The pediatric asymptomatic SARS-CoV-2 IgG seropositivity in the Turkish Republic of Northern Cyprus.

BACKGROUND: While children were initially thought to have serious contributions to the coronavirus disease 2019 (COVID-19) transmission, recent studies suggest otherwise. However, the possible effect of asymptomatic pediatric spread still has not yet received enough attention. The aim of our study was to estimate asymptomatic infection rates among children in the Turkish Republic of Northern Cyprus, by using pediatric patients admitted to a university hospital without any COVID-19-associated symptoms. METHODS: Blood samples collected from 80 pediatric patients with no symptoms and history of COVID-19 infection, who were admitted to a university hospital between September 2020 and January 2021, were included in the retrospective study. Isolated serum samples were tested by Dia.Pro SARS-CoV-2 IgG ELISA assays. RESULTS: The patient group included 40 (50%) male and 40 (50%) female patients. The average age of children was 7.6 ± 4.0 years, with min-max ages ranging from 2 to 15 years. Among the 80 patients tested, only one (1.3%) was detected positive by the Dia.Pro IgG ELISA kit. CONCLUSIONS: The asymptomatic seropositivity reported in our study suggests the use of randomly performed serologic tests to monitor SARS-CoV-2 infection among the pediatric population in schools that would contribute to the public health fight against COVID-19.

Surgical procedures for coronary arteries in pediatric cardiac surgery: Risk factors and outcomes.

BACKGROUND: Limited data exist regarding the coronary revascularization procedures needed during the repair of several congenital and pediatric cardiac malformations. We aimed to determine risk factors for in-hospital mortality and long-term outcomes of various pediatric coronary revascularization procedures. METHODS: We retrospectively reviewed the records of 32 consecutive pediatric patients who underwent coronary revascularization procedures at our institution between May 1995 and June 2020. In-hospital mortality, risk factors, surgical indications, revascularization patency, and mid- and long-term follow-up data were investigated. Patients were categorized into the coronary artery bypass grafting (n = 11) and other coronary artery procedure (n = 21) groups. RESULTS: The median age and weight of patients at the time of surgery were 9 months and 4.8 kg, respectively. There were five in-hospital deaths (5/32, 15.6%). The mortality rates were 27.2% (3/11) in the coronary artery bypass grafting group and 9.5% (2/21) in the other coronary artery procedure group (p = .206; 95% confidence interval: 0.496-25.563). The mortality rates for planned and rescue procedures were 8.3% (2/24) and 37.5% (3/8) (p = .06), respectively. The median follow-up time was 12.5 years. Control imaging studies for coronary patency were performed in 70.3% (19/27) of surviving patients. The overall coronary patency rate was 94.7% (18/19). CONCLUSIONS: Pediatric coronary revascularization procedures with elective-planned indications can be performed with good outcomes. Young age and rescue and emergency procedures may carry an increased risk of in-hospital mortality, although not found to be statistically significant. Surviving patients require lifelong follow-up regarding the patency of reperfused coronary arteries.

Pulmonary valve replacement in patients with repaired tetralogy of Fallot: early results for recovery of right ventricular dilatation and QRS duration

Background/aim: Although pulmonary valve replacement (PVR) improves ventricular function and symptoms, the benefit and optimal timing of PVR are controversial. This study aimed to evaluate early response to PVR for right ventricle (RV) dilatation and QRS duration. Materials and methods: Retrospective analysis was performed for 32 patients with repaired tetralogy of Fallot (TOF) between March 2005 and October 2017. The differences between preoperative and postoperative changes in echocardiographic parameters, clinical symptoms, and QRS duration were evaluated. Results: There were no in-hospital or late deaths. Mean age at the time of PVR was 16.57 ± 7.97 years. The interval between TOF repair and PVR was 12.99 ± 7.06 years. Postoperative echocardiographic findings showed significant reduction in indexed RV end-diastolic diameter (RV-EDDI) and the ratio of RV/LV-EDDI (P = 0.001 and P = 0.001, respectively). Higher preoperative RV-EDDI was associated with decreased change in RV-EDDI after PVR (r = 0.63; P = 0.001). Normalization of RV diameters was found to be independent of age at PVR, interval between TOF repair and PVR, preoperative QRS duration, and preoperative RV-EDDI. Conclusion: Significant improvement in RV diameter and symptoms could be obtained with PVR in patients with severe pulmonary regurgitation.

