Bicuspid aortic valve caused subaortic stenosis with bulging of valve calcification through subaortic area in a young patient.

Bicuspid aortic valve is the most common congenital cause for the development of aortic valve calcification and stenosis. Calcification cause valvular stenosis or valvular insufficiency due to coaptation failure. We report a unique case of calcification of bicuspid valve was extending to left ventricular outflow tract and attached to interventricular septum which caused subvalvular stenosis.

Pediatric hydatid cyst with ventricular aneurysm and surgical treatment with dor procedure, case report.

BACKGROUND: Cardiac involvement of hydatid cyst disease (HCD) is a rare presentation but may lead to life-threatening complications such as cyst rupture and should be treated surgically. METHODS: A 10-year-old male patient with cranial and complicated cardiac HCD lesions that caused lower extremity peripheral arterial occlusion and aneurysmatic dilatation in the left ventricular apex is presented. RESULTS: Although the patient was in the pediatric age group, the Dor procedure was successfully applied to preserve the ventricular geometry. The Dor procedure for a ventricular aneurysm caused by a cardiac hydatid cyst (CHC) was rarely applied in the pediatric age group. CONCLUSION: In conclusion, this case differs from other CHCs previously reported in the literature due to the advanced stage of the disease, atypical clinical presentation, and rare complications despite the young age of the case. The surgical method used in treating the patient makes the subject more interesting.

Assessment of Cardiovascular Surgery Requirements in Children and Adolescents Admitted With Chest Pain To A Pediatric Emergency Clinic.

INTRODUCTION: Chest pain in children and adolescents is an important symptom in the pediatric emergency clinic. The aim of this study is to assess the characteristics of chest pain and cardiovascular surgery in the pediatric population. MATERIALS AND METHODS: There were 352 children who presented with chest pain to the pediatric emergency department between December 2007 and February 2017. These children were included in this study, which is a retrospective observational study. RESULTS: Among the 352 patients, six patients (1.7%) underwent cardiovascular surgery. Forty-eight patients (13.6%) were diagnosed with cardiac disease, and the most common cardiac causes were myocarditis and pericarditis. CONCLUSION: Only six patients (1.7%) who were admitted to the emergency department with chest pain needed cardiovascular surgery. The chest pain in children required less surgery, and mortality and morbidity were lower compared with adult cardiac chest pain.

On-pump coronary artery bypass with concomitant descending thoracic aorta-bi-iliac bypass: A case report.

The presence of critical coronary artery disease and concomitant critical limb ischemia represents a clinical challenge. Single-stage operations for cardiac and peripheral revascularization can be an option in such cases. The "Süzer technique" provides a more physiological extra-anatomical vascular reconstruction by using the descending thoracic aorta as the inflow source. This is an alternative to the more widely used technique of ascending aorta to bifemoral bypass and concomitant coronary revascularization. We report a case of critical limb ischemia with juxtrarenal aortic occlusion and left main coronary artery stenosis treated with concomitant coronary artery bypass grafting and descending thoracic aorto-bi-iliac bypass using a modification of the Süzer technique.

Coarctation of the aorta with aortic and subclavian artery aneurysms.

Coarctation of the aorta discovered in adulthood is uncommon. The formation of aneurysms from the coarctation segment and in the low-pressure area is even rarer. The surgical management of coarctations can be challenging due to calcifications and concomitant cardiovascular and lung disease. We present a case with coronary artery disease, bilateral bullae, left subclavian artery aneurysm, saccular aortic aneurysms originating proximal to the coarctation and from the coarctation itself, and a remnant of ductus arteriosus. The surgical management and possible histopathologic causes for aneurysm formation are discussed.

Aortic valve replacement for papillary fibroelastoma.

Surgery is indicated for symptomatic patients with papillary fibroelastomas (PFE) on the aortic valve. The valve is commonly spared during tumor excision. Rarely, aortic valve replacement (AVR) is needed. We present a case requiring AVR for an aortic valve PFE and review the literature to determine the risk factors for failure of aortic valve-sparing techniques in patients with PFE.

Acute dissociative reaction to spontaneous delivery in a case of total denial of pregnancy: Diagnostic and forensic aspects.

