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J Thorac Cardiovasc Surg 2006;132:1245
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Omer Ali Sayin, MD, Murat Ugurlucan, MD, Emin Tireli, MD

Istanbul University, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Istanbul, Turkey

We thank Dr Basaran and appreciate his kind comments and suggestions regarding our article.1Go First of all, we have to stress that the purpose of our article was mainly to describe this rare cardiac morphologic condition—bifid cardiac apex. Although the patient was examined by several cardiologists in the preoperative period, none of them was able to diagnose the pathologic condition precisely. During the diagnostic workup, magnetic resonance imaging was also performed; however, the bifid apex and the third chamber could not be identified. As we mentioned in the article, the preoperative echocardiogram and intraoperative data were not consistent. We had no data about the preoperative right ventricular volume and tricuspid valve. Therefore, intraoperatively, we decided to close the large atrial septal defect partially, without knowing of the existence of the third chamber. We absolutely agree that the long-term effects of this accessory chamber on right ventricular contractile function are not well known. Also, the intermediate and long-term results of one and a half ventricle repair for these kinds of patients are controversial owing to the evidence of pulmonary arteriovenous fistulas on follow-up. However, we disagree with the underestimation of the blind sac as a potential source of postoperative embolism and arrhythmias, because the exact pathologic condition could not be diagnosed preoperatively.

References

  1. Sayin OA, Ugurlucan M, Dursun M, Ucar A, Tireli E. Bifid cardiac apex: a rare morphologic structure. J Thorac Cardiovasc Surg 2006;131:474-475.[Free Full Text]

Related Article

Bifid cardiac apex: A rare morphologic structure
Murat Basaran
J. Thorac. Cardiovasc. Surg. 2006 132: 1245. [Extract] [Full Text] [PDF]




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