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Şişli E, Yıldırım C, Aka İB, Tuncer ON, Atay Y, Özbaran M, Pekkan K. Switching the Left and the Right Hearts: A Novel Bi-ventricle Mechanical Support Strategy with Spared Native Single-Ventricle. Ann Biomed Eng 2023; 51:2853-2872. [PMID: 37635154 DOI: 10.1007/s10439-023-03348-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
End-stage Fontan patients with single-ventricle (SV) circulation are often bridged-to-heart transplantation via mechanical circulatory support (MCS). Donor shortage and complexity of the SV physiology demand innovative MCS. In this paper, an out-of-the-box circulation concept, in which the left and right ventricles are switched with each other is introduced as a novel bi-ventricle MCS configuration for the "failing" Fontan patients. In the proposed configuration, the systemic circulation is maintained through a conventional mechanical ventricle assist device (VAD) while the venous circulation is delegated to the native SV. This approach spares the SV and puts it to a new use at the right-side providing the most-needed venous flow pulsatility to the failed Fontan circulation. To analyze its feasibility and performance, eight SV failure modes have been studied via an established multi-compartmental lumped parameter cardiovascular model (LPM). Here the LPM model is experimentally validated against the corresponding pulsatile mock-up flow loop measurements of a representative 15-year-old Fontan patient employing a clinically-approved VAD (Medtronic-HeartWare). The proposed surgical configuration maintained the healthy cardiac index (3-3.5 l/min/m2) and the normal mean systemic arterial pressure levels. For a failed SV with low ejection fraction (EF = 26%), representing a typical systemic Fontan failure, the proposed configuration enabled a ~ 28 mmHg amplitude in the venous/pulmonary waveforms and a 2 mmHg decrease in the central venous pressure (CVP) together with acceptable mean pulmonary artery pressures (17.5 mmHg). The pulmonary vascular resistance (PVR)-SV failure case provided a ~ 5 mmHg drop in the CVP, with venous/pulmonary pulsatility reaching to ~ 22 mmHg. For the high PVR failure case with a healthy SV (EF = 44%) pulmonary hypertension is likely to occur as expected. While this condition is routinely encountered during the heart transplantation and managed through pulmonary vasodilators a need for precise functional assessment of the spared failed-ventricle is recommended if utilized in the PVR failure mode. Comprehensive in vitro and in silico results encourage this novel concept as a low-cost, more physiological alternative to the conventional bi-ventricle MCS pending animal experiments.
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Affiliation(s)
- Emrah Şişli
- Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Osmangazi University Faculty of Medicine, Büyükdere District, Campus of Meşelik, Tepebaşı, 26480, Eskisehir, Turkey.
| | - Canberk Yıldırım
- Department of Biomedical Sciences and Engineering, Koç University, Istanbul, Turkey
| | - İbrahim Başar Aka
- Department of Mechatronics Engineering, İstanbul Bilgi University, Istanbul, Turkey
| | - Osman Nuri Tuncer
- Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Özbaran
- Heart Transplantation, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kerem Pekkan
- Department of Mechanical Engineering, Koç University, Rumeli Feneri Campus, Sarıyer, Istanbul, Turkey.
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Erek E, Yalçınbaş YK, Sarıosmanoğlu N, Özkan M, Yıldız O, Şenkaya I, Özdemir F, Biçer M, Sarıtaş AB, Atay Y, Seçici S, Kutsal A, Haydin S, Bilen C, Onan IS, Tuncer ON, Citoglu G, Doğan A, Turkoz R, Temur B, Koc M, Sarıoğlu CT. First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting. World J Pediatr Congenit Heart Surg 2021; 12:377-386. [PMID: 33942691 DOI: 10.1177/2150135121995474] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
OBJECTIVES A new congenital heart surgery database (CKCV) with real-time online reporting function was recently developed in Turkey. All standard international parameters were used, but Aristotle Comprehensive Complexity score was modified. In this study, the first analysis of the CKCV Database is reported. METHODS The CKCV Database included 2307 procedures from 12 centers between January 2018 and March 2020. All parameters, including 10 real-time online reports, which represent the number of centers, number and mortality rates of all procedures, number of extracorporeal membrane oxygenation (ECMO) and results, details of postoperative complications, age-group statistics, analysis for priority status, mean intensive care and hospital stay durations of the procedures, results of Aristotle Basic, Modified Aristotle Comprehensive (MACC) and Society of Thoracic Surgeons-European Association (STAT) Score Categories, comparison of centers were analyzed. RESULTS Most common 10 procedures were ventricular septal defect (VSD) repair (n = 273), tetralogy of Fallot (TOF) repair (n = 243), atrial septal defect (ASD) repair (n = 181), complete AVSD repair (n = 95), cavopulmonary anastomosis (n = 81), systemic to pulmonary shunt (n = 79), modified Fontan (n = 71), subaortic resection, (n = 66) PA banding (n = 66), and arterial switch operation (n = 66). Cardiopulmonary bypass was used in 84.6% of the procedures. Overall mortality rate was 6.0%. A total of 618 major and 570 minor complications were observed in 333 and 412 patients, respectively. According to six MACC categories, number of the patients and mortality rates were I (293; 0.3%); II (713; 1.4%); III (601; 3.3%); IV (607; 12%); V (84; 35.7%); and VI (9; 55.6%), respectively. Analysis of five STAT Categories showed 0.7, 3.8, 5.4, 14.9, and 54.7% mortality rates. CONCLUSIONS CKCV Database has a great potential for nationwide quality improvement studies. Users could instantly analyze and compare their results to national and international aggregate data using a real-time online reporting function. This is the first multicenter congenital database study in Turkey.
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Affiliation(s)
- Ersin Erek
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Istanbul, Turkey.,Children Heart Foundation, Istanbul, Turkey
| | - Yusuf Kenan Yalçınbaş
- Children Heart Foundation, Istanbul, Turkey.,Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Nejat Sarıosmanoğlu
- Health Sciences University, Dr. Behçet Uz Training and Research Hospital, Izmir
| | - Murat Özkan
- Başkent University, Ankara Hospital, Ankara, Turkey
| | - Okan Yıldız
- Health Sciences University, Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | | | - Fatih Özdemir
- Health Sciences University, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Biçer
- Health Sciences University, Erzurum Training and Research Hospital, Erzurum, Turkey
| | | | | | | | - Ali Kutsal
- Health Sciences University, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Sertac Haydin
- Health Sciences University, Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | - Cagatay Bilen
- Health Sciences University, Dr. Behçet Uz Training and Research Hospital, Izmir
| | - Ismihan Selen Onan
- Health Sciences University, Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | | | | | | | - Riza Turkoz
- Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Bahar Temur
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Istanbul, Turkey
| | - Murat Koc
- Health Sciences University, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - C Tayyar Sarıoğlu
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Istanbul, Turkey.,Children Heart Foundation, Istanbul, Turkey.,Acibadem Bakirkoy Hospital, Istanbul, Turkey
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Uygur Ö, Altun Köroğlu Ö, Levent RE, Sözmen E, Ergin F, Atay Y, Yalaz M, Akisü M, Kültürsay N. Can urinary biomarkers predict acute kidney injury in newborns with critical congenital heart disease? Turk J Med Sci 2021; 51:175-180. [PMID: 33021763 PMCID: PMC7991857 DOI: 10.3906/sag-2004-370] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim Congenital heart disease (CHD) is the most common congenital malformation group and is the leading cause of newborn mortality in developed countries. Most of the infants with CHD develop preoperative or postoperative acute kidney injury (AKI). Acute kidney injury may develop before the serum creatinine rise and oliguria. Urinary biomarkers such as kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, and cystatin C may predict AKI in patients with critical CHD (CCHD) before the serum creatinine rise. In this study, we aimed to determine the AKI incidence among newborn patients with CCHD and investigate the predictivity of urinary biomarkers for AKI. Materials and methods Newborns with a gestational age >34 weeks and birth weight >1500 g with a diagnosis of CCHD were enrolled in the study. Blood and urine samples were collected at birth, during the first 24–48 h, and in the preoperative and postoperative periods. Results A total of 53 CCHD patients requiring surgery during the neonatal period were enrolled in the study. The 24–48 h KIM-1 levels of the cases with exitus were higher (P = 0.007). The 24–48 h cystatin C and preoperative NGAL levels were higher in patients with postoperative AKI (P = 0.02). Conclusion In newborns with CCHD, high KIM-1 levels may predict mortality, whereas high cystatin C and preoperative NGAL levels may be indicative of AKI. These biomarkers deserve further investigation in larger study populations.
