IntroductionPericardial effusion and atrial fibrillation occur commonly after coronary artery surgery.Aim of the studyA prospective randomized clinical trial was conducted to evaluate the effects of posterior pericardiotomy on the occurrence of pericardial effusion, tamponade, and atrial fibrillation.Material and methodsThe study group consisted of 96 patients (77 male and 19 female) at a mean age of 58.1 ± 9.8 years. The patients were randomly assigned to one of three study groups: patients undergoing posterior pericardiotomy (group I, n = 30), controls (group II, n = 33), and patients with additional posterior pericardial drainage tubes (28 mm) who did not undergo posterior pericardiotomy (group III, n = 33).ResultsPostoperative hospitalization (p = 0.03; 11.56 ± 10.64) and reoperation due to tamponade (p = 0.019; 12.1%) were significantly higher in group II. Extensive pericardial effusions were detected in one patient on the first postoperative day (group II, n = 1), in one patient on the fifth postoperative day (group III, n = 1), and in one patient on the 30th day after the operation (group III, n = 1). Pericardial effusion exhibited regression in group I on postoperative day 30 (p = 0.028). A higher rate of postoperative atrial fibrillation was noted in group I, but no significant differences were found between the groups with regard to postoperative atrial fibrillation.ConclusionsPatients who did not undergo posterior pericardiotomy or did not receive posterior chest tubes exhibited residual pericardial effusion, required longer hospitalization, and had to be reoperated due to tamponade. Both posterior pericardiotomy and the use of posterior tubes are effective in the early postoperative period.

Complications after percutaneous atrial septal defect closure such as residual shunting or device-related events are generally treated using conventional sternotomy or thoracotomy incisions. In these cases, minimally invasive approaches including mini-sternotomy, mini-thoracotomy or endoscopic techniques can also be used in the management of complications, residual defects and concomitant procedures. However, robotic surgery is a reasonable alternative for removal of septal occluder devices and concomitant repair procedures to prevent cardiopulmonary morbidities. Herein, we report an adult, who underwent a totally endoscopic robotic removal of septal occluder device, closure of septal defect with autologous pericardial patch and tricuspid valve annuloplasty through a right atriotomy approach.

A 32-year-old male patient was admitted to our hospital because of dyspnea and fatigue. He had a history of aortic valve replacement and a simultaneous Nicks procedure 4 years earlier because of a small aortic root and aortic regurgitation. Results of laboratory tests such as leukocyte count, C-reactive protein, and procalcitonin were normal. Blood cultures were sterile. Transthoracic echocardiography demonstrated severe mitral regurgitation. Subsequent transesophageal echocardiography detected a systolic jet flow on the anterior mitral leaflet and perforation (Figs 1A-1D [Ao ¼ aorta; Fig 1.

The PP with intrapericardial tube approach is safe, easy, and effective in the prevention of PE, cardiac tamponade, and AF. The use of this approach may reduce the risk of developing AKI during the postoperative period. Besides, this technique also reduces the length of hospital stay.

Background: Our goal is to evaluate postoperative outcomes of continuous versus interrupted suturing techniques in ventricular septal defect (VSD) closure surgery. Methods: The study included 286 patients with isolated VSD who underwent VSD closure surgery between June 2010 and April 2017. VSD closure was performed by using the interrupted suturing technique in group 1 (n = 74, 25.9%) and the continuous suturing technique in group 2 (n = 212, 74.1%). The groups were compared in terms of mortality and rates of clinical morbidities such as infection and complete atrioventricular (AV) block. Results: Early mortality occurred in 3 cases in group 1 (4.0%) and 5 cases in group 2 (2.3%). There was no late mortality in either group. One patient from both groups required extracorporeal membrane oxygenation (ECMO) at postoperative 48 hours. Five patients in group 1 (6.8%) and 11 patients in group 2 (5.2%) developed complete AV block postoperatively and received permanent pacemaker implants. Conclusion: Complication rates were similar between the patient groups operated on by using continuous and interrupted suturing techniques in our study, suggesting that neither technique is superior for VSD closure surgery.

ÖZETGi rifl: Bu çalışmanın amacı nöroblastomlu (NBL) çocuklarda tanısal özelliklerin belirlenmesidir. Gereç ve Yöntem: Hastaların kayıtları retrospektif olarak değerlendirildi. Yaş, başvuru yakınmaları ve süreleri, tümör yerleşimi ve evre belirlendi. Hemogram, laktat dehidrogenaz (LDH) ve VMA sonuçları kaydedildi. Veriler istatistiksel olarak karşılaştırıldı. Bulgular: NBL'lu 115 hastanın ortalama yaşı 2,57±2,49 yıl (sınırlar 0-12) olup %32'si bir yaşından, %89'u ise beş yaşından küçüktü. Hastaların %74,8'inde abdominal (%66'sı adrenal, %8,8'i adrenal dışı), %12'sinde paraspinal, %7'sinde mediastinal ve %3,5'inde pelvik kitle saptandı. Olguların %30,4'ünde evre 1 ve 2, %13'ünde evre 3, %46,1'inde evre 4 ve %10,4'ünde evre 4S hastalık belirlendi. Olguların %11'i klinik özellikler, sitolojik bulgular ve VMA ölçümü ile tanı aldı. VMA yüksekliği %83 oranında idi. Ortanca yakınma süresi 6,5 hafta olarak bulundu. En sık gözlenen yakınmalar solukluk, karın şişliği, karın ağrısı ve kemik ağrısı idi. Sonuç: NBL küçük çocukların tümörüdür. Primer yerleşime ve yaygınlığa göre klinik bulgular değişmektedir. Anemi, karın ağrısı ve kemik ağrıları uyarıcı bulgulardır. (Gün cel Pe di at ri 2013; 11: 6-12) Anah tar ke li me ler: Nöroblastom, klinik özellikler, metastaz SUM MARYIn tro duc ti on: The aim of this study was to evaluate the diagnostic characteristics of children with neuroblastoma (NBL). Materials and Methods: Hospital records were reviewed retrospectively. Age, symptoms and their durations, tumor site, stage and results of complete blood count, LDH and VMA were recorded. Statistical comparisons and calculations were made. Results: The mean age at diagnosis was 2.57±2.49 yrs (ranges 0-12). Of children, 89% were under 5 years and 32% were below 1 year. The most common tumor sites were abdomen [74.8%; (adrenal 66%), (non-adrenal 8.8%)], paraspinal region (12%), chest (7%) and pelvis (3.5%). Most of the tumors were in advanced stage (stage 1 and 2= 30.4 %, stage 3 and 4=13% and 46,1% and stage 4S=10.4%). The diagnosis was made from bone marrow cytology and increased VMA in 11% of the cases. VMA level was high in 83% of the patients. Median duration of symptoms was 6.5 weeks. The most frequent complaints were pallor, abdominal mass, abdominal pain and bone pain. Conclusions: NBL mainly involves young children. Clinical presentation varies with primary tumor site and dissemination. Anemia, abdominal and bone pain have diagnostic signifi cance. (Jo ur nal of Cur rent Pe di at rics 2013; 11: 6-12)

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Background: Surgical indications for moderate to severe tricuspid regurgitation (TR) during atrial septal defect (ASD) closure are still unclear.