ABSTRACT: BACKGROUND: 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). METHODS: Between July 1, 2002 and May 31, 2012, 282 patients aged less than one year underwent isolated VSD closure at a median age of five months (range, 21 days to 1 year) and a median weight of 5.3 kg (range, 2.9 to 12.5 kg). Patients were divided into three groups according to the age at surgery (0-3, 3-6, and 6-12 months), and groups were compared in regard to severity of PH associated with morbidity and mortality. RESULTS: Four (1.4%) early and four (1.4%) late deaths occurred postoperatively. All mortalities were patients with severe PH, aged between 3 and 12 months. Although hemodynamic studies revealed a higher incidence of persistent postoperative PH in patients above three months of age, there was no statistically significant difference in morbidity associated with prolonged mechanical ventilation, and long intensive care unit and hospital stays between age-related groups. CONCLUSION: In this study, the incidence of mortality was higher in patients over three months of age undergoing repair of isolated VSD; the data suggest that the mortality may be decreased in patients with severe PH who were operated on earlier in life. We conclude that in infants with severe PH, early surgical repair (less than three months) of isolated VSDs is strongly advised to achieve more favorable results. doi: 10.1111/jocs.12073 (J Card Surg 2013;28:174-179).
Journal of Cardiac Surgery 03/2013; 28(2):174-179. · 0.87 Impact Factor
ABSTRACT: Abstract Background: This study was conducted to evaluate the outcomes of patients undergoing complete atrioventricular septal defect (CAVSD) repair with particular attention to age at surgery, surgical era, and technique. Methods: One hundred and forty-seven patients undergoing CAVSD repair between November 2002 and February 2012 were grouped according to surgical era and technique. Group I (age: 9.4 ± 5.0 months; weight: 6.8 ± 1.7 kg) consisted of 45 patients, operated before August 2006, and was divided into subgroup Ia (31 patients; two-patch repair) and subgroup Ib (14 patients; modified single-patch repair). One hundred and two patients operated after August 2006 were included in Group II (age: 5.2 ± 3.1 months; weight: 4.9 ± 2.6 kg), and was divided into subgroup IIa (59 patients; two-patch repair) and subgroup IIb (43 patients; modified single-patch repair). Groups were compared with regard to perioperative variables and postoperative data. Results: There were 19 early and five late deaths. Overall mortality was significantly higher in Group I, compared to Group II (p < 0.01). Comparison of Groups Ia to Ib and IIa to IIb revealed no statistically significant difference in mortality or morbidity. Age >8 months and preoperative common atrioventricular valve (CAVV) regurgitation ≥ moderate were significant risk factors for mortality and morbidity. After 40.8 ± 24.4 months, 99 (80.4%) of 123 (83.7%) survivors were asymptomatic without any medication, and 24 (19.5%) have mild symptoms. Conclusion: Our current results indicate that younger patient age and better preoperative CAVV functions were the main factors for a favorable outcome after surgical correction of CAVSD; and outcomes did not differ by the surgical technique. (J Card Surg 2012;27:745-753).
Journal of Cardiac Surgery 11/2012; 27(6):745-53. · 0.87 Impact Factor
ABSTRACT: Background: In this article, we present early and midterm results
of patients who underwent right ventricular outflow tract (RVOT)
reconstructions using different types of valved xenografts.
Methods: Between July 2002 and December 2010, 56 patients (33
males, 23 females; mean age 3.7 years; range 1 month-19 years) who
underwent RVOT reconstructions using different types of valved
xenografts were included. The mean size of the valved conduits
was 16.5 mm (range 11-23 mm). Regarding different types of
valved conduits; porcine aortic valve implanted bovine pericardial
conduit (LabCor, Sulzer Carbomedics), bovine valved jugular vein
(Contegra, Medtronic), glutaraldehyde fixed porcine aortic valved
root (Freestyle, Medtronic) and bovine pericardial tube containing
stentless porcine pulmonary valve were used in 41, 13, one and one
Results: Eight patients (14.2%) died in early postoperative period and one
patient (1.8%) died in late postoperative period. Conduit stenoses were
encountered in 15 patients (31.9%) through the follow-up with a mean of 22.5
months (range 1 month to 6 years). Among the patients with conduit stenosis,
mild stenosis was present in 10 (21.2%) (mean gradient 26.5 mmHg),
moderate in two (4.2%) (mean gradient 42 mmHg) and severe in three patients
(6.3%) (mean gradient 66.6 mmHg). Percutaneous balloon angioplasty was
performed in patients with severe conduit stenosis. Following balloon
angioplasty, right ventricle (RV)-pulmonary artery (PA) stenosis gradients
decreased to 33-37 mmHg in two patients. Intraconduit stent implantation
was required in one patient with a RV-PA gradient of 50 mmHg following
balloon angioplasty (residual stenosis gradient 30 mmHg).
