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Large thrombus formation from right atrial incision site after closure of atrial septal defect.

Atrial septal defect (ASD) is the common congenital anomaly which requires surgical interventions. Right atrial thrombus formations after primary suture repairs of the ASD and evidences of thromboembolic complications are extremely rare. Specifically, the cases of thromboembolic complications have high mortality and morbidity risks. Two cases of giant intra-atrial thrombus formation detected in the late stage after primary repairs of ASDs are being discussed.

Right axilloaxillary cannulation for surgical management of a giant ascending aortic aneurysm

Aortic aneurysms larger than 10 cm are defined as “giant aortic aneurysms” and may occur in adults and infants. When these ascending aneurysms are in close proximity to the sternum, peripheral cannulation may be necessary prior to opening the chest. Currently, the axillary artery is the second most common site for arterial cannulation for ascending aortic pathology and may also be recannulated if it has been used previously. In addition, the axillary vein may also be used to initiate cardiopulmonary bypass (CPB) when the femoral venous system is diseased. We present images of a patient with a giant ascending aortic aneurysm in which axilloaxillary cannulation was used to initiate CPB. A 35-year-old male presented with dyspnea and chest pain. He had a history of chronic venous insufficiency and edema of the lower extremities. On physical examination, there was a 4/6 diastolic murmur and diffuse, bilateral varicose veins, and edema of the lower extremities. A computed tomography (CT) angio revealed a 14.5-cm ascending aortic aneurysm involving the root and extending to just below the arch vessels (Figure 1). A transthoracic echocardiogram also demonstrated 4+ aortic insufficiency, an ejection fraction of 45%, and a pulmonary artery pressure of 50/27 mmHg. Doppler ultrasound of the lower extremities revealed diffuse, dilated superficial, and deep varicose veins. Since the aneurysm was in close proximity to the sternum, it was elected to place the patient on CPB before opening the chest. The right axillary artery was directly cannulated with a 21-Fr DLP arterial cannula (Medtronic Inc., Minneapolis, MN). In view of the diseased femoral venous system, the axillary vein was directly cannulated with a 24-Fr DLP femoral artery cannula. Partial CPB

The Surgical Repair of a Hyperimmunoglobulin E Syndrome Associated Ascending Aortic Aneurysm

Hyperimmunoglobulin E syndrome (HIES) is an immunodeficiency disorder that manifests itself by affecting more than one system. Arterial aneurysms are among the significant complications associated with HIES. Surgical procedures for patients with such aneurysms are uncommon. In this study, we aim to present the case and surgical repair of a male child who was previously diagnosed with HIES and presented with rapidly expanding ascending aortic aneurysm.

Successful Surgical Treatment of a Ruptured Giant Atherosclerotic Aneurysm of Arcus Aorta

Background: Due to its high mortality and morbidity rates, the surgical treatment for ruptured aortic arch aneurysms is challenging. There is no consensus on the optimal treatment modality in this patient group. Herein, we present a case of a ruptured giant atherosclerotic aortic arch aneurysm treated successfully with emergency surgical intervention. Case Report: A 74-year-old female patient was admitted to our emergency clinic with complaints of blurred consciousness, chest pain, and dyspnea. In physical examination arterial blood pressure, pulse, oxygen saturation was 80/40 mmHg, 122 beats/min, 85-90% respectively. In oscultation of left hemithorax breath sounds was decreased. Chest X-ray revealed a giant aortic aneurysm and opacity at left hemithorax which was suggestive of pleural effusion. A ruptured saccular aortic arch aneurysm with a size of 8x6 cm2 was detected in the contrasted tomography. Emergency surgery with right selective antergrade cerebral perfusion performed uneventfully. Because of pulmonary complications she wasnÂ’t tolerate extubation and re-intubated. After appropriate therapy in anesthesiology and reanimation clinic she was discharged in the postoperative 15th day. Conclusion: Recent outcomes of open arch repair and hybrid TEVAR demonstrate acceptable results, particularly early after the procedure, open arch repair provides more reliable outcomes during follow-up. These two surgical strategies, when properly selected according to the individual risk, can improve the surgical outcomes in patients with aortic arch aneurysms

The effects of pulmonary hypertension on early outcomes inpatients undergoing coronary artery bypass surgery.

BACKGROUND/AIM To investigate the effects of pulmonary hypertension on early clinical variables in patients undergoing coronary artery bypass grafting surgery. MATERIALS AND METHODS The preoperative echocardiographic data of patients who underwent isolated coronary artery bypass surgery were evaluated retrospectively. A total of 1244 patients were included in the study. The patients were divided into two groups: one group consisted of patients with systolic pulmonary artery pressure (SPAP) values equal to or greater than 30 mmHg (Group 1, n = 184), while the other group consisted of patients with SPAP values below 30 mmHg (Group 2, n = 1060). RESULTS Early mortality was similar in both groups (0% in Group 1 and 1.2% in Group 2; P > 0.05). Comparison of postoperative data indicated that Group 1 had a higher need for inotropic agent treatment, a longer average duration of ventilation, and a longer average duration of stay in the intensive care unit (P < 0.05). For the other variables, no significant differences were identified between patients with and without pulmonary hypertension (P > 0.05). CONCLUSION Mild pulmonary hypertension (mean SPAP = 37.7 ± 8.4 mmHg) was not associated with a significant difference in the mortality of patients undergoing coronary artery bypass grafting. For patients undergoing this type of coronary bypass surgery, lower morbidity and mortality rates can be achieved through comprehensive preoperative examinations and effective perioperative medical procedures.