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66±13 h and 401±297 ?g at 24 h, respectively p less then 0.05). Partial pressure of oxygen levels at 10 and 16 h during the postoperative intensive care unit stay were lower, while partial pressure of carbon dioxide levels at 24 h was higher in Group 1 than Group 2 (p less then 0.05). Conclusion The bupivacaine protocol is a relatively more useful analgesic method which produces improved results in blood gas analysis by reducing the effects of pain and shortens the length of intensive care unit stay. Low levels of free cortisol also confirm this finding. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Background This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. Methods Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3±15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve r epair w as p erformed w ith d e Vega a nnuloplasty t echnique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. Results Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p less then 0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. Conclusion Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Background This study aims to compare outcomes of minithoracotomy versus median sternotomy for atrial septal defect closure. Methods Between January 2012 and May 2017, a total of 44 patients (8 males, 36 females; mean age 33.86 years; range, 14 to 63 years) who underwent atrial septal defect repair through mini-thoracotomy or median sternotomy in our clinic were retrospectively analyzed. Pre-, intra-, and postoperative data of the patients were recorded. Results There was no significant difference in the cardiopulmonary bypass and cross-clamp times between the groups, although the duration of operation was shorter in the mini-thoracotomy group (p=0.001). No significant difference was observed between the groups in terms of early mortality, neurological complications, and residual atrial septal defect. The mean mechanical ventilation time and length of intensive care unit and hospital stay were statistically significantly shorter, and the amount of bleeding was statistically significantly lower in the mini-thoracotomy group (p=0.001 for all). Conclusion Mini-thoracotomy should be kept in mind as a favorable alternative to sternotomy following a satisfactory learning curve period with less cost and higher patient benefit. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Background This study aims to evaluate the results of transcatheter occlusion of antegrade pulmonary blood flow in children with univentricular heart. Methods Medical data of a total of seven patients (4 females, 3 males; median age 11.7 years; range, 1 to 24 years) who underwent transcatheter occlusion of the antegrade pulmonary blood flow following Glenn shunt or Fontan operation between September 2014 and January 2017 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, type of surgery, echocardiographic and cardiac catheterization findings were recorded. Results Four patients had a previous pulmonary artery banding operation, while three had pulmonary stenosis. Two patients had facial and upper extremity edema after Glenn operation, one had prolonged pleural effusion, one had prolonged pleural effusion after Fontan operation, and one developed dyspnea and effort intolerance several years after Fontan operation. selleckchem In two patients, antegrade pulmonary blood flow was occluded to decrease systemic ventricular load before surgery. The Amplatzer Septal Occluder was used in five patients and the Amplatzer Vascular Plug-2 was used in two patients. Two patients developed transient, complete atrioventricular block during the procedure and the procedure was terminated early in one of these patients. Transient hemolysis was observed in one patient following the operation. Conclusion Transcatheter occlusion of antegrade pulmonary blood flow is an effective alternative to surgery in patients with hemodynamic compromise after Glenn shunt or Fontan operation. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Background This study aims to present the outcomes of arterial switch operation for Taussig-Bing anomaly versus transposition of the great arteries and ventricular septal defect. Methods Between November 2010 and December 2016, a total of 100 consecutive arterial switch operations in 42 pediatric patients (25 males, 17 females; median age 17 days; range, 2 to 210 days) were performed in two centers. Among them, 42 patients had associated ventricular septal defect and were diagnosed with Taussig-Bing anomaly (n=15) or transposition of the great arteries and ventricular septal defect (n=27). Aortic arch anomalies were present in six patients (40%) with Taussig-Bing anomaly and two patients (7.4%) with transposition of the great arteries and ventricular septal defect (p=0.016). Coronary anomaly was observed in five (33.3%) and six (22.2%) patients, respectively. All patient had a large defect (multiple n=4), except for eight patients who had moderate defect in the transposition of the great arteries group. Results Early mortality was 13.3% in the Taussig-Bing anomaly group and 7.4% in the other group. Extracorporeal membrane oxygenation support was needed in