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Midline one-stage complete unifocalization early outcomes from a single center Objective: This study aims to present our experience with single-stage complete unifocalization and intraoperative flow study for the repair of ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. Methods: This study was conducted through retrospective chart review of all the patients who underwent complete single-stage midline unifocalization in a single tertiary-care institution. Results: Twenty-two patients underwent midline single-stage unifocalization. The median age was 11 months (IQR: 5-21 months). The number of collateral arteries unifocalized was between one and three (median two). In-hospital mortality was 5%. Follow-up was complete; and the median follow-up regarding survival was 20 months (IQR: 10-28 months). There were three late deaths, and the estimated survival rate was 80% at 10 months and on. Out of 22 patients, ventricular septal defect was closed in the first surgery in three patients (14%) and the second surgery in four patients (19%). Total seven patients underwent surgical total repair (32%). Additionally, one out of four patients whose ventricular septal defects were closed with a fenestrated patch is under follow-up with a small ventricular septal defect, while two are waiting for ventricular septal defect closure. Therefore, total eight patients (36%) have reached total correction. Conclusion: Single-stage unifocalization is a feasible treatment option in ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. This cohort had unfavorable results regarding the rate of complete repair. The pitfalls encountered were related to problems with meticulous surgical technique, complete unifocalization, and correct implementation of the flow study.

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ÖZET Konjenital kalp hastalıklarında morbidite ve erken mortalitenin en önemli nedenlerinden biri konjenital kalp hastalıklarına bağlı pulmoner hipertansiyondur (PHT). TANIMPulmoner hipertansiyon (PHT) çocukluk çağında nadir görülmekle beraber, konjenital kalp hastalıkların-da mortalite ve morbiditenin en önemli nedenlerinden biridir. Pediyatrik pulmoner hipertansiyonun en sık nedenleri idiopatik pulmoner hipertansiyon (İPHT) ve soldan sağa şantlı konjenital kalp hastalıklarıdır.Ortalama pulmoner arter basıncının (OPAB) istirahatte ≥25 mmHg ve egzersiz sırasında ≥30 mmHg olması pulmoner hipertansiyon olarak tanımlanmak-tadır (1) . Pediyatrik kardiyologlar infantlarda sistolik pulmoner arter basıncının sistemik basınçtan % 50 fazla olmasını pulmoner hipertansiyon olarak kabul etmektedirler.Alındığı tarih: 24

Objective: Desflurane is used in cardiac anesthesia because it provides hemodynamic stability and rapid recovery. In this study, the effects of using different minimal alveolar concentrations (MAC) of desflurane on jugular venous oxygen saturation (SjvO2) and hemodynamic parameters in coronary artery bypass surgery (CABG) were investigated. Methods: Sixty patients who were scheduled for CABG were divided into 3 groups after obtaining the hospital ethics committee and patient consent. Desflurane was used in these groups at 0.5, 1.0 and 1.5 MAC values, respectively. In addition to routine invasive catheterization, a retrograde jugular venous catheter was inserted. Hemodynamic data, SjvO2, other parameters and blood gas values were recorded before, during and after CPB. Results: SjvO2 values in all groups were not within the desaturation limit. Glucose, lactate, partial arterial O2 saturation (PaO2) and partial jugular venous O2 saturation (PjvO2) values remained normal. In each group, a decrease was observed in arterial and jugular venous O2 content difference O2CT (a-jv) values due to hypothermia and hemodilution at admission to CPB (p<0.05). Conclusion: SjvO2 reflects the balance between cerebral blood flow and cerebral oxygen metabolic rate and the adequacy of cerebral perfusion. In previous studies; The effects of isoflurane, sevoflurane and desflurane on SjvO2 at 0.5 MAC level during CABG were investigated. The effects of the three inhalation agents on SjvO2 were similar. It was determined that cerebral autoregulation was not impaired and SjvO2 values did not decrease in 3 different MAC values of desflurane used in our study. However, it was observed that 0.5 MAC dose, which was also reflected in the hemodynamic findings, did not suppress the stress response sufficiently, and higher MAC values provided hemodynamic stability, especially in hypertensive patients. 1.5 MAC causes hypotension in some patients and vasopressor drugs may be needed. Hemodynamic stability is provided at a MAC value of 1.0.