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

{"title":"[MSB-13] Instutional ERAS Applications for Totally Endoscopic Mitral Valve Surgery.","authors":"Serkan Ertugay, Sedat Karaca, İrem Demiray, Yaprak Engin, Seden Kocabaş, Tanzer Çalkavur, Bağdat Çullu, Emine Satır, Mustafa Özbaran","doi":"10.5606/tgkdc.dergisi.2024.msb-13","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-13","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to present our institutional protocol for enhanced recovery after surgery (ERAS) and its results in patients who underwent totally endoscopic mitral valve surgery (TEMVS).</p><p><strong>Methods: </strong>One hundred thirteen consecutive patients (63 females, 50 males; mean age: 54.7 years) who underwent TEMVS between 2021 and 2023 were included in this study. The TEMVS was performed using a three-dimensional endoscopic technique. Institutional protocols were as follows: <i>(i)</i> education on operative course and cessation of smoking and alcohol; <i>(ii)</i> anemia; <i>(iii)</i> optimization of blood glucose; <i>(iv)</i> rehabilitation; <i>(v)</i> anxiety and analgesia treatment; <i>(vi)</i> blood conservation techniques such as antifibrinolytic, acute normovolemic hemodilution, miniincision, meticulous surgery by a three-dimensional endoscope; <i>(vii)</i> postoperative early extubation, prevention of nausea, aggressive analgesia, early mobilization, early removal of tubes; <i>(viii)</i> restrictive transfusion strategy; <i>(ix)</i> early discharge.</p><p><strong>Results: </strong>The rate of intravenous iron therapy for anemia was 26.5%. The repair rate of a degenerative mitral valve was 96.9%. Among all patients, 68.1% did not receive any erythrocyte suspension, and 15.9% had only one unit. The mean extubation time was 5 h. Ninety-six percent of Foley catheters, 87% of all central venous catheters, and 93% of all drainage tubes were removed on the first postoperative day. The rate of respiratory, infectious, and renal complications was 9%, 3.5%, and 3.4%, respectively. The median intensive care unit stay was 1 day, and the median hospitalization time was 5 days. There was one mortality in the early postoperative period.</p><p><strong>Conclusion: </strong>Totally endoscopic mitral valve surgery provides lesser surgical trauma. By the addition of wellestablished ERAS protocols, less complication, less transfusion, early recovery, and greater patient satisfaction can be achieved.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"031-31"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-10] The Biomarker Potential of Serum-Derived Exosomes Carrying Autophagic Regulators in Carotid Artery Stenosis Patients.","authors":"Ceyda Colakoglu Bergel, Isil Ezgi Eryilmaz, Bilge Arioz, Atif Yolgosteren, Unal Egeli, Basak Erdemli Gursel, Murat Bicer, Gulsah Cecener, Mustafa Tok","doi":"10.5606/tgkdc.dergisi.2024.msb-10","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-10","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the biomarker potential of exosomes as autophagic regulators for discriminating ulcerated from smooth ones by serum-derived exosome isolation and real-time quantitative polymerase chain reaction (RT-qPCR) analysis.</p><p><strong>Methods: </strong>Eight carotid artery stenosis (CAS) patients (6 males, 2 females; mean age: 65.7±11 years) were included in the study conducted. Plaque ulceration was determined by Doppler ultrasonography. Afterward, the serum was separated and exosome/exosomal RNA isolation was performed using an exoRNeasy Midi Kit. Transmission electron microscopy and nanoparticle tracking analysis were performed for exosome characterization. Finally, the expression of autophagy-related genes (Atg5, Atg12, Beclin, and LC3) was analyzed by RT-qPCR.</p><p><strong>Results: </strong>Five (62.5%) patients had ulcerated carotid plaques. The patients' stenosis degree was 70% or greater. Based on the RT-qPCR (120 nm), Atg12, Beclin, LC3, and Atg5 levels were downregulated by 3.79-, 5.28-, 2.40- (p>0.05), and 4.83-fold (p=0.02) in ulcerated plaques, respectively.</p><p><strong>Conclusion: </strong>Although further validation is needed, data suggests that autophagy-related mRNA cargoes of serum-derived exosomes may be potential biomarkers for risk stratification based on plaque surface morphology in CAS patients.