Omer Ali Sayin

The benefits of continuous ultrafiltration in pediatric cardiac surgery

Background—Systemic inflammatory response and capillary leak syndrome, caused by extracorporeal circulation, have negative effects on the function of vital organs during the postoperative period. Modified ultrafiltration (MUF) has been developed as an alternative method to reduce the detrimental effects of cardiopulmonary bypass. The aim of this prospective, randomized study is to analyze the effects of MUF in a pediatric population undergoing congenital cardiac surgery. Methods—Twenty‐seven patients who underwent open‐heart surgery at our institution were included in this prospective study. They were randomized into two groups as follows: Group I (n=14) of conventional ultrafiltration during bypass and Group II (n=13) receiving both conventional and modified ultrafiltration during and after the cessation of the bypass, respectively. The amount of prime volume, postoperative chest drain loss, transfusion requirements, hemodynamical parameters, duration of mechanical ventilatory support, and length of intensive care unit stay were compared between the two groups. During the postoperative period, the concentrations of hematological, biochemical and inflammatory parameters were also compared by analyzing the blood samples obtained at various time points. Results—MUF resulted in a significant increase in hemoglobin, hematocrit and platelet levels, and significantly reduced the amount of chest tube output and transfused blood and blood products. MUF also shortened the duration of postoperative mechanical ventilatory support, length of the intensive care unit stay and improved postoperative hemodynamical parameters. During the early postoperative hours, IL‐8 is significantly reduced in patients undergoing MUF, however, the concentrations of IL‐8 were similar in both groups at the end of 24 h. Conclusions—MUF decreases the duration of mechanical ventilatory support, the length of intensive care unit stay, the need for blood transfusion and improves postoperative hemodynamics. It is associated with increased levels of hemoglobin, hematocrit and platelets. We can conclude that MUF attenuates the inflammatory response by decreasing the levels of inflammatory mediators.

Complication of Behcet's Disease: Spontaneous Aortic Pseudoaneurysm

Abstract  Behcets disease is an autoimmune multisystemic disorder based on vasculitis. In this disease, the most important predictor of morbidity and mortality is the vascular complications. Appropriate surgical interventions are critical and must be planned strategically. Here, we will describe a very rare complication of the disease; spontaneous aortic pseudoaneurysm in a 33‐year‐old patient.

Cerebral Protection With a Crossover External Carotid Artery Bypass During Arch Debranching

Endovascular stent graft repair of the thoracic aorta sometimes requires debranching of the aortic arch and reimplantation of the left common carotid and left subclavian arteries to the brachiocephalic trunk. Cerebral protection has utmost importance during such a procedure. The surgical technique detailed here offers pulsatile flow inside the internal carotid arteries despite proximal clamping of the common carotid arteries throughout the whole procedure.

Combination of unicuspid aortic valve, aortic coarctation, and aberrant right subclavian artery in a child: MR imaging and CTA findings.

Unicuspid aortic valve is a rare, but well-described congenital valve anomaly in the pediatric population. However, series of congenital unicuspid aortic valves in adults are limited. The estimated incidence of congenital unicuspid aortic valve in an adult echocardiographic population was reported to be about 0.02% [1]. It is often discovered during surgery or autopsy and can easily be mistaken for a bicuspid aortic valve, which, in contrast, is a common congenital cardiac anomaly occurring in up to 2% of live births [2, 3]. Multiplanar and biplanar transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are widely used diagnostic imaging tools for aortic valve abnormalities. Multiplanar TEE is found to be much more sensitive and specific in determining the anomalies [3]. A few cases of unicuspid aortic valve with coexisting anomalies detected by echocardiography have been reported [1, 4]. However, to the best of our knowledge, the combination of unicuspid aortic valve with aortic coarctation and aberrant right subclavian artery has not been reported previously. Furthermore, we assume that this is the first case report depicting magnetic resonance (MR) imaging and computed tomography angiography (CTA) findings of unicuspid aortic valve with coexisting anomalies.

Successful Bleomycin Pleurodesis in a Patient With Prolonged Pleural Effusion After Extracardiac Fontan Procedure

Abstract  Pleural effusions after modified Fontan operations are unpredictable and contribute significantly to the morbidity and prolonged hospitalization. Chemical pleurodesis is widely performed in adults for malignant pleural effusions, but has found less chance of usage for benign cases or the cases with unidentified etiology. Although it is a safe and easily performed procedure, the use of bleomycin for the treatment of pleural effusions in the pediatric age population has been rarely reported in the literature. In this manuscript, we present a case with prolonged pleural effusion after extracardiac Fontan operation, which was successfully treated with bleomycin pleurodesis.

