Patients undergoing cardiovascular and thoracic procedures are at an accentuated risk of higher morbidity and mortality, which are a consequence of the proliferative nature of the severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) on the lung vasculature, which in turn reflects as a cascading effect on the interdependent physiology of the cardiovascular and pulmonary organ systems. These are secondary to systemic inflammatory response syndrome and immunosuppressive responses to surgery and mechanical ventilation. Thus, the need to establish guidelines for the practice of cardiothoracic surgery which is safe for both the patient and the healthcare team presents as a priority, which is the mainstay of this article.

Background: We reviewed our experience with ruptured sinus of Valsalva aneurysms (RSOV) to determine a correlation with preexisting heart failure (HF) and coexisting cardiac lesions (aortic regurgitation [AR] and ventricular septal defect [VSD]) to postoperative left ventricular (LV) dysfunction and postoperative outcomes. Materials and Methods: Retrospective review of RSOV cases over 15 years showed that RSOV repair was done in 87 patients. We looked for patients who presented with HF and patients having AR and/or VSDs. Statistical analysis was done to see if the coexisting lesions and preoperative HF were associated with postoperative LV dysfunction. Chi-square test was used on contingency table for statistical analysis. Complications in the postoperative period and prolonged Intensive Care Unit stay were noted. Results: 17% (15/87) presented with HF. Fifty-two patients had moderate to severe AR and 50 patients had VSD. Seventeen patients had postoperative LV dysfunction. The correlation of preoperative HF and coexisting lesions with postoperative LV dysfunction was not statistically significant. Two patients underwent redo surgery for residual RSOV and AR. Two patients had arrhythmias. One patient had cerebrovascular accident. No mortality was seen in the study. Conclusion: Preoperative HF and the presence of VSD and/or AR have no statistical significant correlation with postoperative LV dysfunction. As the outcome of RSOV repair is good, all patients need to undergo early repair to avoid complications.

Protez aort kapakçığının intermitan disfonksiyonu nadir, fakat saptanması güç olabilen yaşamı tehdit eden bir durumdur. Klinik tablo kendini yük/perfüzyon dengesizliğine bağlı şiddetli bir akut iskemi veya kalp yetmezliği olarak gösterebilir. Bu yazıda inen aort anevrizması ile birlikte biküspid aort kapakçık stenozu nedeniyle beş yıl önce Bentall ameliyatı yapılan, protez aort kapakçığında intermitan disfonksiyon olan 37 yaşında bir kadın olgu sunuldu. Elektrokardiyografide aVR ve V1 derivasyonlarda geçici ST yükselmesinin eşlik ettiği sinüs taşikardi ve I, II, III, aVF ve V3-V6 derivasyonlarında ST çökmesi izlendi. Fizik muayene ve laboratuvar sonuçları normal olmakla birlikte, transtorasik ekokardiyografide sol ana ostiumun yakınındaki kapaktan köken alan flep benzeri pannus izlendi. Koroner anjiyografide koronerler normaldi. Hastaya ameliyat planlandı ve pannus eksize edildi. Ameliyat sonrası dönem sorunsuzdu.Anah tar söz cük ler: Akut koroner sendrom; intermitan aort yetmezliği; pannus.

Background: Patient prosthesis mismatch is a real problem observed in patients receiving aortic valves too small for their body surface area. This situation is entirely preventable with the apt use of root augmentation procedures. This study aims to evaluate and analyze short-term outcomes in patients who have undergone root enlargement procedures.Methods: Fifty-five patients with ages ranging from 11 to 65 years (36.74 ± 13.27), who have undergone root enlargement procedures between January 2009 and January 2019 are recruited for this study. The group comprises 23 males (41.8%) and 32 females (58.2%). Admission and follow-up parameters recorded over a period of 1 year were used for analyzing outcomes. The mean iAVA (aortic valve area indexed to body surface area) of the group was 0.49 ± 0.06 cm 2 /m 2 .Results: There was a significant increase in the indexed aortic valve area after root enlargement surgery from 0.49 ± 0.06 to 1.09 ± 0.19 cm 2 /m 2 . The difference was statistically significant (p < .05). St Jude Masters bileaflet prosthesis resulted in the highest iEOA (1.29 ± 0.18 cm 2 /m 2 ). TTK Chitra monoleaflet valve was the most commonly used valve in 61.81% of the cohort. At 1 year follow-up, there was a progressive decrease in left ventricle (LV) mass Index and mean gradients resulting in progressive improvement in the New York Heart Association functional class among patients. Conclusion:In experienced hands, root enlargement procedures result in good curative outcomes for patients through effective LV regression and symptom resolution on a short-term basis.

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We describe a case of a 46-year-old man with calcified amorphous tumour in the right atrium and significant coronary artery disease. Preoperative investigations revealed a polypoid oscillating mass arising from the interatrial septum and attached to the tricuspid valve annulus. On-pump complete extirpation of the tumour with concomitant coronary artery bypass grafting was performed successfully. The patient’s postoperative course was uneventful.

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