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Erkanli Senturk G.,Acibadem University | Erkanli K.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Aydin U.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Yucel D.,Acibadem University | And 3 more authors.
Peptides | Year: 2013

Oxytocin (OXY), a well-known nonapeptide, plays a crucial role in reproduction, and has effects on modulating the immune and inflammatory processes in living organisms as well. Recently it is also known as an antioxidant in several organs. The present study aims to demonstrate the protective effect of OXY against ischemia/reperfusion (I/R) injury in urinary bladder tissue. Abdominal aorta of rats, were clamped to perform urinary bladder ischemia. OXY (0.5 μg/kg) was injected intraperitoneally before ischemia in I/R + OXY group, whereas the vehicle solution was injected to I/R group. At the end of reperfusion, tissue samples from urinary bladder were processed for histochemical, ultrastructural and biochemical analysis. Tissue sections were stained by toluidine blue for mast cell counting and hematoxylin-eosin for histopathology. In addition, malondialdehyde (MDA) and glutathione (GSH) levels were determined biochemically. The results demonstrated that there was an extreme damage at urothelium, dilatation of intercellular junctions, inflammatory cell infiltration in I/R group. I/R + OXY group demonstrated a reduction in the severity of urinary bladder damage. According to mast cell counting results, both granulated and degranulated mast cells were decreased in I/R + OXY group compared to I/R group. The mean MDA level was higher in I/R group compared to control and lower in I/R + OXY group compared to I/R group. GSH level reduced in I/R group compared to the control and increased in I/R + OXY group compared to I/R group. In conclusion, oxytocin, as confirmed by histological evaluation and biochemical assays has a potential protective effect in the urinary bladder tissue against ischemia/reperfusion injury. © 2013 Elsevier Inc. All rights reserved.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital and Acibadem University
Type: Case Reports | Journal: Journal of cardiac surgery | Year: 2016

We present the use of Konnos procedure for the reconstruction of a huge left ventricular outflow tract pseudoaneurysm formed after aortic valve replacement.


Onan B.,Nightingale | Onan B.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Onan I.S.,Nightingale | Kilickan L.,Nightingale | And 2 more authors.
Journal of Cardiac Surgery | Year: 2013

Objective: To evaluate the effects of thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia (GA) on postoperative pain after coronary artery bypass grafting (CABG). Methods: Between April 2009 and March 2010, 40 patients with ischemic heart disease scheduled for elective CABG were prospectively randomized to receive either GA (n = 20) or GA + TEA (n = 20). Through epidural catheters, patients received an infusion of (10-20 mg/h) 0.25%-bupivacaine intraoperatively and during the first 24 hours after surgery. Study endpoints included assessment of postoperative pain at rest and with coughing, rescue analgesic need, and postoperative course. Results: The differences in pain scores were decreased at rest during 6 (0.1 ± 0.3 vs. 2.4 ± 1.8; p < 0.05) and 12 hours (0.1 ± 0.3 vs. 3.9 ± 2.3; p < 0.05) and with coughing at 6 (0.1 ± 0.3 vs. 5.6 ± 2.2; p < 0.05), 12 (0.1 ± 0.3 vs. 5.9 ± 2.3; p < 0.05), and 24 hours (0.05 ± 0.2 vs. 4.6 ± 2.9; p < 0.05) in the GA + TEA group. At one-month follow-up, pain scores were decreased in GA + TEA group (0.3 ± 0.7 vs. 1.6 ± 1.3; p = 003). There was no significant difference at three and six months. Mechanical ventilation time (4.7 ± 1.2 vs. 2.9 ± 1.1 hours; p < 0.05), intensive care unit stay (28.4 ± 9.0 vs. 22.4 ± 3.4 hours; p < 0.05), and hospital stay (7.2 ± 1.1 vs. 6.1 ± 0.3 days; p = 0.001) were reduced in the GA + TEA group. Conclusions: TEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery. © 2013 Wiley Periodicals, Inc.


