Kürşad Tokel | Baskent University (original) (raw)
Papers by Kürşad Tokel
Transplantation, 2018
Introduction: The most important causes of mortality and morbidity after Conclusion: Each patient... more Introduction: The most important causes of mortality and morbidity after Conclusion: Each patient who develops CAV must be evaluated individually and then the most appropriate treatment should be decided.
Pediatric Cardiology, Dec 27, 2023
Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2014
PubMed, Sep 5, 2007
Although thrombocytosis is frequently detected in newborns, few reports have focused on its risk ... more Although thrombocytosis is frequently detected in newborns, few reports have focused on its risk factors. This report documents the characteristics of 89 neonates with thrombocytosis followed up in a neonatal intensive care unit (NICU). We reviewed the patients' medical and laboratory records retrospectively to determine the associated conditions and risk factors for neonatal thrombocytosis, and complications related to thrombocytosis. We also discussed the differences of neonatal thrombocytosis from that of childhood in the light of literature. The mean platelet count of these newborns was 579.7 ± 111.5 (451-936) x 109/L. Associated conditions included anemia (73.7%), high- isk pregnancies (56. %), prematurity (51.7%), infections (37.1%), antenatal drug use (22.7%), indirect hyperbilirubinemia (20.2%), cardiac disorders (14.6%), respiratory distress syndrome (14.6%), history of hypoxia (13.5%), surgery (12.4%), and hemorrhage (3.4%). In most cases, more than one risk factor for thrombocytosis existed in the same newborn. No hemorrhagic complications related to thrombocytosis were observed; however, 1 newborn had portal vein thrombosis associated with intestinal malrotation. In summary, risk factors and associated conditions for thrombocytosis in newborns differed from those in children. In light of associated disorders, the mechanism of thrombocytosis in newborns may differ from that of childhood thrombocytosis.
Birth Defects Research, Jul 22, 2002
TÃœRK KARDÄ°YOLOJÄ° DERNEÄÄ° ARÅÄ°VÄ°, Apr 1, 2018
Turkiye Klinikleri Cardiovascular Surgery - Special Topics, 2018
Türk kardiyoloji derneği arşivi, Jun 1, 2011
Page 1. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2011;39(4):283-291 doi: 10.5543/tkda.2011.... more Page 1. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2011;39(4):283-291 doi: 10.5543/tkda.2011.01443 283 Down sendromlu çocuklarda kardiyopulmoner baypas sonrası trombositopeni sıklığı The incidence of thrombocytopenia ...
European Journal of Haematology, Apr 24, 2009
To the Editor: Protein C (PC) is a vitamin K-dependent plasma protein that acts as a major inhibi... more To the Editor: Protein C (PC) is a vitamin K-dependent plasma protein that acts as a major inhibitor in the procoagulant system through proteolytically degrading activated Factor V and Factor VIII. Researchers have found over 160 different mutations of the PC gene that lead to the absence, or a defective form, of PC (1). Protein S (PS), another vitamin K-dependent protein, acts as a cofactor for PC. It is activated at the endothelial surface when thrombin binds to thrombomodulin (2). Isolated deficiencies of PC and PS are well known, but combined deficiency of these two proteins is a rare finding. A 6-month-old boy with congenital heart disease who was born to apparently healthy, second-degree-related parents was referred to our hospital for surgery. Cardiac catheterization was performed to confirm the diagnosis that had been obtained through echocardiography: right atrial isomerism, dextrocardia, complete atrioventricular septa1 defect, left-hand topology and pulmonary stenosis. However, despite heparinization of the lumen before the procedure, the catheterization needle filled with clotted blood, making it impossible to insert a guide wire even after several attempts. A coagulopathic disorder was suspected, and subsequent testing revealed the following (Table 1): prothrombin time 12.9 s (normal 10.7-1 3 s), activated partial thrombo-
Turkiye Klinikleri Cardiovascular Surgery - Special Topics, 2018
The Journal of Maternal-Fetal & Neonatal Medicine, 2022
