The outcomes of superior cavopulmonary connection operation: a single center experience

Abstract Introduction: The superior cavopulmonary connection operation is one of the stages of the palliative surgical management for patients with functionally single ventricle. After surviving this stage, the patients are potential candidates for the final palliative procedure: the Fontan operation. Objectives: This study aimed to analyze the outcomes of superior cavopulmonary connection operations in our center and to identify factors affecting the survival and the progression to Fontan stage. Methods: The outcomes of 161 patients were retrospectively analyzed after undergoing superior cavopulmonary connection operation in our center between 2005 and 2015. Results: The early mortality rate was 2.5%. Five (3.1%) patients underwent takedown of the superior cavopulmonary connection. The rate of exclusion from the Fontan stage was 8.3%. Statistical analysis revealed that elevated mean pulmonary artery pressure preoperatively and the prior palliation with pulmonary artery banding were risk factors for both early mortality and takedown; however, the age, the morphology of the single ventricle and the type of operation were not considered risk factors. Conclusion: The superior cavopulmonary connection operation can be performed with low rate mortality and morbidity; however, the elevated mean pulmonary artery pressure preoperatively and the prior pulmonary artery banding are associated with poor outcomes.

Surgical Repair for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare congenital heart defect. Herein, we describe three cases of ARCAPA in an 8 months old, 18 months old, and 4 year old child. Two cases were incidentally diagnosed using a computed tomographic angiograph, and the other was incidentally diagnosed using a coronary angiograph. These cases underwent a reimplantation technique on diagnosis and resulting in positive clinical outcomes during the follow-up period which was a mean of 1.5 years.

Association between periodontal pathogens and coronary artery disease: a case-control study

We sought to answer the questions about the role of inflammatory factors in the formation of pathological lesions in the endothelium of the coronary vessels and also the role of host-based bacteria, including chronic periodontitis, in the clot formation in the blood vessels, all of which destabilize the atherosclerotic plaque. This case-control study was done on 40 patients who underwent elective coronary artery bypass grafting surgery [CABG] with the need of coronary endarterectomy. In Group A, patients had chronic periodontitis and group B consisted of patients without it. Both groups were well matched regarding their demographic data. The subgingival plaque was collected by a sterile curette from periodontal pockets >/= 5mm and CAL >/= 4mm. Also, atherosclerotic plaque was collected during the coronary endarterectomy surgery from all of the 40 patients. The specimens were assessed using the PCR technique to detect the specific bacteria responsible for chronic periodontitis such as actinobacillus actinomycetemcomitans [Aa], prevotella intermedia [Pi], porphyromonas gingivalis [Pg], Tanerella forsythensis [Tf], Treponema denticola [Td], and fusobacterium nucleatum [Fn]. In the atherosclerotic plaque of group A patients, Aa was identified in 18 [90%], Pg in 16 [80%], Tf in 13[65%],Td in 11 [55%], Pi in 10 [50%], and Fn in 6 [30%] specimens, whereas in group B the incidence was significantly lower [p< 0.0001]. In the subgingival plaque of group A, Aa and Tf were found in all 20 individuals and Pg, Pi, Td and Fn were identified in 19 specimens [95%]. The differences in the incidence of Aa and Pg in two plaque samples were not significant, but the two plaque samples showed significant differences regarding the incidence of the other pathogens [Pi: p<0.001, Tf: p<0.008, Td: p<0.003 and Fn :p<0.0001]. In the present study, the same organisms were found in both coronary atherosclerotic and subgingival plaques. The findings support the potential role of the periodontopathogenic bacteria species in some steps of the atherosclerotic process as a contributor that worsens this disease. However, further studies are required to achieve more definite results regarding the role of periodontal diseases in the atherosclerotic disease, focusing on patients' background variables

Thromboendarterectomy in chronic pulmonary thromboembolism

Chronic pulmonary thromboembolic disease in entrapment of thrombus in pulmonary arteries from a single episode or repeated embolic episodes that subsequently organize, or thrombi that develop inside the pulmonary arteries into firm, fibrous tissue that becomes incorporated into the vessel wall. We operated 7 patients with stage chronic pulmonary thromboembolism over a two year period at our center. Four patients had good function class after operation on follow up at 6 to 12 months and we administered warafarin prophylaxis [with international normalized ratio, INR, of 3] for them. Three patients died in hospital postoperatively. We used extracorporeal membrane oxygenation [ECMO] for one of them but it failed on the third postoperative day