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Biomedical subjects

Emin Tireli

Publications and source records attributed to Emin Tireli.

At least 19 recordsLinked to original sources
PubMed2007

Rastelli and Norwood combination for the treatment of type I truncus arteriosus and hypoplastic aortic arch: a case report.

Although truncus arteriosus is often treated with low mortality and morbidity rates, truncal valve patency and aortic arch and coronary artery anomalies are factors that can contribute to a worse outcome. In this report, we present our experience with the combination of Rastelli and Norwood procedures for the treatment of Type I truncus arteriosus that was complicated by a hypoplastic aortic arch.

Aorta, Thoracic↗
PubMed2005

A novel technique for creation of a systemic-to-pulmonary arterial shunt.

A systemic-to-pulmonary arterial shunt is still widely used for palliation of some neonates with cyanotic congenital cardiac lesions. This procedure, however, is well known to be associated with some degree of morbidity and mortality. To reduce the incidence of iatrogenic pulmonary arterial deformities, we have devised a new and simple technique to create the shunt using a partial sternotomy, and have used our technique in 10 neonates with cyanotic cardiac malformations. All but one of our patients survived, and an early reoperation was needed in only one further patient for revision of the shunt. Successful bidirectional Glenn procedures were performed in five of the nine surviving patients within 18 months of the initial procedure. We believe that our technique provides superior palliation by permitting equal enlargement of the right and left pulmonary arteries, and thus facilitates subsequent completion of the Fontan circulation.

Blood Vessel Prosthesis Implantation↗
PubMed2005

Patency and venous pressure of arteriovenous fistulas for hemodialysis.

The early patency of arteriovenous fistulas created for hemodialysis is affected by various factors, including venous stenosis. We conducted a study to investigate the effect of venous stenosis on early patency by examining perioperative arterial and venous pressures of the fistula. Among the 15 patients selected for the study, 11 had snuff-box fistulas, 3 Brescia-Cimino, and 1 brachial. A thrill was palpable over the anastomosis in 10 patients and absent in 5 patients. In terms of venous pressure, the patients with a thrill had a mean systolic pressure of 35.8 mm Hg and systolic-diastolic pressure gradient of 3.4 mm Hg. In the patients without a thrill, the values were 102.6 mm Hg and 42.8 mm Hg, respectively. In conclusion, patients with venous obstruction in the fistula had a much higher venous pressure than those with a patent fistula. If venous stenosis is suspected, measurement of fistula pressures may be useful for determining the early patency of arteriovenous fistulas.

Aged↗
PubMed2005

Myocardial ischemia after Cabrol operation.

A 33-year-old woman who had undergone a Cabrol-type aortic root replacement for acute aortic dissection during labor 27 months ago was admitted with chest pain. Electron-beam tomography and coronary angiography showed stenosis at the level of the anastomosis. Urgent coronary revascularization was performed using bilateral internal mammary artery grafts. Although graft occlusion after the Cabrol procedure is an infrequent complication, it should be considered during follow-up.

Adult↗
PubMed2004

Arterial switch operations for single coronary artery ostium or intramural coronary artery.

BACKGROUND: Successful transfer of the coronary arteries is the most critical step during arterial switch operations for patients with transposition of the great arteries with a single coronary artery ostium and/or intramural coronary arteries. Various techniques have been reported and the present study was an evaluation of them in 10 neonatal patients. METHODS AND RESULTS: Coronary artery transfers are achieved by implantation of coronary buttons to the previously anastomosed neo-aorta using pericardial or pulmonary artery hood techniques. One patient died perioperatively because of myocardial malperfusion. Following prolonged mechanical ventilation, another died from sepsis on the 28th postoperative day. Coronary artery perfusion abnormality was not observed in the remaining patients. CONCLUSIONS: Transfer of the coronary button by the pericardial or pulmonary artery hood augmentation technique to the previously anastomosed neo-aorta is a practical, easy and convenient combination of methods for the treatment of these patients.

Coronary Vessel Anomalies↗
PubMed2003

Results of surgical treatment for nonthymomatous myasthenia gravis.

PURPOSE: To clarify the factors that influence improvement and remission after thymectomy for patients with nonthymomatous myasthenia gravis (MG). METHODS: We retrospectively reviewed 204 patients with nonthymomatous MG who underwent thymectomy and anterior mediastinal dissection through a partial median sternotomy, between 1980 and 2001, and examined whether age, sex, preoperative classification, and duration of symptoms influenced their prognosis. RESULTS: There was no perioperative or hospital mortality. The mean follow-up period was 7.2 +/- 1.2 years, with early and late postoperative remission rates of 44.6% and 73%, respectively. Seven patients died; two from pneumonia and five from causes unrelated to MG. Preoperative treatment and classification, duration of symptoms, age, and sex did not seem to have a significant influence on remission, but the response to thymectomy was greater in patients with thymic hyperplasia. Remission and improvement rates were significantly better at the end of the first year, with the same status found at the last follow-up. CONCLUSION: Thymectomy is an effective and highly curative method of treatment for patients. with MG. It provides excellent symptomatic improvement, which is enhanced over the long term.