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Affiliation(s)
- Özgün Uygur
- Department of Pediatrics, Faculty of Medicine, Ege University İzmir, Turkey
| | - Özge Altun Köroğlu
- Department of Pediatrics, Faculty of Medicine, Ege University İzmir, Turkey
| | | | - Eser Sözmen
- Department of Biochemistry, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Firat Ergin
- Department of Pediatrics, Faculty of Medicine, Ege University İzmir, Turkey
| | - Yüksel Atay
- Department of Cardiovasculer Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mehmet Yalaz
- Department of Pediatrics, Faculty of Medicine, Ege University İzmir, Turkey
| | - Mete Akisü
- Department of Pediatrics, Faculty of Medicine, Ege University İzmir, Turkey
| | - Nilgün Kültürsay
- Department of Pediatrics, Faculty of Medicine, Ege University İzmir, Turkey
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Bilen Ç, Akkaya G, Tuncer ON, Atay Y. Assessment of Tricuspid Valve Detachment Efficiency for Ventricular Septal Defect Closure: A Retrospective Comparative Study. Acta Cardiol Sin 2020; 36:360-366. [PMID: 32675928 DOI: 10.6515/acs.202007_36(4).20191012a] [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] [Indexed: 11/23/2022]
Abstract
Background The aim of this study was to investigate the efficiency of tricuspid valve detachment (TVD) during the surgical treatment of perimembranous ventricular septal defects (VSDs) and to compare the early and mid-term results to patients without TVD in terms of tricuspid insufficiency. Methods A total of 170 patients who had undergone surgical closure of perimembranous VSDs between November 2012 and January 2019 were included in this study, of whom 50 had an additional TVD procedure during the surgery. All patients were examined by transthoracic echocardiography before and after the operation with regular intervals, and the tricuspid valve function was then evaluated. Results There was no significant difference between subgroups with an unchanging degree of TVR, however, the result was also similar among those who had a decreased degree of TVR at any level (p = 0.271, p = 0.451). At the end of the study, all patients were in New York Heart Association class I. Conclusions We suggest that, in appropriate patients, VSD closure can be safely performed with an additional TVD application through an incision of the septal leaflet of the tricuspid valve without impairing the valve function or reducing the growth potential of the valve at midterm follow-up.
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Affiliation(s)
- Çağatay Bilen
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Gökmen Akkaya
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Osman Nuri Tuncer
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
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Tekin A, Yağmur İ, Ergün O, Ayık MF, Atay Y, Ulman İ, Avanoğlu A. Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass. Turk J Pediatr 2020; 61:436-439. [PMID: 31916725 DOI: 10.24953/turkjped.2019.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tekin A, Yağmur İ, Ergün O, Ayık MF, Atay Y, Ulman İ, Avanoğlu A. Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass. Turk J Pediatr 2019; 61: 436-439. The treatment of atrial-extention Wilms` tumor thrombus is surgical excision after chemotherapy. Atriotomy with cardiovascular by-pass is the one of the most common method for this procedure. Herein, we aimed to present a case of Wilms` tumor with a tumor thrombus extending into the right atrium totally excised with retrohepatic cavatomy. A 3.5 year-old girl was admitted with the symptom of dysuria. The examinations revealed a mass consistent with Wilms` tumor in the middle and lower poles of the left kidney. Doppler ultrasound and Echocardiographic examinations showed a tumor thrombus extending into the right atrium and some pulmonary nodules which were interpreted to be metastasis. Wilms` tumor was histopathologically diagnosed by an open biopsy. After three courses of chemotherapy imaging studies revealed that the atrial axtention of the tumor thrombus persisted. The tumor thrombus was found to be fibrotic on the magnetic resonance imaging scan of the patient. Therefore, nephroureterectomy along with the excision of the tumor thrombus from the inferior vena cava was done with intraoperative continuous trans-esophageal echocardiography (TEE). The suprarenal and retrohepatic vena cava were exposed by dissecting and ligating all short hepatic veins and completely mobilizing the right lobe of the liver. The thrombus was dissected out via Vertical cavatomy at the retrohepatic level. TEE confirmed complete removal of the thrombus from the atrium; Vena cava was then repaired. There was no need for a blood transfusion, or cardiovascular by-pass (CPB) during the operation. Total exposure of the retrohepatic and subdiaphragmatic vena cava using transplantation techniques is an effective method for the excision of a tumor thrombus without sternotomy, atriotomy and CPB, avoiding possible intra- and postoperative complications in selected cases of Wilms` tumor with intraatrial thrombus extension. The case emphasises the importance of multidisciplinary communication and collaboration.
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Affiliation(s)
- Ali Tekin
- Division of Pediatric Urology, Ege University Faculty of Medicine, İzmir, Turkey
| | - İsmail Yağmur
- Division of Pediatric Urology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Departments of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Fatih Ayık
- Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yüksel Atay
- Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - İbrahim Ulman
- Division of Pediatric Urology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ali Avanoğlu
- Division of Pediatric Urology, Ege University Faculty of Medicine, İzmir, Turkey
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6
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Tuncer O, Akkaya G, Aydin D, Atay Y. Extracorporeal Membrane Oxygenation Cannula Malposition. J Indian Acad Echocardiogr Cardiovasc Imaging 2020. [DOI: 10.4103/jiae.jiae_26_20] [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: 11/04/2022] Open
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Akkaya G, Bilen Ç, Tuncer ON, Ayık MF, Atay Y. Long-Term Assessment of Left Ventricular Ejection Fraction and Mitral Regurgitation Following Takeuchi Repair. Braz J Cardiovasc Surg 2019; 34:687-693. [PMID: 31364346 PMCID: PMC6894018 DOI: 10.21470/1678-9741-2018-0376] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the early operative outcomes and to compare the left ventricle and mitral valve functions after initial Takeuchi repair in patients with anomalous left coronary arising from pulmonary artery (ALCAPA). METHODS Fourteen patients (5 males, 9 females; mean age 4.3 years, ranging from 25 days to 34 years) who were operated for ALCAPA between 2007 and 2018 were included in this study. Data were evaluated retrospectively based on our medical records. RESULTS Hospital mortality rate was 7.1% (n=1). Thirteen surviving patients were kept in follow-up mean 4.3±3.05 years. When compared to preoperative measurements, both left ventricular ejection fraction (LVEF), (P=0.007) and mitral regurgitation (MR) (P=0.001) significantly improved before discharge. Moreover, LVEF values were improved in the late follow-up, considering early postoperative outcomes, and this alteration was significant (P=0.014). Nevertheless, alteration in the degree of MR among patients did not differ in the long-term follow-up (P=0.180). There was no late-term mortality or need for reoperation among patients. CONCLUSION Although some centers prefer to direct implantation in ALCAPA, Takeuchi procedure can be accepted as a reliable method that provides satisfactory long-term results, considering that it aids to improve left ventricle ejection fraction and reduced mitral valve regurgitation.
