Researcher:
Biçer, Mehmet

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Mehmet

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    Publication
    Effect of cardiopulmonary bypass on thiol/disulfide homeostasis in congenital heart surgery
    (Bayçınar Medical Publ-Bayçınar Tıbbi Yayıncılık, 2023) Yetimakman, Ayse Filiz; Yazici, Mutlu Uysal; Kumbasar, Ulas; Alisik, Murat; Bayrakci, Benan; Erel, Ozcan; N/A; Tanyıldız, Murat; Oğuz, Sinem; Biçer, Mehmet; School of Medicine; Koç University Hospital
    Background: This study aims to investigate whether thiol/disulfide homeostasis parameters measurements could be used as a new biomarker to predict the pre-and post-cardiopulmonary bypass oxidative status of pediatric patients undergoing congenital heart surgery.Methods: A total of 40 children with congenital heart disease (17 males, 23 females; mean age: 39.6 +/- 40.0 months; range, 2 to 216 months) who underwent open-heart surgery were included. The control group consisted of 40 age-and sex-matched healthy children (18 males, 22 females; mean age: 42.8 +/- 46.6 months; range, 12 to 156 months). The patients with congenital heart disease were divided into two groups as cyanotic patients (n=18) and acyanotic patients (n=22). Thiol/disulfide parameters were compared among the cyanotic, acyanotic congenital heart disease patients, and control group preoperatively (pre-CPB). The effects of cardiopulmonary bypass on thiol/disulfide parameters, pre-CBP, immediately after cardiopulmonary bypass (post-CPB0), and 24 h after cardiopulmonary bypass (post-CPB24) were investigated.Results: The mean native and total thiol levels in the cyanotic patients were significantly lower than those in the acyanotic patients and control group (p<0.0001). The cyanotic group exhibited higher disulfide levels than the acyanotic group (p<0.01). The mean native thiol and total thiol levels significantly decreased in the post-CPB0 (p<0.0001). The mean disulfide levels significantly increased in the post-CPB0 than the pre-CPB values (p<0.001). Post-CPB24 native and total thiol levels were elevated compared to post-CPB0 (p<0.0001). The mean disulfide levels significantly increased in the post-CPB24 period than the post-CPB0 values (p<0.001). The survivor patients responded better to oxidative stress than non-survivor patients.Conclusion: Thiol/disulfide measurement is a promising biomarker in determining the pre-and post-cardiopulmonary bypass oxidative status of pediatric patients undergoing congenital heart surgery. The interpretation of thiol/disulfide levels, pre-and postoperatively, may be used in predicting mortality and outcomes of these patients earlier./ÖZ Amaç: Bu çalışmada tiyol/disülfid homeostazı parametrelerinin ölçümünün doğumsal kalp cerrahisi geçiren pediatrik hastalarda kardiyopulmoner baypas öncesi ve sonrası oksidatif durumu öngörmede yeni bir biyobelirteç olarak kullanılabilip kullanılamayacağı araştırıldı. Ça¬lış¬ma pla¬nı: Açık kalp cerrahisi yapılan doğumsal kalp hastalığı olan toplam 40 çocuk (17 erkek, 23 kız; ort. yaş: 39.6±40.0 ay; dağılım, 2-216 ay) çalışmaya alındı. Kontrol grubu yaş ve cinsiyet ile eşleştirilmiş 40 sağlıklı çocuktan (18 erkek, 22 kız; ort. yaş: 42.8±46.6 ay; dağılım, 12-156 ay) oluşuyordu. Doğumsal kalp hastalığı olan hastalar siyanotik olanlar (n=18) ve asiyonatik olanlar (n=22) olmak üzere iki gruba ayrıldı. Ameliyat öncesinde (KPB öncesi) siyanotik, asiyanotik doğumsal kalp hastalığı olan hastalar ve kontrol grubu arasında tiyol/disülfid parametreleri karşılaştırıldı. Kardiyopulmoner baypasın tiyol/disülfid parametrelerin üzerine etkileri KPB öncesi, kardiyopulmoner baypastan hemen sonra (KPB0 sonrası) ve kardiyopulmoner baypastan 24 saat sonra (KPB24 sonrası) incelendi. Bulgular: Ortalama native ve total tiyol düzeyleri siyanotik hastalarda asiyanotik hastalar ve kontrol grubuna kıyasla anlamlı düzeyde daha düşük bulundu (p<0.0001). Disülfid düzeyleri siyanotik hastalarda asiyanotik hastalara kıyasla daha yüksek idi (p<0.01). Ortalama native ve total tiyol düzeyleri KPB0 sonrasında anlamlı düzeyde azaldı (p<0.0001). Ortalama disülfid düzeyleri KPB öncesi değerlere kıyasla KPB0 sonrası dönemde anlamlı düzeyde arttı (p<0.001). KPB24 sonrası dönemde native ve total tiyol düzeyleri, KPB0 sonrasına kıyasla artış gösterdi (p<0.0001). Ortalama disülfid düzeyleri, KPB0 sonrası değerlere kıyasla KPB24 sonrası dönemde anlamlı düzeyde arttı (p<0.001). Sağkalan hastalar, kaybedilen hastalara kıyasla oksidatif strese daha iyi yanıt verdi.
