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Öğe Air gun pellet: Cardiac penetration and peripheral embolization [Havalı tüfek saçması kardiyak penetrasyon ve periferal embolizasyonu](Turkish Association of Trauma and Emergency Surgery, 2016) Işık O.; Engin Ç.; Daylan A.; Şahutoğlu C.Use of high-velocity air guns can to lead to serious injuries. Management options of cardiac pellet gun injuries are based on patient stability, and course and location of the pellet. Presently reported is the case of a boy who was shot with an air gun pellet. Following right ventricular entry, the pellet lodged in the left atrium and embolized to the right iliac and femoral artery. Following pellet localization, right ventricular injury was repaired, and the pellet was removed successfully. © 2016 TJTES.Öğe Anaesthetic management in a heart transplantation patient with amiodarone associated thyrotoxicosis [Amiodaron i·lişkili tirotoksikozlu kalp transplantasyonunda anestezi yönetimi](2013) Şahutoglu C.; Pestilci Z.; Kocabaş S.; Aşkar F.Z.; Hepkarşi A.; Engin Ç.Introduction: The elective surgery of patients with abnormal thyroid function can be delayed until they are euthyroid with medical treatment. We present the anaesthetic management of a patient with amiodarone associated thyrotoxicosis who underwent heart transplantation. Case Report: A 20- year -old female patient diagnosed as cardiomyopathy developed cardiac tamponade and cardiac arrest following heart biopsy. The patient was resuscitated, after decompresion of cardiac tamponade and amiodarone was started for the management of ventricular premature beats. The patient's ejection fraction was 30% as estimated during echocardiography done two years later and thyroid function tests were as follows: FT3: 11.8 pg mL-1, FT4>12 ng dL -1 ve TSH: 0.001 µIU mL-1. The patient was started on propylthiouracil and metilprednisolone therapy with the diagnosis of thyrotoxicosis secondary to amiodarone therapy. Ventricular tachycardia developed three months later and the patient's ejection fraction was under 20% on echocardiography. Ventricular assist device implantation was planned for the patient. Plasmapheresis was performed 3 times and 28% reduction in FT4 levels was achieved. The patient underwent heart transplantation after a suitable donor heart was found. The patient was monitorized with ECG, pulse oximetry, invasive arterial pressure, central venous pressure, rectal temperature measurements, and transoesophageal echocardiograms. Anaesthesia was induced with ketamine, midazolam, rocuronium, fentanyl and maintained with sevoflurane and propofol. The signs of thyrotoxicosis did not develop during the perioperative period. Conclusion: Amiodarone is at the top of the most widely used drugs in the treatment of arrhthymias. The surgical candidates who are using or have given up using this drug must be followed closely for perioperative complications.Öğe Anesthetic management for implantation of total artificial heart device: Case series [Total yapay kalp cihazi implantasyonunda anestezik yaklaşim: Olgu serisi](Nobelmedicus, 2016) Sahutoğlu C.; Karaca N.; Kocabaş S.; Askar F.Z.; Ertugay S.; Engin Ç.; Yağdı T.; Özbaran M.The treatment of end-stage heart failure is heart transplant; however the majority of patients die due to deficiency of organ donation. Total artificial heart implantation made for the purpose of extending the life span and bridging to transplantation in patients with end-stage heart failure is a good option. We present our initial experiences in the anesthetic management of total artificial heart implantation cases performed in our institution. Five out of seven patients (46.8±8.4 years) were taken to surgery with inotropic support. Four patients were diagnosed as dilated cardiomyopathy. Three patients were subject to cardiac arrest during the preoperative period and mechanical ventilation was applied for one of these patients. Intraoperative ketamine, midazolam, fentanyl, rocuronium were used in doses of 192±89 mg, 8±3.5 mg, 335±157 µg and 192±43 mg, respectively. Fresh donor blood, fresh frozen plasma, thrombocyte and erythrocyte suspension requirements were 2.1±1.6 unit, 2± 1.8 unit, 0.43±0.5 unit and 0.6± 0.9 unit, respectively. At least one complication developed in all of the patients; four patients who had sepsis and renal failure died and; 3 patients who were not subject to this complication were discharged from the hospital. Total artificial heart implantation made for the purpose of bridging to transplantation for end-stage heart failure patients is a valuable option and its anaesthetic management is challenging. It is important that anesthesiologists have knowledge about the implanted device and the surgical procedure. © 2016 Nobelmedicus. All rights reserved.