Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery最新文献

Background: In this study, the flip technique was compared with the classical method in terms of procedural success and procedure time during ductal stent implantation (DSI) via the carotid artery in patients whose pulmonary blood flow is dependent on the vertical type of ductus arteriosus (DA).

Methods: Between January 2019 and June 2023, 40 patients (24 males, 16 females; mean age: 15.9±15.4 days; range, 1 to 68 days) with vertical ductus-dependent pulmonary circulation who underwent patent DA stent implantation via the carotid artery were included in the study. Patients were divided into two groups: those who underwent the flip technique (Group 1) and those who did not undergo the flip technique (Group 2). Data were retospectively compiled by reviewing patient files and catheter images.

Results: Demographic findings were similar in the groups. The distribution of the DA in terms of tortuosity index was also similar in the groups. The procedure was successful in 18 (90%) patients in Group 1 and 20 (100%) patients in Group 2. There was no procedure-related mortality in both groups. The frequency of procedure-related complications was similar. Procedure duration was 53.6±18.4 min in Group 1 and 41.5±9.1 min in Group 2; the difference was significantly lower in Group 2 (p=0.028). The shorter follow-up in Group 2 was attributed to the flip method starting to be used later in the clinic. During follow-up, stent dilatation was required in two patients in Group 1 and one patient in Group 2, and a second stent implantation was needed in one patient in Group 2. No significant difference was observed between the two groups in terms of reintervention.

Conclusion: The success rate of DSI using the carotid artery access is high with both the classical and the flip method in patients with vertical DA. However, the use of the flip technique could be preferred in terms of operator habituation, ergonomic use of the catheter, guidewires, and shorter procedure time.

Background: In this meta-analysis, we aimed to systematically examine the relationship between body mass index and major adverse cardiovascular events in acute coronary syndrome patients and to provide theoretical guidance for body weight management in these patients.

Methods: A comprehensive analysis of applicable research published between 2008 and 2021 was conducted using the PubMed, Cochrane, Web of Science, Wanfang, and CNKI databases. Extracted odds ratios from the randomized-controlled studies were pooled using fixed-effects meta-analysis. Publication bias was addressed through evaluation methods such as funnel plot or sensitivity analysis.

Results: Ten studies with a total of 58,992 individuals were included. The consequences of this meta-analysis confirmed that, compared to normal body mass index, patients with acute coronary syndrome significantly increased the risk of major adverse cardiovascular events (odds ratio= 1.20; 95% confidence interval: 1.12-1.29, p<0.001).

Conclusion: Patients with acute coronary syndrome being overweight or obese significantly increased the risk of major adverse cardiovascular events compared to those with normal body mass index. The results suggest that patients may focus on weight management to reduce the risk of major adverse cardiovascular events in acute coronary syndrome.

A 67-year-old female patient presented with a lung nodule one month ago which was detected by physical examination. She was diagnosed with tracheobronchopathia osteochondroplastica complicated with right lower lobe nodules by chest computed tomography, bronchoscopy, and pathological examinations of the biopsy specimens. We performed lobectomy and lymphadenectomy by video-assisted thoracoscopic surgery and small pulmonary lesions were diagnosed as pulmonary adenocarcinomas. At 36 months of follow-up, the patient was free from recurrence. In conclusion, tracheobronchopathia osteochondroplastica complicated with a pulmonary adenocarcinoma is rare, and clinicians should be aware of this possibility, particularly in patients with pulmonary malignancy and tracheal irregularities on chest imaging. Otherwise, tracheobronchopathia osteochondroplastica can be easily misdiagnosed as malignant invasion of the trachea.

Failed midline ventral fusion of sternal bars is the cause of complete sternal cleft, which is a rare congenital anomaly that may cause cardiopulmonary compromise. Very few cases of complete sternal cleft have been reported so far in the literature. Surgical correction is recommended to protect mediastinal structures and to restore respiratory dynamics. Herein, we present a case of complete sternal cleft in a five-month-old female infant which was repaired using patch, titanium plate, and bilateral pectoralis muscular flap.

Carotid body tumors are rarely encountered pathologies in the pediatric age group but still exist in the differential diagnosis of cervical painless masses. Genetic and familial background should be studied in addition to contrast imaging studies. Complete subadventitial resection, with or without prior embolization, which is still controversial, is the mainstay of therapy. Follow-up gains importance due to its nature. Herein, we report a nine-yearold girl presented with a unilateral asymptomatic mass on the neck with a diagnosis of carotid body tumor treated surgically without embolization. We emphasize the specific aspects of the pediatric age group.

