This study aimed to evaluate the prognostic significance of serum endocan levels in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB). This prospective observational study included 31 patients. Endocan levels were measured preoperatively, and postoperative day 1 and 6. Correlations between endocan levels, laboratory, clinical parameters were analyzed using Spearman’s rank correlation and receiver operating characteristic (ROC) analysis. Preoperative endocan levels were higher in patients with adverse outcomes, however it didn’t reach statistical significance. The ROC analysis demonstrated a moderate predictive capacity of preoperative endocan levels for mortality (AUC = 0.68). A statistically significant positive correlation was found between endocan and aspartate aminotransferase (AST) (r = 0.42, p = 0.020), while a significant negative correlation was observed with the neutrophil count (r = − 0.38, p = 0.034). No significant associations were identified with Aristotle scores or acute kidney injury (AKI). Preoperative endocan levels showed trends toward associations with adverse outcomes but lacked sufficient discriminative power. Endocan does not appear to be a reliable standalone predictor of postoperative risk. Further studies with larger samples and serial measurements are needed.

Background: Atrial myxomas are the most common primary cardiac neoplasms, typically presenting with obstructive cardiac symptoms or embolic events. Surgical excision remains the definitive treatment; however, concerns persist regarding surgical exposure, postoperative arrhythmia, and recurrence. This study compared the early and mid-term outcomes of atrial myxoma excision performed exclusively using the superior transseptal technique with outcomes reported in the current literature. Methods: This retrospective cohort study included 10 patients who underwent surgical resection of atrial myxoma using a superior transseptal approach between January 2018 and December 2025. Demographic, preoperative, intraoperative, and postoperative data were collected. Outcomes analyzed included perioperative morbidity and mortality, rhythm disturbances, recurrence, and length of hospital stay. Results: The cohort consisted of 7 women and 3 men with a mean age of 52.9 Å} 9.0 years. Dyspnea was the most common presenting symptom (70%), and embolic events occurred in 10% of patients. All tumors were excised en bloc with a surrounding margin of septal tissue; 100% required atrial septal defect closure using an autologous pericardial patch. Postoperative atrial fibrillation was observed in 50% of patients, though none required permanent pacemaker implantation. There was no in-hospital mortality or tumor recurrence during a mean follow-up period of 3.5 Å} 1.6 years. Conclusion: The superior transseptal approach provided optimal exposure and enabled safe, effective resection of atrial myxomas, resulting in no mortality, no recurrence, and acceptable complication rates. These findings support the use of this technique as a reliable strategy in the surgical management of atrial myxomas. Cite this article as: İştar H, Harmandar B, Korkmaz Toker M.. Early and midterm outcomes of atrial myxoma resection via superior transseptal approach. Eurasian J Med. 2026, 58(1), 1151, doi: 10.5152/eurasianjmed.2026.251151.

Introduction:This study investigated the relationship between the serum aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio, the presence and progression of abdominal aortic aneurysms (AAA), assessing its potential as an accessible biochemical marker for patients at risk of rapid aneurysmal growth. Methods: A total of 180 patients were retrospectively analyzed: 90 with AAA and 90 age-and risk factor-matched controls. Demographic characteristics, risk factors, laboratory parameters, and imaging data were reviewed. The AAA group was divided into rapid and slow enlargement subgroups based on six-month computed tomography measurements. Logistic regression, receiver operating characteristic (ROC) analyses were used to evaluate predictive and discriminative performance, and quartile analysis explored potential threshold effects. Results: AST/ALT ratio, triglycerides, low-density lipoprotein (LDL) cholesterol, and white blood cell (WBC) count were significantly higher in patients with AAA. Rapid AAA enlargement group had higher AST/ALT ratios, triglycerides, LDL cholesterol, and WBC counts. The AST/ALT ratio was independently associated with AAA presence (odds ratio 2.63; 95% confidence interval [CI] 1.44-5.09; P = 0.002) but not with rapid progression (P = 0.10). ROC analysis showed good discrimination for AAA presence (area under the curve [AUC] = 0.72; 95% CI 0.65-0.79) and moderate ability for rapid enlargement (AUC= 0.65; 95% CI 0.54-0.76). Quartile-based analysis revealed a stepwise increase in AAA prevalence with higher AST/ALT categories. Conclusion: An elevated AST/ALT ratio is associated with AAA presence but does not independently predict progression, suggesting it reflects hepatic-vascular inflammatory interaction rather than serving as a prognostic marker.

