Diaphragmatic paralysis (DP) after cardiac surgery is an important complication especially in infants. We analyzed the incidence, clinical course, surgical management and follow up of the patients with DP, retrospectively. Between 1996 and 2005, 3,071 patients underwent cardiac surgery. Total number of patients with DP was 152 (4.9%). Out of 152 patients, 42 were surgically treated with transthoracic diaphragm plication (1.3%). The overall incidence of diaphragm paralysis was higher in correction of tetralogy of Fallot (31.5%), Blaloc-Taussig (B-T) shunt (11.1%) and VSD closure with pulmonary artery patch plasty (11.1). The incidence of DP which require plication was higher in B-T shunt (23.8%) arterial switch (19%) and correction of tetralogy of Fallot (11.9%). Mean and median age at the time of surgery were 17.8 +/- 3.6 and 6 months, respectively. Median time from cardiac surgery to surgical plication was 12 days. Indications for plication were repeated reintubations (n = 22), failure to wean from ventilator (n = 12), recurrent lung infections (n = 5) and persistent respiratory distress (n = 3). Mortality rate was 19.1%. Being under 1 year of age, pneumonia and plication 10 days after mechanical ventilation were associated with higher incidence mortality (P < 0.05). Phrenic nerve injury is a serious complication of cardiac surgery. It is more common after some special procedures. Spontaneous recovery is very rare. Being under 1 year of age, plication after 10 days from the surgery and pneumonia are major risk factors for mortality even in plicated patients. Transthoracic plication is helpful if performed early.

Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery.

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Extrapleural haematoma (EH) is a rare clinical condition of which four cases are presented. Different etiologies were encountered. Identical findings were found on the chest X-ray. Two cases were secondary to spontaneous rib fracture and the other two were iatrogenic. Surgical exploration was necessary in one patient following pleural biopsy. Medical treatment and clinical observation were the treatment of choice in the remaining three stable patients.

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RA had a significantly greater prevalence of atherosclerosis than the same patients' ITA. There was a strong correlation between ITA atherosclerosis and age. The presence of calcification may lead surgeons to avoid an extra incision according to risk factors, although most of these are not predictive.

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ÖZETAmaç: Çalışmamızın amacı, kardiyopulmoner baypas (KPB) uygulanan ve uygulanmayan (OPCAB) hastalarda intestinal iskemi ile intestinal yağ asidi bağlayıcı protein (I-FABP) arasında ilişki olup olmadığını belirlemektir. Yöntemler: Çalışma prospektif, gözlemsel olarak planlandı. Elektif koroner arter baypas greftleme cerrahisi uygulanacak 50-70 yaşları arasında hastalar ardışık olarak çalışmaya alındı. Kardiyopulmoner baypas uygulanan 35 hasta birinci grup (CPB), uygulanmayan 16 hasta ikinci grup (OPCAB) olarak kabul edildi. Gruplar arası ve grup içi karşılaştırmalar Student's t, Mann-Whitney U, Friedman ve Wilcoxon testleri ile analiz edildi. Bulgular: Kardiyopulmoner baypas uygulanan grubun I-FABP düzeylerinde operasyon sonunda, başlangıca göre anlamlı yükselme olurken (p<0.005), postoperatif 12. ve 24. saatlerde operasyon bitişine göre anlamlı düşme görüldü (sırasıyla p<0.001, p<0.001). Kardiyopulmoner baypas uygulanmayan grupta ise operasyon sonunda operasyon başlangıcına göre yükselme görülürken (p<0.001), postoperatif 24. saatte operasyon başlangıcına göre anlamlı düşme görüldü (p<0.001). Her iki grubun I-FABP düzeyleri cerrahi bitiminde preoperatif değerlere göre anlamlı şekilde yükseldi. Sonuç: Çalışmamız sırasında hiçbir hastamızda intestinal iskemi görülmezken, I-FABP düzeylerindeki değişiklik bize açık kalp cerrahisi geçiren hastalarda intestinal iskemi monitörizasyonunda I-FABP'nin kullanılabileceğini düşündürdü. ABSTRACTObjective: The aim of this study was to determine whether serum levels of intestinal type fatty acid binding protein (I-FABP) are related to intestinal ischemia in patients undergoing coronary bypass surgery. Methods: The study was planned as prospective, observational. Elective coronary artery bypass candidate patients between ages of 50 and 70 were consecutively included in the study. Thirty-five patients scheduled for cardiopulmonary bypass (CPB) were identified as the CPB group and 16 patients not scheduled for CPB were identified as the off-pump coronary artery bypass surgery (OPCAB) group. The variables between and within the groups were analyzed with Student's t, Mann-Whitney U, Friedman and Wilcoxon tests respectively. Results: In both CPB and OPCAB groups, I-FABP level at the end of the operation was significantly higher than that noted at the beginning of the operation (p<0.005). In the CPB group, there was a significant drop in I-FABP from the end of the operation to each of the postoperative time points (12 th hour and 24 th hour) (respectively p<0.001, p<0.001). In the OPCAB group, the I-FABP levels at both postoperative time points were lower than that at the end of the operation (p<0.001), and the level at 24-hour post-surgery was significantly lower than at both the end-of-operation I-FABP value (p<0.001) and the 12-hour post-surgery I-FABP value. Conclusion: Since we have not observed any intestinal ischemia through our research, slight changes of I-FABP measurements make us believe that I-FABP would be a valuable way to monitor for intestinal ischemia in patients w...