Serife Ozalp

Background: Double-outlet right ventricle is a complex congenital cardiac anomaly in which both great arteries arise predominantly from the right ventricle. Accurate anatomical evaluation is critical for surgical planning. While transthoracic echocardiography is commonly used for intracardiac assessment, its limitations in visualising extracardiac structures highlight the need for additional imaging modalities like CT angiography. Objective: To compare the diagnostic accuracy and clinical utility of transthoracic echocardiography and CT angiography in the pre-operative evaluation and surgical planning of infants with double-outlet right ventricle. Methods: This retrospective, single-centre study included 78 infants diagnosed with double-outlet right ventricle. All patients underwent both transthoracic echocardiography and CT angiography before surgical intervention. Imaging findings were compared with intraoperative surgical results to assess sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for each modality. Results: CT angiography was significantly more effective than transthoracic echocardiography in identifying extracardiac anomalies such as coronary artery anomalies ( p = 0.014), aortic arch hypoplasia ( p = 0.024), aortopulmonary collateral vessels ( p = 0.039), anomalous pulmonary venous connections ( p = 0.001), and persistent left superior vena cava ( p = 0.001). In contrast, transthoracic echocardiography was more sensitive in detecting small ventricular septal defects ( p = 0.035). Conclusion: Transthoracic echocardiography remains the first-line modality for intracardiac evaluation in double-outlet right ventricle, but CT angiography provides superior visualisation of extracardiac structures. The combined use of both imaging techniques improves diagnostic accuracy and surgical planning, supporting better outcomes in the management of CHD.

Objectives: The objective of this study was to evaluate the impact of combining near-infrared spectroscopy (NIRS) and bispectral index (BIS) for monitoring cerebral oxygenation and detecting ischemia during pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods: A prospective, single-center study was conducted between March 01, 2024, and July 01, 2024, involving 50 pediatric patients undergoing congenital heart surgery. Cerebral oxygenation was continuously monitored using NIRS and BIS at 6 time points during surgery: T1 (entry), T2 (immediately after CPB initiation), T3 (deepest hypothermic temperature), T4 (post-rewarming), T5 (end of surgery), and T6 (postoperative intensive care unit [ICU]). Central venous saturation, hematocrit (Htc), temperature, mean arterial pressure (MAP), and lactate levels were also monitored. The primary outcomes included correlations between cerebral oxygenation parameters and neurological outcomes within 3 months. Results: The study was conducted with a total of 50 children cases, of which 56% (n=28) were male, and 44% (n=22) were female. The age of the cases ranged from 6 to 200 months, with a mean 42.4±52.7 months. Weight measurements ranged from 14.2 to 65 kg, with a mean of 16.3±14.3 kg. The average CPB duration was 96.1±34.8 min. The cases had an average ICU stay of 3.2±2 days. Upon reviewing the final status, it was found that there were no mortality among the patients and only three patients experienced transient neurological complications, which resolved without long-term deficits. NIRS values remained stable between 55% and 65% during surgery. BIS monitoring detected no significant decreases, supporting the absence of severe ischemia. Conclusion: Combining NIRS and BIS in pediatric cardiac surgery enhances cerebral perfusion monitoring and enables early detection of ischemic events, potentially reducing postoperative neurological complications. Larger studies are needed to validate these findings and further assess the role of intraoperative parameters such as Htc and MAP in preventing cerebral ischemia.

Background: Down syndrome (DS) is associated with unique anatomical and physiological characteristics that complicate the perioperative management of infants undergoing cardiac surgery. While ventricular septal defect (VSD) repair is commonly performed in this population, detailed data comparing perioperative outcomes in DS versus non-syndromic infants remain limited. Methods: This retrospective matched study analysed 100 infants (50 with DS and 50 without DS) who underwent isolated VSD closure between January 2021 and January 2025. Patients were matched by age and surgical date. Intraoperative anesthetic management, complications, postoperative outcomes, and mortality were compared between groups. Results: DS patients had lower age, weight, and height at surgery. They required significantly smaller endotracheal tube sizes, more intubation and vascular access attempts. The DS group had significantly lower rates of extubation in the operating room and experienced longer durations of mechanical ventilation and ICU stay. However, no significant differences were observed in total hospital stay or mortality between groups. Conclusions: Although DS infants present with increased anesthetic complexity and respiratory challenges, they do not exhibit higher surgical mortality following isolated VSD closure. Tailored perioperative strategies may improve respiratory outcomes in this high-risk group.

