Murat Ugurlucan

Sexually transmitted bacteria are unusual culprits for infective endocarditis (IE), often presenting a diagnostic challenge due to their atypical clinical and microbiological features. In this chapter, we explore the pathogenesis and surgical management of IE caused by these venereal pathogens, focusing primarily on Neisseria gonorrhoeae and Chlamydia trachomatis. When gonococcal bacteremia reaches the heart, the resulting valvular infection is usually acute and rapidly destructive. The bacterium tends to spread beyond the valve annulus, frequently causing severe aortic root abscesses and tissue perforation that leave no option but emergent valve replacement. C. trachomatis, an obligate intracellular organism, presents an entirely different clinical picture by running a much slower, subacute course. Because standard automated blood culture systems cannot grow these fastidious pathogens, these pathogens remain a classic driver of culture-negative IE. Pinning down the exact etiology relies heavily on specialized molecular techniques such as multiplex polymerase chain reaction (PCR), metagenomic next-generation sequencing (mNGS), and targeted serology. Ultimately, managing the complex cardiac structural damage left in the wake of these infections requires a highly tailored approach. The following sections detail current diagnostic algorithms, specific antimicrobial regimens, and the clinical thresholds for surgical intervention.

Background: Coronary artery bypass grafting (CABG) is the standard revascularization procedure, and the left internal mammary artery (LIMA) is the most widely used conduit owing to its long-term patency and favorable impact on survival. Although fibrosis and calcification are comparatively infrequent in internal mammary artery (IMA) grafts, progressive remodeling may still compromise patency. Tumor necrosis factor-α (TNF-α) is a pro-inflammatory cytokine implicated in vascular remodeling and calcification, whereas L-arginine, a precursor of nitric oxide, may exert vasoprotective effects. Aim: To investigate the effects of ex vivo TNF-α and combined TNF-α plus L-arginine treatment on the morphology, calcification, elemental composition, and biomechanical properties of human LIMA grafts. Patients and Methods: LIMA graft segments from 18 male CABG patients were allocated to one control group (G0) and two ex vivo treatment groups. Grafts were assessed using hematoxylin and eosin and Masson’s Trichrome staining under brightfield microscopy, using Alizarin Red S fluorescence staining to measure calcification, and by scanning electron microscopy with energy-dispersive spectroscopy (SEM/EDS) to assess ultrastructure and elemental composition. Scanning acoustic microscopy (SAM) was used to derive acoustic impedance as a label-free index of tissue stiffness. Results: TNF-α treatment was associated with increased acoustic impedance, consistent with graft stiffening, together with greater calcification signatures, whereas combined TNF-α and L-arginine treatment shifted impedance toward control-like values and showed more organized tissue architectures with reduced calcification. Conclusions: In this preliminary ex vivo model, L-arginine attenuated TNF-α-associated remodeling and stiffening of LIMA grafts, suggesting a potential role in supporting graft durability; larger, statistically powered studies with molecular validation are required to confirm these findings.

The present pilot study included obese 21 patients (13 females and 8 males; mean age: 33.2 ± 11.0 years) who underwent bariatric surgery between December 2021 and June 2022. Echocardiographic evaluations and brain natriuretic peptide measurements were performed preoperatively and 3 months postoperatively. All patients underwent sleeve gastrectomy, and myocardial function was assessed using standard 2-dimensional M-mode Doppler echocardiography. The mean body mass index decreased from 44.8 ± 3.2 to 34.2 ± 2.9 kg/m ² ( P < .001). Left ventricular (LV) ejection fraction increased from 62.5% ± 5.0% preoperatively to 64.8% ± 3.5% postoperatively ( P = .003). Interventricular septum, posterior wall thickness, systolic pulmonary artery pressure, P max, and isovolumic relaxation time decreased significantly ( P < .05). Left ventricular septal E′ and left ventricular lateral E ′ values increased ( P = .020 and .002, respectively). Although the mean pro- brain natriuretic peptide level decreased post-operatively, an increase was observed in 10 patients. Bariatric surgery significantly improves myocardial function, even in the absence of preoperative cardiac disease. However, given the short follow-up period, these findings reflect early myocardial changes. Further follow up with larger cohorts are warranted to interpret long-term clinical outcomes.

