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Abstract Introduction: Del Nido cardioplegia was reported to provide adequate myocardial protection and clinical outcomes with improved surgical flow in adult cardiac surgical procedures. And many clinicians have already modified the traditional formula. This study aims to investigate the efficacy and safety of tepid modified del Nido cardioplegia compared to cold blood cardioplegia in adult patients undergoing cardiac surgery. Methods: This retrospective study included one hundred consecutive adult patients undergoing cardiac surgical procedures using tepid modified del Nido cardioplegia. One hundred consecutive adult patients undergoing cardiac surgical procedures with cold blood cardioplegia were the control group. Propensity score matching yielded 89 modified del Nido and 89 cold blood cardioplegia patients. Results: There were no significant differences when comparing the two matched groups regarding the requirement for intraoperative defibrillation (P=0.36), postoperative peak troponin T levels (0.18), perioperative inotropic support (P=0.26), intra-aortic balloon pump requirement (P=0.62), and postoperative left ventricular ejection fraction at discharge (P=0.4) and on the sixth postoperative month (P=0.37). Mean cross-clamping time (P=0.005), cardiopulmonary bypass time (P=0.03), and total operation time (P=0.03) were significantly shorter in the del Nido group. Conclusion: Tepid modified del Nido cardioplegia may be a safe alternative to cold blood cardioplegia in adult patients undergoing cardiac surgical procedures.

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ABSTRACT Introduction: In this study, we aimed to present three different methods for symptomatic aberrant right subclavian artery (ARSA) surgery. Methods: We identified 11 consecutive adult patients undergoing symptomatic and/or aneurysmal ARSA repair between January 2016 and December 2020. Symptoms were dysphagia (n=8) and dyspnea + dysphagia (n=3). Six patients had aneurysm formation of the ARSA (mean diameter of 4.2 cm [range 2.8 - 6.3]). All data were analyzed retrospectively. Results: Median age of the patients (7 females/4 males) was 55 years (range 49 - 62). The first four patients (36.4%) underwent hybrid repair using thoracic endovascular aortic repair (TEVAR) and bilateral carotid-subclavian artery bypass (CScBp). Three patients (27.2%) were treated by open ARSA resection/ligation with left mini posterolateral thoracotomy (LMPLT) and right CScBp. And the last four patients (36.4%) underwent ARSA resection/ligation with LMPLT and ascending aorta-right subclavian artery bypass with upper mini sternotomy (UMS). Two of the four patients who underwent TEVAR + bilateral CScBp had continuing dysphagia cause of persistent esophageal compression. Brachial plexus injury developed in one of three patients who underwent LMPLT + right CScBp. Pleural effusion treated with thoracentesis alone was observed in one of four patients who underwent UMS + LMPLT. Conclusion: Among the symptomatic and/or aneurysmal ARSA treatment approaches, surgical and hybrid methods are used. There is still no consensus on how to manage these patients. In our study, we recommend the UMS + LMPLT method, since the risk of complications with anatomical bypass is less, and we have more successful surgical results.

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ABSTRACT Introduction: Medical improvements are needed to prevent ischemia-reperfusion injury in thoracoabdominal aortic surgery. The aim of this study was to determine the antioxidant effects of thymoquinone, silymarin, and curcumin against ischemia-reperfusion injury associated with abdominal aorta. Methods: Twenty-five Wistar albino rats were included in the study. Sham, control, and treatment (thymoquinone, silymarin, and curcumin) groups were set in equal numbers. Ischemia-reperfusion was applied by clamping (120 minutes) and de-clamping (60 minutes) the infrarenal aorta of all groups, except the sham group. Before reperfusion, thymoquinone, silymarin, and curcumin were given intraperitoneally to the treatment groups. After reperfusion, blood samples were taken from the right ventricle. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in serum samples and histopathological examination was performed on the gastrocnemius muscle. Results: There was a significant difference in TOS and OSI values between the control and sham groups. Both values were found higher in the control group than in the sham group (P<0.05). OSI values were found to be lower in the thymoquinone group compared to the control group (P<0.05). All three parameters were found to be lower in the silymarin group than in the control group (P<0.05). TAS and TOS levels were found to be higher in the curcumin group than in the control group (P<0.05). There was no histopathological difference between the groups. Conclusion: Silymarin and thymoquinone administration decreases oxidative stress in experimental aortic ischemia-reperfusion injury. Antioxidant effect of curcumin was lower than silymarin and thymoquinone.

