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Item Recommendations for the selection of techniques and components used in congenital heart surgery in Turkey(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012-01-01) Undar, Akif; Haydin, Sertac; Erek, Ersin; Yivli, Perihan; Odemis, Ender; Agirbasli, Mehmet; Alkan-Bozkaya, Tijen; Turkoz, Ayda; Turkoz, Riza; Sasmazel, Ahmet; Karaci, Ali Riza; Cicek, Ali Ekber; Yalcinbas, Yusuf; Akcevin, Atif; Sarioglu, Tayyar; Bakir, IhsanThere is no standard for the selection of technical and mechanical components (heart-lung machine system, oxygenator, arterial and venous cannulae, arterial filter and other specifically-designed components and devices) used in cardiopulmonary bypass in Turkey. The cost of the component plays a significant role in the selection, as well as the preference of the facility. Only a limited number of hospitals decide which components to be used based on scientific data. Studies have confirmed that selected novel techniques and components having no basis of scientific justification may pose risk for the life of the patient in the short- and long-term. The objectives of this study are to show how to use quality-control procedures and scientific data for the selection of novel techniques and components and to share, also, recent techniques experienced to minimize the complication risk after surgery.Item 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, TayyarObjective: 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 flowItem 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, KeremIn 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.Item 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, TayyarBackground 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.Item 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, TayyarLeft 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.Item Myocardial bridge of the left anterior descending artery(WILEY, 2017-01-01) Arnaz, Ahmet; Akansel, Serdar; Yalcinbas, Yusuf; Sarioglu, TayyarItem Double covered stent closure of extracardiac Fontan multiple fenestrations(TURKISH SOC CARDIOLOGY, 2012-01-01) Saygili, Arda; Tokel, Kursad; Kocyigit, Ozgen Ilgan; Sarioglu, TayyarItem 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, TayyarBackground/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 = 0.63Item 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, AyseBackground 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 = .206Item Late Cardiac Rupture after Amplatzer Septal Occluder Implantation(TEXAS HEART INST, 2016-01-01) Arnaz, Ahmet; Turkekul, Yasemin; Yalcinbas, Yusuf; Saygili, Arda; Sarioglu, TayyarTranscatheter 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.