Coronary artery bypass grafting in children.

BACKGROUND: We present our clinical experience with coronary artery bypass grafting (CABG) in children. METHODS: Ten children who underwent CABG between July 1995 and August 2017 were retrospectively analyzed. Data including congenital cardiac malformations, previous surgical procedures, age and sex, type of coronary complications, ischemic events preceding surgery, and ventricular function before and after CABG were recorded. RESULTS: The study population consisted of five males and five females with a median age of 2.5 years (range, 88 days to 15 years). Eight internal mammary arteries (IMAs) and two saphenous veins were used for grafting. Indications for bypass grafting were coronary artery (CA) complications related to the post-arterial switch operation in six, CA complications during the Ross procedure in two, and an iatrogenic CA injury during complete repair of tetralogy of Fallot with abnormal CA, crossing the right ventricular outflow tract in two patients. Six of the grafts were performed as rescue procedures. Three patients died during hospitalization. The mean follow-up time was 6.8 years (range, 3 months to 18 years). Anastomoses were evaluated by coronary angiography in four patients, and were all patent. Echocardiography revealed normal myocardial function in all patients. CONCLUSION: Our study suggests that the IMA should be the graft of choice in children due to its growth potential and long-term patency.

Surgical Repair of Congenital Left Atrial Aneurysm and Mitral Valve Insufficiency in a Four-Year-Old Child.

Left atrial aneurysm is an extremely rare anomaly, which can be associated with supraventricular arrhythmia, compression of coronary arteries, intracardiac thrombus, life-threatening systemic embolization, pulmonary venous obstruction, mitral valve insufficiency, and congestive heart failure. Herein, we report a four-year-old boy who had a giant aneurysm of the left atrium and severe mitral regurgitation. The aneurysm and mitral valve cleft causing severe mitral regurgitation were successfully repaired.

Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants.

BACKGROUND: Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years. METHODS: The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days). RESULTS: Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively (P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group (P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively). CONCLUSION: Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.

Challenges in the management of patients with functionally univentricular heart in Turkey.

Management of patients with functionally univentricular heart encompasses a wide array of developments over the years in every country. This article describes our working group experiences and 30-year story of single ventricle surgery in Turkey. Diagnosis, surgical treatment, and medical treatment of this complex group of patients necessitate courageous and continuous team effort with multi-institutional collaboration.

Surgical repair of a cause of sudden death: left coronary artery originating from right coronary sinus.

Left coronary artery originating from the right coronary sinus is one of the most frequent causes of sudden death in young people. We present a reconstructive surgical technique for left coronary artery and main pulmonary artery in a case with anomalous origin of the left coronary artery from the right coronary sinus. A 15-year-old boy underwent unroofing of the left main coronary artery and patch arterioplasty with autologous pericardium after transection of the main pulmonary artery. The pulmonary artery was reconstructed with autologous pericardium and a piece of dacron patch in order to prevent coronary artery compression. This surgical approach resulted in successful clinical outcome.

[Pulmonary artery banding operation and results of terminal biventricular and univentricular repair]. / Pulmoner arter bant ameliyati ve sonrasinda biventriküler ve üniventriküler tamir sonuçlari.

