Aybala Tongut

Introduction: Discrepancies between preoperative echocardiographic diagnosis and intraoperative surgical findings for incomplete atrioventricular septal defects are frequently encountered. We assess the frequency of diagnostic discordance and its impact, focusing on subtype-specific predictors of the postoperative course. Methods: We reviewed 172 patients post repair of incomplete atrioventricular septal defects at a single institution between November 2000–February 2025, including transitional atrioventricular septal defects ( n = 74), partial atrioventricular septal defects ( n = 71), and primum atrial septal defect with isolated left atrioventricular valve cleft ( n = 27). Preoperative echocardiographic diagnoses were compared with intraoperative surgical diagnoses to determine diagnostic discordance and assess impact. Results: Baseline characteristics were similar across subtypes. Transitional atrioventricular septal defects were associated with a higher prevalence of syndromic diagnoses (52.7% versus 33.8% versus 22.2%, p = 0.008) and greater preoperative ventricular dilation (LVIDd Z -score −0.88 versus −1.70 versus −1.70, p = 0.031). Diagnostic discordance occurred most frequently in partial atrioventricular septal defects (74.6%), followed by primum atrial septal defect with isolated left atrioventricular valve cleft (37.0%) and transitional atrioventricular septal defects (13.5%) ( p < 0.001). Transitional atrioventricular septal defect repairs were associated with longer cardiopulmonary bypass and cross-clamp times, prolonged ventilation, and longer hospital stays (all p < 0.05). Residual shunt was more frequent in transitional atrioventricular septal defects early postoperatively and at the last follow-up ( p < 0.001). One death was observed in the partial atrioventricular septal defects group, reintervention rates were similar across subtypes ( p = 0.643), and follow-up duration differed modestly between groups ( p = 0.047). Conclusion: The high rate of diagnostic discordance reflects inherent challenges in preoperative classification and suggests that a simplified, clinically oriented nomenclature may improve communication, surgical planning, and outcome prediction.

OBJECTIVES: Pulmonary atresia with ventricular septal defect (PA-VSD) without major aortopulmonary collateral arteries is a rare congenital heart defect. Surgical management strategies include staged palliation or primary neonatal repair. We evaluated the midterm outcomes of neonatal primary repair in patients without MAPCAs. METHODS: A retrospective single-center analysis was performed of 31 neonates who underwent primary repair for PA-VSD without MAPCAs between 2005 and 2024. Primary outcomes included mortality, reintervention rates, and right ventricular (RV) function. RESULTS: Thirteen patients (41.9%) underwent urgent surgery and 18 (58.1%) underwent emergent surgery. Median weight at repair was 2.8 kg (interquartile range [IQR] 2.6–3.2). Overall survival was 96.8% (n = 30), with one mortality (3.2%) related to multi-organ failure. Postoperative RV function was normal in 25 patients (80.7%). Median follow-up for hospital survivors was 5.4 years (IQR 1.2–7.6). Freedom from surgical reoperation was 56.7%; 13 patients (43.3%) required reoperation, most commonly for RV-to-pulmonary artery conduit revision (n = 11). Catheter-based reinterventions were performed in 24 patients (80.0%). RV function remained preserved in 29 patients (96.7%) at last follow-up. CONCLUSIONS: Neonatal primary repair of PA-VSD without major aortopulmonary collaterals can be performed with excellent midterm survival and preserved right ventricular function. Reintervention, largely conduit-related, represents an anticipated component of longitudinal management rather than failure of the primary strategy.

Objectives: This study compares outcomes of patch repair vs direct anastomosis in neonatal aortic arch repair with the goal of identifying any long-term differences in restenosis, reoperation, and reintervention rates. Methods: Neonates who underwent aortic arch repair via median sternotomy between 2004 and 2021, using either patch repair or direct anastomosis techniques, were included in this study. Patch materials were glutaraldehyde-treated pericardium and femoral vein homograft. Statistical comparisons included descriptive and bivariable analyses to evaluate patient characteristics, reintervention, reoperation, and restenosis at a 20 mm Hg threshold. Results: Seventy-five neonates, who underwent neonatal arch repair using patch technique (n = 53) or direct anastomosis (n = 22), were included in the study. No significant differences in reintervention, reoperation, or restenosis were found between surgical approaches at 20 mm Hg threshold (P > .13). Patient characteristics such as younger age (P = .06), shorter height (P = .1), and lower weight (P = .2), at the time of surgery were not significant predictors of restenosis. Cardiopulmonary bypass and circulatory arrest times were shorter with direct anastomosis. Ten-year mortality was 11% (n = 8). Conclusions: There is no clear advantage of either patch or direct anastomosis for neonatal aortic arch repair regarding early- to mid-term outcomes. Patient-specific factors did not appear to be stronger predictors of restenosis risk than the surgical technique employed.

