Numan Ali Aydemir

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).

Randomized comparison between mild and moderate hypothermic cardiopulmonary bypass for neonatal arterial switch operation

OBJECTIVES To compare neonates receiving arterial switch operation (ASO) either with mild or moderate hypothermic cardiopulmonary bypass. METHODS Forty neonates undergoing ASO were randomized to receive either mild (Mi > 32 °C, n = 20) or moderate (Mo > 26 °C, n = 20) hypothermic cardiopulmonary bypass (CPB) between April 2007 and June 2010. All patients were diagnosed with simple transposition of the great arteries. Mean age (Mi: 8.32 ± 4.5 days, Mo: 7.54 ± 5.0 days, P = 0.21) and body weight were similar in both groups (Mi: 3.64 ± 0.91 kg, Mo: 3.73 ± 0.84 kg, P = 0.14). Follow-up was 3.1 ± 2.5 years for all patients. RESULTS Lowest perioperative rectal temperature was 33.5 ± 1.4 °C (Mi) versus 28.2 ± 2.1 °C (Mo) (P < 0.001). All patients safely weaned from CPB required lower doses of dopamine (Mi: 5.1 ± 2.4 µg/kg min, Mo: 6.5 ± 2.1 µ/kg min, P = 0.04), dobutamine (Mi: 7.2 ± 2.5 µg/kg min, Mo: 8.6 ± 2.4 µ/kg min, P = 0.04) and adrenalin (Mi: 0.02 ± 0.02 µg/kg min, Mo: 0.05 ± 0.03 µ/kg min, P = 0.03) in mild hypothermia group. Intraoperative blood transfusion (Mi: 190 ± 58 ml, Mo: 230 ± 24 ml, P = 0.03) and postoperative lactate levels (Mi: 2.7 ± 0.9 mmol/l, Mo: 3.1 ± 2.2 mmol/l, P = 0.02) were lower under mild hypothermia. Secondary chest closure was performed in 30% (Mi) versus 35% (Mo) (P = 0.65). Duration of inotropic support (Mi: 7 (4-11) days, Mo: 11 (7-15) days, P = 0.03), time to extubation (Mi: 108 (88-128) h, Mo: 128 (102-210) h, P = 0.04), lengths of intensive care unit (ICU) stay (Mi: 9 (5-14) days, Mo: 12 (10-18) days, P = 0.04) and hospital stay (Mi: 19 (10-29) days, Mo: 23 (15-37) days, P = 0.04) were significantly shorter under mild hypothermia. Two-year freedom from reoperation was 100% for both the groups. CONCLUSIONS The ASO under mild hypothermia seemed to be beneficial for pulmonary recovery, need for inotropic support and length of ICU and hospital stay. No worse early- or intermediate-term effects of mild hypothermia were found.

Diagnosis, treatment and outcomes of patients with aortopulmonary window.

BACKGROUND Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. AIMS To present our experience with the diagnosis and outcome of APW cases. STUDY DESIGN Retrospective cohort study. METHODS Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. RESULTS Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. CONCLUSION In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect.

An unusual presentation of pericardial cyst: recurrent syncope in a young patient.

Although pericardial cysts are generally benign structures and detected incidentally, they may be associated with life-threatening complications. We present the case of a 24 year-old man with a giant hemorrhagic pericardial cyst diagnosed after evaluation for recurrent syncope which caused compression of the right ventricle. Spontaneous hemorrhage into a pericardial cyst is an extremely rare event, and to our knowledge this is the first case in which a pericardial cyst has been shown to cause recurrent syncope.

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.1,2 We 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, …

Giant mycotic pseudoaneurysm of the aorta protruding over the sternal notch in a child

Aortic mycotic pseudoaneurysms are rare pathologies in children, which are mostly caused by an infection or trauma. Surgical and perioperative antibiotic therapies are mandatory in the treatment. Surgical timing and operational strategy are also critical factors. Herein, we report the successful repair of a giant mycotic pseudoaneurysm of the ascending aorta following a previous cardiac surgery in a 7-year old girl.

The effects of antedgrade cerebral perfusion on immediate postoperative outcome in neonatal and infant aortic arch repair concomitant with intracardiac surgery

Araştırma Hastanesi, İstanbul-Türkiye Phone: +90 216 459 44 40 Fax: +90 216 337 97 16 E-mail: sasmazel@yahoo.com Accepted Date/Kabul Tarihi: 30.05.2013 Available Online Date/Çevrimiçi Yayın Tarihi: 25.10.2013 ©Telif Hakk› 2013 AVES Yay›nc›l›k Ltd. Şti. Makale metnine www.anakarder.com web sayfas›ndan ulaş›labilir. ©Copyright 2013 by AVES Yay›nc›l›k Ltd. Available on-line at www.anakarder.com doi:10.5152/akd.2013.262 Scientific Letter Bilimsel Mektup 804

Emergency Management for Critical Left Main Coronary Artery Stenosis

BACKGROUND Increased experience and improvements in technology seem to have encouraged the use of percutaneous interventions for left main coronary artery (LMCA) occlusions. There is no consensus, however, and the data are inadequate on whether surgery or percutaneous procedures should be the intervention of choice for critical occlusions. METHODS From January 2002 to December 2006, 108 patients with unprotected LMCA stenosis >80% were treated at our center. Eighty-three patients (77%) underwent bypass grafting and 20 (18%) underwent percutaneous intervention for the purpose of myocardial revascularization. We analyzed parameters demonstrated as risk factors for myocardial revascularization and their predicted effects on outcome. RESULTS Five patients (5%) died following emergency cardiopulmonary resuscitation before any intervention was performed. The early survival rate was 84.1% in the coronary bypass group and 63% in the percutaneous intervention group. The mean (±SD) survival time was 55.7 ± 2.6 months in the bypass group and 7.6 ± 1.3 months in the percutaneous group. The late-survival rate was also significantly higher in the bypass group. The mean late-survival time was 44.5 ± 3.6 months in the bypass group and 2.3 ± 0.8 months in the percutaneous group. CONCLUSION Although emergency percutaneous interventions are lifesaving in some cases, these results clearly demonstrate that coronary bypass grafting should be the intervention of choice for myocardial revascularization in patients with critical LMCA occlusion.

Transaortic and Transmitral Extended Myectomy and Concomitant Supracoronary Myotomy in a Girl with Hypertrophic Cardiomyopathy

Concomitant idiopathic hypertrophic subaortic stenosis and disseminated myocardial bridging is an uncommon clinical entity with poor prognosis. We describe a symptomatic 19-year-old girl who had myocardial debridging and transaortic and transmitral extended septal myectomy in the same surgical session. An early and simultaneous surgical approach may prevent sudden cardiac death in these high-risk patients.

Two Challenging Translocation Procedures for Intramural Coronary Arteries in the Setting of Transposition of Great Arteries

Translocation of the coronary arteries remains a technical challenge in anatomic correction of transposition of great arteries. Myocardial ischemia related to the difficulties with coronary relocation is an important factor in perioperative and postoperative morbidity and mortality, particularly in the patients with complex coronary artery anatomy. Intramural coronary artery is a rare anatomic variety which may complicate the arterial switch operation in 2% to 4.6% of the reported cases. Even in the hands of experts, the mortality rate may be in twofold in this subset of patients compared with simple transposition of great artery procedures. In this report, 2 successful translocation techniques for intramural coronary arteries in the setting of arterial switch operation are described.