Browsing by Author "Altun, Dilek"

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    Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block
    (BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2020-01-01) Altun, Dilek; Dogan, Abdullah; Amaz, Ahmet; Yuksek, Adnan; Yalcinbas, Yusuf Kenan; Turkoz, Riza; Asar, Sinan; Saneglu, Tayyar
    Background: In this study, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy. Methods: Between January 2016 and January' 2019. a total of 63 pediatric patients (37 males, 26 females: mean age 34.8 +/- 26.8 months
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    Coronary artery bypass grafting in children
    (WILEY, 2018-01-01) Arnaz, Ahmet; Sarioglu, Tayyar; Yalcinbas, Yusuf; Erek, Ersin; Turkoz, Riza; Oktay, Ayla; Saygili, Arda; Altun, Dilek; Sarioglu, Ayse
    BackgroundWe present our clinical experience with coronary artery bypass grafting (CABG) in children. MethodsTen children who underwent CABG between July 1995 and August 2017 were retrospectively analyzed. Data including congenital cardiac malformations, previous surgical procedures, age and sex, type of coronary complications, ischemic events preceding surgery, and ventricular function before and after CABG were recorded. ResultsThe study population consisted of five males and five females with a median age of 2.5 years (range, 88 days to 15 years). Eight internal mammary arteries (IMAs) and two saphenous veins were used for grafting. Indications for bypass grafting were coronary artery (CA) complications related to the post-arterial switch operation in six, CA complications during the Ross procedure in two, and an iatrogenic CA injury during complete repair of tetralogy of Fallot with abnormal CA, crossing the right ventricular outflow tract in two patients. Six of the grafts were performed as rescue procedures. Three patients died during hospitalization. The mean follow-up time was 6.8 years (range, 3 months to 18 years). Anastomoses were evaluated by coronary angiography in four patients, and were all patent. Echocardiography revealed normal myocardial function in all patients. ConclusionOur study suggests that the IMA should be the graft of choice in children due to its growth potential and long-term patency.
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    Intrahospital Transport of a Critically Ill Patient on Extracorporeal Membrane Oxygenation Support with Severe Acute Respiratory Distress Syndrome due to COVID-19
    (GALENOS YAYINCILIK, 2021-01-01) Hergunsel, Gulsum Oya; Zeydan, Ayten Guresci; Kandemir, Canan; Eser, Berna Irmak; Altun, Dilek
    Patients who do not respond to conventional mechanical ventilation (MV) support for respiratory failure due to the Coronavirus disease-19 may require the support of extracorporeal membrane oxygenation (ECMO). Intrahospital transportation of critically ill patients under MV and ECMO support carries potential risks that could be life-threatening. A structured process performed by a professional team plays a vital role in improving patient safety during transportation of the patient. In this presentation, we aim to share our experiences during the intrahospital transportation of a patient on ECMO support with appropriate equipment and a team of experienced personel.
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    Measuring potassium level in packed red blood cells before using: Word of caution for congenital cardiac surgery
    (WILEY, 2022-01-01) Altun, Dilek; Arnaz, Ahmet; Dogan, Abdullah; Yalcinbas, Yusuf; Turkoz, Riza; Yuksek, Adnan; Altun, Demet; Abdullah, Taner; Ozgen, Serpil Ustalar; Toraman, Fevzi; Sarioglu, Tayyar
    Background and Aim of the Study Transfusion-associated hyperpotassemia is a serious complication of packed red blood cell (PRBC) transfusion after congenital cardiac surgery. Our study aimed to identify risk factors and potential preventive measures of transfusion-associated hyperpotassemia in neonates and infants after congenital cardiac surgery. Methods Pediatric patients who underwent congenital cardiac surgery and need transfusion were enrolled in this prospective study. The potassium concentration of PRBC was checked from the sample taken from the segment. The volume of transfusion, age of PRBC, potassium concentration of unit were recorded. The estimated increment of potassium level in patients after PRBC transfusion was calculated. Results Seventy-four individual patients, 95 distinct transfusions, 112 blood products were evaluated. The mean age of the blood unit was 3.8 +/- 1.4 days. The mean potassium concentration in the PRBCs was 9.9 +/- 2.4 mmol/L. A weak correlation was observed between the potassium value of the PRBC and the age of PRBC (p = 0.049, r = 0.2, y = 0.24 x x + -0.68). There was a weak correlation between the potassium value of PRBCs and the age of the unit (p < 0.001, r = 0.37, y = 2.8 x x + -3.6). Conclusions Before transfusion, even PRBC is fresh, measuring the potassium level of PRBC and the potassium that will be given to the pediatric patient with transfusion can prevent transfusion-related hyperpotassemia and related complications. Otherwise, high potassium levels, which may be overlooked despite being fresh, may cause serious complications, even cardiac arrest, especially in neonates and infants.
