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Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Marcapaso Artificial , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Arteria Axilar/diagnóstico por imagen , Arteria Axilar/cirugía , Humanos , Resultado del Tratamiento , TurquíaRESUMEN
These evidence-based guidelines from the Turkish Society of Cardiovascular Surgery, National Society of Vascular and Endovascular Surgery, and Phlebology Society intend to support clinicians in best decisions regarding the treatment of venous thromboembolism (VTE). The Editor was selected by the three national societies and was tasked with the recruitment of the recognized panel. All financial support was solely derived from the sponsoring societies without the direct involvement of industry or other external stakeholders. The panel prioritized clinical questions and outcomes according to their importance for clinicians in terms of VTE. The panel agreed on 42 recommendations under 15 headings for the diagnosis, initial management, secondary prevention of VTE, and treatment of recurrent VTE events. Important recommendations included the use of ultrasonography, preference for home treatment over hospital treatment for uncomplicated VTE, preference for direct oral anticoagulants (DOACs) over vitamin K antagonists for primary treatment of cancer and non-cancer-related VTE, extended or indefinite anticoagulation with DOACs in selected high-risk patients. Early catheter-directed thrombectomy was recommended in only young symptomatic patients with a diagnosis of fresh iliofemoral deep vein thrombosis.
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Hydatid cyst is a parasitic disease caused by Echinococcus granulosus. It is endemic in Asia, Africa, South America, and the Mediterranean region including Turkey. Cardiac involvement is rare. Surgery is the definitive treatment of cardiac hydatid cysts; however, to avoid recurrence after surgery, medical therapy should be also continued. Left ventricular free wall is the most common location, followed by the right ventricle and interventricular septum. Involvement of mitral valve is extremely rare. Herein, we present a case of hydatid cyst with myocardial involvement leading to severe mitral valve regurgitation which was successfully treated with surgery.
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Papillary fibroelastomas (PFEs) are primary cardiac tumors with a benign and avascular nature. Majority of the PFEs are originated from the valvular endocardium, while the most common site is aortic valve. In this case, we present a patient with multiple PFEs originating from the right ventricular outflow tract who was admitted to our clinic with exertional dyspnea. As far as we know, this is the first case of this unusual presentation of multiple PFEs and also had a history of breast cancer and permanent pacemaker reported in the literature.
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Fibroma/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Anciano , Medios de Contraste , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Femenino , Fibroma/cirugía , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Although the efficacy and safety of transfemoral transcatheter aortic valve implantation (TAVI) have been improved with new devices, careful patient selection is essential and awkward complications associated with the procedure persist. Despite a gradual reduction in the delivery system size and the development of access site arterial closure devices, vascular complications remain one of the main challenges of TAVI. The aim of this single-center study was to prospectively evaluate the incidence and predictors of vascular complications in transfemoral TAVI. METHODS: A total of 211 patients (mean age 77.98 ± 8.20 years) who underwent transfemoral TAVI between 2011 and 2014 at the authors' institution, using two different commercially available devices, was included in the study. Technical success, vascular complications, predictors of vascular complications and mortality were each assessed. Vascular complications were defined by the current Valve Academic Research Consortium-2 (VARC-2) criteria. RESULTS: The mean logistic EuroSCORE of the patients was 21.04 ± 7.51. An Edwards SAPIEN XT valve was used in 69.7% of cases, and a Medtronic CoreValve in 30.3%. Completely percutaneous transfemoral TAVI was successful in 81.6% of patients. Procedural and 30-day mortalities were 1.4% and 8.5%, respectively. Vascular complications occurred in 16.1% of patients (minor 10.4%, major 5.7%), and necessitated surgical repair in 25 cases (11.8%). Major vascular complications were predictive of 30-day mortality (58.3% versus 5.6% (p = 0.000). Predicted major vascular complications (by multivariate analysis) were female gender (hazard ratio (HR) 5.45; 95% confidence interval (CI) 0.91-32.5, p = 0.063), arterial calcification (HR 2,88; 95% CI 1.14-7.30, p = 0.025) and sheath to iliofemoral artery ratio (SIFAR) (HR 1.91, 95% CI 1.27-2.87, p = 0.001). CONCLUSIONS: Although vascular preclosure devices have revolutionized transfemoral TAVI, and offer a simple but effective percutaneous procedure, vascular complications are still observed in a considerable number of patients. The major vascular complications were predictive of 30-day mortality, and included female gender, iliofemoral calcification and SIFAR. Further technological and procedural developments are required to reduce vascular complication rates and related mortality.
