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OBJECTIVE: The aim of this study is to evaluate our early and mid- term results and the qualities of life of the patients aged eighty years or older who underwent heart surgery. METHODS: Eighty- eight patients aged 80 years and older who underwent open-heart surgery at Göztepe Safak Hospital between May 2004 and December 2010 have been included to the study. This study was designed as two-stage: in the first stage, determinants of survival were analyzed retrospectively. In the second stage, the quality of life of survived patients was evaluated by using Short- Form 36 (SF-36), Turkish version in the cross-sectional study. The statistical analysis was performed using Fischer's exact, Pearson Chi-square test, Student t-test, Mann-Whitney U test and logistic regression analysis. RESULTS: In the logistic regression analysis; the left ventricular ejection fraction as <50% (OR: 11.02, 95% CI: 2.6-46.6, p<0.05), application of redo surgery (OR: 8.3, 95% CI: 1.04-66.6, p<0.05), coronary bypass and mitral surgery procedures in the same session (OR: 9.2, 95% CI: 1.6-53.7, p<0.05), left main coronary lesion as >50% (OR: 4.3, 95% CI: 1.1-17.7, p<0.05), preoperative creatinine as >1.8 mg/dl (OR: 14.1, 95% CI: 2.6-76.1, p<0.01), New York Heart Association class III-IV (OR: 4.9, 95% CI: 1.2-20.1, p<0.05), chronic obstructive pulmonary disease (OR: 10.3, 95% CI: 2.5-41.7, p<0.01) were found to be risk factors of hospital mortality. Physical functions, social functions and all sub-scales other than the role limitation depending on the emotional situation were evaluated as general population mean or above. CONCLUSION: We think that with a successful heart surgery in patients aged 80 years and older under appropriate conditions, their life qualities and mean life expectations can return to normal and they can lead a symptomless life. [ABSTRACT FROM AUTHOR]

Aim: We investigated the relationship between the severity of reciprocal ST depression and the extent of coronary artery disease in patients with inferior myocardial infarction. Method: Ninety-five consecutive patients (52 women 43 men, with a mean age of 54±5 years) who had acute inferior myocardial infarction were included in the study. Reciprocal changes in the ST segment were defined as ST depression of> 1 mm in at least two out of four of the precordial leads V1-V4. All the patients had undergone coronary angiography within seven days of admission. The extension of coronary artery disease which was measured by Gensini and Reardon scores, was compared with the reciprocal changes on ECG recorded at the time of admission. Result: There was a significant correlation between reciprocal ST depression and disease extension (r=0.68 for Gensini score, r= 0.88 for Reardon score, p< 0.05 for both). Conclusion: The presence of ST segment depression in the precordial leads during the acute inferior myocardial infarction was associated with greater myocardial necrosis and more frequent left coronary artery disease. [ABSTRACT FROM AUTHOR]

