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Item Selective Upper-Body Perfusion Technique for Removal of Renal Cell Carcinoma Extending into the Inferior Vena Cava and Right Atrium(TEXAS HEART INST, 2017-01-01) Aydin, Selim; Cengiz, Bora; Gokay, Banu Vural; Mammadov, Anar; Emiroglu, Remzi; Eskicorapci, Saadettin; Erek, ErsinInvasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava is particularly challenging because the liver covers the surgical field. We report the case of a 61-year-old man who underwent surgery for a renal cell carcinoma of the right kidney that extended into the inferior vena cava and right atrium. During dissection of the liver to expose the inferior vena cava, transesophageal echocardiograms revealed right atrial mass migration into the tricuspid valve. On emergency sternotomy, the tumor embolized into the main pulmonary artery. We used a selective upper-body perfusion technique involving moderately hypothermic cardiopulmonary bypass, cardioplegic arrest, and clamping of the descending aorta, which provided a bloodless surgical field for precise removal of the mass and resulted in minimal blood loss. Our technique might be useful in other patients with tumor thrombus extending into the right atrium because it reduces the need for transfusion and avoids the deleterious effects of deep hypothermic circulatory arrest. Our case also illustrates the importance of continuous transesophageal echocardiographic monitoring to detect thrombus embolization.Item Collateral dependent cerebral and coronary circulation in a newborn(SPRINGER INDIA, 2020-01-01) Suzan, Dilek; Aydin, Selim; Demir, Ibrahim Halil; Erek, ErsinAssociation of interrupted aortic arch with aortic atresia as a variant of hypoplastic left heart syndrome (HLHS) is extremely rare and could not be compatible with life without a reliable source for cerebral and coronary blood flow. The patient with a large collateral artery between the descending aorta and the right subclavian artery is presented.Item Extracorporeal membrane oxygenation for the support of pediatric patients with acute fulminant myocarditis(TURKISH J PEDIATRICS, 2019-01-01) Sik, Guntulu; Annayev, Agageldi; Demirbuga, Asuman; Deliceo, Elif; Aydin, Selim; Erek, Ersin; Demir, Halil Ibrahim; Citak, AgopAcute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of children with severe acute myocarditis who are resist to medical treatment is not well known. We studied the clinical courses of patients with acute fulminant myocarditis supported by extracorporeal membrane oxygenation (ECMO). We performed a retrospective chart review of six children with acute fulminant myocarditis who were treated with ECMO. Demographic information, clinical and vital signs, as well as laboratory results were investigated. The median age of 63 months (13-140 months), the mean ECMO duration was 164 hours (79-402 hours), and median intensive care unit stay was 24 days. The most common symptoms were chest pain (66\%) and fever (66\%). Severe arrhythmia were seen in two patients. One patient received extracorporeal cardiopulmonary resuscitation. In two patients, right femoral arteries and right femoral veins were used, in others, right common carotid artery and right internal jugular veins were used. Five patients (83.3 \%) survived to discharge. ECMO can be used effectively in pediatric patients with acute fulminant myocarditis to support the circulation while awaiting myocardial recovery. Timely use of ECMO can improve the survival rate and may be associated with better outcomes.Item Utility of Cervical Cannulation During Difficult Resternotomy in Congenital Heart Surgery(SAGE PUBLICATIONS INC, 2020-01-01) Temur, Bahar; Davutoglu, Arda; Dogruoz, Alper; Aydin, Selim; Suzan, Dilek; Kirat, Baris; Odemis, Ender; Erek, ErsinBackground: Adhesions due to previous surgeries and some anatomical difficulties may make resternotomy dangerous in children. Femoral vessels are usually small and may not be suitable for cannulation. The aim of this report is to describe our experience with cervical cannulation during risky resternotomy in children. Methods: Between January 2014 and January 2018, cervical cannulation was performed in eight pediatric patients during sternal reentry. Their ages were between 3 months and 17 years (mean: 5.4 years). Three patients underwent stage III extracardiac Fontan operation with the diagnosis of hypoplastic left heart syndrome. Three patients had supravalvular aortic and/or pulmonary stenosis after previous arterial switch operation. One patient had proximal aortic arch stenosis and subvalvular aortic stenosis after interrupted aortic arch repair. The last patient had aortic root pseudoaneurysm and aortic insufficiency due to endocarditis. Through a separate cervical incision, a polytetrafluoroethylene graft was anastomosed to the common carotid artery and the arterial cannula was inserted into the graft. Antegrade selective cerebral perfusion (ASCP) was used in two patients. Results: During resternotomies, no major injury or bleeding occurred. Three-month-old patient who had previous interrupted aortic arch repair died despite extracorporeal membrane oxygenation support due to sepsis and multi-organ failure. Median intensive care unit stay and hospital stay were 3 days (1-40 days) and 17 days (7-60 days), respectively. Mean follow-up was 17.9 +/- 15.8 months. All patients were in good clinical condition. Conclusions: Cervical cannulation may be a useful and safe technique during high-risk resternotomy in children. This technique may also simplify the performance of ASCP if necessary.Item Clinical and laboratory predictors of survival for pediatric patients on non-postcardiotomy extracorporeal membrane oxygenation (ECMO)(TURKISH J PEDIATRICS, 2020-01-01) Sik, Guntulu; Demirbuga, Asuman; Annayev, Agageldi; Temur, Bahar; Aydin, Selim; Demir, Halil Ibrahim; Erek, Ersin; Citak, AgopExtracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmonary failure who do not respond to conventional therapy