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Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Arteria Femoral , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Enfermedades Vasculares/etiología , Anciano , Anciano de 80 o más Años , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Distribución de Chi-Cuadrado , Estudios de Factibilidad , Femenino , Prótesis Valvulares Cardíacas , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Estudios Prospectivos , Punciones , Factores de Riesgo , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del Tratamiento , Turquía , Dispositivos de Cierre Vascular , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/mortalidadRESUMEN
PURPOSE: Acute thoracic aortic syndrome (ATAS) is a novel term to define emergency aortic conditions with common clinical features and challenges. Traditional management of ATAS includes surgical replacement of the aorta and is correlated with high perioperative mortality and morbidity. We aimed to evaluate our experience and outcomes in patients presenting with ATAS, managed by endovascular techniques. METHODS: This cohort consisted of 31 consecutive patients (24 males; mean age, 57.5±13.81 years; range, 19-84 years) with acute thoracic aortic pathologies who underwent endovascular repair between January 2011 and January 2015. The study was designed as a retrospective analysis of prospectively maintained data. RESULTS: Complicated acute type-B aortic dissection was the most common pathology (35.5%). All aortic stent-grafts (n=37) and dissection stents (n=9) were implanted with 100% procedural success. The overall in-hospital mortality was 9.7%. The mean follow-up duration of patients who were alive at 30 days was 25.9±11.49 months (3-53 months). So far, there have been no late deaths after 30 days. CONCLUSION: In the high-risk setting of ATAS, endovascular procedures come forward as novel therapeutic strategies with promising results. Endovascular repair of ATAS can be considered as a first-line treatment alternative under emergency conditions with encouraging results, particularly when conventional surgical repair cannot be implemented due to prohibitive comorbidities.
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Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: This study aimed to present our experience in patients with acute traumatic thoracic aortic transection treated by endovascular stent-graft. METHODS: From October 2011 to October 2014, eleven patients were brought to our hospitals after suffering motor vehicle accident or fall from height. Computed tomography revealed acute traumatic transection of the thoracic aorta at the aortic isthmus just distal to the left subclavian artery in nine patients, at the middle or distal thoracic aorta in two, and both aortic isthmus and middle thoracic aorta in one. Endovascular technique was preferred as the treatment modality. All patients, except one, were treated within twelve hours of diagnosis. RESULTS: Deployment of stent-grafts was successful in all cases. The stent-grafts were oversized between 10% and 20%. The origin of left subclavian artery was covered with stent-graft in six patients to achieve adequate proximal landing zone. In two of them, carotico-subclavian bypass and periscope graft placement were applied to maintain subclavian artery blood flow. There were no procedure related deaths, paraplegia or ischemic complications. A patient with cardiac arrest, on whom cardiopulmonary resuscitation and transient aortic balloon occlusion within the aorta were applied in the angiography suit died at the postoperative twelve hours. Mean hospital stay after procedures was 14.8 days (range, 4-60 days). Mean follow-up time of ten patients was 16.6 months (range, 1-36 months). CONCLUSION: Our study supports that thoracic endovascular aortic stenting for acute transection is promising in terms of short- and mid-term results similar to other studies in the literature.
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Aneurisma de la Aorta Torácica/cirugía , Lesiones del Sistema Vascular/cirugía , Accidentes por Caídas , Accidentes de Tránsito , Adolescente , Adulto , Anciano , Angiografía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Stents , Arteria Subclavia/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagenRESUMEN
Parallel endografts such as "chimney" and "periscope" are being increasingly used to maintain blood flow to visceral and supra-aortic branches in patients with different aortic disorders. We present a new technique, "iliorenal periscope graft", in a patient with abdominal aortic aneurysm undergoing endovascular aortic repair. In this case, left accessory renal artery flows were provided by an iliorenal periscope graft that extends from the left accessory renal artery to the right common iliac artery in a retrograde fashion.
