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Öğe Complete Absence of The Left Pericardium in On-Pump Coronary Artery Bypass Operation(2018) Orhan, AtillaThe complete absence of the left pericardium is a rarecondition, which is found incidentally during surgicalprocedures. Preoperative computerized tomographyimaging is not a routine practice in open heart surgery, andthe diagnosis of these cases is often overlooked. In a patientundergoing on-pump coronary artery bypass surgery, wepresent a rare case of a left pericardium after sternotomy.Öğe Concomitant Heart Surgery with Pulmonary Hamartoma Resection: A Case Report(Selçuk Üniversitesi, 2022) Tanyeli, Ömer; Görmüş, Niyazi; Orhan, AtillaConcomitant lesions of the heart and lung are rare, but when present, they pose a therapeutic challenge to surgeons. A combined procedure clears the need for a second major procedure, improving outcomes and providing economic benefits. However, cardiopulmonary bypass may adversely affect the natural history of pulmonary masses when malignancy is suspected. To avoid these suspects, off-pump techniques may be preferred in suitable patients. This article presents a case of simultaneous off-pump coronary artery bypass grafting and pulmonary hamartoma resection in a 53-year-old man who detected a lung mass during preoperative preparation.Öğe Emergent surgical treatment of lethal valve dysfunction during pregnancy in a last-trimester patient(SAUDI MED J, 2018) Akbayrak, Hakan; Çiçek, Ömer Faruk; Orhan, AtillaA mechanical heart valve thrombosis during pregnancy is one of the most lethal conditions to experience due to its detrimental effects on both mother and fetus. Cardiac surgery during pregnancy is reserved for cases where medical treatment fails due to harmful maternal and fetal effects. A 24-year-old female in the 38th week of pregnancy was admitted to the emergency room with aggravated dyspnea, tachypnea, and palpitations. She had 2 previous cardiac operations in her medical history. A stuck mechanical valve was diagnosed in the mitral position via transthoracic echocardiography, which had resulted from her decision to cease taking warfarin when planning to become pregnant. In pregnant patients who have prosthetic mechanical valve thrombosis, surgical approach should be considered depending on the conditions of the mother and the baby. When emergency delivery of the baby is feasible, emergent surgical treatment should be utilized for patients who are in critical condition.Öğe A Huge True Axillobrachial Aneurysm Following Arteriovenous Fistula Ligation(2019) Orhan, Atilla; Özergin, UfukAneurysmal degeneration of the upper limb arteriesis a rare entity. We discuss the clinical characteristics,surgical options for a huge true axillobrachial arteryaneurysm following arteriovenous fistula closure afterrenal transplantation. The underlying pathogenesis of thetrue axillobrachial artery aneurysm remains unclear. Thecurrent theory is that the adaptive arterial wall enlargementis secondary to the increased flow in the inflow artery.Immunosuppressive therapy and corticosteroids contributeto the aneurysmal formation. Surgical treatment includinganeurysmal excision, bypass with autogenous or prostheticgrafts are the primary therapeutic options.We believe that this case will be inspiring and helpful to thecardiovascular surgeons during their daily practice.Öğe Iliac artery ınjury during lumbar disc hernia surgery(ELSEVIER SCIENCE INC, 2019) Şahinoğlu, Mert; Arun, Oğuzhan; Orhan, Atilla; Nayman, Alaaddin; Çalışır, Akın; Bocu, Yasin; Cebeci, Yasemin; Duman, Ateş; Yılmaz, Hüseyin; Köktekir, Ender; Karabağlı, HakanBACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.Öğe Lessons Learned from Crisis Management and Amputation Decisions in the Aftermath of High-magnitude Earthquakes in Kahramanmaras on 6 February 2023(Selçuk Üniversitesi, 2024 Şubat) Orhan, AtillaABSTRACT Introduction: Earthquakes of high magnitude and prolonged duration result in catastrophic events, causing significant loss of life and property. Immediate medical interventions become crucial in the aftermath of such disasters to prevent long-term disabilities and fatalities. This study focuses on the challenges faced by a volunteer medical team in Kahramanmaras, Turkiye, after two major earthquakes struck on February 6, 2023, affecting millions of people. Methods: A team of 35 experienced medical professionals, led by a cardiothoracic surgeon, was dispatched to the disaster site. The team’s schedule, tasks, and logistical details were organized to optimize their response. The study outlines the methods employed by the team to assess and treat extremity traumas, including amputations during the first-week post-earthquake. Results: The earthquake severely impacted local healthcare facilities, resulting in inadequate patient management, insufficient medical personnel, and logistical difficulties. The volunteer team worked tirelessly, performing surgeries and amputations and providing medical