Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery

Sternal dehiscence is an untoward complication of cardiac surgery that leads to increased morbidity as well as length of hospital stay and costs. Although many different conventional and creative techniques have been described using both synthetic and biologic materials, the ideal method of sternal reconstruction is still controversial. In this case, we describe a simple and reproducible "fibula allograft sandwich technique" for the reconstruction of sternal nonunion in a cardiac surgery patient. This technique also facilitates the conventional wiring by creating bilateral landing zones for the wires at both sides of the sternum

Giant left ventricular pseudoaneurysm concomitant with severe mitral regurgitation: Multimodality imaging and successful surgical repair

WOS: 000355207400008PubMed ID: 25564219A 58-year old man with previous myocardial infarction was shown to have a huge pseudoaneurysm (8 × 6 cm) on the left ventricular posterior wall concomitant with severe mitral regurgitation. The left ventricle was reconstructed with resection of the pseudoaneurysm sac and repaired with a Dacron graft (Dor procedure) along with mitral ring annuloplasty (Fig. 1E). Postoperatively, left ventricle was normal in size (5.5 × 3.8 cm) without residual mitral regurgitation

Anticoagulant and vasodilator therapy for nicolau syndrome following intramuscular benzathine penicillin injection in a 4 year old boy

7th IEEE Asia-Pacific Conference on Applied Electromagnetics, APACE 2016 -- 11 December 2016 through 13 December 2016 -- 127632Nicolau syndrome (NS) is a rare complication of intramuscular, intraarticular or subcutaneous injection of particular drugs leading to ischemic necrosis of the surrounding skin, soft tissue and muscular tissue. Benzathine penicilin one of the most widely used antibiotic for upper respiratory tract infections and has been rarely reported to cause NS. Here we describe a 4 year old boy with diagnosis of NS after the injection of benzathine penicillin who was successfuly treated with unfractionized heparin (enoxaparine) and pentoxifylline. The practitioners should pay attention for unnecessary use of benzathine penicillin to avoid from probable complications

Unusual cause of chest pain mimicking acute myocardial infarction: Congenital left ventricular aneurysm

WOS: 000422512900057PubMed ID: 25763365A 36-year-old man without any cardiac history presented to the emergency room with ongoing chest pain. The Electrocardiography (ECG) showed diffuse ST segment elevations on the anterior leads compatible with acute anterolateral wall myocardial infarction [Table/Fig-1]. The patient was a current smoker with a family history of coronary artery disease (CAD). He had a stable hemodynamic status with normal blood pressure and pulse rate. Initial examination revealed mild systolic murmur along the left sternal border as well as lateral displacement of the apical pulse. Lung auscultation was completely normal and all peripheral pulses were palpable. He was evaluated with transthoracic echocardiography that showed reduced ejection fraction of 38% with hypokinesis of the anterior wall along with a diffuse aneurysmal apical segment [Table/Fig-2]. Depending on the high clinical suspicion of acute myocardial infarction, the patient underwent emergency coronary angiography that revealed normal coronary arteries. In order to further define the anatomy, cardiac magnetic resonance imaging (MRI) was performed [Table/ Fig-3], [Video-1 and 2]. Left ventricular cavity was seen to expand at the apical level associated with thinning of the myocardium concordant with a true aneurysm. The aneurysmal pouch had a size of 4x5 cm without any thrombus inside

Giant pericardial tube roll aneurysm after the treatment of aortic interruption

Various techniques have been described for the treatment of interrupted aortic arch pathology. Graft interposition, either autologous or synthetic, is included among these methods. In this article, we present the images of giant pericardial roll aneurysm that was used for the treatment of aortic interruption during the newborn period

Implantation of looped epicardial cardioverter defibrillator coil on the surface of the right ventricular outflow tract

WOS: 000352494400017PubMed ID: 25683331BackgroundWe present the early results of looped epicardial cardioverter defibrillator coil implantation on the anterior surface of right ventricular outflow tract in infants and children. MethodsPatients with a surgical history of an epicardial implantable cardioverter defibrillator system between 2013 and 2014 were included in the study. Patient age, gender, body weight, indications for a cardioverter defibrillator system implantation, defibrillation threshold values, and defibrillation therapies were retrospectively evaluated. ResultsThere were eight patients with a mean age of 4.42.9 years and a mean body weight of 19.5 +/- 11.7kg. Five of the patients had been diagnosed with long QT syndrome, one patient had been diagnosed with genetic channelopathy and noncompaction of the left ventricle, and two patients had been diagnosed with univentricle physiology. The implantable cardioverter defibrillator system was composed of pace-sense leads, an abdominal active can, and a defibrillation coil placed below the pulmonary valve annulus on the anterior surface of the heart. The mean defibrillation threshold was 6.6 +/- 2.3 joules. There were four appropriate therapies in two patients in a mean follow-up of 9 +/- 6.5 months. ConclusionThe significantly low defibrillation thresholds with the defibrillation coils located below the pulmonary valve annulus are encouraging. However, a larger patient series will be necessary to evaluate the safety and reliability of this technique

Correlation between cerebral-renal near-infrared spectroscopy and ipsilateral renal perfusion parameters as clinical outcome predictors after open heart surgery in neonates and infants

The objective of this clinical study is to determine whether correlation exists among cerebral and renal near-infrared spectroscopy (NIRS) measurements, renal Doppler ultrasonography parameters (resistive index, peak systolic velocity), and early postoperative clinical outcomes following cardiac surgery in neonates and infants. Thirty-seven patients undergoing surgery for congenital heart defects with an age of less than 3 months, all of whom were in the high-risk group according to Aristotle Basic Complexity risk stratification score, were enrolled in our study. Cerebral, renal NIRS values and renal Doppler ultrasonography measurements were recorded for each patient at the 4th postoperative hour. The renal resistive indices were calculated for each case, and the patients were divided into two groups according to renal resistive index (RI) values. Group I included the patients with a RI of greater than 0.8 (n=25) and Group II included the patients with a RI of less than 0.8 (n=12). The postoperative outcome parameters were compared in between two groups. Group I (RI >0.8) had lower postoperative mean urine output than Group II (RI <0.8) (P=0.041). The lactate levels were significantly higher in Group I (P=0.049), as well. The postoperative intensive care unit and hospital stay of Group I was significantly higher than Group II (P=0.048). Both cerebral and renal NIRS values and the assessment of renal RI as well as peak systolic values can be used in order to predict the early clinical outcome in cardiac surgery patients in early infantile and neonatal period. © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc

Current strategies for the management of anomalous origin of coronary arteries from the pulmonary artery

INTRODUCTION: The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery. PATIENTS AND METHODS: Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients' demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated. RESULTS: The study included eight patients (six females and two males) - six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy. CONCLUSION: It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals

Eighth Istanbul symposium on pediatric extracorporeal life support systems and pediatric cardiopulmonary perfusion

To improve the outcomes of pediatric extracorporeal life support (ECLS) and cardiopulmonary bypass (CPB) procedures in Turkey, we have established a series of conferences, called “Istanbul Symposiums.” Since the first symposium in June of 2011, we have organized seven additional symposiums in Istanbul (1–3). The objective of this editorial is to share the latest results on pediatric ECLS and CPB patients with the Artificial Organs community

A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia

Treatment of the aneurysms comprising the aortic arch is challenging. Surgical reconstruction usually requires aortic cross-clamping, cardiac arrest, and even deep hypothermia for a bloodless field. In this report, we present our surgical technique providing normothermic ascending aorta, aortic arch, and proximal descending aorta replacement with selective cannulation and perfusion of the whole body