Objectives: An effective and harmless analgesic method for postoperative pain management in abdominal surgery remains undefined. Although intrathecal morphine(ITM) and four-quadrant transversus abdominis plane blocks(four-quadrant TAPB) are frequently preferred for postoperative analgesia, their effectiveness is still controversial. The aim of this study was to evaluate the efficacy of 4 quadrant TAPB with ITM in postoperative analgesia in gynaecological cancer surgeries. Methods: In this study, we retrospectively compared the effectiveness of intrathecal morphine and four-quadrant transversus abdominis plane blocks for postoperative analgesia in patients undergoing clossed or open major gynecologic cancer surgery. Results: We retrospectively evaluated a total of 65 patients operated on for gynecologic cancer. In terms of perioperative analgesic methods, 46% of these patients received ITM and 54% received four-quadrant TAPB. Demographic data, American Society of Anaesthesiology (ASA) clinical classification, operation time and length of hospital stay were similar. Postoperative 1- and 24-hour numeric rating scale (NRS) scores and opioid consumption were lower in the ITM group (p< 0.05). When the patient population was evaluated laparotomically and laparoscopically, it was found that the postoperative 1- and 24-hour NRS values, postoperative 24-hour opioid consumption levels and opioid demand levels in laparoscopic cases were lower in the ITM group (p< 0.05). Postoperative adverse effects and complications were similar in both groups. Conclusion: It was found that in gynecologic cancer surgery, intrathecal morphine was more effective in postoperative pain management and reduced the need for postoperative opioids compared to four-quadrant transversus abdominis plane blocks.

Background: Neonatal cardiac surgery is crucial for addressing congenital heart anomalies yet poses a risk of notable perioperative electrolyte disturbances. Imbalances resulting from blood loss, fluid shifts, and surgical effects can negatively impact patients, leading to issues such as acute kidney injury (AKI), arrhythmias, and elevated mortality rates. Objectives: The objective of this research is to assess the prevalence and outcomes of electrolyte imbalances during the perioperative, intraoperative, and postoperative phases on morbidity and mortality in neonates undergoing cardiac surgery. Methods: This study, conducted as a retrospective, single-center analysis, encompassed 355 neonatal patients who underwent cardiac surgery at a tertiary city hospital from January 2021 to January 2024. The study involved neonates under one month old diagnosed with congenital heart disease who underwent cardiac surgery within this timeframe. Electrolyte levels (sodium, potassium, calcium, chloride) were documented preoperatively, intraoperatively, and postoperatively, along with clinical outcomes such as AKI, arrhythmias, seizures, intensive care unit (ICU) length of stay, and mortality. Statistical analyses, both descriptive and inferential, were conducted to examine the connections between electrolyte imbalances and clinical outcomes, using logistic regression. Results: Notable correlations were identified between preoperative hyponatremia, hypocalcemia, hypochloremia, and the onset of AKI. The presence of arrhythmias was connected to preoperative hypocalcemia and postoperative hypernatremia and hyperchloremia. No significant relationship was found between any electrolyte imbalance and seizures. Mortality showed a significant association with preoperative hyponatremia, hypocalcemia, and hypochloremia, as well as postoperative hypernatremia and hyperchloremia. Conclusions: Perioperative electrolyte imbalances are commonly observed in neonates undergoing cardiac surgery and have a strong association with negative outcomes. Managing these imbalances proactively may result in a decrease in complications, notably AKI and arrhythmias, and an enhancement in survival rates.

Background: This study aimed to investigate the effect of operative and postoperative parameters on late-onset hyperlactatemia (LOHL) after cardiac surgery in the pediatric patient population. Methods: One hundred fifty-nine ventricular septal defect patients (77 males, 82 females; mean age: 8.0±8.6 years; range, 1 to 48 years) were retrospectively examined between August 2020 and February 2023. Patients with the highest lactate value measured between 6 to 12 h postoperatively Results: Cardiopulmonary bypass (CPB) time, aortic cross-clamp time, and CPB flow did not differ between groups (p=0.916, p=0.729, and p=0.699, respectively). The difference between partial oxygen pressure (PaO ₂ ) in the first blood gas obtained after CPB was statistically significant (p=0.017). The lactate level measured in the first arterial blood gas obtained after CPB was 1.74±0.61 mmol/L in Group 1 and 3.01±1.63 mmol/L in Group 2 (p2 in the arterial blood gas measured at 6 h postoperatively was 129.22±61.20 mmHg in Group 1 and 156.07±64.49 mmHg in Group 2 (p=0.046). Conclusion: The development of hyperlactatemia due to ischemia in the early post-CPB period may affect the development of LOHL. Microcirculatory changes at the tissue level may play a role in the etiology of LOHL.

