An experience in the COVID-19 pandemic period: Turkish Cardiovascular Surgery Online Board Exam 2020.

Background: The aim of this study was to provide information about the results of the Turkish Cardiovascular Surgery Board written exam, which was held online due to the pandemic. Methods: This cross-sectional study included a total of 41 cardiovascular surgeons and residents (39 males, 2 females) in November 21st, 2020 between 10:00 A.M. and 12:00 P.M. After the online exam was completed, data on participant information and answers to exam questions were obtained from the information system. Results: Of all participants, 39% were working in university hospitals. A total of 82.9% of the participants were specialists. The total mean score of the participants was 60.3±10.2 and 53.7% of them were declared successful-passed. Aortic surgery (63%), heart failure surgery (50%), and mitral valve surgery (50%) were the most incorrectly answered questions. Conclusion: With the online exam, the Board gained different experiences regarding exam planning and implementation. The Turkish Cardiovascular Surgery Board did not give up the Board exam during the pandemic period and conducted a reliable written exam with many participants.

Cardiac surgery of premature and low birthweight newborns: is a change of fate possible?

Low birthweight (LBW) continues to be a high-risk factor in surgery for congenital heart disease. This risk is particularly very high in very low birthweight infants under 1500g and extremely LBW infants under 1000g. From January 2005 to December 2008, 33 consecutive LBW neonates underwent cardiac surgery in our clinic in keeping with the criteria for choice of surgery. Their weight range was between 800 and 1900g. Nine of them were under 1000g. Cardiopulmonary bypass (CPB) was used in 17 patients (39.5%) and pulsatile perfusion mode was applied to patients in the CPB group. The same surgical team operated to achieve palliation (8 patients, 24.2%) or full repair (25 patients, 75.8%). Median gestational age was 36 weeks with 12 (36.4%) premature babies (≤37 weeks). Median age at operation was 5 days. Pathologies were single ventricle (n=3), pulmonary atresia-ventricular septal defect (n=3), aortic coarctation (n=10), aorticopulmonary window and interrupted aortic arch combination (n=6), patent arterial duct (n=11), critical aortic stenosis (n=8), and tetralogy of Fallot with pulmonary atresia (n=2). One infant had VATER syndrome. Selective cerebral perfusion technique was used in complex arch pathologies for cerebral protection. Median follow-up was 14 months. There were four early postoperative deaths. None of the cases showed a need for early reoperation. The acceptable early- and midterm mortality rates in this group suggest that these operations can be successfully performed. There is a need for further multicenter studies to evaluate these high-risk groups.

[Transcatheter aortic valve implantation: the first applications and early results in Turkey]. / Transkateter aort kapak yerlestirme: Türkiye'deki ilk uygulamalar ve erken sonuçlar.

OBJECTIVES: The objective of this study was to evaluate the first applications and results of transcatheter aortic valve implantation (TAVI) in Turkey, which is a new technology for the treatment of aortic valve stenosis. STUDY DESIGN: We performed TAVI in eight severely symptomatic patients (5 women, 3 men; mean age 81.6 ± 6.7 years; range 71 to 95 years) between May 1 and December 31, 2009. All the patients had severe aortic stenosis (mean valve area 0.6 cm², systolic peak/mean gradients 80.5 ± 22.1/50.0 ± 16.1 mmHg). Two patients had severe coronary artery disease that required intervention during TAVI. All the patients presented a high surgical risk (EuroSCORE 31.1 ± 9.8 and STS score 12.8 ± 7.9). The Edwards Sapien bioprosthetic valve was implanted through the transfemoral approach in seven patients, and transapical approach in one patient. RESULTS: All prosthetic valves were of appropriate size, were implanted in appropriate locations, and functioned perfectly. Two patients with severe coronary stenosis underwent successful simultaneous percutaneous coronary intervention before TAVI. Following TAVI, the mean aortic valve area increased to 1.5 ± 0.1 cm² (p < 0.01), and systolic/mean gradients decreased to 27.6 ± 9.6/14.6 ± 5.8 mmHg (p < 0.01). One patient underwent permanent pacemaker implantation due to persistent atrioventricular block, and two patients had transient atrioventricular block. Two patients died; one on the first day following transapical implantation, and the other after six months of implantation. The mean NYHA functional class decreased from preoperative 3.8 ± 0.3, to 1.1 ± 0.3 after a mean follow-up of 3.5 ± 2.5 months (range 1 to 8 months) (p < 0.01). CONCLUSION: Early results of TAVI are successful in patients with inoperable aortic valve stenosis due to high surgical risk. The results of randomized studies with longer follow-up will clarify widespread use of this technique.

