Pulmoner arter anevrizmasi nadir gorulen klinik bir durum olup, kesin tanisi yuksek derecede klinik suphe gerektirir. Bu yazida, pulmoner arter anevrizmasinin sol ana koroner artere basisi nedeniyle olusan semptom ve bulgularla basvuran 27 yasinda bir kadin olgu sunuldu. Hasta basarili bir cerrahi duzeltme gecirdi. Anah tar soz cuk ler: Gogus agrisi; koroner iskemi; pulmoner arter anevrizmasi. Pulmonary artery aneurysm is a rare clinical entity and its definitive diagnosis requires a high degree of clinical suspicion. In this article, we report on a 27-year-old female patient admitted with the signs and symptoms of coronary ischemia due to the compression of pulmonary artery aneurysm on the left main coronary artery. The patient underwent successful surgical correction.

BACKGROUNDAlthough the avoidance of cardiopulmonary bypass during the Fontan procedure has potential advantages, using cardiopulmonary bypass during this procedure has no adverse effects in terms of morbidity and mortality rates. In this study, we assessed the postoperative outcomes of our first 9 patients who have undergone extracardiac Fontan operation by the same surgeon using cardiopulmonary bypass.METHODSBetween September 2011 and April 2013, 9 consecutive patients (3 males and 6 females) underwent extracardiac Fontan operation. All operations were performed under cardiopulmonary bypass at normothermia by the same surgeon. The age of patients ranged between 4 and 17 (9.8 ± 4.2) years. Previous operations performed on these patients were modified Blalock-Taussig shunt procedure in 2 patients, bidirectional cavopulmonary shunt operation in 6 patients, and pulmonary arterial banding in 1 patient. Except 2 patients who required intracardiac intervention, cross-clamping was not applied. In all patients, the extracardiac Fontan procedure was carried out by interposing an appropriately sized tube graft between the inferior vena cava and right pulmonary artery.RESULTSThe mean intraoperative Fontan pressure and transpulmonary gradient were 12.3 ± 2.5 and 6.9 ± 2.2 mm Hg, respectively. Intraoperative fenestration was not required. There was no mortality and 7 patients were discharged without complications. Complications included persistent pleural effusion in 1 patient and a transient neurological event in 1 patient. All patients were weaned off mechanical ventilation within 24 hours. The mean arterial oxygen saturation increased from 76.1% ± 5.3% to 93.5% ± 2.2%. All patients were in sinus rhythm postoperatively. Five patients required blood and blood-product transfusions. The mean intensive care unit and hospital stay periods were 2.9 ± 1.7 and 8.2 ± 1.9 days, respectively.CONCLUSIONSThe extracardiac Fontan operation performed using cardiopulmonary bypass provides satisfactory results in short-term follow-up and is associated with favorable postoperative hemodynamics and morbidity rates.

Scimitar syndrome is a rare congenital cardiac anomaly, which is characterized by anomalous right pulmonary venous return to the inferior vena cava. In this article, we report a six-month-old girl with the diagnosis of Scimitar syndrome associated with ventricular septal defect, left pulmonary venous stenosis and severe pulmonary hypertension. The patient underwent a successful surgical treatment of all pathologies at a single session. Scimitar syndrome is a rare congenital cardiac anomaly characterized by anomalous pulmonary venous return of the right lung to the inferior vena cava (IVC). The anomaly is usually associated with right lung hypoplasia with dextroposition of the heart and abnormal arterial supply of a variable degree to the right lung. [1-4] The presence of additional cardiac anomalies generally aggravates the clinical picture by causing significant left-to-right shunt, congestive heart failure, and severe pulmonary hypertension. Herein, we present a patient with scimitar syndrome associated with ventricular septal defect (VSD), left pulmonary venous stenosis (PVS), right pulmonary arterial stenosis (PAS), and abnormal arterial supply from the abdominal aorta to the right lung.

Although familial homozygous hypercholesterolemia is a very rare pathology, it may be associated with severe cardiac disease. It causes high plasma levels of cholesterol with accelerated atherosclerosis resulting in the development of cutaneous xanthomas, premature coronary artery disease and aortic atherosclerosis. These patients may require early coronary artery bypass grafting operation. In this article, we describe a 22-year-old female patient with familial homozygous hypercholesterolemia who was treated successfully with a "no-touch" technique coronary artery bypass grafting operation because of severely atherosclerotic ascending aorta. The use of full arterial revascularization by using a "no-touch" technique prevents the risk of systemic embolization and also offers good long-term patency.

