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Öğe Are perioperative near-infrared spectroscopy values correlated with clinical and biochemical parameters in cyanotic and acyanotic infants following corrective cardiac surgery?(Sage Publications Ltd, 2016) Ersoy, Cihangir; Özyüksel, Arda; Bozkaya Alkan, Tijen; Karaaslan, Pelin; Örmeci, Tuğrul; Ündar, Akif; Akçevin, Atıf; Türkoğlu, HalilBackground: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. Methods: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. Results: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. Conclusion: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction.Öğe Correlation between cerebral-renal near-infrared spectroscopy and ipsilateral renal perfusion parameters as clinical outcome predictors after open heart surgery in neonates and infants(Blackwell Publishing, 2015) Örmeci?, Tu?rul; Alkan-Bozkaya, Tijen; Özyüksel, Arda; Ersoy, Cihangir; Ündar, Akif; Akçevin, Atıf; Türko?lu, HalilThe objective of this clinical study is to determine whether correlation exists among cerebral and renal near-infrared spectroscopy (NIRS) measurements, renal Doppler ultrasonography parameters (resistive index, peak systolic velocity), and early postoperative clinical outcomes following cardiac surgery in neonates and infants. Thirty-seven patients undergoing surgery for congenital heart defects with an age of less than 3 months, all of whom were in the high-risk group according to Aristotle Basic Complexity risk stratification score, were enrolled in our study. Cerebral, renal NIRS values and renal Doppler ultrasonography measurements were recorded for each patient at the 4th postoperative hour. The renal resistive indices were calculated for each case, and the patients were divided into two groups according to renal resistive index (RI) values. Group I included the patients with a RI of greater than 0.8 (n=25) and Group II included the patients with a RI of less than 0.8 (n=12). The postoperative outcome parameters were compared in between two groups. Group I (RI >0.8) had lower postoperative mean urine output than Group II (RI <0.8) (P=0.041). The lactate levels were significantly higher in Group I (P=0.049), as well. The postoperative intensive care unit and hospital stay of Group I was significantly higher than Group II (P=0.048). Both cerebral and renal NIRS values and the assessment of renal RI as well as peak systolic values can be used in order to predict the early clinical outcome in cardiac surgery patients in early infantile and neonatal period. © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.Öğe Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants(SAGE Publications, 2015) Özyüksel, Arda; Ersoy, Cihangir; Akçevin, Atıf; Türkoğlu, Halil; Çiçek, Ali Ekber; Kahraman, Aydın; Kayhan, Bekir; Cantürk, EmirAlthough the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox((R)) FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.Öğe eComment. Combined surgical strategies for anomalous connection of coronary artery to pulmonary artery in adults(Oxford University Press, 2015) Özyüksel, Arda; Ersoy, Cihangir; Alkan Bozkaya, Tijen; Akçevin, AtıfWe read with great interest the article by Gurbuz et al. [1]. We congratulate them on their successful effort in the surgical treatment of such a rare case, presenting with both carotid artery stenosis and coronary artery disease accompanied by an anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). In fact, the traditionally-named ALCAPA leads to a left-to-right shunting into pulmonary arteries, resulting in ventricular ischaemia [2]. Although the terminology defines an origin of left anterior descending artery (LAD) from pulmonary artery, the actual flow direction of the blood is from the coronary circulation to main pulmonary artery. This reversed coronary flow leads to a coronary steal phenomenon. In general, in such cases, re-establishment of a dual coronary circulation is the preferred treatment modality [2]. However, we would like to discuss some points about the surgical treatment strategy for the case presented by Gurbuz and colleagues. Coronary artery bypass grafting (CABG) for the revascularization of LAD with the left internal thoracic artery (LITA) will provide the antegrade flow to the distal segment of LAD; however the proximal part will still have the reversed flow pattern. The coronary steal phenomenon will possibly affect the septal or diagonal branches originating proximally to the lesion at the LAD. We would prefer the addition of a pulmonary arteriotomy to the CABG procedure in this case, in order to close the origin of the LAD simply with a pericardial patch, as reported by Tseng and colleagues [3]. In our opinion, this surgical strategy will provide both anatomical and physiological correction of the underlying pathology with prevention of the reversed flow from LAD to pulmonary artery as well as the distal perfusion by means of LITA-LAD anastomosis. In conclusion, in such congenital abnormalities related to the origin of the coronary arteries, the surgical strategy might be determined depending on both the anatomical and physiological effects of the disease.