Browsing by Author "Gokdemir, Mahmut"

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Comparison of Surgical Techniques Used in Ventricular Septal Defect Closure
(2023) Celik, Mehmet; Aygun, Fatih; Gunaydin, Asim Cagri; Gokdemir, Mahmut; Cindik, Nimet; 0000-0002-5018-0068; 36592069; AAT-2031-2021
Introduction: We compared transatrial closure, tricuspid valve septal detachment, and tricuspid valve chordal detachment techniques for ventricular septal defect (VSD) closure. Methods: Patients who had VSD closure with three different techniques in our clinic between September 2016 and December 2020 were retrospectively reviewed. A total of 117 patients were included in the study. The patients were divided into three groups: group 1, classical transatrial closure; group 2, closure with tricuspid valve septal detachment; and group 3, closure with tricuspid valve chordal detachment. The groups were evaluated by serial transthoracic echocardiography (preoperative, postoperative 1st day, postoperative 1st month). Cardiac rhythm checks and recordings were performed. Results: No residual VSD was observed in early or late periods in any of the groups whose VSD closure was performed with the three different techniques. No severe tricuspid regurgitation (TR) was detected during the early and late postoperative periods of all operating procedures. When the groups were compared in terms of early/late TR after the operation (without TR+trace amount of TR and mild TR+moderate TR were compared), no statistically significant difference was found (P>0,05; P=0,969 and P>0,05; P=0,502). Conclusion: In this study, we found no statistically significant difference between three VSD closure techniques in terms of early TR, late TR, residual VSD, and permanent atrioventricular complete block during postoperative period. We hope that our results will be supported by the results of researches that are being made about this subject in large series.
Familial 22q11.2 deletion syndrome with autosomal dominant inheritance
(2016) Gokturk, Bahar; Gokdemir, Mahmut; Reisli, Ismail; Yildirim, Mahmut Selman
22q11.2 deletion syndrome is the most frequent microdeletion syndrome in humans and caused by hemizygote deletion on only one chromosome. Most of probands have a de novo deletion of 22q11.2, but 8-20% have inherited the 22q11.2 deletion from a parent (autosomal dominant mutation). Genotype-phenotype correlation is weak in this patient group. We aimed to present three members in the same family due to an autosomal dominant inheritance with 22q11.2 deletion and different clinical findings.
Fetal rhabdomyoma with maternal tuberous sclerosis that almost completely filled the left ventricle at an early gestational week
(2021) Colak, Eser; Ozcimen, Emel Ebru; Gokmen, Zeynel; Gokdemir, Mahmut; 0000-0002-2746-0547; 0000-0002-5676-2747; 34013241; AAJ-8069-2021; N-4174-2014
Hybrid approach: an alternative prior to corrective surgery in a patient with arch hypoplasia and complete atrioventricular septal defect
(2018) Celik, Mehmet; Gokdemir, Mahmut; Cindik, Nimet; Ozkan, Murat; 32082782
The hybrid approach is mostly preferred in patients with hypoplastic left heart syndrome or univentricular physiology. Here, the hybrid approach is applied as a palliative procedure prior to corrective surgery in a patient with complete atrioventricular septal defect associated with arcus hypoplasia and results are discussed according to the literature.
