Turkish Society of Cardiovascular Surgery (TSCVS) Proposal for use of ECMO in respiratory and circulatory failure in COVID-19 pandemic era.

The document is prepared to guide the members of the The Turkish Society of Cardiovascular Surgery (TSCVS) and other extracorporeal membrane oxygenation (ECMO) centers worldwide to share experiences in using ECMO in COVID-19 pandemic.

Presentation of a true aneurysm of the left antecubital vein.

A venous aneurysm is defined as a dilatation of a localized segment of vein occurring in most major veins, affecting the lower extremities the most and the upper extremities the least, occurring equally between sexes at any age. A 62-year-old man was referred to our polyclinic's cardiovascular surgery department. He presented with a 27-year history of a swelling in the left antecubital fossa. He complained of its increase in size, worsening pain, and paresthesia. Examination of the left antecubital fossa revealed a painless, soft, nonpulsatile mass 3-4 cm in size with no palpable thrill. A Duplex ultrasound scan of the mass displayed an aneurysm of 4 x 3 x 3 cm in the left antecubital vein. His past medical history included repeated nephrolithotomies. The aneurysm was dissected and excised. The patient was discharged on the second postoperative day. Surgery should be performed in cases such as the presence of local discomfort, swelling, and paresthesia for the relief of symptoms.

What is the best predictor of postoperative erectile function in patients who will undergo coronary artery bypass surgery?

PURPOSE: The aim of this prospective study was to evaluate the impact of extracorporeal circulation and cross clamping period on erectile function in patients undergoing coronary artery bypass surgery (CABS). MATERIALS AND METHODS: A total of 50 patients undergoing CABS were evaluated in this prospective study. Before and 6-12 months after the CABS, patients were interviewed for erectile dysfunction (ED) using the International Index of Erectile Function (IIEF). Scoring the IIEF domain of erectile function allowed the classification of each patient as having no (26-30), mild (17-25), moderate (11-16) or severe (0-10) ED. Patients with normal, mild and moderate ED score were designated as group A, B and C, respectively. Patients were classified in 2 groups to evaluate the impact of extracorporeal circulation and cross clamping period on erectile function in patients undergoing CABS. Patients who had no change in ED score in group A and patients who had recovery in group B were included in group1. Patients who had impaired ED score in group A and group B were included in group 2. All patients were also interviewed for sociodemographic and relevant medical history. Sociodemographic data were age, job, marital status, alcohol, narcotic and smoking habit. Medical risk factors were diabetes, hypertension and psychiatric disorders. RESULTS: The mean age of patients included in the study were 46,6 (range 31-55). After the operation, 3 (7.5%) of 41 patients in group A had moderate, 1 (2.5%) had mild and 37 (90%) had no change in ED score. In group B, 2 (28%) of 7 patients had moderate, 4 (57%) had recovery in ED score, 1 had no change in ED score. There were only 2 patients in group C and 1 had severe, the other one had mild ED after the operation. The mean operation period was 234.8 m inutes in group 1 and 280 min in group 2. Cross clamping period and extracorporeal circulation of patients in group 1 and 2 were 33.2, 41.6 min and 54.7, 64.6 min, respectively. The groups were not statistically different with regard to mean operation, cross clamping and extracorporeal circulation period. CONCLUSION: Preoperative erectile function seems to be the best predictor of postoperative erectile function in patients who will undergo CABS.

Left main coronary artery and aortic root compression associated with atrial septal defect and pulmonary hypertension.

The extrinsic compression of left main coronary artery (LMCA) by dilated pulmonary artery is rarely reported. Various congenital and acquired diseases were shown to cause extrinsic LMCA compression. Here we present a child with aortic root and LMCA compression due to dilated pulmonary trunk and causing angina like chest pain. The patient had also electrocardiographic evidence of myocardial ischemia. This case report will be a guide for the evaluation and surgical treatment of the patients with pulmonary hypertension and LMCA compression.

Pregnancy after mechanical mitral valve replacement.

BACKGROUND AND AIM OF THE STUDY: Forty-six pregnancies among 32 patients after mitral valve replacement (MVR) were reviewed. Prosthetic valve-related complications, and outcome of pregnancy including feto-maternal mortality and morbidity for different anticoagulation regimens are presented and discussed. METHODS: Among 521 women of fertile age undergoing MVR with a St. Jude Medical mechanical prosthesis, 32 patients developed a total of 46 pregnancies. Average patient follow up was 5 +/- 4 years (range: 10 months-17 years); total follow up was 155 patient years (pt-yr). Follow up commenced at onset of the first pregnancy. RESULTS: Ten-year Kaplan-Meier survival estimate was 94 +/- 6%; 10-year freedom from valve-related events was 33 +/- 14%. Rates for embolism, anticoagulation-related bleeding and mechanical valve thrombosis were 4.5%, 3.2% and 2.6% per pt-yr, respectively. Among 30 patients receiving uninterrupted low-dose oral warfarin plus aspirin throughout pregnancy, three had normal deliveries, two had premature births, one had a low birth weight, seven had spontaneous abortions, and 17 had therapeutic abortions. By contrast, among eight patients who discontinued anticoagulation despite medical advice, seven had normal-term deliveries without thromboembolic complications, and spontaneous abortion occurred in one patient. Of the five women taking low molecular-weight heparin regimen, three had normal deliveries, one had a premature birth, and one an abortion. Two patients taking warfarin replaced by heparin in the first trimester and in the last two weeks, had term deliveries. One of these women developed left atrial thrombus in the third trimester while receiving heparin; after switching back to warfarin, the thrombus dissolved spontaneously. Another patient on heparin throughout the gestation had an uneventful gestation period that resulted in term delivery. There were four cases of prosthetic valve thrombosis during the postpartum period; all of these developed in women who ceased anticoagulation during pregnancy. CONCLUSION: There were no congenital malformations or maternal mortality/morbidity during pregnancy in this series of 20 live births, probably due to the low-dose anticoagulation regimen used. However, anticoagulation cessation was associated with a high prosthetic valve thrombosis rate in the postpartum period, even when a new-generation prosthetic valve of unique design and expected low thrombogenicity was implanted.