Conclusion: Valved xenografts seem to be alternatives to pulmonary
homografts to be used in RVOT reconstructions. Long-term
durability of these conduits should be supported with further
Turkish Journal of Thoracic and Cardiovascular Surgery 10/2012; 20(4-4):689-698. · 0.09 Impact Factor
ABSTRACT: Our experiences with the surgical repair of truncus arteriosus: early and mid-term results
Background: This study aims to evaluate early and midterm
results of the patients who were operated for truncus
Methods: Between January 2003 and April 2010, 19 patients
(16 males, 3 females; mean age 76±45 days; range 11 to 174
days) who underwent surgery due to TA in our clinic were
included. The mean weight of the patients was 3.5±1.8 kg
(range 2.7-4.3 kg). Six patients (32%) were operated in
neonatal period, while 13 patients (68%) were operated in
early childhood. According to Van Praagh classification,
11 patients (58%) were type A1, six patients (32%) were
type A2 and one patient (5%) were type A3. One patient
with type A4 had accompanying type B-interrupted aortic
arcus. Truncal valve was tricuspid in 15 patients (79%) and
tetracuspid in four patients (21%). All patients underwent
single complete surgical repair of TA. Xenografts were
used for right ventricular-pulmonary artery connection. The
most frequently used extracardiac conduit was No 14 bovine
jugular vein graft (contegra).
Results: Postoperative early mortality rate was 21.1% (n=4).
The mean follow-up period was 21.9±20.8 months. Truncal
valve regurgitation was mild in nine patients (60%) and
moderate in one patient (7%). During follow-up period, six
patients (40%) developed pulmonary artery stenosis. Four
patients (66%) underwent balloon angioplasty, while stent
was implanted in two patients (33%). Reintervention-free
survival was 100% at one year, 69±13% at three years and
23±15% at five years.
Conclusion: Complete surgical repair of truncus arteriosus
results in good outcomes in neonatal and early childhood.
Reintervention may be required for the right ventricular out
Turkish Journal of Thoracic and Cardiovascular Surgery. 07/2012; 20(2):194-199.
Journal of Cardiac Surgery 05/2012; 27(3):394. · 0.87 Impact Factor
ABSTRACT: This retrospective study evaluated factors associated with mortality and morbidity in patients having functionally biventricular heart (FBH) and functionally univentricular heart (FUH) undergoing total anomalous pulmonary venous connection (TAPVC) repair.
We reviewed medical records retrospectively and identified 72 patients undergoing TAPVC repair between July 2002 and December 2010; and 62 patients had FBH and 10 patients had FUH. The median age and weight at repair was 9.1 months (range, 8 days-16 years) and 6.7 kg (range, 2.5-57 kg). The TAPVC anatomy was supracardiac in 41 (56.9%), cardiac in 18 (25%), infracardiac in eight (11.1%), and mixed in five patients (6.9%).
There were seven early deaths (2 FBH [25%] and 5 FUH [62.5%]) and one late death (FUH). Presence of FUH (p < 0.01), heterotaxy syndrome (p = 0.03), young age (p < 0.01), low weight (p < 0.01) and long CPB time (p = 0.04) at the time of surgery were statistically significant risk factors for mortality. Morbidity was related to long duration of postoperative mechanical ventilation, intensive care unit and hospital stay. Presence of FUH was the only significant risk factor for morbidity (p < 0.01). After a mean follow-up of 52.1 months (range, 3-74 months), 59 (92%) of 64 survivors were asymptomatic without any medication, and five have mild symptoms with regular physical activity.
Operative results of TAPVC have dramatically improved in recent years. However, patients having FUH (especially with concomitant palliative surgery), heterotaxy syndrome, low weight, early age, and long CPB time still have an increased operative mortality.
Journal of Cardiac Surgery 04/2012; 27(3):376-80. · 0.87 Impact Factor
ABSTRACT: To compare neonates receiving arterial switch operation (ASO) either with mild or moderate hypothermic cardiopulmonary bypass.
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.
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.
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.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2012; 41(3):581-6. · 2.40 Impact Factor
ABSTRACT: 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. (Cardiol J 2012; 19, 2: 188-191).