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ABSTRACT Introduction: Cardiothoracic surgery (CTS) has seen a decline in interest and application rates in recent years. As a relatively small speciality, teaching and placements in CTS are often not included during undergraduate study and postgraduate training. We aim to evaluate the exposure to CTS during both undergraduate study and postgraduate training. Methods: A ten-question online survey was designed and delivered to Foundation Year Two (FY2) doctors who graduated in 2017 and completed their two-year postgraduate foundation training in 2019. Medical schools with no graduates in 2017 and 2018 were excluded from our study. IBM® SPSS Statistics, version 25, and Microsoft Excel 365® were used for Student’s t-test statistical analysis. Results: Three hundred and six FY2 doctors across 16 medical schools completed the survey, none of which included compulsory CTS attachments as their undergraduate curriculum. Thirty-two respondents (10.5%) underwent CTS attachments lasting between one to three weeks. Only 14 (43.8%) had worked in a cardiothoracic unit during their two-year Foundation Programme; 10 of which (71.2%) subsequently made an application for cardiothoracic speciality training. Most of the participants with previous exposure to CTS, during either undergraduate study or postgraduate Foundation Programme training or both, were significantly more likely to make an application to CTS training (P<0.05). Conclusion: Our study suggests that doctors with increased exposure to CTS during undergraduate study and postgraduate training are more likely to pursue a career in CTS. Targeted interventions at both stages may improve interests in CTS and the number of prospective applicants.

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Abstract Introduction: We aimed to evaluate the use of social media among cardiovascular surgery specialists and their respective perspectives. Methods: In total, 173 cardiovascular surgeons were reached through an online survey. The surgeons surveyed were cardiovascular surgery specialists. The questionnaire consisted of 33 questions, including closed-ended and open-ended questions about social media. Results: We found that 73.4% of the participants think that social media facilitates the communication of the patient with the doctor, and 87.9% think that social media increases the publicity of the physician. Furthermore, 80.9% of the participants believe that informing through social media creates information pollution. We found that personal use of Instagram was more common in state hospital cardiac surgeons. The number of patients who contacted surgeons in private hospital for surgery via social media were found to be statistically significant, and it was found that this group benefitted more economically. Conclusion: Social media usage rates of cardiovascular surgeons were found to be high. On the other hand, it was observed that the rate of surgeons who share medical content is low. However, half the cardiovascular surgeons who participated in the study believe that their colleagues do not fully comply with the ethical rules in medical sharing.

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ABSTRACT Introduction: Infective endocarditis is a disease that progresses with morbidity and mortality, afecting 3-10 out of 100,000 people per year. We conducted this study to review the early outcomes of surgical treatment of infective endocarditis. Methods: In this retrospective study, 122 patients who underwent cardiac surgery for infective endocarditis in our clinic between November 2009 and December 2020 were evaluated. Patients were divided into two groups according to in-hospital mortality. Demographic, echocardiographic, laboratory, operative, and postoperative data of the groups were compared. Results: Between November 3, 2009, and December 7, 2020, 122 patients were operated for infective endocarditis in our hospital. Emergency surgery was performed in nine (7.3%) patients. In-hospital mortality occurred in 23 (18.9%) patients, and 99 (81.1%) patients were discharged. In-hospital mortality was related with older age, presence of periannular abscess, New York Heart Association class 3 or 4 symptoms, low albumin level, high alanine aminotransferase level, and longer cross-clamping time (P<0.05 for all). Conclusion: The presence of paravalvular abscess was the most important prognostic factor in patients operated for infective endocarditis.

