Objective: Takayasu’s arteritis (TA) is first described by a Japanese ophthalmologist, Mikito Takayasu, in 1908. It is a disease of unknown etiology, primarily affecting aorta and its branches. We present mid-term results of 20 patients who underwent surgery or endovascular intervention due to TA. Material and Methods: Between January 2003 and January 2013, 20 patients with TA underwent surgery or endovascular intervention in our clinic. Their symptoms and findings were upper extremity ischemia (n=10), upper extremity hypertension (n=7), lower extremity claudication (n=5), subclavian steal (n=5), syncope (n=2), vertebro-basillary insufficiency (n=2), and visual disturbances (n=1). Of 20 patients, 13 underwent surgery, 6 underwent endovascular intervention, and 1 underwent a hybrid approach. Results: Restenosis was observed in 6 patients. Aneurysm occurred at right distal anastomotic site of the aorto-bifemoral graft in 1 patient who underwent surgery due to atypical coarctation of the aorta. Transient ischemic attack occurred in 1 patient on 48th day after endovascular intervention to the left carotid artery. There was no mortality in our series. Conclusion: Both surgical and endovascular approaches are commonly used techniques in TA. Restenosis rates of these interventions are similar. Treatment depends on the on the characteristics of the lesion, and the experience of the surgeon.

Giriş: Yağ dokusu yalnızca enerji kaynağı olmayıp aynı zamanda adipokin olarak adlandırılan biyoaktif maddeleri salgılayan bir endokrin organdır. Visfatin son dönemlerde keşfedilen, inflamasyon ve ateroskleroz ile ilişkilendirilen bir adipokindir. Bu çalışmada visfatinin koroner arter hastalığı ile ilişkisini araştırmayı amaçladık.Hastalar ve Yöntem: Koroner arter hastalığı sebebiyle koroner arter baypas greftleme planlanan 20 hasta anjiografik olarak koroner arter hastalığı olmayan 20 bireyle kıyaslandı. Cinsiyet, yaş, vücut kitle indeksi ve serum visfatin seviyesi gruplar arasında karşılaştırıldı. Visfatin seviyesinin koroner arter hastalığının ciddiyeti, aortic kros klemp zamanı ve kardiyopulmoner baypas zamanı ile ilişkisi de incelendi.Bulgular: Gruplar arasında yaş, cinsiyet, vücut kitle indeksi ve kan basınçları arasında fark saptanmadı. Serum visfatin seviyeleriyse anlamlı farklı bulundu (47,31±33,03 ng/ml ve 9,04±7,18 ng/ml, p=0,0001). Gensini skoru ile preoperative visfatin seviyesi arasında güçlü korelasyon saptandı (r=0,81; p=0,0001). Visfatin seviyesi ile kardiyopulmoner baypas ve aortic kros klemp zamanı arasında ilişki saptanmadı.Sonuç: Artmış serum visfatin seviyesi inflamasyon ve aterosklerotik kardiyovasküler hastalıklarla ilişkili olabilir. Dolaşımdaki visfatin seviyesi koroner arter baypas greftleme yapılan hastalarda artmıştır. Serum visfatin seviyesinin koroner arter hastalığı ile ilişkisi ve tedavi hedefleri arasındaki yerini belirleyebilmek için büyük ölçekli çalışmalara ihtiyaç vardır.

We read Ugur et al.'s study with interest [1]. Aortic coarctation surgery may be considered a well established procedure in paediatric congenital heart surgery. However, it becomes a complex and challenging procedure in adulthood, especially in the presence of accompanying anomalies. Until the last decade, ascending-descending aortic bypass with a posterior pericardial approach via a sternotomy has been the gold standard for complex coarctation with excellent outcomes [2]. In the era of endovascular interventions, balloon dilatation and stenting have gradually become a reliable option for the management of isolated aortic coarctation [3]. Recently, a hybrid approach has become an alternative technique for treatment of complex cases with encouraging early results [4]. In our institution, we performed ascending-descending aortic bypass as a concomitant procedure in 11 adult patients (9 patients with aortic coarctation and 2 patients with type C interruption of aorta), who had accompanying cardiac diseases. All procedures were done with a median sternotomy and cardiopulmonary bypass in single stage. We performed simultaneous aortic valve replacement, coronary artery bypass grafting, ascending aorta replacement and the Bentall procedure in 4, 3, 2, and 2 patients, respectively. Ascending-descending aortic bypass was done with an anterior aortic approach. The Dacron graft was anastomosed to the lateral ascending aorta and extended toward the left ventricle lateral border. The posterior pericardium was opened and the descending aorta encircled. Descending aorta anastomosis was done with a side clamp. All patients survived surgery without any major adverse cardiac and neurologic events. One patient was reoperated because of infective endocarditis in the second postoperative month. No major adverse cardiac or cerebrovascular events were found in medical follow-up records. The hybrid approach may provide safe and simple repair of coarctation and shortens operative time in patients with accompanying cardiac diseases. Aortic rupture, aneurysmal dilatation, dissection, pseudoaneurysm, restenosis and stent fracture are infrequent but life-threatening complications. Although balloon dilatation and stenting is a well-established treatment in the paediatric population, long-term outcomes and prospective randomized studies comparing surgery and endovascular approaches are necessary in the adult population. Furthermore, extra-anatomic bypass with median sternotomy is a well known technique facilitating the single stage management of concomittant cardiac problems. Limited posterior pericardial incision usually provides adequate exposure for distal anastomosis and decreases the risk of bleeding from excessive collateral vessels. Briefly, we still consider ascending-descending aortic bypass with median sternotomy to be the preferred approach in patients with complex aortic coarctation. Conflict of interest: none declared

