The Robicsek technique for sternal closure and the use of a thorax support vest postoperatively are highly effective in preventing sternal dehiscence after cardiac surgery in patients with moderate and severe chronic obstructive pulmonary disease.

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We report the successful closure of an extracardiac Fontan fenestration with a bio-absorbable device, which may be refenestrated by a transcatheter route when needed, in a 10-year-old boy. The patient presented with cyanosis two years after an extracardiac Fontan operation. Echocardiography revealed a moderate shunt from the Fontan circulation into the systemic circulation with a mean pressure gradient of 3-4 mmHg. Treadmill testing revealed a significant decrease in oxygen saturation (down to the low 50's from a baseline level of 80-85%). Cardiac catheterization revealed normal pressure in the Fontan circuit. A temporary balloon occlusion test showed that the defect was suitable for permanent occlusion. The fenestration was then occluded by a bio-absorbable Biostar (NMT medical, Boston, USA) atrial septal occluder device. The oxygen saturation on room air increased up to 95% after closure.

Rheumatoid heart disease and the mitral stenosis secondary to it in the long term are still important cardiovascular problems in developing countries. Percutaneous balloon mitral valvuloplasty is a valid treatment option with low complication rates for relieving the signs and symptoms of selected patients with mitral valve stenosis. In this report, we describe subacute mitral regurgitation secondary to anterior leaflet rupture following percutaneous balloon mitral valvuloplasty and the management strategy in a 54-year-old female patient. Such a complication is rare in experienced hands in the current era.

Sternal infection has become a rare but challenging problem with significant mortality and morbidity rates since the introduction of sternotomy. Reported rates of mediastinal and sternal infection range from 0.4% to 5%. The ideal reconstruction after sternal debridement is still controversial. Different methods, such as debridement and open packing with continuous antibiotic irrigation, or sternectomy with omental or muscle transposition have been proposed. In this study, we present the cardiac reoperation of a 52 year old man with corrected transposition of great arteries (c-TGA) who had undergone a previous omentoplasty for postoperative mediastinitis.

Purpose: Anomalous origin of the left coronary artery from the pulmonary artery is optimally treated by creating a dual coronary system. Our aim was to review the results of operations performed in these patients and determine the intermediate-term outcomes for left ventricular function and mitral regurgitation. Methods: Between July 2004 and January 2009 seven patients (5 boys, 2 girls) aged between 4 months and 12 years (median, 4.5 years) were operated for anomalous origin of the left coronary artery from the pulmonary artery. The surgical correction was either performed by direct implantation (58%) or restoration of a composite tunnel (42%). Simultaneous mitral annuloplasty was performed in one patient with severe mitral regurgitation and simultaneous total correction of tetralogy of Fallot was performed in another. Results: There was no hospital or late deaths. Postoperative echocardiograms demonstrated a significant improvement in the left ventricular ejection fraction (52% ± 6% versus 39% ± 8%, P = 0.02) and mitral regurgitation (11% mild versus 48% moderate, P = 0.02) compared to those obtained preoperatively. Conclusion: Direct re implantation of the left coronary artery to the aorta and restoration of a composite tunnel from aortic and pulmonary artery walls are equally effective techniques with an acceptable operative mortality, excellent cardiac recovery, and intermediate survival.Keywords: congenital cardiac disease, echocardiography, mitral valve, mitral regurgitation, left ventricular function, pulmonary artery, left coronary artery Ann Thorac Cardiovasc Surg 2012; 18: 12-17 doi: 10.5761/atcs.oa.11.01696 genital heart disease.3) It is one of the most common causes of myocardial ischemia and infarction in children, and if not treated, results in mortality rate of up to 90% within the first year of life. 4) During the neonatal period, increased pulmonary artery pressures, resulting from the high pulmonary vascular resistance, lead to an antegrade flow from the pulmonary artery into the anomalous left coronary artery. However, as the pulmonary vascular resistance gradually decreases, left-to-right shunting increases. Consequently, left ventricular perfusion becomes dependent on intracoronary collateral circulation from an enlarged right coronary artery. Coronary steal results in ischemia, and subsequent infarction of left ventricular myocardium and anterolateral papillary muscle ischemia leads to mitral regurgitation. The current standard management in patients with anomalous origin of the left

Among low-risk patients (defined according to EuroSCORE criteria) who underwent left anterior descending coronary artery bypass, the results obtained with the on-pump and off-pump methods showed no significant differences with respect to morbidity or mortality.

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