OBJECTIVE: In this study, we report the current indications, early-midterm results and the outcome of pulmonary artery banding (PAB) operation after definitive repair. METHODS: Between 2000 and 2007, 28 infants underwent PAB operation. Ages were between 21 days and 6 months (mean 3.0+/-1.7 months). All patients had pulmonary hypertension at systemic level. Fourteen patients were candidates for terminal biventricular repair [atrioventricular septal defect (AVSD) (n=6), double outlet right ventricle (DORV) +ventricular septal defect (VSD) (n=4), Swiss cheese VSD (n=2), transposition of the great arteries (TGA) +Swiss cheese VSD (n=1), ASD+VSD+aortic coarctation (n=1)], and the remaining 14 were candidates for terminal univentricular repair [double inlet left ventricle (n=5), double inlet right ventricle (n=2), AVSD+left ventricular (LV) hypoplasia (n=2), DORV+LV hypoplasia (n=2); tricuspid atresia (n=1), left AV valve atresia (n=1), TGA+Swiss cheese VSD+LV hypoplasia (n=1). RESULTS: Three patients (1 in biventricular group; 2 in univentricular group) died in the early postoperative period (10.7%). Three patients needed long duration of mechanical ventilatory support. Twenty- three of the surviving patients (92%) were followed -up between 1 month to 7 years. Currently 7 patients underwent successful biventricular repair and five patients underwent univentricular repair (extracardiac Fontan 3; Glenn 2). Two patients died early and 1 patient died 1 year after extracardiac Fontan operation. Survival for biventricular group was 92.8% at 1 and 4 years and 85.7% and 58.4% respectively for univentricular group (p<0.05). CONCLUSION: Pulmonary artery banding operation has still a significant role in the palliation of certain congenital cardiac anomalies. Outcome of patients who are candidates for biventricular repair is better than the univentricular repairs.

[Evaluation of surgical approaches and early and midterm results of treatment for atrioventricular septal defect]. / Atriyoventriküler septal defekt tedavisinde cerrahi yaklasimlarin ve erken ve orta dönem sonuçlarin degerlendirilmesi.

OBJECTIVES: We evaluated patients who underwent complete or partial surgical correction for atrioventricular septal defect (AVSD) with regard to surgical techniques and early and midterm results. STUDY DESIGN: Forty-six patients were treated for complete (n=28) or partial (n=18) AVSD between 2000 and 2007. There were nine boys and 19 girls (mean age 5.5 months; range 1.5 to 11 months) with complete AVSD. Of these, 17 patients underwent total repair, while 11 patients underwent palliative procedures. Five males and 13 females (mean age 11 years; range 1 to 50 years) with partial AVSD were treated with total repair. Down syndrome was seen in nine patients (32.1%) and one patient (5.6%) in complete and partial AVSD groups, respectively. Twenty-one patients (75%) and 14 patients (77.8%) could be followed-up for a mean of 26.3 months (range 1-72) and 21.8 months (range 2 to 71) in the two groups, respectively. RESULTS: Total repair of partial AVSD resulted in no mortality or significant morbidity. Early postoperative mortality occurred in three cases (10.7%) after repair of complete AVSD, one of which had Down syndrome. Six patients required prolonged mechanical ventilation beyond one week. Two patients without Down syndrome underwent reoperation due to severe atrioventricular (AV) valve insufficiency in the early postoperative period. None of the patients required permanent pacemaker implantation. Clinical and echocardiographic monitoring showed moderate left AV valve insufficiency in three patients in each group, while the remaining patients had no or minimal insufficiency. CONCLUSION: Total repair of complete AVSD should be the procedure of choice in early infancy. Left AV valve insufficiency continues to be the most important cause of postoperative morbidity in these cases.

[Combination of complete atrioventricular septal defect and tetralogy of Fallot: surgical management and its results]. / Komplet atriyoventriküler septal defekt ve Fallot tetralojisinin birlikte bulundugu hastalarda cerrahi yaklasim ve sonuçlar.

OBJECTIVES: Complete atrioventricular septal defect (AVSD) with tetralogy of Fallot (TOF) is a rare congenital heart anomaly. We evaluated surgical results of total repair in patients with TOF and AVSD. STUDY DESIGN: Seven patients (5 girls, 2 boys; age range 2.5 to 14 years) underwent total repair for AVSD and TOF. Three patients had Down syndrome. Three patients had previous systemic-to-pulmonary shunt operations. Accompanying anomalies were left superior vena cava (n=2), left atrial isomerism (n=1), muscular VSD (n=1), and double outlet right ventricle (n=1). Preoperative diagnoses were based on echocardiographic examinations. The two-patch technique was used for surgical repair. Reconstruction of the right ventricular outflow tract was performed using transannular and infundibular patches in four and three patients, respectively. The follow-up period ranged from six months to nine years (mean 3.4+/-2.9 years). RESULTS: No mortality occurred throughout the follow-up period. Two patients had prolonged hospitalization (>1 month) due to pulmonary infection and sepsis. At the latest follow-up, functional capacity was NYHA class I in five patients, and class II in two patients. Final echocardiographic examinations showed mild left atrioventricular (AV) valve insufficiency in five patients, and mild (n=3) or moderate (n=1) right AV valve insufficiency. Two patients had mild residual pulmonary stenosis, and three patients with a transannular patch had free pulmonary insufficiency. All the patients had proper right and left ventricular functions and all were in sinus rhythm. CONCLUSION: With a proper surgical strategy and technique, AVSD and TOF can be corrected successfully. Long-term follow-up is necessary for AV valve dysfunction and pulmonary insufficiency.