equipment. A total of 16 lower limb amputations and two upper limb amputations were performed due to severe extremity crush injuries. Discussion: The chaotic conditions post-earthquake revealed challenges in managing crush syndrome patients. The study discusses the decision-making process for amputations, fasciotomies and patient transfers. Despite limited facilities, the team restored the hospital to full functionality within a few days. Conclusion: The study concludes that volunteer healthcare teams are crucial in disaster response. Effective organization, communication, and logistics are essential for optimal performance. Continuous training on disaster scenarios for volunteer teams is recommended. The importance of restoring healthcare facilities to routine operation after immediate crisis response is emphasized, as well as the need for comprehensive scientific data to understand the extent of the disaster’s impact.Öğe Primer kalp cerrahisi ameliyatlarından sonra gelişen retrosternal perikardiyal yapışıklıkların Mitomisin C ile önlenmesi (Deneysel çalışma)(Selçuk Üniversitesi Tıp Fakültesi, 2007) Orhan, Atilla; Görmüş, NiyaziAmaç: Retrosternal perikardiyal adezyonlar reoperasyon gereken olgularda önemli oranda kalp ve büyük damar yaralanmalarına neden olabilir. Fibroblast proliferasyonu adezyon oluşum mekanizmalarından biridir. Fibroblast proliferasyonunun engellenmesi retrosternal adezyonların azaltılmasında önemlidir. Mitomisin C (MMC) fibroblast proliferasyonunu azaltmaktadır. Çalışmamızın amacı primer kalp cerrahisi ameliyatlarından sonra gelişen retrosternal perikardiyal yapışıklıkların önlenmesinde MMC'nin etkilerini belirlemekti. Gereç ve yöntem: Çalışmada 30 adet Sprague-Dawley cinsi dişi sıçan kullanıldı. Sıçanlar iki gruba ayrıldı. İlk grup kontrol (N=10) ve ikinci grup MMC çalışma grubu (N=20) olarak belirlendi. Her iki gruba subksifoid kesi yapılarak ksifoid kıkırdak rezeksiyonu ve retrosternal abrazyon yapıldı. Çalışma grubunda, retrosternal alana topikal olarak MMC (1 mg/kg) uygulandı. 15 gün sonra, reoperasyon yapıldı ve adezyon oluşumu evrelendi. Sakrifikasyon işlemi öncesinde doku ve kan örnekleri alındı. Doku örneklerine standart boyama işlemleri ve fibroblast growth faktör reseptör 3 antikor boyası immünhistokimyasal olarak uygulandı. Sonuçlar: Ortalama adezyon skoru kontrol grubunda (N=10) 2.50 ± 1.27 ve MMC çalışma grubunda 0.70 ± 0.86 olarak bulundu. Çalışma grubunda adezyon skoru kontrol grubuna göre daha düşüktü (p<0.05). MMC'ye ait herhangi bir yan etki gözlenmedi. İmmünhistokimyasal örnekler, çalışma grubuna göre kontrol grubunda fibroblast yoğunluğunun daha yüksek bulundu (p<0.05). Hidroksiprolin düzeyleri her iki grupta benzerdi (p>0.05). Sonuç: Bu çalışmada, MMC'nin normal yara iyileşmesinde herhangi bir gecikmeye neden olmaksızın retrosternal perikardiyal adezyonları önlediği ortaya konulmuştur.Öğe Repair of Coarctation-Related Aortic Arch Aneurysm and Ventricular Septal Defect in an Adolescent(TEXAS HEART INST, 2008) Narin, Cuneyt; Ege, Erdal; Orhan, Atilla; Yeniterzi, MehmetA saccular aortic arch aneurysm that is secondary to aortic arch coarctation and that is accompanied by a ventricular septal defect is a rare combination in the adolescent patient. Total simultaneous repair of all of these conditions is desirable, because of the higher morbidity and mortality rates of staged procedures-particularly when resection of the saccular aneurysm is delayed. Herein, we discuss the case of a 16-year-old boy who underwent simultaneous surgical correction of these malformations. With the aid of cardiopulmonary bypass on the beating heart, the coarctation and the aneurysmal segment were resected, and a tubular Dacron graft was interposed. The ascending aorta and femoral artery were both then cannulated to ensure whole-body perfusion during cardiopulmonary bypass. The ventricular septal defect was closed with the patient under cardioplegic arrest. After 70 days, he was discharged from the hospital without sequelae. We conclude that single-staged repair of cardiac abnormalities and of an aortic arch aneurysm that is secondary to coarctation of the aortic arch can be performed safely and effectively in adolescent and adult patients by use of our technique. (Tex Heart Inst J 2008;35(4):466-9)Öğe Tekrarlayan brakiyal arter embolizasyonuna yol açan subklavyan arter anevrizması(2008) Durgut, Kadir; Dereli, Yüksel; Orhan, Atilla; Işık, Mehmet; Görmüş, Niyazi; Yüksek, TahirÜst ekstremite periferik arter anevrizmaları alt ekstremiteye oranla daha az görülür. En sık etkilenen arterler subklavyan, aksiller ve brakiyal arter; daha nadiren de radiyal ve ulnar arterlerdir. Subklavyan arter anevrizmaları en sık poststenotik dilatasyon ve ateroskleroza bağlıdır. İlerlemiş vakalarda anevrizma kesesi içinde tromboz ve uzak embolizasyon gelişebilir. Bu çalışmada rekürren distal embolizasyon kaynağı olan bir subklavyan arter anevrizması vakasını nadir görüldüğü için yayınlamayı uygun bulduk. (Damar Cer Der 2008; 17(l):39-42).
