Aydın Aytaç

Effects of Pulsatile and Nonpulsatile Perfusion on Vital Organ Recovery in Pediatric Heart Surgery: A Pilot Clinical Study

The use of pulsatile flow during cardiopulmonary bypass (CPB) with regard to improved patient outcomes is controversial. We evaluated pulsatile perfusion in pediatric patients undergoing CPB in a clinical setting. Fifty consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n = 25) or the nonpulsatile perfusion group (group NP, n = 25). Study parameters included intubation time, duration of intensive care unit (ICU) stay and hospital stay, need for inotropic support, preoperative and postoperative enzymes, creatinine, C-reactive protein, blood count, mean urine output, and total drainage. Group P, compared with group NP, had significantly less inotropic support (number of agents, 1.48 ± 1.05 versus 2.44 ± 1.03, p = 0.0015; dopamine, 6.48 ± 3.27 versus 10.3 ± 4.8 &mgr;g/kg per minute, p = 0.0023; dobutamine, 3.12 ± 6.55 versus 8.03 ± 9.1 &mgr;g/kg per minute, p = 0.034), shorter intubation period (20.36 ± 17.02 versus 35.44 ± 30.72 hours, p = 0.038), and shorter duration of ICU stay (2.16 ± 1.07 versus 4.32 ± 4.21 days, p = 0.028) and hospital stay (7.64 ± 2.48 versus 11.84 ± 6.82 days, p = 0.007). There were no significant differences in creatinine, enzyme levels, or drainage amounts between the two groups. Higher urine output during CPB (553.6 ± 150.89 versus 465.8 ± 151.23 ml/d, p = 0.045) and during the ICU period (658.8 ± 210.99 versus 528,2 ± 224.71 ml/d, p = 0.039) was observed in group P compared with group NP. We concluded that the use of pulsatile flow resulted in improved patient outcome in preserving cardiac function and maintaining better renal and pulmonic function (shorter intubation period) in the early postbypass period.

Aorto—Right Ventricular Tunnel: A New Concept in Congenital Cardiac Malformations

Abstract A case of congenital aorto–right ventricular tunnel diagnosed preoperatively as ruptured sinus of Valsalva is presented. Careful search of the literature pertaining to this subject has revealed an extremely limited number of patients with the lesion, which differs from ruptured sinus of Valsalva by the presence of an intact aortic sinus and cusps displaying normal configuration. The entity has not yet been described in classic textbooks. Successful repair of this abnormal communication is possible with the help of extracorporeal circulation and anoxic arrest.

Direct communication between right pulmonary artery and left atrium: Report of a case and proposal of a new entity

The case of a patient with direct communication between the right pulmonary artery and the left atrium is presented and the literature is reviewed. All reported cases including ours show exactly the same type of abnormality at the same location; therefore it is suggested that this anomaly should be classified as a separate entity.

Pulmonary artery sling.

A case of pulmonary artery sling in a 1-year-old boy, treated by resection of the left pulmonary artery (LPA) at its origin from the right pulmonary artery (RPA) and reanastomosis of the LPA to the main pulmonary artery (MPA), is reported. In this patient the LPA-MPA anastomosis was demonstrated to be patent in a follow-up pulmonary angiogram six months after the operation. Pulmonary artery sling should be kept in mine when assessing respiratory distesss syndrome in children.

Istanbul Symposium on Neonatal and Pediatric Cardiopulmonary Bypass Procedures

Last summer, after organizing two Istanbul symposiums on pediatric extracorporeal life support systems, the third one was held on December 17, 2011 at the American Hospital in Istanbul, Turkey (1). The main topic of the third symposium was “minimizing adverse effects of cardiopulmonary bypass procedures in neonates and pediatric cardiac patients.”The objective of this editorial is to present the outcomes of the third symposium and suggest more topics for future symposiums in 2012. The third symposium is dedicated to honor Prof. Dr. Aydın Aytaç for his lifelong contributions as a pioneering surgeon and educator of the development of pediatric cardiac surgery in Turkey (Fig. 1) (2–6).

Surgical repair of tracheobronchial compression by tuberculous lymph nodes

We describe a patient with a tuberculous lymph node pressing on the trachea and right lobe of the bronchus who was managed with resection of the node and Dacron patch closure of a defect in the tracheobronchial tree.

Foreign Body in the Right Atrium: a Complication of Pudenz Ventriculo-Atrial Shunt: A Case Report

A dislodged Pudenz ventriculo-atrial shunting catheter in a 1.5 year old girl, removed from the right heart by right atriotomy, is presented. The diagnosis, complications and treatment of this unusual complication of the Pudenz shunt are discussed.

Use of Non-Valved Extracardiac Conduits in Complex Congenital Anomalies

Between March, 1986 and September, 1989, nonvalved conduits were used in 9 patients, ages ranging between five and seventeen years. Cardiac pathologies were atrioventricular and ventriculoarterial discordance with ventricular septal defects (VSD) and pulmonary stenoses (PS) in 5, transposition of great arteries (TGA) + VSD + PS in 1, and double-outlet left ventricle (DOLV) + VSD + PS in 3. Pulmonary obstruction was valvular in 1, valvular and infundibular in 7. There was 1 patient with pulmonary atresia. Valveless conduits 16-22 mm in diameter were used between the pulmonic ventricle and the pulmonary artery. All patients recovered from operation and remained well, except 1 with DOLV who died with severe arrhythmias the third postoperative day. During the mean follow-up of 32 ± 11.8 months 1 patient died of acute cardiac failure in the ninth month and all other patients were asymptomatic without needing reoperations. These results have been encouraging for the use of nonvalved conduits in complex congenital cardiac anomalies.

Cor Triatriatum Sinistrum Case Report and Review of Current Concepts

A case of classic cor triatriatum sinistrum in an adolescent, correctly diagnosed preoperatively and operated on successfully is presented. Current concepts regarding this rare cardiovascular malformation are reviewed and the possibility of misdiagnosis of this lesion as rheumatic mitral valve disease is emphasized, especially in countries where rheumatic fever is still the predominant cause of valvular heart diseases.