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Abstract Introduction: Bleeding after transcatheter aortic valve replacement (TAVR) has a negative impact on the outcome of the procedure. Risk factors for bleeding vary widely in the literature, and the impact of preoperative antithrombotic agents has not been fully established. The objectives of our study were to assess bleeding after TAVR as defined by the Valve Academic Research Consortium-2 (VARC-2), identify its risk factors, and correlate with antithrombotic treatment in addition to its effect on procedural mortality. Methods: The study included 374 patients who underwent TAVR from 2009 to 2018. We grouped the patients into four groups according to the VARC-2 definition of bleeding. Group 1 included patients without bleeding (n=265), group 2 with minor bleeding (n=22), group 3 with major bleeding (n=61), and group 4 with life-threatening bleeding (n=26). The median age was 78 (25th-75th percentiles: 71-82), and 226 (60.4%) were male. The median EuroSCORE was 3.4 (2-6.3), and there was no difference among groups (P=0.886). The TAVR approach was transfemoral (90.9%), transapical (5.6%), and trans-subclavian (1.9%). Results: Predictors of bleeding were stroke (OR: 2.465; P=0.024) and kidney failure (OR: 2.060; P=0.046). Preoperative single and dual antiplatelet therapy did not increase the risk of bleeding (P=0.163 and 0.1, respectively). Thirty-day mortality occurred in 14 patients (3.7%), and was significantly higher in patients with life-threatening bleeding (n=8 [30.8%]; P<0.001). Conclusion: Bleeding after TAVR is common and can be predicted based on preprocedural comorbidities. Preprocedural antithrombotic therapy did not affect bleeding after TAVR in our population.

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Abstract Introduction: To clarify the potential protective role of cilostazol on rat myocardial cells with ischemia-reperfusion injury (IRI) models. Methods: The study was conducted with three groups of 10 Wistar rats (control group, rats without any coronary ischemia; sham group, rats with coronary ischemia but without cilostazol administration; and cilostazol group, rats with coronary ischemia and cilostazol administration). The level of myocardial injuries was measured by analyzing cardiac troponin T and creatine kinase MB levels in blood samples. In tissue samples, adenosine triphosphate (ATP), nitric oxide, superoxide dismutase (SOD), and malondialdehyde were used to determine the amount of tissue damage. Tissues were stained with hematoxylin-eosin method, and samples were examined under light microscope. Results: The mean level of ATP was 104.4 in the cilostazol group and 149.1 in the sham group (P=0.044). SOD level was significantly higher in the cilostazol group than in the sham group (2075.3 vs. 1783.7, P=0.043). According to histopathological examination, all samples were classified as G0 in the control group. In the sham group, one sample was categorized as G1, six samples as G2, and three samples as G3. In the cilostazol group, nine samples and one sample were categorized as G1 and G2, respectively (P=0.011). Conclusion: Cilostazol has beneficial effects on Wistar rats’ myocardial cells in regard to decreasing inflammatory process, necrosis, and fibrosis. Our findings revealed that the use of cilostazol significantly decreased ATP and increased SOD levels in Wistar rats’ myocardial cells after IRI.

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ABSTRACT Introduction: Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence. Methods: This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups. Results: PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001). Conclusion: QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery.

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ABSTRACT Introduction: Classic coronary artery bypass grafting (CABG) surgery involves diastolic cardiac arrest under cardiopulmonary bypass, while off-pump CABG (OPCABG) has become widespread in recent years. Methods: 174 patients who underwent OPCABG were included in the study. Patients were divided into two groups. Group I (n=90) received ivabradine and Group M (n=84) received metoprolol before surgery until postoperative day 10. Intraoperative arrhythmias and hypotension were recorded. Postoperative atrial fibrillation (AF) and arrhythmia, mortality and morbidity rates were assessed based on the 30-day postoperative follow-up. Results: There were no significant differences in the intraoperative amount of inotropic support and red blood cell transfusion between groups (P=0.87 and P=0.31). However, the rates of intraoperative arrhythmias and hypotension were not significantly higher in Group M (P=0.317 and P=0.47). Ventricular tachycardia/ventricular fibrillation (VT/VF) was observed in 2 patients in both groups. Postoperative AF occurred in 7 patients (7.7%) in Group I and in 10 patients (11.9%) in Group M. Although there was a trend towards a higher prevalence of AF in Group M patients, this did not reach statistical significance. In addition, mortality and morbidity rates were comparable between groups.