Inferior Vena Cava Oxygen Saturation during the First Three Postnatal Days in Preterm Newborns with and without Patent Ductus Arteriosus
(2014) Yapakci, Ece; Ecevit, Ayse; Ince, Deniz Anuk; Gokdemir, Mahmut; Tekindal, M. Agah; Gulcan, Hande; Tarcan, Aylin; 25337418
Background: Inferior vena cava (IVC) oxygen saturation as an indicator of mixed venous oxygenation may be valuable for understanding postnatal adaptations in newborn infants. It is unknown how this parameter progresses in critically ill premature infants. Aims: To investigate IVC oxygen saturation during the first three days of life in preterm infants with and without patent ductus arteriosus (PDA). Study Design: Case-control study. Methods: Twenty-seven preterm infants were admitted to the Neonatal Intensive Care. Preterm infants with umbilical venous catheterization were included in the study. Six umbilical venous blood gas values were obtained from each infant during the first 72 hours of life. Preterm infants in the study were divided into two groups. Haemodynamically significant PDA was diagnosed by echocardiography in 11 (41%) infants before the 72nd hour of life in the study group and ibuprofen treatment was started, whereas 16 (59%) infants who didn't have haemodynamically significant PDA were included in the control group. Results: In the entire group, the highest value of mean IVC oxygen saturation was 79.9% at the first measurement and the lowest was 64.8% at the 72nd hour. Inferior vena cava oxygen saturations were significantly different between the study and control groups. Posthoc analysis revealed that the first and 36th hour measurements made the difference (p=0.01). Conclusion: Inferior vena cava oxygen saturation was found to be significantly different between preterm infants with and without PDA. Further studies are needed to understand the effect of foetal shunts on venous oxygenation during postnatal adaptation in newborn infants.
Management of pediatric cardiac transplantation candidates with pulmonary hypertension and high pulmonary vascular resistance
(2020) Yakut, Kahraman; Varan, Birgul; Erdogan, Ilkay; Cindik, Nimet; Gokdemir, Mahmut; Gumus, Ayten; Tokel, N. Kursad; Sezgin, Atilla; 0000-0002-6759-1795; 32558420
Background and objectives. Right ventricular failure is an important cause of mortality and morbidity after orthotopic heart transplantation (OHT). The right ventricle of the donor may fail to accommodate to the high pulmonary vascular resistance (PVR) of the recipient. Pulmonary hypertension (PH) due to chronic heart failure with PVRi > 4 Wood units.m(2), transpulmonary gradient > 15 mmHg adversely affect the outcome of OHT. In this study we aimed to evaluate management strategies in our pediatric cardiac transplantation candidates with PH and high PVR prior to OHT. Method. Twenty-six cardiac transplantation candidates (age: 10.2 +/- 4.6, 1-17 years) underwent cardiac catheterization for the determination of PVR and pulmonary arterial pressure. They were admitted to the hospital and received 1-3 days of intravenous (IV) vasodilator therapy; 0.5-3 mu g/kg/min nitroglyserin and/or 0.5-3 mu g/kg/min nitroprusside, 5-15 mu g/kg/min dobutamin and/or dopamin to keep systolic blood pressure above 80 mmHg. Results. Thirteen patients had dilated cardiomyopathy (CMP), 11 had restrictive CMP, one had hypertrophic CMP and one had congenital heart disease (CHD). Nineteen of the 26 patients underwent OHT. Mean pulmonary arterial pressure of the patients ranged between 11 and 82 mmHg (30.4 +/- 16 mmHg) and PVRi between 0.41-21.4 Wood units.m(2) (5.3 +/- 5.7). Nine patients had PVRi above 4 Wood units.m(2). Six of these patients had IV treatment for longer than three days and some received specific anti-PH treatment. Eventually they underwent a pulmonary vasoreactivity test with IV iloprost and six had PVRi <4 Wood units.m(2). Five of them underwent OHT. Conclusion. Cardiac transplantation candidates with PH and high PVR should be evaluated after conditioning with vasodilator and inotropic treatment. Specific treatment for PH and vasoreactivity testing may help selected patients reenter the transplantation list.
