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Ergin S, Turan N, Gode S, Yilmaz H, Saribas S, Dinc O, Cizmecigil U, Bakir I, Keskin M, Sirekbasan S, Atalik K, Yeniterzi M, Demirci M, Gurcan M, Erdogan S, Gareayaghi N, Kocazeybek BS. Evaluation of the possible involvement of Ad-36-induced adipogenesis and coronary artery disease development in mediastinal adipose tissue samples. Infez Med 2019; 27:290-298. [PMID: 31545773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mediastinal fat has been suggested to be associated with cardiovascular diseases such as carotid stiffness, atherosclerosis and coronary artery calcification. We investigated the possible role of Ad-36-induced obesity in the pathogenesis of the coronary artery disease (CAD). Ad-36 DNA was investigated in the anterior mediastinal fat tissue samples of obese adults with CAD. Seventy-five obese adults with left main coronary artery (LMCA) disease, 28 non-obese adults with valvular heart diseases, and 48 healthy individuals without cardiovascular problems were included as the obese patient group (OPG), non-obese patient group (NOG) and healthy control group (HCG), respectively. We also simultaneously investigated Ad-36 antibodies by serum neutralization test (SNA), and measured leptin and adinopectin levels. Ad-36 antibodies were detected only in 10 patients (13.3%) within the 75 OPG. A statistically significant difference was detected between OPG, NOG and HCG in terms of Ad-36 antibody positivity (p>0.05). Ad-36 DNA was not detected in mediastinal tissue samples of OPG and NOP without PCR inhibitors. We suggest that Ad-36 may not have an affinity for mediastinal adipose tissue in obese patients with left main CAD and valvular heart diseases. Ad-36 antibody positivity results are not sufficient to reach a causal relationship.
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Affiliation(s)
- Sevgi Ergin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Nuri Turan
- Istanbul University-Cerrahpasa, Veterinary Faculty, Department of Virology, Avcilar, Istanbul, Turkey
| | - Safa Gode
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Huseyin Yilmaz
- Istanbul University-Cerrahpasa, Veterinary Faculty, Department of Virology, Avcilar, Istanbul, Turkey
| | - Suat Saribas
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Oyku Dinc
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Utku Cizmecigil
- Istanbul University-Cerrahpasa, Veterinary Faculty, Department of Virology, Avcilar, Istanbul, Turkey
| | - Ihsan Bakir
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Melike Keskin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serhat Sirekbasan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Kevser Atalik
- Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Mehmet Yeniterzi
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Mehmet Demirci
- Beykent University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Mert Gurcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sarper Erdogan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Public Health Department, Istanbul, Turkey
| | - Nesrin Gareayaghi
- Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center, University of Health Sciences, Istanbul, Turkey
| | - Bekir S Kocazeybek
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
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Houas A, Bakir I, Ksibi M, Elaloui E. Étude de l'élimination de bleu de méthylène dans l'eau par le charbon actif commercial CECA40. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp:1999139] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ozyilmaz S, Akgul O, Uyarel H, Pusuroglu H, Gul M, Satilmisoglu MH, Bolat I, Ozyilmaz I, Uçar H, Yildirim A, Bakir I. The importance of the neutrophil-to-lymphocyte ratio in patients with hypertrophic cardiomyopathy. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ozyilmaz S, Akgul O, Uyarel H, Pusuroglu H, Gul M, Satilmisoglu MH, Bolat I, Ozyilmaz I, Uçar H, Yildirim A, Bakir I. The importance of the neutrophil-to-lymphocyte ratio in patients with hypertrophic cardiomyopathy. Rev Port Cardiol 2017; 36:239-246. [PMID: 28318851 DOI: 10.1016/j.repc.2016.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/27/2016] [Accepted: 09/26/2016] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Previous studies have demonstrated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in many cardiovascular disorders. The aim of this study was to assess whether NLR is associated with echocardiographic or electrocardiographic parameters, or with predicted five-year risk of sudden cardiac death (SCD), in patients with hypertrophic cardiomyopathy (HCM). METHODS This prospective observational study included 74 controls and 97 HCM patients. Three years of follow-up results for HCM patients were evaluated. RESULTS NLR was significantly higher in patients with fragmented QRS, ventricular tachycardia, and presyncope than in those without (p=0.031, 0.030, and 0.020, respectively). NLR was significantly higher in patients whose predicted five-year risk of SCD was more than 6% and whose corrected QT interval was greater than 440 ms (p=0.022 and 0.001, respectively). It was also significantly higher in patients whose left ventricular ejection fraction (LVEF) was <60% than in those with LVEF >60% (p=0.017). CONCLUSION NLR was significantly higher in patients with HCM compared to the control group. A high NLR is associated with a higher five-year risk of SCD in patients with HCM.
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Affiliation(s)
- Sinem Ozyilmaz
- Biruni University, School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ozgur Akgul
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Huseyin Uyarel
- Bezmialem Vakıf University, School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Hamdi Pusuroglu
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Gul
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Muhammet Hulusi Satilmisoglu
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ismail Bolat
- Fethiye State Hospital, Department of Cardiology, Mugla, Turkey
| | - Isa Ozyilmaz
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Pediatric Cardiology, Istanbul, Turkey.
| | - Hakan Uçar
- Biruni University, School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Aydin Yildirim
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ihsan Bakir
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
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Tola H, Ozturk E, Yildiz O, Erek E, Haydin S, Turkvatan A, Ergul Y, Guzeltas A, Bakir I. Assessment of children with vascular ring. Pediatr Int 2017; 59:134-140. [PMID: 27454661 DOI: 10.1111/ped.13101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 06/22/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vascular rings may cause pressure on the trachea and/or esophagus of varying degree, resulting in symptoms. This study assessed the presentation symptoms, diagnostic methods and treatment results after surgery in children with vascular ring. METHODS Symptomatic vascular ring patients undergoing surgery between January 2010 and August 2014 at Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, were retrospectively assessed. The presentation symptoms, demographic characteristics, and diagnostic tests were evaluated. Operative data and postoperative follow up, complications and problems were also examined in detail. RESULTS Twenty-one patients underwent surgery, 13 (63%) of whom were male. Median age was 12 months (range, 1 month-8 years). Among these patients, 62% (n = 13) had double aortic arch, 24% (n = 5) had right-sided aortic arch + ligamentum arteriosum, 10% (n = 2) had left-sided aortic arch + aberrant right subclavian artery, and 4% (n = 1) had pulmonary sling abnormality. Computed tomography (CT) angiography was performed in 17/21 patients. All the patients were successfully operated on. In the early postoperative period, two patients had chylothorax and one had nerve paralysis of nervus laryngeus recurrens. One patient died in the early period, and two patients had ongoing stridor on follow up. CONCLUSIONS CT angiography is effective for the differential diagnosis and visualization of vascular ring abnormality. In such cases, full recovery can be assured with early diagnosis and surgery.
