Additional Benefits of Serum Oncostatin M Levels Compared to Cardiac Troponin in Non-ST Elevation Myocardial Infarction.

Background: The use of high-sensitivity troponin levels increases the sensitivity of the diagnosis of non-ST elevation myocardial infarction (NSTEMI). However, the inclusion of other factors in the differential diagnosis, apart from atherothrombosis causing myocardial injury, decreases the specificity of high-sensitivity troponin. In this study, we compared the efficacy of high-sensitivity troponin with serum oncostatin M in NSTEMI cases with elevated urea and creatinine. Methods: This study was performed with a prospective cross-sectional sample. Ninety participants with coronary angiography performed due to a preliminary diagnosis of NSTEMI were included. High-sensitivity troponin I, creatine kinase-MB, lactate dehydrogenase, serum transaminase and oncostatin M levels were quantitatively measured for the first 4-8 hours from the onset of symptoms. All participants had coronary angiography performed within the first 12 hours after attending the emergency service. Based on coronary angiography data, patients with significant coronary stenosis or occlusion detected during coronary angiography were defined as group A, and patients with no occlusion in the coronary artery and who did not require an additional interventional procedure were defined as group B. The SYNTAX 2 score was used to determine the severity of coronary artery disease. Results: Patients in both groups A and B had similar age, sex distribution and comorbidities. Group A had higher serum urea, creatinine, oncostatin M and high-sensitivity troponin I values than group B. With 585 pg/ml as the cut-off value, serum oncostatin M had a sensitivity of 88.6% and specificity of 85% for the diagnosis of NSTEMI. Logistic regression multivariate analysis showed that serum oncostatin M and high-sensitivity troponin I values had diagnostic efficacy for NSTEMI. Serum oncostatin M was found to be more effective than high-sensitivity troponin I in patients with elevated urea and creatinine. Conclusions: Serum oncostatin M had similar sensitivity and specificity for NSTEMI diagnosis as high-sensitivity troponin I. Serum OSM can especially be considered as a complementary diagnostic biomarker for NSTEMI in patients with renal dysfunction.

Early results of ring-reinforced conduit and curved porcine patch in Sano-Norwood procedure.

BACKGROUND: Patch augmentation of the aortic arch as well as construction of an unobstructed pulmonary blood supply are two important surgical targets in patients with hypoplastic left heart syndrome. In this report, we aimed to present our preliminary results with a combination of two relatively new approaches in Norwood-Sano procedure. METHODS: A retrospective analysis was performed in 10 newborns with the diagnosis of hypoplastic left heart syndrome. Our surgical approach incorporated the interposition of a 6.0-mm ring-reinforced tube graft with the "dunked technique" between the right ventricle and the pulmonary artery; and reconstruction of the aortic arch using a curved porcine pericardial patch which is specifically designed for the Norwood procedure. RESULTS: Mean age and body weight at the time of the Sano-Norwood operation were 7.3 ± 2.4 days and 3164 ± 406 g, respectively. We encountered 1 (10%) early and 1 (10%) late mortality. All of the patients were discharged without any residual gradients at the aortic arch. Four out of eight patients underwent stage 2 bidirectional cavopulmonary anastomosis at a median age of 5 months (range, 4-6 months). Pericardial patch augmentation of the left pulmonary artery was deemed mandatory in one of our patients. CONCLUSIONS: The dunked technique of interposing a ring-reinforced conduit between the right ventricle and pulmonary artery along with the utilization of a curved porcine pericardial patch specifically designed for aortic arch reconstruction are promising modifications of the Sano-Norwood procedure in newborns with hypoplastic left heart syndrome.

Ninety-two days of extracorporeal membrane oxygenation support following congenital heart surgery.

We report on a case involving a 10-month-old infant who received prolonged ECMO therapy following cardiac surgery for multiple ventricular septal defects (VSD). The patient was successfully weaned from 92 days of ECMO support without any long-term deficits.

Double Switch Procedure and Surgical Alternatives for the Treatment of Congenitally Corrected Transposition of the Great Arteries.