Pregnancy-related spontaneous coronary artery dissection (P-SCAD) is a life-threatening condition that occurs during or after pregnancy, is rare and can be overlooked. It is one of the most important causes of pregnancy-related acute myocardial infarction. A 25-year-old female patient was admitted with a complaint of chest pain in her 37th week of pregnancy. There was nothing specific in her medical history except for a cesarean section, performed 2 years ago. There was diffuse ST-segment depression, and ST-segment elevation in leads V1, V2, and AVR. The patient was evaluated multidisciplinary and it was decided to perform a cesarean section and then urgently perform coronary angiography (CAG). Dissection within the lumen of the left anterior descending artery (LAD) was observed. The LAD was filling retrogradely from the right coronary artery, but no antegrade filling was observed (Type 2 SCAD). The patient, whose hemodynamics were stable and whose electrocardiography (ECG) showed no change, was monitored intubated, and stabilized in the intensive care unit (ICU) to minimize cardiac demand and reduce the risk of further myocardial ischemia. After that, an on-pump beating heart coronary artery bypass grafting (CABG) was performed 2 days later due to the high risk of bleeding related to the recent cesarean section operation. The LAD and diagonal artery were anastomosed with the left internal thoracic artery and saphenous vein grafts. She was discharged from the intensive care unit on postoperative day 2 and discharged from the hospital on day 8. P-SCAD is an important condition that can occur especially at a young age, its diagnosis may be overlooked, but it can cause serious clinical consequences. The treatment strategy should be decided in a multidisciplinary manner and should be individualized for each patient. This diagnosis should be kept in mind, especially when a young pregnant patient without cardiovascular risk factors presents with myocardial infarction findings., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Surgical treatment is recommended in patients with symptomatic severe tricuspid regurgitation and pulmonary regurgitation. Although renal transplant patients are a high-risk patient group for cardiac surgery, heart valve surgeries can be performed successfully. There are a limited number of studies published on this subject in the literature. Therefore, we present a case who underwent tricuspid ring annuloplasty (TRA) before being followed up with renal transplantation and then successfully performed redo tricuspid valve replacement (TVR) and pulmonary valve replacement (PVR)., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Objectives: This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR., Methods: Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%)., Results: The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings., Conclusion: When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Prosthetic valve endocarditis with mechanical complications causing pulmonary edema is fatal, therefore it needs to be diagnosed early and should be treated surgically in emergency setting. Transesophageal echocardiogram is crucial for recognizing the mechanical complications, which can be encountered on daily practice, but the coexistence of complications occurring on different mechanism is rather uncommon. Herein, we report a 21-year-old gentleman presenting with acute heart failure, whose imaging tests showed a combination of dehiscence of mechanical aortic valve prosthesis, aortic dissection, pseudoaneurysm, and hematoma causing right ventricular collapse., (© 2022 Wiley Periodicals LLC.)

Purpose: We aimed to compare COVID-19 imaging findings of young adults (19-35 years of age) with those of children (0-18 years) and to correlate imaging findings of young adults with their laboratory tests., Materials and Methods: This retrospective study included Real Time-Polymerase Chain Reaction (RT-PCR) confirmed 130 young adults (mean age: 28.39 ± 4.77; 65 male, 65 female) and 36 children (mean age: 12.41 ± 4.51; 17 male, 19 female), between March and June 2020. COVID-19 related imaging findings on chest CT were examined in young adults and compared with children by the Mann-Whitney U, and Chi-square or Fisher's exact test. Laboratory examinations of young adults were assessed in terms of correlation with radiological findings by the Spearman's correlation analysis., Results: Bilateral multiple distributions (p = 0.014), subpleural involvement, and pleural thickening (p = 0.004), GGOs with internal consolidations were more frequent in adults (p = 0.009). Infiltrations were significantly larger than 20 mm in young adults (p = 0.011). The rates of feeding vessel sign, vascular enlargement, and halo sign were significantly higher in young adults (p < 0.003). Highly significant positive correlations were found between radiological and biochemical parameters., Conclusion: Distribution, size, and pattern of COVID-19 related imaging findings differed in children and young adults. Radiological findings were correlated with biochemical parameters but not with blood count results of young adults., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children. Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% ( n = 582) and females constituted 49.7% ( n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) ( n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4°C (38.0-38.7°C). The second most common symptom was cough ( n = 543, 46.9%). The other common symptoms were sore throat ( n = 143, 12.4%), myalgia ( n = 141, 12.2%), dyspnea ( n = 118, 10.2%), diarrhea ( n = 112, 9.7%), stomachache ( n = 71, 6.1%), and nasal discharge ( n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition ( p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have ( p = 0.38), but the need for intensive care was higher in patients who had an underlying condition ( p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Karbuz, Akkoc, Bedir Demirdag, Yilmaz Ciftdogan, Ozer, Cakir, Hancerli Torun, Kepenekli, Erat, Dalgic, Ilbay, Karaaslan, Erdeniz, Aygun, Bozdemir, Hatipoglu, Emiroglu, Sahbudak Bal, Ciftci, Bayhan, Gayretli Aydin, Ocal Demir, Kilic, Hacimustafaoglu, Sener Okur, Sen, Yahsi, Akturk, Cetin, Sutcu, Kara, Uygun, Tural Kara, Korukluoglu, Akgun, Üstündağ, Demir Mis, Sali, Kaba, Yakut, Kılıc, Kanik, Cetin, Dursun, Cicek, Kockuzu, Sevketoglu, Alkan, Guner Ozenen, İnce, Baydar, Ozkaya, Ovali, Tekeli, Celebi, Cubukcu, Bal, Khalilova, Kose, Hatipoglu, Dalkiran, Turgut, Basak Altas, Selcuk Duru, Aksay, Saglam, Sari Yanartas, Ergenc, Akin, Duzenli Kar, Sahin, Tuteroz, Bilen, Ozdemir, Senoglu, Pariltan Kucukalioglu, Besli, Kara, Turan, Selbest Demirtas, Celikyurt, Cosgun, Elevli, Sahin, Bahtiyar Oguz, Somer, Karadag, Demirhan, Turk Dagi, Kurugol, Taskin, Sahiner, Yesil, Ekemen Keles, Sarikaya, Erdem Eralp, Ozkinay, Konca, Yilmaz, Gokdemir, Arga, Ozen, Coksuer, Vatansever, Tezer and Kara.)