INTRODUCTION:The selection of the ideal cannulation site is still one of the major concerns in ascending aortic surgery. In the last decade, many surgeons have chosen to utilize antegrade cerebral perfusion in hypothermic circulatory arrest. In this study, we aimed to evaluate arterial cannulation techniques in patients who underwent root replacement for annuloaortic ectasia.MATERIALS AND METHODS:Between 2005 and 2012, a total of 69 patients with a diagnosis of annuloaortic ectasia underwent aortic root replacement with femoral artery, axillary artery, and direct innominate artery cannulation (IAC). Patients demographic, operative, and postoperative data were collected prospectively and analyzed.RESULTS:A total of 69 patients were investigated. Their ages varied from 13 to 78 (mean age was 54.25 ± 15.69) and 48 patients were male (69.5%). Mean aortic diameter was 5.65 ± 1.58 cm (min: 4.5 cm to max: 7.8 cm) by computerized tomography. The procedures included modified Bentall operation in 61 patients, and Cabrol operation in eight patients. In hospital, the mortality rate was 1.85%, and a 30-day mortality rate was 3.7% in the IAC group and 6.6% in patients who underwent femoral and axillary artery cannulation. Temporary cognitive dysfunction and stroke rate were similar between groups.CONCLUSION:Innominate cannulation is associated with low morbidity and mortality in patients who underwent ascending aorta surgery.

Double aortic arch (DAA) is the most common form of complete vascular ring and results in respiratory and feeding problems because the trachea and the esophagus are circumscribed by the ring. It often occurs as an isolated anomaly; however, DAA may be associated with other congenital cardiovascular anomalies such as the tetralogy of Fallot (TOF), transposition of the great arteries, coarctation of the aorta, ventricular septal defect, and patent ductus arteriosus. [1-3] The coexistence of TOF and DAA is a rare entity. [2,4] We herein present our experience with a patient who was diagnosed with symmetrical DAA in conjunction with TOF along with pulmonary atresia, which resulted in tracheoesophageal compression symptoms. CASE REPORT A six-day-old girl weighing 2.37 kg was referred to our hospital with a diagnosis of pulmonary atresia and TOF. She was intubated immediately after birth due to severe respiratory problems. A physical examination showed the typical findings of TOF, and echocardiography confirmed the diagnosis of TOF with pulmonary atresia. Through a median sternotomy, a shunt was inserted between the right innominate artery and the right pulmonary artery using a 3.5 mm polytetrafluoroethylene (PTFE) graft. An intraoperative evaluation detected the presence of DAA, with both arches being patent and about equal in size. Postoperative multislice computed tomography (MSCT) confirmed the diagnosis of symmetrical DAA. The right subclavian and right common carotid arteries originated from the right aortic arch, whereas the left common carotid and left subclavian arteries originated from the left aortic arch (Figure 1). The trachea and esophagus were circumscribed and compressed by the vascular ring, resulting in tracheal stenosis (Figure 2). In the second operation, a left posterolateral thoracotomy was performed in which the right arch

Background: This study aims to evaluate the effects of pulsatile and non-pulsatile cardiopulmonary bypass techniques on renal functions in elderly.Methods: Between January 2011 and June 2011, 41 patients aged above 70 years who underwent coronary artery bypass grafting (CABG) in our clinic were enrolled in the study. Patients were randomly divided into two groups according to the perfusion technique: pulsatile and non-pulsatile flow. Preoperative, post-cardiopulmonary bypass and at third day following surgery, creatinine, cystatin C, blood urea nitrogen values, urine output during cardiopulmonary bypass and the incidence of acute kidney injury were recorded.Results: At third day following operation, cystatin C, creatinine and blood urea nitrogen values were significantly lower in pulsatile flow group. A significant difference was observed between the groups in terms of urine output during cardiopulmonary bypass and the incidence of acute kidney injury.Conclusion: Pulsatile flow cardiopulmonary bypass is a simple and safe method which may prevent acute kidney injury in elderly.

