IntroductionSignificant anatomical and functional changes occur following pneumonectomy. Mediastinal structures displace toward the side of the resected lung, pulmonary reserve is reduced. Owing to these changes, surgical access to heart and great vessels becomes challenging, and there is increased risk of postoperative pulmonary complications.MethodsWe performed a mitral valve replacement combined with a Ravitch procedure in a young female with previous left pneumonectomy and pectus excavatum.ResultsShe was discharged on postoperative day 9 and remains symptom-free 3 months after surgery.ConclusionThorough preoperative evaluation and intensive respiratory physiotherapy are essential before performing cardiac operations on patients with previous pneumonectomy.

Objectives: Sternotomy is still the most commonly used incision in cardiac surgery. Sternal complications are seen at a rate of 0.5% to 6.1%. Sternal dehiscence increases morbidity and mortality after cardiac surgery. To prevent dehiscence, the search for alternative sternum closure methods continues today. Titanium plates produced for this purpose can also be used in patients who are re-operated due to sternal dehiscence. In our study, we investigated the effects of titanium plate repair and robicsek repair on the results in patients who were reoperated due to sternal dehiscence. Methods: Thirty-four patients who underwent reoperation due to sternal detachment in our hospital between September 2013 and December 2020 and had no signs of infection in the pre-operative period were analyzed retrospectively. The patients were divided into three groups according to the surgical method applied. These groups are as follows: Group 1: The cases in which the robicsek method was used, Group 2: the cases in which the titanium plate method was used, and Group 3: The cases where the robicsek + titanium plate methods were used together. Results: There was no significant difference between the groups in terms of basic demographic characteristics and risk factors, leading to sternal dehiscence. There was no significant difference between the groups in terms of mortality and length of hospital stay. Considering the infection rates in the post-operative period, 20% and 21.4% post-operative infections were detected in Group 1 and Group 3, respectively, while 70% post-operative infection was observed in Group 2, which was repaired only with the Robicsek technique (p<0.05). Conclusion: As supported by most studies in the literature, titanium plate application provides a superior sternum stabilization compared to the classical wire cerclage method. When evaluated in terms of cost-effectiveness, titanium plate method can be applied in high-risk patients in terms of sternal dehiscence.

Carotid body tumors (CBTs), also known as paragangliomas, are rare neuroendocrine hypervascularized neoplasms. They are slowly growing pulsatile masses, usually benign, near the carotid arteries. Besides the endocrinological effects of the tumor, compression and hypervascular invasion effects can be also seen. A 63-year-old female patient who had hearing loss in the right ear was admitted to our clinic. Coil embolization was performed to the major arteries feeding the tumor before total excision of the tumor. A decrease in the hearing loss was observed after the operation which might be due to compression and hypervascular steal effects of the tumor. In conclusion, hearing functions can be improved with success CBT resection.

In this study, we aimed to examine the relationship between preoperative pulmonary function test (PFT) parameters and postoperative length of invasive mechanical ventilation (IMV), length of intensive care unit (ICU) and hospital stay in patients who underwent coronary artery bypass grafting (CABG). Patients and methods:Between October 2017 and July 2018, a total of 100 patients (84 males, 16 females; mean age: 61.1±10.0 years; range, 41 to 85 years) who underwent elective CABG surgery for the first time and who did not have any additional cardiac problems, except for coronary artery disease, had an ejection fraction (EF) of ≥30% and underwent preoperative PFTs were retrospectively analyzed. The percent forced vital capacity (FVC %) predicted from the PFT values and percent forced expiratory volume in 1 sec (FEV 1 %) were recorded. An IMV duration of ≤12 h was considered normal and >12 h was considered prolonged. A length of ICU stay for ≤24 h was considered normal and >24 h was considered prolonged. A length of hospital stay for ≤7 days was considered normal and >7 was considered prolonged. Results:As the predicted FVC (%) value decreased in the preoperative PFTs, the length of IMV, length of ICU and hospital stay increased significantly (p=0.040, p=0.036, p=0.009, respectively). In terms of the predicted FEV 1 (%) value, as the predicted FEV 1 (%) value decreased, the duration of IMV, length of ICU and hospital stay prolonged (p=0.023, p=0.044, p=0.024, respectively). Conclusion:It is possible to have an idea about postoperative duration of ventilation, ICU and hospital stay based on PFT parameters. Also, the result would be more realistic when adapted to existing scoring systems to assess postoperative complications. Therefore, we believe that scoring systems for evaluating complications after cardiac surgery should include not only chronic lung disease, but also PFT parameters that give a more detailed information.

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