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Affiliation(s)
- Hasan Tola
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Aysel Turkvatan
- Department of Radiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Onan B, Aydin U, Kahraman Z, Erkanli K, Bakir I. Robot-Assisted Mitral Valve Repair with Posterior Leaflet Extension for Rheumatic Disease. Innovations 2017. [DOI: 10.1177/155698451701200111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Burak Onan
- Departments of Cardiovascular Surgery, Istanbul, Turkey
| | - Unal Aydin
- Departments of Cardiovascular Surgery, Istanbul, Turkey
| | - Zeynep Kahraman
- Departments of Anesthesiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
| | | | - Ihsan Bakir
- Departments of Cardiovascular Surgery, Istanbul, Turkey
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Oz K, Aydın Ü, Kyaruzi M, Karaman Z, Göksel OS, Yeniterzi M, Bakir I. Staged or Combined Approach for Carotid Endarterectomy in Patients Undergoing Coronary Artery Bypass Grafting: A 5-Year-Long Experience. Heart Surg Forum 2016; 19:E276-E281. [DOI: 10.1532/hsf.1551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/09/2016] [Accepted: 10/06/2016] [Indexed: 11/20/2022]
Abstract
Background: Optimal surgical approach for patients with hemodynamically significant carotid and coronary disease remains controversial. We analyzed our 5-year experience and compared early and long-term outcome following staged and combined carotid and coronary artery bypass. Methods: 312 consecutive patients undergoing carotid endarterectomy and coronary artery bypass between 2008 and 2013 were prospectively enrolled in the study. Patients were scheduled for a staged (carotid endarterectomy followed by coronary artery bypass within 1 week) procedure (Group S) unless they were unstable in terms of cardiac status (were deemed to a combined procedure; Group C). All patient data including demographics, risk factors, immediate perioperative events, 30-day, and long-term outcome were prospectively recorded and then analyzed. Groups S and C were compared for pre- and perioperative data as well as immediate, 30-day, and long-term survival. A P value less than .05 was considered significant. Survival analysis was made using Kaplan-Meier method and log-rank test.Results: Group S included 204 patients and Group C included 108 patients. Preoperative demographics and clinical data were similar in the two groups except that preoperative cerebrovascular events were more common in Group C (31.7% versus 22.22%, P = .036) and bilateral carotid disease was more common in Group S. The EuroSCORE was higher in Group C (2.91 versus 2.65, P = .013). Carotid surgery techniques were similar; intraluminal shunting was more frequent in group C than group S (33.33% versus 9.88%, P = .001). Additional cardiac procedures in addition to coronary surgery was predominant in Group C. 30-day neurological adverse event rates, ICU, and hospital stay were significantly higher in Group C. The 30-day mortality was also sigficantly higher in Group C (1.96% versus 4.62%, P = .001). Conclusion: Staged and combined surgical approaches yield comparable outcomes. A staged approach may provide a more favorable neurological outcome with significantly reduced need for intraluminal shunting. Long-term outcome is, however, similar.
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Piskin S, Altin HF, Yildiz O, Bakir I, Pekkan K. Hemodynamics of patient-specific aorta-pulmonary shunt configurations. J Biomech 2016; 50:166-171. [PMID: 27866675 DOI: 10.1016/j.jbiomech.2016.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Optimal hemodynamics in aorta-pulmonary shunt reconstruction is essential for improved post-operative recovery of the newborn congenital heart disease patient. However, prior to in vivo execution, the prediction of post-operative hemodynamics is extremely challenging due to the interplay of multiple confounding physiological factors. It is hypothesized that the post-operative performance of the surgical shunt can be predicted through computational blood flow simulations that consider patient size, shunt configuration, cardiac output and the complex three-dimensional disease anatomy. Utilizing only the routine patient-specific pre-surgery clinical data sets, we demonstrated an intelligent decision-making process for a real patient having pulmonary artery atresia and ventricular septal defect. For this patient, a total of 12 customized candidate shunt configurations are contemplated and reconstructed virtually using a sketch-based computer-aided anatomical editing tool. Candidate shunt configurations are evaluated based on the parameters that are computed from the flow simulations, which include 3D flow complexity, outlet flow splits, shunt patency, coronary perfusion and energy loss. Our results showed that the modified Blalock-Taussig (mBT) shunt has 12% higher right pulmonary artery (RPA) and 40% lower left pulmonary artery (LPA) flow compared to the central shunt configuration. Also, the RPA flow regime is distinct from the LPA, creating an uneven flow split at the pulmonary arteries. For all three shunt sizes, right mBT innominate and central configurations cause higher pulmonary artery (PA) flow and lower coronary artery pressure than right and left mBT subclavian configurations. While there is a trade-off between energy loss, flow split and coronary artery pressure, overall, the mBT shunts provide sufficient PA perfusion with higher coronary artery pressures and could be preferred for similar patients having PA overflow risk. Central shunts would be preferred otherwise particularly for cases with very low PA overflow risk.
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Affiliation(s)
- Senol Piskin
- Department of Biomedical Engineering, Koc University, Istanbul, Turkey
| | - H Firat Altin
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
| | - Kerem Pekkan
- Department of Biomedical Engineering, Koc University, Istanbul, Turkey; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, USA.
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Aydin U, Sen O, Kadirogullari E, Onan B, Yildirim A, Bakir I. Surgical Transapical Approach for Prosthetic Mitral Paravalvular Leak Closure: Early Results. Artif Organs 2016; 41:253-261. [PMID: 27862027 DOI: 10.1111/aor.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/14/2016] [Accepted: 03/23/2016] [Indexed: 12/12/2022]
Abstract
The objective is to demonstrate safety and early clinical results of surgical transapical closure of paravalvular leaks (PVLs) following mitral valve replacement in significant regurgitation. Between March 2014 and February 2015, 12 patients (mean age 52.1 ± 6.0 years, 66.6% male) with severe symptomatic mitral PVLs (n = 13) underwent surgical transapical closure procedure through left mini-thoracotomy. All patients were in NYHA functional class III-IV and median logistic EuroSCORE was 24.2 ± 6.4% (range, 13.5-34.6%). Indications were heart failure (n = 10) and symptomatic hemolysis (n = 2) due to severe mitral regurgitation (MR). Amplatzer Vascular Plug-III devices (n = 9) were used for smaller and regular defects; whereas Atrial Septal Defect closure devices (n = 4) were used for larger defects. Technical success was achieved in 10 (83.3%) patients. One (8.5%) patient with 2 + MR was treated medically. A patient with residual 4 + MR underwent re-operation. There was no procedure-related complication including mortality, device migration, embolization, or cardiac laceration. Mean procedure and fluoroscopy times were 166.4 ± 39.5 (range, 90-210) and 25.7 ± 17.3 (range, 16-64) minutes, respectively. The mean intensive care and hospital stays were 2.1 ± 1.3 and 10.3 ± 6.5 days, respectively. Clinical efficacy was achieved in 9 (75%) of 12 patients at early follow-up of 8.5 ± 2.1 months. NYHA status was class II in two patients, and no hemolytic anemia was diagnosed. Echocardiographic studies revealed a significant reduction of preoperative MR (3-4+) to less than 1+ MR after operations (P < 0.05). Surgical transapical approach to PVL closure is a safe and effective procedure following mitral valve replacement. Early results show that this procedure can be an alternative to re-operation for high-risk patients. Further studies are needed to prove its effectiveness in the long term.
