Mehmet Salih Bilal

Early and Intermediate Term Results for Surgical Correction of Total Anomalous Pulmonary Venous Connection

Abstractu2003 Background: This retrospective study evaluated factors associated with mortality and morbidity in patients having functionally biventricular heart (FBH) and functionally univentricular heart (FUH) undergoing total anomalous pulmonary venous connection (TAPVC) repair. Methods: We reviewed medical records retrospectively and identified 72 patients undergoing TAPVC repair between July 2002 and December 2010; and 62 patients had FBH and 10 patients had FUH. The median age and weight at repair was 9.1 months (range, 8 days–16 years) and 6.7 kg (range, 2.5–57 kg). The TAPVC anatomy was supracardiac in 41 (56.9%), cardiac in 18 (25%), infracardiac in eight (11.1%), and mixed in five patients (6.9%). Results: There were seven early deaths (2 FBH [25%] and 5 FUH [62.5%]) and one late death (FUH). Presence of FUH (p < 0.01), heterotaxy syndrome (p = 0.03), young age (p < 0.01), low weight (p < 0.01) and long CPB time (p = 0.04) at the time of surgery were statistically significant risk factors for mortality. Morbidity was related to long duration of postoperative mechanical ventilation, intensive care unit and hospital stay. Presence of FUH was the only significant risk factor for morbidity (p < 0.01). After a mean follow‐up of 52.1 months (range, 3–74 months), 59 (92%) of 64 survivors were asymptomatic without any medication, and five have mild symptoms with regular physical activity. Conclusion: Operative results of TAPVC have dramatically improved in recent years. However, patients having FUH (especially with concomitant palliative surgery), heterotaxy syndrome, low weight, early age, and long CPB time still have an increased operative mortality. (J Card Surg 2012;27:376‐380)

Results for Surgical Closure of Isolated Ventricular Septal Defects in Patients Under One Year of Age

This study evaluated the outcomes of patients undergoing surgical repair of isolated ventricular septal defect (VSD) in the first year of life with particular attention to age and severity of pulmonary hypertension (PH).

Embolization of the Systemic Arterial Supply via a Detachable Silicon Balloon in a Child with Scimitar Syndrome

Scimitar syndrome is a rare congenital disorder. It is characterized by partial or total abnormal venous drainage of the right lung into the inferior vena cava, which is often associated with anomalous systemic arterial supply to the right lung, congenital cardiac anomalies, hypoplasia of the right lung and bronchial anomalies. Symptoms depend on the degree of the shunt and severity of the associated anomalies, which determine the treatment. We present a 6-year-old boy who was diagnosed as having the adult form of scimitar syndrome during evaluation for recurrent pulmonary infections, and underwent embolization with a detachable silicon balloon of the anomalous systemic arterial supply from the abdominal aorta to the right lower lung lobe. Successful elective surgery was performed 6 months later, in which right pulmonary veins were directed to the left atrium using a Gore-Tex patch by creating an intra-atrial tunnel. The patient has been symptom-free period during 6 months of follow-up, which supports the idea that recurrent pulmonary infections can be eliminated by embolization of the anomalous arterial supply.

A Magic Bullet Through the Heart

Penetrating cardiac trauma caused by gunshot constitutes the most fatal form of cardiothoracic injury because of its potential mortality. The heart lesions encountered in such situations are different and are sometimes surprising.1,2nnWe report a 16-year-old boy whom a relative accidentally shot at close range while trying to fieldstrip the handgun. The pistol, originally a replica manufactured to fire blank cartridges, was illegally converted by a gunsmith to fire live ammunition. In this case, …

Transcatheter device closure of a residual postmyocardial infarction ventricular septal defect

Postmyocardial infarction ventricular septal defect (VSD) carries a high mortality and, even after successful surgery, residual defect is common. A 75-year-old woman was admitted with the diagnosis of hyperacute anterior myocardial infarction. Primary percutaneous intervention was performed by stenting of a totally obstructed segment in the proximal left anterior descending artery. The patients condition deteriorated on the second postprocedural day with a 3/6 pansystolic murmur at the mesocardium. Echocardiography revealed an apical anteroseptal VSD and moderate pulmonary hypertension. She underwent surgical VSD closure with a Gore-Tex patch and coronary artery bypass grafting to the left anterior descending and circumflex arteries. The patients condition continued to be unstable due to septicemia and hemodynamically significant residual VSD. After medical management of septicemia, the residual defect was successfully closed using a 10-mm Cardio-O-Fix septal occluder under fluoroscopic and transesophageal echocardiographic guidance. The clinical condition of the patient was then stabilized and there was no significant residual shunt on echocardiography on the third postprocedural day.