BACKGROUND: We present our experience with the double switch operation in sixteen patients with congenitally corrected transposition of the great arteries. METHODS: We enrolled 16 patients with congenitally corrected transposition of the great arteries operated by a single surgeon between 1995 and 2015. The mean age was 25 months (range 4 to 72 months) and the mean body weight was 8.9 kg (range 4.3 to 19 kg) at the time of operation. RESULTS: We encountered seven patients with moderate to severe tricuspid regurgitation, five of which had Ebstein anomaly. We performed a combination of atrial and arterial switch procedures in 11 cases, one of which had a concomitant coarctation of the aorta that was repaired along with the double switch procedure. Atrial switch and the Rastelli procedures were performed in three cases with concomitant pulmonary stenosis. A combination of arterial switch, Hemi-Mustard procedure, and bidirectional cavopulmonary anastomosis was performed in two cases. During a mean follow-up period of 67 months (range three months to 18 years), we encountered one early postoperative mortality related to intracerebral bleeding. All but one of the patients are now in NYHA class I-II. CONCLUSIONS: Congenitally corrected transposition of the great arteries is a rare congenital cardiac anomaly in which the results of the anatomical repair with double switch operation appear to be superior to that achieved by a physiological repair.

Modified Single Versus Double-Patch Technique for the Repair of Complete Atrioventricular Septal Defect.

OBJECTIVES: We present our single center results of two commonly used surgical techniques, the modified single-patch and double-patch technique for the repair of the complete atrioventricular septal defect. METHODS: We enrolled 49 patients with complete atrioventricular septal defect who were operated by a single surgeon between 2004 and 2014. The modified single-patch technique was performed in 32 cases (group S), whereas the defect was repaired with the double-patch technique in 17 patients (group D). RESULTS: The mean age at the time of operation was 7.7 ± 8.6 (range 1-48) months and 9.9 ± 12.5 (range 1.5-48) months, in groups S and D, respectively. Mean body weight was 6.7 ± 3 (range 3.5-15.5) kilograms and 7.2 ± 3.8 (range 4.3-14.5) kilograms in groups S and D, respectively. Cross-clamp and cardiopulmonary bypass times were shorter in the modified single-patch group (65.6 ± 16.3 vs. 98.7 ± 19.8 minutes, p = 0.0001; 88.9 ± 23.3 vs. 128.9 ± 28.0 minutes, p = 0.0001). Postoperative atrioventricular valve function was improved in both groups. Mean follow-up period was 4.4 ± 3.2 (range 1.2-9.9) years. One patient in each group underwent reoperation for left atrioventricular valve insufficiency. We encountered two early and one late mortalities in modified single-patch group. One early mortality was experienced in the unmodified group. CONCLUSIONS: The modified single-patch and two-patch techniques have comparable results; however, the modified single-patch technique is performed with significantly shorter cross-clamp and cardiopulmonary bypass times, therefore we have adopted this technique on a routine basis for the treatment of the complete atrioventricular septal defect in our institute.

Mid-Term Results of Congenital Supravalvar Mitral Ring Resection.

BACKGROUND: Supravalvar mitral ring is a rare congenital anomaly leading to left ventricle inflow obstruction. We present our surgical experience and mid-term results in patients operated for supravalvar mitral ring and associated congenital heart defects. MATERIALS AND METHODS: A retrospective analysis was performed in order to evaluate the cases surgically treated with the diagnosis of supravalvar mitral ring between 2001 and 2014. Ten patients were identified, seven of whom had accompanying congenital heart defects. Median age at the operation was 4.5 years. RESULTS: Ventricular septal defects were encountered in half of the cases. Two of the patients had mitral annular hypoplasia, another two had the components of Shone's complex. The mean preoperative gradient across the supravalvar mitral ring decreased from 14.1 ± 4.2 mmHg to 4.6 ± 2.2 mmHg. All patients are alive and remain in a good clinical condition after a mean follow-up of five years. CONCLUSION: Supravalvar mitral ring is a surgically treatable cause of left ventricular inflow obstruction. Although residual gradients may be encountered in patients with mitral annular hypoplasia, surgical resection of the ring is encouraged.

Reverse anastomosis technique for the treatment of a rare coronary artery anomaly in D-transposition of the great arteries.

Arterial switch operation remains the gold standard surgical therapy for D-transposition of the great vessels. Coronary anomalies may complicate the surgical strategy and lead to an increased morbidity and mortality. However, as of today, even challenging coronary anomalies should not be a contraindication for the performance of complete repair. Here, we describe a technique for the translocation of an intramural, high-origin conal branch in a 5-month-old patient with D-transposition of the great vessels and ventricular septal defect.

Extracorporeal membrane oxygenation for the treatment of acute respiratory failure due to respiratory syncytial virus after congenital heart surgery.

Mechanical circulatory support using extracorporeal membrane oxygenation is a therapeutic option for intractable cardiac or respiratory failure. It has widely been used for adult and pediatric patient population with considerable success in cases with otherwise dismal prognosis. We describe the successful use of extracorporeal membrane oxygenation in a 9-month-old patient suffering from a virus-related respiratory failure after congenital cardiac surgery.