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Aneurisma de la Aorta Abdominal/cirugía , Arteria Ilíaca/cirugía , Injerto Vascular/métodos , Anciano , Procedimientos Endovasculares , Humanos , Masculino , Arteria Renal/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Patient-prosthesis mismatch (PPM) is defined when the ratio of the effective orifice area of the normally functioning prosthetic valve to the body surface area of the patient is <0.85 cm(2)/m(2). The aim of this study was to assess the measurements of the mean platelet volume (MPV) as an indicator of platelet activation in patients with PPM. METHODS: A total of 109 patients with isolated aortic valve replacement (AVR) procedures with a mechanical prosthesis and a control group from a normal population of 102 people compatible in terms of age and sex were chosen for the study. The AVR group was subdivided into a PPM group (n = 41) and non-PPM group (n = 68). All patients and control participants underwent echocardiographic examinations, with simultaneous measurements of the serum MPV values. RESULTS: The MPV measurements were significantly higher in the patients with AVR compared to the control group (8.97 ± 0.93 vs. 8.26 ± 0.14, p < 0.001). Higher results were also obtained in the patients with PPM compared to the non-PPM group (9.36 ± 0.61 vs. 8.73 ± 1.01, p < 0.001). The platelet counts were found to be similar in both groups (p > 0.05). CONCLUSIONS: We have herein shown that the PPM patients had a significantly higher MPV compared to the patients with AVR without PPM and healthy subjects.
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Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Volúmen Plaquetario Medio , Ajuste de Prótesis/efectos adversos , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Velocidad del Flujo Sanguíneo , Ecocardiografía , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Activación Plaquetaria , Diseño de Prótesis , Falla de Prótesis/efectos adversosRESUMEN
The prevalence of aortic stenosis (AS) increases in the elderly. They present high surgical risk due to comorbid factors that increase with age. Transcatheter aortic valve implantation (TAVI) is an effective method in patients who present with severe aortic stenosis with a higher surgical risk or who cannot undergo surgical aortic valve replacement (s-AVR). In our case, the presence of saccular thoracic aortic aneurysm with severe AS, which is a vital co-morbidity, requires the treatment of both. The rise in systolic pressure following the TAVI procedure increases the saccular thoracic aneurysm rupture risk and this is why the timing and method of the two treatments become crucial. In this case, which is as far as we know the fi rst and only report in the literature, both TAVI and endovascular thoracic aortic saccular aneurysm repair were applied simultaneously and successfully to the patient via the same transfemoral route. After 1 month, the patient had good functional capacity and there were no complications in control tomography and echocardiography. In this way, we attempted to emphasize with a multidisciplinary study that the patients be assessed carefully before the procedure, and found that even in patients with common peripheral vascular diseases, a transfemoral route could be used together with the proper methods, and that both procedures could be performed simultaneously.
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Aneurisma de la Aorta Torácica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Procedimientos Endovasculares/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Aortografía , Ecocardiografía Transesofágica , Femenino , Humanos , Tomografía Computarizada MultidetectorAsunto(s)
Cateterismo Cardíaco/instrumentación , Defectos del Tabique Interatrial/terapia , Hipersensibilidad/diagnóstico , Níquel/efectos adversos , Dispositivo Oclusor Septal/efectos adversos , Adulto , Remoción de Dispositivos , Diagnóstico Diferencial , Femenino , Humanos , Hipersensibilidad/etiología , Pruebas CutáneasRESUMEN
Coarctation of aorta and sinus of Valsalva aneurysm are frequently missed congenital cardiac defects that their diagnosis might be delayed. To our knowledge, coincidence of these cardiac defects is unusual and has not been reported in the literature before. Here, we present a patient with coarctation of aorta and ruptured noncoronary sinus of Valsalva aneurysm leading to aorto-right atrial fistula in the early postpartum period and our management of this unusual case.
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BACKGROUND: In the present study, we aimed to investigate the effects of off-pump coronary artery bypass grafting and on-pump cardiopulmonary bypass on the serum S-100 beta (S-100B) protein levels and neurocognitive functions of the patients. MATERIALS AND METHODS: Sixty-four patients undergoing coronary artery bypass grafting (CABG) were enrolled in the study and were divided into two groups: off-pump (group I, n = 24) and on-pump CABG (group II, n = 40) group. Serum S-100B levels were measured before and 0, 6, and 24 h after the operation. Neurocognitive function tests were done preoperatively and were repeated in the postoperative period as well. RESULTS: Serum S-100B levels were similar between the two groups preoperatively. However, median S-100B levels at 0, 6, and 24 h after the surgery were found to be significantly lower in the off-pump CABG group than in the on-pump group. The preoperative neurocognitive functions of the patients were similar between the two groups, whereas neurocognitive function was found to be significantly impaired postoperatively in the on-pump group in comparison with the off-pump CABG group. CONCLUSION: We concluded that off-pump CABG is associated with decreased serum S100 protein levels and less impairment on neurocognitive functions compared with the on-pump group.
