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Öğe Arrhythmia during diagnostic cardiac catheterization in pediatric patients with congenital heart disease(Ali Cangül, 2018) Kasar, Taner; Cansaran Tanıdır, İbrahim; Öztürk, Erkut; Gökalp, Selman; Tunca Şahin, Gülhan; Topkarcı, Mehmet Akın; Ergül, Yakup; Güzeltaş, AlperObjective: Diagnostic and interventional cardiac catheterization procedures for congenital heart diseases (CHD) are becoming increasingly more popular, and arrhythmia is a well-known complication. This study was an evaluation of the incidence and causative agents of arrhythmia and the subsequent treatment strategies applied during cardiac catheterization. Methods: The catheterization data of all of the patients who underwent diagnostic cardiac catheterization for CHD between January 2012 and 2018 at a single center were examined retrospectively. Results: A total of 1316 children underwent diagnostic cardiac catheterization due to CHD. The median age and body weight was 18 months (6 days-21 years) and 9.9 kg (2.2–135 kg), respectively. Patients with ventricular septal defect (281 patients) and those with tetralogy of Fallot (257 patients) represented 2 major groups of the study population. In 93 (7%) patients, arrhythmia developed during cardiac catheterization. Among them, there were 58 (62%) cases of bradyarrhythmia and 35 (38%) cases of tachyarrhythmia. Arrhythmia was classified as low, high, or major, according to the adverse event severity score; the rates were 2.7%, 4.3%, and 1.2%, respectively. In 36 (39%) patients, there was no need for therapy, whereas 57 (61%) required treatment to eliminate the arrhythmia. Treatment modalities included catheter manipulation in 15, pharmacological therapy in 24, and cardioversion in 3 patients. Eleven patients required cardiopulmonary resuscitation. Temporary pacemaker implantation was required in 2 patients, while 2 others underwent permanent pacemaker implantation secondary to catheterization-related arrhythmia. There were no cases of mortality secondary to catheterization-related arrhythmia. Conclusion: Diagnostic cardiac catheterization in CHD may result in various types of cardiac arrhythmias. The proper management of arrhythmias may reduce morbidity and mortality related to cardiac catheterization.Öğe Examining the Correlation Between the GOSE Index and Atrial Arrhythmia Development with Electrocardiographic P-wave Properties in Patients with Ebstein’s Anomaly(Kartal Koşuyolu Yüksek İhtisas EAH, 2019) Kasar, Taner; Tanıdır, Cansaran; Ayyıldız, Pelin; Öztürk, Erkut; Ergül, Yakup; Güzeltaş, AlperIntroduction: Ebstein’s anomaly (EA) is a congenital malformation of the tricuspid valve. In the present study, the aim was to examine the relationship between the Great Ormond Street Score (GOSE) index and P-wave characteristics in patients with EA. Patients and Methods: Unoperated patients with EA were evaluated retrospectively. Echocardiographic GOSE indices were calculated for each patient. The P-wave characteristics on the 12-channel electrocardiography (ECG) were also evaluated simultaneously. Results: There were EA 24 cases in the study. The median age was 12 months (range, 1 day-8 years). The median P-wave dispersion was 18 msn (range, 8-36 msn), median P-max duration was 86 msn (range, 58-104 msn), median P-min duration was 62 ms (range, 18-88 msn), and median P amplitude was 2.7 mm (range, 1.2-5 mm). Atrial arrhythmia was detected in eight cases. In the arrhythmia group, the P dispersion and P-max duration were significantly higher than in the non-arrhythmic group (p< 0.05). The median GOSE index was measured as 0.62 (range, 0.2-1.3). The GOSE index grade was detected as Grade 1 in 8 cases, Grade 2 in 12 cases, and Grade 3 in 4 cases. When the patients’ GOSE index and P-wave characteristics were evaluated, a positive correlation was found between the P-max (r= 0.5, p= 0.02) and P amplitude (r= 0.780, p= 0.001). There was no significant correlation between the P dispersion and P-min durations (p> 0.05). Conclusion: In EA cases, the GOSE index can be estimated, especially by evaluating the P-wave maximum duration and amplitude. Thus, clinicians may have an idea about the prognosis of cases with EA by evaluating the P-wave changes in ECG and especially the development of supraventricular arrhythmia.