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Affiliation(s)
- Unal Aydin
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Onur Sen
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Ersin Kadirogullari
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Aydin Yildirim
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
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Bakir I, Onan B, Kadirogullari E. Robotically Assisted Repair of Partial Atrioventricular Canal Defect. Artif Organs 2016; 40:917-8. [DOI: 10.1111/aor.12800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ihsan Bakir
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Kucukcekmece Istanbul 34510 Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Kucukcekmece Istanbul 34510 Turkey
| | - Ersin Kadirogullari
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital; Kucukcekmece Istanbul 34510 Turkey
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Eksik A, Yildirim A, Gul M, Aslan S, Tosu AR, Surgit O, Cakmak HA, Satilmisoglu MH, Akkaya E, Bakir I. Comparison of Edwards Sapien XT versus Lotus Valve Devices in Terms of Electrophysiological Study Parameters in Patients Undergoing TAVI. Pacing Clin Electrophysiol 2016; 39:1132-1140. [PMID: 27418419 DOI: 10.1111/pace.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/16/2016] [Accepted: 07/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study is to assess the electrocardiographic and electrophysiological parameters of conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI) due to severe aortic valve stenosis. METHODS The study included 55 patients who underwent TAVI using either the Boston Scientific Lotus (n:25) (Boston Scientific, Natick, MA, USA) or Edwards Sapien XT (n:30) (Edwards Lifesciences, Irvine, CA, USA) prostheses. An electrophysiological study (EPS) was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after prosthesis implantation. RESULTS QRS duration and His-bundle to His-ventricle (HV) intervals, which were similar between the two groups before the procedure, were found to be significantly higher in the Lotus valve group postprocedure. Permanent pacemakers (PPMs) were required more frequently in the Lotus group than in the Sapien XT group at discharge (24.0% vs 6.7%, P = 0.07). With the exception of a higher prevalence of paravalvular leakage (P < 0.001) in patients undergoing Sapien XT implantation, other clinical outcomes were similar between the two groups. Multiple regression analysis revealed that baseline atrioventricular (AV) conduction disorders and HV intervals after the procedure were independently associated with PPM implantation after TAVI. CONCLUSION In this first study comparing the findings of EPS and electrocardiography, the impact of the Lotus valve on AV conduction systems was greater than that of the Sapien XT. However, the need for PPM was higher in the Lotus valve than in the Sapien XT. PPM requirement is related to valve design; it may decrease with reduced frame height and metal burden in novel valve systems.
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Affiliation(s)
- Abdurrahman Eksik
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aydin Yildirim
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Gul
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Serkan Aslan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aydin Rodi Tosu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Surgit
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | | | - Muhammet Hulusi Satilmisoglu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emre Akkaya
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Onan B, Aydin U, Basgoze S, Bakir I. Totally endoscopic robotic repair of coronary sinus atrial septal defect. Interact Cardiovasc Thorac Surg 2016; 23:662-4. [DOI: 10.1093/icvts/ivw200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/15/2016] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Burak Onan
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Unal Aydin
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Aysel Turkvatan
- Department of Radiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
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14
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Affiliation(s)
- Burak Onan
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
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Yildirim A, Goktekin O, Gorgulu S, Norgaz T, Akkaya E, Aydin U, Unal Aksu H, Bakir I. A New Specific Device in Transcatheter Prosthetic Paravalvular Leak Closure: A Prospective Two-Center Trial. Catheter Cardiovasc Interv 2016; 88:618-624. [DOI: 10.1002/ccd.26439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/04/2016] [Accepted: 01/09/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Aydin Yildirim
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Omer Goktekin
- Cardiology Department; Bezmialem University Medical Faculty; Istanbul, Turkey
| | - Sevket Gorgulu
- Cardiology Department; Acibadem University Medical Faculty; Istanbul Turkey
| | - Tugrul Norgaz
- Cardiology Department; Acibadem University Medical Faculty; Istanbul Turkey
| | - Emre Akkaya
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Unal Aydin
- Cardiovascular Surgery Department; Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Hale Unal Aksu
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Cardiovascular Surgery Department; Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
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Akkuş M, Utkusavaş A, Hanözü M, Kaya M, Bakir I. Stabilization of Flail Chest and Fractured Sternum by Minimally Invasive Repair of Pectus Excavatum. Thorac Cardiovasc Surg Rep 2015; 4:11-3. [PMID: 26693119 PMCID: PMC4670315 DOI: 10.1055/s-0035-1563399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/26/2015] [Indexed: 12/02/2022] Open
Abstract
We report a 55-year-old male patient with a massive flail chest that required chest stabilization by minimally invasive repair of pectus excavatum (MIRPE) employing a Nuss bar. Surgical stabilization of severe flail chest and fractured sternum with Nuss bar by MIRPE is a safe and useful treatment modality in properly selected patients.
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Affiliation(s)
- Murat Akkuş
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayfer Utkusavaş
- Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Hanözü
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaya
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Ergul Y, Kiplapinar N, Tanidir IC, Ozturk E, Guzeltas A, Haydin S, Akcay A, Erek E, Yeniterzi M, Odemis E, Bakir I. Role of thrombophilia factors in acute systemic-pulmonary shunt obstruction. Pediatr Int 2015; 57:1072-7. [PMID: 26096312 DOI: 10.1111/ped.12727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/24/2015] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systemic-pulmonary shunts are widely used in initial palliation in cyanotic congenital heart disease. The incidence and the relationship between acute shunt obstruction and thrombophilia are not precisely defined. The aim of this study was to determine the frequency of shunt obstruction in the early postoperative period, and to define the frequency and presence of thrombophilia factors in patients treated for acute shunt thrombosis. METHODS Between October 2010 and October 2012, 77 patients who had systemic-pulmonary shunt operation were included in this prospective study. Patients who developed shunt obstruction were examined in terms of inherited and acquired thrombophilia factors. RESULTS Median patient age was 61 days and median weight was 4.3 kg. Thirty-three patients were neonates. Diameter of the Gore-Tex grafts used for the shunt ranged from 3 mm to 5 mm. Acute shunt occlusion rate was 10% (8/77), and all of these occurred in the first 24 h. Thrombophilia was found in three of eight patients who underwent intervention (surgical and/or transcatheter) due to shunt thrombosis (presence of anti-phospholipid antibodies, n = 1; protein C deficiency, n = 1; and factor V Leiden mutation, n = 1) and only one patient died. CONCLUSIONS Acute shunt obstruction developed in 10% of patients who underwent systemic-pulmonary shunt, and emergency surgery or transcatheter intervention can be life saving in this context. Acute shunt obstruction can occur due to mechanical and hemodynamic problems, but clinicians should also consider and evaluate thrombophilia factors.