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"027-27"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-53] Clinical Efficacy and Safety of Using N-Butyl Cyanoacrylate in the Treatment of Perforator Vein Insufficiency.","authors":"Nur Dikmen, Evren Özçınar, Ahmet Kayan, Nadir Polat, Zeynep Eyileten, Mustafa Şırlak","doi":"10.5606/tgkdc.dergisi.2024.msb-53","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-53","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy of a nonthermal and nontumescent embolization method using N-butyl cyanoacrylate for managing perforator incompetence.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed 98 consecutive patients diagnosed with perforator vein insufficiency treated with N-butyl cyanoacrylate. The study protocol included physical examinations, Doppler ultrasonography, venous clinical severity scoring, CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification, and quality of life assessments before and after the procedure. The primary goal was to compare clinical, functional, and duplex ultrasonography parameters in managing varicose vein diseases with isolated primary perforator incompetence using duplex ultrasonography-guided N-butyl cyanoacrylate treatment. Furthermore, the study evaluated the occlusion rate, procedural pain, phlebitis, ecchymosis, and paresthesia.</p><p><strong>Results: </strong>The occlusion rate at six months was 96.9%, with a significant reduction in pain and other symptoms of chronic venous insufficiency. The incidence of complications was low. Phlebitis was observed in 3.4% of cases, ecchymosis in 2.8%, and transient paresthesia in 1.7%. There were no reports of severe adverse events, such as deep vein thrombosis or allergic reactions.</p><p><strong>Conclusion: </strong>Interruption of perforators effectively reduces the symptoms of chronic venous insufficiency and promotes rapid ulcer healing. This nontumescent, nonthermal embolization method can be safely applied with high success rates. The results of this study suggest that N-butyl cyanoacrylate is a viable option for treating perforator incompetence.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"078-79"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-71] Optimizing Total Coronary Revascularization: Exploring Total Coronary Revascularization with Anterior Thoracotomy Access Via Third vs. Fourth Intercostal Space in Coronary Artery Bypass Graft Surgery.","authors":"Muhammet Sefa Sağlam, Ozan Ertürk, Fatih Gümüş, Cengiz Bolcal, Mustafa Serkan Durdu","doi":"10.5606/tgkdc.dergisi.2024.msb-71","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-71","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the feasibility and comparative advantages of accessing total coronary revascularization with right anterior thoracotomy (TCRAT) for coronary artery bypass grafting (CABG) through the third and fourth intercostal spaces.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 465 patients who underwent CABG utilizing TCRAT via either the third or fourth intercostal space between January 2022 and April 2024. The third intercostal space was utilized in 315 (67.7%) patients (Group 1), while the fourth intercostal space was utilized in 150 (32.2%) patients (Group 2). Data regarding patient demographics, intraoperative details, postoperative outcomes, and longterm follow-up were collected and analyzed. The primary endpoints included procedural success, perioperative complications, and left internal mammary artery (LIMA) length.</p><p><strong>Results: </strong>The LIMA length was significantly higher in Group 2 (16.8±0.18 cm <i>vs.</i> 18.2±1.12 cm, p=0.013), despite efforts to turn the retractor back and remove the distal side in Group 1. The mean cardiopulmonary bypass time was shorter in Group 1 (73.8±17.2 min <i>vs.</i> 89.3±13.4 min) since CPB was not needed for proximal LIMA harvesting, and proximal anastomosis was mostly performed with a cross-clamp. However, cross-clamp time was similar between the groups.</p><p><strong>Conclusion: </strong>Total coronary revascularization with right anterior thoracotomy for CABG surgery is feasible and effective when accessed through either the third or fourth intercostal space. The fourth intercostal space may provide slightly better visualization for the distal part of LIMA, a longer LIMA graft, and lesser rib fracture, leading to lesser postoperative pain. On the other hand, the third intercostal space is best for proximal LIMA harvesting with lesser LIMA injury without the need for CPB initiation for proximal LIMA harvesting. Surgeon preference, patient anatomy, and procedural considerations should guide the choice of intercostal space for TCRAT implementation in CABG.