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PubMed | Tokat State Hospital and Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Type: Journal Article | Journal: Congenital heart disease | Year: 2016

Arterial switch operation has become the treatment of choice for neonates with transposition of the great arteries. The most important step of the procedure is transferring the coronary arteries to the neoaorta successfully. This study shows the impact of coronary anatomy on early mortality and morbidity after arterial switch operation.Ninety-two patients with transposition of the great arteries who underwent arterial switch operation between October 2010 and September 2014 were included in this retrospective study. The patients were classified into two groups: group I (n = 68, patients with usual coronary artery anatomy) and group II (n = 24, patients with unusual coronary artery anatomy). Median age was 10 days (6-25 days) in group I and 14 days (7-29 days) in group II. In group I, 25 patients had ventricular septal defect, nine patients had coarctation of the aorta or distal aortic arch hypoplasia, seven patients had Taussig Bing anomaly. In group II, nine patients had ventricular septal defect, one patient had coarctation of aorta, and one patient had Taussig Bing anomaly.Regarding the postoperative variables, no significant statistical difference was found between two groups. But cardiopulmonary bypass time is significantly longer in group II (P = .004). There was no difference in complications including the mortality (P = .265). It is statistically found that associated anomalies did not affect the mortality and complication rates. All mortality cases (n = 4) were related to ventricular dysfunction in group II, whereas only four of the eight patients died because of ventricular dysfunction in group I.Coronary artery pattern was not a predictor of mortality in early postoperative period. There may be an impact of unusual coronary artery pattern on the development of ventricular dysfunction as a cause of mortality.


PubMed | Izmir Kâtip Celebi University, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center Training Research Hospital, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital and Ordu State Hospital
Type: Journal Article | Journal: Angiology | Year: 2016

It is unclear whether changes in mean platelet volume (MPV) are associated with total mortality in acute coronary syndromes. We investigated whether the change in MPV predicts total mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We retrospectively analyzed 419 consecutive patients (19 patients were excluded). The remaining patients were categorized as survivors (n = 351) or nonsurvivors (n = 49). Measurements of MPV were performed at admission and after 24 hours. The difference between the 2 measurements was considered as the MPV change (MPV). The end point of the study was total mortality at 1-year follow-up. During the follow-up, there were 49 deaths (12.2%). Admission MPV was comparable in the 2 groups. However, both MPV (9.6 1.4 fL vs 9.2 1.0 fL, P = .044) and MPV (0.40 [0.10-0.70] fL vs 0.70 [0.40-1.20] fL, P < .001) at the first 24 hours were higher in nonsurvivors than survivors. In multivariate analysis, MPV was an independent predictor of total mortality (odds ratio: 1.84, 95% confidence interval: 1.28-2.65, P = .001). An early increase in MPV after admission was independently associated with total mortality in patients with NSTEMI. Such patients may need more effective antiplatelet therapy.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital and Mustafakemalpasa State Hospital
Type: Journal Article | Journal: Pacing and clinical electrophysiology : PACE | Year: 2016

The purpose of this study is to assess the electrocardiographic and electrophysiological parameters of conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI) due to severe aortic valve stenosis.The study included 55 patients who underwent TAVI using either the Boston Scientific Lotus (n:25) (Boston Scientific, Natick, MA, USA) or Edwards Sapien XT (n:30) (Edwards Lifesciences, Irvine, CA, USA) prostheses. An electrophysiological study (EPS) was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after prosthesis implantation.QRS duration and His-bundle to His-ventricle (HV) intervals, which were similar between the two groups before the procedure, were found to be significantly higher in the Lotus valve group postprocedure. Permanent pacemakers (PPMs) were required more frequently in the Lotus group than in the Sapien XT group at discharge (24.0% vs 6.7%, P = 0.07). With the exception of a higher prevalence of paravalvular leakage (P < 0.001) in patients undergoing Sapien XT implantation, other clinical outcomes were similar between the two groups. Multiple regression analysis revealed that baseline atrioventricular (AV) conduction disorders and HV intervals after the procedure were independently associated with PPM implantation after TAVI.In this first study comparing the findings of EPS and electrocardiography, the impact of the Lotus valve on AV conduction systems was greater than that of the Sapien XT. However, the need for PPM was higher in the Lotus valve than in the Sapien XT. PPM requirement is related to valve design; it may decrease with reduced frame height and metal burden in novel valve systems.