1-Ferrocenylmethyl-3-(2,4,6-trimethylbenzyl)-1H-imidazolidin-3-ium iodide and trans-bis(3-benzyl-1-ferrocenylmethyl-1H-imidazolidin-2-ylidene)diiodidopalladium(II).

Owing to increasing interest in the use of N-heterocyclic carbenes (NHCs) based on imidazolidinium ions as ligands in the design of highly efficient transition-metal-based homogeneous catalysts, the characterizations of the 1-ferrocenylmethyl-3-(2,4,6-trimethylbenzyl)imidazolidin-3-ium iodide salt, [Fe(C(5)H(5))(C(19)H(24)N(2))]I, (I), and the palladium complex trans-bis(3-benzyl-1-ferrocenylmethyl-1H-imidazolidin-2-ylidene)diiodidopalladium(II), [Fe(2)Pd(C(5)H(5))(2)(C(16)H(17)N(2))(2)I(2)], (II), are reported. Compound (I) has two iodide anions and two imidazolidinium cations within the asymmetric unit (Z' = 2). The two cations have distinctly different conformations, with the ferrocene groups orientated exo and endo with respect to the N-heterocyclic carbene. Weak C-H donor hydrogen bonds to both the iodide anions and the π system of the mesitylene group combine to form two-dimensional layers perpendicular to the crystallographic c direction. Only one of the formally charged imidazolidinium rings forms a near-linear hydrogen bond with an iodide anion. Complex (II) shows square-planar coordination around the Pd(II) metal, which is located on an inversion centre (Z' = 0.5). The ferrocene and benzyl substituents are in a trans-anti arrangement. The Pd-C bond distance between the N-heterocyclic carbene ligands and the metal atom is 2.036 (7) Å. A survey of related structures shows that the lengthening of the N-C bonds and the closure of the N-C-N angle seen here on metal complexation is typical of similar NHCs and their complexes.

Tetralogy of Fallot and subglottic stenosis surgery with holmium laser in the same session.

The incidence of subglottic stenosis after pediatric cardiac surgery is around 0.57-2.3%. An 11-year-old female patient, who underwent modified Blalock-Taussig shunt surgery at the age of 4 months, was interned for total repair of tetralogy of Fallot. Subglottic stenosis was revealed in preoperative examination with indirect laryngoscopy. Total repair of tetralogy of Fallot was performed under cardiopulmonary bypass support. While the patient was still on cardiopulmonary bypass support, subglottic stenosis was treated by holmium laser successfully without a complication. In suitable patients, cardiac and endoscopic laryngeal operations can be successfully and safely performed under cardiopulmonary bypass with a holmium laser.

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.

Validation of the Vasoactive-Ventilation-Renal Score for Neonatal Heart Surgery.

OBJECTIVES:  We aimed to validate the vasoactive-ventilation-renal (VVR) score and to compare it with other indices as a predictor of outcome in neonates recovering from surgery for critical congenital heart disease. We also sought to determine the optimal time at which the VVR score should be measured. METHODS: We retrospectively reviewed neonates recovering from cardiac surgery between July 2017 and June 2020. The VVR score was calculated at admission, 24, 48, and 72 hours postoperatively. Max values, defined as the highest of the four scores, were also recorded. The main end result of interest was a composite outcome which included prolonged intensive care unit stay and mortality. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling was also performed. RESULTS: We reviewed 73 neonates and 21 of them showed composite outcomes. The area under the curve value for VVR score as a predictor of composite outcome was greatest at postoperative 72-hour max (AUC= 0.967; 95% confidence interval, (0.927-1). On multivariable regression analysis, the VVR max 72 hours remained a strong independent predictor of prolonged ICU stay and mortality (odds ratio, 1.452; 95% confidence interval, 1.036-2.035). CONCLUSIONS: We validated the utility of the VVR score in neonatal cardiac surgery for critical congenital heart disease. The VVR follow-up in postoperative 72 hours is superior to other indices and especially the maximum VVR value is a potentially powerful clinical tool to predict ICU stay and mortality.

The Ideal Timing of Bedside Surgical Ligation of Patent Ductus Arteriosus in Premature Babies Less Than 30 Gestational Weeks.