Chylothoraces are mostly secondary to trauma and tumors, and rarely idiopathic. Chylothoraces secondary to lung tumors are mostly seen postoperatively. In this article, we, for the first time, present massive chylothorax developing after diagnostic transthoracic Tru-cut biopsy in a lung adenocarcinoma case. The patient was successfully treated with drainage and octreotide. In conclusion, it should be kept in mind that chylothorax can be also seen as a complication after interventional biopsy procedures; therefore, the patients should be followed carefully.

Non-bacterial thrombotic endocarditis is a rare condition characterized by the formation of thrombotic vegetations on heart valve leaflets, leading to valvular dysfunction, heart failure and thromboembolic events. It is known to be associated with other diseases and some cases remain undiagnosed or can be diagnosed in the postmortem analysis. Surgical excision of the mass may be necessary to prevent further embolic events and other complications. In this article, we report a young patient with non-bacterial thrombotic endocarditis, whose medical history was significant for primary hypoparathyroidism and a positive family history of coagulation disorders.

Background: In this study, we aimed to compare the results of operated patients diagnosed with trisomy 18 with those who were followed with medical treatment alone.

Methods: Between May 2014 and January 2022, a total of 18 patients (6 males, 12 females; median age: 39 days; range, 32 to 79 days) diagnosed with trisomy 18 were retrospectively analyzed. Patient data were obtained from the pediatric cardiovascular surgery digital database. The patients were divided into two groups: those who underwent surgery (n=10) and those who were followed with medical treatment (n=8).

Results: Cardiac pathology was detected in all 18 patients included in the study. Three (30%) patients in the surgical group and two (25%) patients in the medical treatment group were discharged and followed with medical treatment. One of the three patients discharged after surgery died during follow-up. The median survival in surgical and medical treatment groups was 150 (range, 75 to 308) days and eight (range, 3 to 51) days, respectively (p=0.009). While patients in the medical treatment group died due to multi-organ failure, those in surgical group died due to sepsis, heart failure, and respiratory failure.

Conclusion: Although cardiac surgery contributed positively to survival in patients with trisomy 18, the mortality rate was still high due to non-cardiac causes. We believe that a multidisciplinary approach would contribute positively to the treatment of this patient group with multi-organ failure and would aid in prolonging their life span.

Background: In this systematic review and meta-analysis, we aimed to identify recipient-related preoperative risk factors for airway complications following lung transplantation in adults.

Methods: Articles published between November 1995 and February 2023 were searched by a thorough exploration of databases. Studies that addressed recipient-related risk factors for airway complications following adult lung transplantation, such as cohorts, case-control, or cross-sectional studies, were included. Fixed-effects or random-effects models were used to calculate the odds ratios (ORs) or mean differences (MDs) with 95% confidence interval (CI).

Results: Twenty-one studies including a total of 38,321 recipients fulfilled the inclusion criteria. Based on the pooled analyses, taller height (MD=5.98, 95% CI: 5.69-6.27, I²=57.32%), intraoperative mechanical ventilation (OR=1.83, 95% CI: 1.41-2.38, I²=0%), male sex (OR=1.52, 95% CI: 1.33-1.74, I² =15.91%), preoperative extracorporeal membrane oxygenation (OR=1.58, 95% CI: 1.1-2.26, I²=41.47%), and preoperative steroid use (OR=1.21, 95% CI: 1.04-1.41, I²=0%) elevated the risk of airway complications following lung transplantation.

Conclusion: Taller height, intraoperative mechanical ventilation, male sex, preoperative extracorporeal membrane oxygenation, and preoperative steroid use can increase the risk of airway complications after lung transplantation. Identifying high-risk recipients or riskless situations can support the advancement of selective treatments or prevent the unnecessary avoidance of certain interventions.

Background: This study aims to investigate the value of the CHA2DS2-VASc score in predicting long-term major cardiovascular events following coronary artery bypass grafting.

Methods: Between January 2008 and January 2010, a total of 559 patients (445 males, 114 females; mean age: 62.7±9.1 years; range, 35 to 84 years) who underwent elective coronary artery bypass grafting were retrospectively analyzed. At a mean of 10.7±3.1-year follow-up, major cardiovascular events were considered as the primary endpoint.

Results: The multivariate Cox hazard analysis identified the CHA₂DS₂-VASc score as an independent predictor of major cardiovascular events (hazard ratio: 1.615; 95% confidence interval: 1.038-2.511; p=0.034). The receiver operating characteristic curve analyses revealed that 3.5 was the most optimal cut-off value of the score predicting major cardiovascular events and the patients were divided into two groups accordingly. The Kaplan-Meier analysis demonstrated a significantly higher incidence of major cardiovascular events in proportion to a higher CHA₂DS₂-VASc score (p<0.001).

Conclusion: CHA₂DS₂-VASc score ≥4, which includes many risk factors for cardiovascular events, can be used as an independent predictor of long-term major cardiovascular events after coronary artery bypass grafting.