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Affiliation(s)
- Gökmen Akkaya
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Çağatay Bilen
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Osman Nuri Tuncer
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Mehmet Fatih Ayık
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
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Şişli E, Kalın S, Tuncer ON, Ayık MF, Alper H, Levent RE, Şahin H, Atay Y. Comparison Between Nomograms Used to Define Pediatric Aortic Arch Hypoplasia: Retrospective Evaluation Among Patients Less Than 1 Year Old with Coarctation of the Aorta. Pediatr Cardiol 2019; 40:1190-1198. [PMID: 31165902 DOI: 10.1007/s00246-019-02130-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/13/2019] [Accepted: 05/30/2019] [Indexed: 01/18/2023]
Abstract
Although various modalities are currently in use to define pediatric aortic arch hypoplasia (AAH), there is little uniformity among them. We aimed to determine the inter-rater strength of agreement of the nomograms in a survey of patients less than 1 year old, who had undergone coarctation of the aorta (CoA) repair with or without AAH. This retrospectively designed study comprised of 105 patients with CoA, who had been evaluated between 2008 and 2018 by means of a computed tomography angiogram. Through re-estimation of the aortic arch segmental diameters, the z scores were calculated using three nomograms (Cantinotti, Pettersen, Lopez). Along with a t test and Pearson's correlation coefficient, a linear regression analysis, Bland-Altman plots, and Cohen's kappa k value were used to evaluate inter-rater strength of agreement. The mean age and weight of the cohort was 73.3 ± 81.2 days and 4.2 ± 1.6 kg, respectively. Sixty-four (61%) patients were neonates. The z scores of the nomograms for each aortic arch segment were significantly different. Although there was a significantly positive correlation between the nomograms with their related aortic arch diameter, the differences in z scores revealed considerable deviations in the scatter plot diagrams. The mean difference of z scores was significantly different from the testing value of zero, which was also presented in Bland-Altman plots. None of the comparisons reached a kappa k value of > 0.9. The current nomograms do not reveal an acceptable level of agreement for the definition of the AAH. The question is which modality to rely on when deciding on the surgical approach and technique of CoA repair to address the hypoplastic aortic arch segment. Decisions about the surgical approach and the technique of repair warrant a reliable definition of AAH. It is high time that a consensus is reached in this regard.
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Affiliation(s)
- Emrah Şişli
- Section of Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Üniversite Street, Kazım Dirik District, Bornova, 35400, Izmir, Turkey.
| | - Sevinç Kalın
- Section of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Osman Nuri Tuncer
- Section of Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Üniversite Street, Kazım Dirik District, Bornova, 35400, Izmir, Turkey
| | - Mehmet Fatih Ayık
- Section of Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Üniversite Street, Kazım Dirik District, Bornova, 35400, Izmir, Turkey
| | - Hüdaver Alper
- Section of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Reşit Ertürk Levent
- Section of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hatice Şahin
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yüksel Atay
- Section of Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Üniversite Street, Kazım Dirik District, Bornova, 35400, Izmir, Turkey
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Akkaya G, Bilen Ç, Tuncer ON, Ayık MF, Atay Y. Ebstein anomalisinin cerrahi tedavisi: Tek merkez deneyimi. Ege Tıp Dergisi 2019. [DOI: 10.19161/etd.551164] [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: 11/23/2022] Open
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10
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Ayık MF, Şişli E, Dereli M, Şahan YÖ, Şahin H, Levent RE, Atay Y. A Retrospective Survey Comparing Suture Techniques Regarding the Risk of Permanent Epicardial Pacemaker Implantation After Ventricular Septal Defect Closure. Braz J Cardiovasc Surg 2019; 33:339-346. [PMID: 30184030 PMCID: PMC6122755 DOI: 10.21470/1678-9741-2018-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of this study is to compare the continuous and combined suturing
techniques in regards to the needing epicardial pacing at the time of
weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent
epicardial pacemaker (PEP) implantation in patients who had undergone
surgical ventricular septal defect (VSD) closure. Methods This single-centre retrospective survey includes 365 patients who had
consecutively undergone VSD closure between January 2006 and October 2015.
Results The median age and weight of the patients were 15 months (range 27 days -
56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and
combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%)
patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was
implanted in eight (2.2%) patients. Comparison of the continuous and
combined suturing techniques regarding the need for EP-CPB (72%
vs. 28%, P=0.231) and PEP implantation
(87.5% vs. 12.5%, P=1.0) were not
statistically significant. The rate of PEP implantation in patients with
perimembraneous VSD without extension and perimembraneous VSD with inlet
extension did not reveal significant difference between the suture
techniques (P=1.0 and P=0.16,
respectively). In both univariate and multivariate analyses, large VSD
(P=0.001; OR 8.63; P=0.011) and
perimembraneous VSD with inlet extension (P<0.001; OR
9.02; P=0.005) had a significant influence on PEP
implantation. Conclusion Both suturing techniques were comparable regarding the need for EP-CPB or PEP
implantation. Caution should be exercised when closing a large
perimembraneous VSD with inlet extension.
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Affiliation(s)
- Mehmet Fatih Ayık
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Emrah Şişli
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Münevver Dereli
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Hatice Şahin
- Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Yüksel Atay
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Şişli E, Tuncer ON, Şenkaya S, Doğan E, Şahin H, Ayık MF, Atay Y. Correction to: Blalock-Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size? Pediatr Cardiol 2019; 40:45-46. [PMID: 30203290 DOI: 10.1007/s00246-018-1978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/28/2022]
Abstract
The original version of the article unfortunately contained an alignment error in Table 1. The correct version of Table 1 is given below.
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Affiliation(s)
- Emrah Şişli
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey. .,Section of Pediatric Cardiovascular Surgery, Department of Cardiovasular Surgery, Ege University Faculty of Medicine, Kazım Dirik District, Üniversite Street, 35140, Bornova, Izmir, Turkey.
| | - Osman Nuri Tuncer
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Suat Şenkaya
- Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Eser Doğan
- Pediatric Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hatice Şahin
- Medical Education, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Fatih Ayık
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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Şişli E, Tuncer ON, Şenkaya S, Doğan E, Şahin H, Ayık MF, Atay Y. Blalock-Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size? Pediatr Cardiol 2019; 40:38-44. [PMID: 30121861 DOI: 10.1007/s00246-018-1958-9] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/09/2018] [Indexed: 12/28/2022]
Abstract
The study aimed to revisit the in-hospital predictors of shunt thrombosis (ST) in the foreground of the pulmonary artery size in patients who received modified Blalock-Taussig shunt (mBTS) as the first-stage palliation. Data from 80 patients who received mBTS as their initial palliative procedure between February 2012 and January 2017 was retrospectively collected. The median age and weight of the patients at the time of their mBTS procedure was 4 days (IQR 2-22 days) and 3.2 kg (IQR 2.8-3.7 kg), respectively. Of the 80 patients in the study, 11 (13.8%) developed ST. The diameter and corresponding z scores of the pulmonary arteries were significantly lower in patients with ST. The median shunt size/shunted pulmonary artery size (S/PA) ratio was considerably higher in patients with ST. In logistic regression analysis, pulmonary artery hypoplasia (PAH) [odds ratio (OR) = 13.7 (0.06-0.21), p < 0.001], S/PA ratio ≥ 0.9 [OR = 8.1 (0.03-0.53), p = 0.03], prematurity [OR = 9.5 (0.05-0.33), p = 0.003], and shunt size/weight (S/W) ratio ≥ 1.3 [OR = 6.4 (0.04-0.67), p = 0.012] were found to have a significant impact on ST. The best combination of sensitivity and specificity of the S/W (0.73 and 0.75) and the S/PA ratio (0.73 and 0.80) were achieved at the cut-off value of 1.3 and 0.9, respectively. The Youden index of S/PA was 0.52. While the area under the curve (AUC) of the S/W ratio was 0.686 ± 0.12 (p = 0.049), the AUC of the S/PA ratio was 0.791 ± 0.08 (p = 0.002). In conclusion, instead of weight, considering the size of the target pulmonary artery and thereby, the S/PA ratio would be more instructive in determining shunt size. There were a high number of patients in our study who showed PAH having received a shunt size based on their body weight. By contrast, our results showed that the S/PA ratio of ≥ 0.9 would be a good predictor of in-hospital ST.