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Abstract Introduction: Acyanotic congenital heart disease (ACHD) patients with pulmonary hypertension (PH) are prone to postoperative complications, and characterization of the risk profile continues to fail in identifying inflammatory predilection. Our objective is to investigate the role of platelet-leukocyte indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII] [neutrophil × platelet/lymphocyte]) in predicting poor outcomes following cardiac surgery in ACHD cohort with preoperative PH. Methods: This single-center, retrospective risk-predictive study included ACHD patients undergoing surgical correction at our tertiary cardiac center between January 2015 and December 2019. Standard institutional perioperative management protocol was followed, and poor postoperative outcome was defined as ≥ 1 of: low cardiac output syndrome, new-onset renal failure, prolonged mechanical ventilation (MV > 24 hours), stroke, sepsis, and/or death. Results: One hundred eighty patients out of 1,040 (17.3%) presented poor outcome. On univariate analysis, preoperative factors including right ventricular systolic pressure (RVSP) (PH-severity marker), congestive heart failure, albumin, NLR, PLR, SII, and aortic cross-clamping (ACC) and cardiopulmonary bypass (CPB) times predicted poor outcome. However, on multivariate analysis, RVSP, NLR, SII, and ACC and CPB times emerged as independent predictors. An NLR, SII prognostic cutoff of 3.33 and 860.6×103/mm3 was derived (sensitivity: 77.8%, 78.9%; specificity: 91.7%, 82.2%; area under the curve: 0.871, 0.833). NLR and SII values significantly correlated with postoperative MV duration, mean vasoactive-inotropic scores, and length of intensive care unit and hospital stay (P<0.001). Conclusion: Novel parsimonious, reproducible plateletleukocyte indices present the potential of stratifying the risk in congenital cardiac surgical patients with pre-existing PH.

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ABSTRACT Introduction: The minimally invasive implantation of aortic valve prosthesis via thoracotomy has numerous advantages and is comfortable, especially during the early postoperative period. Disadvantages of this method include peripheral vessel complications and groin infections. Central cannulation (direct aortic cannulation with superior vena cava cannulation) eliminates these drawbacks. In this report, we evaluated this method of treatment in patients with obesity. Methods: We retrospectively analyzed the medical records of 21 obese patients with severe aortic stenosis who underwent minimally invasive aortic valve implantation via thoracotomy and central cannulation with a bovine pericardial aortic prosthesis between 2017 and 2021. We compared these records with the medical records of 27 obese patients with severe aortic stenosis who underwent conventional aortic valve surgery. Results: Mean cross-clamp and cardiopulmonary bypass times were similar in both groups. Operating time was significantly longer in the minimally invasive group (P <0.05). In the minimally invasive group, acute renal failure occurred in 2 patients. In terms of postoperative complications, deep sternal wound infection/sternal instability was much higher in the conventional group. This was not statistically significant (P=0.090). Minimally invasive operated patients had a comfortable early postoperative period, with a mean visual analog scale for pain of 1.10±0.83 (no pain-mild pain). When we assessed patient satisfaction with the postoperative period, 13 patients were extremely satisfied, 7 patients were satisfied, and 1 patient was quite satisfied. Conclusion: Minimally invasive aortic valve implantation via thoracotomy and central cannulation is a safe and effective treatment for obese patients.

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ABSTRACT Introduction: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results: Patients’ mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.

