ventrikül miyokardında noncompaction idi. Atriyalseptal defekt cerrahi olarak fenestre biçimde kapatılırken maze prosedürüuygulandı. Sendromlu hastalarda saptanan konjenital kalp defektlerinin cerrahitedavisinde sendromu olmayan hastalara göre farklı güçlükler ilekarşılaşılmaktadır. Bu nedenle sendromlu vakalarda özellikli bir yaklaşımihtiyacı vardır., Noonan syndrome is a raredisorder in which different cardiac abnormalities can exist. This reportdescribes the combination of cardiac abnormalities in a patient with Noonansyndrome, which has not been reported previously. Coexisting cardiacabnormalities were: atrial septal defect, atrial fibrillation and noncompactionof the ventricular myocardium. Surgical fenestrated closure of atrial septaldefect and concomitant maze procedure were performed. Surgery of congenitalheart defects in syndromic patients has different difficulties than those innonsyndromic patients. Thus, specific approach should be taken in thesepatients.