BACKGROUND:Surgical closure of atrial-septal defects is now associated with low morbidity and mortality rates. We assessed surgical, cosmetic, and psychological results of 3 different surgical approaches to atrial-septal defect repair.METHODS:Study participants were 82 patients who underwent surgery for atrial-septal defect. Mean age was 21 +/- 8 years, and the female:male ratio was 23:59. Patients were divided into 3 groups according to the incision used; group 1 (n = 26), partial lower sternotomy; group 2 (n = 34), right anterolateral thoracotomy via a submammary incision, and group 3 (n = 22), conventional median sternotomy.RESULTS:There was no operative or late mortality. No significant differences between groups were associated with the surgical technique used. Direct closure was the procedure of choice performed in 53 patients (64.6%). In the remaining patients the repair was performed with a pericardial patch (29 patients, 35.4%). One patient in group 1 required conversion to median sternotomy because transoesophageal echocardiography performed at the operating theater revealed a partial anomalous pulmonary venous connection of right pulmonary veins to the inferior vena cava. This patient was excluded from the study group. All patients were symptom free postoperatively, and control echocardiography revealed a trivial shunt in only 1 patient, with a Qp:Qs ratio of 1.3. Rhythm abnormalities, including atrioventricular block, atrial fibrillation, and flutter, were observed in 7 patients but were found to be unrelated to the surgical incision (P = .3). Cardiopulmonary bypass, cross-clamp, and operative times were longer with minimally invasive approaches; but these differences were not statistically significant. Intensive care unit and hospital stay periods were significantly shorter in groups 1 and 2. During the postoperative follow-up period, patients in groups 1 and 2 showed superior results in satisfaction with their cosmetic outcomes.CONCLUSIONS:With the development of minimally invasive techniques that yield surgical results comparable to those of standard techniques, surgeons have changed their focus from survival to cosmetic and psychological outcomes, especially in the repair of simple cardiac defects. Operations performed via limited skin incisions are surgically safe and provide superior cosmetic and psychological results.

The purpose of this study was to assess the viability and dilator response of the saphenous vein segments harvested during cardiac surgery. The saphenous veins were incubated with either normal saline (group A) or papaverine solutions (group B). The viability of saphenous vein endothelial cells was assessed by counting the number of total cells. Maximal endothelium-dependent vasodilator response to acetylcholine was also investigated. Cell viability of vein samples was decreased after 4 hours of incubation with normal saline (34 +/- 6.5%) as compared to solution containing papaverine (92 +/- 3.7%). By 24 hours, the viabilities of the endothelial cells incubated with saline and papaverine solutions were 22 +/- 4.5% and 87 +/- 5%, respectively.There was significant difference in vasodilatation responses to acetylcholine between saline-incubated and papaverine-incubated groups. By 4 hours of incubation, the relaxation response to acetylcholine significantly deteriorated in group A when compared to the initial value (P < 0.001). Furthermore, the decrease in this vasorelaxation response has also continued throughout the observation period and the values obtained by 24 hours were observed to be significantly lower than those obtained at the end of 4 hours (P < 0.01). In contrast, although a decrease was noticed in group B over time, this decrease was not statistically significant (P, not significant). We thus conclude that the use of papaverine solution improves endothelial cell viability and is associated with preservation of the maximal endothelial-dependent vasodilator response of a vein segment.