This article presents the history of a 21-year-old female college student with total denial of pregnancy who experienced an acute dissociative reaction during the spontaneous delivery at home without medical assistance where the newborn died immediately. Psychiatric examination, self-report questionnaires, legal documents, and witness reports have been reviewed in evaluation of the case. Evidence pointed to total denial of pregnancy, that is, until delivery. The diagnoses of an acute dissociative reaction to stress (remitted) and a subsequent PTSD were established in a follow-up examination conducted 7 months after the delivery. Notwithstanding the inherently dissociative nature of total denial of pregnancy, no other evidence has been found about pre-existing psychopathology. For causing the newborn's death, the patient faced charges for "aggravated murder," which were later on reduced into "involuntary manslaughter." Given the physical incapacity to perform voluntary acts due to the loss of control over her actions during the delivery, and the presence of an acute dissociative reaction to unexpected delivery, the legal case represents an intricate overlap between "insanity" and "incapacitation" defenses. The rather broad severity spectrum of acute dissociative conditions requires evaluation of the limits and conditions of appropriate legal defenses by mental health experts and lawyers. Denial of pregnancy as a source of potential stress has attracted little interest in psychiatric literature although solid research exists which documented that it is not infrequent. Arguments are presented to introduce this condition as a diagnostic category of female reproductive psychiatry with a more neutral label: "unperceived pregnancy."

Is decreased tissue elasticity more important than histopathological changes in ruptures of ascending aortic aneurysms?

Background: In this study, we aimed to investigate the natural properties of ascending aortic aneurysms and to compare dilated aortic tissues of patients with ascending aortic aneurysms and the non-pathological aortic tissues of cadavers. Methods: Between January 2017 and January 2020, a total of 14 patients (12 males, 2 females; mean age: 66.6±8.4 years; range, 54 to 77 years) who underwent elective ascending aortic surgery without genetic disease or family history in the etiology were included in the study. Aortic tissues taken from the patients with ascending aortic aneurysms and cadavers without any aortic pathology were compared histopathologically and biomechanically. An experienced pathologist performed a histological evaluation with appropriate staining and scoring. In the biomechanical examination, stress-strain curves were created with the uniaxial tensile test. The instantaneous elastic modulus was calculated based on the first regions of the curves (Ei) and the slopes of the linear region close to rupturing (Es). Results: In the pathological examination, there was no statistically significant difference in the parameters of both the patient and control groups (p>0.05). In the biomechanical examination, Ei values were significantly higher in the patients with ascending aortic aneurysms, while Es values were comparable between the groups (p=0.028 and p=0.609, respectively). Conclusion: Our study results showed that the tissues of the ascending aortic aneurysm were much more rigid, although no significant histopathological changes were detected. These findings are meaningful in understanding the structure of normal and pathological aortic tissue.

Extension of coronary artery with double flap technique in a complicated arterial switch operation.

The increased distance between the coronary ostium and the reimplantation site poses technical challenges in older patients with transposition of the great arteries (TGA) and complex coronary artery anomalies. In this report, we describe a technique for coronary artery reimplantation using a pedicle flap on the pulmonary artery (PA) to create a tunnel resulting in an extension of the coronary button.

A Pseudocoarctation of the Aorta With a Left Subclavian Artery Aneurysm, A Case Report and A Review of the Literature.

Here we present a 47-year-old male diagnosed with a pseudocoarctation of the aorta and a funnel-like subclavian artery aneurysm with a large orifice and severe aortic valve insufficiency. The patient underwent a two-stage repair for both pathologies. After an aortic valve replacement, postcardiotomy pericardial effusion occurred and was medically managed. Six months later, the patient underwent a distal arcus aorta and subclavian artery replacement with a left posterolateral thoracotomy as the second stage. Due to the strict adhesions, pulmonary veins were not cannulated and an extracorporeal bypass between the pulmonary artery and femoral artery was used for distal body perfusion. The coincidence of subclavian aneurysms and a pseudocoarctation of the aorta is rare and a literature review was performed to identify treatment options for this pathology.

Intraatrial baffle repair of anomalous systemic venous return without hepatic venous drainage in heterotaxy syndrome.

A 7-month-old boy with heterotaxy syndrome had partial atrioventricular septal defect and interrupted inferior vena cava with hemiazygos continuation to a left superior vena cava. The left side of the common atrium receiving all the venous drainage was in connection with the left ventricle and the aorta. The small atrium and the proximity of the pulmonary and hepatic vein orifices precluded complete baffling. This report describes an intraatrial baffle repair of anomalous systemic venous return without hepatic venous drainage. This resulted in good oxygenation postoperatively, with oxygen saturation ranging from 93% to 98%.