A severely calcified aorta carries a high risk of atheroemboli and bleeding for cardiac surgery with an incidence range of 14% to 29%. Various techniques were described avoiding cannulation and clamping of the aorta. Nowadays, the no-touch beating heart technique seems to be the best alternative in patients with calcific aorta. Herein, we present a closed proximal anastomosis technique in this high-risk patient group.

Öze l l i k le 1970' l i y ı l la rdan s o n r a k a p a k ce r rah i s i nde öneml i i l e r leme le r o l m u ş ve p ro tez k a p a k yer leşt i r i len h a s t a say ıs ındak i a r tma , be rabe r i nde , doğurgan l ı k ç a ğ ı n ­ dak i prostet ik kapak l ı kad ın h a s t a say ıs ında da art ışı ge t i rmiş t i r . Öze l l i k l e m e k a n i k k a p a k pro tez i t aş ı yan h a s t a l a r d a t r omboembo l i k o lay lar ın s ık o lmas ı neden iy le , kes in t i s i z bir a t i koagü lan tedav i esastır . M e k a n i k k a p a k tak ı lmış g e b e l e r d e vvarfarin ku l lan ımına bağ l ı , fetal ö l ü m ve d o ğ u m s a l defekt ler in s ık l ığ ında a r tma gibi öneml i so run la r o r taya ç ıkmaktad ı r . (1-3).

Interrupted aortic arch is one of the rarest anomalies among the congenital cardiac defects. Patients must be treated early in life, otherwise death is inevitable. Reports on adult patients with aortic interruption are very rare in the literature. In this report, we present a 21-year-old patient with type A interrupted aortic arch. The patient underwent successful anatomical reconstruction of the descending aorta.

BACKGROUND:The aim of this study was to determine the effects of neonatal thymectomy on the immune system in later life. METHODS AND RESULTS:Immune system tests were performed in 26 children at 1 year of age. Thirteen of them had been operated for transposition of the great arteries and had thymectomy in the same operation in the neonatal period. Thirteen control subjects were normal. Immune system tests including white blood cell count, lymphocyte count, T and B cells subgroups (CD2, CD4, CD5, CD7, CD8, CD16, CD20, CD22, CD56), mitotic reaction to phytohaemagglutinin in lymphocyte culture. White blood cell count and lymphocyte count were performed. In the statistical analysis, Mann-Whitney U and Wilcoxon rank sum W tests were used for both groups. Statistical significance was taken at a value of P < 0.05. There was no significant difference in mean white blood cell count, mean blastic transformation reaction of lymphocytes to phytohaemagglutinin, and CD7, CD4/CD8, CD20, CD22, CD56 ratios between the two groups (P > 0.05). Significant differences in mean lymphocyte number, and CD2, CD4, CD5, CD8, CD16 ratios between the two groups were defined (P < 0.05). CONCLUSIONS:In our study, it was noticed that mainly T lymphocyte subgroups were effected by neonatal thymectomy. Although no infection requiring therapy was seen in the thymectomized patients, we advise to limit total thymectomy as much as possible in neonatal heart operations.

Background: There is still controversy about early and late results of sequenital use of internal thoracic artery (ITA) in coronary artery bypass (CAB) operations. Methods: In this study, we report on a series of 430 consecutive patients who underwent CAB operations between 1986 and 1998, with the use of at least one sequential ITA graft. The patients, 379 men and 51 women had a mean age of 56.4 years (range 29–80 years). Both ITA grafts were used in 227 (52.8%) patients. A total of 1744 (mean 4.05 per patient) distal coronary anastomoses were performed: 1172 of which (mean 2.72) were arterial and 980 (mean 2.28) were sequential ITA anastomoses. Results: Thirty-day mortality was 1.8% ( n = 8 patients). Perioperative myocardial infarction occurred in 12 patients (2.8%) and five of them (1.2%) were confined to the sequential ITA grafted area. Follow-up ranged from 1 month to 13 years (mean 63 ±37.7 months) for 372 patients (86.5%). Nine patients died during follow-up period. According to Kaplan-Meier method, 5 and 10 year survival rates were 95.6 and 93.4%, respectively. Coronary angiography was performed in 64 patients (17.2%) after a mean of 33 months. In 31 of these patients angiography was performed due to return of symptoms. Overall patency rate of sequential ITA anastomoses was 91.7% (111/121). Two patients underwent repeat CAB operations. Conclusion: Sequential use of ITA grafts was not associated with the increased perioperative mortality and morbidity and has the potential to improve the long-term results of CAB surgery because of excellent patency rates of sequential ITA anastomoses.