Ventricular septal defect (VSD) is the most common acyanotic congenital heart disease that affects the right heart and pulmonary vascular system by increasing pulmonary vascular resistance. Undiagnosed subaortic VSD may over time cause aortic valve insufficiency as well as severe pulmonary arterial hypertension. Moreover, right heart dilatation can be seen due to the left-to-right shunt through the VSD. The final stages may include irreversible pulmonary artery hypertension (PAH) (Eisenmenger’s syndrome) and right-to-left shunting. In our case report, we present a 45-year-old female patient suffering from exertional dyspnea. She was diagnosed with severe aortic and pulmonary valve insufficiency caused by late-diagnosed VSD. Successful surgical repair of degenerated semilunar valves with concomitant heart defect was performed. Both valves were repaired using autologous pericardium tissue. Instead of performing double mechanical valve replacement in our patient, we preferred valve repair to avoid complications related to lifelong anti-coagulation. This case report aims to present the congenital heart surgeon’s interpretation of valvular pathology in the adult patients. We believe that our case is unique in that VSD complicated both the semilunar valves insufficiency, limited the pulmonary overflow due to the prolapsus of these valves until adult ages.

Background: The neutrophil-lymphocyte ratio (NLR) is a simple, cost-effective marker of systemic inflammation. This study aims to evaluate the association between perioperative NLR and postoperative outcomes in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB). Methods: We retrospectively reviewed 70 patients under 18 years of age who underwent surgery between 2018 and 2023. NLR was measured preoperatively and on postoperative days (POD) 0, 1, 2, 3, and 6. Receiver operating characteristic analysis identified optimal cutoffs, and associations with postoperative outcomes were assessed. Results: The preoperative NLR cutoff of 1.14 (AUC = 0.75) was associated with prolonged mechanical ventilation (>72 h) (p = 0.02), extended intensive care unit (ICU) stay (p = 0.004), and longer hospital stay (p = 0.006). NLR values on POD3 (AUC = 0.74) and POD6 (AUC = 0.78) also demonstrated strong predictive ability for these outcomes. Conclusions: Elevated perioperative NLR-particularly preoperative values >= 1.14-is associated with prolonged mechanical ventilation, longer ICU admission, and extended hospitalization in pediatric congenital heart surgery. NLR may serve as a practical biomarker for early risk stratification and postoperative management.