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    Publication
    Second harvest of Congenital Heart Surgery Database in Türkiye: current outcomes
    (Bayçınar Medical Pub.-Bayçınar Tıbbi Yayıncılık, 2024) Erek, Ersin; Bagoze, Serdar; Yildiz, Okan; Sariosmanoglu, Nejat Osman; Yalcinba, Yusuf Kenan; Turkoz, Riza; Kutsal, Ali; Secici, Serkan; Ergun, Servet; Chadikovski, Vladimir; Arnaz, Ahmet; Koc, Murat; Korun, Oktay; Senkaya, Isik; Ozdemir, Fatih; Saritas, Bulent; Atay, Yuksel; Haydin, Sertac; Bilen, Cagatay; Onan, Ismihan S.; Tuncer, Osman N.; Citoglu, Gorkem; Dogan, Abdullah; Temur, Bahar; Ozkan, Murat; Sanoglu, C. Tayyar; N/A; Biçer, Mehmet; School of Medicine
    Background: This second harvest of the Congenital Heart Surgery Database intended to compare current results with international databases. Methods: This retrospective study examined a total of 4007 congenital heart surgery procedures from 15 centers in the Congenital Heart Surgery Database between January 2018 and January 2023. International diagnostic and procedural codes were used for data entry. STAT (Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery) mortality scores and categories were used for comparison of the data. Surgical priority status was modified from American Society of Anesthesiologist guidelines. Centers that sent more than 5 cases to the database were included to the study. Results: Cardiopulmonary bypass and cardioplegic arrest were performed in 2,983 (74.4%) procedures. General risk factors were present in 22.6% of the patients, such as genetic anomaly, syndrome, or prematurity. Overall, 18.9% of the patients had preoperative risk factors (e.g., mechanical ventilation, renal failure, and sepsis). Of the procedures, 610 (15.2%) were performed on neonates, 1,450 (36.2%) on infants, 1,803 (45%) on children, and 144 (3.6%) on adults. The operative timing was elective in 56.5% of the patients, 34.4% were urgent, 8% were emergent, and 1.1% were rescue procedures. Extracorporeal membrane oxygenation support was used in 163 (4%) patients, with a 34.3% survival rate. Overall mortality in this series was 6.7% (n=271). Risk for mortality was higher in patients with general risk factors, such as prematurity, low birth weight neonates, and heterotaxy syndrome. Mortality for patients with preoperative mechanical ventilation was 17.5%. Pulmonary hypertension and preoperative circulatory shock had 11.6% and 10% mortality rates, respectively. Mortality for patients who had no preoperative risk factor was 3.9%. Neonates had the highest mortality rate (20.5%). Intensive care unit and hospital stay time for neonates (median of 17.8 days and 24.8 days, respectively) were also higher than the other age groups. Infants had 6.2% mortality. Hospital mortality was 2.8% for children and 3.5% for adults. Mortality rate was 2.8% for elective cases. Observed mortality rates were higher than expected in the fourth and fifth categories of the STAT system (observed, 14.8% and 51.9%; expected, 9.9% and 23.1%; respectively). Conclusion: For the first time, outcomes of congenital heart surgery in T & uuml;rkiye could be compared to the current world experience with this multicenter database study. Increased mortality