Uğur Göçen

Simultaneous Heart and Bilateral Lung Hydatid Cyst Operated in a Single Session

A 48 year-old man was admitted to our hospital because of coughing with dispnoea and chest pain. On physical examination he showed marked respiratory difficulty, with a respiratory rate of 25 breaths per minute, and his jugular veins were mildly distended. Transthoracic echocardiography showed a cystic mass located in the diaphragmatic surface of the right ventricular wall without any protrusion into the ventricular cavity. These cardiac and also bilateral pulmonary hydatic cysts were demonstrated by thoracic CT imaging. There were three hydatic cysts which were located in the right middle lobe medial segment (20 mm × 20 mm) and two of them were located in the left lower lobe laterobazal segment (15 mm × 15 mm and 17 mm × 14 mm). Extracorporeal bypass via median sternotomy was used and all components of hydatid cysts in heart and lungs were removed in same session. Patient recovered well. So one-stage surgery by median sternotomy is an excellent approach for cardiac and lung cyst hydatid.

Ochronotic involvement of the aortic and mitral valves in a 72-year-old man.

Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis.

An Unusual Complication of the Ventricular Septal Defect Closure by Device: Late Right Aortic Cusp Perforation.

Aortic regurgitation (AR) is a rare complication of transcatheter closure of perimembranous ventricular septal defects (pmVSD). It results from iatrogenic pinching of the aortic valve by the VSD occluder or perforation by the catheter. It is usually detected during control echocardiography (ECHO). The current study reports the first case of a late AR, which resulted from late right coronary cusp perforation by the VSD occluder. The current manuscript discusses the possible causes of late cusp erosion due to occluder, advantages of early operation in such cases, and an alternative treatment method where the occluder removal is not possible at the operation.

Left atrial extension of hepatoblastoma via left superior pulmonary vein.

Hepatoblastoma is the most common malignant liver tumour in early childhood. The metastatic extension of hepatoblastoma into the left atrium via the pulmonary vein is rare. Reported lesions almost always involve a right-sided approach. Here we report the case of a 3-year-old girl with a recurrent hepatoblastoma at multiple sites, including the left atrium, brain, and lung. The patient was treated surgically for the prevention of further embolic complications and cardiac failure.

Short- and mid-term results of xenograft–bovine pericardial patch in the repair of intracardiac defects: final results of a single-centre study

INTRODUCTION A variety of patch materials have been used in the repair of intracardiac defects. We evaluated the short- and mid-term clinical and echocardiography results of glutaraldehyde-preserved bovine pericardium patches used to repair intracardiac defects in our clinic. METHODS AND RESULTS This study examines the short- (up to 30 days post-operatively) and mid-term (up to 24 months post-operatively) results of 533 patients with intracardiac defects who underwent surgical correction with glutaraldehyde-preserved bovine pericardium patches between 2004 and 2010 at a university clinic. Short- and mid-term post-operative echocardiographic studies showed no evidence of calcification, thrombus, or aneurysmal dilatation on the patch. Vegetation developed in two (0.37%) of the 533 patients. CONCLUSION These results that have been obtained from a group of large number of patients imply that the glutaraldehyde-preserved bovine pericardium patches may be preferable in the closure of cardiac defects because of their low complication rates and ease of use.

Urgent surgery for cardiac hydatid cyst located in interventricular septum.

A 6-year-old girl was referred with acute chest pain and dyspnea. Transthoracic echocardiography revealed a single large well-defined intramyocardial cystic mass in the interventricular septum. A serologic test was positive for echinococcal infection. Urgent open heart surgery was undertaken to remove the cyst, and albendazole treatment was started. The postoperative course was satisfactory, and the patient was discharged on the 5th postoperative day without any complication.

Succesfull multidisciplinary treatment in a case of Buerger

A 58-year-old male patient had diagnosed with Buergers disease for 30 years. Patient referred us with non-healing scar on his right thumb. In another center, amputation was suggested due to his non-healing scar. We have assessed the patient multidisciplinary with cardiovascular and plastic reconstructive esthetic surgery for non-healing scar. During the multidisciplinary surgical treatment we applied radial artery endarterectomy, cross finger flap reconstruction, after operation medically we have treated with cilostazol. Patients scar completely healed. Follow up one year patient have no problem and radial artery in angiography was opened.

