Browsing by Author "Arnaz, Ahmet"

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Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2018-01-01) Arnaz, Ahmet; Gullu, A. Umit; Akyol, Ahmet; Zencirci, Ertugrul; Senay, Sahin; Degirmencioglu, Aleks; Kocyigit, Muharrem; Alhan, Cem
Background: In this study, we aimed to present mid-term results of concomitant argon-based cryoablation in patients undergoing cardiac surgery. Methods: Between August 2014 and May 2016, 33 patients (17 males, 16 females
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.
Double switch operations: Should we perform physiologic or anatomic repair in congenitally corrected transposition of the great arteries
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2018-01-01) Sanoglu, Tayyar; Arnaz, Ahmet
The seeking for the optimal surgical treatment of congenitally corrected transposition of the great arteries (cTGA) is ongoing. Physiologic (conventional) repair approaches, leaving the morphologic right ventricle (MRV) on the systemic circulation side, cause systemic ventricle and tricuspid valve failure, particularly in the long-term. Double Switch operations (anatomic repair) were aimed to convert the morphologic left ventricle to systemic ventricle and MRV to pulmonic ventricle. Gradual improvement in the early and midterm results of double switch operations in the last 20 years rendered anatomic repair to become a preferred procedure. Thanks to the preservation of ventricular functions through anatomic repair, patients with congenitally cTGA may survive longer with normal/near normal functional capacity. However, studies with larger sample size and longer follow-up duration are required to establish a more definite judgement.
Ebstein's Anomaly
(GAZI UNIV, FAC MED, 2018-01-01) Arnaz, Ahmet; Dogan, Abdullah; Oktay, Ayla; Yalcinbas, Yusuf; Turkoz, Riza; Saygili, Arda; Sarioglu, Ayse; Sarioglu, Tayyar
Objectives: In this study, it is aimed to evaluate the operations performed for Ebstein `s anomaly retrospectively. Study design: Between July 2003 and February 2018, the medical records of 13 patients who were operated on with the diagnosis of Ebstein's anomaly were reviewed retrospectively according to the clinical symptoms, surgical procedure, and postoperative follow-up. Results: Of the thirteen patients, 46.2\% (n = 6) were female and 53.8\% (n = 7) were male. The mean age of the cases is 13,15 +/- 11,07 years (2-31 years). Preoperative echocardiographic evaluations revealed severe tricuspid regurgitation in 92.3\% (n = 12) of the patients. In these patients, tricuspid valve replacement was performed in 4, tricuspid valve plasty in 5, Cone reconstruction in 2, and cava-pulmonary shunt with tricuspid valve plasty in 2 were performed. Patients were followed for an average of 6.31 +/- 3.40 (1-14 years). Atrial septal defect closure in 53.8\% (n = 7) patients and mitral valve replacement in 7.7\% (n = 1) patients were performed due to additional anomalies. Atrial fibrillation/flutter was present in 23.1\% of the patients and ablation procedure was applied to these three patients. Conclusion: Long-term clinical follow-up is required for the signs and symptoms of heart failure, arrhythmia, cyanosis and other related findings both in operated and non-operated patients with Ebstein's anomaly.