rate of neonatal and complex heart operations could be delineated as areas that need improvement. The Congenital Heart Surgery Database has great potential for quality improvement of congenital heart surgery in T & uuml;rkiye. In the long term, participation of more centers in the database may allow more accurate risk adjustment./ ÖZ Amaç: Çocuk Kalp Cerrahisi Veritabanı'nın bu ikinci hasadında, mevcut sonuçların uluslararası veritabanlarıyla karşılaştırılması amaçlandı. Çalışma planı: Ocak 2018 ile Ocak 2023 tarihleri arasında yapılan bu retrospektif çalışmada, Çocuk Kalp Cerrahisi Veritabanında bulunan 15 merkezden toplam 4007 konjenital kalp cerrahisi işlemi incelendi. Veri girişi için uluslararası tanı ve işlem kodları, verilerin karşılaştırlması için STAT (Göğüs Cerrahları Derneği ve Avrupa Kardiyotorasik Cerrahi Birliği) mortalite skor ve kategorileri kullanıldı. Cerrahi öncelik durumu, Amerikan Anesteziyoloji Birliği kılavuzundan modifiye edildi. Veritabanına 5 ve üzerinde olgu gönderen merkezler çalışmaya alındı. Bulgular: İşlemlerin 2,983’ünde (%74.4) kardiyopulmoner baypas ve kardiyoplejik arrest uygulandı. Hastaların %22.6’sında genetik anomali, sendrom veya prematürite gibi genel risk faktörleri mevcuttu. Genele bakıldığında, ameliyat öncesi risk faktörleri (örn., mekanik ventilasyon, böbrek yetersizliği ve sepsis) %18.9 hastada vardı. İşlemlerin 610'u (%15.2) yenidoğanlara, 1,450'si (%36.2) bebeklere, 1,803'ü (%45) çocuklara ve 144'ü (%3.6) yetişkinlere uygulandı. Ameliyat zamanlaması hastaların %56.5’inde elektif, %34.4’ünde erken, %8’inde acil ve %1.1’inde ise kurtarıcı özellikte idi. Hastaların 163’ünde (%4) ekstrakorporeal membran oksijenasyonu desteği kullanıldı ve bu hastalarda sağkalım oranı %34.3 idi. Bu çalışmada genel mortalite %6.7 (n=271) idi. Prematürite, düşük doğum ağırlıklı yenidoğanlar ve heterotaksi sendromu gibi genel risk faktörlerine sahip hastalarda mortalite riski daha yüksekti. Ameliyat öncesi mekanik ventilasyon uygulanan hastalarda mortalite %17.5 idi. Pulmoner hipertansiyon ve ameliyat öncesi sirkülatuar şok sırasıyla %11.6 ve %10 mortalite oranlarına sahipti. Ameliyat öncesi risk faktörleri olmayan hastalarda mortalite %3.9 idi. Yenidoğan hastalar en yüksek mortalite oranına (%20.5) sahipti. Yenidoğanların yoğun bakım ve hastane kalış süreleri de (sırasıyla, ortanca 17.8 gün ve 24.8 gün) diğer yaş gruplarına kıyasla yüksek bulundu. Bebeklerin mortalitesi %6.2 idi. Hastane mortalitesi çocuklar için %2.8 ve yetişkinler için %3.5 idi. Elektif ameliyatlarda mortalite oranı %2.8 idi. STAT sisteminin dördüncü ve beşinci kategorilerinde gözlenen mortalite oranları beklenden daha yüksekti (sırasıyla; gözlenen %14.8 ve %51.9; beklenen %9.9 ve %23.1). So¬nuç: Bu çok merkezli veritabanı çalışması ile ilk kez Türkiye’deki konjenital kalp cerrahisi sonuçları güncel dünya deneyimleri ile karşılaştırılabildi. Yenidoğan ve kompleks kalp cerrahisindeki artmış mortalite, iyileştirilmesi gereken noktalar olarak açığa çıkarıldı. Türkiye’de konjenital kalp cerrahisinin kalitesinin iyileştirmesi için Çocuk Kalp Cerrahisi Veritabanı büyük potansiyele sahiptir. Uzun vadede veritabanına daha fazla merkezin katılımı ile daha doğru risk belirlenmesi mümkün olabilir.