Introduction and Aim: Gastrointestinal bleeding is a potential complication in paediatric patients undergoing cardiopulmonary bypass, as it develops secondary to low gastrointestinal perfusion. This study aimed to examine the incidence of gastrointestinal bleeding and identify its risk factors in these patients.Method: This retrospective study was undertaken to examine the demographic features, clinical findings, and operative data of paediatric patients under years old who had undergone congenital heart surgery with cardiopulmonary bypass between November 1, 2021, and November 1, 2023. The study aimed to investigate the incidence of gastrointestinal bleeding associated with cardiopulmonary bypass and to identify potential risk factors for gastrointestinal bleeding. The obtained results were statistically evaluated.Results: The study period included 1100 patients who underwent congenital heart surgery with cardiopulmonary bypass. Fifty-two percent of the total participants were male. The median weight of the patients was 4.4 kg, with an interquartile range of 3.5–5.8 kg. The patients were categorised by age, revealing that 62% were newborns, 24% were infants, and 14% were children. Forty-four (4.2%) of the total number of patients experienced gastrointestinal bleeding. Newborns had a significantly higher incidence of bleeding (6% or 34 patients) compared to infants (3% or 8 patients) and children (1.5% or 2 patients) (p < 0.05). Patients who experienced gastrointestinal bleeding had a longer median hospital stay of 24 days compared to those who did not, with a median hospital stay of 14 days. Moreover, patients who suffered from bleeding had a significantly higher mortality rate (30%) in comparison to those who did not (9.9%) (p < 0.05). The incidence of gastrointestinal bleeding was found to be associated with several risk factors, such as low operative age and weight, high surgical score, presence of low cardiac output syndrome, extracorporeal membrane oxygenation (ECMO) usage, high lactate levels, and low platelet count.Conclusion: Gastrointestinal bleeding is a potential complication for patients who undergo cardiopulmonary bypass. It is particularly relevant for newborns who have undergone prolonged surgery, have a high surgical complexity score, exhibit high lactate levels, display low cardiac output, utilise ECMO, and possess low platelet counts. In such cases, there may be a heightened incidence of gastrointestinal bleeding. It is important to consider this possibility in order to ensure the best possible patient outcomes.

In the low-weight newborn patient group, the development of catheter related bloodstream infections after cardiac surgery significantly impacts morbidity and mortality. In our study, the effects of choosing femoral or internal jugular vein localization in newborns on postoperative infection will be examined. Our hypothesis is that there may be a higher risk of catheter related bloodstream infections in the femoral region. This study was conducted retrospectively on newborn cases who underwent congenital heart surgery between September 1, 2020, and March 1, 2022. The cases were divided into 2 groups: those with central catheters inserted in the femoral and in internal jugular veins. Postoperative infection parameters were examined and the results were statistically evaluated. The study was conducted with a total of 201 newborn cases, of which 61.2% (n = 123) were male and 38.8% (n = 78) were female. The age of the cases ranged from 0 to 1 month, with a mean of 12 ± 9 days. Weight measurements ranged from 1.8 to 5.5 kg, with a mean of 3.20 ± 0.66 kg. Central catheters were placed in the femoral vein (FV) region in 71.6% of the babies (n = 144) and in the internal jugular vein region in 28.4% (n = 57). When culture results were examined between postoperative days 3 to 14, blood culture tests were positive in 12.4% (n = 25). The most common bacteria in positive cases were Klebsiella spp. (n = 13) and methicillin-resistant Staphylococcus aureus (n = 5). There was no statistically significant difference in blood culture results between the groups (P > .05). Changes in white blood cells, C-reactive protein, and procalcitonin measurements between preoperative and postoperative day 3 did not show statistically significant difference between the groups (P > .05). According to the results of our study, the placement of FV and internal jugular vein in neonates undergoing cardiac surgery did not differ in terms of postoperative infection risk. With appropriate sterilization, preventive measures and care considerations, FV or internal jugular vein region may be preferred based on the practitioner’s expertise and choice in this patient group.