Modified Single Versus Double-Patch Technique for the Repair of Complete Atrioventricular Septal Defect.

We present our single center results of two commonly used surgical techniques, the modified single‐patch and double‐patch technique for the repair of the complete atrioventricular septal defect.

Late presentation of interrupted aortic arch in childhood.

Correspondence: Tugcin B. Polat, MD, 5. Gazeteciler Sitesi A-1 blok 7 nolu villa Akatlar/Istanbul, Turkey. Email: tugcin75@mynet.com Received 21 December 2005; revised 2 April 2007; accepted 23 May 2007. doi: 10.1111/j.1442-200X.2008.02781.x Interrupted aortic arch (IAA) is a rare congenital anomaly that occurs in three per million live births, which is characterized by a lack of continuity between the ascending and descending thoracic aorta. 1 Patients with IAA are dependent on collateral fl ow to the descending aorta, usually through a patent ductus arteriosus (PDA), and the pathology is incompatible with life once the ductus arteriosus has closed. Most infants so affected die within the fi rst year of life, and median age at death is 4 days. 2 Survival to adolescence and young adulthood is extremely rare: only 19 patients have been reported in the literature. 3 – 5 We describe the rare presentation of this anomaly in two patients who underwent successful surgical repair in late childhood.

Triple coronary bypass in a child with homozygous familial hypercholesterolemia.

Here we report triple coronary bypass procedure in a 12-year-old girl with familial homozygous hypercholesterolemia and extensive coronary atherosclerosis. She had successful cardiopulmonary resuscitation at home by her father 4 months before the operation. Total cholesterol level was 1300 mg/dL initially without antilipidemic treatment. Extensive three vessel disease with right coronary proximal stenosis and left coronary ostial stenoses was determined by angiography. Left internal thoracic artery, left radial artery, and saphenous vein grafts were used for coronary revascularization. Saphenous vein graft to right posterior descending artery, radial artery graft to obtuse marginal artery, and LITA to left anterior descending artery anastomoses were performed consecutively. Ten months after the operation, she is in good condition under intensive antilipidemic therapy and weekly lipid apheresis.

Double Switch Procedure and Surgical Alternatives for the Treatment of Congenitally Corrected Transposition of the Great Arteries

We present our experience with the double switch operation in sixteen patients with congenitally corrected transposition of the great arteries.

Surgical correction of cor triatriatum sinister in the paediatric population: mid-term results in 15 cases

OBJECTIVESnCor triatriatum sinister (CTS) is a rare developmental cardiac abnormality resulting in left ventricular inflow obstruction. In this report, we aimed to present our mid-term results of early childhood patients operated for CTS and associated cardiac abnormalities.nnnMETHODSnWe enrolled 15 patients with CTS who were operated by a single surgeon between 2001 and 2013. A retrospective analysis was performed in order to determine the demographics, operative and postoperative results of the patients. The median age was 14 months and the median body weight was 8.2 kg at the time of operation.nnnRESULTSnFourteen patients had concomitant cardiac pathology. Three of the patients had atrial septal defect and 1 of the patients had partial abnormal pulmonary venous connection, whereas 4 of the patients had both. In 2 cases of complete atrioventricular septal defect, 1 case with ventricular septal defect, 1 case with patent ductus arteriosus, 1 case with double outlet right ventricle and another case with tetralogy of Fallot, complete repair was performed together with membrane resection in the left atrium (LA). The mean preoperative left atrial gradient was 13.3 mmHg, whereas the mean LA pressure at the first postoperative year was 4.2 mmHg. There was 1 case with early mortality due to septic multiorgan failure secondary to pneumonia.nnnCONCLUSIONSnCTS is a rare congenital cardiac anomaly in which the results of the corrective surgery are encouraging. Early and long-term outcomes may be variable according to the associated congenital heart defects.