Onan I.S.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Haydin S.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Yeniterzi M.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
Cardiology in the Young | Year: 2015

Inverted left atrial appendage is an unusual complication associated with congenital cardiac surgery. Inversion of the left atrial appendage may occur during the surgical procedure or afterwards. The left atrial appendage may invert iatrogenically or as a result of the negative pressure during placement or removal of the left atrial vent or during deairing manoeuvres. This event can be life-threatening because of the mass effect of the atrial appendage within the left atrial cavity. © Cambridge University Press 2014.


Haydin S.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Onan B.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Onan I.S.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Ozturk E.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | And 3 more authors.
Artificial Organs | Year: 2013

Near-infrared spectroscopy (NIRS) is a noninvasive modality to monitor regional brain oxygenation (rSO2). In this study, we aimed to investigate the correlation between cerebral rSO2 and lactate, pump flow, hematocrit, pCO2, and mean blood pressure (MBP) during cardiopulmonary bypass (CPB). Between March and September 2011, 50 pediatric patients who underwent congenital heart surgery were enrolled into the study. Ages ranged from 6 days to 168 months (median 14 months). A NIRS sensor (Somanetics 5100B, Troy, MI, USA) was placed on the right forehead of patients. CPB period was divided into five stages: 1-at the beginning of CBP, 2-cooling at 32°C, 3-at final hypothermic temperature, 4-rewarming at 32°C, 5-before weaning from CPB. Data collection included measurements of each parameter at five stages of CPB. Data were analyzed using multivariate analysis within groups and Spearman's correlation to test association between parameters. Lactate levels increased significantly from stage 1 to stage 5 during CPB (P<0.05). There was no significant correlation between cerebral rSO2 and MBPs, pump flows, hematocrit, or pCO2 during CPB. Cerebral rSO2 levels showed changes between the stages; there was a significant increase during cooling period, compared to stage 1 (P<0.05). Significant changes during cooling stage did not happen for other parameters. At stage 3, there was a negative correlation between lactate level and MBP. At stage 4, there was no significant change in cerebral rSO2 levels despite decreased MBP. At the warming stage, low MBPs, but normal rSO2 values, are observed despite increased pump flows. Increased rSO2 levels despite insignificant changes at other parameters during the cooling stage of CPB may show that optimal pump flow with adequate intravascular volume may provide effective cerebral perfusion even without changes in MBP. Considering normal rSO2 values during CPB in this study, it may be speculated that brain protection can be assessed by using NIRS and applying a standard bypass protocol. © 2013, The Authors. Artificial Organs © 2013, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.


Haydin S.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Ozturk E.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Ergul Y.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Tuzcu V.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
Journal of Cardiac Surgery | Year: 2013

Congenital complete atrioventricular block can be concomitant with congenital heart diseases or maternal connective tissue disorders like systemic lupus erythematosus and Sjögren's syndrome. Such patients may require implantation of a permanent pacemaker due to ventricular dysfunction. While many methods of pacemaker implantation have been tested, one that is optimal for low birth weight infants remains to be determined. We present a preterm infant with maternal Sjögren's syndrome with congenital heart block and describe the technique for implantation of an intrathoracic dual-chamber pacemaker. © 2013 Wiley Periodicals, Inc.


Erkanli K.,Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Education and Research Hospital | Onan B.,Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Education and Research Hospital | Akturk I.F.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital | Bakir I.,Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Education and Research Hospital
Heart Surgery Forum | Year: 2012

Interrupted aortic arch (IAA), a rare congenital malformation of the aortic arch, is defined as a loss of luminal continuity between the ascending and descending portions of the aorta. It is rarely diagnosed as an isolated anomaly in adulthood. Surgical repair is feasible through a sternotomy or thoracotomy incision. In this report, we describe the surgical repair of an isolated IAA in a 29-year-old patient by performing an ascending-to-descending aortic bypass via a sternotomy with cardiopulmonary bypass. © 2012 Forum Multimedia Publishing, LLC.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
Type: Journal Article | Journal: The heart surgery forum | Year: 2017

