Cardiac Echinococcosis: A Single-Centre Study with 25 Patients.

BACKGROUND: In this study, we aimed to analyse patients who underwent surgery for cardiac echinococcosis in our department. METHODS: Between June 2005 and June 2013, 25 patients (15 male, 10 female) underwent cardiac hydatid cyst operation. The mean patient age was 33.4±12.6 (15-75) years. RESULTS: The most common presenting symptom was dyspnoea. Cysts were located only in the heart in 16 patients, lung in 4 patients, liver in 4 patients, and brain with lung involvement in 1 patient. Concomitant cardiac and pulmonary surgery was performed in 2 patients. The cardiac hydatid cysts were intracavitary in 11 patients and extracavitary in 14 patients. We used cardiopulmonary bypass in all but 1 patient, who presented with an extracavitary cyst. In 3 patients, surgery was performed with cardiopulmonary bypass without cross-clamping of the aorta. There were no mortalities in the early follow-up period. CONCLUSION: Cardiac echinococcosis is a rare but fatal disease and should be surgically treated when diagnosed. There is some controversy about how echinococcosis spreads to the heart (via haematogenous spread or direct extension from adjacent structures). According to our study, we think that haematogenous spread is the main method of the distribution of cardiac echinococcosis, and the direct extension method from adjacent structures must be questioned.

"V-PLASTY": a novel technique to reconstruct pulmonary valvular and annular stenosis in patients with right ventricular outflow tract obstruction.

BACKGROUND: The goal of repair of right ventricular outflow tract obstruction with or without Tetralogy of Fallot (TOF) is to eliminate valvular and/or subvalvular obstruction. However, this operation has a high risk of late complication of pulmonary insufficiency. In this study, we aimed to present early period results of our new technique that we call "V-Plasty" developed to prevent pulmonary insufficiency after pulmonary valve reconstruction in selected patients. METHODS: Between January 2006 and January 2010, we performed V-plasty for pulmonary valve reconstruction in 10 patients. Eight patients (5 males, 3 females) had TOF and 2 patients (1 male, 1 female) had atrial septal defect concomitant with pulmonary valve stenosis. Patient selection for V-plasty reconstruction was made due to the pulmonary valve anatomy and degree of stenosis. The mean follow-up time was 55.7 ± 16.2 months (ranging from 32 to 80 months). RESULTS: Functional capacity of the patients improved immediately after the surgery. There were no mortality and re-operation in follow-up period. Patients were followed up with echocardiography one week after the operation, at 1st, 6th, 12th months and annually. There was no pulmonary insufficiency. CONCLUSIONS: Operative correction of the pulmonary outflow tract obstruction with or without TOF, frequently requires transannular enlargement because of the infundibular and/or annular-valvular obstruction. This conventional technique is usually a reason for late pulmonary insufficiency. In our study, we have not seen pulmonary insufficiency in early term follow-up period. Our early term results are encouraging, but long term follow-up results are needed with large case series.

Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment.

BACKGROUND: The aim of the present study is to compare negative pressure wound therapy versus conventional treatment outcomes at postoperative mediastinitis after cardiac surgery. METHODS: Between January 2000 and December 2011, after 9972 sternotomies, postoperative mediastinitis was diagnosed in 90 patients. The treatment modalities divided the patients into two groups: group 1 patients (n = 47) were initially treated with the negative pressure wound therapy and group 2 patients (n = 43) were underwent conventional treatment protocols. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student's test and Fisher's exact test. RESULTS: The 90-days mortality was found significantly lower in the negative pressure wound group than in the conventionally treated group. Overall survival was significantly better in the negative pressure wound group than in the conventionally treated group. CONCLUSION: Negative pressure wound therapy is safe and reliable option in mediastinitis after cardiac surgery, with excellent survival and low failure rate when compared with conventional treatments.