Effect of modified Blalock-Taussig shunt anastomosis angle and pulmonary artery diameter on pulmonary flow
(TURKISH SOC CARDIOLOGY, 2018-01-01) Arnaz, Ahmet; Piskin, Senol; Oguz, Gokece Nur; Yalcinbas, Yusuf; Pekkan, Kerem; Sarioglu, Tayyar
Objective: This study aimed to identify the best graft-to-pulmonary artery (PA) anastomosis angle measuring pulmonary blood flow, wall shear stress (WSS), and shunt flow. Methods: A tetralogy of Fallot with pulmonary atresia computer model was used to study three different modified Blalock-Taussig shunt (mBTS) anastomosis angle configurations with three different PA diameter configurations. Velocity and WSS were analyzed, and the flow rates at the right PA (RPA) and left PA (LPA) were calculated. Results: A 4-mm and 8-mm diameter of RPA and LPA, respectively with vertical shunt angle produces the highest total flow. In the RPA larger diameter than the LPA configutations, the left-leaning shunt produces the lowest total PA flow whereas in the LPA larger diameter than the RPA configuratios, the right-leaning shunt produces the lowest total PA flow. Therefore, the shunt anastomosis should not be leaned through the narrow side of PA to reach best flow. As the flow inside the shunt increased, WSS also increased due to enhanced velocity gradients. Conclusion: The anastomosis angle between the conduit and PA affects the flow to PA. Vertical anastomosis configurations increase the total PA flow
Late Cardiac Rupture after Amplatzer Septal Occluder Implantation
(TEXAS HEART INST, 2016-01-01) Arnaz, Ahmet; Turkekul, Yasemin; Yalcinbas, Yusuf; Saygili, Arda; Sarioglu, Tayyar
Transcatheter device implantation has become an attractive alternative to surgery in the closure of atrial septal defects in selected patients. However, it can lead to early and late sequelae, some of them life threatening. For example, 79 days before her admission to our emergency department with sudden-onset respiratory distress and respiratory arrest (leading to cardiac tamponade and rupture), a 22-year-old woman had undergone percutaneous closure of an atrial septal defect. We describe the damage and its treatment. Although the adverse effects of transcatheter device implantation are rare, physicians should know that these events can be life threatening. Further data are needed to prevent such sequelae and to design new devices. It is of utmost importance that patients and their family members be informed both of possible sequelae and of life-saving interventions to be administered at early diagnosis.
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.
Myocardial bridge of the left anterior descending artery
(WILEY, 2017-01-01) Arnaz, Ahmet; Akansel, Serdar; Yalcinbas, Yusuf; Sarioglu, Tayyar
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.
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
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
Tetralogy of Fallot Surgical Repair: Shunt Configurations, Ductus Arteriosus and the Circle of Willis
(SPRINGER, 2017-01-01) Piskin, Senol; Unal, Gozde; Arnaz, Ahmet; Sarioglu, Tayyar; Pekkan, Kerem
In this study, hemodynamic performance of three novel shunt configurations that are considered for the surgical repair of tetralogy of Fallot (TOF) disease are investigated in detail. Clinical experience suggests that the shunt location, connecting angle, and its diameter can influence the post-operative physiology and the neurodevelopment of the neonatal patient. An experimentally validated second order computational fluid dynamics (CFD) solver and a parametric neonatal diseased great artery model that incorporates the ductus arteriosus (DA) and the full patient-specific circle of Willis (CoW) are employed. Standard truncated resistance CFD boundary conditions are compared with the full cerebral arterial system, which resulted 21, -13, and 37\% difference in flow rate at the brachiocephalic, left carotid, and subclavian arteries, respectively. Flow splits at the aortic arch and cerebral arteries are calculated and found to change with shunt configuration significantly for TOF disease. The central direct shunt (direct shunt) has pulmonary flow 5\% higher than central oblique shunt (oblique shunt) and 23\% higher than modified Blalock Taussig shunt (RPA shunt) while the DA is closed. Maximum wall shear stress (WSS) in the direct shunt configuration is 9 and 60\% higher than that of the oblique and RPA shunts, respectively. Patent DA, significantly eliminated the pulmonary flow control function of the shunt repair. These results suggests that, due to the higher flow rates at the pulmonary arteries, the direct shunt, rather than the central oblique, or right pulmonary artery shunts could be preferred by the surgeon. This extended model introduced new hemodynamic performance indices for the cerebral circulation that can correlate with the post-operative neurodevelopment quality of the patient.
Transcatheter Closure of Left Ventricular Pseudoaneurysm After Mitral Valve Replacement
(ELSEVIER SCIENCE INC, 2020-01-01) Arnaz, Ahmet; Akansel, Serdar; Yalcinbas, Yusuf; Saygili, Arda; Sarioglu, Tayyar
Left ventricular pseudoaneurysm (LVPA) is a rare but lethal complication of mitral valve replacement (MVR) or myocardial infarction. Early correction is necessary for patients with extensive and expanding LVPA. We report a transcatheter closure of LVPA after MVR. A 63-year-old woman presented with an LVPA 2 months afterMVR. The repeated computed tomographic scan and transthoracic echocardiography showed enhancement of pseudoaneurysm. The LVPA was closed successfully with Amplatzer Vascular Plug using a transcatheter approach. (C) 2020 by The Society of Thoracic Surgeons.