Yener O.,Turkiye Yuksek Ihtisas Hospital | Turkvatan A.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital | Yuce G.,Turkiye Yuksek Ihtisas Hospital | Yener A.U.,Turkiye Yuksek Ihtisas Hospital
Canadian Association of Radiologists Journal | Year: 2015

Introduction In this study, we aimed to reveal the normal anatomy and variations of the bronchial arterial system and to determine the sex distribution of these variations by retrospectively reviewing the images of patients who underwent thoracal multidetector computed tomographic angiography for various reasons. Materials and Methods Multidetector computed tomographic images of a total of 208 patients (151 men; mean age, 59 years) were retrospectively reviewed to assess the normal anatomy and variations of the bronchial arterial system. Results A total of 531 bronchial arteries (median, 3; minimum, 1; maximum, 5; mean, 2.5) were detected. The number (mean diameter) of the right bronchial arteries were higher than the left bronchial arteries (290 [1.43 mm] and 241 [1.26 mm], respectively; P <.05 for both number and diameter). The mean number (diameter) of the bronchial arteries were higher with men than with women (2.58 [1.45 mm] and 2.47 [1.32 mm], respectively; P <.05 for both number and diameter). The most common (24%) branching pattern was the combination of 1 right intercostal-bronchial trunk and 1 left bronchial artery, and, secondarily (13.46%), the combination of 2 right (1 intercostal-bronchial trunk and 1 bronchial artery) and 1 left bronchial arteries. Seventy-eight ectopic bronchial arteries were detected in 59 cases (28.3%). They most commonly originated from the aortic arch (37.2%), the descending aorta below the level of T6 (35.9%), or the aortic branches (16.7%). The number of right ectopic bronchial arteries was significantly higher than the left ectopic bronchial arteries (50 [64%] vs 28 [36%]; P <.01). The incidence of ectopic bronchial arteries was statistically higher with men versus women (45 [29.8%] vs 14 [24.6%]; P <.05). Conclusion The origins, numbers, diameters, and courses of the bronchial arteries can vary substantially among individuals. Multidetector computed tomographic angiography enables a detailed road map of the bronchial arterial system to interventional radiologists and thoracic surgeons. © 2015 Canadian Association of Radiologists.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital and Turkiye Yuksek Ihtisas Hospital
Type: Journal Article | Journal: Diagnostic and interventional imaging | Year: 2016

The purpose of this retrospective study was to investigate the prevalence of renal artery (RA) and renal vein (RV) variations, the distribution of these variations with respect to gender and the types of RA and RV variations on multi-detector computed tomographic (MDCT) angiography.The MDCT angiography examinations of 504 patients (317 men, 187 women) with a mean age of 56.4 years11.7 (SD) (range: 18-92 years) were retrospectively reviewed to determine the number and branching pattern of the RAs and the number and variations of the RVs (retroaortic or circumaortic left RV, late venous confluence).The prevalence of multiple RAs was 31.3% (22.2% for two RAs, 7.5% for three RAs, 1.4% for four RAs, 0.2% for five RAs) and prehilar branching was 6.5%. The prevalence of multiple right RVs was 21.6% (19.2% for two RVs, 2.2% for three RVs and, 0.2% for four RVs). The prevalence of circumaortic left RV was 5.2%, retroaortic left RV was 4.2% and, late venous confluence was 7.3%. No associations were found between gender and presence of RA or RV variations (P=0.630 and 0.650, respectively).Accessory RAs are frequently observed. Multiple right RVs is the most common RV variation. No associations are found between gender and RA or RV variations.


Yazici P.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital | Oz K.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital | Celik O.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital | Erek E.,Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

A 66-year old man was admitted to the hospital with chest and back pain and wide chest wall ecchymosis. His medical history revealed no chest trauma or resuscitation, but coronary angiography had been performed 20 days previously. Subacute type A aortic dissection was diagnosed. The likely cause of an ecchymosis located in this way, correlated with vasculature of thoracic wall, was thought to be progression of the dissection through the arterial branches feeding the chest wall. Perioperative observation confirmed the diagnosis and a hemiarch replacement was performed with a good outcome. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


PubMed | Hannover Medical School and Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Type: Journal Article | Journal: The heart surgery forum | Year: 2016