Öğe Association between the low percentage of forced vital capacity and increased mortality after left ventricular assist device implantation(Baycinar Medical Publishing, 2020) Ekren P.K.; Öztürk P.; Ertugay S.; Özdil A.; Nalbantgil S.; Engin Ç.; Özbaran M.Background: This study aims to investigate the effect of low percentage of forced vital capacity measured in the preoperative period on the 28-day mortality in patients undergoing left ventricular assist device implantation. Methods: A total of 131 patients (111 males, 20 females; median age 54 years; range, 47 to 59 years) who underwent left ventricular assist device implantation with HeartWare™ between December 2010 and January 2016 were retrospectively analyzed. The patients were divided into two groups according to the results of pulmonary function test as a forced vital capacity percentage of ?60% (n=113) and <60% (n=18). Both groups were compared in terms of laboratory and clinical characteristics, and postoperative complications. Risk factors for postoperative 28-day mortality were analyzed. Results: Pre- and intraoperative characteristics were similar in both groups, except for left ventricular end-diastolic diameter. The ventilator-free days up to 28 days was shorter (p=0.046) and the length of intensive care unit stay was longer (p=0.011) in the low percentage of forced vital capacity group. The 28-day mortality rate was also higher (22.2% vs. 9.7%, respectively; p=0.12) in this group. The history of prior cardiac operation (odds ratio: 4.40; 95% confidence interval 1.19-16.20, p=0.026) and tricuspid valve repair at the time of device implantation (odds ratio: 5.30; 95% confidence interval 1.33-21.00, p=0.018) were found to be independent risk factors for mortality. Multivariate analysis showed that a forced vital capacity of <60% was not associated with mortality (odds ratio: 3.96; 95% confidence interval 0.95-16.43, p=0.058). Conclusion: The length of intensive care unit stay and duration of mechanical ventilation may be longer in patients with a low percentage of forced vital capacity. Although the association between 28-day mortality and low percentage of forced vital capacity is not significant, the risk of 28-day mortality is higher in this group. Therefore, the patients should be assessed carefully before the left ventricular assist device operation. © 2020 © 2020 All right reserved by the Turkish Society of Cardiovascular Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Öğe Changes in etiology, cause of death, survival, and mortality rates in cardiac transplant patients from 1998 to 2011 [1998-2011 arasi dönemde kalp nakli hastalarinda etyoloji, ölüm nedenleri, sagkalim ve mortalite oranlarindaki degişim](2012) Güngör H.; Nalbantgil S.; Oguz E.; Ayik M.F.; Zoghi M.; Ertugay S.; Karakula S.; Engin Ç.; Yagdi T.; Özbaran M.Objectives: We retrospectively analyzed changes in heart failure etiology, causes of death, mortality and survival rates in cardiac transplant patients from 1998 to 2011. Study design: A total of 144 patients (112 men, 32 women; mean age 40.2±14.3 years) underwent cardiac transplantation between February 1998 and January 2011. The patients were divided into two groups; hence, 63 patients (group 1; mean age 42.5±12.6 years) receiving transplantation up to January 2006, and 81 patients (group 2; mean age 38.4±15.3 years) receiving transplantation from 2006 to 2011. In the latter period, a ventricular assist device was used in 17 patients before transplantation. Results: Dilated cardiomyopathy was the main cause of heart transplantation in both groups (71.4% vs. 74.1%). Overall mortality, in-hospital mortality (<30 days), and late mortality (?30 days) rates were 39.6% (n=57), 13.9% (n=20), and 25.7% (n=37), respectively. Survival rates for 1, 2, 5, and 10 years were 76%, 69%, 59%, and 46%, respectively. The second group had significantly lower rates of overall mortality and late mortality compared to group 1 (29.6% vs. 52.4%, p=0.005; 16.0% vs. 38.1%, p=0.002, respectively), whereas early mortality rates were similar. Survival rates were also higher in the second group, but these differences did not reach significance (1-year, 76.1% vs. 74.6%; 2-year, 73.0% vs. 65.1%; 5-year, 63.8% vs. 55.6%; log rank 0.33). In both groups, infections (30.3% vs. 33.3%), right ventricular failure (12.1% vs. 29.2%), and sudden cardiac death (15.2% vs. 16.7%) were the leading causes of death. Conclusion: Our data show that overall and late mortality rates show significant decreases in cardiac transplant patients from 1998 to 2011. © 2012 Türk Kardiyoloji Dernegi.