8 At younger ages the gland’s tissue is situated mostly in the lateral sections and therefore less tissue is needed to be removed in order to reach the heart. However, we have found no relationship between age at which surgery is performed and subsequent visualization of the thymus. The method of thymus removal is not usually mentioned in patients’ records. This issue remains controversial and it is necessary to conduct additional related studies. We found a significant relationship between patient’s age at the time of MRI and visibility of the thymus, which was not found in the previous study. The mean Inhibitors,research,lifescience,medical age of the patients in whom the thymus was visible was higher. This finding could be attributed

to the age of the selected patients because in younger patients the surgeon should remove more thymic tissues compared to

older patients. Considering the larger size of the thymus in adolescence, after surgery the thymic residue is larger and the peripheral part Inhibitors,research,lifescience,medical of the thymus could remain in place even after removal of the thymus compared with younger patients whose entire thymus gland is removed. Several studies have shown that patients who undergo sternotomy and thymectomy experience long-term reduction in the amount of T lymphocytes and a disruption in their function.9,10 However, the long-term effects of reduction in the active tissue of the thymus and T Inhibitors,research,lifescience,medical lymphocytes on children who undergo related surgeries has yet to be evaluated. It is widely known that children who lack a Inhibitors,research,lifescience,medical thymus gland during the fetal period (GSK J4 price DiGeorge syndrome) experience complete deficiency and dysfunction in T lymphocytes and have severe cellular immune deficiency. In patients who undergo sternotomy or thymectomy, it is possible that T lymphocytes may mature outside the thymus and the remaining tissue may suffice. However, the long-term effects of this defect under certain conditions such as infections have not been proven. Therefore, designing a long-term study to assess different groups of patients who have undergone median sternotomy can be beneficial. A limitation of the current Inhibitors,research,lifescience,medical study was the inability

to evaluate the T-cell counts for our patients. However none of the patients in the case group had any important health problems or developed malignant diseases. The long-term risk of reduced/absent thymic tissue in this population also with respect to infectious or malignant diseases should be evaluated. We recommend that prospective studies be conducted. Conclusion In pediatric patients who undergo cardiac surgery the possibility of remained or regenerated thymic tissues should be evaluated using MRI. The remaining portion of the thymus could have any shape, size, or location. Therefore, it could be misinterpreted as a mass if the history of previous surgeries and patient’s age at the time of surgery has not been considered. Conflict of Interest: None declared.