Transcatheter aortic valve implantation for pure aortic insufficiency in a patient following David-type aortic valve-sparing root replacement after aortic dissection-A successful off-label procedure.

Transcatheter aortic valve implantation (TAVI) has traditionally been indicated for the treatment of aortic stenosis. However, in this case report, we describe a successful TAVI procedure in a 46-year-old male patient who had previously undergone David aortic valve-sparing aortic root replacement for type 1 aortic dissection. The patient presented with aortic valve insufficiency 4 years after the initial surgery and was subsequently treated with a 34 mm Medtronic CoreValve Evolut R prosthesis via TAVI. This case highlights the feasibility of TAVI as a viable treatment option for postoperative aortic valve insufficiency in patients with prior ascending aortic or aortic arch surgery.

Neonatal Outcomes of Critical Congenital Heart Defects: A Multicenter Epidemiological Study of Turkish Neonatal Society : Neonatal Outcomes of CCHD.

Critical congenital heart disease (CCHD) is one of the leading causes of neonatal and infant mortality. We aimed to elucidate the epidemiology, spectrum, and outcome of neonatal CCHD in Türkiye. This was a multicenter epidemiological study of neonates with CCHD conducted from October 2021 to November 2022 at national tertiary health centers. Data from 488 neonatal CCHD patients from nine centers were entered into the Trials-Network online registry system during the study period. Transposition of great arteria was the most common neonatal CHD, accounting for 19.5% of all cases. Sixty-three (12.9%) patients had extra-cardiac congenital anomalies. A total of 325 patients underwent cardiac surgery. Aortic arch repair (29.5%), arterial switch (25.5%), and modified Blalock-Taussig shunt (13.2%). Overall, in-hospital mortality was 20.1% with postoperative mortality of 19.6%. Multivariate analysis showed that the need of prostaglandin E1 before intervention, higher VIS (> 17.5), the presence of major postoperative complications, and the need for early postoperative extracorporeal membrane oxygenation were the main risk factors for mortality. The mortality rate of CCHD in our country remains high, although it varies by health center. Further research needs to be conducted to determine long-term outcomes for this vulnerable population.

A surgical method to be reminded for the treatment of symptomatic ipsilateral central venous occlusions in patients with hemodialysis access: Axillo-axillary venous bypass case report and review of the literature.

BACKGROUND: In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central venous occlusions together with their clinical presentation, surgical management and brief review of the literature. METHODS: The first patient who was a 63-year-old female patient with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functioning right brachio-cephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema, and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present for sustaining temporary hemodialysis access. The second patient was a 47-year-old male with a history of failed renal transplant, CABG surgery, multiple AV fistula procedures from both extremities, leg amputation caused by peripheral arterial disease, and decreased myocardial functions. He was receiving 3/7 hemodialysis and admitted to our clinic with right arm edema, accompanied by pain, stiffness, and skin hyperpigmentation symptoms ipsilateral to a functioning brachio-basilic AVF. He was not able to flex his arms, elbow, or wrist due to severe edema. RESULTS: Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After failed attempts of PTA, the patient was scheduled for axillo-axillary venous bypass in order to preserve the AV access function. In second patient, venography revealed right subclavian vein occlusion caused secondary to the subclavian venous catheters. Previous attempts for percutaneously crossing the chronic subclavian lesion failed multiple times by different centers. Hence, the patient was scheduled for axillo-axillary venous bypass surgery. CONCLUSION: In case of chronic venous occlusions, endovascular procedures may be ineffective. Since preserving the vascular access function is crucial in this particular patient population, venous bypass procedures should be kept in mind as an alternative for central venous reconstruction, before deciding on ligation and relocation of the AVF.

Patent ductus arteriosus ligation under high-frequency oscillatory ventilation in two critically ill pre-mature newborns.

Information on the use of high-frequency oscillatory ventilation in neonatal surgeries is very rare. In this report, we discuss two pre-term infants who had to receive high-frequency oscillatory ventilation as a rescue treatment due to severe pre-maturity. These two cases underwent successful bedside patent ductus arteriosus ligation under high-frequency oscillatory ventilation, and this shows us that patent ductus arteriosus ligation can be performed successfully in neonates even under high-frequency oscillatory ventilation.

Giant pulmonary pseudoaneurysm following balloon dilatation of the pulmonary artery to relieve pulmonary band.