OBJECTIVE:To compare the analgesic efficacy of anesthesiologist-performed ultrasound-guided superficial parasternal intercostal plane block (SPIPB) and surgeon-performed deep parasternal intercostal plane block (DPIPB) in patients undergoing coronary artery bypass grafting (CABG) via median sternotomy. DESIGN:A prospective, randomized, single-blind clinical trial. SETTING:A single, tertiary care university hospital. PARTICIPANTS:Seventy-five participants (aged 45-80 years, ASA III-IV) scheduled for elective isolated CABG surgery. INTERVENTIONS:Participants were randomly assigned to the SPIPB, DPIPB, or control groups. Regional blocks were performed either under ultrasound guidance after sternal closure and sterilization of the surgical site (SPIPB) or intraoperatively under direct vision (DPIPB). Postoperative pain was managed with multimodal analgesia protocols. MEASUREMENTS AND MAIN RESULTS:Outcomes included pain scores and tramadol administration at the 1st, 4th, 12th, and 24th postoperative hours, as well as after extubation. The cumulative 24-hour tramadol administration (primary outcome) was significantly lower in the DPIPB group (95 ± 44 mg) compared with the SPIPB (141 ± 58 mg) and control groups (176 ± 61 mg) (p < 0.001). Compared with the control group, the DPIPB group had a significantly reduced likelihood of requiring high-dose tramadol (odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.06-0.56, p = 0.003). The SPIPB group showed an intermediate effect compared with control (OR: 0.52, 95% CI: 0.23-1.18, p = 0.095). When directly compared, DPIPB was associated with significantly lower tramadol use than SPIPB (OR: 0.34, 95% CI: 0.16-0.72, p < 0.001). Pain scores at all time points were significantly lower in both block groups compared with control (p < 0.05), with DPIPB showing the most pronounced effect. No block-related complications were observed. CONCLUSIONS:Both parasternal intercostal blocks improved postoperative analgesia compared with standard care. The SPIPB was performed under ultrasound guidance, whereas the DPIPB was applied under direct vision by the surgeon. The DPIPB demonstrated superior opioid-sparing effects and improved dynamic pain control. These findings support the use of parasternal fascial plane blocks, whether performed under ultrasound guidance or direct vision, as effective components of multimodal analgesia in cardiac surgery.

Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS) is an extremely rare variant of TOF, with a ratio of 3-6%. Significant pulmonary insufficiency due to this valvular absence promotes dilation of the pulmonary arteries, and this can lead to airway compression during intrauterine life and after birth. The degree of compression is relative to the degree of hypoplasia of the respiratory tract. The severity of the respiratory problems indicates high mortality rates. This study aimed to present the short and mid-term outcomes following surgical repair of three TOF-APVS patients. One patient also had associated Townes-Brock Syndrome, which is extremely rare by itself. On follow-up, one patient could not be separated from cardiopulmonary bypass (CPB), and she was placed on arterio-venous extracorporeal membrane oxygenator (A-V ECMO) support before she died on the 5th day post-operatively. The patient with Townes-Brock syndrome died post-operatively 3.5th months due to pulmonary complications.

Rare combinations of congenital heart pathologies can make the management of the surgical repair difficult and may complicate the procedure. We would introduce a newborn diagnosed with ventricular septal defect, pulmonary atresia and double aortic arch and the successful palliative surgery with shunt procedure of the patient. Atypical ductus, double aortic arch and the different configuration of its branches can complicate the usual shunt procedure. Variations in vascularstructures may be the reason for complications in congenital heart surgery. Before planning the surgical procedure, vascular anatomy should be presented in detail even for palliative operations. Blalock-Taussig shunt can be performed safely in the case of a double aortic arch.

Infective endocarditis is an infection of the endocardial tissue of the heart, primarily affecting the cardiac valves. Of various causes, untreated or undiagnosed congenital heart defects are known contributors. This report presents the case of a 63-year-old man with infective endocarditis of the tricuspid valve associated with an uncorrected ventricular septal defect. We describe our elderly patient who underwent successful surgical repair, including tricuspid valve reconstruction and closure of the ventricular septal defect, after a long life uncomplicated by severe pulmonary hypertension.

Life expectancy is improving worldwide. The number of septuagenarian and older patients requiring open heart surgery is increasing. The aim of this study was to determine the risk factors associated with in-hospital mortality and poor outcomes in septuagenarian and elderly patients undergoing various open heart surgery procedures in regards of gender. We retrospectively collected the medical records of 104 patients aged >70 years who underwent open heart surgery between 2018 and 2024. Preoperative comorbidities, cross-clamp time, cardiopulmonary bypass time, postoperative bleeding, acute kidney insufficiency, arrhythmia, stroke, low cardiac output, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays, mortality were evaluated. The mean age was 74.27 ± 4.80 years; that of women was 74.9 ± 4.9 years, and men was 73.7 ± 4.6 years. Preoperative myocardial infarction was more frequent in men. Coronary artery bypass grafting and thoracic aorta surgery were more frequent in men and women, respectively. Women were more affected by postoperative atrial fibrillation, more frequently required extended mechanical ventilatory support, and had longer ICU stays. Hosmer–Lemeshow and Omnibus tests revealed that age of >76 years, cardiopulmonary bypass time longer than 200 minutes, revision for bleeding, low cardiac output were significant predictors of in-hospital mortality. Despite increased costs and longer hospital stays, cardiac operations can be successfully performed in septuagenarian and elderly patients.