New Approach in Stage 1 Surgery for Hypoplastic Left Heart Syndrome: Preliminary Outcomes
(2023) Celik, Mehmet; Gokdemir, Mahmut; Cindik, Nimet; Gunaydin, Asim C.; Aygun, Fatih; Ozkan, Murat; 0000-0002-5018-0068; 0000-0002-5676-2747; 36004405; AAT-2031-2021; N-4174-2014
Objectives: We present the short-term results of an alternative method in stage 1 surgery for hypoplastic left heart syndrome. Methods: Data of 16 consecutive patients who were treated with the novel method in our clinic between February 2019 and March 2021 were analysed retrospectively. Preoperative data and postoperative follow-up were recorded. Results: Of the 16 operated patients, 12 were diagnosed with hypoplastic left heart syndrome, while four were diagnosed with hypoplastic left heart syndrome variants. Seven patients died during early postoperative period. One patient died at home waiting stage 2 surgery. Three patient underwent stage 2 surgery. Pulmonary artery reconstruction was performed in one patient due to left pulmonary artery distortion. Conclusions: We believe that our method can be an effective alternative in the surgery of hypoplastic left heart syndrome and its variants. It is hoped that with increasing number of studies and more experience better outcome will be achieved.
A Pulmonary Artery Sling and In Vitro Fertilization
(2017) Silahli, Musa; Ozkiraz, Servet; Gokdemir, Mahmut; Cifci, Bilal E.; Gokmen, Zeynel; 0000-0002-2746-0547; 0000-0002-5676-2747; 0000-0003-0944-7178; 27984391; AAJ-8069-2021; N-4174-2014; AAB-5059-2022; AAX-9343-2021
A Rare Case of Ectopia Cordis with Double Outlet Right Ventricle
(2019) Silahlı, Musa; Gokmen, Zeynel; Gokdemir, Mahmut; 0000-0003-0944-7178
Ectopiacordis is a rare anomaly. It is described that hearth is placed as partially or totally outside of thoracic cavity. Sometimes this can be accompanied liver and other organs such as intestine. Congenital heart defects are also likely to accompany to this situation. So, we present an ectopiacordis with double outlet right ventricule case who has lived for 121 days in neonatal intensive care unit.
The Relationship Between Placental Transfusion, and Thymic Size and Neonatal Morbidities in Premature Infants - A Randomized Control Tiral
(2018) Silahli, Musa; Duman, Enes; Gokmen, Zeynel; Toprak, Erzat; Gokdemir, Mahmut; Ecevit, Ayse; 0000-0002-2746-0547; 0000-0002-2877-1232; 0000-0002-5676-2747; 0000-0002-2232-8117; 30410129; AAX-9343-2021; AAJ-8069-2021; ABI-5902-2020; N-4174-2014; AAJ-4616-2021
Objectives: To compare the effect of umbilical cord milking and early cord clamping on thymic size, and neonatal mortality and morbidity in preterm infants. Methods: This single-center, prospective, double-blind, randomised controlled study was conducted at Baskent University, Konya Education and Research Centre, Konya, Turkey, between October 2015 and April 2016. Pregnant women who delivered before 32 weeks of gestation were randomised to receive umbilical cord milking (group 1) or early cord clamping (group 2). Ultrasonographic evaluation was performed in each newborn by an experienced radiologist within the first 24 hours of life. Thymic size was estimated in line with literature. SPSS 15 was used for all data analyses. Results: There were 38 subjects in group 1 and 37 in group 2. There were as many infants in the two groups (p>0.05) The haemoglobin levels was higher in group 1, but not significantly (p=0.213). The absolute neutrophil count in group 1 was significantly lower (p=0.017) than group 2. In terms of neonatal mortaility and morbidity, there were no significant differences between the groups (p>0.05). Conclusion: Umbilical cord milking was not associated with thymic size during the the first 24h of life.