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Affiliation(s)
- Emrah Şişli
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey. .,Section of Pediatric Cardiovascular Surgery, Department of Cardiovasular Surgery, Ege University Faculty of Medicine, Kazım Dirik District, Üniversite Street, 35140, Bornova, Izmir, Turkey.
| | - Osman Nuri Tuncer
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Suat Şenkaya
- Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Eser Doğan
- Pediatric Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hatice Şahin
- Medical Education, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Fatih Ayık
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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Işık O, Akyüz M, Karakuş E, Işık E, Ayık MF, Levent E, Atay Y. Early and mid-term outcomes after surgical repair of congenital supravalvular aortic stenosis with the Doty technique. Turk Kardiyol Dern Ars 2018; 46:385-391. [PMID: 30024395 DOI: 10.5543/tkda.2018.65960] [Citation(s) in RCA: 1] [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: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and safety of the Doty surgical approach in pediatric patients with congenital supravalvular aortic stenosis (SVAS) by examining early and mid-term outcomes. METHODS Surgical repair using the Doty technique was performed in a total of 10 pediatric patients with SVAS between January 2005 and July 2015 at this clinic. These patients were evaluated retrospectively. Demographic characteristics, echocardiographic findings, and clinical outcomes were analyzed. RESULTS The mean patient age was 4.8±3.9 years. Williams-Beuren syndrome was diagnosed in 4 of the patients. Early mortality was observed in 1 patient with diffuse SVAS. At the final follow-up (mean follow-up: 3.7±1.2 years; range: 6-61 months), echocardiograms revealed a mean pressure gradient of 14±4.2 mmHg. Two patients displayed minimal aortic insufficiency during the follow-up period. No reoperation or reintervention was required. CONCLUSION The Doty technique is an anatomically and technically effective surgical approach to treating SVAS.
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Affiliation(s)
| | - Muhammet Akyüz
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
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Tuncer O, Ayik M, Bilen Ç, Atay Y. Unusual form of partial pulmonary venous connection. J Indian Acad Echocardiogr Cardiovasc Imaging 2018. [DOI: 10.4103/jiae.jiae_24_18] [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: 11/04/2022] Open
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Şişli E, Özdemir Şahan Y, Ayık MF, Nart D, Atay Y. A rare complication of chronic granulomatous disease in a child: constrictive aspergillus pericarditis. Turk Kardiyol Dern Ars 2017; 45:660-663. [PMID: 28990950 DOI: 10.5543/tkda.2017.52284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 3-year-old girl with the diagnosis of chronic granulomatous disease (CGD) was hospitalized for bronchopneumonia and congestive heart failure. Her medical history included methylprednisolone medication for autoimmune gastric outlet obstruction. Computed tomography revealed pneumonic infiltrations and pericardial thickening. A pulsed-wave Doppler recording revealed E/A >1. During a pericardiectomy, multiple islands of thick, firm-walled, fibrinous exudate-containing, small abscess formations were observed. Histopathological evaluation of pericardial tissue revealed granulomatous inflammation. Aspergillus fumigatus was cultured from the abscess. In conclusion, development of constrictive aspergillus pericarditis should be considered in patients with CGD because immediate initiation of antifungal management with aggressive surgical treatment is life-saving.
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Affiliation(s)
- Emrah Şişli
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
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Şişli E, Ayik MF, Akyüz M, Dereli M, Atay Y. A circumflex coronary artery-to-right atrial fistula in a 10-month-old child. Cardiovasc J Afr 2016; 27:e1-e3. [PMID: 27965995 PMCID: PMC5408498 DOI: 10.5830/cvja-2016-044] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 04/03/2016] [Indexed: 11/28/2022] Open
Abstract
A coronary fistula (CF) is a rare congenital cardiac anomaly in which there is a connection between the coronary artery and a cardiac chamber or a great vessel. In the paediatric population, a CF is usually asymptomatic. While the circumflex coronary artery (Cx) is the least common source of a CF, the right heart chambers are the most common location of drainage. Herein, we present a symptomatic 10-month-old boy with an atrial septal defect (ASD) in whom we incidentally detected a CF, which stemmed from the Cx and drained to the right atrium. Because the patient was symptomatic and his small size was not appropriate for percutaneous closure of the ASD, surgical closure of the ASD and CF was performed.
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Affiliation(s)
- Emrah Şişli
- Section of Paediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Mehmet Fatih Ayik
- Section of Paediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Muhammet Akyüz
- Section of Paediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Münevver Dereli
- Section of Paediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yüksel Atay
- Section of Paediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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Işık O, Akyüz M, Ayık MF, Atay Y. [Subtotal cor triatriatum sinister associated with bilateral partial anomalous pulmonary venous return]. Turk Kardiyol Dern Ars 2016; 44:148-50. [PMID: 27111313 DOI: 10.5543/tkda.2015.51812] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cor triatriatum sinister is a rare congenital cardiac pathology, representing only 0.1% of congenital cardiac anomalies, and often associated with other cardiac defects. In classic cor triatriatum sinister, the pulmonary venous chamber receives all pulmonary veins and drains into the left atrium through a variable-sized orifice. The case of a 4-month-old male patient who had subtotal cor triatriatum sinister associated with right and left upper anomalous pulmonary venous return is presented.
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Affiliation(s)
- Onur Işık
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Muhammet Akyüz
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
| | - Mehmet Fatih Ayık
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yüksel Atay
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Işık O, Akyüz M, Ayık MF, Atay Y. Konjenital kalp cerrahisi sonrası şilotoraks tanı ve tedavisine güncel yaklaşım. Ege Tıp Dergisi 2016. [DOI: 10.19161/etd.344179] [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: 11/23/2022] Open
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Abstract
OBJECTIVE As a highly rare congenital defect, cor triatriatum sinister represents only 0.1% of congenital cardiac anomalies. Depending on the degree of obstruction and the accompanying symptoms, cor triatriatum can be diagnosed at any age. This case series described 5 patients with cor triatriatum sinister who underwent operation. METHODS Five patients with cor triatriatum sinister were seen at our institution between 2007 and 2013. The demographic characteristics and surgical results of these patients are outlined in this retrospective review. RESULTS The surgical approach consists of left or right atriotomy, excision of the obstructing membrane, and repair of the associated intracardiac anomalies. After an uneventful postoperative hospital stay, all patients were discharged 5-10 days postoperatively. There were no instances of recurrent constriction after surgical treatment of the cor triatriatum membrane. Patients were followed up for a median of 4 years and were symptom free. CONCLUSION In the surgical management of this easily and fully treatable congenital cardiac anomaly, it is difficult to determine which atriotomy approach is comparatively more advantageous. However, in the management of cor triatriatum sinister, priority should be given to confirmation of the diagnosis and full resection of the membrane. Thus, the surgeon should not hesitate to perform additional incisions if deemed necessary.
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Affiliation(s)
- Onur Işık
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Muhammet Akyüz
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Fatih Ayık
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ertürk Levent
- Department of Pediatric Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yüksel Atay
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Işık O, Akyüz M, Ayık MF, Atay Y. [Late development of double-chambered right ventricle after repair of a ventricular septal defect]. Turk Kardiyol Dern Ars 2015; 43:640-3. [PMID: 26536990 DOI: 10.5543/tkda.2015.50870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Double-chambered right ventricle is a rare heart defect causing right ventricular outflow tract (RVOT) obstruction. In this malformation, the right ventricle is divided into two chambers by a fibromuscular band. A 12-year old female patient who had undergone repair of a ventricular septal defect at 5 months old was admitted to our hospital with complaints of dyspnea and fatigue. The patient was diagnosed with an isolated double-chambered right ventricle and surgical correction was successfully performed. Post-operative transesophageal echocardiography showed no residual gradients across the RVOT. Following an uneventful recovery, the patient was discharged five days after surgery.