Optimal surgical approach for patients with hemodynamically significant carotid and coronary disease remains controversial. We analyzed our 5-year experience and compared early and long-term outcome following staged and combined carotid and coronary artery bypass.312 consecutive patients undergoing carotid endarterectomy and coronary artery bypass between 2008 and 2013 were prospectively enrolled in the study. Patients were scheduled for a staged (carotid endarterectomy followed by coronary artery bypass within 1 week) procedure (Group S) unless they were unstable in terms of cardiac status (were deemed to a combined procedure; Group C). All patient data including demographics, risk factors, immediate perioperative events, 30-day, and long-term outcome were prospectively recorded and then analyzed. Groups S and C were compared for pre- and perioperative data as well as immediate, 30-day, and long-term survival. A P value less than .05 was considered significant. Survival analysis was made using Kaplan-Meier method and log-rank test.Group S included 204 patients and Group C included 108 patients. Preoperative demographics and clinical data were similar in the two groups except that preoperative cerebrovascular events were more common in Group C (31.7% versus 22.22%, P = .036) and bilateral carotid disease was more common in Group S. The EuroSCORE was higher in Group C (2.91 versus 2.65, P = .013). Carotid surgery techniques were similar; intraluminal shunting was more frequent in group C than group S (33.33% versus 9.88%, P = .001). Additional cardiac procedures in addition to coronary surgery was predominant in Group C. 30-day neurological adverse event rates, ICU, and hospital stay were significantly higher in Group C. The 30-day mortality was also sigficantly higher in Group C (1.96% versus 4.62%, P = .001).Staged and combined surgical approaches yield comparable outcomes. A staged approach may provide a more favorable neurological outcome with significantly reduced need for intraluminal shunting. Long-term outcome is, however, similar.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
Type: Journal Article | Journal: Cardiology in the young | Year: 2014

To investigate the efficacy of dornase alpha, a mucolytic agent, in children who developed pulmonary atelectasis after congenital heart surgery.Retrospective case-control study.Paediatric cardiac intensive care unit at a tertiary care hospital.Between July, 2011 and July, 2012, 41 patients who underwent congenital cardiac operations and developed post-operative pulmonary atelectasis that was resistant to conventional treatment and chest physiotherapy.In all, 26 patients received dornase alpha treatment. As a control group, 15 patients were treated with conventional medications and chest physiotherapy.The median age of patients was 25.5 (3-480) days in the study group and 50.0 (3-480) days in the control group. A total of 15 (57.6%) patients in the study group and 8 (53.3%) patients in the control group were male. The median weight was 4.2 (2.9-14.2) kg and 4.0 (3.5-13.6) kg in the study and control group, respectively. In the study group, pulmonary atelectasis was diagnosed at a median period of 5 (2-18) days after operations, whereas in the control group atelectasis was diagnosed at a median period of post-operative 6 (3-19) days. In the study group, the median atelectasis score decreased from 3.4 (1-6) to 0.8 (0-3) (p = 0.001). The median pO2 level increased from 69 (17-142) mmHg to 89 (30-168) mmHg (p = 0.04). In addition, heart rate and respiratory rate per minute were significantly decreased (p < 0.05). There were no significant changes in these parameters in the control group.The use of dornase alpha can be effective for the management of pulmonary atelectasis that develops following congenital heart surgery.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
Type: Case Reports | Journal: Cardiology in the young | Year: 2015

Inverted left atrial appendage is an unusual complication associated with congenital cardiac surgery. Inversion of the left atrial appendage may occur during the surgical procedure or afterwards. The left atrial appendage may invert iatrogenically or as a result of the negative pressure during placement or removal of the left atrial vent or during deairing manoeuvres. This event can be life-threatening because of the mass effect of the atrial appendage within the left atrial cavity.

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