Benefits of pulsatile perfusion on vital organ recovery during and after pediatric open heart surgery.

Controversy continues concerning the utilization of pulsatile flow during cardiopulmonary bypass (CPB) procedures with regard to improved patient outcomes. We evaluated 215 consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease who were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n = 151) or the nonpulsatile perfusion group (group NP, n = 64). All patients received identical surgical, perfusional, and postoperative care. Major complications and clinical outcome were documented. There were no statistically significant differences seen in either preoperative or operative parameters between the two groups (age, body surface area, weight, X-clamp and CPB time, base flow, flow rates, and hemofiltration). Group P, compared with group NP, had significantly less inotropic support (number of agents 1.4 +/- 0.07 vs. 2 +/- 0.12, p = 0.0012; dopamine 7.14 +/- 0.28 vs. 9.04 +/- 0.42 microg 32 x kg x min, p = 0.00025; dobutamine 4.12 +/- 0.3 vs. 5.3 +/- 0.6 microg 32 x kg x min, p = 0.036), adrenalin (0.026 +/- 0.005 vs. 0.046 +/- 0.005 microg 32 x kg x min, p = 0.021), shorter intubation period (10.26 +/- 1.04 vs. 18.64 +/- 1.99 hours, p = 0.021), shorter duration of intensive care unit (ICU) (1.53 +/- 0.07 vs. 2.75 +/- 1.19 days, p = 0.012), and hospital stay (6.71 +/- 0.19 vs. 11.16 +/- 0.58 days, p = 0.002). Although there were no significant differences in either creatinine, enzyme levels, and drainage amounts between two groups, lower lactate levels 16.27 +/- 2.02 vs. 24.66 +/- 3.05 mg/dl, p = 0.00034), higher albumine levels (3.15 +/- 0.03 vs. 2.95 +/- 0.06 mg/dl, p = 0.046), and higher urine output (602.82 +/- 21.5 vs. 505.55 +/- 34.2 ml/d, p = 0.016) during ICU period was observed in group P compared with group NP, respectively. We concluded that the use of pulsatile flow resulted in improved patient outcomes in terms of preserving better cardiac, renal, and pulmonary functions in the early post-CPB period.

Shprintzen (velo-cardio-facial) syndrome: a rare case.

Shprintzen syndrome (velo-cardio-facial, VCFS) is a very rare morbid entity, seen in either familial or sporadic forms, with major clinical findings such as facial dysmorphism, cleft palate, cardiovascular (especially conotruncal-anomalies), mild/moderate mental retardation, or, more commonly, observed learning difficulty. Tendency to behavioral disorders and bipolar schizophrenic diseases may be present in these cases. Autosomal dominant inheritance has been reported. VCFS appears as a consequence of microdeletion in the 22q11 chromosomal band. Although each syndrome has different clinical reflections, genetically the defect is located on the same chromosome.A 4-year-old boy was admitted to our clinic with a syndromic face and the diagnosis of tetralogy of Fallot. The patient underwent total correction of the cardiac defect. Atypical facial appearance, cleft palate, and malformed hand-fingers were present. With the aid of pediatric and genetic consultation (fluorescence in situ hybridization test), Shprintzen syndrome was confirmed. Both early and late postoperative periods of the patient were uneventful. The patient was closely consulted by a specialist psychologist during and after the hospitalization period. These children can be integrated into social life earlier through early surgical intervention for cardiac defects and facial deformations as well as neurologic and/or neuropsychiatric evaluation.

Symptomatic lipoma in the interventricular septum.

Cardiac lipomas, which are benign nonmyxomatous neoplasms of the heart, are rare and among those least often encountered. Because they normally cause no symptoms, diagnosis is often purely accidental. We report the case of a 24-year-old woman who presented with palpitations of recent onset and was found to have a lipoma attached to the left side of the interventricular septum (IVS). Transthoracic and transesophageal echocardiograms were performed and showed a mass in the left side of the IVS. During successful surgical excision of the mass, intraoperative histologic diagnosis showed the tumor was lipoma. Our review of the English literature revealed that our case is only the seventh of removal of lipoma in the IVS. The postoperative course was uneventful, and an echocardiogram taken 6 months after the operation showed no evidence of enlargement of the tumor tissue.

Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery.