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Affiliation(s)
- Onur Işık
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Muhammet Akyüz
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Fatih Ayık
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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Onan İS, Haydin S, Ündar A, Yalındağ-Öztürk MN, Demirkol D, Kalkan G, Ceyran H, Atay Y, Şaşmazel A, Karacı AR, Şevketoğlu E, Köroğlu T, Altın HF, Yazıcı P, Yıldızdaş D, Çicek AE, Ödemiş E, Akçevin A, Bakır İ. A multidisciplinary approach to expand the use of pediatric ECLS systems in Turkey. Artif Organs 2015; 39:7-13. [PMID: 25626574 DOI: 10.1111/aor.12374] [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] [Indexed: 11/28/2022]
Affiliation(s)
- İsmihan Selen Onan
- Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Division, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey
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Coskun I, Colkesen Y, Ayik F, Berdeli A, Atay Y. Novel non-synonymous polymorphisms in the COX-1 gene in Turkish pediatric patients with cardiovascular anomalies. Genet Mol Res 2014; 13:262-8. [PMID: 24535852 DOI: 10.4238/2014.january.17.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Variation in the gene encoding cyclooxygenase-1 (COX-1) is involved in the process of aspirin resistance. This study investigated the genetic variations in the COX-1 gene. The 4 coding regions of the human COX-1 gene in 90 pediatric patients (median age of 6.5 months, 55% males) with cardiovascular anomalies were screened using DNA sequencing. Twenty coding-region variants causing amino acid substitutions as well as 2 new non-synonymous polymorphisms were identified. All variants were compared with an independent Caucasian population (N = 24 unrelated individuals). Most of the discovered polymorphisms were rare, although some variants resulted in amino acid changes occurring at a frequency >5% (W8R, P17L, Q41Q, Q240Q, D189E, and P188P). In addition, 2 new non-synonymous polymorphisms (F200L and D189E) were identified. These findings demonstrated novel genetic variants of the human COX- 1 gene. Future studies characterizing the functional impact of these variants are warranted.
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Affiliation(s)
- I Coskun
- Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Adana, Turkey
| | - Y Colkesen
- Department of Cardiology, Baskent University, Faculty of Medicine, Adana, Turkey
| | - F Ayik
- Department of Cardiovascular Surgery, Ege University, Faculty of Medicine, Izmir, Turkey
| | - A Berdeli
- Molecular Medicine Laboratory, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Y Atay
- Department of Cardiovascular Surgery, Ege University, Faculty of Medicine, Izmir, Turkey
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Bakiler AR, Eliaçık K, Köse S, Atay Y. Anomalous origin of the left coronary artery from the pulmonary artery presenting as dilated cardiomyopathy. Turk Kardiyol Dern Ars 2013; 41:448-50. [PMID: 23917013 DOI: 10.5543/tkda.2013.46020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly and one of the causes of myocardial ischemia. It often presents with atypical signs and symptoms, especially in childhood. In this case report, an 11-year-old girl presented with dilated cardiomyopathy in our clinic and was followed for five years. Echocardiography showed multiple left-to-right shunts on the interventricular septum, the confirmation of which was done by multi-slice computed tomography and coronary angiography. Therefore, we suggest that ALCAPA should be suspected in young patients diagnosed with dilated cardiomyopathy.
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Affiliation(s)
- Ali Rahmi Bakiler
- Department of Pediatrics, Cardiology Subdivision, Tepecik Training and Research Hospital, İzmir, Turkey
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Güngör H, Ertugay S, Ayık MF, Demir E, Engin C, Yağdı T, Ozbaran M, Atay Y, Nalbantgil S. [Clinical and hemodynamic features of Eisenmenger syndrome patients at the time of first admission: a tertiary referral-center experience]. ACTA ACUST UNITED AC 2012; 12:11-5. [PMID: 22214737 DOI: 10.5152/akd.2012.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed. METHODS The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6 ± 9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission. RESULTS The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9 ± 33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112 ± 6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV1 (forced expiratory volume), FEV1/FVC values were respectively, 3.1 ± 0.4, 2.5 ± 0.4 L and 76.7 ± 3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 ± 1.0 ml / kg/min and VE/VCO2 rate was 53.9 ± 3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low. CONCLUSION The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters.
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Affiliation(s)
- Hasan Güngör
- Ege Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir-Turkey.
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Ayik F, Oguz E, Engin C, Yagdi T, Ulger Z, Atay Y, Ozbaran M. Surgical Therapy of End-Stage Heart Failure in Pediatric Patients. Transplant Proc 2011; 43:935-7. [DOI: 10.1016/j.transproceed.2011.01.100] [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: 11/26/2022]
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Bakiler AR, Aydoğdu SA, Erişen S, Yenigün A, Atay Y. A case of mitral papillary muscle rupture due to blunt chest trauma. Turk J Pediatr 2011; 53:97-99. [PMID: 21534349] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mitral regurgitation due to papillary muscle rupture after blunt chest trauma is uncommon. Sudden onset severe mitral regurgitation may lead to death due to heart failure if surgical repair is delayed. A previously healthy 12-year-old girl underwent splenectomy and chest tube insertion for pneumothorax after a traffic accident in a vehicle 15 days before. She was discharged from the hospital after a nine-day follow-up. She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized. Transthoracic echocardiogram showed severe mitral regurgitation with freely moving posterior mitral chordae and prolapse of the posterior mitral valve leaflet. She received reimplantation of the complete ruptured posteromedial papillary muscle of the mitral valve. Her medical condition improved after the operation. On the postoperative echocardiogram, the left ventricular systolic function was normal with no mitral regurgitation.
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Affiliation(s)
- Ali Rahmi Bakiler
- Department of Pediatrics, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
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Demir SC, Çetin MT, Ürünsak IF, Atay Y, Toksöz L, Kadayifçi O. Removal of intra-abdominal intrauterine device by laparoscopy. EUR J CONTRACEP REPR 2009. [DOI: 10.1080/ejc.7.1.20.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Arslan MT, Ozyurek R, Kavakli K, Levent E, Ulger Z, Gurses D, Akyol B, Atay Y. Frequency of acquired von Willebrand's disease in children with congenital heart disease. Acta Cardiol 2007; 62:403-8. [PMID: 17824302 DOI: 10.2143/ac.62.4.2022285] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Bleeding tendency of paediatric patients with congenital heart disease has been well recognized. The underlying pathologies of this bleeding tendency have been studied extensively and many causes were identified. Among these causes, we aimed to find the frequency of acquired von Willebrand's disease (AvWD) in children with congenital heart disease. MATERIAL AND METHODS Forty-nine children with different forms of congenital cardiopathies who were assigned for surgery, are included in the study. Serum von Willebrand factor antigen level as well as ristocetin cofactor agglutination ratios were determined preoperatively and at one week and 6 months postoperatively. RESULTS Six patients (12.2%) were found to have AvWD. However, we found no relation between bleeding tendency and AvWD status. CONCLUSION Although frequency of von Willebrand factor deficiency is higher in children with congenital heart disease than in the normal population, this condition does not result in adverse clinical outcomes like increased bleeding tendency during operation.
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Yaǧdl T, Atay Y, Çikirikçioǧlu M, Boǧa M, Posacioǧlu H, Özbaran M, Alayunt A, Büket S. Determinants of Early Mortality and Neurological Morbidity in Aortic Operations Performed Under Circulatory Arrest. J Card Surg 2007. [DOI: 10.1111/j.1540-8191.2000.tb00454.x-i1] [Citation(s) in RCA: 6] [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: 12/01/2022]
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Islamoglu F, Apaydin AZ, Posacioglu H, Calkavur T, Yagdi T, Atay Y. Effects of thoracic and hiatal clamping in repair of ruptured abdominal aortic aneurysms. Ann Vasc Surg 2007; 21:423-32. [PMID: 17512162 DOI: 10.1016/j.avsg.2006.12.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 12/26/2006] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to determine the effects of hiatal and thoracic clamping on postoperative outcome and morbidity and factors affecting mortality and morbidity. The records of 102 patients who had undergone ruptured abdominal aortic aneurysm repair between 1993 and 2005 were evaluated retrospectively. Hiatal clamping and thoracic clamping were performed in 72 patients and 30 patients, respectively. Postoperative complications and survival were evaluated comparatively between the two groups by univariate and multivariate statistical analyses. Overall mortality and hospital mortality rates were 63 (61.8%) and 24 (23.5%) patients, respectively; and there was no difference between the two groups. Postoperative respiratory complications, gastrointestinal complications, and blood requirement were higher in the thoracic clamping group. Preoperative shock and renal ischemia time (>30 min) were found to be significant predictors of hospital mortality. Postoperative renal failure was the only independent postoperative predictor of mortality. In the follow-up period, cardiac event was an independent predictor of late mortality. If hospital mortalities were excluded, 5-year and 10-year cumulative survivals were 57.82 +/- 5.85% and 38.16 +/- 6.97%, respectively. Cross-clamp level did not have a significant effect on long-term survival. Although both thoracic and hiatal clamping had no effect on mortality, postoperative respiratory complications, blood requirement, and intestinal ischemia were more pronounced in patients operated with thoracic clamping. Hiatal clamping is preferable for a safe postoperative period.