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ABSTRACT Objective: ST-segment elevation myocardial infarction (STEMI) is a serious, life-threatening disease. Inflammatory markers have recently become the focus of attention in the assessment of severity in the early stages of STEMI. This study aimed to evaluate the importance of immature granulocytes (IG) as a prognostic marker in STEMI. Methods: Patients admitted to the coronary care unit with a diagnosis of STEMI and who underwent primary percutaneous coronary intervention (pPCI) within the period from January 1, 2019 to January 1, 2020, were retrospectively scanned. A total of 146 patients were analised; of these, 112 (76.7%) were male and 34 (33.3) were female, with a mean age of 62.65±14.06 years. Patients’ age, gender, haemogram, biochemistry, and mortality results were recorded. The patients were divided into two groups as low (<0.6) and high (≥0.6) IG levels and compared. Results: The mean IG levels were significantly higher in the non-survivor group compared to the survivor group (1.12±0.22 vs. 0.50±0.28, P<0.001). Mortality rates were significantly higher in the high IG group compared to the low IG group (26.9% vs. 9.6%, P=0.006). IG was shown to predict mortality with a sensitivity of 72.2% and a specificity of 77.8% at a cut-off value of 0.65 (area under the curve: 0.740, 95% CI: 0.635-0.846, P<0.001). Conclusion: High IG values in the blood collected at the time of admission to the emergency department are a marker of mortality in patients with STEMI.

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ABSTRACT Introduction: The benefit of implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (DCM) is still an issue under discussion. Studies examining the relationship between ventricular scar tissue and ICD shock with cardiac magnetic resonance (CMR) are promising. CMR studies have shown that ventricular scar tissue size and Selvester score show a correlation. In the light of this information, this study aimed to investigate the potential relationship between Selvester score and ICD therapies. Methods: The study included 48 patients who had undergone ICD implantation with a diagnosis of DCM and who had undergone routine 6-month ICD control in outpatient clinic controls between December 2018 and October 2019. Selvester score and other data were compared between patients who received ICD therapy (n=10) and those who did not (n=38). Results: Selvester score (P<0.001) was higher in ICD therapy group. Positive correlation was found between ICD shock therapy and Selvester score (P=0.002, r=0.843). Selvester score was detected as an independent predictor for ICD therapy after multiple linear regression analysis (P=0.004). Receiver operating characteristic curve analysis showed that Selvester score (P<0.001) was a significant predictor of ICD therapy. Selvester score cutoff points of 5 for were calculated to estimate ICD therapy, with a sensitivity of 100% and specifity of 81%. Conclusion: In our study, it was found that a high Selvester score may be a predictor for ICD therapies in patients with DCM. As an inexpensive and non-invasive method, Selvester score can help in the decision-making in these patients.

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ABSTRACT Introduction: The relationship between mitral annular calcification (MAC) and the controlling nutritional status (CONUT) score has not been previously studied. In this study, we investigated the relationship between MAC and CONUT score to evaluate the nutritional status of patients with MAC. Methods: A total of 275 patients, including 150 patients with MAC and 125 patients without MAC, who presented to a cardiology outpatient clinic were enrolled in the study. Results: There was no difference in the CONUT score between the two groups. Correlation analysis indicated that CONUT score was positively correlated with left atrial (LA) diameter (r=0.190, P=0.020) and interventricular septum thickness (r=0.179, P=0.028) in the MAC+ group. In multivariate regression analysis, only LA diameter (odds ratio 95% confidence interval = 1,054-1,189, P=0.0001) was independently associated with MAC. Conclusion: The present study investigated the relationship between CONUT score and MAC for the first time in the literature. We demonstrated that CONUT score was not significantly higher in patients with MAC without chronic diseases. However, CONUT score was correlated with LA diameter in patients with MAC. We therefore conclude that, for patients admitted with MAC and high LA diameter, CONUT is a valuable nutritional and inflammatory status index.