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Affiliation(s)
- Yakup Ergul
- Departments of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Neslihan Kiplapinar
- Departments of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ibrahim Cansaran Tanidir
- Departments of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Departments of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Departments of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Arzu Akcay
- Department of Pediatric Hematology and Oncology, Kanuni Sultan Süleyman Children's Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Yeniterzi
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ender Odemis
- Departments of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Saygi M, Ergul Y, Tola HT, Ozyilmaz I, Ozturk E, Onan IS, Haydin S, Erek E, Yeniterzi M, Guzeltas A, Odemis E, Bakir I. Factors affecting perioperative mortality in tetralogy of Fallot. Pediatr Int 2015; 57:832-9. [PMID: 25807889 DOI: 10.1111/ped.12627] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/14/2015] [Accepted: 02/13/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND We evaluated the preoperative, operative and postoperative risk factors affecting early mortality in patients who underwent total correction of tetralogy of Fallot (TOF). METHODS One hundred and twenty-two TOF patients who underwent reparative surgery between January 2010 and November 2013 were enrolled in the study. RESULTS Mean patient age and weight was 2.3 ± 2.5 years and 11.3 ± 6.4 kg, respectively. Cardiac catheterization was performed in 101 patients (83%),and coronary anomalies were found in 11 patients. Mean McGoon index, pulmonary annulus z-score, main pulmonary artery z-score, left pulmonary artery z-score and right pulmonary artery z-score were 2.0 ± 0.4, -1.85 ± 1.54, -2.84 ± 2.06, 1.17 ± 1.73, and 0.74 ± 1.57, respectively. Total reparative surgery with a transannular patch was performed in 97 patients (79.6%); the rest underwent valve-sparing surgery. Median duration of postoperative mechanical ventilation, intensive care and hospital stay were 19 h, 3 days and 9 days, respectively. Extracorporeal membrane oxygenation (ECMO) was required in 10 patients in the postoperative early period. Arrhythmias occurring in the early postoperative period were junctional ectopic tachycardia (n = 13), complete atrioventricular block(n = 10; permanent epicardial pacemaker implanted in four) and ventricular tachycardia (n = 4). Nine patients died in the early postoperative period (7.3%). Parameters found to be associated with increased mortality were low preoperative oxygen saturation; high right ventricular/aortic pressure ratio immediately after surgery; presence of coronary anomaly; requirement of postoperative ECMO; and pacemaker (P = 0.02, P = 0.04, P = 0.01, P = 0.0001, P = 0.03, respectively). CONCLUSIONS Poor preoperative oxygenation, presence of coronary anomaly, complete AV block in the early postoperative period, high RV pressure and requirement of ECMO appear to be the most significant factors that affect early mortality in the surgical treatment of TOF. Appropriate preoperative assessment, correct surgical strategies and attentive intensive care monitoring are required in order to reduce mortality.
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Affiliation(s)
- Murat Saygi
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ismihan Selen Onan
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Yeniterzi
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Kaya M, Savaş AU, Erkanli K, Güler S, Kyaruzi M, Birant A, Karaçalilar M, Akkuş M, Bakir I. Erratum to: The Preventive Effects of Posterior Pericardiotomy with Intrapericardial Tube on the Development of Pericardial Effusion, Atrial Fibrillation, and Acute Kidney Injury after Coronary Artery Surgery: A Prospective, Randomized, Controlled Trial. Thorac Cardiovasc Surg 2015; 64:e1-e2. [PMID: 26277076 DOI: 10.1055/s-0035-1563409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mehmet Kaya
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayfer Utku Savaş
- Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Korhan Erkanli
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Güler
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mugisha Kyaruzi
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Birant
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Karaçalilar
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Akkuş
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Aslan S, Gul M, Cakmak HA, Ozturk D, Celik O, Satilmisoglu MH, Gode S, Tasbulak O, Yildirim A, Bakir I. Short-term effects of transcatheter aortic valve implantation on left atrial appendage function. Cardiol J 2015; 22:527-34. [PMID: 26004939 DOI: 10.5603/cj.a2015.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 05/20/2015] [Accepted: 04/11/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The beneficial effects of the transcatheter aortic valve implantation (TAVI) on echocardiographic parameters including left atrial (LA) and left ventricular (LV) functions were described by previous studies. The aim of this study was to analyze the effects of TAVI on left atrial appendage (LAA) function assessed by transthoracic and transesophageal echocar-diography. METHODS Fifty-five patients with severe symptomatic aortic stenosis were included in this prospective study. LAA early and late emptying velocities, LAA filling velocity, peak early diastolic (EM), late diastolic (AM), and systolic (SM) velocities were measured with pulsed wave Doppler and tissue Doppler imaging, and E/Em ratio was calculated before and 7.1 ± 2.8 days after TAVI. A subgroup analysis was performed in accordance with the left ventricular ejection fraction (LVEF) of the patients and the severity of their LV diastolic dysfunction. RESULTS Although the post-procedure peaks and mean gradients of the patients decreased sig-nificantly, the LVEF increased significantly in those who had low LVEF before the procedure. The post-procedure E/Em ratio decreased significantly (p < 0.001). The post-procedural LAA mean filling velocity and EM velocity were significantly higher than the pre-procedural filling velocity (p < 0.001, p = 0.002, respectively). In the subgroup analysis, the post-procedural LAA filling velocity, early and late LAA emptying velocities, in addition to the mean velocity of the EM, AM, and SM were significantly higher than before the procedure in patients with LVEF of < 50% and E/Em ratios of > 15. CONCLUSIONS LAA function improved soon after the TAVI procedure, especially in patients with low LVEF and marked LV diastolic dysfunction.
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Affiliation(s)
- Serkan Aslan
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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21
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Aydin U, Kadirogullari E, Sen O, Ersoy B, Erkanli K, Bakir I. Endovascular stent-graft excision and surgical aortic reconstruction. Asian Cardiovasc Thorac Ann 2015; 24:382-5. [PMID: 25742781 DOI: 10.1177/0218492315574794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovascular aneurysm repair is being used more often and replacing open surgical repair as the treatment option for aortic aneurysm. Early results are better than those of open surgical repair, but the need for a second intervention is greater. Excision of a previously placed stent-graft by different surgical methods is very difficult and has high mortality and morbidity rates. We describe 3 patients who had previous endovascular aneurysm repair and were treated by an open surgical method with near total excision, leaving part of the stent-graft in the native aortic tissue.
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Affiliation(s)
- Unal Aydin
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Kadirogullari
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Onur Sen
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Burak Ersoy
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Korhan Erkanli
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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22
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Kaya M, Kyaruzi M, Guler S, Bakir I, Yeniterzi M. The incidence and predictors of transient acute kidney injury in patients with preoperative normal kidney functions undergoing coronary artery bypass graft surgery. ACTA ACUST UNITED AC 2015. [DOI: 10.5455/jcvs.2015341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Onan B, Yeniterzi M, Onan IS, Ersoy B, Gonca S, Gelenli E, Solakoglu S, Bakir I. Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy. Tex Heart Inst J 2014; 41:484-90. [PMID: 25425979 DOI: 10.14503/thij-13-3658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting. Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson's trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA. In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04). The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.
