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ABSTRACT: In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed.
The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6 ± 9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission.
The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9 ± 33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112 ± 6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV1 (forced expiratory volume), FEV1/FVC values were respectively, 3.1 ± 0.4, 2.5 ± 0.4 L and 76.7 ± 3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 ± 1.0 ml / kg/min and VE/VCO2 rate was 53.9 ± 3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low.
The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 01/2012; 12(1):11-5. · 0.44 Impact Factor
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ABSTRACT: Middle aortic syndrome is a rare variation of aortic coarctation that is localized to the distal thoracic and abdominal aorta, and can involve the visceral and renal arteries. Irreversible organ damage and end-stage congestive heart failure may be the possible harmful complications of this disease in untreated patients. We report a three-year-old patient with diffuse thoracic and abdominal aorta hypoplasia treated with a thoracic to abdominal aortic bypass graft.
Journal of Cardiac Surgery 11/2011; 26(6):659-62. · 0.87 Impact Factor
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ABSTRACT: Bleeding tendency of paediatric patients with congenital heart disease has been well recognized. The underlying pathologies of this bleeding tendency have been studied extensively and many causes were identified. Among these causes, we aimed to find the frequency of acquired von Willebrand's disease (AvWD) in children with congenital heart disease.
Forty-nine children with different forms of congenital cardiopathies who were assigned for surgery, are included in the study. Serum von Willebrand factor antigen level as well as ristocetin cofactor agglutination ratios were determined preoperatively and at one week and 6 months postoperatively.
Six patients (12.2%) were found to have AvWD. However, we found no relation between bleeding tendency and AvWD status.
Although frequency of von Willebrand factor deficiency is higher in children with congenital heart disease than in the normal population, this condition does not result in adverse clinical outcomes like increased bleeding tendency during operation.
Acta cardiologica 09/2007; 62(4):403-8. · 0.61 Impact Factor
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ABSTRACT: Objective: Aneurysms and dissections of the thoracic aorta continue to present a surgical challenge and their incidence is increasing in recent years. The mortality rate of surgical treatment is still higher than those of other cardiovascular operations. Neurological injury is the most feared complication resulting from repair of these lesions. This study aims to determine the factors that influence the neurological outcome and mortality after thoracic aortic operations. Methods: During the period from November 1993 through May 1999, 144 patients were operated on for conditions involving the ascending aorta and/or aortic arch. Ninety-five (66.0%) were operated for aortic dissection and 49 (34.0%) were for aortic aneurysms. Sixty-two patients (43.1%) had replacement of ascending aorta with distal open technique; 82 patients (56.9%) had hemiarch or total arch replacement or repair of the distal arch. Results: Twenty-seven (18.7%) early deaths occurred. New stroke occurred in two patients (1.4%) and temporary neurological dysfunction in nine patients (6.3%). Deep hypothermic circulatory arrest with retrograde cerebral perfusion was used in all patients. On multivariate logistic regression analysis, risk factors for mortality were chronic renal failure, preoperative organ malperfusion, rupture, total circulatory arrest time > 60 minutes, postoperative acute renal failure, postoperative low cardiac output, sepsis, and multiple organ failure. Risk factors for neurological morbidity were preoperative chronic renal failure, preoperative hemodynamic instability, postoperative low cardiac output, and pulmonary complications. Conclusions: Hypothermic circulatory arrest with retrograde cerebral perfusion was not an independent predictor of neurological morbidity on multivariate analysis, even if the arrest period was more than 60 minutes. Lengths of circulatory arrest periods and clinical presentations of the patients are important determinants of mortality.
Journal of Cardiac Surgery 07/2007; 15(3):186 - 193. · 0.87 Impact Factor
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ABSTRACT: The purpose of this study was to determine the effects of hiatal and thoracic clamping on postoperative outcome and morbidity and factors affecting mortality and morbidity. The records of 102 patients who had undergone ruptured abdominal aortic aneurysm repair between 1993 and 2005 were evaluated retrospectively. Hiatal clamping and thoracic clamping were performed in 72 patients and 30 patients, respectively. Postoperative complications and survival were evaluated comparatively between the two groups by univariate and multivariate statistical analyses. Overall mortality and hospital mortality rates were 63 (61.8%) and 24 (23.5%) patients, respectively; and there was no difference between the two groups. Postoperative respiratory complications, gastrointestinal complications, and blood requirement were higher in the thoracic clamping group. Preoperative shock and renal ischemia time (>30 min) were found to be significant predictors of hospital mortality. Postoperative renal failure was the only independent postoperative predictor of mortality. In the follow-up period, cardiac event was an independent predictor of late mortality. If hospital mortalities were excluded, 5-year and 10-year cumulative survivals were 57.82 +/- 5.85% and 38.16 +/- 6.97%, respectively. Cross-clamp level did not have a significant effect on long-term survival. Although both thoracic and hiatal clamping had no effect on mortality, postoperative respiratory complications, blood requirement, and intestinal ischemia were more pronounced in patients operated with thoracic clamping. Hiatal clamping is preferable for a safe postoperative period.