Pulmonary artery pseudoaneurysms are uncommon. They may occur secondary to trauma, infectious diseases, vasculitis syndromes, neoplasms, congenital diseases, and pulmonary hypertension. Due to increasing number of cardiac interventions, iatrogenic complications are among the major causes of pulmonary artery pseudoaneurysms.In this report, we present a 6-month-old patient with pulmonary pseudoaneurysm that occurred following pulmonary balloon angioplasty for the relief of a pulmonary band.

Congenital tricuspid insufficiency due to rupture of chordae tendinea secondary to intrauterine obliteration of ductus arteriosus.

Congenital rupture of tricuspid chordae tendinea leading to severe tricuspid insufficiency is an extremely rare pathology associated with signs and symptoms of congestive heart failure presenting at birth. If the diagnosis and treatment of this pathology are not made early in life fetal demise may become inevitable.We herein present a neonate with central cyanosis and congestive heart failure due to rupture of an anterior leaflet chordae resulting in severe insufficiency of the tricuspid valve who was treated with appropriate surgery.

Cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure of infected cardiac surgical wounds.

OBJECTIVE: Postoperative wound infection in cardiac surgery remains a subject of significant concern due to associated morbidity, prolonged hospital stay and rise in treatment cost. A conservative management approach to postoperative wound infection with topical dressings and healing by secondary intention is not cost-effective and cosmetic results are less acceptable. We developed our institutional protocol for the treatment of infected postoperative cardiac surgical wounds to reduce hospital stay and improve cosmetic outcome. This study aims to compare our institutional protocol with the conservative management approach. METHODS: Adult patients with postoperative superficial or deep sternal and/or leg wound infection were divided into two equal-sized groups and data collected from medical records. Group A was treated according to our institutional protocol of aggressive surgical debridement and delayed primary closure. Group B was treated according to conservative management with topical antiseptic wound dressings and healing by secondary intention. Data were analysed in retrospect with comparative statistics. RESULTS: A total of 30 patients took part in the study. Group A (n=15, seven male, eight female) had a mean age of 55.34±12.84 years. Group B (n=15, eight male, seven female) had a mean age of 56.46±10.21 years. Mean length of hospital stay in Group A and Group B was 5.13±2.06 and 36.67±22.28 days, respectively (p<0.0001). Calculated mean hospital costs were 16,271.61±6815.50 Saudi Riyals (approximately equivalent to $4330±700 USD) in Group A and 116,212.2±26,311 Saudi Riyals (approximately equivalent to $30,932±1813 USD) in Group B (p<0.05). Patients in Group A had linear scars comparable with primary postoperative wound scars, whereas patients in Group B had excessive non-linear scarring. CONCLUSION: In this study, cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure was superior to conservative management with topical antiseptic wound dressings and healing by secondary intention in terms of a shorter hospital stay and better cosmetic outcome.

Preliminary Results of a New Illuminated Radiofrequency Ablation Catheter for the Treatment of Great Saphenous Vein Reflux Disease.

Introduction: In the current study, we present single surgeon experience of a new radiofrequency ablation system, the catheter, and the device. Patients and Methods: The new system, which comprises a generator and an intervally illuminated radiofrequency ablation catheter, was used for the treatment of 272 consecutive patients with chronic venous insufficiency of the great saphenous vein between November 2017 and October 2018. Mean age of the patients was 53.40 ± 11.91 years. Mean saphenous vein diameter was 8.51 ± 2.45 mm. Bilateral great saphenous vein reflux disease was present in 19% (51 cases) of the patients. At the end of the procedure, the closure of the great saphenous vein was confirmed with Doppler ultrasonography. Results: Procedures could be successfully performed in all, except 1 obese (BMI> 30 kg/m2) male patient. At the 3rd month, outpatient clinic follow-up control Doppler USG revealed successful ablation of the treated great saphenous vein in 260 patients (96%), whereas in 12 cases (4%), there was continuing reflux. The diameters of the saphenous veins in these patients ranged between 6.9 mm and 19.5 (mean: 10.68 ± 3.41) mm. Ten patients could be treated successfully with ablation with the same device controlled both at the interventional section as well as on the 3rd month outpatient clinic follow-up. The remaining patients underwent high ligation of the great saphenous vein. Paresthesia occurred in 1 patient and had been permanent. Hematoma occurred in a male patient and resolved spontaneously. Conclusion: Preliminary results of our new radiofrequency ablation device with illumination guidance for the treatment of great saphenous vein reflux disease indicated successful results with enhanced physician utilization, comfort, and reliability.

Efficiency of Prophylactic Ablation of the Tributary Venous Pathways Draining Around the Saphenofemoral Junction to Decrease the Rate of Future Varicose Vein and Symptoms Occurence.

