Early and mid-term outcomes after surgical repair of congenital supravalvular aortic stenosis with the Doty technique.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the Doty surgical approach in pediatric patients with congenital supravalvular aortic stenosis (SVAS) by examining early and mid-term outcomes. METHODS: Surgical repair using the Doty technique was performed in a total of 10 pediatric patients with SVAS between January 2005 and July 2015 at this clinic. These patients were evaluated retrospectively. Demographic characteristics, echocardiographic findings, and clinical outcomes were analyzed. RESULTS: The mean patient age was 4.8±3.9 years. Williams-Beuren syndrome was diagnosed in 4 of the patients. Early mortality was observed in 1 patient with diffuse SVAS. At the final follow-up (mean follow-up: 3.7±1.2 years; range: 6-61 months), echocardiograms revealed a mean pressure gradient of 14±4.2 mmHg. Two patients displayed minimal aortic insufficiency during the follow-up period. No reoperation or reintervention was required. CONCLUSION: The Doty technique is an anatomically and technically effective surgical approach to treating SVAS.

Low-virulent chronic sternal osteomyelitis in children.

Sternal osteomyelitis is a fatal and serious complication of open heart surgery. Application of current surgical techniques and the use of prophylactic antibiotherapy have reduced the sternal wound infections and the development of osteomyelitis. As a treatment, many methods have been described, from wound dressing to partial sternal resection, although complete recovery cannot be achieved without rationale and long-term antibiotherapy. In this article, we discuss the clinical approach to three pediatric cases who were diagnosed with low-virulent chronic sternal osteomyelitis.

The impact of oral anticoagulation on false lumen patency in acute type A aortic dissections.

BACKGROUND: In this study, the effect of postoperative oral anticoagulation on the false lumen patency of the distal aorta in patients with acute type A aortic dissection was investigated. METHODS: Forty-one patients (32 male, 9 female; mean age 56.8±13.6 years; range, 30 to 84 years) who were diagnosed with acute type A aortic dissection and underwent surgical treatment in our clinic, and whose entire data of both control computed tomographic assessments and all postoperative follow-up visits could be accessed were enrolled. The patients were divided into two groups according to the type of surgical intervention that was performed. Computed tomography imaging of the patients were scanned and false lumen patency rates were evaluated. Besides oral anticoagulation, preoperative, intraoperative, and postoperative risk factors that may have affected false lumen patency secondary to acute type A aortic dissection were evaluated and statistically analyzed. RESULTS: Twenty-one patients (51.2%) had concomitant hypertension. Thirty five (85.4%) of the patients had the main symptom of angina. Sixteen patients (39%) in Group 1 underwent ascending aortic replacement combined with aortic valve replacement (Bentall procedure); while 25 patients (61%) in Group 2 underwent isolated ascending aortic replacement. Mean follow-up was 43.9±26.3 (range: 5-120) months. No statistically significant difference was found between the study subgroups in any of the operation parameters except for cardiopulmonary bypass time (p=0.035) and cross-clamp time (p=0.002). Evaluation of the control contrast-enhanced tomographic imaging of the patients showed false lumen patency in the thorax in 34 patients (82.9%) and in the abdominal region in 33 patients (80.5%). When analyzing subgroups according to the type of surgical procedure, or indirectly anticoagulant use, no statistically significant difference was found in false lumen patency prevalence between the thoracic and abdominal groups (p=0.534 and p=0.922). CONCLUSION: No potential effect of postoperative anticoagulation on false lumen patency was found in cases with acute type A aortic dissection.