Interruption of vena cava inferior (VCI) is extremely rare, in occurrence in isolation or association with asplenia or polysplenia syndromes. In this abnormality, the infrahepatic segment of the VCI is absent, by representing the inadequacy of fusion of subcardinal embryological parts of the VCI. It is compensated by an azygos or hemiazygos vein that continues on the posterior wall of the thoracic cavity. In this case report, a case of incidentally diagnosed interrupted VCI in a patient diagnosed with tetralogy of Fallot (TOF), major aortopulmonary collateral artery (MAPCA), right arcus aorta, absence of right vena cava superior (VCS), and persistent left vena cava superior (PLVCS), and its successful surgical treatment was presented. If the hepatic vein confluence is of adequate size, the cannulation for cardiopulmonary bypass circuit through the hepatic vein confluence is safe in case of interrupted VCI.

Ventricular septal defect (VSD) can be repaired using cardiopulmonary bypass, resulting in a favorable postoperative outcome with minimal bleeding. Thrombocytopenia-absent radius (TAR) syndrome is rare, occurring in approximately 0.42 out of 100,000 live births. This syndrome is characterized by hypo-megakaryocytic thrombocytopenia and bilateral absent radii. TAR syndrome can be life-threatening within the first 14 months of life due to severe bleeding. In this report, we present the case of a 4-month-old male patient diagnosed with both VSD and TAR syndrome. We describe the surgical management of the VSD as well as the perioperative treatment for hemorrhagic diathesis.

Double chamber right ventricle (DCRV) is a congenital disease in which a hypertrophied muscle band divides the right ventricle chamber into two. The early-mid-term follow-up of 6 patients with DCRV and distant genetic syndromes is reported in this paper. A retrospective analysis was performed of 6 DRCV patients with a mean age of 3.9±1.4 years. Concomitant cardiac anomalies were perimembranous ventricular septal defect (n=3), atrial septal defect (n=1), mild aortic regurgitation (n=1), discrete subaortic membrane (n=1). Associated genetic syndromes were Costello (n=1), Seckel (n=1) and Down syndromes (n=4). The mean follow-up period was 4.86±4.6 years. Mean systolic pressure gradient in the right ventricle in the postoperative was 18.5±11.5 mmHg. No mortality occurred and there was no requirement for reintervention. To the best of our knowledge, this is the first report in literature of concomitant DCRV with Costello and Seckel syndromes.

Aortic aneurysms (AA) have a significant mortality rate in population. We aimed to identify the etiologic factors associated with thoracic aortic aneurysms (TAAs) and abdominal aortic aneurysms (AAAs). Our study included 181 patients; 98 patients diagnosed with TAA or AAA made up the aortic aneurysm (AA) group, 83 patients without either condition made up the control group. Within the AA group, 72.4% of the patients were male, the patients had been diagnosed with TAA and AAA in ratio of 57.1% and 42.9% respectively. All AA group patients had an aortic diameter in range from 41 to 108 mm. Initial serum biochemical measures, two consecutive computed tomography angiography measurements were recorded, the enlargement rate per year for the aorta was calculated for all. The mean age in the AA group was 62.89±13.55 compared to 68.10±11.69 in the control group (p=0.007), higher ratio for hypertension (p=0.021). TAA patients had a higher AST level (p=0.016) and platelet counts (p=0.010) compared to control group. AAA patients had a higher mean neutrophil/lymphocyte ratio (NLR) (p=0.044) compared to control group. Among the patients with AAA, 90.5 % were male. Smoking was more prevalent in the abdominal AA group (p=0.08). An enlargement rate of more than 1 cm/year was detected in 25% of the patients with TAA and in 75% of the patients with AAA. TAA was associated with higher AST levels and higher platelet counts than were in the AAA group, whereas AAA showed strong relationships with male gender and smoking.