Objective: Serum D-dimer levels, as well as other biomarkers related to coagulation, are significantly elevated during severe community acquired pneumonia. The aim of this study is to investigate the utility of plasma D-dimer levels determining the severity of inflammation and prognosis in pediatric patients with COVID-19 infection., Methods: We retrospectively chart reviewed medical records of pediatric patients (< 18 years of age) admitted to Istanbul Fcaulty of Medicine, Department of Pediatrics Infectious Disease Service between March 11, and June 30, 2020. We collected demographic, clinical, biochemical and radiographic data., Results: A hundred and seventy-one pediatric patients (1 - 216 months of age) admitted to pediatric infecitous disease service included in this study. Patients were classified into 4 categories; 1) COVID-19 infection confirmed by PCR, 2) Suspected COVID-19 infection due to close exposure history and radiographic findings, 3) Lower respiratory tract infection other than COVID-19 confirmed with multiplex respiratory viral panel, and 4) Systemic infections other than lower respiratory tract infection. Lymphopenia was observed significantly higher in patients with COVID-19 infection compared to patients with other respiratory viral infections (p=0.06). In patients with radiographic findings concerning for COVID-19 infection, elevated serum D-dimer levels were detected significantly higher than lymphopenia (p=0.07)., Conclusions: Elevated serum D-dimer levels at baseline are associated with inflammation especially in patients with COVID-19 infection with radipgraphic findings. Monitoring serum D-dimer levels may be used for early identification of severe cases in children.

Objectives: We aimed to perform a comparison between V/Q single-photon emission computed tomography/computed tomography (SPECT/CT) and V/Q Quotient single-photon emission computerized tomography (SPECT) in the detection of chronic thromboembolic pulmonary hypertension (CTEPH) and in depicting the extent of the disease on per-segment basis in patients with CTEPH., Methods: Between January 2015 and November 2019, a total of 412 patients with pulmonary hypertension secondary to CTEPH at the preoperative assessment underwent pulmonary endarterectomy (PEA), of whom 92 consecutive patients with their V/Q SPECT/CT scans have been performed in our institution prior to PEA were included in this study. Histopathological findings and post-PEA fully resected surgical specimens were used as the reference standard., Results: On a per-patient basis analysis, V/Q SPECT/CT and V/Q Quotient SPECT both revealed CTEPH in the same 85 of the 92 patients (κ = 1) with a detection rate of 92.4%. In six of these patients, chronic thromboembolic disease could not be reported on both of these two methods due to extensive 'matched' V/Q defects. On a per-segment basis analysis, V/Q SPECT/CT and V/Q Quotient SPECT showed a sensitivity of 75.8 and 73.1%, respectively. Correlation analysis results showed a significant correlation (κ = 0.933) between these two methods on a per-segment basis analysis., Conclusion: In the light of histopathological findings and post-PEA surgical specimen examinations, the results of the present study indicated that both V/Q SPECT/CT and V/Q Quotient SPECT showed relatively high efficacy for the detection of CTEPH on per-patient and per-segment bases with an excellent agreement., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