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Cognición , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Factores de Crecimiento Nervioso/sangre , Proteínas S100/sangre , Adulto , Anciano , Puente Cardiopulmonar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Subunidad beta de la Proteína de Unión al Calcio S100RESUMEN
PURPOSE: We aimed to present our clinical experience with the renal artery catheterization (RAC) technique, which reduces the volume of intra-arterial contrast media (ICM) used during endovascular aortic repair (EVAR), and describe the short-term results of this technique. MATERIALS AND METHODS: We retrospectively evaluated 16 patients (15 males and one female) who underwent EVAR between March 2011 and February 2012 using the RAC technique for an abdominal aortic aneurysm. A Simmons-1 catheter was preferred for renal artery cannulation. The mean age of the patients at the time of treatment was 70 years (range, 61-82 years). Fifteen cases were fusiform aneurysms, and one case was a saccular aneurysm. Creatinine and estimated glomerular filtration rate (eGFR) values were recorded before the procedure and during the first 72 hours postprocedure. RESULTS: Bifurcated stent grafts were implanted with 100% procedural success using the RAC technique. The inferiorly positioned renal artery was cannulated with a Simmons-1 catheter in the first five patients, and was maintained at the level of the renal artery orifice in the remaining patients. The mean volume of the ICM used was 47 mL (range, 23-83 mL). The creatinine and eGFR values were not significantly different between the pre- and postoperative periods (P > 0.05). CONCLUSION: Reducing the volume of ICM used during EVAR is critical for protecting renal function. The RAC technique is a safe and effective method in appropriate patients when performed by experienced clinicians.
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Aneurisma de la Aorta Abdominal/cirugía , Cateterismo Periférico/métodos , Yohexol , Arteria Renal/diagnóstico por imagen , Stents , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular/métodos , Medios de Contraste , Creatinina , Procedimientos Endovasculares/métodos , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica/métodos , Radiografía Intervencional/métodos , Estudios RetrospectivosRESUMEN
This study was undertaken to compare early postoperative results, programmed multi-detector row computed tomography coronary angiographic patency and midterm results of revascularization by sequential radial artery grafting with those of single radial artery grafting during a five-year period. Patients were grouped as those with sequential radial artery grafts (Group A, n = 27) and single radial artery grafts (Group B, n = 26). Multi-detector row computed tomography coronary angiography was scheduled at 1 and 5 years postoperatively. Each distal anastomosis was accepted as nonfunctional if a radial artery graft was occluded proximally or there was a critical stenosis. One sequential radial artery graft and two single radial artery grafts failed in the 1-year period (p>0.05). In the 5-year period, three radial artery grafts failed in each group (p>0.05). In Group A, there was no mortality in the five-year period, but in Group B, one patient died four years after the operation due to cardiac problems (p>0.05). In addition to one death in Group B, there were three percutaneous interventions and two myocardial infarctions among the 26 patients during the five-year follow-up. In group A, among 27 patients, there were 4 percutaneous interventions and one myocardial infarction (p>0.05). Although the sample size is relatively small to be conclusive, these data suggest that sequential radial artery grafting may be considered as a method of choice for maximizing arterial graft survival and patency. Noninvasive control of sequential and single radial artery grafts with multi-detector row computed tomography is feasible with no discomfort for the patient and excellent visualization of grafts.