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Affiliation(s)
- Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
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25
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Isil CT, Yazici P, Bakir I. Risk factors and outcome of increased red blood cell transfusion in cardiac surgical patients aged 65 years and older. Thorac Cardiovasc Surg 2014; 63:39-44. [PMID: 25191761 DOI: 10.1055/s-0034-1383818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The use of blood products is not uncommon during cardiac surgery in elderly patients. We conducted this study to investigate the risk factors and adverse outcomes of increased red blood cell (RBC) transfusion in the patients aged ≥ 65 years undergoing cardiac surgery. METHODS During 1 year period, 288 patients (197 male/91 female) aged ≥ 65 years who underwent coronary and/or valvular surgery were retrospectively reviewed. Patients were stratified into groups on the basis of the number of transfusions received (< 4 and ≥ 4 U) which was classified as increased transfusion. Univariate analysis and multivariate logistic regression were used to identify risk factors for increased transfusion. RESULTS The mean unit of RBC transfusion was 4.5 ± 3.1 and 55.9% (n = 161) of patients received ≥ 4 U RBC. The overall postoperative complication rate was 36% and significantly higher in those with ≥ 4 U) RBC transfusion (p < 0.01). Risk factors including age, EuroSCORE, and low body surface were significantly higher in patient with ≥ 4 U RBC transfusion. Besides, preoperative anemia, postoperative drainage volume, and fresh frozen plasma (FFP) transfusion during hospital stay were found to be significantly associated with increased transfusion requirements. No difference was observed in mortality (p = 0.13). CONCLUSION These results suggest that improvement in blood transfusion policy in elderly patients undergoing cardiac surgery requires elimination of preoperative anemia, careful attention to surgical hemostasis, and FFP use.
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Affiliation(s)
- Canan Tulay Isil
- Department of Anesthesiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Pinar Yazici
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
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Kaya M, Yeniterzi M, Yazici P, Diker M, Celik O, Ertürk M, Bakir I. Epicardial adipose tissue is associated with extensive coronary artery lesions in patients undergoing coronary artery bypass grafting: an observational study. Maedica (Bucur) 2014; 9:135-43. [PMID: 25705268 PMCID: PMC4296755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/24/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate the relationship between the epicardial adipose tissue (EAT) volume measured by 256-slice dual source computed tomography (DSCT) and the complexity with the presence of significant coronary artery disease (CAD) in patients undergoing coronary artery bypass graft surgery (CABG). MATERIAL AND METHODS Study subjects were enrolled as they were undergoing DSCT for coronary evaluation. Two subgroups were formed according to coronary artery bypass history: Group A (patients with significant CAD), Group B (patients with normal coronary arteries). In both groups, EAT volume was measured by DSCT with the same technique. The complexity of CAD was assessed by using Syntax score (SxS). Group A patients were subdivided into two groups according to these results (Group A1, A2). OUTCOMES Ninety-three patients (53 male, 40 female) with a mean age of 55.1 years were enrolled in the study (48 in group A and 45 in Group B). The serum levels of fasting plasma glucose (FPG), total cholesterol (TC) and low-density lipoprotein (LDL) were found statistically higher in Group A. In Group A, mean EAT volume was 44.87±21.28 cm(3) while it was in normal range (32.37±17.50 cm(3)) in control group (p=0.003). Higher EAT volume was found to be related to FPG (r=0.242, p=0.015) and body surface area (BSA) (r =0.268, p=0.009) and also correlated positively with CAD. On the other hand, there was no significant difference between subgroups when considering the complexity of CAD. CONCLUSIONS Our data shows that increased EAT volume is associated with significant CAD. EAT volume contributes to the development of coronary lesions, but it does not affect the complexity of the lesions.
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Affiliation(s)
- Mehmet Kaya
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yeniterzi
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Pınar Yazici
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Diker
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Odemis E, Saygi M, Guzeltas A, Tanidir IC, Ergul Y, Ozyilmaz I, Bakir I. Transcatheter closure of perimembranous ventricular septal defects using Nit-Occlud(®) Lê VSD coil: early and mid-term results. Pediatr Cardiol 2014; 35:817-23. [PMID: 24413836 DOI: 10.1007/s00246-013-0860-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/31/2013] [Indexed: 11/26/2022]
Abstract
Our objective was to investigate the short- and mid-term results of transcatheter ventricular septal defect (VSD) closure with the Nit-Occlud(®) Lê VSD coil. Retrospective data collection study. Data were collected from 20 patients who underwent transcatheter VSD closure with the Nit-Occlud(®) Lê VSD coil device between October 2011 and June 2013. The mean age of the study subjects was 7.3 ± 4.0 years, and the mean weight was 25.7 ± 11.8 kg. The distance between the defect and the aortic valve, measured using angiography, was an average of 5.1 ± 2.0 mm, and the left ventricular opening averaged 8.2 ± 2.1 mm. The mean value of the Q p/Q s ratio was 1.7 ± 0.4. Intravascular hemolysis developed in the first few hours after the procedure in three patients. In one of these cases, despite medical treatment and the implantation of a detachable coil placed into the Nit-Occlud(®) device transcatheterly, hemolysis persisted. This device was removed and the VSD was closed surgically. In the other two cases, although the residual shunt persisted on echocardiography, the hemolysis regressed spontaneously. There were no rhythm problems or other complications during the follow-up period of 12.3 ± 6.6 months. In the selected cases, for the transcatheter treatment of VSD, the Nit-Occlud(®) Lê VSD coil device can be used. When compared with other VSD closure devices, there was no development of a permanent atrioventricular block, which is an important advantage. However, patients with a residual shunt should be monitored closely for the development of hemolysis during the first few hours.
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Affiliation(s)
- Ender Odemis
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey,
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Aksu HU, Erkanli K, Uslu N, Bakir I. Cardiac mass of the right atrium: an incidental finding. Anadolu Kardiyol Derg 2014; 14:404, 410. [PMID: 24818982 DOI: 10.5152/akd.2014.5230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hale Unal Aksu
- Clinic of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul-Turkey.
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Bakir I, Casselman FP, Onan B, Van Praet F, Vermeulen Y, Degrieck I. Does a minimally invasive approach increase the incidence of patient-prosthesis mismatch in aortic valve replacement? J Heart Valve Dis 2014; 23:161-167. [PMID: 25076545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The impact of a minimally invasive approach on patient-prosthesis mismatch (PPM) in patients undergoing aortic valve replacement (AVR) remains unknown. The study aim was to identify the impact of a minimally invasive approach for AVR on the incidence of PPM. METHODS The results of a single-center experience in 506 patients who underwent isolated AVR through a minimally invasive or conventional sternotomy were analyzed. Postoperative PPM was defined as an effective orifice area index < 0.85 cm2/m2, and was correlated with surgical approach, mortality and cardiac events after surgery. RESULTS Overall, postoperative PPM was present in 26.0% of the patients. The ratio of PPM was 24.1% in minimal access patients and 27.7% in conventional AVR patients (p = 0.35). Hospital mortality was similar in both groups (3.8% versus 3.4%, p = 0.62). The body mass index (BMI) was higher in patients with PPM (28.5 +/- 4.4 versus 25.3 +/- 3.6 kg/m2; p = 0.0001), but obesity was significantly associated with PPM (36.3% versus 9.4%; p = 0.0001). The PPM group included more patients with a left ventricular ejection fraction (LVEF) < 0.50 (12.8% versus 5.3%; p = 0.004). The independent risk factors for PPM were increased BMI (p = 0.0001), LVEF < 0.50 (p = 0.007) and preoperative aortic stenosis (p = 0.029). A LVEF < 0.50 increased the risk for PPM by 3.77-fold (95% CI: 1.4-9.9), while a high BMI increased the risk by 1.42-fold (95% CI: 1.3-1.5). Preoperative aortic insufficiency was associated with PPM, but did not significantly increase the risk. CONCLUSION A minimally invasive approach for AVR did not lead to an increased incidence of PPM and associated adverse events following surgery.