A rare anatomic variation: a combination of anomalous origin of the right subclavian artery from the main pulmonary artery, ventricular septal defect, and aortic coarctation.

BACKGROUND: We present a rare case of an anomalous origin of the right subclavian artery (SA) from the pulmonary artery (PA) associated with ventricular septal defect (VSD) and aortic coarctation. CASE REPORT: Critical aortic coarctation and VSD were diagnosed in a neonate, and coarctation angioplasty was successfully performed. Severe cardiac failure developed after this procedure, however, and closure of the VSD was planned. RESULTS: The anomalous SA was diagnosed during the operation when the cardiopulmonary bypass was initiated. As the pulmonary blood flow decreased, a difference in pulse pressures between the right radial artery and the ascending aorta was noticed to be due to the subclavian steal phenomenon. The difference decreased from 60 mm Hg to 25 mm Hg following ligation of the SA at its origin from the PA. The patient was discharged on the eighth postoperative day without any problems. CONCLUSION: An abnormal origin of the right SA from the main PA associated with VSD and aortic coarctation is a unique combination that, if unnoticed preoperatively, may create difficulties during the operation.

A new technique to avoid the intraoperative complications of septal myectomy in patients with obstructive hypertrophic cardiomyopathy.

Although transaortic septal myectomy in obstructive hypertrophic cardiomyopathy (OHC) is accepted as a safe procedure, it may end up with serious peroperative complications. We developed a practical method to avoid this unfavorable outcome by using a 20-cc syringe body. We believe this apparatus will provide safe and effective septal myectomy procedures without additional cost.

Posterior pericardial annuloplasty in ischemic mitral regurgitation.

BACKGROUND: Ischemic mitral regurgitation (IMR) is an important risk factor in coronary artery bypass grafting (CABG) operations. The decision to perform concomitant mitral annuloplasty along with the CABG depends on the surgeon's choice. The aim of this study was to evaluate the results of posterior annuloplasty procedures with autologous pericardium performed in patients with midadvanced and advanced functional ischemic mitral regurgitation. METHODS: Study participants were 36 patients with IMR (mean age 59 +/- 10 years) who underwent posterior pericardial annuloplasty and CABG operations between 2002 and 2007. Preoperative and postoperative (mean follow-up 18 +/- 1 months) MR grade, left atrium diameter, left ventricle end systolic diameter, left ventricle end diastolic diameter, left ventricle ejection fraction, and mitral valve gradients were measured with transthoracic echocardiography. RESULTS: There was one late mortality (2, 8%) but none of the patients required reoperation for residual MR. We did not observe thromboembolism, bleeding, or infective endocarditis. The mean MR grade decreased from 3.4 +/- 0.5 to 0.5 +/- 0.6 (P < .01), left atrium diameter decreased from 45.3 +/- 5.5 mm to 43.2 +/- 3.8 mm (P < .01), left ventricle end diastolic diameter decreased from 53.2 +/- 5.6 mm to 50.9 +/- 5.5 mm (P < .01), and left ventricle end systolic diameter decreased from 39.7 +/- 5.8 mm to 34.6 +/- 6.5 mm (P < .01), whereas mean left ventricle ejection fraction increased from 37.9% +/- 6.1% to 43.7% +/- 7.3% (P < .01). In the late postoperative term, the functional capacity of the patients increased from mean New York Heart Association class 2.6 +/- 0.9 to 1.1 +/- 0.5. We did not observe any gradient in the mitral valve preoperatively in any patient, but in the follow-up, the mean gradient increased to 1.3 +/- 2.1 mmHg (P < .01). CONCLUSION: Posterior pericardial annuloplasty with CABG in the treatment of IMR provides efficient mitral repair and significant decrease in the left atrium and left ventricle diameters, and provides a significant increase in left ventricular function. These results show IMR to be as effective as the other annuloplasty techniques. IMR is performed with autologous material and therefore does not entail any risk of complications from prosthetic material and is highly cost-effective.

Treatment of Candida sternal infection following cardiac surgery - a review of literature.