Cardiology journal 01/2012; 19(2):188-91. · 1.31 Impact Factor
ABSTRACT: This study assesses surgical procedures, operative outcome, and early and intermediate-term results of infective valve endocarditis in children with congenital heart disease.
Seven consecutive children (five females, two males; mean age, 10.8 years) who underwent surgery for infective valve endocarditis between 2006 and 2010 were included in the study. The aortic and mitral valves were affected in two and tricuspid in five patients. Indications for operation included cardiac failure due to atrioventricular septal rupture, severe tricuspid valve insufficiency, and septic embolization in one, moderate valvular dysfunction with vegetations in three (two tricuspid, one mitral), and severe valvular dysfunction with vegetations in the other three patients (two tricuspid, one mitral). The pathological microorganism was identified in five patients. Tricuspid valve repair was performed with ventricular septal defect (VSD) closure in five patients. Two patients required mitral valve repair including one with additional aortic valve replacement.
There were no operative deaths. Actuarial freedom from recurrent infection at one and three years was 100%. Early echocardiographic follow-up showed four patients to have mild atrioventricular valve regurgitation (three tricuspid and one mitral) and three had no valvular regurgitation. No leakage from the VSD closure or any valvular stenosis was detected postoperatively.
Mitral and tricuspid valve repairs can be performed with low morbidity/mortality rates and satisfactory intermediate-term results in children with infective valve endocarditis.
Journal of Cardiac Surgery 11/2011; 27(1):93-8. · 0.87 Impact Factor
ABSTRACT: The aim of this study is to evaluate gastric mucosal oxygenation together with whole-body oxygen changes in infants undergoing congenital heart surgery with cardiopulmonary bypass (CPB) procedure and the use of either pulsatile or nonpulsatile mode of perfusion with normothermia and pulsatile or nonpulsatile moderate hypothermia. Sixty infants undergoing congenital cardiac surgery were randomized into four groups as: nonpulsatile normothermia CPB (NNCPB, n = 15), pulsatile normothermia CPB (PNCPB, n = 15), nonpulsatile moderate hypothermia CPB (NHCPB, n = 15), and pulsatile moderate hypothermia CPB (PHCPB, n = 15) groups. In NNCPB and PNCPB groups, mild hypothermia was used (35°C), whereas in NHCPB and PHCPB groups, moderate hypothermia (28°C) was used. Gastric intramucosal pH (pHi), whole-body oxygen delivery (DO(2)) and consumption (VO(2)), and whole-body oxygen extraction fraction were measured at sequential time points intraoperatively and up to 2 h postoperatively. The measurement of continuous tonometry data was collected at desired intervals. The values of DO(2), VO(2), and whole-body oxygen extraction fraction were not different between groups before CPB and during CPB, whereas the PNCPB group showed higher values of DO(2), VO(2), and whole-body oxygen extraction fraction compared to the other groups at the measurement levels of 20 and 60 min after aortic cross clamp, end of CPB, and 2 h after CPB (P < 0.0001). Between groups, no difference was observed for pHi, lactate, and cardiac index values (P > 0.05). This study shows that the use of normothermic pulsatile perfusion (35°C) provides better gastric mucosal oxygenation as compared to other perfusion strategies in neonates and infants undergoing congenital heart surgery with CPB procedures.
Artificial Organs 11/2011; 35(11):1010-7. · 2.00 Impact Factor
ABSTRACT: 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.
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.
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.
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.
Heart Surgery Forum 02/2011; 14(1):E12-7. · 0.63 Impact Factor
ABSTRACT: Anomalous origin of one pulmonary artery branch from the aorta in the presence of separate aortic and pulmonary valves is a rare but important entity necessitating early diagnosis and surgery to prevent irreversible vascular pulmonary disease. We evaluated our experience with seven infants having this anomaly.
Between December 2003 and 2009, a total of seven infants (2 girls, 5 boys, age range 4 days to 84 days) were diagnosed as having anomalous origin of one pulmonary artery branch from the aorta. Clinical records were reviewed for clinical features, operative procedures, and postoperative follow-up.