Adolescent↗
PubMed2003

Peri-operative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt.

OBJECTIVE: In patients with functional single ventricular physiology, the avoidance of cardiopulmonary bypass offers many advantages including earlier extubation, decreased necessity of inotropic support, improved hemodynamical status and reduced likelihood of post-operative prolonged pleural effusion. We believe that the bidirectional cavopulmonary anastomosis operations may be performed with transient external shunt techniques. The purpose of this prospective study is the peri- and post-operative comparison of different transient external shunt methods used in bidirectional cavopulmonary shunt operations. METHODS: Between years 1997 and 2000, 30 patients have undergone bidirectional cavo-pulmonary shunt operation by using three different types of external shunt. The mean patient age was 13 months (range, 3 months-3 years). Previous operations had been performed in ten patients (33%). All patients were divided into three groups according to type of external shunt used. In group A (ten patients), the transient external shunt was constructed between superior vena cava and right atrium by uniting two standard venous cannulas with a Y-connector. In group B (ten patients), the external shunt was performed with a single short venous cannula constructed between superior vena cava and right atrium. In group C (ten patients), the external shunt was constructed between superior vena cava and left pulmonary artery by using a single short venous cannula. During operation, central venous pressure (CVP), arterial O(2) saturation and mean arterial blood pressure were recorded continuously. RESULTS: All operations are completed without the establishment of cardiopulmonary bypass. Hospital mortality was 3.3%. One patient in group A died because of low cardiac output at the end of postoperative day 2. All patients were extubated within 4h. In groups A-C mean superior vena caval pressures were measured 28, 24 and 21 mmHg, respectively during superior vena cava-right pulmonary artery anastomosis. In both groups A and B patients, arterial O(2) saturation decreased to a minimum 53+/-2 and 53+/-2%, respectively during the operation. In the group C, minimum arterial O(2) saturation was measured 82+/-2%. Although mean arterial pressure decreased in all groups during clampage; in group C patients, this drop is not significant. CONCLUSION: Based on the study presented here, bidirectional cavo-pulmonary anastomosis can be carried out by using different types of transient external shunt. The best hemodynamical condition and arterial O(2) levels were achieved with the shunt constructed between superior vena cava and left pulmonary artery.

Anastomosis, Surgical↗
PubMed2002

Single-stage unifocalization and correction with median sternotomy in complex pulmonary atresia.

OBJECTIVE: This study assessed the surgical and post-operative outcome of single-stage complete unifocalization and repair procedure in patients with complex pulmonary atresia. METHODS: From 1999 to 2001, we performed complete unifocalization and correction in 10 patients with complex pulmonary atresia. Their ages ranged from 10 months to 17 years. All patients were evaluated with pulmonary angiography and divided into two groups according to the development of native pulmonary arteries. Group I patients had hypoplastic pulmonary arteries and MAPCAs and Group II patients had only MAPCAs without native pulmonary arteries. With median sternotomy, all MAPCAs were prepared and anastomozed to native pulmonary arteries in group I patients or on a pericardial roll in group II patients without using cardiopulmonary bypass. Right ventricle to pulmonary arterial continuity was established with a valved conduit under CPB. VSD was closed in two patients. RESULTS: Eight patients had complete repair without VSD closure. They were followed periodically with pulmonary angiography. Two patients developed congestive heart failure. One of them was reoperated and VSD was closed. The other patient died because of untractable congestive heart failure. The decision for VSD closure was made in two patients due to suitable pulmonary arterial vascular tree. However, one of them had to be reoperated and VSD patch was removed. This patient died because of sepsis on the postoperative 26th day. We are following the rest of the patients with echocardiography and pulmonary angiography. CONCLUSION: Single stage complete unifocalization and repair should be the treatment of choice in patients with complex pulmonary atresia. This procedure provides a significant development in neopulmonary arterial system. However, the accurate criterias for VSD closure are still controversial. After the operation, these patients had to be followed closely with echocardiography and pulmonary angiography because of the absolute risk of congestive heart failure in patients with VSD left open.

Adolescent↗
PubMed2002

Successful repair of ascending aortic aneurysm due to Takayasu's arteritis.

A 2-year-old girl with Takayasu's arteritis and an ascending aortic aneurysm underwent successful graft replacement. Although aneurysms of the great vessels are rarely encountered, this disease should be considered in the differential diagnosis of ascending aortic aneurysms in children.

Aortic Aneurysm↗