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"093-93"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-61] Open Heart Surgery in Patients with A Lung Mass: A Single-Center Experience.","authors":"Abdussamet Asaroğlu, Zeki Temiztürk, Gökhan Güneş, Mehmed Yanartaş","doi":"10.5606/tgkdc.dergisi.2024.msb-61","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-61","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to share our experience with patients with heart disease requiring open heart surgery who also had a concomitant lung mass.</p><p><strong>Methods: </strong>This retrospective study included 22 patients (20 males, 2 females; mean age: 63.6 years; range, 43 to 79 years) who required open heart surgery and had a detected lung mass during preoperative evaluation. All the patients were discussed between cardiac and thoracic surgery teams, and different approaches according to patient and mass characters were chosen. Thoracic computed tomography and positron emission tomography scans and, when needed, biopsies were used to determine mass characters.</p><p><strong>Results: </strong>Seven patients were deemed to have small benign nodules, and it was decided not to intervene on the mass. A biopsy before surgery was performed in two patients, and an intervention was not deemed necessary in these patients. One patient was evaluated as having late-stage lung cancer, and no cardiac surgical intervention was performed. Ten patients underwent cardiac surgery and lung resections or lobectomies in a simultaneous operation. Two of the patients subsequently underwent a separate thoracic surgery after the cardiac surgery. There was no perioperative mortality or myocardial infarction.</p><p><strong>Conclusion: </strong>Managing patients with both cardiac disease requiring surgery and a lung mass is complex and necessitates a multidisciplinary approach. The decision to perform combined surgery or staged procedures should be individualized based on patient-specific factors, the nature of the lung mass, and the urgency of the cardiac condition. While outcomes for combined procedures are generally favorable in well-selected patients, they require meticulous perioperative planning and long-term follow-up.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"085-85"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-23] Investigation of the Effects of Sex On Shunt Use in Patients Undergoing Carotid Endarterectomy.","authors":"Abdullah Burak Balci, Hasan Tezcan, Gökhan Güneş, Zeki Temiztürk, Mehmed Yanartaş","doi":"10.5606/tgkdc.dergisi.2024.msb-23","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-23","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate whether the use of shunts differs between sexes in patients undergoing carotid endarterectomy (CEA) and to reveal the effect of patient sex on postoperative events.</p><p><strong>Methods: </strong>In this retrospective study, 225 patients (152 males, 73 females) aged 18 years and older who underwent CEA between September 2020 and November 2023 were analyzed. The patients were divided into two groups according to their sex. Patient characteristics were obtained from electronic medical records. Whether the use of shunts differed between the sexes and the outcomes were evaluated.</p><p><strong>Results: </strong>Intraoperative shunt use was present in 60 (26.7%) patients; this rate was 30.9% in males and 17.8% in females. A statistically significant difference was found between the groups in shunt use (p=0.037); however, this difference did not affect perioperative complications.</p><p><strong>Conclusion: </strong>The results revealed that the use of shunts was significantly higher in males than in females. This may be interpreted as indicative of a more complex or advanced disease in males, or it may reflect a surgical bias or different approaches to managing the perceived risks during CEA. Despite this difference in treatment approach, there was no significant difference in mortality and stroke rates between the sexes, which warrants further investigation of the criteria used for shunt use and its effect on outcomes.