PURPOSE OF THE ARTICLE Acute kidney injury (AKI) after cardiac surgery in children with congenita... more PURPOSE OF THE ARTICLE Acute kidney injury (AKI) after cardiac surgery in children with congenital heart disease (CHD) is a serious complication closely associated with high morbidity and mortality. Despite numerous studies on AKI in children, most studies have excluded neonates. We sought to characterize AKI associated with cardiac surgery in neonates, determine its incidence, perioperative and postoperative risk factors, and short-term results. MATERIALS AND METHODS This retrospective study included 177 neonates who were operated on for CHD in our hospital between January 2015 and December 2019. Data of the patients were analyzed according to nKDIGO (neonatal Kidney Disease Improving Global Outcomes) and nRIFLE (neonatal Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria for evaluating AKI retrospectively. Data of groups with and without AKI were analyzed. RESULTS The average age of 177 neonates were 8.2 ± 6.1 (1-28) days. Twenty-two (12.4%) neonates had CS-AKI defined according to nKDIGO criteria. Four (2.3%) neonates reached nKDIGO stage I, 1 (0.6%) reached stage II, 17 (9.6%) reached stage III. Thirty-eight (21.5%) neonates had CS-AKI defined according to nRIFLE criteria. Twenty-four (13.6%) neonates reached nRIFLE stage risk(R), 6 (3.4%) reached stage injury(I), 8 (4.5%) reached stage failure (F). The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) in neonates was 12.5% and 21.5% for nKDIGO and nRIFLE, respectively. The percentage difference between nKDIGO and nRIFLE for AKI assessment was due to the criteria for nRIFLE stage risk(R) urine output < 1.5 mL/kg/h for 24 h. In both classifications, the duration of cardiopulmonary bypass, operation, inotropic treatment, and mechanical ventilation, length of intensive care unit (ICU), and hospital stay were significantly higher in the AKI group than those without AKI group (p˂.05). The mortality rate in the groups with AKI was found to be significantly higher (p˂.05) than in the groups without AKI. In Kappa analysis, when two classifications were compared according to AKI stages, a significant agreement was found between nKDIGO and nRIFLE classifications (p˂.05) (Kappa: 0.299). CONCLUSION AKI and mortality rates were similar between groups according to the nKDIGO and nRIFLE criteria. For early prediction of AKI and adverse outcomes, diagnostic reference intervals might be specified in more detail in neonates undergoing cardiac surgery for CHD.
Archives of the Turkish Society of Cardiology, 1997
Turkiye Klinikleri Journal of Pediatrics, 2008
300 e vo id ba zal hüc re li kar si nom sen dro mu (NBHKS)(OMIM #109400) ilk kez 1960 yı lın da G... more 300 e vo id ba zal hüc re li kar si nom sen dro mu (NBHKS)(OMIM #109400) ilk kez 1960 yı lın da Gor lin ve Goltz1 ta ra fın dan ta nım lan mış olup, ba zal hüc re li kar si nom, odon to je nik ke ra to kist ler, pal mar ve/ve ya plan tar çu kur cuk lar ve du ral kıv rım la rın ek to pik kal si fi kas yon la rı ile karak te ri ze bir sen drom dur. Oto zo mal do mi nant ge çiş li bu sen dro mun ge ni (PTCH: patc hed ge ne) kro mo zom 9q22.3 üze rin de ha ri ta lan mış tır. Bu tü mör sup re sör ge nin de ki mu tas yon lar odon to ge nez ve kar si no ge ne zi de kapsa yan ba zı gen ler de dis re gü las yo na ne den ol mak ta dır. En be lir gin bul gu er ken baş lan gıç lı ba zal hüc re li kar si nom ve man di bu ler kist ler dir. On do Kardiyak Tümör, Fötal Rabdomiyom ve Odontojenik Keratokistleri Olan Gorlin-Goltz Sendromlu Bir Olgu
Journal of Pediatric Infection, 2021
Abiotrophia defectiva is a nutritional defective streptococcus that is difficult to grow in routi... more Abiotrophia defectiva is a nutritional defective streptococcus that is difficult to grow in routine culture media, is found in the oral mucosa, gastrointestinal and urogenital system flora and is a rare cause of infective endocarditis. An 11-year-old boy with underlying operated congenital heart defect presented with prolonged fever. Abiotrophia defectiva is yielded in the blood cultures taken properly with a pre-diagnosis of infective endocarditis. Although there was no vegetation or other finding of endocarditis on echocardiography, surgery decision was made because bacteria continued to grow in the blood culture under appropriate antibiotic treatment. During surgery, it was observed that the contegrapulmonic valved conduit was severely degenerated and calcified. A new contegrapulmonic valve conduit replacement was performed. Serious complications occur more frequently in infective endocarditis caused by Abiotrophia defectiva compared to other etiogic agents of infective endocarditis. With this case, we wanted to emphasize that in Abiotrophia defectiva infective endocarditis, the possibility of antibiotic treatment failure and surgical procedure requirement is quite high.