Öğe Clinical and hemodynamic features of Eisenmenger syndrome patients at the time of first admission: A tertiary referral-center experience [Eisenmenger sendromlu hastalari{dotless}n ilk başvuru ani{dotless}ndaki klinik ve hemodinamik özellikleri: Tersiyer merkez deneyimi](2012) Güngör H.; Ertugay S.; Ayik M.F.; Demir E.; Engin Ç.; Yagdi T.; Özbaran M.; Atay Y.; Nalbantgil S.Objective: In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed. Methods: The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6±9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission. Results: The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9±33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112±6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV 1 (forced expiratory volume), FEV 1/FVC values were respectively, 3.1±0.4, 2.5±0.4 L and 76.7±3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 ±1.0 ml / kg/min and VE/VCO2 rate was 53.9±3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low. Conclusion: The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters. © 2012 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd.ss}k Ltd.Öğe Current status of heart transplantation in Turkey [Türkiye'de kalp transplantasyonunun güncel durumu](Turkish Society of Cardiology, 2014) Ya?di T.; Engin Ç.; Özbaran M.Heart failure is a clinical picture that occurs when the heart is unable to provide sufficient blood to the tissues and organs due to low performance. In end-stage heart failure, quality of life and survival rates are affected adversely. Heart transplantation is still the best method of treatment in many end-stage heart failure patients who remain symptomatic despite guideline-directed medical therapy. The current situation of heart transplantation in Turkey is discussed in this review. © 2014 Türk Kardiyoloji Derne?i.Öğe The effect of heart transplantation on mortality in end-stage heart failure patients with UNOS status 2 [UNOS 2 statüsündeki son dönem kalp yetersizligi hastalarinda kalp naklinin mortaliteye etkisi](2006) Duygu H.; Zoghi M.; Nalbantgil S.; Engin Ç.; Yagdi T.; Akilli A.; Akin M.; Özbaran M.Objectives: Despite recent developments in medical treatments and assist device applications, management strategies for end-stage heart failure patients with UNOS status 2 (United Network for Organ Sharing) are still controversial. We evaluated the clinical condition and prognosis of end-stage heart failure patients with UNOS status 2, who were placed on the waiting list for heart transplantation. Study design: The study included 78 patients (62 men, 16 women; mean age 43±12 years) with UNOS status 2. The patients were assessed in terms of frequency of hospitalization during waiting for transplantation, shift to a higher level of UNOS status, transplantations performed, and mortality. Results: The mean duration of waiting on the list was 17±10 months. The frequency of hospitalization due to heart failure was 4±2/year. An implantable cardioverter defibrillator was used in seven patients (9%) for persistent ventricular tachycardia. Nine patients (11.5%) shifted to UNOS status 1B. Eighteen patients (23.1%) underwent orthotopic heart transplantation following six months of waiting on the list. Mortality rates were 25% (n=15) and 22.2% (n=4) for patients on the waiting list and for transplant patients at the end of the first year of transplantation, respectively (p=0.03). The main cause of mortality was sudden cardiac death (73.3%, n=11) for patients on the transplantation list. There was a significant difference in terms of combined end-point of mortality and shift to UNOS status 1B between transplanted (n=24, 40%) and untransplanted (n=4, 22.2%) patients (p=0.01). Conclusion: Heart transplantation is an appropriate alternative for preventing impending clinical deterioration, frequent attacks of heart failure, and cardiac deaths in patients with UNOS status 2.Öğe Evaluation of cardiac arrhythmia in pediatric patients with Left Ventricular Assist Device (L-VAD)(Verduci Editore s.r.l, 2024) Doğan E.; Ergin F.; Beyter M.B.; Kaşikçi G.K.; Ay O.; Levent R.E.; Engin Ç.– OBJECTIVE: Pediatric heart failure is an important cause of morbidity and mortality in childhood. Left ventricular assist devices (L-VAD) are used for bridging to transplantation in patients with indications for heart transplantation. PATIENTS AND METHODS: The children included in the study were patients who underwent implantation of an L-VAD due to advanced heart failure at Ege University Faculty of Medicine Hospital between January 2009 and January 2023. RESULTS: Of the 33 patients who underwent L-VAD implantation, 16 (48.5%) were female and 17 (51.5%) were male. The median age at surgery was 13 years (IQR, 9.5-15). The median weight was 44 kg (IQR, 25.65-52), the median height was 158 cm (IQR, 134.5-168.5), and the median body surface area was 1.37 m2 (IQR, 0.95-1.51). All patients who underwent L-VAD implantation had an echocardiographic diagnosis of dilated cardiomyopathy. The patients underwent a median of 16 (IQR, 9-21) ECGs, and the median number of 24-hour Holter ECGs obtained was 3 (IQR, 2-5). Arrhythmias that occurred after L-VAD implantation were classified as atrial and ventricular. Ventricular arrhythmia included ventricular tachycardia (VT) lasting for more than 30 seconds (sustained VT), VT lasting for less than 30 seconds (nonsustained VT), and ventricular fibrillation. Atrial arrhythmias included atrial flutter, atrial fibrillation, supraventricular tachycardia, and