Successful treatment of thoracic aortic graft infection by omental flap following vacuum-assisted closure therapy.

BACKGROUND: Postoperative thoracic aortic graft infection (TAGI) is a serious and potentially fatal complication. The classical approach is to replace the infected graft. However, this approach has a high mortality rate. Alternatively, treatment of TAGI without graft replacement can be performed METHOD: Herein, we present a 72-year-old case with mediastinitis and graft infection after type A aortic dissection operation and successful treatment using omental flap coverage following vacuum-assisted wound closure therapy without graft replacement. CONCLUSION: The patient had an uneventful postoperative course and remains infection-free to date.

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.

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation.

Transcatheter device implantation has become an attractive alternative to surgery in the closure of atrial septal defects in selected patients. However, it can lead to early and late sequelae, some of them life threatening. For example, 79 days before her admission to our emergency department with sudden-onset respiratory distress and respiratory arrest (leading to cardiac tamponade and rupture), a 22-year-old woman had undergone percutaneous closure of an atrial septal defect. We describe the damage and its treatment. Although the adverse effects of transcatheter device implantation are rare, physicians should know that these events can be life threatening. Further data are needed to prevent such sequelae and to design new devices. It is of utmost importance that patients and their family members be informed both of possible sequelae and of life-saving interventions to be administered at early diagnosis.

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.

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.