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Öğe Aortopulmonary artery fistula - Presenting with congestive heart failure in a patient with aortic dissection(Texas Heart Inst, 1998) Atay, Y; Can, L; Yagdi, T; Buket, SAlthough it is a rare occurrence, aortic dissections can rupture into the cardiac chambers or great vessels. A review of The English literature revealed only 3 cases of fistula between an aortic false lumen and the main pulmonary artery that were repaired successfully. in this article, we report the case of a chronic type I aortic dissection with an aortopulmonary artery fistula. The patient presented with congestive heart failure. One year earlier he had undergone aortic valve replacement. To our knowledge, this is the 4th case of a successfully repaired type I aortic dissection with rupture into the pulmonary artery and the Ist such case involving a patient who had undergone a previous cardiac operation.Öğe The combined use of pravastatin with thrombolytic agents in acute myocardial infarction: Results of clinical and angiographical follow-up(Elsevier Science Inc, 2000) Kayikcioglu, M; Turkoglu, C; Can, L; Payzin, S; Kultursay, HÖğe Diagnosis and treatment of concomitant aortic and coronary disease - A retrospective study and brief review(Texas Heart Inst, 1999) Islamoglu, F; Atay, Y; Can, L; Kara, E; Ozbaran, M; Yuksel, M; Buket, SCoronary arteriosclerosis seriously complicates the surgical treatment of aortic diseases. The aim of our retrospective study was to determine the incidence of coronary artery disease among our surgical patients in treatment for aortic dissection or aneurysm, and to determine whether coronary intervention before aortic surgery appears to affect outcomes. Between January 1993 and 1 March 1998, our center treated 253 patients for aortic dissection or aneurysm. We examined these cases retrospectively for information on diagnostic and treatment methods, both for the aortic lesions and for concomitant coronary arteriosclerosis. Aortic dissection had been detected in 86 (33.9%) patients and aortic aneurysm in 167 (66.1%). Coronary angiography was performed to search for concomitant coronary artery disease in 29 (33.8%) patients with dissection and in 112 (67.1%) patients with aneurysm; of these, 11 (12.7%) and 54 (32.3%), respectively, were found to have coronary disease. Among 43 patients with abdominal aortic aneurysm in whom coronary angiography was performed concomitant coronary disease was detected in 36 (83.7%). Coronary artery bypass surgery was performed in 10 patients who had dissection and in 30 patients who had aneurysm; percutaneous transluminal coronary angioplasty was performed in 7 patients who had aneurysm. Perioperative mortality rates in the dissection and aneurysm groups, overall, were 23.2% and 13.8%, respectively. Unfortunately the prospective, random clinical study that would be necessary to prove the case for or against preoperative coronary angiography among subsets of patients in need of aortic repair would raise ethical questions, given the strength of the information already in our possession, gathered by less formal methods. Our study reinforces existing evidence that preoperative angiography can reduce mortality and morbidity in the elective repair of aortic aneurysm, especially thoracic or abdominal aneurysm. However; angiography should not be performed routinely in cases of aortic dissection and should be withheld in cases of type A dissection.Öğe Does serum HDL-cholesterol level predict coronary bypass graft patency?(Elsevier Sci Ireland Ltd, 1999) Kayikcioglu, M; Yavuzgil, O; Can, L; Kultursay, H; Akin, M; Turkoglu, CÖğe Does statin therapy affect the recurrence of angina in patients with aortocoronary bypass grafts depending on the graft type?(W B Saunders Co Ltd, 2000) Kultursay, H; Kayikcioglu, M; Can, L; Yavuzgil, O; Payzin, S; Soydan, IÖğe Early use of pravastatin in patients with acute myocardial infarction undergoing coronary angioplasty(Taylor & Francis Ltd, 2002) Kayikcioglu, M; Can, L; Kultursay, H; Payzin, S; Turkoglu, CAim - To determine whether statin therapy initiated early in acute myocardial infarction together with thrombolytic therapy in patients with acute myocardial infarction results in clinical benefit through early plaque stabilization. Methods and results - The study population consisted of 77 patients who underwent coronary balloon angioplasty of the infarct-related artery during the first month of acute myocardial infarction. These patients belonged to the cohort of the Pravastatin Turkish Trial (PTT). Forty of them were assigned randomly to have immediate pravastatin (40 mg/day) therapy adjunctive to thrombolytic therapy regardless of serum lipid levels and received statin treatment throughout the study. Lipid levels were determined immediately after admission and before angioplasty and at the end of 6 months. Patients were re-evaluated clinically and angiographically for cardiovascular adverse events and restenosis after a 6-month follow-up period. The baseline angiographic and clinical characteristics of the two groups were similar. The incidence of angina was significantly lower in the pravastatin group (30.0%, 12 patients) compared to the control group (59.5%, 22 patients) (p = 0.018). The cumulative major adverse cardiac events in the pravastatin group were significantly lower when compared to the control group (32.5% vs. 75.6%, p = 0.0001). Conclusions - Early initiation of pravastatin therapy immediately after an acute myocardial infarction significantly decreased the frequency of major cardiac adverse events. Such early potential clinical benefits further strengthen the rationale for starting statin treatment as soon as possible after acute coronary events particularly in patients in whom invasive intervention is planned.