Common symptoms were dyspnea, tachypnea, and poor feeding. All the cases were diagnosed by echocardiography. The right pulmonary artery in six cases and the left pulmonary artery in one case originated from the ascending aorta. In addition, three patients had patent ductus arteriosus (PDA), five patients had patent foramen ovale, and one patient had interruption of the aortic arch and aortopulmonary window. All patients underwent surgical re-implantation of the anomalous pulmonary artery branch to the pulmonary trunk. Associated surgical procedures included PDA ligation in three patients, and total repair of interrupted aortic arch and aortopulmonary window in one patient. There were no in-hospital deaths. Two patients had prolonged intubation (10 and 16 days). All patients were discharged in good clinical condition. During a follow-up period ranging from two months to six years, only one patient developed stenosis at the site of anastomosis.
Prompt diagnosis at infancy, improved surgical technique, and good patient care decrease mortality and morbidity associated with anomalous origin of the pulmonary artery from the aorta.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 09/2010; 38(6):411-5.
ABSTRACT: Tetraplegia is a rare complication after coronary artery bypass surgery. The authors present a case of tetraplegia after uncomplicated coronary artery bypass surgery because of cervical disc herniation. No distinct abnormality was found in the preoperative neurologic examination although the postoperative cervical magnetic resonance imaging revealed a huge hernia at C5-C6 level presenting with tetraplegia. Surgical decompression was performed on the second postoperative day of bypass surgery, and neurologic deficits gradually improved.
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 03/2010; 5(2):134-5.
ABSTRACT: A 59-year-old male patient admitted to our hospital with a pulsatile right gluteal mass with history of formation after blunt trauma. Persistent sciatic artery and its traumatic aneurysm was diagnosed after medical examination followed by peripheric digital substraction angiography. Surgery was performed under general anesthesia, and the patient was discharged from the hospital on postoperative day 7 without any problems. The sciatic artery, a continuation of the internal iliac artery into the popliteal-tibial vessels, represents the major blood supply to the lower limb in early embryologic development. Its persistence is very rare, and the aneurysmatic dilatation is the most common pathology diagnosed. Here, we present a rare case of persistent sciatic artery presenting with a traumatic aneurysm treated by iliopopliteal bypass surgery and ligation of the internal iliac artery proximal to the aneurysm.
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 03/2010; 5(2):131-3.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2010; 38(1):69.
ABSTRACT: 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.
Heart Surgery Forum 02/2008; 11(1):E59-61. · 0.63 Impact Factor
Circulation 06/2007; 115(20):e467-8. · 14.74 Impact Factor
ABSTRACT: Here we report triple coronary bypass procedure in a 12-year-old girl with familial homozygous hypercholesterolemia and extensive coronary atherosclerosis. She had successful cardiopulmonary resuscitation at home by her father 4 months before the operation. Total cholesterol level was 1300 mg/dL initially without antilipidemic treatment. Extensive three vessel disease with right coronary proximal stenosis and left coronary ostial stenoses was determined by angiography. Left internal thoracic artery, left radial artery, and saphenous vein grafts were used for coronary revascularization. Saphenous vein graft to right posterior descending artery, radial artery graft to obtuse marginal artery, and LITA to left anterior descending artery anastomoses were performed consecutively. Ten months after the operation, she is in good condition under intensive antilipidemic therapy and weekly lipid apheresis.
Heart Surgery Forum 02/2005; 8(5):E351-3. · 0.63 Impact Factor
ABSTRACT: Diabetic patients have a higher risk to acquire coronary artery disease at younger ages and vein grafts used in these patients have a tendency to develop stenosis earlier. No significant differences have been reported between the patency of internal thoracic artery (ITA) grafts in diabetic and non-diabetic patients. However, bilateral ITA grafting in diabetic patients remains a controversial topic due to increased risks in the perioperative morbidity.
The effects of bilateral ITA grafting on perioperative morbidity for diabetic patients were studied in two different trials. The first study compared 25 diabetic patients with 25 non-diabetic patients with bilateral ITA grafts for the length of the intensive care unit and hospital stay periods, for superficial wound infection, sternal dehiscence, mediastinitis rates and readmissions following discharge. The second study compared 30 diabetic patients with bilateral ITA grafts to 30 diabetic patients with unilateral ITA grafts for the same criteria as in the first study.
The first study showed no statistical difference between diabetic and non-diabetic patients for the criteria studied, but a slight increase was clinically observed in the readmission rate for diabetic patients due to superficial wound infection. The second study showed neither statistical, nor clinical differences between the two groups.
Full arterial revascularization is very important for the prognosis of diabetic patients. With a careful management, the slight increase in the perioperative morbidity could be reduced to acceptable levels enabling the diabetic patients to benefit from the long-term advantages of bilateral ITA grafting.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 01/2005; 4(4):290-5. · 0.44 Impact Factor