Background: Sternal wound infection, especially deep sternal wound infection, is a serious complication after open heart surgery. It leads to a marked increase in hospital stay, financial expenses, and mortality. Treatment is primarily surgical and may be divided into conventional treatment methods and negative pressure wound therapy. Materials and methods: Between 2010 and 2021, 77 patients presenting back after cardiac surgery with deep sternal wound infection were treated surgically. Conventional treatment methods were utilized in 45 patients and included wound revision with primary closure, continuous wound irrigation, and open treatment with secondary closure. Negative-pressure wound therapy (NPWT) was applied in 32 patients. The two treatment arms were compared by two primary outcomes – rate of recurrent infection and hospital mortality. Predictors of mortality and infectious recurrence were identified using multivariate logistic regression. Results: Recurrent infection occurred in 18.2% of cases and mortality was 13% in the whole group. NPWT was more successful in preventing recurrent infection OR: 5.4 (95% CI: 1.1-27.5; P = 0.044) than conventional treatment and more than moderate left ventricular systolic dysfunction (EF<40%) predisposed to infectious recurrence - OR: 4.7 (95% CI: 1.05-22.1; P = 0.049). Recurrent infection itself was the strongest predictor of mortality in the multivariate model OR: 0.14 (95% CI: 0.03 - 0.58; P = 0.007). Conclusion: NPWT as an initial method of wound preconditioning followed by definitive wound closure effectively reduces the rate of infectious recurrence and patient mortality. It may become the modality of first choice when dealing with complicated incisional infections following heart surgery.

The direct cannulation of the ascending aorta is a safe alternative for patients with AADA, offering the opportunity for antegrade cerebral perfusion. It is easy to perform, reliable, and associated with acceptable early results.

Citation: Stoitsev GJ, Gavrilov V, Manchev G, Markov B, Goranovska V, Tsankov B, Gegouskov V. Therapy with L-thyroxine and omnadren after cardiac operation. A case report. Folia Med (Plovdiv) 2019;61(4):650-4. AbstractBackground: Cardiopulmonary bypass in cardiac surgery produces systemic inflammatory response and catabolic state. Severe stress frequently causes abnormalities in thyroid hormones in the absence of primary thyroid disease, defined as sick euthyroid syndrome (SES). Materials and methods:Supplementation therapy with thyroid and anabolic hormones in combination with an adequate nutritional support has been used to improve outcome in critically ill patient after cardiac surgery.Results: Administration of thyroid and anabolic hormones significantly improved patient's condition. Conclusions:Supplementation therapy with thyroid and anabolic hormones in combination with an adequate nutritional support could be used to improve hemodynamics, achieve transition to anabolic metabolism and enhance recovery, which could eventually help for a reduction in post-operative morbidity and mortality. Адрес для корреспонденции: Георги Й. Стоицев, Кафедра кардиохирургии, УМБАЛ "Св. Ана", ул. "Димитр Молов" № 1. Образец цитирования: Stoitsev GJ, Gavrilov V, Manchev G, Markov B, Goranovska V, Tsankov B, Gegouskov V. Therapy with L-thyroxine and omnadren after cardiac operation. A case report. Folia Med (Plovdiv) 2019;61(4):650-4. doi: 10.3897/folmed.61.e47962. АбстрактВведение: Кардиопульмональное шунтирование в кардиохирургии вызывает системный воспалительный процесс и катаболическое состояние. Острый стресс часто вызывает нарушения гормонов щитовидной железы при отсутствии первичного заболевания щитовидной железы, называемого синдромом эутиреоидной болезни (SES).

INTRODUCTION:We report a case of ectopic thyroid tissue of the heart (struma cordis), which is an exceptionally rare defect in the embryonic development of the primitive gut tube. The most common location in the heart is the right side of the ventricular septum and the right ventricular outflow tract (RVOT). METHOD: The patient is 57 years old woman, presenting with symptoms of heart failure and a systolic murmur best heard at second left intercostal space. The patient had right ventricular hypertrophy measuring 9 mm in thickness. HISTOLOGICAL DIAGNOSIS: It confirmed differentiated thyroid tissue in the tumor-macro and microfollicular goiter with cholesterol deposits and PAS-positive for colloid. CONCLUSION: First of all we excluded metastatic thyroid carcinoma. Because of the lack of history of deep venous thrombosis and the location of the tumor in an area with high rate of the blood flow, we ruled out the possibility of intraventricular thrombus and suggested neoplasm.