[Early-mid term results of the one and a half ventricle repair]. / Bir buçuk ventrikül tamirinin erken-orta dönem sonuçlari.

OBJECTIVE: The aim of this study is to investigate the early and mid term results of one and a half ventricle repair. METHODS: Pathological and demographic data, prior palliative operations selection criteria and operative properties of six patients with right ventricular hypoplasia undergoing one and a half ventricle repair were investigated. Patients were followed for mean 55.6+/-18.9 months by clinical and echocardiographic examinations. RESULTS: One patient died in the early-mid term follow-up period. The intensive care unit and hospitalization mean time were 2.8+/- 0.83 and 11.25+/- 6.55 days respectively. One patient had recurrent pleural effusion; she also had epicardial permanent pace implantation for atrioventricular block within the postoperative second month. Another patient was reoperated for important tricuspid and pulmonic valve regurgitation at postoperative 3rd year. All other patients were followed with medical therapy in NYHA class I-II status. CONCLUSION: The early and mid-term results of one and a half ventricle repair seem to be acceptable. This method can be a good alternative to Fontan repair in suitable patients.

Total autologous Ross procedure in a child with aortic root abscess.

BACKGROUND AND AIM OF THE STUDY: Endocarditis with aortic root abscess is one of the most complicated surgical problems. METHODS: An 8-year-old girl presented with dyspnea, high fever, and fatigue. She had stenotic bicuspid aortic valve with endocarditis and aortic root abscess. Ross procedure was performed with fresh autologous pericardial tube and pericardial monocusp valve. Right internal mammary artery to right coronary artery bypass was also done due to destroyed right coronary artery ostium. RESULTS: Four years after the operation she is in excellent clinical condition without medications. Echocardiography reveals mild autograft regurgitation and mildly stenotic right ventricular outflow tract. CONCLUSIONS: If homografts are not available, total reconstruction of RVOT with autologous fresh pericardium may offer reasonable early and mid-term results especially when active endocarditis and aortic root abscess is involved.

Stentless heterograft conduits for pulmonic ventricle to pulmonary artery connection: is it the right option?

BACKGROUND AND AIM OF THE STUDY: A variety of stentless heterograft conduits has been developed as alternatives for pulmonary outflow reconstruction. Herein are reported the authors' results with four different types of stentless heterograft conduit implanted during the past nine years. METHODS: Between January 1996 and March 2005, stentless heterograft conduits were used in 54 patients (mean age 9.9 +/- 7.5 years; median age 7 years; range: 1-32 years) to reconstruct the pulmonary outflow tract. The main pathologies were tetralogy of Fallot, transposition of the great arteries and aortic valve disease (Ross operation). A Baxter-Edwards Prima valve (EP) was used in three patients, a Medtronic Freestyle bioprosthesis (MF) in 27, a Cryolife Ross pulmonic heterograft (CR) in 14, and a Medtronic Contegra bovine jugular vein conduit (MC) in 10. The mean conduit diameter was 20.4 +/- 1.7 mm (range: 16-23 mm). RESULTS: Early mortality was 5.5%. Mean intensive care unit and hospital stays were 4.3 +/- 4.8 days and 11.7 +/- 7.2 days, respectively. Clinical follow up was complete for 92.1% of patients; the mean follow up period was 45.6 +/- 20 months. Excluding early deaths, the probability of patient survival (Kaplan-Meier) was 97.9% and 74.6% at one and five years, respectively. Transconduit gradients increased significantly in all conduit types during follow up. Conduit failure occurred in 15 patients (two EP, nine MF, three CR, one MC) at a median duration of 70 +/- 7 months (range: 56-84 months). To date, nine patients have undergone conduit re-replacement, without mortality and major morbidity. The probability of freedom from conduit failure was 91.6%, 66.4% and 27.9% at three, five and seven years, respectively. CONCLUSION: Stentless heterograft conduits are suitable alternatives to homografts, with acceptable early and mid-term results. However, they do not offer any significant advantage over homografts or other conventional Dacron or pericardial conduits.