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"043-43"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-72] Comparison of Different Surgical Approaches for Ascending Aortic Surgery with or without Aortic Valve Involvement: Right Anterior Minithoracotomy Versus Conventional Median Sternotomy.","authors":"Ozan Ertürk, Muhammet Sefa Sağlam, Fatih Gümüş, Cengiz Bolcal, Mustafa Serkan Durdu","doi":"10.5606/tgkdc.dergisi.2024.msb-72","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-72","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to present our initial clinical experience and show the feasibility and safety of the right anterior minithoracotomy (RAT) approach for ascending aorta surgery with or without aortic valve involvement.</p><p><strong>Methods: </strong>This single-center study included 112 patients who underwent ascending aortic replacement with or without aortic valve intervention between September 2018 and March 2024. Patients with aortic dissection and a history of previous cardiac surgery were excluded. RAT was performed in 48 (42.9%) patients, and conventional median sternotomy was performed in 64 (57.1%) patients. The primary endpoints included operative variables, reoperation for bleeding, transfusion requirements, extubation time, length of intensive care unit (ICU) and hospital stays, and postoperative complications. The secondary endpoint was 30-day mortality. Ascending aorta and aortic valve morphology were evaluated preoperatively using computed tomography angiography and Doppler echocardiography. Surgical procedures for both groups included the Bentall procedure, valve sparing root replacement (the David procedure), supracoronary ascending aorta replacement, and supracoronary ascending aorta replacement+aortic valve replacement.</p><p><strong>Results: </strong>Total operation time was significantly lower in the conventional median sternotomy group (237.84±24.87 min <i>vs.</i> 259.57±27.41 min, p=0.0001). The mean ventilation time (12.73±2.96 h <i>vs.</i> 19.43±4.21 h) and the mean length of ICU stay (1.71±0.86 days <i>vs.</i> 3.6±1.71 days) were both shorter in the RAT group (p<0.0001 for both). The rate of wound infection was significantly lower in the RAT group (p=0.036).</p><p><strong>Conclusion: </strong>Right anterior minithoracotomy is a novel and promising approach for ascending aortic surgery with or without aortic valve involvement. This study suggests that this approach is both feasible and safe. Furthermore, it has the advantages of better wound healing, shorter ICU and hospital stays, less blood transfusion, and a quicker extubation period.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"094-94"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MEP-48] Perioperative Management Strategies in Cardiac Surgery for Patients with Ankylosing Spondylitis.","authors":"Murat Yücel","doi":"10.5606/tgkdc.dergisi.2024.mep-48","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.mep-48","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to discuss preoperative, intraoperative, and postoperative management strategies in patients with ankylosing spondylitis undergoing cardiac surgery.</p><p><strong>Methods: </strong>A retrospective analysis was performed with patients who underwent cardiac surgery between 2009 and 2024. Fourteen patients diagnosed with ankylosing spondylitis and followed by relevant clinics were identified. These patients were compared with 15 randomly selected patients who had similar profiles in terms of age, sex, and type of cardiac surgery. Age, sex, mode of intubation, length of hospital stay, duration of intubation, postoperative pulmonary complications, transfusion requirements, mobilization time, and the incidence of postoperative venous thromboembolism were evaluated.</p><p><strong>Results: </strong>Of the patients, 78.6% were male, with a mean age of 55±8 years. The postoperative intubation duration was significantly longer in the ankylosing spondylitis group (14±8 h vs. 6±5 h). Due to intubation difficulty, the need for fiberoptic intubation was higher in the ankylosing spondylitis group (16.6% vs. 0%). There were no significant differences between the groups in terms of hospital stay, postoperative exploration rates, transfusion requirements, or venous thromboembolism incidence. No postoperative sternal dehiscence was observed in either group. The need for rehabilitation due to postoperative pulmonary complications was higher in the ankylosing spondylitis group (33.3% vs. 13.3%). Cardiovascular mortality rates were similar in both groups.</p><p><strong>Conclusion: </strong>The management of cardiac surgery in patients with ankylosing spondylitis requires a multidisciplinary approach. Appropriate perioperative management, including preoperative patient planning as well as intraoperative and postoperative follow-up and care, is essential.