BACKGROUND: There are various other collaterals draining into the venous system around the saphenofemoral junction in addition to the great saphenous vein. We aimed to determine the efficiency of prophylactic ablation of tributary veins in long term varicose vein and symptom recurrence. METHODS: Two hundred and sixty-three consecutive patients whom underwent radiofrequency ablation therapy for the treatment of superficial venous reflux disease were investigated. There were 129 patients who received isolated great saphenous vein ablation (Group A) where as 134 patients underwent ablation of the other tributary veins in addition to the great saphenous vein (Group B) between June 2015 and January 2017. The tributary superficial veins; refluxing and/or not refluxing, draining into the saphenofemoral junction were selectively catheterized and ablated in Group B. Patients are followed at least 1 year after the procedures regulary and researched for recurrence of varciose veins and symptoms. RESULTS: Gender, mean age, body mass index, diameter of the great saphenous veins, small saphenous vein disease, and grade of deep venous insufficiency did not differ significantly between the two groups. The mean number of tributary veins were similar in both groups (n: 1.9 ± 0.4 in Group A vs. n: 1.8 ± 0.7 in Group B) which were detected preoperatively as well as during the procedure. The mean number of ablated tributary venous pathways could be 1.4 ± 0.6 in Group B. During the follow up period symptoms related with varicose veins recurred in 19 patients in Group A where as in 7 patients in Group B (P < 0.05). Three of these symptomatic patients in Group B were the ones in whom the tributary pathways could not be catheterized ablated where as 14 patients in Group A were diagnosed with newly refluxing tributary pathways. All the symptomatic patients in both groups were managed medically and/or with additional interventions. CONCLUSION: The absence of any fascial unsheathing and the parietal weakness are suggestive of a lower resistance of the tributary veins wall, so collapse and size of veins make it more complex to catheterization regarding to great saphenous vein. Ablation of the tributary superficial venous pathways during the treatment of great saphenous vein reflux disease decreased the rate of recurrence of superficial venous reflux disease and patients symtoms in our modest cohort.

Efficacy of Rotational Atherectomy Followed by Drug-coated Balloon Angioplasty for the Treatment of Femoropopliteal Lesions-Comparison with Sole Drug-coated Balloon Revascularization: Two-year Outcomes.

BACKGROUND: We aimed to evaluate the results of the combined use of rotational atherectomy (RA) followed by drug-coated balloon (DCB) treatment against DCB angioplasty alone in patients who had significantly calcified and symptomatic femoropopliteal peripheral arterial disease. METHODS: Patients presented to the clinic with symptoms of chronic limb ischemia of femoropopliteal segment such as moderate or severe claudication and rest pain, who received endovascular therapy between January 2016 and January 2018 in our hospital comprised the study cohort and investigated, retrospectively. Patients with minor or major tissue loss were excluded from the study. We evaluated the effect of RA system followed by DCB with DCB alone in 121 patients and a total of 226 significantly calcified and symptomatic femoropopliteal lesions. Fifty-eight patients and 112 (49.5%) lesions were treated with RA + DCB, whereas 63 patients and 114 (50.5%) lesions were treated with DCB only. The mean age was 61.2 ± 9.7 years. Primary patency is evaluated with duplex ultrasound/angiography at 6, 12, and 24 months and with angiography on 12 and 24 months. Patients were followed up for 24 months to assign clinically driven target lesion revascularization (TLR). Overall survival rates were 96.5% (56/58) in RA + DCB group and 93.6% (59/63) in DCB alone group both at one-year and two-year follow-up. Amputation-free survival rates of RA + DCB and DCB-only groups are 96.5% (56/58) to 87.3% (55/63) at one year, and 94.8% (55/58) to 82.5% (52/63) at two years, respectively. RESULTS: Baseline characteristics of groups were similar. The lesions were longer in the RA + DCB group than the DCB alone group (14.4 ± 5.2 cm vs. 10.2 ± 3.1 cm; P = 0.05). The technical success rate in the RA + DCB group was superior to that of DCB-only group (95.4% vs. 84.8%, P = 0.006). The 12-month and 24-month patency rates with angiography in the RA-DCB group were similar to those in the DCB-only group (85.7% vs. 74.6% and 73.2% vs. 62.7%, respectively). The rates of bailout stenting were significantly lower among patients treated with RA + DCB (n = 3; 5.1% vs. n = 13; 20.6%, P < 0.001). The rates of flow-limiting dissections and vessel recoils after procedures were significantly in RA + DCB group (n = 2; 3.4% vs. n = 8; 12.6%, P < 0.001) than DCB only (n = 1; 1.7% vs. n = 4; 6.3%, P < 0.002). The freedom from TLR rate was significantly increased in the RA + DCB group at 12 months (95.2% vs. 76.3%, P = 0.002) and 24 months (93.4% vs. 63.7%, P = 0.002). The mean ankle brachial index at discharge in the RA-DCB group improved by 0.35 ± 0.24, and in the DCB-only group, it was 0.30 ± 0.23 (P = 0.683). CONCLUSIONS: Combined use of RA and DCB treatment is an effective, safe, and durable method for the treatment of the complex femoropopliteal lesions. Combination of RA and DCB angioplasty reveals increased technical success, fewer flow-limiting dissections, significantly reduced TLR, and bailout stenting rates compared with sole DCB angioplasty.