Molecular Genetics and Metabolism, 2019
The Turkish Journal of Pediatrics, 2020
Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical rel... more Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical relevance of CAF focuses mainly on the mechanism of 'coronary steal phenomenon', which causes myocardial functional ischaemia even in the absence of stenosis. Common symptoms of this phenomenon are angina, dyspnoea during physical exertion, and heart palpitations. 2-5 The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations such as the electrocardiogram, treadmill test, echocardiography, computed tomography and coronary angiography. Bacterial endocarditis is rarely observed in patients with CAF. 6,7 Small, asymptomatic fistulae can be followed by echocardiography, while treatment of symptomatic or large asymptomatic fistulae is recommended. 2-5,8,9 Coronary angiography is required to plan
The Turkish Journal of Pediatrics, 2020
Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment... more Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short-and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. Methods. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Results. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 ± 4.9 years (range: 6 months-19 years). The mean age of the patients at the first ABV was 14.5 ± 10.6 days (range: 1-30 days) and body weight was 3.25 ± 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 ± 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 ± 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. In the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p <0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. Conclusions. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.
Transplantation, 2018
Introduction: The most important causes of mortality and morbidity after Conclusion: Each patient... more Introduction: The most important causes of mortality and morbidity after Conclusion: Each patient who develops CAV must be evaluated individually and then the most appropriate treatment should be decided.
Pediatric Cardiology, Dec 27, 2023
Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2014
PubMed, Sep 5, 2007
Although thrombocytosis is frequently detected in newborns, few reports have focused on its risk ... more Although thrombocytosis is frequently detected in newborns, few reports have focused on its risk factors. This report documents the characteristics of 89 neonates with thrombocytosis followed up in a neonatal intensive care unit (NICU). We reviewed the patients' medical and laboratory records retrospectively to determine the associated conditions and risk factors for neonatal thrombocytosis, and complications related to thrombocytosis. We also discussed the differences of neonatal thrombocytosis from that of childhood in the light of literature. The mean platelet count of these newborns was 579.7 ± 111.5 (451-936) x 109/L. Associated conditions included anemia (73.7%), high- isk pregnancies (56. %), prematurity (51.7%), infections (37.1%), antenatal drug use (22.7%), indirect hyperbilirubinemia (20.2%), cardiac disorders (14.6%), respiratory distress syndrome (14.6%), history of hypoxia (13.5%), surgery (12.4%), and hemorrhage (3.4%). In most cases, more than one risk factor for thrombocytosis existed in the same newborn. No hemorrhagic complications related to thrombocytosis were observed; however, 1 newborn had portal vein thrombosis associated with intestinal malrotation. In summary, risk factors and associated conditions for thrombocytosis in newborns differed from those in children. In light of associated disorders, the mechanism of thrombocytosis in newborns may differ from that of childhood thrombocytosis.