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Angiografía Coronaria/métodos , Puente de Arteria Coronaria/métodos , Oclusión de Injerto Vascular/diagnóstico por imagen , Tomografía Computarizada Multidetector , Arteria Radial/diagnóstico por imagen , Arteria Radial/trasplante , Anciano , Distribución de Chi-Cuadrado , Puente de Arteria Coronaria/efectos adversos , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/terapia , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiología , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Estudios Prospectivos , Arteria Radial/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Turquía , Grado de Desobstrucción VascularRESUMEN
A modified Blalock-Taussig shunt had been implanted 3 times to treat cyanosis to a patient who has uncorrectable congenital cardiac deformity. We repaired the entire pulmonary artery, from one hilus to the other, to prevent future stenosis while making cardiac transplant. Our patient was also heterozygous for 2 thrombophilic mutations: methylene tetrahydrofolate reductase C677T and Factor V A4070G. Congenital risk factors should be evaluated in patients who have experienced a thromboembolic event before cardiac surgery.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Factor V/genética , Cardiopatías Congénitas/cirugía , Trasplante de Corazón , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Mutación , Trombofilia/genética , Trombosis/genética , Anticoagulantes/uso terapéutico , Coagulación Sanguínea/genética , Niño , Cardiopatías Congénitas/sangre , Cardiopatías Congénitas/complicaciones , Heterocigoto , Humanos , Masculino , Arteria Pulmonar/cirugía , Recurrencia , Reoperación , Factores de Riesgo , Trombofilia/sangre , Trombofilia/congénito , Trombosis/sangre , Resultado del TratamientoRESUMEN
OBJECTIVE: We aimed to investigate the risk factors for hospital mortality, short (five years) and mid-term (10 years) survival in patients who underwent mitral valve replacements in redo patients with previous mitral valve procedures. PATIENTS AND METHODS: Between September 1989 and December 2003, 62 redo patients have undergone mitral valve replacements due to subsequent mitral valve problems. Preoperative, operative, and postoperative data were analyzed retrospectively and evaluated for risk factors affecting hospital mortality, mid- and long-term survival. RESULTS: The hospital mortality was 6.4%. The one-, five-, and 10-year actuarial survival rates were 94%+/- 2%, 89%+/- 6%, and 81 +/- 9%. New York Heart Association (NYHA) functional class IV, low left ventricular ejection fraction (<35%), increased left ventricular end-diastolic diameter (LVEDD) > 50 mm, female gender, pulmonary edema, and urgent operations were found to be risk factors in short-term survival. NYHA functional class IV, low left ventricular ejection fraction, increased LVEDD, and increased left atrial diameter (LA > 60 mm) were risk factors in mid-term survival. CONCLUSION: Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery.
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Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/fisiopatología , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/patología , Válvula Mitral/cirugía , Estudios Retrospectivos , Factores de Riesgo , Sobrevida , Factores de TiempoAsunto(s)
Lesiones Cardíacas/complicaciones , Insuficiencia de la Válvula Tricúspide/cirugía , Heridas no Penetrantes/cirugía , Accidentes de Tránsito , Adulto , Cuerdas Tendinosas/lesiones , Lesiones Cardíacas/etiología , Humanos , Masculino , Rotura , Técnicas de Sutura , Factores de Tiempo , Válvula Tricúspide/lesiones , Insuficiencia de la Válvula Tricúspide/etiologíaRESUMEN
Diaphragmatic paralysis (DP) after cardiac surgery is an important complication especially in infants. We analyzed the incidence, clinical course, surgical management and follow up of the patients with DP, retrospectively. Between 1996 and 2005, 3,071 patients underwent cardiac surgery. Total number of patients with DP was 152 (4.9%). Out of 152 patients, 42 were surgically treated with transthoracic diaphragm plication (1.3%). The overall incidence of diaphragm paralysis was higher in correction of tetralogy of Fallot (31.5%), Blaloc-Taussig (B-T) shunt (11.1%) and VSD closure with pulmonary artery patch plasty (11.1). The incidence of DP which require plication was higher in B-T shunt (23.8%) arterial switch (19%) and correction of tetralogy of Fallot (11.9%). Mean and median age at the time of surgery were 17.8 +/- 3.6 and 6 months, respectively. Median time from cardiac surgery to surgical plication was 12 days. Indications for plication were repeated reintubations (n = 22), failure to wean from ventilator (n = 12), recurrent lung infections (n = 5) and persistent respiratory distress (n = 3). Mortality rate was 19.1%. Being under 1 year of age, pneumonia and plication 10 days after mechanical ventilation were associated with higher incidence mortality (P < 0.05). Phrenic nerve injury is a serious complication of cardiac surgery. It is more common after some special procedures. Spontaneous recovery is very rare. Being under 1 year of age, plication after 10 days from the surgery and pneumonia are major risk factors for mortality even in plicated patients. Transthoracic plication is helpful if performed early.