Öğe eComment. Evidence-based selection of conduits in coronary artery bypass grafting(Oxford University Press, 2015) Özyüksel, Arda; Ersoy, Cihangir; Kayan, Ekin; Akçevin, AtıfWe read with great interest the article by Gaudino et al. [1]. They have performed coronary artery bypass grafting (CABG) with both internal thoracic arteries (ITA) in a 68-year old patient with a surgical history of aortic coarctation repair. However, there Figure 2: Postoperative angiographic control showing normal functioning left (A) and right (B) ITA grafts. CASE REPORT M. Gaudino et al. / Interactive CardioVascular and Thoracic Surgery 279 Downloaded from https://academic.oup.com/icvts/article-abstract/20/2/279/734665 by guest on 09 April 2020 are some issues we would like to discuss regarding the surgical strategy of the graft selection in this patient. The patient was reported to be hypertensive, both at admission and during the postoperative period. The authors performed a histopathological evaluation of the discarded ITA segments and markedly thickened endothelium was encountered. We wondered how they had decided that the discarded distal segment of the ITA with markedly thickened endothelium guaranteed an intact proximal arterial wall. The atherosclerotic involvement of the ITA may be segmental, hence distal ITA sampling may not accurately predict the degree of atherosclerosis at the proximal part of the graft [2]. Moreover, the same authors had published a review on the use of ITAs in patients with aortic coarctation recently [3]. In that paper, they reviewed 13 reports related to this topic and only one of them included an angiographic control at the long-term follow-up. The authors concluded that, ’a careful evaluation of the conduit is obviously paramount in the context that preoperative transthoracic Doppler ultrasound and selective LITA and RITA catheterization at the time of cardiac catheterization will provide with optimal preoperative planning’.Öğe Eighth Istanbul symposium on pediatric extracorporeal life support systems and pediatric cardiopulmonary perfusion(Blackwell Publishing, 2015) Alkan Bozkaya, Tijen; Özyüksel, Arda; Salihoğlu, Ece; Haydin, Sertaç; Tanyıldız, Murat; Pekkan, Kerem; Hatemi, Ali Can; Türköz, Ayda; Erkan, Halime; Aydın, Sibel; Kahraman, Aydın; Savaş, Alper; Ersoy, Cihangir; Türko?lu, Halil; Ündar, Akif; Akçevin, AtıfTo improve the outcomes of pediatric extracorporeal life support (ECLS) and cardiopulmonary bypass (CPB) procedures in Turkey, we have established a series of conferences, called “Istanbul Symposiums.” Since the first symposium in June of 2011, we have organized seven additional symposiums in Istanbul (1–3). The objective of this editorial is to share the latest results on pediatric ECLS and CPB patients with the Artificial Organs community.Öğe Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery(Elsevier, 2014) Ersoy, Cihangir; Özyüksel, Arda; Malkoç, Melih; Kayhan, Bekir; Kayan, Ekin; Akçevin, Atıf; Türko?lu, HalilSternal dehiscence is an untoward complication of cardiac surgery that leads to increased morbidity as well as length of hospital stay and costs. Although many different conventional and creative techniques have been described using both synthetic and biologic materials, the ideal method of sternal reconstruction is still controversial. In this case, we describe a simple and reproducible "fibula allograft sandwich technique" for the reconstruction of sternal nonunion in a cardiac surgery patient. This technique also facilitates the conventional wiring by creating bilateral landing zones for the wires at both sides of the sternum.Öğe Implantation of looped epicardial cardioverter defibrillator coil on the surface of the right ventricular outflow tract(Blackwell Publishing, 2015) Özyüksel, Arda; Ersoy, Cihangir; Akdeniz, Celal; Akçevin, Atıf; Türko?lu, Halil; Tuzcu, VolkanBackgroundWe present the early results of looped epicardial cardioverter defibrillator coil implantation on the anterior surface of right ventricular outflow tract in infants and children. MethodsPatients with a surgical history of an epicardial implantable cardioverter defibrillator system between 2013 and 2014 were included in the study. Patient age, gender, body weight, indications for a cardioverter defibrillator system implantation, defibrillation threshold values, and defibrillation therapies were retrospectively evaluated. ResultsThere were eight patients with a mean age of 4.42.9 years and a mean body weight of 19.5 +/- 11.7kg. Five of the patients had been diagnosed with long QT syndrome, one patient had been diagnosed with genetic channelopathy and noncompaction of the left ventricle, and two patients had been diagnosed with univentricle physiology. The implantable cardioverter defibrillator system was composed of pace-sense leads, an abdominal active can, and a defibrillation coil placed below the pulmonary valve annulus on the anterior surface of the heart. The mean defibrillation threshold was 6.6 +/- 2.3 joules. There were four appropriate therapies in two patients in a mean follow-up of 9 +/- 6.5 months. ConclusionThe significantly low defibrillation thresholds with the defibrillation coils located below the pulmonary valve annulus are encouraging. However, a larger patient series will be necessary to evaluate the safety and reliability of this technique.Öğe Progressive supra-aortic stenosis in a young adult with the findings of Singleton Merten Syndrome(BMJ Publishing Group, 2014) Özyüksel, Arda; Ersoy, Cihangir; Cantürk, Emir; Akçevin, AtıfSingleton Merten Syndrome is an autosomal dominant disorder of unknown origin. Patients often present with muscular weakness, failure to thrive, abnormal dentition, glaucoma, psoriatic skin lesions, aortic calcifi cation and musculoskeletal abnormalities. In this case, we present a young girl with a history of aortic root replacement, who had an unusual progressive supra-aortic stenosis managed with urgent surgery during the course of the syndrome. Cardiovascular involvement needs special attention, since it is the major cause of mortality along with rhythm disturbances in the course of Singleton Merten Syndrome.
