Ersin Erek

Early Degeneration of Extracellular Matrix Used for Aortic Reconstruction During the Norwood Operation

The use of prosthetic patch material is often required during the surgical reconstruction of complex congenital cardiac malformations. Decellularized porcine small intestinal submucosa, a type of extracellular matrix, was recently introduced as a patch for cardiac and vascular tissue repair. Extracellular matrix was used for aortic reconstruction during the Norwood procedure in 8 consecutive neonates with hypoplastic left heart syndrome. Rapid degeneration or aneurysm formation developed in 3 of these patients who came to second-stage surgery. Extracellular matrix should be used cautiously for aortic reconstruction in infants until additional reports from other centers provide confirmation of its safety.

Coronary artery bypass grafting in children

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

The effect of intravenous iloprost on pulmonary artery hypertension after paediatric congenital heart surgery

OBJECTIVES To investigate the effects of intravenous iloprost on pulmonary artery hypertension (PAH) in infants undergoing congenital heart surgery. METHODS In this prospective, randomized study, the study group (n = 15) received a continuous infusion of iloprost (2.0 ng/kg/min) that was delivered immediately after weaning from cardiopulmonary bypass and continued for 72 h postoperatively. Patients in the control group (n = 12) were managed conventionally. The groups were compared in terms of postoperative data, including systolic and mean pulmonary artery (PA) pressures, PA/systemic pressure ratio, lactate level, PAH crisis, ventilation time, reintubation and lengths of intensive care unit (ICU) and hospital stay. Transthoracic echocardiography was used to assess PA pressures at 1 day, 7 days and 30 days after surgery. RESULTS No mortality occurred. PAH crisis occurred in 2 (16.6%) patients in the control group and 4 (26.7%) patients in the study group (P = 0.53). Postoperative PA pressures and PA/systemic pressure ratios were similar between the groups (P > 0.05). The durations of ICU (P = 0.40) and hospital (P = 0.98) stays were similar between the groups. Echocardiographic studies demonstrated a significant decrease in postoperative PA pressures in the control (P = 0.001) and study (P = 0.0001) groups. However, no significant change was observed between the groups (P > 0.05). The Tukey multiple comparison test showed a significant decrease in PA pressures at each follow-up in both groups (P < 0.05). CONCLUSIONS Intravenous iloprost demonstrated no additional benefit over the conventional management of infants with PAH after repair of intracardiac defects. Clinicians may prefer other alternative agents in infants with a high risk of PAH crisis.

Right Atrial Flap Repair for Left Superior Vena Cava Draining into Left Atrium.

There are different surgical methods for the repair of persistent left superior vena cava that connects directly to the left atrium. We describe an extracardiac surgical technique that includes direct anastomosis of persistent left superior vena cava to the right atrium with right atrial flap and autologous pericardium. We have performed this procedure in four cases and there is no obstruction at postoperative control studies. Right atrial flap repair is a feasible extracardiac technique that offers growth potential.