BACKGROUNDThe prevention of perioperative ischemia-reperfusion injury is of critical importance, and this issue becomes more important in patients undergoing an early emergent revascularization procedure after an acute myocardial infarction. In this study, we sought to test the hypothesis that our simplified pressure-controlled initial reperfusion technique would be protective against ischemia-reperfusion injury in this subgroup of patients.METHODSThe data of 20 patients (group I) who underwent an emergent coronary artery bypass grafting procedure were analyzed and compared with the results of 37 patients (group II) underwent an innovative reperfusion technique. In group I patients, the operation was carried out using standard techniques. In group II, after the completion of all anastomoses, reperfusion was initiated before rewarming with a pressure of 20 to 25 mmHg and continued for a 2-minute period. Systemic blood pressure was then gradually increased to 40 mmHg and the aortic root was perfused at this pressure for another 2-minute period. Following the completion of the second low-pressure reperfusion period, cardiopulmonary bypass flow was regulated to preoperatively calculated values until systemic temperature reached 37 degrees C.RESULTSBoth groups showed significant differences in terms of cardiac output, arrhythmia rates, and biochemical parameters. Spontaneous sinus rhythm recurred more frequently in group II (P < .01, 86% versus 45%). Atrial fibrillation attacks were observed in 5 and 3 patients in groups I and II, respectively. All patients were medically converted to sinus rhythm with amiadarone and/or beta-blockers. Persistent electrocardiographic changes indicating postoperative myocardial infarction occurred in 5 patients in group I and in 1 patient in group II (P = .003). Postoperative enzyme levels were found to be lower in group II patients and the differences became statistically significant at the end of 24 hours.CONCLUSIONThese results indicate that our controlled initial reperfusion technique is effective in the prevention of ischemia-reperfusion injury. We advocate the use of this innovative technique as an alternative to complex controlled aortic root reperfusion with the guidance of the early promising results of this study.

OBJECTIVE Pain after coronary artery bypass graft (CABG) surgery remains a significant problem and may cause serious complications because of restricted breathing and limited early mobilization. The aim of this study was to assess the effects of intrapleural analgesia on the relief of postoperative pain in patients undergoing CABG surgery. DESIGN Postoperative pain, pulmonary function tests, and outcomes were compared with a placebo group after CABG surgery in a double-blind randomized clinical trial. SETTINGS Cardiovascular surgery clinic. PARTICIPANTS One hundred twenty-five patients with decreased lung function were studied. INTERVENTIONS Group A (62 patients) received 20 mL of 0.5% bupivacaine bilaterally in the intrapleural spaces every 6 hours for 4 days, and group B (63 placebo patients) received sterile saline solution. MEASUREMENTS AND MAIN RESULTS Group A had a significantly shorter extubation time than the placebo group (8 +/- 1 h v 10 +/- 4 hours, p < 0.001). Blood gas analysis showed higher PaO2 and lower PaCO2 levels in group A. The patients receiving bupivicaine had significantly higher FEV1, FCV, VC, MVV, PEF, and FEF 25-75% values postoperatively when compared with the placebo group. Postoperative analgesic requirements and visual analog pain scales were significantly lower in group A. The intensive care unit stay in group A was shorter (1.2 +/- 0.7 v 1.4 +/- 0.6 days, p = 0.04); however, the hospital stay did not differ between groups. CONCLUSIONS Improvement in lung function parameters correlating with decreased postoperative pain with intrapleural bupivacaine was observed. Intrapleural analgesia provided a good level of analgesia, improved respiratory performance, and allowed rapid mobilization, which led to a reduction of postoperative respiratory complications.

OBJECTIVE:Despite the refinements in surgical techniques and postoperative care, elderly women still have a higher prevalence of postoperative morbidity. METHODS:The outcomes of 112 elderly women (>80 years) who underwent an elective CABG procedure were compared with those of males operated during the same time interval (n, 164). RESULTS:Median age of female and male patients were 82 and 83 years, respectively. Mean number of grafts did not differ significantly (3.7+/-0.8 vs 3.9+/-0.3, p=0.4) between groups. Overall early operative mortality rate was 8.6% (24 of 276 patients); 8.9% (10 of 112 patients) for female and 8.5% (14 of 164 patients) for male patients (p=0.1). Postoperative complications including prolonged ventilation time (13.4% in females vs 8.5% in male, p<0.01), atrial fibrillation (40% in females vs 33% in males, p=0.01), sternal reclosure (8% in females vs 4.2% in males, p=0.01), pneumonia (5.3% in females vs 3% in males, p=0.03), leg wound infection (11.7% in females vs 2.4% in males, p<0.001), renal dysfunction (10.7% in females vs 7.3% in young patients, p=0.02) have been found to be significantly higher in elderly women. Mean intensive care unit (3.2+/-1.1 days in females vs 1.6+/-0.4 in males, p=0.03), and hospital stays (13.6+/-2.1 days in females vs 9.1+/-1.2 in males, p=0.02) were also longer in female patients. Five-year survivals including all deaths for female and male patients were 57% and 62%, respectively. CONCLUSIONS:In elderly women, revascularization procedures can be done with acceptable mortality rates; but these patients are still associated with a higher prevalence of postoperative morbidity when compared with the male counterparts. Therefore, these patients have to be very carefully evaluated preoperatively and their postoperative care should be more comprehensive to reduce the incidence of postoperative complications.