Birth Defects Research, Jul 22, 2002
TÃœRK KARDÄ°YOLOJÄ° DERNEÄÄ° ARÅÄ°VÄ°, Apr 1, 2018
Turkiye Klinikleri Cardiovascular Surgery - Special Topics, 2018
Türk kardiyoloji derneği arşivi, Jun 1, 2011
Page 1. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2011;39(4):283-291 doi: 10.5543/tkda.2011.... more Page 1. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2011;39(4):283-291 doi: 10.5543/tkda.2011.01443 283 Down sendromlu çocuklarda kardiyopulmoner baypas sonrası trombositopeni sıklığı The incidence of thrombocytopenia ...
European Journal of Haematology, Apr 24, 2009
To the Editor: Protein C (PC) is a vitamin K-dependent plasma protein that acts as a major inhibi... more To the Editor: Protein C (PC) is a vitamin K-dependent plasma protein that acts as a major inhibitor in the procoagulant system through proteolytically degrading activated Factor V and Factor VIII. Researchers have found over 160 different mutations of the PC gene that lead to the absence, or a defective form, of PC (1). Protein S (PS), another vitamin K-dependent protein, acts as a cofactor for PC. It is activated at the endothelial surface when thrombin binds to thrombomodulin (2). Isolated deficiencies of PC and PS are well known, but combined deficiency of these two proteins is a rare finding. A 6-month-old boy with congenital heart disease who was born to apparently healthy, second-degree-related parents was referred to our hospital for surgery. Cardiac catheterization was performed to confirm the diagnosis that had been obtained through echocardiography: right atrial isomerism, dextrocardia, complete atrioventricular septa1 defect, left-hand topology and pulmonary stenosis. However, despite heparinization of the lumen before the procedure, the catheterization needle filled with clotted blood, making it impossible to insert a guide wire even after several attempts. A coagulopathic disorder was suspected, and subsequent testing revealed the following (Table 1): prothrombin time 12.9 s (normal 10.7-1 3 s), activated partial thrombo-
Turkiye Klinikleri Cardiovascular Surgery - Special Topics, 2018
The Journal of Maternal-Fetal & Neonatal Medicine, 2022
PURPOSE OF THE ARTICLE Acute kidney injury (AKI) after cardiac surgery in children with congenita... more PURPOSE OF THE ARTICLE Acute kidney injury (AKI) after cardiac surgery in children with congenital heart disease (CHD) is a serious complication closely associated with high morbidity and mortality. Despite numerous studies on AKI in children, most studies have excluded neonates. We sought to characterize AKI associated with cardiac surgery in neonates, determine its incidence, perioperative and postoperative risk factors, and short-term results. MATERIALS AND METHODS This retrospective study included 177 neonates who were operated on for CHD in our hospital between January 2015 and December 2019. Data of the patients were analyzed according to nKDIGO (neonatal Kidney Disease Improving Global Outcomes) and nRIFLE (neonatal Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria for evaluating AKI retrospectively. Data of groups with and without AKI were analyzed. RESULTS The average age of 177 neonates were 8.2 ± 6.1 (1-28) days. Twenty-two (12.4%) neonates had CS-AKI defined according to nKDIGO criteria. Four (2.3%) neonates reached nKDIGO stage I, 1 (0.6%) reached stage II, 17 (9.6%) reached stage III. Thirty-eight (21.5%) neonates had CS-AKI defined according to nRIFLE criteria. Twenty-four (13.6%) neonates reached nRIFLE stage risk(R), 6 (3.4%) reached stage injury(I), 8 (4.5%) reached stage failure (F). The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) in neonates was 12.5% and 21.5% for nKDIGO and nRIFLE, respectively. The percentage difference between nKDIGO and nRIFLE for AKI assessment was due to the criteria for nRIFLE stage risk(R) urine output < 1.5 mL/kg/h for 24 h. In both classifications, the duration of cardiopulmonary bypass, operation, inotropic treatment, and mechanical ventilation, length of intensive care unit (ICU), and hospital stay were significantly higher in the AKI group than those without AKI group (p˂.05). The mortality rate in the groups with AKI was found to be significantly higher (p˂.05) than in the groups without AKI. In Kappa analysis, when two classifications were compared according to AKI stages, a significant agreement was found between nKDIGO and nRIFLE classifications (p˂.05) (Kappa: 0.299). CONCLUSION AKI and mortality rates were similar between groups according to the nKDIGO and nRIFLE criteria. For early prediction of AKI and adverse outcomes, diagnostic reference intervals might be specified in more detail in neonates undergoing cardiac surgery for CHD.