Bilateral PDA in a Patient with VSD and Pulmonary Atresia

Abstract  Patent ductus arteriosus is one of the most common congenital cardiac pathologies, besides patency of ductus may be somewhat vital for various congenital cardiac defects, otherwise death is inevitable. Anatomically, ductus is single and located between the descending aorta and the pulmonary artery. The review of the literature reveals presence of more than one ductus arteriosi in sporadic cases, most commonly associated with aortic arch anomalies. In this report, we present a nine‐month‐old baby with the diagnosis of ventricular septal defect (VSD), pulmonary atresia (PA), nonconfluent pulmonary arteries, and bilateral patent ductus arteriosi. He underwent a successful pulmonary reconstruction and central‐shunt operation with modified aortopulmonary window technique without cardiopulmonary bypass. This is a very rare case with double ductus arteriosi associated with VSD, PA, and nonconfluent pulmonary arteries. (J Card Surg 2011;26:107‐110)

Infrarenal aortic coarctation.

ZusammenfassungEine hypoplastische infrarenale Aorta oder infrarenale Coarctatio aortae abdominalis ist eine seltene vaskuläre Pathologie, die durch eine diffuse Stenose der infrarenalen abdominellen Aorta charakterisiert ist. Sie ist eine Variante einer arteriosklerotischen Verschlusskrankheit. Die genaue Inzidenz und die Ätiologie sind nicht bekannt. Die Symptome sind vielfältig und die meisten Patienten fallen zufälligerweise mit einer schweren arteriellen Hypertonie ungeklärter Ursache auf. Wir berichten über einen 49-jährigen Patienten mit der Diagnose einer Coarctatio aortae abdominalis und geben einen Überblick über die existierende Literatur. Der Patient wurde mit einer chirurgischen Revaskularisation der unteren Extremitätenarterien erfolgreich behandelt.SummaryHypoplastic infrarenal aorta or infrarenal aortic coarctation is an uncommon vascular pathology characterized with diffuse stenosis in the infrarenal abdominal aorta. It is a variant of atherosclerotic occlusive diseases. The exact incidence and etiology are not known. Presenting symptoms are versatile and incidentally most of the patients have severe hypertension with an unidentified mechanism. Here, we report a 49-year-old male patient diagnosed with abdominal aortic coarctation together with the review of the literature. He underwent successful revasvcularization of the lower extremities.

Common Carotid Trunk & Right Vertebral Artery Originating From the Right Common Carotid Artery in a Patient With Carotid Stenosis

Abstract  Truncus bicaroticus is a very rare vascular malformation. In this report, we present a very rare anomaly in a patient with left internal carotid artery stenosis together with truncus bicaroticus and right vertebral artery originating from the right common carotid artery.

Hydatid Cyst of the Interventricular Septum

A 12-year-old girl was admitted with acute onset dyspnea and palpitation. Echocardiographic examination indicated cardiac tamponade, and emergent pericardial tube drainage was performed. Histopathologic examination of the pericardial materials revealed cuticula-like structures and fluid rich in histiocytic cells and eosinophiles. Postoperative control echocardiography showed cystic …

Effects of Ginkgo biloba Extract on Spinal Cord Ischemia–Reperfusion Injury in Rats

BACKGROUND We aimed to assess the biochemical and histopathologic effects of Ginkgo biloba extract (EGb) in an ischemia-reperfusion (IR) model of spinal cord ischemia induced by cross-clamping of the infrarenal abdominal aorta. METHODS A total of 24 Sprague-Dawley rats were divided into 3 groups as group 1: control (sham laparotomy), group 2: IR, and group 3: IR+EGb treatment (IR+T) group. All subjects were euthanized 2 days postsurgery and their spinal cords were removed. Tissue malondialdehyde, superoxide dismutase, glutathione (GSH), and glutathione peroxidase levels were measured, and the spinal cord tissue samples were examined histopathologically. RESULTS No significant difference was detected in ischemia markers between control, IR, and IR+T groups, with the exception of GSH, which was significantly lower in the IR group. GSH levels in group 1 and group 3 were similar. The group 2 displayed significant ischemic damage to the medulla spinalis. This damage was less pronounced in group 3 compared with group 2 only, but in extent and intensity comparable with the controls. CONCLUSIONS Although we were not able to demonstrate a uniform effect of EGb on biochemical markers of IR injury, the histopathologic data appear to show a protective effect conferred on the spinal cord tissue by EGb.