Background: Deep vein thrombosis (DVT) is one of the most common cardiovascular diseases and is especially prevalent in areas with environmental pollution. Bioaccumulation of toxic heavy metals may lead to deterioration of homeostasis with cellular change, endothelial dysfunction, DNA impairment and cellular signaling. The reason for this is usually the accumulation of thrombogenic toxins in the body as a result of long-term exposure or a lack of regulatory gene expression. In this study, we aimed to measure the minerals that potentially accumulate in the nail. The measurement method was laser-induced breakdown spectroscopy (LIBS), which is a form of atomic emission spectroscopy. It uses a highly energetic laser source to form a plasma of excited atoms emitting light of characteristic wavelengths. It provides accurate quantification and reveals the relationship between tissue accumulation of toxic heavy metals and DVT formation. Methods: Between January 2020 and December 2021, 100 patients diagnosed with lower-extremity deep vein thrombosis were screened in a single tertiary healthcare center. Among them, 50 patients who met the eligibility criteria and consented to participate were included in the study. An additional 50 age-matched healthy volunteers were enrolled as controls. Demographic and clinical characteristics were recorded. Nail samples were obtained from each participant, and elemental emission intensities were quantitatively analyzed using laser-induced breakdown spectroscopy (LIBS). Results: No difference in clinical characteristics was detected between the groups. While iron, calcium and silicon were found to be high in DVT patients, magnesium was found to be low. Regarding the magnesium emission, ROC analysis showed 76–90% specificity and 69–82% sensitivity, respectively. Conclusions: LIBS is a useful method because it is easy to use and can be used with a small sample. According to the results of our study, information about the pathogenesis of DVT was obtained through nail analysis. Therefore, we believe that LIBS analysis is a method that may be useful in determining the causes and predisposing factors for DVT.

Background: Autologous arteriovenous fistulas (AVFs) are the preferred vascular access modality for hemodialysis due to superior durability and lower infection rates. However, long-term secondary functional patency remains a critical determinant of dialysis success and patient survival. Although sex-related differences in vascular access outcomes have been reported, their impact on long-term secondary patency remains insufficiently clarified. Objective: The primary objective of this study was to evaluate long-term gender differences in the secondary functional patency of AVFs and to determine clinical, anatomical, and procedural factors contributing to these disparities. Methods: A retrospective cohort study including 968 ESRD patients undergoing AVF creation between 2012 and 2024 was conducted. Secondary patency was analyzed using Kaplan–Meier survival curves. Multivariate logistic regression identified independent predictors. The overall primary functional patency rates were 78.9% at 1 year, 71.2% at 3 years, and 62.7% at 5 years. When stratified by gender, male patients demonstrated primary patency rates of 80.3% at 1 year, 72.8% at 3 years, and 64.5% at 5 years, whereas female patients showed slightly lower rates of 77.3% at 1 year, 69.4% at 3 years, and 60.6% at 5 years. Conclusions: Female gender, particularly in the postmenopausal period, is an independent determinant of reduced long-term secondary AVF patency. Early identification of high-risk patients and structured risk factor optimization are essential to improve vascular access durability.

Background/Objectives: Neurological complications remain a critical source of morbidity and mortality following pediatric cardiac surgery for congenital heart disease (CHD). While advances in surgical and perioperative care have improved survival, the incidence of postoperative neurological events and their associations with perioperative characteristics remain incompletely characterized in heterogeneous pediatric populations. This study aimed to assess the incidence of postoperative neurological complications and to examine factors associated with adverse clinical outcomes in pediatric patients undergoing cardiovascular surgery. Methods: This retrospective, single-center study included 210 pediatric patients (p < 0.001). In-hospital mortality occurred in 18 patients (8.6%). Postoperative neurological complications, reoperation, prolonged intubation, extended ICU stay, and longer cardiopulmonary bypass duration were significantly associated with in-hospital mortality. Conclusions: Postoperative neurological complications were associated with prolonged ICU stay and increased in-hospital mortality. These findings emphasize the clinical importance of close neurological monitoring and perioperative strategies aimed at preserving cerebral perfusion and minimizing cardiopulmonary bypass duration in pediatric cardiac surgery.