Risk factors and frequency of acute and permanent femoral arterial occlusion in neonates with CHD who undergo ultrasound-guided femoral arterial access
(2023) Gokdemir, Mahmut; Cindik, Nimet; 0000-0002-5676-2747; 36062562; N-4174-2014
Objective: We investigated frequency and risk factors of acute loss of the arterial pulse and permanent femoral arterial occlusion in neonates with CHD who underwent ultrasound-guided femoral arterial access. Methods: We divided the patients into groups according to the presence of acute loss of the arterial pulse and permanent femoral arterial occlusion. We obtained data related to patient characteristics and access variables of ultrasound-guided femoral arterial access from our database of cardiac catheterisation between August, 2017 and May, 2021. We used an echocardiography-S6, 12-MHz linear probe, 21-gauge needle, 0.018"guidewire, and a 4F sheath for arterial access. Results: Ultrasound-guided femoral arterial access was obtained in 323 (98.8%) of the 327 neonates. We identified acute loss of the arterial pulse in 130 (40.2%) patients and permanent femoral arterial occlusion in 19 (5.9%) patients. Median weight was 3.05 (Interquartile range (IQR): 2.80-3.40) kg, first attempt success rate was 88.2%, and median access time was 46 sec (IQR: 23-94). Logistic regression analysis identified coarctation of the aorta (odds ratio: 2.46; 95% CI: 1.30-4.66; p = 0.006) as independent risk factor for acute loss of the arterial pulse, but did not identify any independent risk factors for permanent femoral arterial occlusion. Conclusions: This study showed coarctation of the aorta as an independent risk factor for acute loss of the arterial pulse, but did not identify any independent factors for permanent femoral arterial occlusion in neonates with CHD. Although most cases of acute loss of the arterial pulse resolve in the early period, the frequency of permanent femoral arterial occlusion remains high despite effective treatment.
Risk Factors for and Incidence of Hospital-Acquired Infections After Cardiac Surgery in Children with Congenital Heart Disease: A Single Center Experience
(2023) Cindik, Nimet; Gokdemir, Mahmut; Celik, Mehmet; Gunaydin, Asim Cagri; 0000-0001-8544-0125; 37853968; AAD-9425-2021
Background. The epidemiology of hospital-acquired infections (HAIs) has been less well studied in critically ill children in pediatric cardiothoracic intensive care units. This study aimed to investigate independent risk factors for and incidence of HAIs after cardiac surgery in children with congenital heart disease (CHD).Methods. Our study included 574 patients who underwent congenital heart surgery and were followed up in the cardiothoracic intensive care unit between September 2016 and December 2020. All patients were divided into four groups according to age: 0-1 months, 1-6 months, 6-12 months, and 1-18 years, and into two subgroups according to HAI development.Results. The patients' median age and weight at surgery were 3.28 (interquartile range [IQR]): 0.43-8.1) months and 4.34 (IQR: 4.34-6.69) kg, respectively. HAIs and infection-related deaths were observed in 223 and 21 patients, respectively. Age at surgery, weight at surgery, concomitant syndromes and immunodeficiency status, presence of cyanotic heart disease, intubation, and use of antibiotics during hospitalization were statistically significant between the two groups with and without infection (p<0.05). In logistic regression analysis, surgical weight <5 kg (odds ratio [OR]: 2.55; 95% confidence interval [CI]: 1.56-4.17; p <0.001), preoperative mechanical ventilation (OR: 2.0; 95% CI: 1.26-3.12; p=0.003), complexity of cardiac surgery according to the risk-adjusted congenital heart surgery classification score 3 (OR: 3.13; 95% CI: 1.24-7.92; p=0.016), presence of an concomitant syndrome (OR: 1.56; 95% CI: 1.02-2.88; p=0.040), age (OR: 1.01; 95% CI: 1.01-1.04; p=0.044) were independent risk factors for HAIs after cardiac surgery in children with CHD.Conclusions. In this study, younger age, presence of an associated syndrome, preoperative mechanical ventilation, and weight less than 5 kg were found to be independent risk factors for HAI after cardiac surgery in children with CHD.