A 24-year-old man was admitted to our outpatient clinic for his routine checkup of consecutively percutaneously treated atrial septal defect (ASD) and pulmonary valvular stenosis 45 days ago. A 24 mm ASD occluder device was implanted under transthoracic echocardiographic guidance and 80 mm Hg peak-to-peak pulmonary valvular gradient decreased to 20 mm Hg gradient after pulmonary valve dilatation with 23 mm NUMED II transluminal valvuloplasty catheter balloon. Atrial septal defect (ASD) closure is now routinely performed using a percutaneous approach under echocardiographic guidance especially transthoracic echocardiography (TEE). Centrally located, ostium secundum type and less than 3.5 cm in size are considered ideal for device closure. Although there is considerable variation in size and location of the defects, TEE guidance is quite important for this proportion of ASDs. The selection of patients for percutaneous transcatheter closure of a secundum ASD requires accurate information regarding the anatomy of the defect such as its maximal diameter and the amount of circumferential tissue rims., (© 2017, Wiley Periodicals, Inc.)

The fastest growing demographic group in Europe and America is the elderly, and significant mitral regurgitation is very prevalent in this population. At present, with mitral valve surgery in elderly individuals gaining greater acceptance worldwide, the question whether to repair or replace the valve remains controversial. Recent studies have demonstrated the safety, feasibility, and durability of repair over replacement in elderly patients. Herein, we report the case of an elderly patient who underwent surgical re-interventions on the mitral valve following an unsuccessful mitral valve repair procedure.

Background: Fragmented QRS (fQRS) arises from impaired ventricular depolarization due to heterogeneous electrical activation of ischemic and/or infarcted ventricular myocardium. The short- and long-term prognostic values of fQRS have been reported for myocardial infarction, heart failure, fatal cardiac arrhythmias, and sudden cardiac death. The aim of this study was to investigate the predictive value of admission fQRS complex for in-hospital cardiovascular mortality of patients with type 1 acute aortic dissection (AAD)., Methods: In this retrospective study, 203 consecutive patients with type 1 AAD who had been admitted to either of two large-volume tertiary hospitals between December 2008 and October 2013 were included. The patients were divided into two groups according to the presence or absence of the fQRS complex on admission., Results: In-hospital cardiovascular mortality (P < 0.001), major adverse cardiovascular events (P < 0.001), acute renal failure (P = 0.022), multiorgan dysfunction (P < 0.001), and acute decompensated heart failure (P < 0.001) were observed to be significantly more frequent in the fQRS-positive group than in the fQRS-negative group. fQRS (odds ratio [95% confidence interval]: 4.184 [1.927-9.082], P < 0.001), operation duration (4.184 [1.927-9.082], P = 0.001), and Killip class IV (3.900 [1.699-8.955], P = 0.001) were found to be significant independent predictors of in-hospital cardiovascular mortality after adjustment of other risk factors in the multivariate analysis., Conclusions: fQRS is a simple, inexpensive, and readily available electrocardiographic entity that provides an additional risk stratification level beyond that provided by conventional risk parameters in predicting in-hospital cardiovascular mortality in type 1 AAD., (© 2014 Wiley Periodicals, Inc.)

Background: The addition of 6% hydroxyethyl starch (HES) into Ringer lactate priming solution may have adverse effects on hemostasis in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) with or without the use of tranexamic acid., Methods: In a prospective, randomized clinical trial, 132 patients were assigned to receive 20 ml/kg of Ringer priming solution with or without tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10 ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31). Estimated blood loss, chest tube drainage, amount of blood products, hemoglobin, hematocrit, platelet and coagulation parameters were examined before and 24 hour after surgery., Results: For Group HES with tranexamic acid, when compared to other groups, estimated blood loss, postoperative 24 hour drainage loss and blood product transfusions were less (P=0.023; P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12 and 24 hours after surgery increased in comparison to other groups (P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet concentrations were similar between groups (P>0.05)., Conclusions: In CABG, the administration of tranexamic acid in HES 130/0.4 prime solution study group decreased estimated blood loss and chest tube drainage in comparison to patients receving Ringer prime solution with or without tranexamic acid postoperatively however, no effects on renal functions or postoperative complications were shown.