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Guzeltas A, Ozyilmaz I, Tanidir C, Odemis E, Tola HT, Ergul Y, Bilici M, Haydin S, Erek E, Bakir I. The Significance of Transesophageal Echocardiography in Assessing Congenital Heart Disease: Our Experience. CONGENIT HEART DIS 2013; 9:300-6. [DOI: 10.1111/chd.12139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Alper Guzeltas
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Cansaran Tanidir
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Meki Bilici
- Department of Pediatric Cardiology; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
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Erek E, Haydin S, Onan B, Onan IS, Yazici P, Kocyigit O, Tanidir C, Yivli P, Odemis E, Yeniterzi M, Bakir I. Extracorporeal life support experiences of a new congenital heart center in Turkey. Artif Organs 2013; 37:E29-34. [PMID: 23305584 DOI: 10.1111/aor.12023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extracorporeal life support (ECLS) provides mechanical support following cardiac surgery when respiratory and cardiac failure occurs. We retrospectively reviewed medical records of patients who needed ECLS at a new congenital heart center in Turkey. Between December 2009 and February 2012, 616 congenital heart operations were performed. A total of 13 patients (seven female) underwent ECLS. The ages of the patients ranged between 16 days and 33 years. There were two neonatal, seven infant, three pediatric, and one adult congenital cases. Medos DPII ECLS system was used in all patients. Mean duration of ECLS was 6.2 ± 5.8 days (ranged from 29 h to 24 days). While central vascular access with aorta and right atrial cannulation was used in 11 patients, neck vessels were used in the other patients. Four patients (30.7%) weaned successfully from ECLS (two infant, two pediatric cases). Three of them had ECLS intraoperatively. In all patients, two (15.4%) were discharged from the hospital. One of them had mild neurologic deficit. Bleeding from the surgical and cannulation sites was the most common complication. Thrombus was detected in pump head and changed uneventfully in three patients. Arterial pH and lactate levels at the beginning of ECLS were significantly lower in patients who were successfully weaned from ECLS than nonsurvivors (P = 0.04 and P = 0.02, respectively). ECLS can be a lifesaving modality in the perioperative period. It may be more beneficial if ECLS is used before the development of severe acidosis and high lactate levels.
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Affiliation(s)
- Ersin Erek
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Eksik A, Gul M, Uyarel H, Surgit O, Yildirim A, Uslu N, Aksu H, Satilmisoglu H, Erol MK, Bakir I. Electrophysiological evaluation of atrioventricular conduction disturbances in transcatheter aortic valve implantation with edwards sapien prosthesis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Erkanli K, Erkanli Senturk G, Aydin U, Arbak S, Ercan F, Tuncdemir M, Isiksacan N, Bakir I. Oxytocin Protects Rat Skeletal Muscle Against Ischemia/Reperfusion Injury. Ann Vasc Surg 2013; 27:662-70. [DOI: 10.1016/j.avsg.2012.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/05/2012] [Accepted: 10/23/2012] [Indexed: 11/28/2022]
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Eksik A, Gul M, Uyarel H, Surgit O, Yildirim A, Uslu N, Aksu H, Turen S, Uzun F, Satılmısoglu H, Erol MK, Bakir I. Electrophysiological evaluation of atrioventricular conduction disturbances in transcatheter aortic valve implantation with Edwards SAPIEN prosthesis. J Invasive Cardiol 2013; 25:305-309. [PMID: 23735359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS Permanent pacemaker requirement is a known complication after transcatheter aortic valve implantation (TAVI). The aim of the present study was to analyze the effects of Edwards SAPIEN prosthesis implantation on atrioventricular conduction. METHODS The study included 28 patients who underwent TAVI due to severe aortic valve stenosis. An electrophysiological study was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after Edwards SAPIEN prosthesis implantation. RESULTS His-ventricle interval was significantly prolonged postprocedure (55.9 ± 11.5 ms) vs preprocedure (47.3 ± 7.8 ms) (P<.001). The antegrade Wenckebach point was observed to be significantly prolonged postprocedure (354.4 ± 41.3 ms) vs preprocedure (333.7 ± 45.4 ms) (P=.001). Despite atrial-His interval prolongation, it was not statistically significant. After the procedure, we observed significant conduction disturbances in 3 patients (10.7%). These conduction problems recovered before discharge. One of the patients (3.6%) with right bundle branch block + left anterior fascicular block required permanent pacemaker implantation. At postprocedure electrocardiogram, QRS duration increased, QRS axis shifted to the left, and both of the values became normal before discharge. The patient's echocardiographic and clinical parameters were improved during follow-up. CONCLUSION The effect of Edwards SAPIEN on the conduction system was mostly infranodal and temporary. The physical properties of the Edwards SAPIEN prosthesis may explain this observation. This complication may be lessened if the frame height characteristics can be improved.
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Affiliation(s)
- Abdurrahman Eksik
- 1Istanbul Mehmet Akif Ersoy Thoracic – Cardiovascular Surgery Training and Research Hospital Cardiology Department, Istanbul, Turkey.
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Odemis E, Guzeltas A, Saygi M, Ozyilmaz I, Momenah T, Bakir I. Percutaneous pulmonary valve implantation using Edwards SAPIEN transcatheter heart valve in different types of conduits: initial results of a single center experience. CONGENIT HEART DIS 2013; 8:411-7. [PMID: 23448542 DOI: 10.1111/chd.12047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation is frequently used as a less invasive method in patients with conduit dysfunction. The common valve type cannot be used in conduits with a diameter larger than 22 mm. There has been limited experience concerning the used of the SAPIEN Transcatheter Heart Valve, produced for use in conduits with a large diameter. This study presents hemodynamic and early follow-up results from a single center in Turkey concerning the use of the SAPIEN Transcatheter Heart Valve in different types of conduits and different lesions. PATIENTS AND METHOD Between October 2010 and July 2012, seven SAPIEN Transcatheter Heart Valve implantations were performed. There was mixed type 2 pure insufficiency with stenosis and insufficiency in five patients. Three different conduits were used, and one native pulmonary artery process was performed. Patients were followed for hemodynamic findings, functional capacities, valve competence, reshrinking, and breakage in the stent, and the results were evaluated. RESULTS Implantations were successfully performed in all patients. Right ventricular pressures and gradients were significantly reduced, and there was no pulmonary regurgitation in any patient. Functional capacities evidently improved in all patients except for one with pulmonary hypertension. No major complication was observed. During the mean time of follow-up (7.2 ± 4.7 months), no valve insufficiency or stent breakage was observed. CONCLUSION Procedural results and short-term outcomes of the SAPIEN Transcatheter Heart Valve were very promising in the patients included in the study. The SAPIEN Transcatheter Heart Valve can be a good alternative to surgical conduit replacement, particularly in patients with larger and different types of conduits.