Severe Hypernatremia Associated Catheter Malposition in An Intensive Care Patient
(2016) Silahli, Musa; Gokdemir, Mahmut; Duman, Enes; Gokmen, Zeynel; 0000-0003-0944-7178; 0000-0002-2746-0547; 0000-0002-5676-2747; 27555161; AAB-5059-2022; AAX-9343-2021; AAJ-8069-2021; N-4174-2014
We present a catheter related severe hypernatremia in a 2-month-old baby who was admitted to the pediatric intensive care. Imbalance of plasma sodium is commonly seen in pediatric intensive care patients. The water and sodium balance is a complex process. Especially, brain and kidneys are the most important organs that affect the water and sodium balance. Other mechanisms of the cellular structure include osmoreceptors, Na-K ATPase systems, and vasopressin. Hypernatremia is usually an iatrogenic condition in hospitalized patients due to mismanagement of water electrolyte imbalance. Central venous catheterization is frequently used in pediatric intensive care patients. Complications of central venous catheter placement still continue despite the usage of ultrasound guidance. Malposition of central venous catheter in the brain veins should be kept in mind as a rare cause of iatrogenic hypernatremia. (C) 2016 Elsevier Inc. All rights reserved.
"Shunt Index'' Can Be Used to Predict Clinically Significant Patent Ductus Arteriosus in Premature Neonates in Early Post-Natal Life
(2014) Yapakci, Ece; Ecevit, Ayse; Torer, Birgin; Ince, Deniz Anuk; Gokdemir, Mahmut; Gulcan, Hande; Tarcan, Aylin; https://orcid.org/0000-0002-2232-8117; https://orcid.org/0000-0002-4369-2110; https://orcid.org/0000-0002-5676-2747; 23816200; AIC-4823-2022; AAJ-4616-2021; I-6746-2016; N-4174-2014
Background: This study aimed to examine the differences between arterial and inferior caval vein oxygen saturation, fractional oxygen extraction, and the shunt index, which were calculated in the diagnosis of patent ductus arteriosus. Methods: Twenty-seven preterm infants were included in this study and were divided into two groups according to patent ductus arteriosus. Among them, 11 (41%) infants had haemodynamically significant patent ductus arteriosus and 16 (59%) did not have significant patent ductus arteriosus. Synchronous arterial and venous blood gases were measured during the first post-natal hours after the insertion of umbilical catheters. The differences between arterial and inferior caval vein oxygen saturation, inferior body fractional oxygen extraction, and the shunt index were calculated. Echocardiography was performed before the 72nd hour of life in a selected group of patients who had haemodynamically significant patent ductus arteriosus. Ibuprofen treatment was administered to patients with patent ductus arteriosus. Echocardiography was performed on the 72nd hour of life in preterm infants without any clinical suspicion of patent ductus arteriosus. Results: The early measured differences between arterial and inferior caval vein oxygen saturation and inferior body fractional oxygen extraction were found to be lower and the shunt index was found to be higher in the haemodynamically significant patent ductus arteriosus group than in the group without haemodynamically significant patent ductus arteriosus. Conclusion: We found that the shunt index, calculated in the first hours of life as >= 63%, predicted haemodynamically significant patent ductus arteriosus with a sensitivity of 78% and specificity of 82% in preterm newborns.
Traumatic craniocervical junction ligamentous and brain stem injuries and retroclival hematoma: unusual combination of craniocervical junction injuries
(2017) Gokdemir, Mahmut; Cifci, Bilal Egemen; Cifci, Gokcen Coban; Duman, Enes; 0000-0002-5676-2747; N-4174-2014
Cervical spine injuries are common in pediatric population and usually seen in craniocervical junction due to the anatomical and physiological differences. Combination of rapid hyperextension/hyperflexion traumas due to highspeed motor vehicle accident are known to be the reason of ligamentous injury and retroclival epidural hematoma. Our aim is to describe a rare combination injury of the the apical ligament, retroclival epidural hematoma and the suspicion of brain stem slits, due to rapid hyperextension/hyperflexion and rotational trauma with high-speed motor vehicle accident in a 3 year 8 month old girl. The cervical spine was immobilized with a Philadelphia collar. She is still under treatment in the pediatric intensive care unit with a Glascow Coma Scale of 8 for six months.