Biomedical subjects
Publications and source records attributed to A Saylam.
Two patients with Ebstein's anomaly had valve replacement with Starr-Edwards cloth-covered valves 11 and 8 years ago. They have been asymptomatic and very active despite the absence of anticoagulation. These cases provide some of the long-term results needed for proper evaluation of the different methods of operative treatment of Ebstein's anomaly.
Embolectomy was carried out in eight patients with pulmonary emboli. Angiographic diagnosis was obtained in six, and in two cases pulmonary angiography could not be done because of the very critical condition of the patients. In the latter two, diagnosis was made based only on clinical findings. Two patients died in the operating room (25 percent). Six patients were discharged in good condition. It is emphasized that pulmonary embolectomy should be done in cases of pulmonary emboli when a clinical status of shock is present (systolic blood pressure less than 80 mm of mercury and the patient in low cardiac output syndrome) and when there is no response to medical treatment regardless of the degree of obstruction in the pulmonary arterial tree.
One hundred patients with pulmonary hydatid disease underwent thoractomy and operative removal of the cysts. Of the 60 men and 40 women, most were between 3 and 19 years old. Cough, fever, dyspnea, and chest pain were the prominent symptoms in the majority of cases. Intact hydatid cysts were found in 67 patients and infected or ruptured cysts in 33. The Casoni skin test, Weinberg reaction, and eosinophilia were found to be unreliable diagnostic criteria and therefore were not used routinely in our patients. Roentgenological examination was the most valuable diagnostic aid. A single lobe was affected in 72 patients. Unilateral multiple foci were present in 15 patients and bilateral multiple foci in 13. Cystectomy and capitonnage were the preferred operative procedures in most cases. Pulmonary resection was necessary to only a limited number of patients. We conclude that conservative surgical methods such as cystectomy (with or without capitonnage) are preferable, especially for children, whose residual lung parenchyma has great capacity for expansion. The mortality rate among our 100 patients was 2%; both died of cardiac arrest during operation.
Inhalation of foreign bodies is a major cause of accidental death during childhood. Aspiration of foreign bodies is common in children aged 1 to 3 years, especially in boys. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airways, because some children with aspirated foreign bodies are without symptoms and chest x-ray films may not show abnormalities. Bronchoscopic removal of the foreign bodies requires close communication between the anesthesiologist and the endoscopist. Forgotten foreign bodies in the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess. Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience in 500 children with suspected foreign body inhalation. We routinely use prednisolone, 1 to 2 mg. per kilogram, and nebulization just after bronchoscopic examination of the airways. This medication greatly diminishes the rate of postbronchoscopic complications such as laryngeal edema, which require tracheostomy. In our series of 500 case, the incidence of postbronchoscopic tracheostomy is 1.4 per cent and the total mortality rate is 1.8 per cent.
A case of pulmonary artery sling in a 1-year-old boy, treated by resection of the left pulmonary artery (LPA) at its origin from the right pulmonary artery (RPA) and reanastomosis of the LPA to the main pulmonary artery (MPA), is reported. In this patient the LPA-MPA anastomosis was demonstrated to be patent in a follow-up pulmonary angiogram six months after the operation. Pulmonary artery sling should be kept in mine when assessing respiratory distesss syndrome in children.
Total bifid sternum with or without ectopia cordis is a rare congenital anomaly which is treated successfully in a limited number of cases. Several methods of correction have been described using tissue grafts (cartilage, bone), inert artificial prostheses (acrylic plaques, marlex mesh), and techniques to approximate the sternal bands by relaxation of costal cartilages. In our case the method described by Verska was used to approximate the bifid sternal bands. The successful result in our patient proves the efficiency of this technique.
A dislodged Pudenz ventriculo-atrial shunting catheter in a 1.5 year old girl, removed from the right heart by right atriotomy, is presented. The diagnosis, complications and treatment of this unusual complication of the Pudenz shunt are discussed.
50 consecutive patients undergone open heart surgery were analyzed regarding postoperative arrhythmias in the first postoperative 3 days. Disturbances of rhythm occurred in each case of our group, serious or not serious (100%). Ventricular premature beats were the most frequent type of arrhythmia in the first and second postoperative days (80%). Two cases expired postoperatively. In one of them complete atrioventricular block developed after double valvular replacements (mitral and tricuspid). The other died of low cardiac output syndrome. Etiology of the arrhythmias after open heart surgery is not clear in the absence of electrolyte and metabolic disturbances, digitalis intoxication and surgical trauma to the conduction system and coronary arteries. Low cardiac output syndrome, hypotension and hypoxia can also be blamed in the formation of these arrhythmias. Other factors such as the prolongation of anoxic arrest, irritation of the ventricular septum by valvular prostheses, cardiac irritation by thoracic tubes, psychologic trauma, halothane anesthesia and coronary arterial disease in the old age group may be the possible predisposing factors in these patients.
A patient with a rare case of cardiac tumor in the right atrium secondary to Wilms' tumor of the right kidney, underwent open heart surgery and removal of the mass was presented. This is the 10th. case of intracardiac tumor secondary to renal malignancy. Careful auscultation of the heart is necessary in patients with malignancy in the kidney to detect the possible right heart metastases through the inferior vena cava. Cardiac symptoms precede the renal manifestations in most cases. Malignant renal metastases to the heart should always be in mind in space occupying masses of the right heart chambers.
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A rare variant of cor triatriatum is presented with a large true atrial septal defect and partial anomalous pulmonary venous return into the right atrium. The correct diagnosis was made at the operation and abnormal left atrial septum was excised completely and a new interatrial septum was created with pericardial patch in such a position that the abnormally drained right upper pulmonary vein was left in the left atrium. It was thought to use the abnormal left atrial septum to close the atrial septal defect by excising only the right lateral border of this abnormal septum and resuturing it to the right atrial wall to close the true atrial septal defect. This thought could not be realized because of the small size of this abnormal septum and large size of the atrial septal defect. This technique can be realized in small or medium sized atrial septal defects associated with cor triatriatum.
Routine use of open mitral commissurotomy in all cases of rheumatic mistral stenosis is the recommended treatment of choice in recent years. Effective division of the subvalvular apparatus (chordae tendineae and papillary muscles) can be accomplished easily during open commissurotomy and therefore recurrences after the open approach is less than the recurrences after closed commissurotomy. These subvalvular elements can not be freed easily during closed mitral commissurotomy. Low mortality rates after open approach suggests that this operation can be performed safely in cases of MS. Open approach has several advantages versus closed commissurotomy. We believe that closed commissurotomy should be replaced by open commissurotomy in all cases of MS.