Jugular venous pseudoaneurysm represents an exceedingly rare vascular abnormality and may present as an atraumatic neck mass. We report the clinical presentation, imaging findings, operative management under local anesthesia, anticoagulation strategy, and follow-up of a patient with a thrombosed jugular venous pseudoaneurysm after exclusion of common secondary causes. Duplex ultrasonography and CT angiography confirmed the diagnosis and guided surgical planning; complete excision with preservation of venous continuity was performed without perioperative complications, and follow-up duplex at 3 months demonstrated no recurrence. A jugular venous pseudoaneurysm should be considered in the differential diagnosis of atraumatic neck swelling; management should be individualized based on symptoms, thrombus burden, and imaging findings, with surgery favored for symptomatic or thrombosed lesions.

Resumo Fundamento: As técnicas cirúrgica e percutânea representam as duas principais abordagens para o fechamento do defeito do septo atrial (DSA). Embora ambas sejam amplamente utilizadas, as evidências comparativas sobre seus efeitos em médio prazo no remodelamento cardíaco e na função do ventrículo direito (VD) permanecem limitadas. Objetivos: Comparar o remodelamento estrutural cardíaco em médio prazo e a recuperação funcional do ventrículo direito após o fechamento cirúrgico versus percutâneo do DSA em pacientes pediátricos, utilizando avaliação seriada por ecocardiografia com Doppler colorido. Adicionalmente, determinar se alguma das técnicas promove melhora mais rápida ou mais pronunciada da morfologia e da função das câmaras cardíacas direitas. Métodos: Avaliamos retrospectivamente 69 pacientes pediátricos submetidos ao fechamento de DSA em um único centro. Um total de 39 pacientes foi submetido à correção cirúrgica (Grupo 1) e 30 pacientes ao fechamento percutâneo (Grupo 2). A ecocardiografia transtorácica com Doppler colorido foi realizada antes do procedimento e aos 3 e 12 meses após a intervenção. Foram analisadas medidas de morfologia e função atrial e ventricular. Resultados: Aos 3 meses, o grupo cirúrgico apresentou melhora significativamente maior no eixo maior do átrio direito (AD), volume do AD, espessura do septo interventricular na diástole, espessura do septo interventricular na sístole e diâmetro diastólico final do VD (dDFVD) em comparação ao grupo percutâneo (todos p < 0,05). Aos 12 meses, a correção cirúrgica manteve superioridade quanto à melhora do eixo maior do AD, volume do AD e dDFVD (todos p < 0,05). Shunt residual foi identificado em apenas um paciente em cada grupo aos 12 meses. Conclusões: O fechamento cirúrgico do DSA esteve associado a recuperação mais precoce e mais consistente da geometria e da função atrial e ventricular direitas em comparação ao fechamento percutâneo. Esses achados indicam que o fechamento cirúrgico pode oferecer vantagens para pacientes selecionados, particularmente em relação ao remodelamento do coração direito durante o primeiro ano pós-operatório.

Background: Surgical and transcatheter techniques represent the two principal approaches for atrial septal defect (ASD) closure. Although both are widely used, comparative evidence regarding their mid-term effects on cardiac remodeling and right ventricular (RV) function remains limited. Objectives: To compare mid-term cardiac structural remodeling and right ventricular functional recovery after surgical versus transcatheter ASD closure in pediatric patients using serial color Doppler echocardiographic assessment. Additionally, to determine whether either technique leads to faster or greater improvement in right heart morphology and function. Methods: We retrospectively evaluated 69 pediatric patients who underwent ASD closure at a single center. A total of 39 patients underwent surgical repair (Group 1), and 30 patients underwent transcatheter closure (Group 2). Transthoracic color Doppler echocardiography was performed before the procedure and at 3 and 12 months after intervention. Measures of atrial and ventricular morphology and function were analyzed. Results: At 3 months, the surgical group showed significantly greater improvement in right atrium (RA) major axis, RA volume, interventricular septal thickness in diastole, interventricular septal thickness in systole, and RV end-diastolic diameter (RVEDd) compared with the transcatheter group (all p < 0.05). At 12 months, surgical repair remained superior regarding improvement in RA major axis, RA volume, and RVEDd (all p < 0.05). Residual shunt was identified in only one patient in each group at 12 months. Conclusions: urgical ASD closure was associated with earlier and more consistent recovery of right atrial and ventricular geometry and function compared with transcatheter closure. These findings indicate that surgical closure may offer advantages for selected patients, particularly in relation to right heart remodeling during the first postoperative year.