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Affiliation(s)
- Fatih Islamoglu
- Department of Cardiovascular Surgery, Ege University Medical Faculty, 35100 Izmir, Turkey.
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Atay Y, Altintaş A, Tuncer I, Cennet A. Ovarian actinomycosis mimicking malignancy. EUR J GYNAECOL ONCOL 2005; 26:663-4. [PMID: 16398234] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To emphasize the importance of frozen section diagnosis in the treatment of ovarian carcinoma and to remind physicians that it may mimic ovarian carcinoma and occur in women without intrauterine contraceptive devices (IUDs). METHODS Three cases operated on in Adana University Hospital between the year 2001-2003 with the diagnosis of ovarian actinomycosis were reported. CASE REPORT Three female patients who had never used IUDs, aged 37, 45 and 47, who presented with pelvic pain and tumoral masses in the pelvis were operated on with the initial diagnosis of ovarian carcinoma between the years 2001 and 2003. Intraoperative frozen-section diagnoses of the pelvic masses were actinomycosis. In the postoperative period the patients received long-term antibiotic therapy initially intravenously (15 days), and later orally with 4 g/day for three months. They were healthy without evidence of actinomycosis infection for two years after the treatment. DISCUSSION Pelvic actinomycosis is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. The behavior of the disease, which mimics malignancy and urogenital manifestation, poses difficulties in diagnosis and management. Preoperative examinations could not establish the nature of the tumour. An initial diagnosis of ovarian carcinoma is usually considered in all cases. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.
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Affiliation(s)
- Y Atay
- Gynecologic Oncology Clinic, Cukurova University Medical Faculty, Adana, Turkey
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Islamoğlu F, Posacioğlu H, Apaydin AZ, Calkavur T, Yağdi T, Atay Y, Büket S. Perioperative determinants of mortality and morbidity in distal arch and proximal descending aortic aneurysm surgery. Med Sci Monit 2004; 10:CR137-42. [PMID: 15039643] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2003] [Accepted: 07/31/2003] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The purpose of this article is to describe our experience on distal arch and proximal descending aortic aneurysm repair, and to evaluate retrospectively the determinants of mortality and morbidity. MATERIAL/METHODS Between 1994 and 2002, 30 patients (mean age 53.4 years) underwent repair of distal arch or proximal descending aortic aneurysm approached through left thoracotomy with deep hypothermic circulatory arrest. Femoro-femoral bypass was used in all patients except for four, in whom the left subclavian artery was cannulated. Retrograde cerebral perfusion was performed in 16 patients. The mean circulatory arrest time was 30.7 min. RESULTS Overall hospital mortality was 13.3%. Excessive blood (p=0.008) and plasma (p=0.009) transfusions, and coronary artery disease (p=0.012) were correlated with mortality. The overall rate of postoperative complications was 30%. Renal failure and respiratory failure were the most frequent complications (16.7%), while the rates of stroke and transient neurological dysfunction were 6.7% and 3.3%, respectively. Age >70 years, bypass time >140 min, distal ischemia time >55 min, and excessive blood or plasma transfusions were determinants of postoperative complications. CONCLUSIONS Deep hypothermic circulatory arrest with left thoracotomy is a valid procedure with acceptable mortality rates in the management of aneurysms of distal arch and proximal descending aorta. Prolonged bypass and distal ischemia times and excessive blood transfusions are associated with increased postoperative morbidity.
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Affiliation(s)
- Fatih Islamoğlu
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Levent E, Arslan MT, Ozyürek AR, Atay Y, Alayunt A, Parlar A. Cardiac perforation due to crochet hook: a pediatric patient with penetrating cardiac injury. Anadolu Kardiyol Derg 2003; 3:177-9. [PMID: 12826516] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Ertürk Levent
- Ege University, Medical Faculty, Department of Pediatric Cardiology, Izmir, Turkey.
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Durmaz I, Yagdi T, Calkavur T, Mahmudov R, Apaydin AZ, Posacioglu H, Atay Y, Engin C. Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery. Ann Thorac Surg 2003; 75:859-64. [PMID: 12645707 DOI: 10.1016/s0003-4975(02)04635-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction. METHODS Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group 1 (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed. RESULTS The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively). CONCLUSIONS Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients.
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Affiliation(s)
- Isa Durmaz
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Bornova, Izmir, Turkey
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Posacioğlu H, Apaydin AZ, Islamoğlu F, Calkavur T, Yağdi T, Atay Y, Büket S. Adverse effects of cell saver in patients undergoing ruptured abdominal aortic aneurysm repair. Ann Vasc Surg 2002; 16:450-5. [PMID: 12089630 DOI: 10.1007/s10016-001-0123-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A retrospective analysis of 56 patients undergoing ruptured abdominal aortic aneurysm (AAA) repair was performed to find out if cell saver had any impact on postoperative morbidity and mortality. All patients but one were male. The mean age was 68 +/- 8 years (35-85 years). Cell saver was used in 40 patients (CS group) and was not used in 16 patients (NCS group). We compared the incidences of respiratory, renal, and gastrointestinal complications; reoperation; transfusion requirement; length of hospital stay; and mortality between the groups. This study demonstrated that intraoperative cell saver usage significantly increased the incidence of respiratory complications and the need for blood and fresh frozen plasma transfusion, and prolonged the hospital stay in patients with ruptured AAA, but did not have any impact on mortality. Postoperative complications were more prominent in patients who received >3000 mL cell saver blood.
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Affiliation(s)
- Hakan Posacioğlu
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
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Demir SC, Cetin MT, Ucünsak IF, Atay Y, Toksöz L, Kadayifçi O. Removal of intra-abdominal intrauterine device by laparoscopy. EUR J CONTRACEP REPR 2002; 7:20-3. [PMID: 12041860] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. METHODS A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. RESULTS The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. DISCUSSION Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.
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Affiliation(s)
- S C Demir
- Cukurova University, Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
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Tetik O, Yagdi T, Islamoglu F, Calkavur T, Posacioglu H, Atay Y, Ayik F, Canpolat L, Yuksel M. The effects of L-carnitine on spinal cord ischemia/reperfusion injury in rabbits. Thorac Cardiovasc Surg 2002; 50:11-5. [PMID: 11847597 DOI: 10.1055/s-2002-20157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Paraplegia after distal aortic aneurysm repair remains a persistent clinical problem. We hypothesized that the tolerance of the spinal cord to an ischemic period could be improved with hypothermic Ringer's Lactate containing L-Carnitine. MATERIALS AND METHODS Twenty-eight New Zealand white rabbits were used as spinal cord ischemia models. We separated rabbits into four equal groups and clamped each animal's abdominal aorta distal to the left renal artery. We occluded the aortas above the iliac bifurcation for 30 minutes. In group I, the infrarenal aorta was clamped without infusing any solution. In group II, Ringer's Lactate solution was infused at + 25degrees C for 3 minutes at a rate of 5 ml/min into the isolated aortic segments immediately after cross-clamping and the last 3 minutes of ischemia. In group III, Ringer's Lactate solution at +3 degrees C was given in the same method as that of group II. In group IV, Ringer's Lactate solution at +3 degrees C plus 100 mg/kg of L-carnitine was infused using the same technique. We assessed the neurological status of the hind limbs 24 and 48 hours after operation according to Tarlov's criteria. All animals were sacrificed and spinal cords were harvested for histological analyses. RESULTS The neurological status in groups III and IV was significantly superior to that of groups I and II. All the animals in group I had complete hind-limb paraplegia. Complete hind-limb paraplegia occurred in 5 rabbits in group II. Two of the 7 animals in group III had spastic paraplegia, and none at all in group IV. Histological analysis of the cross-clamped segments of the rabbits with paraplegia in group I, II and III revealed changes consistent with ischemic injury, while findings were normal for the normal animals in group III and IV. CONCLUSIONS In this model, the infusion of hypothermic Ringer's Lactate contained L-carnitine provided sufficient spinal cord protection against ischemia. Clinically, this may be a useful adjunct for prevention of paraplegia during surgery of the descending aorta.