A rare cause of respiratory distress in infants: tracheal compression due to anomalous course of innominate artery.

Incomplete vascular ring is a rare congenital vascular anomaly causing tracheal compression. A case of anomalous innominate artery causing tracheal compression and low grade tracheomalacia with remarkable dyspnea and intermittent apnea in a five-month-old infant is reported. Chest X-ray revealed enlarged upper mediastinum. Patent foramen ovale and thymus hyperplasia were detected on echocardiographic examination. Angiography demonstrated left aortic arch with normal arterial branching pattern. Thorax computerized tomography (CT) revealed tracheal compression of more than 50% at innominate artery level and aberrant position of the hyperplastic thymus. Operation was planned for subtotal thymectomy and relocation of innominate artery in order to relieve tracheal obstruction. Postoperative thorax CT demonstrated satisfactory relief of tracheal compression. Patient was discharged from hospital on sixth postoperative day in good condition. On clinical follow-up he is completely asymptomatic without any signs of dyspnea or intermittent reflex apnea. In severely symptomatic cases, surgical treatment offers excellent results.

Acute pulmonary edema in a newborn with infracardiac type total anomalous pulmonary venous return and surgical repair.

Total anomalous pulmonary venous return (TAPVR) is a rare congenital pathology. Early diagnosis and urgent surgery are life-saving, especially in newborns with pulmonary venous obstruction, which is most commonly seen with infracardiac type. A three-day-old baby boy presented to another clinic with tachypnea and cyanosis. Initial work-up aimed at ruling out persistant pulmonary hypertension, respiratory distress syndrome and pneumonia. Acute pulmonary edema then developed, and on echocardiography obstructive type infracardiac TAPVR was suspected. Cardiac catheterization was done for definitive diagnosis. Urgent surgery was undertaken and pulmonary veins were anastomozed to left atrium with posterior approach. Patient was extubated at 10th day and discharged after three weeks. During one-year follow-up the patient was free of symptoms. Infracardiac type TAPVR is a rare pathology in which early diagnosis and urgent surgery with special postoperative case are mandatory for survival.

Double root re-replacement after Ross-Konno operation in a patient with straight back syndrome: clamshell approach.

The most common indication for reoperation after Ross operation is degeneration of the pulmonic conduit. Pulmonary autograft (aortic root) dilatation and insufficiency is another potential problem during follow-up. This report describes double (aortic and pulmonary) root re-replacement 5 years after Ross-Konno operation in a patient with straight back syndrome. The causes of reoperation were pulmonary conduit degeneration, moderate aortic insufficiency, aortic root dilatation compressing left atrium, left main bronchus and left pulmonary artery. Clamshell technique provided safe and effective approach for this patient with very narrow thoracic cavity.

Fate of stentless bioprostheses on right side of the heart.

Newly developed stentless bioprostheses have shown good midterm results in the aortic position, but few data are available on their use at the right side of the heart. Four types of stentless bioprosthesis were used for right-side reconstruction of congenital heart anomalies in 50 patients (3 Baxter-Edwards Prima, 27 Medtronic Freestyle, 14 Cryolife Ross, and 6 Medtronic Contegra). Mean age was 9.03 +/- 6.25 years. Serial Doppler echocardiographic studies were performed to evaluate transvalvular pressure gradients. The hospital mortality was 6%. Reoperation was required in 3 patients in the early postoperative period because of left ventricular outflow tract obstruction, endocarditis, or tricuspid insufficiency. Measurements from 34 patients were available for statistical analysis. Clinical follow-up was complete in 43 of the 47 hospital survivors; the mean follow-up period was 16.6 +/- 16 months. Four patients died during follow-up; 93% of the survivors have an unrestricted lifestyle. Although peak transvalvular conduit gradients increased in all types of conduit, no reoperation has yet been performed for conduit stenosis. The newly developed stentless bioprostheses may be a useful alternative for right-side reconstruction of congenital heart anomalies.