Ayse Sarioglu

Coronary artery bypass grafting in children

We present our clinical experience with coronary artery bypass grafting (CABG) in children.

Indications and Risks of Delayed Sternal Closure After Open Heart Surgery in Neonates and Early Infants

Background: Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years. Methods: The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days). Results: Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively (P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group (P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively). Conclusion: Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.

Challenges in the management of patients with functionally univentricular heart in Turkey.

Management of patients with functionally univentricular heart encompasses a wide array of developments over the years in every country. This article describes our working group experiences and 30-year story of single ventricle surgery in Turkey. Diagnosis, surgical treatment, and medical treatment of this complex group of patients necessitate courageous and continuous team effort with multi-institutional collaboration.

Surgical repair of a cause of sudden death: left coronary artery originating from right coronary sinus.

Left coronary artery originating from the right coronary sinus is one of the most frequent causes of sudden death in young people. We present a reconstructive surgical technique for left coronary artery and main pulmonary artery in a case with anomalous origin of the left coronary artery from the right coronary sinus. A 15-year-old boy underwent unroofing of the left main coronary artery and patch arterioplasty with autologous pericardium after transection of the main pulmonary artery. The pulmonary artery was reconstructed with autologous pericardium and a piece of dacron patch in order to prevent coronary artery compression. This surgical approach resulted in successful clinical outcome.

Interrupted aortic arch with intact ventricular septum: a multidetector CT angiography evaluation.

rasik ekokardiyografi yapıldı. Sol ventrikül fonksiyonları ve duvar hareketleri normaldi. Sol ventrikül apeksinde 3.5x1.4 cm boyutlarında, saplı ve hareketli, heterojen görünümlü kitle tespit edildi (Şekil 1, Video 1. Video/ hareketli görüntüler www.anakarder.com’da izlenebilir). Trombolitik tedavi uygulanması açısından yüksek risk faktörleri bulunması (yaşlı ve serebrovasküler hastalık öyküsü), nedeniyle cerrahi ile kitle eksizyonu planlandı. Anjiyografide sol ön inen arterin 1. diyagonal (D1) sonrası önemli darlık yapmayan musküler köprüleme, D1 başında %50 darlık mevcuttu (Şekil 2). Kalp Damar Cerrahisi Kliniği tarafından kardiyopulmoner baypas altında sol ventrikülotomi yoluyla apikal kitle eksizyonu yapıldı (Şekil 3). Patolojisi aterom plağı üzerine yerleşimli trombüs olarak yorumlandı. Hiperkoagülabiliteye neden olabilen herhangi bir patolojiye rastlanmadı. Sol ventrikül fonksiyonlarının korunduğu durumlarda da sol ventrikül kavitesinde trombüs görülebilir. Komplikasyonları önlemek açısından erken dönem trombolitik veya cerrahi tedavi uygulanmasının katastrofik sonuçları önleyeceği kanaatindeyiz.

Total correction of tetralogy of Fallot without “routine”preoperative cardiac catheterization—management of 99 patients

Between January 1989 and March 1993, total correction was performed in 99 patients with tetralogy of Fallot without submitting them to prior cardiac catheterization. The age of the patients ranged from 1.33 to 18 years (mean 5.33±3.77). After complete echocardiographic examination, the diameters of the right and left pulmonary arteries at the prebranching point and the descending thoracic aorta at the diaphragm were measured by cross-sectional echocardiography and the McGoon ratio was calculated. Total correction was performed in all patients with a McGoon ratio greater than 1.7. In none of the patients were the sizes of the pulmonary artery measured by echocardiography smaller than the measurements obtained during surgery. Transannular patching was performed in 76 patients. A conduit from the right ventricle to the pulmonary arteries was constructed in two patients with coronary arterial anomalies. Postrepair right ventricular to left ventricular systolic pressure ratios were between 0.25 and 0.85 (mean 0.54±0.13). There were two hospital deaths, neither being related to the diagnostic method used nor the criteria for surgery. We conclude that the diagnosis of tetralogy of Fallot together with measurements of pulmonary arteries and descending thoracic aorta can safely and reliably be achieved echocardiographically. The McGoon ratio can be adapted to echocardiography and total correction can be performed successfully based on echocardiographic examination.

Bir Sol Atriyal Miksoma Olgusu

Klinik olarak mitral stenoz belirtisi veren diyastolde ventrikulun icine dogru hareket eden sistolde sol atriyumun onemli bir kismini kapsayan ve ekokardiyografik olarak atriyal miksoma saptanan 9 yasinda bir vak a bildirilmistir Sapla sol atriyumun septumuna bagli olan tumor cerrahi olarak cikarilmis ve miksoma tanisi patolojik anatomik olarak teyid edilmistir 1 yil sonrasi postoperatif kontrol klinik ve ekokardiyografik olarak normal sinirlarda bulunmustur Anahtar kelimeler: Atriyal Miksoma Ekokardiyografi Mitral Stenoz

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.