Visualization of HeartMate 3 Outflow Graft Twisting by Selective Graft Angiography.

A 55-year-old male patient presented with a history of left ventricular assist device (LVAD) implantation due to ischemic cardiomyopathy. Low-flow alarms were detected on the LVAD, which was temporarily stopped to demonstrate retrograde flow from the aorta through the outflow graft. Selective visualization was performed after engagement of a pigtail catheter in the outflow graft. Twisting at the beginning of the outflow graft was clearly depicted. The patient underwent surgery to correct the twisting. After correction, flow increased immediately back to normal levels.

Left ventricular assist device implantation following multisystem inflammatory syndrome in children due to SARS-CoV-2.

Multisystem inflammatory syndrome in children (MIS-C) is rare, however, severe hyperinflammatory condition in children generally weeks after acute SARS-CoV-2 infection. A subset of MIS-C patients is presented with severe heart failure. We hereby report 8-year-old girl presenting acute severe left ventricular failure. Various medical treatments including inotropic agents and drugs related to SARS-CoV-2 infection and MIS-C were applied. However, venoarterial extracorporeal membrane oxygenation (ECMO) was needed to be performed. Due to unsuccessful attempts for ECMO weaning, left ventricular assist device was implanted to the patient with temporary right ventricular support from ECMO.

Surgical approach to recurrent secondary aortoenteric fistulas: A case report.

The increasing number of abdominal aortic grafts due to abdominal aortic aneurysms has caused secondary aortoenteric fistulas to be seen more frequently as a cause of gastrointestinal bleeding. High index of suspicion plays a significant role in the diagnosis in patients having clinical symptoms ranging from fecal occult blood to massive gastrointestinal bleeding, accompanied by hemorrhagic shock. A 65-year-old male patient developed two secondary aortoenteric fistulas consecutively. The first one was aortic graft-jejunal and the second one was aortic graft-duodenal in a short period. Secondary aortoenteric fistula developed after aortobifemoral bypass. The patient underwent graft revision and jejunal repair. He was reoperated three months later due to the newly developed aortic graft-duodenal fistula. The duodenal defect was closed, and an extra-anatomic aortoiliac bypass was performed to avoid graft-related enteric fistula. The patient was discharged uneventfully and was free from any complication at nine months after surgery.

Sutureless Aortic Valve Replacement.

OBJECTIVE: To compare the results of sutureless aortic valve replacement (AVR) with the conventional method. STUDY DESIGN: A case-control study. PLACE AND DURATION OF STUDY: Cardiovascular Surgery Unit, Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Turkey, from December 2014 to December 2019. METHODOLOGY: Patients undergoing AVR were enrolled. The inclusion criteria were severe symptomatic aortic valve disease, New York Heart Association (NYHA) class II or higher, and age >55 years. Perioperative clinical and echocardiographic outcomes were assessed in all patients. RESULTS: Ninety-one patients (45 women, 46 men) underwent AVR (49 sutureless, 42 conventional). The average age was 73.08 ± 7.54 years in the sutureless group and 66.26±8.63 years in the conventional group. The mean cross-clamp and cardiopulmonary bypass (CPB) times were 72.86 ± 34.09 and 91.88 ± 36.98 minutes, respectively, in the former; and 104.96 ± 41.64 and 119.81 ± 40.45 minutes, respectively, in the latter. In the sutureless group, 30 (61.2%) patients underwent additional procedures such as CABG, mitral interventions, tricuspid repair, ascending aortic surgery, and myxoma removal. Preoperative peak and mean pressure gradients decreased from 76 and 48 mmHg to 16 and 9 mmHg postoperatively in the sutureless group; and from 70.9 and 44 mmHg to 24 and 12 mmHg in the conventional group. Paravalvular leak and permanent pacemaker requirement due to AV-block rates were 6.1%. The mean ICU stay was 3.69±6.75 and 2.31±1.80 days, the mean hospital stay was 10.08±6.56 and 8.62±3.28 days, and the 30-day overall mortality rates were 8.2% and 4.8% in the sutureless and conventional groups, respectively.   Conclusion: Sutureless AVR has advantages of shorter cross-clamp time, reduced CPB duration, and postoperative aortic gradients. However, there was no advantage in terms of mortality or hospital stay. Its benefits could be more prominent in complex cases or minimally invasive surgery. Key Words: Sutureless valves, Aortic valve stenosis, Valve replacement.