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    PublicationOpen Access
    Approach to red blood cell transfusions in post-operative congenital heart disease surgery patients: when to stop?
    (Cambridge Univ Press, 2023) Tanyıldız, Murat; Güngörmüş, Asiye; Erden, Selin Ece; Özden, Ömer; Biçer, Mehmet; Akçevin, Atıf; Ödemiş, Ender; School of Medicine; Koç University Hospital
    Background: The best transfusion approach for CHD surgery is controversial. Studies suggest two strategies: liberal (haemoglobin <= 9.5 g/dL) and restrictive (waiting for transfusion until haemoglobin <= 7.0 g/dL if the patient is stable). Here we compare liberal and restrictive transfusion in post-operative CHD patients in a cardiac intensive care unit.Methods: Retrospective analysis was conducted on CHD patients who received liberal transfusion (2019-2021, n=53) and restrictive transfusion (2021-2022, n=43).Results: The two groups were similar in terms of age, gender, Paediatric Risk of Mortality-3 score, Paediatric Logistic Organ Dysfunction-2 score, Risk Adjustment for Congenital Heart Surgery-1 score, cardiopulmonary bypass time, vasoactive inotropic score, total fluid balance, mechanical ventilation duration, length of cardiac intensive care unit stay, and mortality. The liberal transfusion group had a higher pre-operative haemoglobin level than the restrictive group (p < 0.05), with no differences in pre-operative anaemia. Regarding the minimum and maximum post-operative haemoglobin levels during a cardiac intensive care unit stay, the liberal group had higher haemoglobin levels in both cases (p<0.01 and p=0.019, respectively). The number of red blood cell transfusions received by the liberal group was higher than that of the restrictive group (p < 0.001). There were no differences between the two groups regarding lactate levels at the time of and after red blood cell transfusion. The incidence of bleeding, re-operation, acute kidney injury, dialysis, sepsis, and systemic inflammatory response syndrome was similar.Conclusions: Restrictive transfusion may be preferable over liberal transfusion. Achieving similar outcomes with restrictive transfusions may provide promising evidence for future studies.
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    PublicationOpen Access
    Comparison of pericardial and prosthetic rings for mitral repair: are pericardial rings durable in the mid- to long-term follow up?
    (Forum Multimedia Publishing LLC, 2023) Kehlibar, Tamer; Elibol, Ahmet; Günay, Rafet; Ceylan, Levent; Yılmaz, Mehmet; Ketenci, Bulend; Biçer, Mehmet; Kozan, Şima; Faculty Member; Undergraduate Student; School of Medicine; School of Medicine; 310599; N/A
    Background: While prosthetic rings are commonly used for mitral valve repairs, autologous pericardium is an alternative ring material that can be used in these procedures. In this report, we aim to present a comparison of two types of rings used for mitral repair. Methods: Between January 2005 and January 2009, 107 patients who underwent mitral valve repair surgery were analyzed. Patients were divided into two groups, according to the type of ring that was used for mitral annular stabilization. Glutaraldehyde-treated pericardial rings were used for 31 patients (group 1), whereas prosthetic rings were used for 76 patients (group 2). Survival, freedom from reoperation, recurrent mitral regurgitation, and the effects of rheumatic mitral disease on these parameters were evaluated and compared for both groups. Results: Follow-up time for our cohort was 4.24±0.4 years. There were four and seven late mortalities in groups 1 and 2, respectively, and five reoperations in each group. There was no significant difference between the groups, in terms of survival, freedom from reoperation, and recurrent mitral regurgitation (log-rank analyses for both groups were P = 0.777, P = 0.346, and P = 0.781, respectively). There was no significant difference in freedom from reoperation and recurrent mitral regurgitation for both groups, in terms of underlying rheumatic valvular disease and other types of pathology. Conclusion: Pericardial ring annuloplasty shows to be a considerable alternative technique for mitral valve repair procedures in the mid- to long-term follow up. Rheumatic mitral valves had poor outcomes, when compared with other types of structural valvular pathologies in cases where pericardial rings were used in the repair procedure.
