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1.
Perfusion ; 29(1): 70-4, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23863488

ABSTRACT

BACKGROUND: The deep hypothermic circulatory arrest (DHCA) technique has been used in aortic arch and isthmus hypoplasia for many years. However, with the demonstration of the deleterious effects of prolonged DHCA, selective cerebral perfusion (SCP) has started to be used in aortic arch repair. For SCP, perfusion via the innominate artery route is generally preferred (either direct innominate artery cannulation or re-routing of the cannula in the aorta is used). Herein, we describe our technique and the result of arch reconstruction in combination with selective cerebral and myocardial perfusion (SCMP) and short-term total circulatory arrest (TCA) (5-10 min) through ascending aortic cannulation. METHODS: Thirty-seven cases with aortic arch and isthmus hypoplasia accompanying cardiac defects were operated on with SCMP and short TCA in Baskent University Istanbul Research and Training Hospital between January 2007 and Sep 2012. There were 17 cases with ventricular septal defect (VSD)-coarctation with aortic arch hypoplasia (CoAAH), 4 cases of transposition of the great arteries-VSD-CoAAH, 4 cases of Taussing Bing Anomaly-CoAAH, 2 cases complete atrioventricular canal defect-CoAAH, 3 cases single ventricle-CoAAH, 3 cases of type A interruption-VSD, 2 subvalvular aortic stenosis-CoAAH and 2 cases of isolated CoAAH. The aorta was cannulated in the middle of the ascending aorta in all cases. The cross-clamp was applied to the aortic arch distal to either the innominate artery or the left carotid artery. In addition, a side-biting clamp was applied to the descending aorta. The aorta between these two clamps was reconstructed with gluteraldehyde-treated autogeneous pericardium, using SCMP. The proximal arch and distal ascending aorta reconstructions were carried out under short TCA. RESULTS: The mean age of the patients was 2.5 ± 2 months. The mean cardiopulmonary bypass and cross-clamp times were 144 ± 58 and 43 ± 27 minutes, respectively. The mean SCMP and descending aorta ischemia times were 22.6 ± 4.8 and 27 ± 6.3 minutes, respectively. Mean TCA time was 7.6 ± 2.1 minutes (min: 4, max 10 min). The mean in-hospital stay time was 8.6 ± 1.9 days. None of the cases operated with this technique had neurological defects. The mortality rate was 2.7% (1 patient). CONCLUSION: SCMP with aortic cannulation and short TCA (under 10 minutes) in aortic reconstruction is safe and practical in this high-risk patient group.


Subject(s)
Aorta, Thoracic/surgery , Circulatory Arrest, Deep Hypothermia Induced/methods , Heart Defects, Congenital/surgery , Hypothermia, Induced/methods , Aorta, Thoracic/abnormalities , Catheterization , Cerebrovascular Circulation , Child, Preschool , Humans , Perfusion/methods , Plastic Surgery Procedures/methods
2.
Cardiovasc J Afr ; 23(1): e13-5, 2012 Feb 12.
Article in English | MEDLINE | ID: mdl-22331270

ABSTRACT

We present the case of a three-month-old infant with a giant right atrial myxoma obstructing the tricuspid valve, who following haemodynamic deterioration and cardiac arrest, was operated upon as an emergency. On echocardiogram, there was a mass attached to the tricuspid annulus, in close proximity to the septal leaflet, with dimensions of 16.6 × 12.5 mm. The mass was prolapsing through the tricuspid valve into the right ventricle and obstructing the inflow. While preparing for surgery, cardiac arrest occurred, so the patient underwent an emergency operation under cardiopulmonary resuscitation. The mass was excised without damaging the tricuspid valve and the conduction system. Histologically, the mass consisted of a myxoid matrix with scatted globoid and star-shaped myxoma cells. The patient stayed 15 days in the intensive care unit and was discharged home on the 20th day postoperatively. Although accepted as a benign tumour, a myxoma can display an aggressive clinical course in infants. In centres where cardiac operations cannot be performed, these patients need to be transferred to cardiac centres as soon as possible. Whatever the clinical presentation, we advocate immediate surgical extirpation of the tumour in order to avoid any unpredictable consequences in its clinical course.


Subject(s)
Heart Neoplasms , Myxoma , Cardiac Surgical Procedures , Heart Arrest , Heart Neoplasms/surgery , Humans , Myxoma/surgery , Tricuspid Valve
3.
Vasa ; 40(4): 333-5, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21780060

ABSTRACT

Recently, extra-anatomical bypass surgery has been widely used in complicated adult aortic coarctation cases with concomitant intracardiac repair. Stent implantation has been widely used for primary aortic coarctation as well. The procedure has been shown to be effective with long term follow ups. However, failed stent implantations like stent fracture and dislodgement may complicate the clinical status and subsequent surgical procedure. Extra-anatomic bypass can provide effective results and lower morbidity in cases with concomitant intracardiac problems and stent failure. Here we present an adult aortic coarctation patient who had undergone a Bentall operation and two unsuccessful stent implantations for recurrent aortic coarctation. The patient then got an extra-anatomic bypass for aortic coarctation and concomitant mitral valve commissurotomy through median sternotomy.


Subject(s)
Aortic Coarctation/surgery , Cardiac Surgical Procedures , Endovascular Procedures , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Sternotomy , Adult , Aortic Coarctation/diagnostic imaging , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Foreign-Body Migration/etiology , Foreign-Body Migration/surgery , Humans , Male , Mitral Valve/diagnostic imaging , Mitral Valve Stenosis/diagnostic imaging , Prosthesis Failure , Recurrence , Reoperation , Stents , Tomography, X-Ray Computed , Treatment Failure
4.
Thorac Cardiovasc Surg ; 58(6): 359-60, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20824591

ABSTRACT

BACKGROUND: Pediatric coronary artery bypass is performed for ischemic complications of Kawasaki disease, congenital coronary anomalies, and iatrogenic pediatric coronary artery problems. METHODS: We performed myocardial revascularization using the internal mammary artery in 6 children. A review of outcomes is presented here. Patient ages ranged from 7 days to 10 years. RESULTS: There was no operative mortality. All coronary bypass grafts were patent at 3 months to 3 years postoperatively. No patient had recurrent angina or showed signs of myocardial ischemia. CONCLUSION: Internal mammary artery bypass grafting can be successfully performed in infants and children with good results. Long-term patency and growth of the anastomosis of the distal vessel are not clear, but good clinical and angiographic results have been reported even after 25 years.


Subject(s)
Coronary Circulation , Coronary Vessels/surgery , Internal Mammary-Coronary Artery Anastomosis , Myocardial Ischemia/surgery , Austria , Child , Coronary Vessels/physiopathology , Female , Humans , Infant, Newborn , Internal Mammary-Coronary Artery Anastomosis/adverse effects , Male , Myocardial Ischemia/diagnostic imaging , Myocardial Ischemia/etiology , Myocardial Ischemia/physiopathology , Radiography , Time Factors , Treatment Outcome , Vascular Patency
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