OBJECTIVE: The aim of our study is to determine the relationship between exposure to hemodynamically significant patent ductus arteriosus and morbidities in premature babies, the optimal number of pharmacologic treatment cycles, and ideal ductus ligation timing. MATERIALS AND METHODS: The study was a retrospective single-center study conducted in a 3-year period between July 2017 and June 2020. Premature babies, born ≤30 weeks of gestation and transferred to our unit for bedside ductus ligation, were included in the study. The subjects were divided into 2 groups; Group A consisted of the patients who received ≥3 pharmacologic treatment cycles, and group B consisted of the patients who received ≤2 cycles. The groups were compared according to preoperative and postoperative features. The main outcome of the study was the presence of severe bronchopulmonary dysplasia. The secondary outcomes were specified as the length of stay in the neonatal intensive care unit and the duration of invasive mechanical ventilation (MV). RESULTS: The study group consisted of 24 patients. There were 10 patients in group A and 14 patients in group B. The mean gestational week and the mean birthweight were found to be 26,7 ± 2.2 weeks and 928 ± 190 g, respectively. The incidence of severe bronchopulmonary dysplasia was significantly higher in group A (70% vs. 14.3%; P = .019). Post-ligation invasive MV, duration, and length of stay in the intensive care unit were found to be significantly longer in group A. None of the patients had hemodynamic disturbances or complications during and after the operation. CONCLUSIONS: Bedside surgical ductus ligation is a safe procedure. Prolonging pharmacologic treatment in order to avoid surgery increases the risk of severe bronchopulmonary dysplasia and prolongs hospital stay.

Prognostic Nutritional Index and CRP, age, platelet count, albumin level score in predicting mortality and intensive care unit admission for COVID-19.

Aim: In our study, we investigated the efficiency of the prognostic nutritional index (PNI) score and the CRP, age, platelet count, albumin level (CAPA) score predicting mortality and intensive care unit (ICU) admission in COVID-19 disease. Materials & methods: PNI and CAPA score of patients confirmed with COVID-19 calculated by using the complete blood count and biochemical parameters at admission to the hospital, in predicting the COVID-19-associated mortality and ICU admission were analyzed. Results: PNI and CAPA scores in predicting mortality were detected as AUC: 0.67 (p < 0.001), AUC: 0.71 (p < 0.001), respectively. For predicting ICU admission AUC was 0.66 (p < 0.001), AUC was 0.77 (p < 0.001), respectively. Conclusion: PNI and CAPA scores are effective scores in COVID-19, with CAPA score being better in predicting mortality and ICU admission.

Lay abstract The COVID-19 pandemic is a global health problem that affects all societies. In order to deal with this urgent situation, the rapid spread of the disease in outbreaks requires categorizing patients according to risk group and regulating follow-up and use of resources accordingly. Effective, practical and inexpensive biomarkers are needed. We present to you the CAPA score calculated from CRP, age, platelet count, albumin levels, which is an effective score in predicting mortality and ICU admission in COVID-19.

Elevation of Serum Transaminase Levels Due to Favipiravir Use in the Treatment of COVID-19.

BACKGROUND AND AIMS: Favipiravir is a ribonucleic acid (RNA)-dependent RNA polymerase (RdRP) inhibitor antiviral agent used in the treatment of coronavirus disease-2019 (COVID-19). In this study, we investigated the changes in serum transaminase levels of patients and the relationship between serum transaminase elevation with mortality in patients who were hospitalized with the diagnosis of COVID-19 and received favipiravir treatment. MATERIALS AND METHODS: 454 patients who received favipiravir and 113 patients who did not receive favipiravir were evaluated. Serum transaminase levels of the patients were compared at baseline and after five days of treatment, and the relationship between serum transaminase elevation and mortality was investigated. RESULTS: No significant aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation was detected due to favipiravir treatment. AST elevation was found, respectively, as 133 (29.3%), 32 (28.3%) (p=0.100), ALT elevation as 112 (24.7%), 35 (29.3%) (p=0.100) in the groups receiving and not receiving favipiravir. High AST level was found as a risk factor for mortality in all patient groups (p=0.008). CONCLUSIONS: There was no statistically significant elevation in serum transaminase levels due to favipiravir use in patients hospitalized for COVID-19. A high level of AST is a significant risk factor to show mortality and intensive care unit (ICU) admission in patients with COVID-19.

Effect of Anastomosis Technique on Pancreatic Fistula Formation in Proximal Pancreaticoduodenectomy.