Thoracoabdominal Aortic Aneursym Accompanied by Leriche Syndrome in a Patient with Coronary Artery Disease: Management Strategy in a Single Case Experience.

Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.

The Commando procedure: Can it be a preventive option from reoperation in pediatric patients?

Rheumatic heart disease is still an important pathology affecting young people. When valve repair techniques are not possible, valve replacement is inevitable in pediatric patients despite the risk of patient prosthesis mismatch with the growing child. In this report, we present aortomitral fibrous body remodeling, Commando procedure, in a 12-year-old male patient with rheumatic aortic and mitral valve disease to provide adult size mechanical double valve replacement.

Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery.

INTRODUCTION: The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery. PATIENTS AND METHODS: Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients' demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated. RESULTS: The study included eight patients (six females and two males) - six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy. CONCLUSION: It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals.

A Rare and Subtle Etiology of Chronic Oropharyngeal Pain: Isolated Internal Carotid Artery Kinking without Stenosis.

Carotid artery kinking is a frequent finding in duplex ultrasonography. However, isolated morphological changes without significant carotid stenosis are rarely symptomatic. Neck pain is a rare symptom in patients with carotid artery kinks. The vascular etiology in patients with persistent neck pain is usually overlooked. A 58-year-old female patient with chronic neck pain presented to our clinic. Following multidisciplinary team review, the symptoms were found due to the kinking of the internal carotid artery. In this report, we present the clinical presentation of the patient with the kinking of the internal carotid artery without stenosis, surgical management of the pathology, and a brief literature review.

A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia.

Treatment of the aneurysms comprising the aortic arch is challenging. Surgical reconstruction usually requires aortic cross-clamping, cardiac arrest, and even deep hypothermia for a bloodless field. In this report, we present our surgical technique providing normothermic ascending aorta, aortic arch, and proximal descending aorta replacement with selective cannulation and perfusion of the whole body.

Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch.

AIM: Standard surgical treatment of the interrupted aortic arch with the use of cardiopulmonary bypass is risky especially in critically ill babies. In this manuscript, we present the results of off-pump pericardial roll bypass for the treatment of aortic interruption. MATERIAL AND METHODS: The technique was applied in nine critically ill infants between July 2011 and December 2019. Data were reviewed retrospectively. There were four girls and five boys. The types of the interruption were type B in six cases and type A in three babies. Additional cardiovascular anomalies were ventricular septal defect in all, atrial septal defect or patent foramen ovale in all, single-ventricle pathologies in two and bicuspid aortic valve in three cases. All the patients were in critical situations such as intubated, having symptoms of infection, congestive heart failure or ischaemia and malperfusion leading visceral organ dysfunction. RESULTS: All patients underwent off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll. Post-operative early mortality occurred in one patient with severe mitral regurgitation due to cardio-septic shock. One patient who had single-ventricle pathology underwent bidirectional Glenn and was lost on the post-operative 26th day due to sepsis 2 years after operation. Two patients presented with dilatation of the pericardial tube 18 and 24 months after the operations and one underwent reconstruction of the neo-arch. The remaining patients are asymptomatic, active and within normal limits of body and mental growth. CONCLUSION: Treatment of interrupted aortic arch with a bypass with an autologous pericardial roll treated with gluteraldehyde without cardiopulmonary bypass seems a safe and reliable technique especially for the treatment of critically ill infants.

Congenital cardiac interventions during the peak phase of COVID-19 pandemics in the country in a pandemics hospital in Istanbul.