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Affiliation(s)
- Ender Odemis
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
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Abstract
A 54-year-old woman was referred to our institution suffering from severe dyspnea and asthenia due to progressive heart failure. Multidetector computed tomography angiography revealed biatrial enlargement with an image of pulmonary vein aneurysm. She underwent valvuloplasty for mitral and tricuspid valves, ligation of left atrial appendage, and left atrial reduction plasty concomitant with minimaze procedure using radiofrequency ablation but no intervention for aneurysm.
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Affiliation(s)
- Korhan Erkanli
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Pinar Yazici
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery, Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery, Training and Research Hospital, Istanbul, Turkey
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Onan IS, Erek E, Haydin S, Onan B, Kocyigit OI, Topuz U, Odemis E, Yeniterzi M, Bakir I. Clinical Outcome of Patients in a Start-Up Congenital Heart Surgery Program in Turkey. Artif Organs 2013; 37:E18-23. [DOI: 10.1111/j.1525-1594.2012.01580.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ismihan Selen Onan
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Sertac Haydin
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Ozgen Ilgaz Kocyigit
- Department of Anesthesiology and Reanimation; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Ufuk Topuz
- Department of Anesthesiology and Reanimation; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Mehmet Yeniterzi
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital; Istanbul; Turkey
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Bakir I, Onan B, Onan IS, Gul M, Uslu N. Is rheumatic mitral valve repair still a feasible alternative?: indications, technique, and results. Tex Heart Inst J 2013; 40:163-169. [PMID: 23678214 PMCID: PMC3649788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Rheumatic heart disease is still a major cause of mitral valve dysfunction in developing countries. We present our early results of rheumatic mitral valve repair. From August 2009 through July 2011, 60 patients (24 male and 36 female) with rheumatic disease underwent mitral repair. The mean age was 51.1 ± 13.8 years (range, 16-77 yr). Forty-nine patients were in New York Heart Association functional class III or IV. Repair procedures included chordal and papillary muscle splitting, secondary chordal division, mitral ring annuloplasty (n=58), commissurotomy (n=36), chordal replacement (n=9), posterior leaflet extension (n=4), annular decalcification (n=2), and quadrangular resection (n=2). Secondary procedures included tricuspid ring annuloplasty, left atrial ablation, obliteration of left atrial appendage, aortic valve replacement, and left atrial reduction. The early (30-d) mortality rate was 1.7%. The mean follow-up time was 14.9 ± 5 months (range, 4-26 mo). Follow-up echocardiography revealed trivial or no mitral regurgitation (MR) in 35.5% and mild (1+) MR in 49.1% of patients. Only 1 patient presented with severe (3+) MR. The mean MR grade decreased from 3.2 ± 0.9 to 0.3 ± 0.4 postoperatively (P=0.001). Left ventricular end-diastolic diameter and left atrial diameter significantly decreased postoperatively (P=0.006 and P=0.001, respectively). The mean gradient over the mitral valve decreased significantly from 11 ± 5.9 mmHg to 3.5 ± 1.8 mmHg (P=0.001). Because current techniques of mitral repair can effectively correct valve dysfunction in most patients with rheumatic disease, the number of repair procedures should be increased in developing countries to prevent complications of mechanical valve placement.
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Affiliation(s)
- Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, 34303 Istanbul, Turkey.
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Haydin S, Onan B, Onan IS, Ozturk E, Iyigun M, Yeniterzi M, Bakir I. Cerebral perfusion during cardiopulmonary bypass in children: correlations between near-infrared spectroscopy, temperature, lactate, pump flow, and blood pressure. Artif Organs 2012; 37:87-91. [PMID: 23145943 DOI: 10.1111/j.1525-1594.2012.01554.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a noninvasive modality to monitor regional brain oxygenation (rSO(2) ). In this study, we aimed to investigate the correlation between cerebral rSO(2) and lactate, pump flow, hematocrit, pCO(2) , and mean blood pressure (MBP) during cardiopulmonary bypass (CPB). Between March and September 2011, 50 pediatric patients who underwent congenital heart surgery were enrolled into the study. Ages ranged from 6 days to 168 months (median 14 months). A NIRS sensor (Somanetics 5100B, Troy, MI, USA) was placed on the right forehead of patients. CPB period was divided into five stages: 1-at the beginning of CBP, 2-cooling at 32°C, 3-at final hypothermic temperature, 4-rewarming at 32°C, 5-before weaning from CPB. Data collection included measurements of each parameter at five stages of CPB. Data were analyzed using multivariate analysis within groups and Spearman's correlation to test association between parameters. Lactate levels increased significantly from stage 1 to stage 5 during CPB (P < 0.05). There was no significant correlation between cerebral rSO(2) and MBPs, pump flows, hematocrit, or pCO(2) during CPB. Cerebral rSO(2) levels showed changes between the stages; there was a significant increase during cooling period, compared to stage 1 (P < 0.05). Significant changes during cooling stage did not happen for other parameters. At stage 3, there was a negative correlation between lactate level and MBP. At stage 4, there was no significant change in cerebral rSO(2) levels despite decreased MBP. At the warming stage, low MBPs, but normal rSO(2) values, are observed despite increased pump flows. Increased rSO(2) levels despite insignificant changes at other parameters during the cooling stage of CPB may show that optimal pump flow with adequate intravascular volume may provide effective cerebral perfusion even without changes in MBP. Considering normal rSO(2) values during CPB in this study, it may be speculated that brain protection can be assessed by using NIRS and applying a standard bypass protocol.
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Affiliation(s)
- Sertac Haydin
- Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Division, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.
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Affiliation(s)
- Canan Tulay Isil
- Department of Anesthesiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery, Training and Research Hospital, Istanbul, Turkey
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Abstract
Interrupted aortic arch (IAA), a rare congenital malformation of the aortic arch, is defined as a loss of luminal continuity between the ascending and descending portions of the aorta. It is rarely diagnosed as an isolated anomaly in adulthood. Surgical repair is feasible through a sternotomy or thoracotomy incision. In this report, we describe the surgical repair of an isolated IAA in a 29-year-old patient by performing an ascending-to-descending aortic bypass via a sternotomy with cardiopulmonary bypass.