BACKGROUND: Candida sternal wound infections (SWIs) following cardiac surgery are rare but are associated with a high mortality rate. Guidelines on this topic either propose no suggestions for management or offer recommendations based on a small number of reports. METHODS: This paper presents a case of a Candida SWI and its successful treatment with debridement using a burr, negative pressure vacuum therapy (NPVT) and dermal grafting. To investigate different methods of treating Candida SWIs following cardiac surgery, a review was completed using the MEDLINE database. Reports without English abstracts and without defined outcomes of therapy for individual patients were excluded. RESULTS: Seventy-seven cases of Candida SWIs following cardiac surgery were identified in 20 articles published since 1999, including our case. Treatment strategies are identified: omentum flap; muscle flap; debridement and secondary wound healing with or without NPVT; debridement and primary closure; incision and drainage; only medical therapy. Patients documented in the articles were classified based on the following outcomes: cured (n = 41 patients [including the present case]), relapse infection (n = 25 patients) and death (n = 11 patients). The various methods used to treat patients were analysed. CONCLUSIONS: Delayed closure reoperation with surgical debridement and NPVT have favourable outcomes. In the presence of widespread osteomyelitis, the use of omental flaps is advocated. Treatment with muscle flaps has a high rate of relapse. Debridement and secondary healing or conservative management with antifungals alone can be considered in the treatment of relapsing infection.

Pulmonary effects of noninvasive ventilation combined with the recruitment maneuver after cardiac surgery.

BACKGROUND: The aim of our study was to evaluate the pulmonary effects of noninvasive ventilation (NIV) with or without recruitment maneuver (RM) after open heart surgery. METHODS: One-hundred patients undergoing coronary artery bypass surgery were randomized into four groups after the operation: 1) RM with sustained inflation during mechanical ventilation postoperatively (RM group, n = 25); 2) RM combined with NIV applied for 1/2-h periods every 6 h in the first postoperative day after tracheal extubation (RM-NIV group, n = 25); 3) NIV after tracheal extubation (NIV group, n = 25); and 4) a control group consisting of patients receiving neither RM nor NIV (control group, n = 25). Pulmonary function tests, oxygenation index, and atelectasis on chest radiograph were evaluated and compared among the groups. RESULTS: RM provided higher arterial oxygen levels during mechanical ventilation and after tracheal extubation compared to other interventions. Oxygenation was better in the RM-NIV and NIV groups than in the control group (P = 0.02 and P = 0.008, respectively) at the end of the study. The postoperative atelectasis score of the control group (median: 1) was higher than those of the RM (1; P = 0.03), RM-NIV (0; P < 0.01) and NIV (0; P < 0.01) groups. Pulmonary function of the NIV groups on postoperative day 2 was better than in the other groups, whereas the tests were similar among the groups on postoperative day 7. CONCLUSIONS: NIV associated with RM provided better oxygenation both during and after the mechanical ventilation period. NIV either alone or in combination with RM provided lower atelectasis scores and better early pulmonary function tests compared to the control group, without a significant difference regarding the duration of mechanical ventilation, intensive care unit stay, and the length of hospitalization. NIV combined with RM is recommended after open heart surgery to prevent postoperative atelectasis and hypoxemia.

Revascularization of left anterior descending (LAD) artery with in situ left internal thoracic artery (LITA) and coronary-coronary free LITA grafts: 12-year patency.

BACKGROUND: We aim to present a patient with coronary-coronary bypass grafting (CCBG), left anterior descending-left anterior descending (LAD-LAD) coronary artery bypass with left internal thoracic artery (LITA), and provide the 12-year follow-up angiogram to confirm the longest reported patency. METHODS AND RESULTS: A 57-year-old man with three vessel disease where LAD had multiple lesions was operated on. LITA with pedicle was grafted in situ onto the proximal LAD, and the distal residual segment was used as a free LITA graft to bypass the distal stenosis. The postoperative course was uneventful. The patient has been recently readmitted to our clinic with atypical chest pain. In angiography, all of the bypasses, including the free LITA graft, were patent. CONCLUSIONS: We used free LITA graft to bypass the distal lesions of LAD in selected patients as a valid alternative to sequential bypass grafting. To the best of our knowledge, this is the only angiographic view of a CCBG in LAD with LITA graft confirming the long-term patency.