Intraoperative transesophageal echocardiography (TEE) has both diagnostic and monitoring functions that are useful in valve surgery, especially valve-repairing operations. The most frequent immediate mitral valve repair failures are a result of residuel regurgitation, calcification, suture dehiscence, ischemia, technical misadventures, stenosis, or systolic anterior motion. Intraoperative TEE is extremely valuable in evaluating the competency of the mitral valve following repair. This review describes the methodology of TEE, focusing on its role in mitral valve repair surgery.

OBJECTIVE: Cardiopulmonary bypass causes a systemic inflammatory response that contributes to development of clinically serious problems. Insulin infusion administered for the control of hyperglisemia in preoperative and postoperative period was shown to have antiinflammatory effects. Therefore, in this study we aimed to investigate the effects of different insulin infusion techniques on blood glucose control and inflammatory response.
METHODS: Thirty seven patients undergoing elective cardiac surgery were included in the study. Patients anesthetized by standart technique were randomly divided into two groups. In Group I patients (n=18) standart insulin infusion was used to maintain blood glucose level at 180 mg/dL. Group II patients (n=19) were administered high dose insulin infusion (5mU/kg/min.) with a seperately infused %20 dextrose to adjust the blood glucose level at 70-110 mg/dL. TNF-α, IL-6 and IL-8 were studied preoperatively and postoperative 0, 6, 12 and 24. hours.
RESULTS: Blood glucose control was more successful in Group II patients(Grup I: 156,32 ± 64,55 mg/dL; Grup II: 116,68 ± 29,12 mg/dL, p<0.05) and this difference was more evident at 90 and 120.min. measurements (Grup I: 158,53 ± 58,49 mg/dL; Grup II: 116,37 ± 37,36 mg/dL, p<0.05). TNFα levels were lower at postoperative 12 and 24. hours in Grup II (medyan 5-4 pg/dL ) than Grup I (medyan 10-10 pg/dL) (p<0.01). There was no difference between IL6 and IL 8 levels between two groups.
CONCLUSION: It was thought that high dose insulin infusion is more effective in blood glucose control and it may have positive effects on inflammatory response in early postoperative period.

It is a rare complication agglutination of blood with cardioplegic solution during extracorporeal bypass in open heart surgery. In this case report in vitro aglutination of patient blood who underwent coronary artery bypass surgery (CABG) with cardioplegic solution prepared from lactated ringer was discussed.

Digoxin is one of the most commonly used cardiac positive inotropic agents. The therapeutic and toxic dose ranges of digoxin are narrow. Therefore, digoxin intoxication may develop easily. Serum digoxin levels of 2 ngmL-1 or higher cause toxic signs. We aimed to share treatment and management of a patient who swallowed 3 boxes of digoxin for suicidal purposes and presented with life-threatening arrhythmias, in the light of current literature.

Marfan Syndrome is an autosomal dominant connective tissue disorder effecting skeletal, cardiovascular, respiratory and ocular systems. The most serious complication of Marfan Syndrome is progressive dilatation of aorta which resulting in aortic dissection and rupture. Although this syndrome is rare, it can be encountered in elective and emergency cases other than cardiac and aortic pathologies. Difficult endotracheal intubation and joint dislocations must be considered in these cases. In this case report we aimed to present our anesthetic approach for an elective thoracoabdominal aneurysm operation in a patient with Marfan Syndrome.