Surgical principles in repair of partial atrioventricular canal defect and short-term results

Parsiyel atrioventriküler kanal defekti (PAVKD) nadir görülen bir kardiak anomali olup tüm atrial septal defekt olgularının yaklaşık % 5 'ini oluşturur. Bu olguların cerrahi tedavisinde izlenen prensipler halen bir taktım farklılıklar göstermektedir. Mitral kapak fonksiyon bozukluğunun onarımda gözetilen prensipler ve atrial septal defektin kapatılmasında ileti sisteminin korunmasına yönelik cerrahi yaklaşımlar halen tartışmalı konulardır. Bu çalışmada İzmir Atatürk Devlet Hastanesi Kalp ve Damar Cerrahisi Kliniğinde 1992 ve 1993 yıllarında opere edilen 8 PAVKD olgusu değerlendirilmiştir. Bu olgularda uygulanan cerrahi teknik, erken postoperatif dönemde izlenen komplikasyonlar ve 1 yıllık poliklinik izlem bulguları sunulmuştur. Tüm olgularda ostium primum defekti yama ile kapatıldı. ileti sisteminin korunması için sütürler yüzeysel olarak defekt dudağımın solunda, mitral annulus üzerinde bırakıldı. Tüm olgularda mitral kleft tek tek sütürlerle kapatıldı. İki olguda postoperatif erken dönemde geçici ritm ve ileti bozuklukları gelişti ve tamamen kayboldu. Hiçbir olguda hastane mortalitesi ve bir yıllık özlerinde mortaliteye rastlanmadı. Preoperatif dönemde çeşitli derecelerde mitral kapak yetmezliği gösteren 5 olgudan 4 'ünde postoperatif dönemde mitral yetmezlik tamamen ortadan kalktı, 1 olguda ise mitral yetmezliği operasyon öncesi orta derecede iken postoperatif dönemde hafif derece olarak sürdü.Parfait atrioventricular canal defects (PAVCD) are unusual cardiac anomalies, representing about 5 percent of all atrial septal defects. There are still some controversies in some principal objectives in the surgical treatment of these patients. The principles in repair of mitral valve dysfunction and the surgical strategies to avoid heart block during patch closure of the atrial septal defect are still controversial issues. In this study, 8 PAVCD cases operated in İzmir Atatürk State Hospital Cardiovascular Surgery Clinic in 1992 and 1993 are included Operative techniques, early postoperative complications and one year follow-up results are presented Ostium primum defect was closed with patch in all cases. To avoid heart black, sutures were placed superficially to the lefi of the rim of the defect, directly in the annulus of the mitral valve. Mitral valve cleft was repaired with interrupted sutures in all patients. Transient arrhythmia and conduction disturbances developed in 2 patients in the early postoperative period and resolved completely. There was no mortality in hospital and one year follow-up period Four of 5 patients who had mitral insufficiency in arioıts degrees preoperatively improved completely. Mitral insufficiency decreased but persisted in one patient to a mild degree

TSUNAMI HAZARD ASSESSMENT IN ISTANBUL USING BY HIGH RESOLUTION SATELLITE DATA (IKONOS) AND DTM

Historical tsunami events have impacted the Istanbul coasts along the Sea of Marmara. Offshore seismic sources may trigger these tsunamis directly or through coseismic underwater failure. The 1999 zmit Bay tsunami led to more comprehensive analyses of these events which are generally caused by underwater failures close to the target coastline. Waves so generated can arrive at nearby coastlines in minutes, causing extensive damage and loss of life. Here this paper propose, on the basis of tsunami models in the Sea of Marmara and methodology used internationally, first generation tsunami inundation maps for the areas along the southern coast of Istanbul using by High Resolution Satellite Data (IKONOS) and Digital Terrain Data (DTM). Such maps and images for selected areas help to understand the possible effects on those regions and should only be used for evacuation planning and reducing possible hazard. 1

Effect of adding diltiazem to cold blood potassium cardioplegia on myocardial protection

It is still controversial whether the use of calcium channel blockers in cardioplegic solutions decreases ischemic and reperfusion damage. In this study, the effect of diltiazem addition to cold blood potassium cardioplegia in the induction phase on myocardial protection was investigated. A prospective, randomized trial was instituted to evaluate the hemodynamic and myocardial metabolic recovery in 20 patients undergoing elective aortocoronary bypass with either diltiazem in cold blood potassium cardioplegia (diltiazem group, n=10) or cold blood potassium cardioplegia (control group, n=10). In the diltiazem group, 150 mg/kg diltiazem was added to the cardioplegic solution in the induction phase of cardioplegia. In all cases, blood samples for measurement of lactate level and calculation of lactate extraction were taken from coronary sinus and radial artery at the beginning and the 30th minute of reperfusion period. CK-MB levels were measured in the intensive care at postoperative 6th and 18th hours. The hemodynamic findings of both diltiazem and control groups were compared in the preoperative and early postoperative periods. Lactate production was significantly lower in the diltiazem group at the beginning of the reperfusion period (p0.05). CK-MB level was significantly higher in the control group in the postoperative period. Similar hemodynamic findings were obtained in both groups in the preoperative and the early postoperative periods. We concluded that diltiazem addition to cold blood potassium cardioplegia decreases ischemic and reperfusion damage and has a beneficial effect on myocardial protection