BackgroundConstrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. The purpose of this study was to evaluate the long-term outcomes following treatment of constrictive pericarditis by pericardiectomy.MethodsBetween September 1992 and May 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively examined. Demographic, pre-, intra- and postoperative data and long-term outcomes were analyzed.ResultsThirty of the patients were male, the mean age was 45.8 ± 16.7. Aetiology of constrictive pericarditis was tuberculosis in 22 (46.8 %) patients, idiopathic in 15 (31.9 %), malignancy in 3 (6.4 %), prior cardiac surgery in 2 (4.3 %), non-tuberculosis bacterial infections in 2 (4.3 %), radiotherapy in 1 (2.1 %), uraemia in 1 (2.1 %) and post-traumatic in 1 (2.1 %). The surgical approach was achieved via a median sternotomy in all patients except only 1 patient. The mean operative time was 156.4 ± 45.7 min. Improvement in functional status in 80 % of patients’ at least one New York Heart Association (NYHA) functional class was observed. In-hospital mortality rate was 2.1 % (1 of 47 patients). The cause of death was pneumonia leading to progressive respiratory failure. The late mortality rate was 23.4 % (11 of 47 patients). The mean follow-up time was 61.2 ± 66 months. The actuarial survival rates were 91 %, 85 % and 81 % at 1, 5 and 10 years, respectively. Recurrence requiring a repeat pericardiectomy was developed in no patient during follow-up.ConclusionPericardiectomy is associated with high morbidity and mortality rates. Cases with neoplastic diseases, diminished cardiac output, cases in need of reoperation are expected to have high mortality rates and less chance of functional recovery.

Our results did not reveal a significant benefit of either surgical technique with respect to early-term clinical outcomes in elderly CABG patients. Further investigations are needed to determine whether off-pump CABG is superior than on-pump CABG in elderly patients.

Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.

Objectives: Clinical characteristics, follow-up and treatment outcomes of patients with isolated traumatic sternal fracture were presented and our clinical experiences on these patients were shared. Methods: Between January 2010 and December 2017, a total of 87 patients with isolated traumatic sternal fracture who were admitted to the emergency department and were hospitalized, were included in this observational cohort study. Medical data of these patients were collected from hospital records and then were retrospectively reviewed. Results: There were 65 (74.7%) male and 22 (25.3%) female patients. Mean age was 42.4 ± 13.7 years (range: 17-83). The most common etiological reason was traffic accident in vehicle. Sternal fractures were localized at corpus in 64 (73.6%) patients and at manubrium in 23 (26.4%) patients. The most common concomitant pathology was rib fracture with a ratio of 23% (20 patients). Mean length of hospital stay of patients was 3.1 ± 0.8 days. During the hospitalization period, no evidence of cardiac injury was observed in any patient. Conclusions: In view of rising healthcare costs and increasing demand for acute hospital and intensive care beds, it is crucial to determine hospitalization criteria for cases with traumatic sternal fracture. We believe that the hospitalization is not necessary in isolated traumatic sternal fractures where there is no other major injury.

INTRODUCTION: Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common type of arrhythmia and it causes serious morbidity. Low levels of triiodothyronine (T3) hormone are thought to be a strong determinative factor on poor prognosis of cardiac patients. This study was planned to investigate the effect of low levels of T3 on the development of AF after off-pump coronary artery bypass surgery (OPCAB) and conventional CABG surgery. METHODS: The study was prospectively planned on 60 patients undergoing CABG surgery. Thirty of them were randomly selected among the patients undergoing OPCAB, and the other 30 were randomly selected among the patients undergoing conventional CABG surgery. Thyroid function profiles of all patients were evaluated before the operation and on the first day of postoperative period. RESULTS: The average age of the patients was 58.7± 8. After the operation, 3 patients from each group, 6 patients in total, developed AF. Postoperatively measured TT3 levels of the patients who developed AF after the operation (0.39±0.09) were found to be significantly lower than the preoperatively measured TT3 levels (0.97± 0.06) (p=0.042). Moreover, postoperatively measured fT3 levels of the patients who developed AF after operation (1.58± 0.30) were found to be significantly lower than the preoperatively measured fT3 levels (2.95±0.37) ( p=0.001). However, by univariate logistic regression analysis, it was seen that the variables that were thought to be risk factors for AF were not significantly effective. Also, when the effects of the variables were examined together by multivariate regression analysis, no significant result was found. DISCUSSION AND CONCLUSION: In our study, it was seen that low levels of thyroid hormone in patients undergoing OPCAB and conventional CABG surgery had no effect on AF development