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.

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.

Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis. Patch extension or interposition of prosthetic grafts with no growth potential have been used in instances of high partial anomalous pulmonary venous connection (PAPVC) to SVC. We report three cases of high PAPVC to SVC using an innovative technique of incorporating the azygos vein into the Warden anastomosis for a tension-free suture line.

Background: Ruptured aneurysms of sinus of Valsalva are defects of the aortic media, which are uncommon yet present concomitantly with either ventricular septal defect, aortic insufficiency or both. Here, we analyse retrospectively outcomes of patients operated on in the last two decades. Patients and Methods: 151 cases of ruptured aneurysms of sinuses of Valsalva were treated here between January 2000 and December 2020. The majority (96%) arose from the right coronary sinus. The right ventricular outflow was the most common site of rupture (56.2%). Ventricular septal defect was associated in 24 patients (16%) all of whom had ruptured right sinus, of which 8 (33%) were of subpulmonic subtype. Aortic incompetence was found in 45 patients (43.3%). Elective surgery was offered to 78 patients (51.6%), while the rest had defects closed by interventional devices. Surgical conversion for device embolization occurred in 12 patients (7.94 %). The defect was closed through the aortic root in 13 patients (14.4% of 90) and employing the bicameral technique (root and ruptured chamber) in the remaining 87 patients. 18 patients (20%) underwent aortic valve repair while 5 (5.5%) underwent aortic valve replacement. Results: We had no hospital deaths, however 4 operated patients (2.6%) had comorbidities. Follow‐up ranged from 1 to 20 years (mean 13 ± 5). There were 3 deaths in this period, and among the majority, quality of life was uneventful. Conclusion: Surgical correction for ruptured aneurysms of Valsalva provides prudent results and must be the preferred modality of treatment in acute and chronic presentation.

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