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    Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery
    (TUBITAK SCIENTIFIC \& TECHNICAL RESEARCH COUNCIL TURKEY, 2020-01-01) Altun, Dilek; Dogan, Abdullah; Arnaz, Ahmet; Yuksek, Adnan; Yalcinbas, Yusuf Kenan; Turkoz, Riza; Sarioglu, Tayyar
    Background and aim: In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO(2)) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO(2) indirectly. In this study, we aimed to determine the correlation between ScvO(2) with NIRSijv in pediatric patients undergoing congenital cardiac surgery. Materials and methods: Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NI RS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NI RS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NI RS (NIRSc) and ScvO(2), were recorded at certain times until postoperative 24th hour. Results: Data were collected at 8 different time points. There was a significant correlation between ScvO(2) and NIRSijv in all measurement time points (r = 0.91), (p = 0.001). The mean bias between ScvO(2) and NIRSijv was 2.92\% and the limits of agreement were from 11\% to -5.2\%. There was a moderate correlation between ScvO(2) and NIRSc (r = 0.45), (13= 0.001). The mean bias between ScvO(2) and NIRSc was 2.7\% and the limits of agreement were from +26\% to -20\%. Conclusion: In this study, we found a strong correlation between ScvO(2) and NI RS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.
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    Pulmonary valve replacement in patients with repaired tetralogy of Fallot: early results for recovery of right ventricular dilatation and QRS duration
    (TUBITAK SCIENTIFIC \& TECHNICAL RESEARCH COUNCIL TURKEY, 2018-01-01) Arnaz, Ahmet; Oktay, Ayla; Akansel, Serdar; Altun, Dilek; Dogan, Abdullah; Serban, Piotr; Saygili, Arda; Yalcinbas, Yusuf; Sarioglu, Ayse; Sarioglu, Tayyar
    Background/aim: Although pulmonary valve replacement (PVR) improves ventricular function and symptoms, the benefit and optimal timing of PVR are controversial. This study aimed to evaluate early response to PVR for right ventricle (RV) dilatation and QRS duration. Materials and methods: Retrospective analysis was performed for 32 patients with repaired tetralogy of Fallot (TOF) between March 2005 and October 2017. The differences between preoperative and postoperative changes in echocardiographic parameters, clinical symptoms, and QRS duration were evaluated. Results: There were no in-hospital or late deaths. Mean age at the time of PVR was 16.57 +/- 7.97 years. The interval between TOF: repair and PVR was 12.99 +/- 7.06 years. Postoperative echocardiographic findings showed significant reduction in indexed RV end-diastolic diameter (RV-EDDI) and the ratio of RV/LV-EDDI (P = 0.001 and P = 0.001, respectively). Higher preoperative RV-EDDI was associated with decreased change in RV-EDDI after PVR (r = 0.63
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    Surgical procedures for coronary arteries in pediatric cardiac surgery: Risk factors and outcomes
    (WILEY, 2021-01-01) Sarioglu, Tayyar; Dogan, Abdullah; Yalcinbas, Yusuf; Erek, Ersin; Arnaz, Ahmet; Turkoz, Riza; Oktay, Ayla; Saygili, Arda; Altun, Dilek; Yuksek, Adnan; Boz, Murat; Sarioglu, Ayse
    Background Limited data exist regarding the coronary revascularization procedures needed during the repair of several congenital and pediatric cardiac malformations. We aimed to determine risk factors for in-hospital mortality and long-term outcomes of various pediatric coronary revascularization procedures. Methods We retrospectively reviewed the records of 32 consecutive pediatric patients who underwent coronary revascularization procedures at our institution between May 1995 and June 2020. In-hospital mortality, risk factors, surgical indications, revascularization patency, and mid- and long-term follow-up data were investigated. Patients were categorized into the coronary artery bypass grafting (n = 11) and other coronary artery procedure (n = 21) groups. Results The median age and weight of patients at the time of surgery were 9 months and 4.8 kg, respectively. There were five in-hospital deaths (5/32, 15.6\%). The mortality rates were 27.2\% (3/11) in the coronary artery bypass grafting group and 9.5\% (2/21) in the other coronary artery procedure group (p = .206