Objective. Visceral artery aneurysms are rare vascular malformations and the literature lacks satisfactory general information about the pathology. The aim of this study was to review our experiences in the diagnosis and treatment of visceral artery aneurysms.Materials and Methods. We retrospectively reviewed data on 10 patients who were diagnosed with visceral artery aneurysms at our institution between June 2002 and September 2005. All available clinical, pathologic, and postoperative data were reviewed and analyzed for postoperative outcome.Results. Four splenic artery aneurysms, 2 hepatic artery aneurysms, 5 renal artery aneurysms, 1 superior mesenteric artery aneurysm, and 1 inferior mesenteric artery aneurysm (13 total visceral artery aneurysms) were diagnosed in 10 patients. All the patients were treated except 1 patient with bilateral renal artery aneurysms. One patient required emergent surgical treatment due to splenic artery aneurysm rupture. Only 1 patient underwent endovascular treatment (ie, coil embolization for a superior mesenteric artery aneurysm); otherwise all the patients were treated surgically on an elective basis. Surgical treatment modalities included ligation with exclusion in 4 patients (2 splenic artery aneurysms, 1 renal artery aneurysm, 1 hepatic artery aneurysm) and resection with revascularization in 4 patients (1 splenic artery aneurysm, 2 renal artery aneurysms, 1 hepatic artery aneurysm, 1 inferior mesenteric artery aneurysm). Histopathologic examination of the vascular materials revealed major atherosclerotic changes except one that showed inflammatory vasculitic changes. One patient required bleeding revision, and mortality did not occur in any of the patients.Conclusions. Visceral artery aneurysms are rare and potentially life-threatening vascular disorders. The number of cases diagnosed every year increases because of advanced radiologic diagnostic methods and screening programs. Careful consideration and early management of these malformations can be life saving.

Behcet's disease is an autoimmune multisystemic disorder based on vasculitis. In this disease, the most important predictor of morbidity and mortality is the vascular complications. Appropriate surgical interventions are critical and must be planned strategically. Here, we will describe a very rare complication of the disease; spontaneous aortic pseudoaneurysm in a 33-year-old patient.

Endovascular grafts have been widely used for the treatment of aneurysms since the early 1990s. They are preferred especially for use in patients in whom conventional surgical methods carry high risks of death and morbidity. Increasing operator experience and technical refinements in endovascular grafting have enabled these procedures to be performed even in critical segments of the aorta, such as the thoracic and arch levels. In this report, we present the case of a patient who was treated successfully with an endovascular graft for a mycotic saccular aneurysm located just below the left subclavian artery.

(2005). Aneurysm of the Kinked Extracranial Internal Carotid Artery Case Report and Review of the Literature. Acta Chirurgica Belgica: Vol. 105, No. 4, pp. 407-409.

Arterial switch operation is the current procedure of choice in the surgical repair of transposition of the great arteries. Patients with complex coronary arterial anatomy in particular are more susceptible to having myocardial ischemia after this operation. The technical modification described in this article proposes a new idea of re-implantation to reduce the risk of incorrect positioning of the coronary buttons. The technique has not been applied on humans. The technical modification was performed only on extracted sheep hearts.

Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and a frequent cause of death. A 49-year-old man was successfully treated for a left ventricular free wall rupture that occurred on the third day after an anterior myocardial infarction. Concomitant myocardial revascularization was performed.

A 2-year-old girl with Takayasu's arteritis and an ascending aortic aneurysm underwent successful graft replacement. Although aneurysms of the great vessels are rarely encountered, this disease should be considered in the differential diagnosis of ascending aortic aneurysms in children.