Objective: The aim of our study was to investigate clinical importance of neutrophil/ lymphocyte ratio in patients with Chronic thromboembolic pulmonary hypertension., Methods: 125 consecutive patients with a diagnosis of Chronic thromboembolic pulmonary hypertension were operated pulmonary thromboendarterectomy in our center between February 2011 and August 2013. 106 patients included into the study due to limitations. The patients were classified into two groups as patients discharged alive (Group 1) and those dying in the hospital (Group 2). Baseline neutrophil/lymphocyte ratio level was measured by dividing neutrophil count to lymphocyte count., Results: 84 patients (79%) were in Group 1, 22 patients (21%) were in Group 2. Patients with higher neutrophil/lymphocyte ratio in admission have a significantly higher mortality rate and postoperative pulmonary vascular resistance was found statistically significant variable to predict the mortality. Receiver operator characteristic (ROC) analysis revealed that using a cut-off point of 2.54, admission neutrophil/lymphocyte ratio predicts mortality. Also, correlation analysis showed a significant correlation between preoperative pulmonary vascular resistance and neutrophil/lymphocyte ratio., Conclusion: The neutrophil/lymphocyte ratio level may be a useful and noninvasive biomarker for operative risk stratification for mortality after pulmonary thromboendarterectomy.

We describe the case of a 60-year-old woman who presented with pulmonary artery sarcoma, a very rare tumor of the cardiovascular system. Her tumor was initially misdiagnosed as chronic pulmonary thromboembolism, and she underwent pulmonary endarterectomy. Early diagnosis of primary pulmonary artery sarcoma is crucial. That alternative should always be considered before settling on a diagnosis of pulmonary embolism. Suspicion should be aroused by the failure of anticoagulant treatment to alleviate pulmonary perfusion abnormalities and systemic symptoms. Surgical resection of the tumor-preferably by pulmonary endarterectomy, followed by reconstruction as needed-is currently the most promising treatment for pulmonary artery sarcoma.

Objective: The effect of levosimendan on renal function in patients with low ejection fraction undergoing mitral valve surgery was investigated., Design: A prospective, double-blinded, randomized clinical trial., Setting: Tertiary teaching and research hospital., Participants: Of a total of 147 patients, 128 patients completed the study. In the levosimendan group (n = 64), levosimendan was administered in addition to standard inotropic support; whereas, in the control group (n = 64), only standard inotropic support was given., Interventions: In the levosimendan group, a loading dose of levosimendan (6 μg/kg) was administered after removal of the aortic cross-clamp, followed by an infusion (0.1 μg/kg/min) in addition to standard inotropic therapy for 24 hours. In the control group, only standard inotropic therapy was administered. Preoperative characteristics, serum creatinine (sCr) levels, and estimated glomerular filtration rate (eGFR) were determined preoperatively, on postoperative days 1, 3, and 10. Independent risk factors for renal replacement therapy (RRT) requirement were investigated with stepwise multivariate logistic regression analysis., Measurements and Main Results: The primary endpoint was the effect of levosimendan on postoperative renal clearance (sCr and eGFR). The secondary endpoint was the effect of levosimendan on clinical outcomes (length of intensive care unit and hospital stays, need for RRT). Preoperative characteristics and eGFR were similar between the groups (p>0.05). On postoperative days 1 and 3, sCr values were lower and eGFR values were higher in the levosimendan group in comparison with the control group (p = 0.0001, p = 0.009, respectively). Six patients (9.4%) in the levosimendan group and 10 patients (15.6%) in the control group required RRT therapy (p = 0.284). Independent risk factors for need of RRT include preoperative sCr value between 1.2 to 2.09 mg/dL and≥2.1 mg/dL (p< 0.05)., Conclusions: Perioperative treatment with levosimendan in addition to standard inotropic therapy in patients with a low ejection fraction undergoing mitral valve surgery improved immediate postoperative renal function and reduced need for RRT., (© 2014 Elsevier Inc. All rights reserved.)