Ventricular assist devices are implanted in patients with intractable heart failure as a bridge to cardiac transplantation to support the circulatory system mechanically. We present a report of a continuous flow ventricular assist device successfully placed as a bridge to transplantation in the intrapericardium of a petite-sized child with a BSA of 0.56 m2. Not only is the use of an intrapericardial, continuous-flow, centrifugal pump feasible for destination therapy, but also for low-weight pediatric patients with end-stage heart failure as a bridge to transplantation when there is chronic shortage of donor organs for heart transplantation. Consequently, the HeartWare system has been implanted in smaller patients with acceptable results, and this patient may be the youngest ever reported.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Type: Journal Article | Journal: World journal for pediatric & congenital heart surgery | Year: 2016

Familial hypercholesterolemia is an uncommon disease that may be associated with atherosclerosis affecting coronary arteries and the ascending aorta. Coarctation of the aorta is rarely involved in this disease. The ideal surgical approach for management of coexisting coronary artery disease and coarctation of the aorta in a child with familial hypercholesterolemia is unclear. We report the case of a 14-year-old girl with familial hypercholesterolemia who underwent double coronary artery bypass grafting due to proximal lesions of both the left anterior descending artery and the right coronary artery.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Type: Journal Article | Journal: Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir | Year: 2016

Experience with administration of inhaled nitric oxide (iNO) in pediatric cardiac intensive care unit was retrospectively reviewed.Data from 32 pediatric patients treated with iNO between 2011 and 2012 were collected. Patients were divided into 3 groups: Group I comprised postoperative patients, Group II comprised newborns with persistent pulmonary hypertension (PPH), and Group III comprised patients with primary pulmonary hypertension (PH) or Eisenmengers syndrome. Age, sex, weight, primary diagnosis, arterial blood sample, pulmonary artery pressure (PAP), systemic arterial pressure (SAP), and oxygen saturation levels were analyzed.Groups I, II, and III included 25, 3, and 4 patients, respectively. Median weight was 8 kg (range: 3-40 kg), and median age was 7 months (range: 2 days-10 years). On average, iNO treatment was initiated at the 12th hour after admission to the unit (range: 1-48 hours) and continued for a median duration of 24 hours (range: 12-168 hours). Systolic PAP was 4015 mmHg, mean SAP was 5718 mmHg, PAP/SAP ratio was 0.69, and oxygen saturation levels were 88% prior to iNO treatment. Following iNO treatment, PAP decreased to 249 mmHg (p<0.05), PAP/SAP ratio decreased to 0.4 (p<0.05), SAP showed no change (6012 mmHg), and saturation levels increased to 98% (p<0.05). Seven patients died during follow-up (Group I, n=5; Group II, n=1; Group III, n=1).iNO seems to effectively reduce PAP, and can be used effectively and safely to prevent pulmonary hypertensive crises in pediatric cardiac intensive care units.


PubMed | Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
Type: | Journal: Kardiologia polska | Year: 2016

Epicardial adipose tissue is a metabolically active visceral fat depot which plays an important role in the pathogenesis of coronary atherosclerosis. Due to its asymmetrical distribution, the relation between location-specific epicardial adipose tissue measurements and coronary atherosclerosis remains unclear. Our study investigated the relationship between location-specific epicardial adipose tissue volume and coronary atherosclerotic plaque burden which was detected by coronary computed tomography angiography in Type 2 diabetic patients without coronary artery disease history.A total of 157 consecutive diabetic patients underwent coronary computed tomography angiography were included retrospectively. After an evaluation of the coronary computed tomography angiography images, the study population was divided into two groups according to the presence of coronary atherosclerosis. In both groups, total and left atrioventricular groove epicardial adipose tissue volumes were measured.Total and left atrioventricular groove epicardial adipose tissue volumes were significantly associated with coronary atherosclerosis, but only left atrioventricular groove epicardial adipose tissue volumes were an independent predictor for coronary artery disease. Also, total and left atrioventricular groove epicardial adipose tissue volumes were positively correlated with C-reactive protein values (p=0.0001/p=0.0001) and the number of coronary atherosclerotic segments (p=0.0001/p=0.0001).Left atrioventricular groove epicardial adipose tissue volume is an independent predictor of coronary artery disease in Type 2 diabetic patients without coronary artery disease history. Left atrioventricular groove epicardial adipose tissue volume may be used to identify Type 2 diabetic patients who may require early coronary artery disease intervention because of the potential risk of coronary atherosclerosis.

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