three patients. Delayed sternal closure was used in most of the patients (92.9%). The median length of intensive care unit and hospital stays were similar between the groups. The median follow-up was 16 (range, 1 to 50) months. Two patients including one planned (debanding and multiple defect closure) and one unplanned (residual defect closure) were reoperated. Three patients needed aortic balloon angioplasty due to recoarctation and one patient underwent pulmonary balloon angioplasty. Overall reintervention rate was 18.4%. Conclusion Although the incidence of aortic arch and coronary anomalies were higher in patients with Taussig-Bing anomaly, early and mid-term results were similar. Based on these results, primary arterial switch operation seems to be successfully performed for both pathologies. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Video-assisted thoracoscopic surgery is becoming more popular in thoracic surgery practice. Use of endostaplers is mandatory for anatomical video-assisted thoracoscopic surgery resections. In this article, we present an unusual complication related to use of endostapler, which, to our knowledge, may be the first reported in the literature. Copyright © 2019, Turkish League Against Rheumatism.Hibernoma is a rare tumor originating from fetal brown fat. Mediastinum is a very rare localization for the hibernoma. In this article, we present the clinical and radiological findings of a 46-year-old male patient with pleuritic chest pain. Copyright © 2019, Turkish League Against Rheumatism.Brachial plexus palsy rarely occurs after Nuss procedure for pectus excavatum. Brachial plexus palsy after surgery may be caused by nerve tension and compression related to surgical positioning. In this article, we report a 21-year-old male patient of brachial plexus palsy after Nuss procedure revealing a narrowing of the costoclavicular space from 7.60 mm to 2.83 mm and an increase to 4.51 mm after upper bar removal. Patient"s symptoms were fully recovered. Our results showed that narrowing of the costoclavicular space after Nuss procedure might trigger brachial plexus palsy and that brachial plexus palsy may not be related to surgical positioning. Copyright © 2019, Turkish League Against Rheumatism.A 49-year-old female patient with hypertension was admitted with an intraabdominal murmur and referred for multidetector computed tomography angiography for suspected renal artery stenosis. Her medical history, clinical examination, serum biochemistry, and ultrasound examination findings showed no pathological findings of diabetes mellitus or any other disease. Axial and coronal reformatted multidetector computed tomography angiography revealed a dilated accessory polar renal vein which drained the venous circulation of the left lower pole into the inferior vena cava at midline. In conclusion, multidetector computed tomography angiography plays a progressively substantial role in the assessment of renal vascularity. Vascular surgeons and urologists should be a thorough knowledge of renal vascular variations. Copyright © 2019, Turkish League Against Rheumatism.Fibromuscular dysplasia is rarely biopsied. Progesterone receptor expression in myofibroblastic cells is useful for the histopathological evaluation in difficult-to-diagnose cases. Herein, we report two unusual cases of fibromuscular dysplasia in which progesterone receptor expression was shown in vessel sections. Copyright © 2019, Turkish League Against Rheumatism.In this article, we present our diagnostic and therapeutic approach in a rare case in whom fluid inside the driveline developed following left ventricular assist device implantation. Copyright © 2019, Turkish League Against Rheumatism.Isolated sinus of Valsalva aneurysm is a rare congenital pathology associated with a life-threatening course when untreated. In this article, we report a 60-year-old male patient with an isolated aneurysm of right sinus of Valsalva treated by modified Bentall procedure. The patient with cardiac symptoms applied to our clinic for further evaluation. Enhanced computed tomographic angiography and transthoracic echocardiography revealed an isolated aneurysm of right sinus of Valsalva. An optimal management for the condition is not clear, while early surgical intervention is recommended due to potentially life-threatening complications. Copyright © 2019, Turkish League Against Rheumatism.Calcified amorphous tumor is a non-neoplastic tumor or intracavitary cardiac mass which is rarely seen in heart. It is frequently associated with left ventricle and mitral valve. Clinical symptoms varies from asymptomatic status to serious neurological and cardiopulmonary symptoms. Imaging studies such as echocardiography, computed tomography, or magnetic resonance imaging can reveal the mass preoperatively, although the exact diagnosis is done by pathological inspection of the specimen. Follow-up is recommended by echocardiography after surgical treatment due to its recurrence potential. Herein, we present a mass attached to the mitral valve posterior leaflet causing rather silent symptoms such as dyspnea and fatigue on exertion. Copyright © 2019, Turkish League Against Rheumatism.
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