Myxomas are considered benign cardiac tumors, most commonly originating in the left atrium (75%) and less frequently in the right atrium (18%). The presenting symptoms can vary widely depending on the size and location of the tumor, and they may seriously occlude the atrial outflow. We herein report a case involving a giant left atrial myxoma in a 63-year-old woman presenting with symptoms of mitral stenosis.

Townes-Brocks syndrome (TBS) is a rare syndrome characterized by triad of anal, ear, and thumb anomalies. Further malformations/anomalies include congenital heart diseases, foot malformations, sensorineural and/or conductive hearing impairment, genitourinary malformations, and anomalies of eye and nervous system. Definitive diagnosis for TBS is confirmed by molecular analysis for mutations in the SALL1 gene. Only one known case of TBS with absent pulmonary valve syndrome (APVS) has been previously described to our knowledge. Here, we report a newborn diagnosed with TBS with APVS and tetralogy of Fallot (TOF) who was found to carry the most common pathogenic SALL1 gene mutation c.826C> T (p. R276X), with its surgical repair and postoperative follow-up. To our knowledge, this is the first genotyped case of TBS from Turkey to date. TBS should be suspected in the presence of ear, anal, and thumb malformations in a neonate. If a patient with TBS and TOF-APVS needs preoperative ventilation within the first months of life, this implies prolonged postoperative intubation and increased risk of mortality.

Aortic aneurysms (AA) have a significant mortality rate in population. We aimed to identify the etiologic factors associated with thoracic aortic aneurysms (TAAs) and abdominal aortic aneurysms (AAAs). Our study included 181 patients; 98 patients diagnosed with TAA or AAA made up the aortic aneurysm (AA) group, 83 patients without either condition made up the control group. Within the AA group, 72.4% of the patients were male, the patients had been diagnosed with TAA and AAA in ratio of 57,1% and 42.9% respectively. All AA group patients had an aortic diameter in range from 41 to 108 mm. Initial serum biochemical measures, two consecutive computed tomography angiography measurements were recorded, the enlargement rate per year for the aorta was calculated for all. The mean age in the AA group was 62.89±13.55 compared to 68.10±11.69 in the control group (p=0,007), higher ratio for hypertension (p=0,021). TAA patients had a higher AST level (p=0,016) and platelet counts (p=0,010) compared to control group. AAA patients had a higher mean neutrophil/lymphocyte ratio (NLR) (p=0,044) compared to control group. Among the patients with AAA, 90.5 % were male. Smoking was more prevalent in the abdominal AA group (p=0.08). An enlargement rate of more than 1 cm/year was detected in 25% of the patients with TAA and in 75% of the patients with AAA. TAA was associated with higher AST levels and higher platelet counts than were in the AAA group, whereas AAA showed strong relationships with male gender and smoking.

Blunt trauma due to motor vehicle accident may result in severe cardiac valve injury. The most part of lesions are about aortic and mitral valves. Acute on-set cardiac valve insufficiency may cause severe dyspnea or cardiac failure. Tricuspid valve injury due to blunt trauma is extremely rare and clinical manifestation is silent in majority of all cases. In case of echocardiographic evaluation, patient can be diagnosed easily with cardiac valve injury. Here we introduce a 46 year-old male patient suffering tricupid papillary muscle rupture and its successful surgical repair. Fever and a mass on the valve caused by multitrauma may mimic infective endocarditis.