EComment. Efforts to further enhance the safety of sternal re-opening in the paediatric age group

WOS: 000320858900069PubMed ID: 23785095We thank Gandolfo et al. for their effective and easy reproducible technique for managing major vessel injuries during chest re-entry in children [1]. As diagnostic and therapeutic interventions in congenital heart diseases advance progressively, cardiac surgeons have begun to deal with chest re-opening more frequently. Although major venous damages like innominate vein can be managed by a Fogarty catheter, cardiac surgeons are still facing challenging problems, such as damage of cardiac chambers, retrosternal right ventricle to pulmonary artery conduits and ascending aortic aneurysms during the re-sternotomy procedures performed in children. In such cases, we believe that the inflation of Fogarty catheters may even enlarge the defect and make it more uncontrollable in an incomplete sternotomy. In our practice, patients with a sternotomy history are carefully evaluated before the operation. Although the best option in imaging work-up is computed tomography, its routine usage is avoided so as not to increase the exposure of ionizing radiation in the paediatric age group. In most of the patients with redo cardiac surgery, magnetic resonance angiography or lateral projection of cardiac cineangiography studies demonstrate the potential adhesions of the anatomic structures to the posterior part of the sternum. At the operation, we regularly mark the femoral vessels with Doppler ultrasonography and prepare a cardiopulmonary bypass (CPB) set-up before initiating the incision

Progressive supra-aortic stenosis in a young adult with the findings of Singleton Merten Syndrome

Singleton Merten Syndrome is an autosomal dominant disorder of unknown origin. Patients often present with muscular weakness, failure to thrive, abnormal dentition, glaucoma, psoriatic skin lesions, aortic calcifi cation and musculoskeletal abnormalities. In this case, we present a young girl with a history of aortic root replacement, who had an unusual progressive supra-aortic stenosis managed with urgent surgery during the course of the syndrome. Cardiovascular involvement needs special attention, since it is the major cause of mortality along with rhythm disturbances in the course of Singleton Merten Syndrome

Varfarine bağlı cilt nekrozu: Eski bir soruna yeni bir çözüm

We present two cases of skin necrosis occurring after initiation of warfarin therapy, bpth of wich were safely treated with novel oral anti-coagulants (NO-ACs). The first case is a 52-years-old male, seen after a transient ischemic event

The effect of treated apical periodontitis before heart valve surgery on C-reactive protein levels

Objective Dental infections produce significant increases in systemic inflammatory responses manifested by cytokines and acute-phase reactants. This study evaluated the postoperative C-reactive protein (CRP) levels according to patients having teeth treated or not treated for apical periodontitis (AP) before heart valve surgery. Materials and Methods Preoperative, postoperative third- and fifth-day CRP levels, and the previous dental data of 91 patients were investigated. Whether the patients had been treated for AP and whether they used antibiotic prophylaxis for this treatment were determined by examining the previous data. The analysis of covariance (ANCOVA) was used for statistical analysis. Results There were no statistically significant differences in the preoperative CRP levels and the third-day CRP levels between all patients treated and those not treated for AP (p > .05). The mean fifth-day CRP levels of the patients with teeth treated for AP were significantly lower than those of the patients with teeth not treated for AP (p < .05). Antibiotic prophylaxis had a significant effect on the fifth-day CRP levels. Conclusion The decrease in CRP levels after AP treatment may contribute to alleviating heart valve disease and maintaining cardiac health

Changes in aortic pulse wave velocity and the predictors of improvement in arterial stiffness following aortic valve replacement

Background: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. Methods: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. Results: The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm²/m². Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005–1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023–1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. Conclusion: The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients’ characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients

Right coroner artery assessment in radiotherapy of breast cancer

WOS: 000467786303104The risk of developing coronary ischemic heart disease and the radiation doses to heart and left anterior descending coronary artery (LAD) have been very well documented in breast cancer patients who underwent radiotherapy (RT). On the other hand, there is limited information regarding the right coronary artery (RCA) doses which feeds the heart in 48% of the human population. In this study proximal RCA (pRCA) doses are evaluated in the treatment plans of breast cancer patients who underwent RT

Simultaneous Hydatid Cysts of Both the Right Atrium and Right Ventricle

Hydatid disease in both chambers of the heart is very rare. Mobile right atrial and right ventricular hydatid cysts were diagnosed incidentally in the etiologic work up for a transient ischemic attack in a 77-year-old man with a history of a hepatic hydatid cyst operation. Transthoracic echocardiography was very successful in the diagnosis of both hydatid cysts. Transesophagial echocardiography and computed tomography confirmed the diagnosis. Both right atrial and right ventricular hydatid cysts were removed under cardiopulmonary bypass to prevent morbidities and potentially fatal complications

Should Sinus of Valsalva be Replaced in Patients with Dilated Ascending Aorta and Aortic Valve Diseases?

Abstract Introduction: The aim of this study is to investigate the change in the dimension of sinus of Valsalva in patients who underwent supracoronary ascending aorta replacement with aortic valve replacement. Methods: A total of 81 patients who underwent supracoronary ascending aorta replacement with aortic valve replacement were included. Ten of 81 patients died during the follow-up. The patients were divided into three groups according to the aortic valve diseases. Group I (n=17) included patients with bicuspid valves, group II (n=30) included patients with stenotic degenerative valves, and patients with aortic regurgitation constituted group III (n=24). In preoperative and follow-up periods, the sinus of Valsalva diameter of the patients was evaluated by echocardiographic examination. The mean age was 54.1±15.1 years. Twenty-eight (34.6%) patients were female and 12 (14.8%) patients were in New York Heart Association functional class III. Results: There was no early mortality. Late mortality was developed in 10 (12.4%) patients, 8 (9.9%) due to non-cardiac reasons. Late follow-up was obtained in 71 patients with a mean of 60±30.1 months postoperatively. During follow-up, the increase in the diameter of the sinus of Valsalva was significant in Group I (P0.05). Conclusion: To avoid the risks associated with sinus of Valsalva dilatation, it is reasonable to replace the sinus of Valsalva in the setting of aortic valve replacement and ascending aorta replacement for bicuspid aortic valve with a dilated ascending aorta and relatively normal sinuses of Valsalva in young patients

IgG4-related aortitis mimicking intramural hematoma

Introduction: Acute aortic syndromes (AAS) are life-threatening conditions,and despite advances in imaging techniques, their diagnosisand treatment remain challenging. While intramural hematomais much less common than acute aortic dissection (AD),which is the most common form of AAS, they have similar mortalityrates (1). On the other hand, aortitis may mimic intramuralhematoma (IMH) due to radiologic similarity and, thus, may leadto misdiagnosis and treatment.Here, we describe an IgG4-related aortitis case mimickingintramural hematoma (IMH) due to radiologic image and presentingwith chest pain and severe aortic regurgitation