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Affiliation(s)
- O Tetik
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Bornova, Izmir, Turkey
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Abstract
Controversy exists concerning the best management of patients with coronary artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of 266 patients undergoing isolated coronary artery surgery. Patients in the combined coronary artery bypass grafting and carotid endarterectomy group were elderly patients (p=0.0001) with a higher prevalence of female gender (p=0.0001), left ventricular dysfunction (p=0.006), left main coronary artery disease (p=0.033), triple-vessel coronary artery disease (p=0.002), unstable angina pectoris (p=0.004), and history of prior neurologic events (p=0.0001). Three (3.4%) patients in the combined group and 5 (1.9%) patients in the isolated coronary artery surgery group (p=0.317) developed perioperative myocardial infarction. Two (2.3%) patients in the combined group developed a permanent postoperative neurologic event. Hospital mortality was 5.7% (5 patients) in the combined coronary artery bypass grafting and carotid endarterectomy group and 1.5% (4 patients) in the isolated coronary artery surgery group (p=0.046). Patients with concomitant carotid and coronary artery disease have an advanced arteriosclerosis. Although combined coronary artery bypass grafting and carotid endarterectomy is associated with a higher risk of death and perioperative myocardial infarction than simple coronary artery surgery, this procedure is a preferable approach for these high-risk patients and results in lower neurologic morbidity.
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Affiliation(s)
- A Hamulu
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Bornova, Izmir, Turkey
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Islamoglu F, Yagdi T, Atay Y, Calkavur T, Ozbek C, Canpolat L, Büket S, Vüksel M. An intraaortic solution trial to prevent spinal cord injury in a rabbit model. Eur J Vasc Endovasc Surg 2001; 22:175-9. [PMID: 11472054 DOI: 10.1053/ejvs.2001.1428] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate the effectiveness of an intraaortic delivered solution on preventing spinal cord injury. DESIGN forty rabbits were allocated into five equal groups. MATERIALS AND METHODS one clamp was placed just distal to the left renal artery, and another was placed just above the iliac bifurcation for 40 min. Group 1 was not infused (control group). Through a 24G vascular catheter inserted into the isolated aortic segment, 20 ml of LR solution at room temperature (Group 2) 20 ml of LR solution at 3 degrees C (Group 3), and 20 ml of LR solution at 3 degrees C containing 30 mg/kg of methylprednisolone (Group 4) were infused over 3 min. In Group 5, 10 mg/kg of vitamins E and C were delivered two days before the experiment, and 20 ml of LR solution at 3 degrees C containing 30 mg/kg of methylprednisolone, and 10 mg/kg of vitamins E and C was infused at the operation. Postoperative spinal cord function was assessed using Tarlov's criteria. RESULTS the neurologic status of Groups 3, 4, and 5 was significantly superior to that of Groups 1 and 2. No paraplegia was observed in Groups 4 and 5. Spastic paraplegia occurred in all rabbits of Groups 1 and 2, and in 20% of Group 3. In the electron microscopic evaluation of spinal cord specimens, normal histologic structure was observed in Groups 4 and 5, whereas, some derangements were observed in all others. CONCLUSIONS intraaortic infusion of a hypothermic blended solution containing methylprednisolone, vitamins C and E provided best protection against postischaemic spinal cord dysfunction.
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Abstract
OBJECTIVES small arterial defects resulting from either trauma or resection of an aneurysm often present difficult problems to the vascular surgeon. DESIGN to demonstrate that certain arterial gaps as a result of traumatic injury or aneurysm resection could be closed with acute intraoperative arterial elongation. MATERIALS fifteen mongrel dogs underwent acute intraoperative arterial elongation of the right superficial femoral artery, with the left side used for a control vessel. METHODS arterial defects created surgically (median 50 (range 25 to 60 mm) mm). Appropriate length of artery was then undermined. A Foley catheter was placed proximally and distally directly beneath this undermined portion of vessel. The vessel is lengthened following 3 expansion/relaxation cycle of Foley catheter. Arterial gaps were closed by end to end anastomosis. Arterial pressure study was performed in all vessels. RESULTS acutely, arterial pressure differences proximal and distal to the anastomosis were seen only when arterial gaps were exceeded 55 mm. There was no occlusion either acutely or after 4 weeks follow-up period. Light microscopic examination of arterial specimens revealed partial disruption of internal elastic lamina. At the end of the follow-up period, formation of neointima with regeneration of the internal elastic lamina was demonstrated. Scanning electron microscopy revealed minimal endothelial denudation. CONCLUSIONS we believe that, acute intraoperative elongation can be used as an alternative technique to vein grafting for the repair of small traumatic arterial defects in selected cases.
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Affiliation(s)
- H Posacioğlu
- Ege University Hospital, Department of Cardiovascular Surgery Bornova, Izmir, Turkey
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Calkavur T, Yagdi T, Islamoglu F, Atay Y, Nalbantgil S, Ozbaran M. Allograft aortic root replacement for aortic valve endocarditis with aortopulmonary fistula. Jpn Heart J 2001; 42:261-4. [PMID: 11384086 DOI: 10.1536/jhj.42.261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute infective endocarditis affecting the aortic root and valve associated with development of a fistulous communication between the aorta and pulmonary artery was presented in a young Turkish girl. Emergency surgery was required. Operation consisted initially of closure of the defect on the main pulmonary artery with a pericardial patch. This was followed by allograft aortic root replacement.
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Affiliation(s)
- T Calkavur
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
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Kumral E, Yüksel M, Büket S, Yagdi T, Atay Y, Güzelant A. Neurologic complications after deep hypothermic circulatory arrest: types, predictors, and timing. Tex Heart Inst J 2001; 28:83-8. [PMID: 11453137 PMCID: PMC101145] [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: 02/20/2023]
Abstract
To determine the nature of neurologic dysfunction after deep hypothermic circulatory arrest during aortic arch surgery, we reconsidered the cases of 154 patients who had undergone aortic arch surgery (either of the ascending or transverse aorta, or both) between November 1993 and July 1999. Temporary postoperative neurologic dysfunction was seen in 9 patients (5.8%), and another 3 patients (1.9%) experienced stroke. Patients with temporary neurologic dysfunction had no new infarct and were discharged home with no residual symptoms. Computed tomographic scans revealed that 2 patients with stroke had multiple infarcts in the brainstem, and the 3rd had bilateral border-zone infarcts. The patients with brainstem infarcts died on postoperative days 7 and 15, and the patient with border-zone infarct was discharged home with no symptoms 3 months after surgery. Univariate analysis revealed that patients with neurologic deficits had significantly higher rates of history of hypertension, concomitant coronary artery bypass grafting, cardiac ischemia times longer than 90 minutes, and chronic renal failure. A multivariate logistic regression analysis revealed that the significant preoperative variables associated with neurologic deficits were a history of hypertension and a cardiac ischemia time longer than 90 minutes. Deep hypothermic circulatory arrest is a safe and useful technique for protection of the brain during surgery for complex aortic problems. In future, some patients at extreme risk for perioperative neurologic complications might be offered novel neuroprotective agents, in combination with deep hypothermia.