Atrial Fibrillation Prediction by Surgical Risk Scores Following Isolated Coronary Artery Bypass Grafting Surgery.

OBJECTIVE: To compare surgical risk scores including Euroscore II, STS and Logistic Euroscore for their predictive ability about postoperative atrial fibrillation (POAF). STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital and Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, from June to December 2018. METHODOLOGY: One hundred and four patients, undergoing isolated coronary artery bypass grafting operation, were enrolled. Surgical risk scores, clinical, laboratory and echocardiographic parameters were compared between POAF-positive and POAF-negative groups Results: Of the 104 patients included, 23 (22.1%) patients developed atrial fibrillation postoperatively. Peripheral artery disease, carotid artery disease, current smoking, cardiopulmonary bypass time, left atrial diameter, and Syntax II score were found to be associated with POAF. Among these, peripheral artery disease and cardiopulmonary bypass time were independently related with POAF. Euroscore II (p = 0.005), STS (p = 0.026) and Logistic Euroscore (p = 0.032) were all statistically higher in POAF developing patients. In terms of ROC analysis, area under the curve was higher in Euroscore II (0.697) than STS and Logistic Euroscore (0.658 and 0.652, respectively). CONCLUSION: Euroscore II, STS and Logistic Euroscore were all associated with POAF development. However, Euroscore II could be a better option for the prediction of POAF.

Outflow graft twisting of Heartmate III left ventricular-assisted device: A case report.

Outflow graft twisting of Heartmate III left ventricular-assisted device is a rare device complication and, due to the recent reports from transplant centers, the firm and the United States Food and Drug Administration have announced explanatory measures. When the outflow graft twisting occurs, the diagnosis and treatment should be done without any delay due to serious decline in the device output and unstable hemodynamics. This article describes the first case of an outflow graft twisting in Turkey.

Endovascular stenting of mid-aortic syndrome due to Takayasu arteritis.

Introduction-patients: Takayasu arteritis may involve various parts of the aorta and its major branches. It leads to occlusive or aneurysmal disease of the vessel. It can be treated either with surgery or percutaneous intervention. We report a successful endovascular treatment of stenosis of the descending thoracic and abdominal aorta in a 19-year-old female. Methods-results-conclusions: Self-expandable nitinol stent was deployed and adequate opening of the aorta was obtained in this patient. Long-term durability of endovascular approach is a matter of debate. We also reviewed the sufficiency of endovascular treatment versus surgery.

Timing of coronary artery bypass surgery in patients with non-ST-segment elevation myocardial infarction and postoperative outcomes.

INTRODUCTION: The aim of the study was to assess whether a cardiac troponin T (cTnT) level 1 ng/ml or below threshold is safe and to evaluate mid-term follow-up results in stable patients with non-ST-segment elevation after acute myocardial infarction. MATERIAL AND METHODS: Among cTnT positive patients who presented to the emergency unit with chest pain and received coronary angiography, 100 patients who underwent isolated coronary artery bypass grafting (CABG) constituted the study group (group 1). The same number of patients (n = 100) who were cTnT negative and underwent an isolated CABG operation under elective conditions were selected as the control group (group 2). RESULTS: Among preoperative criteria, group 1 had significantly higher smoking rates (74% vs. 41%, p = 0.0001), and significantly lower ejection fraction values (47.1 ±8.25, 54.69 ±8.73, p = 0.0001). There were no significant differences between the groups with respect to operative parameters. Postoperative follow-up periods were significantly longer in group 1 (23.25 ±14 vs. 17.55 ±7.95 months, p = 0.001). Average waiting time for cTnT to drop below the 1 ng/ml threshold value was 5.73 ±2.95 (1-12) days. Intra-aortic balloon pump use in Groups 1 and 2 was 3% and 1%, respectively. There were no hospital mortalities in either group. Mortality rates at mid term were 6% in both groups. CONCLUSIONS: This study compared two groups positive and negative for preoperative cTnT. The findings show that it is safe to wait until cTnT levels decrease to the 1 ng/ml threshold value in cTnT positive patients having a stable course. This waiting period is not very long, which is significant with respect to potential complications.

Severe hypokalemia probably associated with sertraline use.

