Although pericardial cysts are generally benign structures and detected incidentally, they may be associated with life-threatening complications. We present the case of a 24 year-old man with a giant hemorrhagic pericardial cyst diagnosed after evaluation for recurrent syncope which caused compression of the right ventricle. Spontaneous hemorrhage into a pericardial cyst is an extremely rare event, and to our knowledge this is the first case in which a pericardial cyst has been shown to cause recurrent syncope.

Objectives We present a surgical technique for closure of a patent ductus arteriosus (PDA) in pre-term neonates. Left anterior mini-thoracotomy is a surgical procedure that consists of an anterior mini-thoracotomy (∼1.5 cm) below the clavicle, clipping the PDA, and closing the thorax without a tube thoracotomy. Methods Using this method between 2009 and 2012, we performed PDA closure in 32 pre-term neonates. Logistic regression analysis of potential risk factors for mortality was determined. Results The mean weight of the patients at the operation was 822.81 ± 24.59. The mean age at the operation was 28.97 ± 2.20 days. No surgery-related mortalities occurred. Four short-term mortalities occurred after the operation (12.5%) before the patients could be discharged. Three were due to sepsis, and one was due to necrotizing enterocolitis. According to the linear regression analysis, no other variables were found to be statistically significant for predicting mortality. A negative linear correlation was found between the weight of the patients at the operation and extubation time (p = 0.39; r = −0.39). Conclusion The surgical outcome of anterior mini-thoracotomy for PDA closure in neonates is compatible with good results. This technique may be advantageous for extremely low birth weight infants and results in less traction on the lungs. doi:10.1111/jocs.12135 (J Card Surg 2013;28:461–464)

Background: In this study, we present our early and mid-term results using two different types of handmade polytetrafluoroethylene (PTFE) valved conduits in patients who require right ventricular outflow reconstruction. Methods: Between March 2021 and May 2024, 72 patients (30 males and 42 females; median age: 69 (IQR: 26–123) months) who underwent implantation of a handmade bicuspid or tricuspid valve PTFE conduit for right ventricular outflow reconstruction were retrospectively analyzed. Preoperative, postoperative, and follow-up echocardiograms were also evaluated. Results: The first postoperative echocardiography revealed that 11 (36.7%) patients had mild regurgitation, and 3 (10%) patients had moderate regurgitation in the bicuspid group initially, while only 7 (16.7%) of the patients in the tricuspid group had mild regurgitation (p = 0.004). None of the patients required reintervention in the early postoperative period because of conduit dysfunction. In the mid-term follow-up, the mean follow-up duration was 22.4 ± 11 months. PTFE-valved conduit dysfunction was observed in three patients in the bicuspid group, while no dysfunction was observed in the tricuspid group (p = 0.049). Even if the median peak gradient was found to be slightly higher in the tricuspid group [15 (IQR: 0–25) vs. 0 (IQR: 0–15)] (p = 0.032), no conduit dysfunction was reported during follow-up. Kaplan–Meier analysis demonstrated that the tricuspid conduit group maintained 100% freedom from dysfunction during the 24-month follow-up period. In contrast, the bicuspid group had rates of 90%, 87%, and 83% at 6, 12, and 24 months, respectively (log-rank p = 0.016). Conclusions: The ePTFE valved conduits provide significant advantages in terms of durability, biocompatibility, cost-effectiveness, and hemodynamic performance for right ventricular outflow tract reconstruction in pediatric cardiac surgery. The findings of our study suggest that tricuspid valve design offers better potential for preventing conduit dysfunction.

ÖZET Giriş: Fontan ameliyatı tek ventrikül fizyolojisi için en sık yapılan ameliyatlardan biridir. Ameliyat sonrasında hastalar, uzamış plevral efüzyon ve başka komplikasyonlar açısından risk altındadır. Bu çalışmada; pulmoner arter basıncının, fenestrasyon yapılıp yapılmamasının, kullanılan ekstra kardiyak greftin çapının ve tromboproflaksi rejimlerinin Fontan ameliyatı sonrası uzamış plevral efüzyon gelişimine olan etkilerini araştırmayı amaçladık. Materyal ve Metotlar: Hastane veri tabanında Fontan ameliyatı yapılan hastalar araştırıldı. Plevral efüzyon oluşumuna etki edebilecek potansiyel faktörler için lojistik regresyon modeli oluşturuldu. Bulgular: Toplam 67 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 63 ay, ortalama kilosu 18 kg'dı. Plevral efüzyon 34 (%51) hastada gelişti. Tromboprofilaksi rejimi açısından değerlendirildiğinde warfarin kullanan 28 (%42) hastanın 19'unda (%68), aspirin kullanan 39 (%58) hastanın ise 15'inde (%38) plevral efüzyon görüldü. Fenestrasyon yapılmayan grupta (43 hastanın 26'sı %60) yapılanlara göre (24 hastanın 8'i %33) plevral efüzyon sıklığı anlamlı olarak daha yüksekti (p=0,03). Lojistik regresyon analizinde, fenestrasyon yapılanlarda daha az (OR, 0,3; 95% CI, 0,1-0,96; p=0,04), buna karşın warfarin kullananlarda ise daha sık (OR, 3,4; 95% CI, 1,1-9,8; p=0,02) plevral efüzyon riski olduğu görüldü. Ameliyat sonrası pulmoner arter basıncı 13 mmHg'ın üzerinde olanlarda plevral efüzyon sıklığı anlamlı olarak daha fazlaydı (p=0,002). Sonuç: Plevral efüzyon oluşumunun, ameliyat sonrasında pulmoner arter basıncının yüksek olması, warfarin kullanılması ve fenestrasyon yapılmaması ile arttığı görüldü. Greft size indeksi göreceli olarak büyük olanlarda pulmoner arter basıncı daha düşüktü; ancak bu durum plevral efüzyon oluşumuna etki etmedi.

Background: This study aimed to present our experience with transcatheter pulmonary debanding, focusing on patient outcomes. Methods: The retrospective study was conducted with 32 patients (17 males, 15 females; mean age: 3.6±2 years; range, 0.5 to 8.8 years) who underwent transcatheter pulmonary debanding between January 2010 and January 2024. The patients were evaluated in two groups. In Group 1 (n=24), total debanding was targeted for patients with spontaneously closed or restrictive ventricular septal defects or those suitable for transcatheter ventricular septal defect closure. In Group 2 (n=8), palliative debanding was utilized in children with ongoing band requirement. Results: The median body weight was 15 kg. In Group 1, the mean right ventricle-to-aortic pressure ratio (RVp/Aop) was 0.91±0.21 before the procedure, which decreased to a mean of 0.33±0.20 after the procedure. In Group 2, the mean RVp/Aop was 1.31±0.47, which decreased to 0.77±0.13 after transcatheter palliative debanding. The mean peripheral oxygen saturation was 80±6% before the procedure and 94±2.5% after the procedure. Transcatheter debanding was successful in all patients when surgical pulmonary banding was performed with 6-0 Prolene and polytetrafluoroethylene band material. Conclusion: Transcatheter banding is a safe and effective procedure that minimizes the need for reoperation.