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    PublicationOpen Access
    A rare complication after an interventional procedure using the common carotid: carotid pseudoaneurysm in an infant
    (Cambridge University Press (CUP), 2023) N/A; Biçer, Mehmet; Kızılkaya, Mete Han; Ödemiş, Ender; Gündoğmuş, Cemal Aydin; Faculty Member; Doctor; Faculty Member; Doctor; School of Medicine; N/A; School of Medicine; N/A; Koç University Hospital; 310599; N/A; 194545; N/A
    The carotid artery is a valuable vascular access that can be used in patients who have undergone repetitive interventional and surgical procedures and premature babies. In the past, cut-down was used but nowadays, mostly the procedure is performed under ultrasonographic guidance. Complications such as bleeding, haematoma, and pseudoaneurysm may occur when the carotid artery is used as a vascular access for the procedures such as aortic balloon valvuloplasty, coarctation balloon angioplasty, or after interventional or surgical treatments to the carotid artery. Although pseudoaneurysm is very rare, prompt diagnosis and accurate treatment planning are life-saving. In this article, the diagnosis and treatment of pseudoaneurysm in the left common carotid after transcatheter coarctation balloon angioplasty in a 6-month-old infant will be presented.
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    PublicationOpen Access
    Fontan completion of a 10-year-old Kawashima patient with extensive arteriovenous malformations: consideration for a lobectomy
    (Cambridge University Press (CUP), 2023) N/A; Biçer, Mehmet; Kozan, Şima; Kızılkaya, Mete Han; Faculty Member; Undergraduate Student; Doctor; School of Medicine; School of Medicine; N/A; Koç University Hospital; 310599; N/A; N/A
    A significant contributing factor to the progression of late cyanosis in individuals undergoing Kawashima operation is pulmonary arteriovenous malformations. Following the Fontan procedure, arteriovenous malformations may regress. However, in cases with extensive malformations causing severe cyanosis, lobectomy can also be a possible treatment approach. Thereby, we present our two-step treatment strategy in a late Fontan completion complicated by arteriovenous malformations in a Kawashima patient.
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    PublicationOpen Access
    Surgical correction of a ventricular septal defect in a child with spinal muscular atrophy type 2 treated with nusinersen sodium: a case report
    (BioMed Central Ltd, 2023) Öztürk, Figen; Akçay, Ayfer Arduç; Biçer, Mehmet; Kozan, Şima; Faculty Member; Faculty Member; Undergraduate Student; School of Medicine; School of Medicine; School of Medicine; 162811; 310599; N/A
    Introduction: Spinal muscular atrophy (SMA) is a severe, inherited neuromuscular disorder characterized by progressive muscle weakness and atrophy. Cardiac pathology co-existence is reported more frequently in the severely affected patient groups. Structural heart anomalies, mainly septal, and outflow tract defects are commonly observed pathologies. Case presentation: We herein report the case of a 23 days-old female patient with the diagnosis of spinal muscular atrophy type 2 complicated with structural heart defects. Successful pulmonary banding, and at the age of 17 months, subsequent surgical atrial and ventricular septal defect closure were performed on our patient who was under treatment of Nusinersen Sodium. Post-operative recovery was uncomplicated. Cardiac assessments were normal, and the patient was neurologically improving in her recent follow-up. Conclusion: In the literature, there are no reported cases of successful surgical repair of heart defects in spinal muscular atrophy patients. These patients can be perceived as risky surgical candidates with suboptimal postoperative recovery given the unfavorable disease prognosis of SMA in untreated patients. We report our promising experience with a SMA type 2 patient undergoing a disease-modifying medical treatment. The SMA patients under treatment may be potential candidates for successful surgical cardiac correction given their overall improved prognosis. © 2023, The Author(s).
