Search PubMed⌕ Search

Biomedical subjects

M A Ergin

Publications and source records attributed to M A Ergin.

At least 73 records · Page 4Linked to original sources
PubMed1986

Extended aortic arch anastomosis for repair of coarctation in infancy.

Surgical repair of coarctation of the aorta was performed in 17 infants, median age 14 days, median weight 3.5 kg. Extended end-to-end aortic arch anastomosis was used. A long incision was made in the inferior aspect of the aortic isthmus and arch, which was then anastomosed to the obliquely trimmed distal aorta. The aortic arch was hypoplastic in eight patients. Mean cross-clamp time was 17.1 min. Pulmonary artery bands were placed in five patients. Follow-up two-dimensional echocardiographic and Doppler studies on 13 patients 1 to 56 months after surgery demonstrated normal distal aortic flow in 10, slightly decreased flow in two, and diminished flow in one. Patients with abnormal Doppler flow showed no gradient in one case and a 30 mm Hg gradient in two. Extended aortic arch anastomosis is safe in infancy, leaves no native coarctation shelf tissue in the repaired segment, does not sacrifice the subclavian artery, is useful in hypoplastic isthmus, and is at low risk to develop aneurysm or recoarctation.

Aorta, Thoracic↗
PubMed1986

Primary reconstruction of interrupted aortic arch by total aortic outflow obstruction.

Primary aortic arch reconstruction was undertaken in three neonates with interrupted aortic arch and ventricular septal defect. Total ascending aortic occlusion without cardiopulmonary bypass or profound hypothermia permitted, in each case, a rapid tension-free end-to-side descending-to-ascending aortic anastomosis without resulting neurologic or cardiac sequelae. This technique offers distinct advantages over previously described methods and should be considered whenever interrupted aortic arch is present with a ventricular septal defect.

Abnormalities, Multiple↗
PubMed1985

Anaesthesia for aortic arch aneurysm repair: experience with 17 patients.

Mortality and morbidity during aortic arch aneurysm repair is high despite improvements in surgical technique which attempt to assure brain protection during surgery. We successfully managed 17 patients using deep hypothermia and circulatory arrest. Anaesthesia consisted of pancuronium, fentanyl, plus isoflurane or halothane if needed. Pulmonary artery and arterial catheters were inserted. Surface cooling was performed followed by core cooling on cardiopulmonary bypass, using a heat exchanger. Total circulatory arrest was performed when esophageal temperature reached 12-14 degrees C after previous administration of thiopentone 30 mg X kg-1, methylprednisolone 2 gm, furosemide 40 mg and mannitol 25 gm. At that time the head was packed in ice and surgical correction performed. Mean arrest time was 36.5 +/- 13 minutes at a mean oesophageal temperature of 12.5 +/- 0.75 degrees C. No serious, permanent neurological deficit was found. Tracheostomy was required in five patients of whom two had chronic obstructive pulmonary disease (COPD). Two of these patients died of adult respiratory distress syndrome (ARDS) and renal failure. The reported technique is safe and can be easily used in patients undergoing aortic arch aneurysm repair.

Adjuvants, Anesthesia↗
PubMed1985

Retrograde intubation in patients undergoing open heart surgery.

Cardiovascular changes during difficult intubation were studied in 25 patients undergoing open heart surgery. The study was divided into two phases. Phase A from the first laryngoscopy to the fourth unsuccessful one; Phase B from a stabilization period until after retrograde intubation was performed. During phase A, heart rate (HR) increased significantly from 75 +/- 6.5 beats/min before laryngoscopy to 95 +/- 8.5 (p less than 0.05) after the last laryngoscopy. Mean arterial pressure (MAP) also increased from 82.5 +/- 4.75 mmHg to 105 +/- 5.15 (p less than 0.005) after the last laryngoscopy. Cardiac index (CI) decreased from 2.9 +/- 0.3 L . min-1 . m-2 before to 2.55 +/-0.2 after the last laryngoscopy. Pulmonary capillary wedge pressure (PCWP) increased from 10.5 +/- 1 mmHg before to 19.25 +/- 1.5 (p less than 0.01) after the last laryngoscopy. No statistically significant changes in HR, MAP, CI, and PCWP occurred before and after intubation during Phase B. Three patients had elevated ST segments during Phase A which responded to IV nitroglycerin and propranolol. None was detected during Phase B. There were more lacerated lips and teeth damaged during Phase A. One patient developed a small peritracheal haematoma after the retrograde intubation, for which no treatment was required. This technique is safe and produces minimal cardiovascular changes for difficult intubation in patients undergoing open heart surgery.

Aortic Valve↗
PubMed1985

Cricothyroidotomy for prolonged ventilatory support after cardiac operations.

