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    Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting
    (Mosby, Inc, 2003) Yagdi, T; Nalbantgil, S; Ayik, F; Apaydin, A; Islamoglu, F; Posacioglu, H; Calkavur, T; Atay, Y; Buket, S
    Objective: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Methods: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group). Results: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P = .017). Duration of atrial fibrillation was 12.8 +/- 4.8 hours for the amiodarone group compared with 34.7 +/- 28.7 hours for the control group (P = .003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 +/- 19.1 beats per minute and 126.0 +/- 18.5 beats per minute, respectively, P = .016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P = .904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 +/- 1.7 days vs 7.8 +/- 2.9 days, P = .014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P = .620). Conclusions: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.
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    Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting
    (Mosby, Inc, 2003) Yagdi, T; Nalbantgil, S; Ayik, F; Apaydin, A; Islamoglu, F; Posacioglu, H; Calkavur, T; Atay, Y; Buket, S
    Objective: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Methods: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group). Results: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P = .017). Duration of atrial fibrillation was 12.8 +/- 4.8 hours for the amiodarone group compared with 34.7 +/- 28.7 hours for the control group (P = .003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 +/- 19.1 beats per minute and 126.0 +/- 18.5 beats per minute, respectively, P = .016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P = .904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 +/- 1.7 days vs 7.8 +/- 2.9 days, P = .014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P = .620). Conclusions: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.
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    Four years' experience with the Edwards-Tekna bileaflet valve prosthesis
    (I C R Publishers, 2002) Calkavur, T; Yagdi, T; Apaydin, A; Islamoglu, F; Posacioglu, H; Durmaz, I; Ozbaran, M
    Background and aim of the study: Although over 20,000 Edwards-Duromedics valves were implanted worldwide between 1982 and May 1988, use of the valve was voluntarily suspended by the manufacturer in May 1988 on the basis of reported leaflet escapes. In 1990, a modified version was introduced to the market, the Edwards-Tekna. The study aim was to evaluate the short-term outcome with this revised valve. Methods: Between 1994 and 1998, 137 patients (67 males, 70 females; mean age 36.3 +/- 9.1 years) underwent heart valve replacement with the Edwards-Tekna prosthesis. Among these patients, 72 had isolated mitral valve replacement, 59 isolated aortic valve replacement, and six double-valve replacement. Results: Early hospital mortality was 0.72% (n = 1). Follow up was 95% complete (1291136 patients discharged from hospital). Mean follow up was 24.9 +/- 10.5 months (range: 2 to 48 months); total follow up was 282.9 patient-years (pt-yr). Actuarial freedom from complications at two-year follow up and linearized incidence (%/pt-yr) of these events were: late mortality 87.8 +/- 8.5% (1.77%/pt-yr); thromboembolism 89.8 +/- 4.9% (2.12%/pt-yr); anticoagulation-related bleeding 97.8 +/- 1.5% (0.71%/pt-yr); prosthetic valve endocarditis 99.1 +/- 0.9% (0.35%/pt-yr); valve-related mortality 98.2 +/- 1.2% (0.71%/pt-yr); and valve-related morbidity and mortality 85.0 +/- 5.0% (4.24%/pt-yr). There was no structural valve failure such as leaflet escape in this series. Clinically significant hemolysis was not encountered (mean postoperative plasma LDH level 345 +/- 124 IU/l). Preoperatively, 69% of patients were in NYHA classes III/IV; at two years postoperatively 90% of survivors were in classes I/II. Conclusion: The Edwards-Tekna mechanical valve prosthesis has shown excellent overall clinical performance in the short term, though long-term data are needed to confirm its durability.
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    A giant inferoposterior true aneurysm of the left ventricle mimicking a pseudoaneurysm
    (Springer, 2006) Yavuzgil, O; Gurgun, C; Apaydin, A; Cinar, CS; Yuksel, A; Kultursay, H
    A left ventricular aneurysm (LVA) is most commonly the result of myocardial infarction, usually involving the anterior wall. A left ventricular pseudoaneurysm (LVPSA) or false aneurysm forms when cardiac rupture is contained by adherent pericardium or scar tissue. The accurate diagnosis, although difficult to establish, is an important one to make because these aneurysms are prone to rupture. In this article, we report a challenging case of a cardiac aneurysm a year after a coronary bypass operation which could not be definitively diagnosed despite of imaging with different techniques including echocardiography, coronary angiography, left ventriculography and magnetic resonance imaging (MRI). The patient underwent a second cardiac surgery, the aneurysm was resected, the mitral valve was replaced and the defect in the ventricular wall was repaired. Because of the combined diagnostic capabilities like detailed and functional pathoanatomy and aneurysmal wall characterization, MRI seems to have multiple advantages in differential diagnosis.