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    PublicationOpen Access
    Outcomes of Norwood procedure with hypoplastic left heart syndrome: our 12-year single-center experience
    (Bayçınar Tıbbi Yayıncılık ve Reklam Hizmetleri, 2022) Özdemir, Fatih; Korun, Oktay; Dedemoğlu, Mehmet; Çiçek, Murat; Yurdakok, Okan; Altın, Hüsnü Fırat; Yılmaz, Emine Hekim; Yurtseven, Nurgül; Aydemir, Numan Ali; Sasmazel, Ahmet; Biçer, Mehmet; Koç University Hospital
    Background: in this study, we aimed to analyze the predictors and risk factors of mortality in patients who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome. Methods: between January 2009 and December 2020, a total of 139 patients (95 males, 44 females) who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome in our center were retrospectively analyzed. Results: the median birth weight was 3,200 (range, 3,000 to 3,350) g and the median age at the time of operation was seven (range, 5 to 10) days. Pulmonary flow was achieved with a Sano shunt in the majority (72%) of patients. Survival rate was 41% after the first stage. Reoperation for bleeding (p=0.017), reoperation for residual lesion (p=0.011), and postoperative peak lactate level (p=0.029), were associated with in-hospital mortality. Nineteen (33%) of 57 patients died before the second stage. Thirty-three (58%) patients underwent second stage, and survival after the second stage was 94%. Thirteen patients underwent third stage, and survival after the third stage was 85%. Estimated probability of survival at six months, and one, two, three, and four years were 33%, 33%, 25%, 25%, and 22% respectively. Conclusion: hospital and inter-stage mortality rates are still high and this seems to be the most challenging period in term of survival efforts of the patients with hypoplastic left heart syndrome. Early recognition and reintervention of anatomical residual defects, close follow-up in the inter-stage period, and the accumulation of multidisciplinary experience may help to improve the results to acceptable limits. / Amaç: bu çalışmada, hipoplastik sol kalp sendromu tanısıyla Norwood I işlemi uygulanan hastalarda mortalitenin öngörücüleri ve risk faktörleri incelendi. Ça¬lış¬ma pla¬nı: Ocak 2009 ve Aralık 2020 tarihleri arasında merkezimizde hipoplastik sol kalp sendromu tanısıyla Norwood I işlemi uygulanan toplam 139 hasta (95 erkek, 44 kadın) retrospektif olarak incelendi. Bulgular: medyan doğum ağırlığı 3200 (dağılım, 3000-3350) g ve ameliyat sırasında medyan yaş yedi (dağılım, 5-10) gün idi. Hastaların büyük kısmında (%72) pulmoner akım, Sano şant ile sağlandı. İlk aşama sonrası sağkalım %41 idi. Kanama nedeniyle tekrar ameliyat (p=0.017), rezidü anatomik lezyon nedeniyle tekrar ameliyat (p=0.011) ve ameliyat sonrası birinci gün pik laktat seviyesi (p=0.029) hastane mortalitesi ile ilişkili idi. Taburcu edilen 57 hastanın 19’u (%33) ikinci aşamaya ulaşamadan kaybedildi. Otuz üç (%58) hastaya ikinci aşama ameliyatı uygulandı ve ikinci aşama sonrası sağkalım %94 idi. On üç hastaya üçüncü aşama ameliyatı uygulandı ve üçüncü aşama sonrası sağkalım %85 idi. Altı ay ve birinci, ikinci, üçüncü ve dördüncü yılda tahmini sağkalım olasılığı sırasıyla %33, %33, %25, %25 ve %22 idi. So¬nuç: hastane ve aşamalar arası mortalite oranları halen yüksek olup, hipoplastik sol kalp sendromu tanılı hastaların sağkalma çabalarındaki en zorlayıcı zaman dilimi olarak görünmektedir. Anatomik rezidü defektlerin erken tanılanması ve erken yeniden girişim yapılması, aşamalar arası dönemde yakın takip ve multidisipliner birikim ve tecrübe sonuçların kabul edilebilir seviyelere ulaşmasına yardım edebilir.
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    PublicationOpen Access
    Surgical management of cardiac cystic echinococcosis in a pediatric patient: a case report
    (Oxford University Press (OUP), 2022) Altın, H.F.; Aydemir, N.A.; Biçer, Mehmet; Kozan, Şima; School of Medicine; Koç University Hospital
    Cystic echinococcosis, a zoonotic parasitic disease, is endemic to many countries worldwide. This slowly progressing disease is seen rarely in the paediatric age group. In terms of cyst localization, cardiac involvement is infrequent. We report the case of a successful surgical and medical management of a paediatric hydatid disease patient with involvement of the heart.