Archives of the Turkish Society of Cardiology, 1997
Turkiye Klinikleri Journal of Pediatrics, 2008
300 e vo id ba zal hüc re li kar si nom sen dro mu (NBHKS)(OMIM #109400) ilk kez 1960 yı lın da G... more 300 e vo id ba zal hüc re li kar si nom sen dro mu (NBHKS)(OMIM #109400) ilk kez 1960 yı lın da Gor lin ve Goltz1 ta ra fın dan ta nım lan mış olup, ba zal hüc re li kar si nom, odon to je nik ke ra to kist ler, pal mar ve/ve ya plan tar çu kur cuk lar ve du ral kıv rım la rın ek to pik kal si fi kas yon la rı ile karak te ri ze bir sen drom dur. Oto zo mal do mi nant ge çiş li bu sen dro mun ge ni (PTCH: patc hed ge ne) kro mo zom 9q22.3 üze rin de ha ri ta lan mış tır. Bu tü mör sup re sör ge nin de ki mu tas yon lar odon to ge nez ve kar si no ge ne zi de kapsa yan ba zı gen ler de dis re gü las yo na ne den ol mak ta dır. En be lir gin bul gu er ken baş lan gıç lı ba zal hüc re li kar si nom ve man di bu ler kist ler dir. On do Kardiyak Tümör, Fötal Rabdomiyom ve Odontojenik Keratokistleri Olan Gorlin-Goltz Sendromlu Bir Olgu
Journal of Pediatric Infection, 2021
Abiotrophia defectiva is a nutritional defective streptococcus that is difficult to grow in routi... more Abiotrophia defectiva is a nutritional defective streptococcus that is difficult to grow in routine culture media, is found in the oral mucosa, gastrointestinal and urogenital system flora and is a rare cause of infective endocarditis. An 11-year-old boy with underlying operated congenital heart defect presented with prolonged fever. Abiotrophia defectiva is yielded in the blood cultures taken properly with a pre-diagnosis of infective endocarditis. Although there was no vegetation or other finding of endocarditis on echocardiography, surgery decision was made because bacteria continued to grow in the blood culture under appropriate antibiotic treatment. During surgery, it was observed that the contegrapulmonic valved conduit was severely degenerated and calcified. A new contegrapulmonic valve conduit replacement was performed. Serious complications occur more frequently in infective endocarditis caused by Abiotrophia defectiva compared to other etiogic agents of infective endocarditis. With this case, we wanted to emphasize that in Abiotrophia defectiva infective endocarditis, the possibility of antibiotic treatment failure and surgical procedure requirement is quite high.
Molecular Genetics and Metabolism, 2019
The Turkish Journal of Pediatrics, 2020
Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical rel... more Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical relevance of CAF focuses mainly on the mechanism of 'coronary steal phenomenon', which causes myocardial functional ischaemia even in the absence of stenosis. Common symptoms of this phenomenon are angina, dyspnoea during physical exertion, and heart palpitations. 2-5 The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations such as the electrocardiogram, treadmill test, echocardiography, computed tomography and coronary angiography. Bacterial endocarditis is rarely observed in patients with CAF. 6,7 Small, asymptomatic fistulae can be followed by echocardiography, while treatment of symptomatic or large asymptomatic fistulae is recommended. 2-5,8,9 Coronary angiography is required to plan
The Turkish Journal of Pediatrics, 2020
Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment... more Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short-and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. Methods. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Results. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 ± 4.9 years (range: 6 months-19 years). The mean age of the patients at the first ABV was 14.5 ± 10.6 days (range: 1-30 days) and body weight was 3.25 ± 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 ± 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 ± 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. In the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p <0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. Conclusions. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.