atrial ectopic tachycardia. During the follow-up, atrial or ventricular arrhythmias were observed in 11 (33%) patients. The most common rhythm disturbances before L-VAD implantation were ventricular arrhythmias, while after the surgery, atrial arrhythmias were found to be the most frequent. A total of 5 patients underwent cardioversion (n=2) or defibrillation (n=3) due to arrhythmia. CONCLUSIONS: In patients undergoing L-VAD implantation, rhythm disorders that could normally lead to hemodynamic instability are frequently encountered. In these rhythm disorders, medical therapy should be attempted before resorting to cardioversion or defibrillation, and subsequently, more aggressive treatment methods should be considered. © 2024 Verduci Editore s.r.l. All rights reserved.Öğe Neoplastic diseases after heart transplantation: Clinical experience and review of the literature [Kalp transplantasyonu sonrasindaki neoplastik hastaliklar: Klinik deneyim ve literatürün gözden geçirilmesi](2004) Yagdi T.; Engin Ç.; Nalbantgil S.; Nart D.; Hamulu A.; Durmaz I.; Özbaran M.Increased risk of malignancy is a well-known complication of heart transplantation. In this report the incidence and the clinical presentation of post-transplant malignancy were evaluated. Between February 1998 and March 2003, 27 patients underwent heart transplantation. Heart transplantation recipients with more than 2 months follow-up were investigated for neoplastic disorders. Neoplastic diseases developed in three of 22 patients (13.6%) who survived more than 2 months. Post-transplant lymphoproliferative disease in 2 patients and Kaposi's sarcoma in 1 patient were the underlying malignancies. Mean age at transplantation was 51 years. The median time between transplantation and detection of a malignancy was 14 months with a range of 2 to 30 months. Macroscopic involvement of the allograft by lymphoma occurred in one patient. The diagnosis was made at postmortem examination in this patient. The other two patients have no evidence of tumor recurrence after treatment at follow-up. Although the majority of post-transplant tumours occur after a relatively long period of follow-up, some malignancies, especially lymphoproliferative disorders, may appear in the early post-transplant period.Öğe One case, two "firsts": First successful double lung and first pediatric lung transplantation in Turkey [Bir olgu, iki ilk: Türkiye'de ilk başarili çift akciger transplantasyonu; pediatrik yaş grubunda Türkiye'de ilk akciger transplantasyonu](2010) Özbaran M.; Turhan K.; Yagdi T.; Gülen F.; Özcan C.; Engin Ç.; Midyat L.; Çagirici U.; Nart D.; Nalbantgil S.; Demir E.; Tanaç R.; Aşkar F.We report the first successful double-lung transplantation in all age groups as well as the first lung transplantation in the pediatric age group in our country. A 14-year-old male who was oxygen dependent for the last three years was diagnosed with septic lung disease and bronchiolitis obliterans. He was followed-up by the "heart and lung transplantation group" of our hospital for approximately one year under non-invasive mechanical ventilatory support while on the lung transplantation waiting list. A sequential double lung transplantation was performed on April 08, 2009. He is now on his 11th month postoperatively and is healthy.Öğe The psychiatric follow-up process of a lung transplantation case [Bir akciger nakli olgusunda psikiyatrik izlem süreci](2010) Özbaran B.; Erermiş S.; Gülen F.; Midyat L.; Turhan K.; Demir E.; Yagdi T.; Tanaç R.; Özcan C.; Engin Ç.; Özbaran M.Organ transplantation practices are increasing worldwide and in our country and patient care opportunities are improving. Organ transplantation process generally includes transplant preparation, coping with disease, transplantation operation and post-transplantation period. Psychiatrists take part in the transplantation team and support the team and the patient, offer treatment if necessary. In this report the psychiatric symptoms and treatment of the first living pediatric case after double lung transplantation were reported. The fifteen years old, male case was followed since age of fourteen in Ege University Medical School Pediatrics Clinic, Respiratory System and Allergy Department with diagnoses of bronchiolitis obliterans, bronchiectasis and pulmonary hypertension and indicated double lung transplantation in year of 2008. In April 2009, the first double lung transplantation surgery in Turkey in pediatric age group was done. In 15th day after transplantation anxiety symptoms were occurred and these symptoms were limited and disappeared with brief supportive interventions. In fifth month after transplantation depressive symptoms were occurred and the case was diagnosed as depressive disorder and treated with fluoxetin 20 mg/day. Psychosocial interventions were also undertaken for his edu-education. The case is still in follow-up in Ege University Child Psychiatry Clinic, Consultation Liaison Department.
