Saphenous venous graft to pulmonary artery fistula is a rare condition.Below we report a casewith saphenous venous graft to left pulmonary artery fistula presenting with coronary ischemia and right heart failure in the literature. 61 year-old male patient was admitted to our emergency department with exertional chest pain. He had previous history of coronary artery bypass graft (CABG) operation.The transthorasic echocardiogram displayed normal left ventricular ejection fraction (55%) .However, right ventricular systolic functional parameters were decreased, tricuspid annular plane systolic excursion (TAPSE)  and tricuspid annular systolic velocity were found as 13mm and 7 cm/sec,respectively. Coronary angiography represented critical stenosis in native coronary arteries.Left internal mammarian arterial graft (LIMA) to LAD remains to be patent. Aorto-CXA saphenous venous graft was also patent. Aorto-RCA and LAD septal sequential saphenous venous graft was patent in RCA course, a fistula from Aorto-RCA and LAD septal sequential venos graft to left pulmonary artery was observed. Coronary computed tomography clearly represented the fistula from venus graft to pulmonary artery. The patient was discussed by Heart Team and re-operation was decided, the patient declined the operation and he was discharged from the hospital under medical therapy. Acquired coronary artery fistulas mostly develop after CABG surgery ; moreover, they may be related to trauma ,neoplasmor infection.They may develop in various areas,there are several data reporting coronary artery fistulas from LIMA or saphenous grafts to pulmonary artery. To the best of our knowledge, this current case was the first case report demonstrating the saphenous venous graft fistulazation without venous aneurysm to pulmonary artery linked to right ventricle failure and coronary ischemia togetherness without any other underlying cause to explain the right heart failure.

Cogan syndrome is an autoimmune disorder characterized with ocular and vestibular symptoms and only minority (less than 15%) of patients suffer from systemic disease which is explained by autoimmuune vasculitis.Cardiovascular involvement of Cogan syndrome is rare and  effects mostly subclavian and carotid arteries, aortic valve or aorta.Mitral valve involvement is rare. Below, we report a case with mitral valve involvement and Cogan syndrome. 39 year old male patient had admitted to our hospital with shortness of breath. He had history of previous aortic valve implantation in 2012. His transthorasic echocardiography demonstrated massively thickened mitral leaflets as well as moderate to severe mitral regurgitation.Transoesaphageal echocardiography revealed moderate to severe mitral regurgitation, severe thickening in both mitral leaflets and and mild restriction in leaflet motions.. Surgery was decided in case progressive dyspnea develops. Cogan syndrome is a vasculitis which effects medium sized arteries and aortic valve. Mitral valve involvement is rare. Differential diagnoses , as well as using certain medical treatments and rheumatic valve disease, were ruled out. This case is one of the rare examples of Cogan syndrome with mitral valve thickening.

Transcatheter aortic valve implantation (TAVI) is the more common choice of procedure for the severe aortic stenosis patients with high surgical risk. While the popularity of TAVI increases, TAVI related complications, such as infective endocarditis (IE) increase in number. There are no specific guidelines for TAVI-IE, so shaping a path according to patient’s clinical status is more reasonable. With different advantages for each, multiple imaging modalities should be used for follow-up. In our case, repeated multiple imaging modalities were used to decide early surgery versus conservative approach by detecting periaortic pseudoaneurysm after TAVI.

Background: Cardiac rehabilitation (CR) is associated with improved clinical outcomes in a broad spectrum of cardiac disease. The beneficial effect of CR has been proven in patients with ischemic heart diseases. Post-operative atrial fibrillation (AF) and atrial arrhythmias are common complications following coronary artery bypass grafting (CABG) surgery. The aim of this study was to evaluate the effect of CR on atrial conductions in patients who underwent isolated CABG surgery. Methods: After the exclusion criterion was applied 545 patients were included in the study, retrospectively. One group (Rehab +) included patients who participated in CR program and the other group (Rehab -) included patients who did not want to or could not be participated in CR program after isolated CABG surgery. ECG parameters of Pmax, Pmin and P wave dispersion (PWD) of both groups were compared. Results: All parameters including heart rate, PR interval, Pmax, Pmin and PWD were significantly changed in rehab (+) group after CABG surgery. There was significant change in rehab (+) group when compared to rehab (-) group in terms of parameters of Pmax (P<0.001), Pmin (P<0.001), P wave dispersion (P<0.001). Conclusion: Our findings referred that CR program significantly improved parameters of atrial conduction including Pmax, Pmin and PWD following isolated CABG surgery. Thereby improvement in atrial conduction by CR program following CABG surgery could reduce atrial arrhythmias.

Nickel allergy was detected in approximately 15% of the population. Despite this rate, very few patients developed symptoms related to nickel allergy after cardiac device insertion. In this case report, pericardial effusion due to nickel allergy that develops after the insertion of Atrial Septal Defect (ASD) device is described. The patient was discharged with ibuprofen. In some cases, dramatic conditions up to the tampon after effusion may develop. These patients responded to high-dose steroid; however, devastating side effects developed. However, more detailed and comprehensive advanced research is needed on this subject.