OBJECTIVE: To find out the association between the pancreatic fistula development and the pancreaticoduodenectomy anastomosis technique performed in three different ways; namely, telescopic pancreatojejunostomy (PJ), ducto-mucosal Wirsungo jejunostomy (WJ), and Peng's variant of the telescopic technique. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Izmir Katip Celebi Universitesi Hospital, Turkey, from January 2011 to January 2018. METHODOLOGY: A total of 144 proximal pancreaticoduodenectomy procedures were performed at the study centre. Patients' data was obtained from the outpatient files and hospital information system, retrospectively; and divided into three groups according to the pancreatic anastomosis techniques. All three groups were compared in terms of eight parameters. Preoperative parameters were age, gender, and serum direct bilirubin values; whereas, postoperative parameters were pathology, pancreatic fistula, drain amylase, serum albumin value and early mortality. RESULTS: All variables by anastomosis type belonging to three groups differed for fistula rates (p=0.384), pathology types (p=0.142), preoperative bilirubin (p=0.631) and postoperative albumin (p=0.516) levels, early mortality (p=0.242) parameters without reaching statistical significance (p>0.05); however, the low anastomosis leak rates in Peng's technique were remarkable. POPF (post-operative pancreatic fistula) developed in 34% patients under 60 years vs. 17.6% patients over 60 years of age (p=0.029); and 13.7% females vs. 29.9% of male patients (p=0.032). CONCLUSION: No factors other than age and gender were found to be significant alone in the development of pancreatic fistula after proximal pancreaticoduodenectomy. Key Words: Postoperative pancreatic fistula, Pancreaticoduodenectomy, Pancreatojejunostomy, Telescopic pancreatojejunostomy (PJ), Ducto-mucosal Wirsungo jejunostomy (WJ), Peng's telescopic technique.

Urgent double switch operation in a patient with congenitally corrected transposition of great arteries and an untrained systemic ventricle.

Congenitally corrected transposition of the great arteries is a rare cardiac abnormality. A nine-month-old male infant with the diagnosis of congenitally corrected transposition of the great arteries was admitted to our clinic with a history of pulmonary artery banding to train the left ventricle three months ago. On admission, he presented with bronchopneumonia, cyanosis, dyspnea, and severe biventricular heart failure associated with significant valvular regurgitation. An urgent double switch operation was performed with atrial and arterial switch procedures. Eight days of mechanical circulatory support was deemed mandatory following surgery. The patient is still under follow-up uneventfully three years after the operation.

A patient with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) and 13 live births.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) or Bland-White-Garland syndrome is a rarely seen congenital anomaly. Adult and infantile types are defined according to the degree of collateral development between the left coronary artery (LCA) and right coronary artery (RCA). If left untreated, ALCAPA has a 90% mortality rate in the first year of life, primarily due to myocardial ischaemia and heart failure. The degree of collateral development and the related LCA perfusion in ALCAPA syndrome determine the occurrence of symptoms. Herein, we present a case of a female patient who had previously, without any symptoms, given live birth to 13 babies. She had been experiencing exertional angina, which started long after the delivery of her 13th child. Since our patient had well-developed collaterals to the LCA, she was asymptomatic and able to give birth to the children via the vaginal route without any problems. Having well-formed collateral vessels between the RCA and LCA may prevent patients from developing symptoms, and even stressful conditions such as pregnancy may be tolerable.

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.

Factors affecting the return to work of total hip arthroplasty due to of developmental hip dysplasia in in young patients.

INTRODUCTION: The aim of this study was to examine the factors affecting return to work after Total hip arthroplasty (THA) applied for coxarthrosis due to developmental hip dysplasia (DDH). METHODS: The study included 51 patients aged <60 years in the period 2004-2010. The demographic information was recorded for all patients and the pre-postoperative Modified Harris score, EQ-5D, EQ-5D VAS and Grimby activity score. With an evaluation of the current employment status at the final follow-up examination. RESULTS: Preoperatively, 21 patients were employed, 16 were unemployed and 14 were housewives, none of whom were able to perform housework tasks. Postoperatively, 30 patients were employed and 10 were unemployed. One of the previously employed patients decided preoperatively to retire and was therefore not employed postoperatively. Of the 14 housewives, 9 were able to undertake the housework themselves postoperatively. The mean time of return to work was 13.4 weeks. Factors affecting finding work postoperatively were determined to be body mass index, National Occupational Level, whether or not osteotomy was applied and the preoperative duration of unemployment. CONCLUSIONS: As coxarthrosis associated with DDH develops earlier than primary coxarthrosis, these patients undergo surgery at a younger age and the vast majority are of working age. THA applied for coxarthrosis on the basis of DDH enables most patients to return to their preoperative work and offers the opportunity of finding work to some of those who were unemployed. This increases the contribution of these patients to the national economy.