Öğe Konjenital Kalp Cerrahisi Operasyonu Sonrası Uzamış Mekanik Ventilasyona Sebep Olan Hipotiroidizm(İstanbul Gelişim Üniversitesi Yayınları / Istanbul Gelisim University Press, 2017-12-30) Öztürk, Erkut; Tanıdır, İbrahim Cansaran; Ergül, Yakup; Güzeltaş, AlperAmaç: Bu çalışmada pediatrik kardiyak operasyon sonrası uzamış mekanik ventilasyon desteği gereksinimi olan olgularda hipotiroidizmin insidansı ve olası etkileri değerlendirilmiştir. Yöntem: Çalışmaya 1 Eylül 2014 - 1 Eylül 2015 tarihleri arasında pediatrik kardiyak cerrahi yoğun bakım ünitesinde yatan, potoperatif dönemde uzamış mekanik ventilatör gereksinimi (> 7 gün) gelişen ve neden olarak hipotiroidi saptanmış olgular alındı. Olguların demografik verileri, kardiyak tanıları ve ek patolojileri belirlendi. Bulgular: Bu dönemde 430 pediatrik kalp cerrahisi operasyonu yapılmış ve 6 olguda (%1,4) hipotiriodizm saptanmıştır. Dört olgu kız (%66) idi. Olguların ortalama yaş 4,8 ±4,1 (aralık 1-12) ay, ortalama ağırlık 5,6±2,4(3-9) kg idi. Olguların 3’ü komplet atrioventriküler septal defekt, 1’i ventriküler septal defekt, 1’i büyük arterlerin transpozisyonu ve 1’i hipoplastik sol kalp sendromu tanılıydı. Üç olguda ayrıca genetik olarak Down Sendromu mevcuttu. Tüm olgularda TSH > 50 µIU/ml iken dört olguda TSH > 100 µIU/ml ve tüm olgularda fT4 < 0,3 ng/dl idi. Oral L-thyroxine 10 µg/kg/gün tedavisi sonrası ortalama 8 gün (4-12 gün) sonra TSH ve fT4 normal düzeye gelmişti. Olguların 5’i (%83) L-thyroxine tedavisi sonrası ortalama 4 gün sonra ekstübe edilip taburcu edildi. Hipoplastik sol kalp sendromlu olgu tedaviye rağmen ekstübe edilemedi ve sepsis nedeniyle kaybedildi. Sonuç: Kardiyak cerrahi sonrası pediatrik olgulardaki uzamış entübasyon durumunda tedavi edilebilen bir durum olan hipotiroidizm varlığı araştırılmalıdır.Öğe The role of intraoperative epicardial echocardiography in pediatric cardiac surgery(WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ, 2018) Öztürk, Erkut; Cansaran Tanıdır, İbrahim; Ayyıldız, Pelin; Gökalp, Selman; Candaş Kafalı, Hasan; Şahin, Murat; Ergül, Yakup; Haydin, Sertaç; Güzeltaş, AlperAim: Our aim was to evaluate the findings and the role of intraoperative epicardial echocardiography (IEE) in the management of pediatric cardiac surgery patients. Methods: Patients evaluated with IEE between December 2015 and December 2017 were analyzed retrospectively. Demographic data, preoperative transthoracic echocardiography (TTE), and IEE reports were evaluated. Results: A total of 410 patients evaluated by IEE were included in the study. Of these, 52% were women, and 48% were men. The median age was 8.5 months (range: 1 month–7 years), and median body weight was 7.1 kg (range: 3.3–61 kg). The most common diagnoses were tetralogy of Fallot (TOF; n = 148), ventricular septal defect (VSD; n = 117), atrial septal defect (ASD; n = 57), and complete atrioventricular septal defect (AVSD; n = 48). There were minor residual lesions not requiring reestablishment of cardiopulmonary bypass (CPB) in 16.6% (n = 68), while major residual lesions requiring return to CPB were determined in 5.1% (n = 21). Major residual lesions were detected in 7 patients with TOF (4 severe right ventricular outflow tract obstructions, 2 pulmonary artery stenosis, 1 residual VSD shunt), 6 patients with VSD (hemodynamically significant residual shunts), and 5 patients with complete AVSD (3 left atrioventricular valve regurgitations, 1 right atrioventricular valve regurgitation, 1 left ventricular outflow tract obstruction). Transient bradycardia was observed in 5 patients. Conclusion: Intraoperative epicardial echocardiography provides good guidance during congenital heart surgery. IEE helps to clarify the surgical planning and decreases morbidity and mortality due to unnecessary invasive procedures, especially for pathologies involving the pulmonary artery and its branches, as well as for apical ventricular septal defects.