Annals of Vascular Surgery 07/2007; 21(4):423-32. · 1.03 Impact Factor
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ABSTRACT: The purpose of this article is to describe our experience on distal arch and proximal descending aortic aneurysm repair, and to evaluate retrospectively the determinants of mortality and morbidity.
Between 1994 and 2002, 30 patients (mean age 53.4 years) underwent repair of distal arch or proximal descending aortic aneurysm approached through left thoracotomy with deep hypothermic circulatory arrest. Femoro-femoral bypass was used in all patients except for four, in whom the left subclavian artery was cannulated. Retrograde cerebral perfusion was performed in 16 patients. The mean circulatory arrest time was 30.7 min.
Overall hospital mortality was 13.3%. Excessive blood (p=0.008) and plasma (p=0.009) transfusions, and coronary artery disease (p=0.012) were correlated with mortality. The overall rate of postoperative complications was 30%. Renal failure and respiratory failure were the most frequent complications (16.7%), while the rates of stroke and transient neurological dysfunction were 6.7% and 3.3%, respectively. Age >70 years, bypass time >140 min, distal ischemia time >55 min, and excessive blood or plasma transfusions were determinants of postoperative complications.
Deep hypothermic circulatory arrest with left thoracotomy is a valid procedure with acceptable mortality rates in the management of aneurysms of distal arch and proximal descending aorta. Prolonged bypass and distal ischemia times and excessive blood transfusions are associated with increased postoperative morbidity.
Medical science monitor: international medical journal of experimental and clinical research 05/2004; 10(4):CR137-42. · 1.70 Impact Factor
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 07/2003; 3(2):177-9. · 0.44 Impact Factor
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ABSTRACT: Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction.
Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group 1 (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed.
The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively).
Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients.
The Annals of Thoracic Surgery 04/2003; 75(3):859-64. · 3.74 Impact Factor
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ABSTRACT: A retrospective analysis of 56 patients undergoing ruptured abdominal aortic aneurysm (AAA) repair was performed to find out if cell saver had any impact on postoperative morbidity and mortality. All patients but one were male. The mean age was 68 +/- 8 years (35-85 years). Cell saver was used in 40 patients (CS group) and was not used in 16 patients (NCS group). We compared the incidences of respiratory, renal, and gastrointestinal complications; reoperation; transfusion requirement; length of hospital stay; and mortality between the groups. This study demonstrated that intraoperative cell saver usage significantly increased the incidence of respiratory complications and the need for blood and fresh frozen plasma transfusion, and prolonged the hospital stay in patients with ruptured AAA, but did not have any impact on mortality. Postoperative complications were more prominent in patients who received >3000 mL cell saver blood.
Annals of Vascular Surgery 07/2002; 16(4):450-5. · 1.03 Impact Factor
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ABSTRACT: The objective of this study was to determine the predictive values of multiple atherosclerotic risk factors in using routine carotid duplex scanning for patients with peripheral vascular disease, even in the absence of any sign of carotid disease. From 1998 through 2000, 108 patients admitted for peripheral vascular reconstruction to our institution were preoperatively screened for carotid artery stenosis. Patients were examined for neurologic status and cervical bruits. As atherosclerotic risk factors, hyperlipidemia, diabetes, smoking, sex and age, coronary artery disease (CAD), coronary artery bypass surgery (CABG), and previous vascular operation were recorded, preoperative ankle-brachial pressure indexes (ABI) were calculated. All patients underwent routine carotid color duplex examinations preoperatively. Eighty five patients (78.7%) had mild (50%) carotid artery stenosis. Age (60 years), coronary artery disease, and carotid bruit were individual factors, and the combination of age 55 and hyperlipidemia had a significant value in predicting presence of 50% stenosis of one or both carotid arteries by univariate analysis. By multivariate logistic regression analysis, however, only carotid bruit was associated with carotid artery stenosis of 50% (p
International Journal of Angiology 01/2001; 10(4):250-253.
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ABSTRACT: Mitral regurgitation due to papillary muscle rupture after blunt chest trauma is uncommon. Sudden onset severe mitral regurgitation may lead to death due to heart failure if surgical repair is delayed. A previously healthy 12-year-old girl underwent splenectomy and chest tube insertion for pneumothorax after a traffic accident in a vehicle 15 days before. She was discharged from the hospital after a nine-day follow-up. She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized. Transthoracic echocardiogram showed severe mitral regurgitation with freely moving posterior mitral chordae and prolapse of the posterior mitral valve leaflet. She received reimplantation of the complete ruptured posteromedial papillary muscle of the mitral valve. Her medical condition improved after the operation. On the postoperative echocardiogram, the left ventricular systolic function was normal with no mitral regurgitation.
The Turkish journal of pediatrics 53(1):97-9. · 0.44 Impact Factor