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Gul M, Uyarel H, Akgul O, Uslu N, Yildirim A, Eksik A, Aksu HU, Ozal E, Pusuroglu H, Erol MK, Bakir I. Hematologic and clinical parameters after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. Clin Appl Thromb Hemost 2012; 20:304-10. [PMID: 23076777 DOI: 10.1177/1076029612462762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that platelet activation occurs in patients with aortic stenosis (AS). This study sought to evaluate the changes in hematologic and clinical parameters noted with the improvement in AS following transcatheter aortic valve implantation (TAVI) in patients with severe AS at high risk of surgery. PATIENTS AND METHODS The study included 33 patients who underwent TAVI. In addition to biochemical, clinical, and echocardiographic examinations, hematologic blood parameters were recorded before TAVI, at discharge, and at 1 and 4 months. RESULTS Mean platelet volume (MPV) showed a progressive decrease after TAVI. On echocardiography at 1 month, aortic valve area significantly increased, with significant decreases in peak and mean gradients. Progressive decreases were also noted in N-terminal proB-type natriuretic peptide levels. CONCLUSION Our findings show that TAVI improves hemodynamic parameters of the valve with marked clinical and echocardiographic improvement, resulting in decreased platelet activation and MPV in patients with severe AS.
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Affiliation(s)
- Mehmet Gul
- 1Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Gul M, Erkanli K, Erol MK, Bakir I. Ventricular embolization of Edwards SAPIEN prosthesis following transcatheter aortic valve implantation. J Invasive Cardiol 2012; 24:537-538. [PMID: 23043038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative therapy in patients with severe aortic stenosis (AS) and high surgical risk. Despite continuous improvements in operators' expertise and device technology, complications associated with TAVI are common. We present a case in which an Edwards SAPIEN prosthetic valve dislocated to the left ventricular outflow tract with hemodynamic collapse 4 hours following implantation and embolized into the left ventricle (LV) during resuscitation.
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Affiliation(s)
- Mehmet Gul
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic-Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Gul M, Aksu HU, Oz K, Bakir I. Rupture of the NovaFlex balloon during transcatheter aortic valve implantation and subsequent dissection of the right iliac arteries. Eur J Cardiothorac Surg 2012; 43:437-8. [DOI: 10.1093/ejcts/ezs508] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haydin S, Onan B, Kiplapinar N, Akdeniz C, Tuzcu V, Bakir I. Combined resection and radiofrequency ablation of rhabdomyoma in a child with sustained ventricular tachycardia. J Card Surg 2012; 27:649-52. [PMID: 22805076 DOI: 10.1111/j.1540-8191.2012.01496.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiac rhabdomyoma is a benign tumor of the heart in childhood and can be associated with life-threatening arrhythmia. In this report, we present the case of a 2-year-old male with right ventricular rhabdomyoma, who was admitted with syncope that was associated with episodes of sustained ventricular tachycardia. The patient underwent combined surgical resection and radiofrequency ablation of the tumor. There was no recurrence of ventricular tachycardia after surgery.
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Affiliation(s)
- Sertac Haydin
- Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Division, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.
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Onan IS, Yivli P, Erkan H, Akçevin A, Ündar A, Bakir I. Perfusion Practices and Education of Perfusionists for Open Heart Surgery in Turkey-Current Practices and Future Suggestions. Artif Organs 2012; 36:492-5. [DOI: 10.1111/j.1525-1594.2012.01454.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Odemis E, Haydin S, Guzeltas A, Ozyilmaz I, Bilici M, Bakir I. Stent implantation in the arterial duct of the newborn with duct-dependent pulmonary circulation: single centre experience from Turkey. Eur J Cardiothorac Surg 2012; 42:57-60. [PMID: 22290915 DOI: 10.1093/ejcts/ezr258] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Implantation of stents into the ductus arteriosus is an alternative treatment to palliative or corrective cardiac surgery in newborns with duct-dependent pulmonary circulation, although the use of this technique for congenital heart disease is limited. METHODS Between April 2010 and June 2011, 13 patients underwent patent ductus arteriosus stenting after full assessment by echocardiogram and angiogram, two of patients had pulmonary atresia (PA) and ventricular septal defect (VSD), six patients had PA with intact ventricular septum (IVS), four patients had critical pulmonary stenosis with IVS and one single ventricle physiology with PA and four patients had radiofrequency-assisted perforation of the pulmonary valve at the same time. All procedures were retrograde through the femoral artery, except one, which was by the femoral vein approach. RESULTS The mean age and weight during intervention were 10.5±5.7 days and 3.1±0.4 kg, respectively. The mean of procedure and scopy time, time of stay in intensive care, total out-of-hospital and total follow-up time were 138.88±67.11 min; 40.32±25.86 min; 4.88±6.07 days; 11.00±6.89 days and 86.40±73.21 days, respectively. The mean of the radiation amount was 1054.27±1106.91 cGy/cm2. The mean of saturation before and after intervention were 64.44±5.83; 81.88±6.95%, respectively. Procedure-related deaths were observed in two patients. The causes of death were pulmonary haemorrhage (n=1) and retroperitoneal haemorrhage (n=1). Two patients also died after discharge before surgery due to sepsis (n=1) and aspiration pneumonia (n=1). Eight of 13 patients achieved stent patency during 6 months of follow up and re-stenosis developed in one patient (1/8; 12.5%) who had undergone a Glenn operation at 4.5 months of age. CONCLUSIONS Ductal stenting is a practicable, effective, safer and less invasive method compared palliative or corrective surgery. Patients with ductal stenting have growth of the pulmonary artery which provides additional time for surgical repair. Our data suggested that ductal stenting should be considered as a first treatment step in newborns with duct-depended pulmonary circulation. However, long-term palliation without stent re-stenosismight still be a concern especially in patients with hypoplastic pulmonary arteries.
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Affiliation(s)
- Ender Odemis
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Onan B, Onan IS, Bakir I. Left anterior descending coronary artery muscular bridge: lengthy and complete. Tex Heart Inst J 2012; 39:598-600. [PMID: 22949793 PMCID: PMC3423295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Burak Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akf Ersoy Thoracic & Cardiovascular Surgery Education & Research Hospital, 34303 Istanbul, Turkey
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Karabulut A, Surgit O, Akgul O, Bakir I. "Removal without Replacement" Strategy for Uncontrolled Prosthetic Tricuspid Valve Endocarditis Associated with Abortion Sepsis. Heart Surg Forum 2011; 14:E357-9. [DOI: 10.1532/hsf98.20101174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Isolated tricuspid valve (TV) endocarditis associated with abortion is a rare entity with a poor prognosis. We report the case of a 22-year-old woman with a diagnosis of isolated prosthetic TV endocarditis secondary to recurrent abortion. The patient had progressed to multiorgan failure and disseminated intravascular coagulation during her clinical course. Because of the high operative risk and uncontrolled infection, we performed an unusual surgical approach that has not previously been reported. Resection of infected valvular tissue without replacement of the prosthesis led to a rapid convalescence period and complete cure.
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Ündar A, Haydin S, Yivli P, Weaver B, Pauliks L, Cicek AE, Erek E, Saşmazel A, Ağirbaşli MA, Alkan-Bozkaya T, Akçevin A, Bakir I. Istanbul Symposiums on Pediatric Extracorporeal Life Support Systems. Artif Organs 2011; 35:983-8. [DOI: 10.1111/j.1525-1594.2011.01368.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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