Comparison of the cardioprotective effects of dexmedetomidineand remifentanil in cardiac surgery

Background/aim: Myocardial protection is an important factor of open heart surgery and biological biomarkers (lactate, CKMB, cardiac troponin I, and pyruvate) are used to assess myocardial damage. This study compares the effects of dexmedetomidine and remifentanil on myocardial protection during coronary artery bypass grafting (CABG) surgery. Materials and methods: Patients scheduled for elective CABG surgery (n = 60) were included in this study. Anesthesia induction was introduced with propofol, fentanyl, and vecuronium bromide. Anesthesia was maintained with remifentanil infusion and sevoflurane in the remifentanil group (Group R) and with dexmedetomidine infusion and sevoflurane in the dexmedetomidine group (Group D). Blood samples for biochemical markers were taken from the coronary sinus catheter before cardiopulmonary bypass (T1), 20 min after aortic cross-clamping (T2), 20 min after removal of the aortic cross-clamping (T3), and 10 min after separation from cardiopulmonary bypass (T4).Results: Demographic data were similar between the groups. Lactate level at the T2 period and CKMB levels during the study period were lower in Group D than in Group R. In both groups, all values except pyruvate significantly increased over time. Conclusion: The dexmedetomidine-sevoflurane combination may improve the cardioprotective effect in comparison with remifentanil-sevoflurane in CABG surgery.

Early and Midterm Results of the Arterial Switch Operation: A 9-Year, Single-Center Experience

Background: The arterial switch operation (ASO) has become the surgical approach of choice for transposition of the great arteries. The aim of this paper was to describe the outcomes in patients who underwent arterial switch operation and to analyze the predictors of in-hospital mortality and further need for reoperation at a single-center institution. We reviewed our 9-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or Taussig-Bing anomaly (TBA) to assess the early and midterm outcomes. Methods: Between January 2007 and May 2016, 34 consecutive patients who underwent ASO for TGA with IVS; and TGA with ventricular septal defect (VSD); and double outlet right ventricle (DORV) with subpulmonary VSD at our institution were included in this retrospective study. The same surgeons operated on all patients. Patients’ charts, surgical reports, and echocardiograms were retrospectively reviewed. Median follow-up time ranged from 1 to 9 years, 54.2 (0.4-108) months. Results: There were 2 (5%) in-hospital deaths. Late death occurred in 1 (2.9%) of 32 survivors. One patient (2.9%) required reintervention. The freedom from reintervention rate was 95.9 ± 1.8% at 9 years. Two patients (3.9%) developed moderate neoaortic regurgitation during the follow-up and one patient underwent reoperation mainly for neopulmonary artery stenosis. The analysis showed that weight, cross-clamp (CC) time, cardiopulmonary bypass (CPB) time, and age of operation are strong predictors for mortality. Conclusion: ASO remains the procedure of choice for the treatment of various forms of TGA with acceptable early and midterm outcome, and can also be performed with a low risk of early mortality and satisfactory midterm outcomes even in a small-volume center. Early and midterm survival is excellent after arterial switch operation.

Arteryel switch operasyonları sonrası gecikmiş sternal kapanma: tek merkez deneyimi

Amac: Arteryel switch ameliyatindan sonra gecikmis sternal kapanma hemoraji, tamponad ve odem tedavisinde terapotik bir secenektir. Bu calismanin amaci, arteryel switch operasyonu sonrasi gecikmis sternal kapanma ile mediastinit iliskisini degerlendirmektir. Gerec ve Yontem: Ocak 2011 ile Kasim 2016 arasinda, Buyuk arter transpozisyonu veya Taussig-Bing anomalisi nedeniyle Arteryel switch ameliyati yapilan ve gecikmis sternal kapatma uygulanan ardisik 43 hasta retrospektif olarak incelendi. Hastalarin ayni cerrah tarafindan uygulandi. Gecikmis sternal kapanma endikasyonu, sternal kapatilma zamani, kardiyopulmoner bypass oncesi ve sonrasi ve metabolik durum, mortalite, enfeksiyon parametreleri kaydedildi. Bulgular: Ortalama sternal kapanma suresi 2.7 gun idi. Olum orani 2.32% (n=1) idi. Postoperatif enfeksiyon nedeniyle 5 (11.63%) hastada antibiyotik kullanimi uzun surdu. Gram negatif mikroorganizma baskinligi vardi. Postoperatif mediastinitli hasta yoktu. Ameliyat sonrasi enfeksiyon hizi istatistiksel olarak kardiyopulmoner baypas zamani, sternal kapatma zamani ve yogun bakim unitesinde kalis suresi ile birlikte artmadi. Ote yandan, mortalite sadece bir hastada gorulmustur. Bu hastalarin tanilari bing anomalisini tek koroner ostia ile, postoperatif donemde ise yogun bakim unitesinde ekstrakorporeal membran oksijenasyonuna ihtiyac duydu. Sonuc: Arterial anahtar islemlerinden sonra gecikmis sternal kapatmanin kullanilmasi onemli bir yonetim stratejisidir. Calismamizda, sternum kapanma suresinin uzamasi postoperatif enfeksiyon ve mediastinit orani ile iliskili bulunmamistir.