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Affiliation(s)
- E Kumral
- Neurology Department, Faculty of Medicine, Ege University, Izmir, Turkey
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Abstract
STUDY OBJECTIVE We documented such menstrual disorders as dysfunctional uterine bleeding (DUB): dangerous health problem during adolescence. DESIGN, SETTING, PARTICIPANTS We gave a questionnaire containing 29 questions about menstruation to 3000 secondary school students in Adana, Turkey. RESULTS The mean age of the students was 15.8 years; their menarche age was 12.9 years. Irregular periods were observed in 26.7% of the cases, 62.2% had at least one irregular bleeding in their lives, 11.3% visited a gynecologist for irregular bleeding, and 4.5% were treated for it. Dysmenorrhea occurred in 38.7% of the students. Forty-one percent used pain killers during their menstruation; half of them received the drugs from their family, and the other half received them over-the-counter without a prescription. Almost half (46.6%) of the girls experienced premenstrual problems. Most of the students (71.4%) discussed their menstrual problems with their mothers. Among the school girls, 15.8% claimed that there was a correlation between school examinations and irregular menses. CONCLUSION The questionnaire's results show that such menstrual disorders during adolescence as DUB are common but neglected. Medical staff who specialize in adolescent gynecology must address the problem.
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Affiliation(s)
- S C Demir
- Department of Obstetrics and Gynecology, Cukurova University School of Medicine, Balcali, Adana, Turkey.
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Ya?dl T, Atay Y, Çikirikçio?lu M, Bo?a M, Posacio?lu H, Özbaran M, Alayunt A, Büket S. Determinants of Early Mortality and Neurological Morbidity in Aortic Operations Performed Under Circulatory Arrest. J Card Surg 2000. [DOI: 10.1111/j.1540-8191.2000.tb00455.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yağdi T, Atay Y, Cikirikçioğlu M, Boğa M, Posacioğlu H, Ozbaran M, Alayunt A, Büket S. Determinants of early mortality and neurological morbidity in aortic operations performed under circulatory arrest. J Card Surg 2000; 15:186-93. [PMID: 11414604] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE Aneurysms and dissections of the thoracic aorta continue to present a surgical challenge and their incidence is increasing in recent years. The mortality rate of surgical treatment is still higher than those of other cardiovascular operations. Neurological injury is the most feared complication resulting from repair of these lesions. This study aims to determine the factors that influence the neurological outcome and mortality after thoracic aortic operations. METHODS During the period from November 1993 through May 1999, 144 patients were operated on for conditions involving the ascending aorta and/or aortic arch. Ninety-five (66.0%) were operated for aortic dissection and 49 (34.0%) were for aortic aneurysms. Sixty-two patients (43.1%) had replacement of ascending aorta with distal open technique; 82 patients (56.9%) had hemiarch or total arch replacement or repair of the distal arch. RESULTS Twenty-seven (18.7%) early deaths occurred. New stroke occurred in two patients (1.4%) and temporary neurological dysfunction in nine patients (6.3%). Deep hypothermic circulatory arrest with retrograde cerebral perfusion was used in all patients. On multivariate logistic regression analysis, risk factors for mortality were chronic renal failure, preoperative organ malperfusion, rupture, total circulatory arrest time > 60 minutes, postoperative acute renal failure, postoperative low cardiac output, sepsis, and multiple organ failure. Risk factors for neurological morbidity were preoperative chronic renal failure, preoperative hemodynamic instability, postoperative low cardiac output, and pulmonary complications. CONCLUSIONS Hypothermic circulatory arrest with retrograde cerebral perfusion was not an independent predictor of neurological morbidity on multivariate analysis, even if the arrest period was more than 60 minutes. Lengths of circulatory arrest periods and clinical presentations of the patients are important determinants of mortality.
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Affiliation(s)
- T Yağdi
- Department of Cardiovascular Surgery, Ege University Medical Faculty Hospital, Bornova, Izmir, Turkey.
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Basarir S, Islamoglu F, Ozkisacik E, Atay Y, Boga M, Bakalim T, Ozbaran M, Telli A. Comparative analysis of left ventricular hemodynamics and hypertrophy after aortic valve replacement with homografts or mechanical valves. J Heart Valve Dis 2000; 9:45-52. [PMID: 10678375] [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: 02/15/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to examine comparatively the effects of prosthetic and homograft valves in the aortic position on ventricular hemodynamics and structure. METHODS Hemodynamic evaluations were performed at rest and during exercise in 38 patients who had undergone aortic valve replacement (AVR) with either a homograft (n = 19) or prosthetic valve (19-23 mm; n = 19). Using echocardiographic, electrocardiographic and hematologic methods, the pressure gradient (PG); aortic valve area; diameters of left anterior wall, posterior wall (PW) and interventricular septum (IVS); ejection fraction (EF); left ventricular mass (LVM) and mass index (LVMI); electrocardiographic data of LV hypertrophy; hemoglobin; hematocrit and lactate dehydrogenase (LDH) levels were measured. RESULTS LVM and LVMI decreased significantly after surgery in both groups (p<0.001), but the decrease was significantly greater in the homograft group (p<0.05). The IVS and PW diameters in the homograft group decreased significantly postoperatively (p<0.05); the inter-group difference was also significant (p<0.01). In the homograft group there was a significant improvement in EF (p<0.05), and the exercise PG was significantly less. Both groups showed improved LV hypertrophy and correlation between V1S >24 mm criteria and LVMI measurements. Postoperative LDH levels in the homograft group were significantly lower than preoperative levels (p<0.05); the intergroup difference was also significant (p<0.001). CONCLUSIONS Our data suggest that homografts, as compared to mechanical prostheses, provide significantly better hemodynamics in the aortic position.
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Affiliation(s)
- S Basarir
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
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Çikirikçioğlu M, Çağirici U, Posacioğlu H, Atay Y, Savaş R, Yüksel M, Bilkay Ö. Intrapulmonary Hematoma and Hemothorax following Penetrating Chest Injury. Asian Cardiovasc Thorac Ann 1999. [DOI: 10.1177/021849239900700415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemothorax and intrapulmonary hematoma were successfully treated in a 25-year-old male who suffered a penetrating chest injury. This very rare combination of clinical entities in the same patient is discussed in the light of pertinent literature.
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Affiliation(s)
| | - Ufuk Çağirici
- Department of Thoracic Surgery, Ege University Bornova, İzmir, Turkey
| | | | | | - Recep Savaş
- Department of Radiology Medical Faculty, Ege University Bornova, İzmir, Turkey
| | | | - Önol Bilkay
- Department of Thoracic Surgery, Ege University Bornova, İzmir, Turkey
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Cağirici U, Bilaceroğlu S, Cikirikçioğlu M, Posacioğlu H, Atay Y, Yağdi T, Bilkay Ö. Parenchymal Stapling in Pulmonary Lobectomies: Is it Really Necessary? Asian Cardiovasc Thorac Ann 1999. [DOI: 10.1177/021849239900700314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Automatic stapling devices are widely used for pulmonary exeresis, particularly in wedge or segmental resections. Infrequently, these instruments are also employed in lobectomies for the division of incomplete fissures. A prospective randomized study was undertaken to determine the efficacy of staplers in performing a lobectomy. Among 102 lobectomy patients, 59 (44 men, 15 women) who had incomplete fissures were included in the study. A stapler was used in 38 patients for completion of the fissures, whereas sharp dissection and the classic suture closure technique were employed in the remaining 21 patients. Duration of air leakage postoperatively did not differ significantly (p > 0.05) but the operation time was found to be shorter in the stapled-lobectomy group (67.63 ± 13.7 min versus 85.71 ± 18.3 min; p < 0.001).
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Affiliation(s)
| | - Semra Bilaceroğlu
- Department of Chest Diseases Chest Diseases and Thoracic Surgery Training Hospital Yenisehir, İzmir, Turkey
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