Tayyar Sarioglu

Fate of Stentless Bioprostheses on Right Side of the Heart

Newly developed stentless bioprostheses have shown good midterm results in the aortic position, but few data are available on their use at the right side of the heart. Four types of stentless bioprosthesis were used for right-side reconstruction of congenital heart anomalies in 50 patients (3 Baxter-Edwards Prima, 27 Medtronic Freestyle, 14 Cryolife Ross, and 6 Medtronic Contegra). Mean age was 9.03 ± 6.25 years. Serial Doppler echocardiographic studies were performed to evaluate transvalvular pressure gradients. The hospital mortality was 6%. Reoperation was required in 3 patients in the early postoperative period because of left ventricular outflow tract obstruction, endocarditis, or tricuspid insufficiency. Measurements from 34 patients were available for statistical analysis. Clinical follow-up was complete in 43 of the 47 hospital survivors; the mean follow-up period was 16.6 ± 16 months. Four patients died during follow-up; 93% of the survivors have an unrestricted lifestyle. Although peak transvalvular conduit gradients increased in all types of conduit, no reoperation has yet been performed for conduit stenosis. The newly developed stentless bioprostheses may be a useful alternative for right-side reconstruction of congenital heart anomalies.

Istanbul Symposium on Neonatal and Pediatric Cardiopulmonary Bypass Procedures

Last summer, after organizing two Istanbul symposiums on pediatric extracorporeal life support systems, the third one was held on December 17, 2011 at the American Hospital in Istanbul, Turkey (1). The main topic of the third symposium was “minimizing adverse effects of cardiopulmonary bypass procedures in neonates and pediatric cardiac patients.”The objective of this editorial is to present the outcomes of the third symposium and suggest more topics for future symposiums in 2012. The third symposium is dedicated to honor Prof. Dr. Aydın Aytaç for his lifelong contributions as a pioneering surgeon and educator of the development of pediatric cardiac surgery in Turkey (Fig. 1) (2–6).

Coronary artery bypass grafting in children

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

Myocardial bridge of the left anterior descending artery

A 41-year-old female with a history of diabetes mellitus and hypertension was evaluated for exertional angina. During an exercise stress test, she developed hypotension and ST-segment depression. Coronary angiography revealed compression of the mid-portion of the left anterior descending (LAD) artery during systole (Fig. 1A) that did not persist during diastole (Fig. 1B). Computed tomography coronary angiography (CTCA) showed a myocardial bridge of the LAD (Fig. 2A). Medical therapy for 1 year, which included a beta blocker, calcium channel blocker, and aspirin, was unsuccessful, and her angina persisted. At the time of surgery, under cardiopulmonary bypass and cardioplegic arrest, the proximal LAD appeared normal, and so an isolated myotomy of the mid-portion of the LAD was performed. This portion of the LAD was also normal in size and had no atherosclerotic lesions (Fig. 2B). The patient tolerated the procedure well and has remained angina free. A CTCA performed 6 months after surgery showed no myocardial bridge and no atherosclerotic lesions (Fig. 2C).

Tetralogy of Fallot Surgical Repair: Shunt Configurations, Ductus Arteriosus and the Circle of Willis

In this study, hemodynamic performance of three novel shunt configurations that are considered for the surgical repair of tetralogy of Fallot (TOF) disease are investigated in detail. Clinical experience suggests that the shunt location, connecting angle, and its diameter can influence the post-operative physiology and the neurodevelopment of the neonatal patient. An experimentally validated second order computational fluid dynamics (CFD) solver and a parametric neonatal diseased great artery model that incorporates the ductus arteriosus (DA) and the full patient-specific circle of Willis (CoW) are employed. Standard truncated resistance CFD boundary conditions are compared with the full cerebral arterial system, which resulted 21, −13, and 37% difference in flow rate at the brachiocephalic, left carotid, and subclavian arteries, respectively. Flow splits at the aortic arch and cerebral arteries are calculated and found to change with shunt configuration significantly for TOF disease. The central direct shunt (direct shunt) has pulmonary flow 5% higher than central oblique shunt (oblique shunt) and 23% higher than modified Blalock Taussig shunt (RPA shunt) while the DA is closed. Maximum wall shear stress (WSS) in the direct shunt configuration is 9 and 60% higher than that of the oblique and RPA shunts, respectively. Patent DA, significantly eliminated the pulmonary flow control function of the shunt repair. These results suggests that, due to the higher flow rates at the pulmonary arteries, the direct shunt, rather than the central oblique, or right pulmonary artery shunts could be preferred by the surgeon. This extended model introduced new hemodynamic performance indices for the cerebral circulation that can correlate with the post-operative neurodevelopment quality of the patient.

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation.

Transcatheter device implantation has become an attractive alternative to surgery in the closure of atrial septal defects in selected patients. However, it can lead to early and late sequelae, some of them life threatening. For example, 79 days before her admission to our emergency department with sudden-onset respiratory distress and respiratory arrest (leading to cardiac tamponade and rupture), a 22-year-old woman had undergone percutaneous closure of an atrial septal defect. We describe the damage and its treatment. Although the adverse effects of transcatheter device implantation are rare, physicians should know that these events can be life threatening. Further data are needed to prevent such sequelae and to design new devices. It is of utmost importance that patients and their family members be informed both of possible sequelae and of life-saving interventions to be administered at early diagnosis.

Accessory Miniature Mitral Valve Causing Subaortic Obstruction

M IS C E L L A N E O U S one; (3) the mechanism can fail (twice in our experience, in more than 200 implantations); (4) it costs approximately

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

1,000. However, it carries the considerable advantage that a single-step procedure can be performed for aortic punching and anastomosis in just a few seconds. Both systems have advantages and drawbacks, and we cannot be sure that the reported results in limiting, or possibly avoiding, stroke in myocardial revascularization can be exclusively ascribed to their use. However, clampless OPCAB seems to overcome any other surgical strategy, including non-anaortic OPCAB, in preventing postoperative stroke and its consequences to patients’ health and hospital costs.

Double covered stent closure of extracardiac Fontan multiple fenestrations.

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.

Myocardial fibroma diagnosed with MRI: importance of the late enhancement pattern.

all patients had their high molecular weight vWF multimers levels and platelet function brought to normal conditions, which proves the relationship between valve disease and hematological abnormality (5). When valve surgery cannot be performed, for high surgical risk, authors suggest performing colectomy after identification of the bleeding site as an initial treatment option, knowing that recurrence of bleeding could occur at another site (6). Today, percutaneous prosthesis can be performed (7).