Purpose: Short term results of on-pump and off-pump techniques in patients undergoing reoperative coronary artery bypass grafting (redo CABG) were investigated in this study., Methods: A total of 14.430 patients have undergone isolated coronary artery bypass grafting in our clinic from 1998 to 2010. Of these patients, 105 patients who have undergone redo CABG, 53 (50.5%) were operated with cardiopulmonary bypass (on-pump) and 52 (49.5%) without cardiopulmonary bypass (off-pump). Early results for which on or off-pump techniques were independent risk factors were determined with logistic regression analysis., Results: Overall mortality in patients undergoing redo CABG was 12.3% with a 11.5% mortality in the off-pump group and 13.2% mortality in the on-pump group and the difference was not statistically significant (p >0.05). Blood product transfusion requirement (p <0.05, OR: 3.620, 95% CI: 1.295-10.119), new onset atrial fibrillation rhythm (AFR) (p <0.05, OR: 13.357, 95% CI: 1.656-107.721), prolonged ventilation (p <0.05, OR: 9.066, 95% CI: 1.091-75.323) and duration of hospitalization (p <0.01, OR: 5.252, 95% CI: 1.784-15.459) were significantly higher in the on-pump group. The number of patients with postoperative low cardiac output was significantly higher in the off-pump group (p <0.05, OR: 5.337, 95% CI: 1.094-26.043). The ratio of complete bypass was significantly higher in the on-pump group compared to the off-pump group (p <0.05, OR: 2.913, 95% CI: 1.204-7.046)., Conclusion: Despite the lower morbidity and mortality in the off-pump group, the rate of target vessel bypass grafting was lower. Off-pump technique may be considered as a safer option for cardiopulmonary bypass in the high risk population.

Objective: To examine the mid-term results of patients on whom a coronary revascularization as well as a mitral ring and suture annuloplasty have been performed due to coronary artery disease (CAD) and ischaemic mitral regurgitation (IMR)., Methodology: Totally 73 patients on whom a revascularization and a mitral valve repair due to CAD and IMR had been performed in our clinic between 2000-2008 were included in the study. Patients were divided into two groups one of which included 38 patients (52.05%) on whom a coronary artery bypass graft (CABG) and a ring annuloplasty on the mitral valve had been performed (Group 1) and the other one 35 patients (47.95%) on whom only suture annuloplasty as well as a CABG had been performed (Group 2). The study was planned retrospectively and study data have been obtained by screening the hospital registries retrospectively. In the mid-term, patients were invited for a check and their intragroup and intergroup echocardiographic parameters and functional capacities were assessed statistically., Results: In pre-operational and post-operational intragroup assessment in terms of echocardiographic findings; although LVEDD, LVESD, EDV, PAP and the degree of recurrent MR have been decreased in both groups, the decrease in LVESD and PAP and the low degree of recurrent MR were statistically significant in Group 1 patients (p=0.047, p=0.023, p=0.01, respectively). When the mid-term intergroup echocardiograpic findings were assessed; PAP and recurrent MR have been determined statistically lower in Group 1 patients (p=0.005, p=0.08, respectively). The length of intensive care unit stay, length of hospitalization and length of detachment from respiratory support were statistically significantly longer in ring annuloplasty performed group (p=0.012, p=0.033, p=0.029, respectively)., Conclusions: In moderate to severe IMR patients, a positive contribution can be provided to ventricular remodeling by a ring annuloplasty through a significant decrease in left ventricular diameter and a low recurrent MR and PAP.

This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, < 0.50), pulmonary artery pressure ≥60 mmHg, and the De Vega annuloplasty technique were risk factors for medium-term recurrent grades 3 and 4 tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available.

Background: The standard surgical treatment of infrarenal aortoiliac obstructive disease is abdominal aortobifemoral bypass (AABFB). However, alternative surgical procedures may be considered in cases of juxtarenal Leriche syndrome and previous aortofemoral graft obstruction. We present midterm results of 20 consecutive patients who underwent thoracic aortobifemoral bypass (TABFB) either as primary or secondary procedure., Method: Between 1999 and 2010, 20 patients who were diagnosed to have juxtarenal Leriche syndrome (n = 17) and failure of previous AABFB graft (n = 3) were enrolled. The patients were classified according to the Rutherford classification. Mean follow-up period was 60.9 ± 38.3 months. Mean preoperative ankle-brachial index on the left lower extremity was 0.18 and on the right lower extremity was 0.20., Results: Seventeen patients with the diagnosis of juxtarenal Lercihe syndrome were primarily and three patients were secondarily (for treatment of failed previous AABFB graft) treated using TABFB procedure. The mean ankle-brachial index at last follow-up was 0.75 on the left lower extremity and 0.76 on the right. One-year patency rate was 100%, and 5-year patency rate was 94%., Conclusion: TABFB precludes the risk of renal artery embolization in cases of juxtarenal obstruction, without adding any risk of morbidity and mortality. Its long-term patency is similar or even superior to conventional surgical bypass techniques. We propose its use as an initial treatment in juxtarenal Leriche syndrome as well as a remedial procedure in cases with previous AABFB graft occlusion., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Aneurysms of the left atrial appendage are extremely rare. Enlargement of the left atrial appendage can be congenital or acquired. Dysplasia of the left atrial muscles leads to congenital left atrial appendage aneurysm and usually presents as atrial tachyarrhythmia or embolic events in the second or third decade of life. We report a case of an asymptomatic 12-year-old child with a congenital left atrial appendage aneurysm. Transthoracic and transoesophageal echocardiography demonstrated a large left atrial appendage aneurysm without thrombus or spontaneous echo-contrast. The patient was successfully treated with surgical resection of the aneurysm.