OBJECTIVE: To report a case of ventricular fibrillation caused by severe hypokalemia probably associated with sertraline use. CASE SUMMARY: A 48-year-old male patient experienced ventricular fibrillation and cardiac arrest 2 hours after an uneventful coronary angiography procedure, which revealed normal, unobstructed coronary arteries. Blood chemistry was immediately obtained, revealing a very low potassium (K+) level of 2.44 mEq/L. Other blood electrolytes, including magnesium, ECG, and corrected QT intervals, were all within normal limits. A thorough search for an etiology of hypokalemia, including adrenal gland causes, herbal product consumption, and toxic exposure, did not reveal any identifiable cause. This led us to consider the only drug he was on--sertraline 50 mg per day--as the possible culprit. DISCUSSION: There has been no clear identification of severe hypokalemia associated with sertraline use in the literature. However, there have been a considerable number of self-reported cases of hypokalemia in patients on sertraline therapy. Scoring according to the Naranjo adverse drug reaction scale revealed a probable relationship between severe hypokalemia and sertraline use in our patient. No clear pathogenic mechanism for the effect of sertraline on serum K equilibrium is known. However, considering the number of self-reported incidences and this case report, the effect of sertraline on serum K levels warrants consideration. CONCLUSIONS: This is the first documented case report of severe hypokalemia probably associated with sertraline use.

Gastrointestinal complications after open heart surgery: incidence and determinants of risk factors.

Acute mesenteric ischemia is a rare but serious complication of open heart surgery. Between January 2009 and January 2012, 1360 adult patients underwent open heart surgery with cardiopulmonary bypass at our institution; 29 patients presented gastrointestinal complications. Eight patients developed acute mesenteric ischemia and all of them died. Significant predictors of the complication were New York Heart Association functional class III/IV, history of extensive atherosclerosis and chronic renal failure, acute renal failure following surgery, low cardiac output, use of 2 or more vasoconstrictor drugs, prolonged mechanical ventilation, and multiorgan failure. Atherosclerosis is a multisystemic disease that affects several organs. Radiologic evaluation of mesenteric arterial system should be performed in high-risk patient populations. Perioperative percutaneous and open vascular procedures will reduce the risk of acute mesenteric ischemia that may develop after cardiac surgery and consequent morbidity and mortality rates.

Mesothelial/monocytic incidental cardiac excrescence in a patient with antiphospholipid syndrome.

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign lesion composed of a mixture of histiocytes, mesothelial cells, fibrin, adipocytes and scattered inflammatory cells without a vascular network or supporting stroma. Its pathogenesis is controversial with some authors favoring an artifactual theory while others consider a reactive phenomenon. To date, only 41 cases of MICE have been reported in the literature. We describe an additional case of MICE in a 24-year-old female with antiphospholipid syndrome. A mobile hyperechogenic mass attached to the left ventricular surface of the aortic valve was documented by transthoracic echocardiography (TTE). The patient did have cardiac catheterization one month before the cardiac surgery. Histopathologic and immunohistochemical examination showed a lesion composed of histiocytes and mesothelial cells together with fibrin and scattered inflammatory cells. To our knowledge, this is the first case of MICE detected in a patient with antiphospholipid syndrome.

Severe tricuspid regurgitation in a patient receiving low-dose cabergoline for the treatment of acromegaly.

Cabergoline, an ergot-derived dopamine receptor agonist, is used widely in the treatment of Parkinson's disease (PD) and hyperprolactinemia, but may cause heart valve fibrosis, retraction, and clinically significant regurgitation in PD patients. While cabergoline has been used at much lower doses in patients with hyperprolactinemia, controversy persists as to whether it may cause heart valve disease in this situation. Cabergoline is also used in acromegaly at doses similar to those used in hyperprolactinemia. The case is reported of a female patient with acromegaly who had been taking low-dose (0.5 mg/day) cabergoline for one year, and presented with signs and symptoms of right-sided heart failure. Echocardiography revealed a thickened and retracted tricuspid valve associated with severe tricuspid regurgitation and enlargement of the right-heart chambers. The morphology of the tricuspid valve was typical for cabergoline-related valvulopathy. Cabergoline may not be totally safe even at lower doses, and close echocardiographic monitoring is recommended in patients receiving cabergoline treatment, regardless of the dose level employed.