INTRODUCTION: In this report, we aim to present our algorithm and results of patients with congenital cardiac disorders who underwent surgical or interventional procedures during the peak phase of the pandemics in our country. PATIENTS AND METHODS: The first COVID-19 case was diagnosed in Turkey on 11 March, 2020, and the peak phase seemed to end by the end of April. All the patients whom were referred, treated, or previously operated but still at the hospital during the peak phase of COVID-19 pandemics in the country were included into this retrospective study. Patient's diagnosis, interventions, adverse events, and early post-procedural courses were studied. RESULTS: Thirty-one patients with various diagnoses of congenital cardiovascular disorders were retrospectively reviewed. Ages of the patients ranged between 2 days and 16 years. Seventeen cases were males and 14 cases were females. Elective cases were postponed. Priority was given to interventional procedures, and five cases were treated percutaneously. Palliative procedures were preferred in patients whom presumably would require long hospital stay. Corrective procedures were not hesitated in prioritised stable patients. Mortality occurred in one patient. Eight patients out of 151 ICU admissions were diagnosed with COVID-19, and they were transferred to COVID-19 ICU immediately. Three nurses whom also took care of the paediatric cases became infected with SARS-CoV-2; however, the children did not catch the disease. CONCLUSION: Mandatory and emergent congenital cardiac percutaneous and surgical procedures may be performed with similar postoperative risks as there are no pandemics with meticulous care and preventive measures.

Preliminary Results of Stent-Assisted Coiling of Wide-Necked Visceral Artery Aneurysms via Self-Expandable Neurointerventional Stents.

PURPOSE: To determine technical feasibility and results of stent-assisted coiling of visceral artery aneurysms (VAAs) with self-expandable LEO PLUS neurointerventional stent. MATERIALS AND METHODS: In this retrospective study, 11 consecutive patients (mean age 61.9 y ± 8.9; range, 45-76 y) with VAAs (splenic, n = 3; common hepatic, n = 2; renal, n = 5; celiac, n = 1) treated with neurointerventional stents were included. MR angiography was evaluated for aneurysmal occlusion and patency of the parent arteries. RESULTS: Technical success was 90.9%. A minor technical complication developed in 1 patient (9%), and thrombosis of the distal part of the stent was seen just after deployment in another patient, but it resolved after tirofiban injection. Complete occlusion was determined in all patients on MR angiography at 6-month follow-up. CONCLUSIONS: Self-expandable LEO PLUS neurointerventional stents could become a useful tool in the treatment of VAAs. Studies with larger groups of patients, including control groups, are needed to assess the true outcome of this treatment method.

Right coronary artery to left carotid artery collateral in the absence of stenosis.

Anomalies as well as variations of vascular structures are widely diagnosed with today's advanced diagnostic tools and healthcare screening programs. Collateral formation is a well known phenomenon in the presence of stenosis or occlusion to provide blood flow to the distal vasculature. In this report, we present the image of a collateral between the left common carotid artery and right coronary artery in the absence of significant stenosis.

Is there any association between rs1303 (Pi*M3) variant of alpha-1 antitrypsin gene and atrial septal aneurysm development?

AIM: Atrial septal aneurysm (ASA) is one of the congenital heart defects. The underlying pathophysiology of ASA has not been fully understood yet. Alpha-1 antitrypsin (A1AT) is a serine protease inhibitor glycoprotein, which is held responsible from tissue wall proteolysis if it is deficient in the body. The aim of this study was to investigate A1AT serum levels and the rs1303 (Pi*M3) variant in A1AT gene in patients with ASA. MATERIAL AND METHODS: Thirty patients (7 male and 23 female) with isolated ASA and 33 patients (11 male and 22 female) with normal atrial septum on echocardiography were included in this study. A1AT serum levels of study patients were measured quantitatively by the enzyme-linked immune sorbent assay (ELISA) method. The A1AT gene mutation rs1303 was analyzed by genotyping, which is performed on genomic DNA extracted from circulating mononuclear blood cells. Single-nucleotide polymorphism was evaluated on polymerase chain reaction using commercial kits. RESULTS: A1AT serum levels were not statistically different among patients with and without ASA (9.52 ± 4.33 µg/mL vs 9.83 ± 5.27 µg/mL, respectively, P = .80). A1AT homozygote mutation (PiM3M3) was significantly higher in the ASA group than the control group (21 vs 11, OR (95% CI): 6.68 [2.09-21.40], P = .001). A1AT serum levels were similar among patients with normal A1AT allele (PiMM), homozygote variant (PiM3M3), and heterozygote variant (PiMM3) (P = .79). CONCLUSION: This preliminary study revealed that homozygote A1AT rs1303 (PiM3M3) variant is significantly higher in patients with isolated ASA and may be associated with ASA development. Large scale comprehensive studies are needed to validate these results.