Antibiotic treatment, surgical intervention and postoperative antibiotic regimens are recommended for the treatment of brucella endocarditis (BE). Our clinical antibiotic regimens involve a triple antibiotic regimen for treating BE before the operation. The combination of three antibiotics is continued for at least six months and until the titres of the Wright serologic test are diminished to 1:160 levels. In this study, our aim was to evaluate the effects of combined medical and surgical treatments on survival and relapse rates in the periods of mid to late terms. We investigated 13 patients who were treated between January 1993 and June 2009. Our clinical observations led us to use a combination of rifampicin (900 mg twice a day), streptomycin (12 to 16 mg/kg/24 h intramuscularly) and doxycycline (200 mg/kg twice a day); rifampicin, tetracycline (8 mg/kg three times a day) and cotrimoxazole (15 mg/kg twice a day) or rifampicin, doxycycline and cotrimoxazole regimen for treating BE before the operation. This treatment should be continued for at least six months after surgery in order to prevent relapses.

We retrospectively investigated preoperative and postoperative characteristics in order to determine factors that affected hospital death in patients who underwent 3 or 4 separate cardiac valvular surgeries. The hospital records of 53 such patients who were operated upon from 1985 through 2006 were obtained. The patients were divided into 2 groups according to whether their initial operation was a closed mitral commissurotomy (group C, n = 33) or open-heart surgery with cardiopulmonary bypass (group O, n = 20). In group C, all patients who had initially undergone 1 or 2 closed mitral commissurotomy procedures underwent subsequent reoperations that entailed median sternotomy and cardiopulmonary bypass. Sternotomy and cardiopulmonary bypass had been used in valvular operations of all group O patients. The total early mortality rate was 11.3% (6 of 53 patients). Multivariate analysis revealed that longer aortic cross-clamp times and double valve replacement at last operation significantly increased the risk of death. Herein, we discuss our conclusion that 3rd or 4th cardiac valvular operations incurred acceptable early postoperative mortality rates.

Background and Aim of the Study: Small valve size and patient-prosthesis mismatch (PPM) generate high postoperative transvalvular gradients and may decrease both early and long-term survival. The study aim was to evaluate whether mismatch affected early mortality after aortic valve replacement (AVR) for isolated aortic stenosis (AS)., Methods: A total of 701 patients (437 males, 264 females; mean age 53.3 +/- 15.1 years; range: 14-84 years) with pure AS underwent AVR at the authors' institution between 1985 and 2005. The majority of patients (92%) received a mechanical valve. PPM was considered severe if the indexed effective orifice area was < or =0.65 cm2/m2, and moderate if > 0.65 but < or = 0.85 cm2/m2., Results: Moderate-severe PPM was present in 47% of patients, and severe PPM in 13%. The early mortality was 5.4% (n=38). Multivariate analysis revealed age > or = 70 years (p < 0.001), female gender (p = 0.04) and severe PPM (p = 0.003) as independent predictors of early mortality. Moderate mismatch was not a predictor of early mortality on both univariate and multivariate analysis. Left ventricular dysfunction (ejection fraction < or = 40%) was a risk factor for early mortality only in patients with severe PPM., Conclusion: Patient-prosthesis mismatch should be prevented in patients undergoing AVR for isolated AS, especially in those with left ventricular dysfunction.