Introduction: Partial anomalous pulmonary venous return (PAPVR) is a congenital heart defect frequently associated with a sinus venosus atrial septal defect (ASD). Surgical repair varies depending on the anatomical position of the anomalous pulmonary veins. This study aims to compare the outcomes of three surgical techniques - single patch, two-patch technique, and Warden procedure- used in the repair of PAPVR with sinus venosus ASD. Methods: A retrospective study was conducted, analyzing the outcomes of 87 patients who underwent surgical repair for PAPVR between January 2011 and August 2024. Patients were divided into three groups based on the surgical technique used: 44 underwent the Warden procedure, 33 were treated with the single-patch technique, and 10 received the two-patch technique. Results: No mortality was observed across all techniques. The median age at operation was 5.4 years (1.4–10.4 years), and the median hospital stay was 3.0 days (IQR 3.0–4.0). Logistic regression analysis revealed a higher likelihood of immediate postoperative complications with the Warden technique (OR: 5.00, 95% CI [1.30–19.25], p = 0.0193). No patients required a pacemaker implantation. Four patients who had a single (2) and double patch (2) technique needed a reintervention on the systemic or pulmonary venous pathway, while no patient who had a Warden procedure needed a reintervention of the venous pathways. Conclusion: Despite a higher risk of early complications, the Warden procedure seems to preserve patients from reinterventions on the systemic or pulmonary venous pathway.

Amaç: Aortopulmoner şant operasyonları, kompleks siyanotik kalp hastalıklarında pulmoner kan akımının arttırılması ve pulmoner arterlerin gelişmesi, dolayısı ile sistemik oksijen saturasyonunun iyileştirilmesini amaçlayan palyatif prosedürlerdir. Çalışmadaki amaç, palyatif aortopulmoner şant operasyonu uygulanan hastalarda preoperatif durum, operatif teknik ve yaklaşımlar ile postoperatif seyir arasındaki ilişkileri tespit etmek, mortalite ve morbiditeye etki eden risk faktörlerini araştırmak ve değerlendirmektir. Gereç ve yöntemler: Çalışmaya Kasım 1985-Ağustos 2009 tarihleri arasında İstanbul Üniversitesi Kardiyoloji Enstitüsü Kalp Damar Cerrahisi Anabilim Dalı’nda Modifiye Blalock-Taussig şant (MBTS) operasyonu uygulanan 587 olgu dahil edildi. Retrospektif olarak preoperatif ve operatif veriler kaydedilerek, hastalar patofizyolojinin tek ya da çift ventrikül tamirine uygunluğu temel alınarak (univentrikül/biventrikül) iki grupta sınıflandırıldı. Birincil sonuç olarak hastane ölümü veya iyi hal ile taburcu olma kabul edildi. Yaş grupları (neonatal, 1 ay-1 yaş ve 1 yaş üzeri) ve cerrahi yaklaşım (torakotomi, sternotomi) temel alınarak, yaklaşımlar arasındaki farkların birincil sonuç üzerine etkisi değerlendirildi. Mortalite ve morbidite üzerine etki eden risk faktörleri istatistiksel olarak araştırıldı. Bulgular: Çalışmaya katılan 364’ü erkek (%62), 223’ü kız (%38), ortalama yaşı 21,6±31,2 ay (0-240) ve ortalama kilosu 10.7±7.2 kg (2.7-54) olan 587 hastanın, 66'sı1 aylık (%11.2), 236'sı 1 ay-1 yaş (%40.2) ve 285'i 1 yaş üzeri (%48.6) grupta değerlendirilmiştir. Yüzdoksanbir hastada univentriküler (%32.5) ve 396 hastada biventriküler (%67.5) tamir planlanmış, 141 hastada median sternotomi (%24), 446 hastada torakotomi (%76) uygulanmıştır. Erken dönem mortalite oranı %11.6’dır. Şant yetmezliği açısından; yaş, tanı, ekstrakorporeal dolaşım (ECC) kullanım ihtiyacı, cerrahi yaklaşım, şant çapı anlamlı bulunmuş ve çoklu değişken lojistik regresyon analizi sonucunda cerrahi yaklaşım bağımsız risk faktörü olarak saptanmıştır (p=0.002). Mortalite açısından anlamlı bulunan yaş, şant çapı ve cerrahi yaklaşım arasında lojistik regresyon analizi ile sternotomi (p=0.0001) ve 1 ay-1 yas arası grup (p=0,008) bağımsız risk faktörü olarak izlenmiştir. Sonuç: Halen özellikle kompleks konjenital kalp hastalıklarında palyatif cerrahinin altenatif yaklaşımlarının azlığı sebebi ile kalp cerrahisindeki yerini koruyacağı görülmektedir. Günümüzde MBTS prosedürü için cerrahi yaklaşımlar ve yoğun bakım takip protokollerinde geniş bir bilgi birikimi ve deneyim edinilmiş olsa bile, bu hasta grubunda mortalite ve morbiditeye etkili risk faktörlerini uzun dönem sonuçları ile araştıran prospektif çalışmalara ihtiyaç vardır.