Peritoneal dialysis after complex congenital cardiac surgery was introduced to a group of neonates and infants (n = 756; age, 0 to 1 year) between May 1993 and December 2005. Indications of peritoneal dialysis were determined as well as methods, prolonged dialysis, and its outcomes. Demographic characteristics, preoperative risk factors, intraoperative variables, and postoperative complications were compared in 756 cases with ages below 1 year. All cases underwent ultrafiltration during the perioperative stage. One hundred eighty-six cases (24.6% of total) required peritoneal dialysis. The cardiac pathology was transposition of great arteries in 133 cases, tetralogy of Fallot in 37, aorticopulmonary window associated with interrupted aortic arch in 4 and total anomalous pulmonary venous return in 5, and other complex pathology in 7 cases. Prolonged peritoneal dialysis was usually required in infants with low weight, with episodes of pulmonary hypertensive crisis (p < 0.05), and with preoperative renal dysfunction. No major complication was observed related to the peritoneal dialysis catheter. Of 186 patients, 23 (12.3%) had acute renal failure, and 4 of them died (2.15% of all patients underwent operation, 17.3% of those with acute renal failure). It has been demonstrated that the combination of peritoneal dialysis with perioperative ultrafiltration application was effective in providing the required postoperative negative fluid balance in especially complex congenital heart cases and affected survival positively.

Effects of pulsatile and nonpulsatile perfusion on vital organ recovery in pediatric heart surgery: a pilot clinical study.

The use of pulsatile flow during cardiopulmonary bypass (CPB) with regard to improved patient outcomes is controversial. We evaluated pulsatile perfusion in pediatric patients undergoing CPB in a clinical setting. Fifty consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n = 25) or the nonpulsatile perfusion group (group NP, n = 25). Study parameters included intubation time, duration of intensive care unit (ICU) stay and hospital stay, need for inotropic support, preoperative and postoperative enzymes, creatinine, C-reactive protein, blood count, mean urine output, and total drainage. Group P, compared with group NP, had significantly less inotropic support (number of agents, 1.48 +/- 1.05 versus 2.44 +/- 1.03, p = 0.0015; dopamine, 6.48 +/- 3.27 versus 10.3 +/- 4.8 microg/kg per minute, p = 0.0023; dobutamine, 3.12 +/- 6.55 versus 8.03 +/- 9.1 microg/kg per minute, p = 0.034), shorter intubation period (20.36 +/- 17.02 versus 35.44 +/- 30.72 hours, p = 0.038), and shorter duration of ICU stay (2.16 +/- 1.07 versus 4.32 +/- 4.21 days, p = 0.028) and hospital stay (7.64 +/- 2.48 versus 11.84 +/- 6.82 days, p = 0.007). There were no significant differences in creatinine, enzyme levels, or drainage amounts between the two groups. Higher urine output during CPB (553.6 +/- 150.89 versus 465.8 +/- 151.23 ml/d, p = 0.045) and during the ICU period (658.8 +/- 210.99 versus 528,2 +/- 224.71 ml/d, p = 0.039) was observed in group P compared with group NP. We concluded that the use of pulsatile flow resulted in improved patient outcome in preserving cardiac function and maintaining better renal and pulmonic function (shorter intubation period) in the early postbypass period.

Diagnosis, management, and results of treatment for aortopulmonary window.

The aortopulmonary window is a communication between the ascending aorta and the pulmonary trunk in the presence of two separate arterial valves. This uncommon congenital anomaly is reported rarely in the literature. We present here our experience with 16 patients, emphasizing the importance of early closure of the defect by a transaortic approach. We performed surgery on 16 patients over a period of 13 years using a transaortic approach under cardiopulmonary bypass. The median age of the patients at the time of operation was 6.5 months, with a range from 1 month to 11 years. Preoperative pulmonary arterial systolic pressure ranged from 30 to 100 mmHg. Associated cardiac anomalies were present in 7 of the patients, and were repaired at the same stage. The defect was between the ascending aorta and the proximal pulmonary trunk in 13 patients, and between the ascending aorta and the distal pulmonary trunk, with overriding of the orifice of the right pulmonary artery, in 3 patients. For closure, we used a patch of 0.4 mm Gore-Tex in 11, and gluteraldehyde-treated autologous pericardium in 5 of the patients. One patient died during surgery. The mean follow-up period for the surviving 15 patients was 52.2 months, with a range from 12 to 130 months. All the patients were in good condition during the follow-up, and no residual defects have been detected. Aortopulmonary window is a rare congenital cardiac anomaly, which can be repaired with very good operative results if surgery is performed before the development of irreversible pulmonary hypertension. We advise early correction of the defect with a transaortic patch, repairing all associated cardiac anomalies at the time of diagnosis.

Right ventricular mass and pulmonary embolism in a patient with essential thrombocythemia.

We report a case of a patient with essential thrombocythosis with a right ventricular mass and massive pulmonary embolism following an abdominal operation and who was operated on due to severe hemodynamic instability.