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ABSTRACT Introduction: The aim of our study was to compare the primary closure (PRC) and patch angioplasty closure (PAC) of carotid artery following carotid endarterectomy (CEA). Methods: Data of patients who underwent CEA in the period from January 2005 to June 2020 were reviewed through files. Demographic characteristics, information about the operation, and postoperative follow-up outcomes of the patients were compared. Results: Of the 144 CEA cases included in the study, PRC and PAC were applied to 62 (43.7%) and 82 (56.3%) patients, respectively, for the carotid artery closure. Duration of surgery and carotid artery clamping time were not different between the PRC and PAC groups (106.73±17.13 minutes vs. 110.48±20.67 minutes, P=0.635; 24.25±11.56 minutes vs. 25.19±8.99 minutes, P=0.351, respectively). Postoperative respiratory impairment was more common in the PRC group (P=0.012); however, nerve injuries (P=0.254), surgical wound hematomas (P=0.605), surgical site infections (P=0.679), and mortality (P=0.812) were not significantly different between the groups. During the mean patient follow-up time of 26.13±19.32 months, restenosis was more common in the PRC group than in the PAC group (n=26, 41.9% vs. n=4, 4.9%, respectively; P=0.003). Frequencies of stroke (n=4, 2.8% vs. n=2, 2.4%, respectively; P=0.679), transient ischemic attacks (n=2, 1.4% vs. n=0, 0%, respectively; P=0.431), and mortality (n=4, 6.5% vs. n=4, 4.9%, respectively; P=0.580) were not significantly different between the PRC and PAC groups. Conclusion: We are of the opinion that the PAC method is effective and safe for carotid artery closure in patients undergoing CEA.

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ABSTRACT The management of Type A aortic dissection has evolved over a period of a decade or so, and contemporary reports are suggesting a paradigm shift from a conservative approach to complete excision of the diseased aorta including root and distal arch. Improved cardiopulmonary bypass perfusion techniques, better understanding of the cerebral perfusion, and wide-ranging obtainability of prosthetic conduits gave surgical teams numerous choices. With improving outcomes and maturing surgical techniques, surgeons are performing extensive resections of the diseased aorta, but there is no standard protocol as far as the extent of the proximal and distal diseased aortic tissue resection is concerned. Aortic root replacement is associated with good early- and long-term outcomes and proffered solution in young and stable patients, for that reason many busy centres are endorsing total arch replacement in complex distal aortic dissections. This systemic review is discussing contemporary literature and associated pros and cons during surgical decision-making for these high-risk cases.

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ABSTRACT Severe functional mitral valve regurgitation should be treated in patients undergoing myocardial revascularization. When replacement is considered the best therapeutic option, preservation of the mitral subvalvular apparatus is crucial, especially in the emergency setting, because of its primary role in preserving geometry and function of left and right ventricles. Here we present a simple and quick technique, where subvalvular apparatus is preserved in toto in patients undergoing mitral valve replacement with a bioprosthesis.

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ABSTRACT The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.

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ABSTRACT Inferior vena cava filter embolization is not uncommon and can reach 11.8%. However, device migration to the heart is not frequent and occurs in cases after inferior vena cava filter fracture. We present the case of a young woman who was submitted to a routine inferior vena cava filter placement three days before and presented with hemodynamic instability. Since the device was not retrievable, the surgical team opted for an open cardiac surgery under cardiopulmonary bypass to remove the inferior vena cava filter and avoid other further complications.

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Abstract Carcinoid tumors can be a cause for right heart valve disease, also known as Hedinger syndrome or carcinoid heart disease. Proper understanding of the pathophysiology is of the uttermost importance for adequate treatment of these patients, especially during heart surgery.

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Abstract Sinus of Valsalva aneurysm is a rare cardiac abnormality which can be acquired or of congenital origin. A spontaneous rupture into the right atrium is possible and, if not adequately treated, may result in a progressive heart failure due to the left-to-right intracardiac shunt. If ruptured sinus of Valsalva aneurysm is diagnosed, surgical repair is indicated, and different surgical techniques have been reported. If concomitant aortic regurgitation is present, aortic valve replacement is usually performed. Herein, we describe an uncommon clinical presentation of a ruptured sinus of Valsalva aneurysm which has been corrected by aortic valve reimplantation.

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Abstract Kawasaki disease (KD) is an inflammatory condition that may affect genetically predisposed individuals in pediatric ages after infectious/environmental triggering. An infrequent finding associated with KD is ascending aortic aneurysm during or after the acute phase of the disease. In this Multimedia presentation, we describe a three-year-old girl submitted to surgical treatment.

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Abstract Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.