Introduction: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare but fatal disease. Untreated cases have a first-year mortality rate of 90%. We aimed to evaluate the early outcomes of patients who were operated on for ALCAPA in our clinic. Patients and Methods: We retrospectively reviewed the cases of seven patients who were operated on in our clinic for ALCAPA between 2013 and 2019. Preoperative, early postoperative, and first year echocardiography results were compared. Results: Five patients (71.4%) underwent reimplantation and two patients (28.6%) underwent Takeuchi repair. The median age was 25 months and 71.4% (n= 5) of the patients were aged ≤1 year. In preoperative echocardiograms, mean ejection fraction (EF) was 32.1 ± 4.9% and mean preoperative MR grade was 2.1 ± 0.7. Two patients with severe MR (grade 3) underwent simultaneous mitral annuloplasty. The mean EF % significantly increased (p= 0.023) and the mean MR grade significantly decreased (p= 0.039, p< 0.05) in the early postoperative period. This finding was not statistically associated with surgical technique or age. The mortality rate was 14.3% (n= 1). The patient who died had severe preoperative LV dysfunction and MR, which did not improve after surgical intervention. Conclusion: Early improvement in LV function and MR grade after ALCAPA repair is crucial for survival regardless of age. Moderate or mild functional MR may spontaneously improve after the surgical correction of LV dysfunction. Simultaneous mitral valve intervention is needed in cases of severe MR and patients aged ≥1 year.

Introduction: Surgical correction of transposition of the great arteries (TGA) is usually performed in the first week of life. There is no consensus on surgical intervention for patients with a late diagnosis. Our study was designed to evaluate the early results of patients who underwent late-term correction based on surgical techniques. Patients and Methods: Our study included patients older than a month, who were operated on due to TGA between 2014 and 2019. Data on the postoperative hospital mortality and morbidity of these patients were examined. Results: The study enrolled 11 patients. Arterial switch operation (ASO) was performed in 36.3% (n= 4) of the patients, while an atrial switch operation was performed in 63.7%. After left ventricular (LV) training, ASO was performed in 25% (n= 1) of the patients. Extracorporeal membrane oxygenation (ECMO) support requirement was present in 36.4% (n= 4) of the patients due to postoperative low cardiac output. The mortality rate was 27.3% (n= 3). Of these deaths, 33.3% occurred among patients who had undergone Senning operations, while 66.7% occurred among those who underwent ASO (n= 1). While 66.7% (n= 2) of the mortality was due to low cardiac output, 33.4% was due to sepsis (n= 1). Conclusion: There is still no absolute consensus on the timing of surgical intervention in cases of TGA. ASO can be performed in cases with an increased need for ECMO and acceptable mortality among patients over one month of age. For patients with LV regression, two-stage ASO and atrial switch operations are alternative options.

Stenting of the ductus arteriosus is part of the hybrid treatment of high-risk patients with hypoplastic left heart syndrome. Dislodgement of a ductal stent is a rare complication. We present challenges faced in successful surgical retrieval of a dislodged ductal stent in a high-risk infant undergoing hybrid palliation for hypoplastic left heart syndrome.