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"148"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MEP-23] Managing Recurrent Chylothorax Post Pediatric Cardiac Surgery.","authors":"Kamran Ahmadov, Kamran Musayev, Fuad Huseynov","doi":"10.5606/tgkdc.dergisi.2024.mep-23","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.mep-23","url":null,"abstract":"<p><p>Recurrent chylothorax following pediatric cardiac surgery poses significant management challenges. Chylothorax may result from direct trauma to lymphatic vessels, or as a complication of central venous hypertension post cardiac surgery, leading to severe complications such as malnutrition, delayed wound healing, infections, and prolonged hospital stays. Initial management includes pleural fluid drainage, dietary modifications or total parenteral nutrition, and pharmacotherapy with octreotide. Surgical options, such as thoracic duct ligation, are considered for refractory cases. Typically, thoracic duct ligation via the right chest is recommended regardless of the chylothorax side, though it may not always be effective. This case report demonstrated the complexities and tailored strategies required to optimize outcomes in such cases. A five-year-old female patient with tricuspid atresia and a large ventricular septal defect, previously treated with pulmonary artery banding, who developed recurrent chylothorax following a cavopulmonary anastomosis, was admitted. Despite initial interventions such as octreotide therapy and total parenteral nutrition, the chylothorax persisted, leading to escalated treatment. Initial right-sided thoracic duct ligation via thoracoscopy did not resolve the chylothorax. Two weeks later, left-sided duct ligation via thoracotomy was performed, which successfully treated the chylothorax. This case emphasizes that lateralization of thoracic duct ligation should be considered based on the side of the chylothorax, challenging the conventional approach of right-sided ligation. Managing recurrent chylothorax requires a systematic and sometimes unconventional approach. This case highlights the need for flexibility in surgical planning and suggests that lateralization of the duct ligation may be more effective in certain scenarios.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"120-121"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[MSB-11] Arrhythmia Course After Surgical Treatment of Mitral Annular Disjunction.","authors":"Serkan Ertugay, Zehra Ünlü, Sedat Karaca, Yaprak Engin, Evrim Şimşek, Mustafa Özbaran","doi":"10.5606/tgkdc.dergisi.2024.msb-11","DOIUrl":"https://doi.org/10.5606/tgkdc.dergisi.2024.msb-11","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the course of arrhythmia in patients with mitral annular disjunction (MAD) based on 24-h Holter electrocardiogram.</p><p><strong>Methods: </strong>In this retrospective study, 140 patients who underwent mitral valve surgery for type 2 dysfunction between 2017 and 2024 were reviewed. Forty-five patients with MAD were identified. A history of arrhythmia was identified in 30 (18 females, 12 males; mean age: 38.5±13.76 years) of these 45 patients.</p><p><strong>Results: </strong>The mean cardiopulmonary bypass time was 134.2 min, and the mean cross-clamp time was 99.1 min. One patient died due to low cardiac output. Control echocardiograms performed one month later showed no severe mitral regurgitation. The prevalence of supraventricular arrhythmia was 17.1% prior to surgery and 3.9% postoperatively. The prevalence of ventricular arrhythmia was 8.1% prior to surgery and 2.8% postoperatively. The relationship between MAD distance and the occurrence of arrhythmia was investigated. A notable correlation was observed between MAD exceeding 10 mm and a reduced prevalence of ventricular arrhythmia, with statistical significance (p<0.05).</p><p><strong>Conclusion: </strong>Mitral annular disjunction can lead to severe arrhythmic episodes and sudden death. In the presence of MAD over 10 mm, surgical treatment may reduce the incidence of ventricular arrhythmias. Surgical treatment of MAD decreased the incidence of arrhythmia; therefore, early operation may be considered in the presence of severe arrhythmic events, even if mitral regurgitation is not severe.</p>","PeriodicalId":49413,"journal":{"name":"Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery","volume":"32 4 Suppl 2","pages":"028-29"},"PeriodicalIF":0.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}