Forty-nine patients required prolonged ventilatory support after cardiac operations. Cricothyroidotomy was used routinely in these patients after approximately 7 days of endotracheal intubation. There were no infections of the median sternotomy wounds despite frequent colonization of the stoma. The only immediate complication was mild stomal bleeding in a patient taking anticoagulants. Nineteen patients (39%) died of underlying disease. The average duration of cricothyroidotomy was 59 days (range, 3 to 270 days). Cannulas were successfully removed in all survivors after an average of 38 days (range, 6 to 187 days). All of the patients were followed by personal interview, telephone contact, or contact with the referring physician. The average length of follow-up was 17 months (range, 2 to 50 months). All symptomatic patients were evaluated by laryngoscopy and bronchoscopy. One patient required endoscopic removal of granulation tissue from the stomal site; 2 others required tracheal resection for stenosis at the balloon site. There were no instances of subglottic stenosis. There were 4 late deaths, none of which was related to the cricothyroidotomy. Based on these findings, we suggest that cricothyroidotomy, with its low complication rate, is the procedure of choice for patients requiring prolonged mechanical ventilation after cardiac operations.

Cardiac Surgical Procedures↗
PubMed1985

Acute dissections of the aorta. Current surgical treatment.

Tremendous progress has been made in the treatment of acute aortic dissections as a result of advances in surgical, medical, and diagnostic modalities. Rapid clinical diagnosis should be followed by aggressive monitoring, pharmacologic manipulation, and definitive elucidation of the anatomy of the disorder. Ultrasonography and CT scanning may provide valuable information on the anatomy of the dissection, but contrast arteriography remains the preferred method for demonstrating the anatomy. Surgical correction is now recommended for both type A and type B dissections during the acute stage. The exact approach is dictated by the location of the intimal tear and the extent of the dissection. The complexity of the operation may extend from interposing an intraluminal graft to full cardiopulmonary bypass with profound hypothermia, circulatory arrest, and replacement of the ascending aorta, aortic arch, or aortic valve apparatus. The rapid advancement of management techniques for acute aortic dissections now offers patients a reasonable expectation of survival without complications. Future improvements in early, noninvasive, and rapid diagnostic methods, as well as increased utilization of invasive monitoring and nonporous graft materials, promise to increase survival for a patient afflicted with acute aortic dissection.

Acute Disease↗
PubMed1985

Repair of complex subvalvular aortic aneurysm with a valved conduit.

A subaortic annular aneurysm involving three fourths of the annular circumference was repaired with a valved conduit to which a Teflon felt flange was attached. This unique prosthetic repair assured a strong stable repair and uncompromised coronary flow otherwise unobtainable with previously described repairs.

Adult↗
PubMed1983

Use of stapling instruments in surgery for aneurysms of the aorta.

Since their inception, surgical stapling devices have been used almost exclusively in pulmonary and gastrointestinal procedures. We present our experience with surgical staplers in operations for aneurysms of the aorta. Three illustrative case reports are presented that demonstrate the applicability of surgical stapling devices in excluding aortic aneurysms. Seven patients have undergone operation using this technique, all with excellent technical results. We believe that surgical stapling devices represent a safe, easy, and rapid means of excluding aneurysms of the aorta.

Aorta, Thoracic↗
PubMed1982

Colo-pericardial fistula: complication of colonic interposition.

This report discusses a unique and previously unreported complication of a colonic interposition following esophageal replacement. A 7-year-old boy under-went a right colonic interposition following extensive esophageal lye burn. Fifteen years post-colonic interposition, the 22-year-old man was admitted to an adult medical ward with chest pain, cardiomegaly, and fever. Barium swallow revealed a colo-pericardial fistula with massive pericarditis. The patient survived an immediate thoracotomy with the removal of the colon and a pericardiectomy. Several months later the patient underwent a successful left colonic interposition. This case illustrates that immediate and aggressive surgical therapy may prevent an otherwise fatal outcome.

Journal Article↗
PubMed1982

Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections.

In a series of 21 consecutive patients, the aortic arch, varying portions of the ascending and descending aorta, and in some the aortic valve were replaced with the aid of a standard method of profound total body hypothermia and circulatory arrest. Fourteen patients underwent elective and seven patients emergency arch replacement. A combination of surface cooling and cardiopulmonary bypass was used to produce total body hypothermia. Replacement of the aortic arch was performed during a single period of circulatory arrest. Cardiopulmonary bypass was utilized for core rewarming. The average cerebral ischemic time was 37 +/- 14 minutes at an average core temperature of 13.7 degrees +/- 1.8 degrees C. The average myocardial ischemic time was 79 +/- 28 minutes with an average duration of cardiopulmonary bypass of 130 +/- 32 minutes. Of the 14 patients undergoing elective operation, three died; of the seven patients undergoing emergency operations, three died (two with ruptured aneurysms and one with acute arch dissection). Fifteen patients are alive and well 2 months to 7 years following the operation. All are free of neurologic sequelae. One has an asymptomatic residual dissection in the descending aorta. This experience indicates that profound total body hypothermia with circulatory arrest is a safe and effective method for elective surgical treatment of enlarging aneurysms of the aortic arch and for emergency treatment of acute dissections if the intimal tear is located in the aortic arch. The technique is simple and produces results superior to those reported for methods which involve selective cerebral perfusion during arch replacement.

Adult↗