Öğe The effect of cholesterol lowering therapy with atorvastatin on flow-mediated vasodilatation in patients with hypercholesterolaemic coronary artery disease(W B Saunders Co Ltd, 2000) Ercan, E; Gurgun, C; Ceyhan, C; Zoghi, M; Akilli, A; Payzin, S; Can, L; Akin, M; Turkoglu, CÖğe Effect of coronary balloon angioplasty on plasma soluble P-selectin levels.(Excerpta Medica Inc, 1999) Kultursay, H; Kayikcioglu, M; Can, L; Payzin, S; Akilli, A; Turkoglu, CÖğe The effect of myocardial surgical revascularization on left ventricular late potentials(Futura Publ Co, 2001) Can, L; Kayikcioglu, M; Halil, H; Kultursay, H; Evrengul, H; Kumanlioglu, K; Turkoglu, CBackground: The presence of ventricular late potentials (LP) is an important indicator for the development of ventricular tachyarrhythmias due to ischemic heart disease. The effect of myocardial revascularization on LP has remained controversial. The purpose of this study was to determine whether complete myocardial surgical revascularization (CABG) documented by myocardial perfusion scintigraphy might alter the substrate responsible for LP. Methods: Prospectively, enrolled patients undergoing elective CABG were evaluated with thallium-201 myocardial perfusion scintigraphy and signal- averaged ECG pre- and postoperatively. SAECG recordings were obtained serially: before, 48-72 hours and 3 months after CABG. LPS were defined as positive if SAECG met at least two of Comes criteria. Scintigraphies were performed pre- and 3 months postoperatively for determination of the success of revascularization. Changes observed in SAECG recordings after CABG were compared between those with and without successful revascularization. Results: CABG resulted in successful revascularization in 23 patients and was unsuccessful in 17 (no change or deterioration of the perfusion defects). Preoperative SAECG values were not different between groups except for RMS values. The incidence of LP decreased significantly postoperatively in patients with improved myocardial perfusion, whereas there were no changes in patients who did not have postoperative perfusion improvement (McNemar test, P < 0.05). Conclusions: LPs disappear following the elimination of myocardial ischemia by complete surgical revascularization. Persistence of ischemia following CABG usually results in the persistence of late potentials. The incidence of ventricular arrhythmias is expected to be unchanged in these patients and they should be reevaluated for reinterventions.Öğe Effect of pre-infarction angina on ventricular late potentials in patients with acute myocardial infarction and successful thrombolysis(Taylor & Francis Ltd, 2003) Evrengul, H; Kayikcioglu, M; Can, L; Payzin, S; Kultursay, HObjective - Pre-infarction angina is considered as a good clinical model of ischaemic preconditioning which facilitates myocardial protection. Late potentials (LP) have prognostic significance following acute myocardial infarction (AMI). It is also well established that thrombolytic therapy reduces the incidence of LP. Our aim was to evaluate the relationship between pre-infarction angina and LP in patients receiving successful thrombolytic therapy. Methods and results - We prospectively studied 55 patients presenting with AMI (<6 hours). All patients received thrombolytic therapy and were evaluated with coronary angiography at predischarge. Signal-averaged recordings (SAECG) were obtained serially prior to thrombolysis, 48 hours after and 10 days later. Pre-infarction angina was present in 14 (25%) patients. There were no significant differences between the clinical characteristics and angiographic findings of the groups. Baseline SAECG parameters of the groups were also similar. After thrombolysis, the 48(th) hour values of LAS (the duration of the terminal low amplitude signals), and both the loth day values of LAS and RMS (root mean square voltage of the last 40 ms of the QRS) were. significantly better in the pre-infarction angina group. The mean filtered QRS duration and RMS 40 values changed significantly at the 10(th) day recordings of patients with pre-infarction angina [QRS duration, 110 +/- 34 ms before to 91 +/- 11 ms after (p = 0.039); RMS 40,40 +/- 17 muV before to 50 +/- 14 muV after (p = 0.02)]. The incidence of LP significantly decreased after thrombolytic therapy in the pre-infarction angina group, however, this change was not observed in patients without angina. Conclusion - Presence of pre-infarction angina reduces the incidence of LP following thrombolysis in AMI. This might be explained by the possible beneficial effect of ischaemic preconditioning on the arrhythmogenic substrate.Öğe Effect of pre-infarction angina on ventricular late potentials in patients with acute myocardial infarction and successful thrombolysis(Taylor & Francis Ltd, 2003) Evrengul, H; Kayikcioglu, M; Can, L; Payzin, S; Kultursay, HObjective - Pre-infarction angina is considered as a good clinical model of ischaemic preconditioning which facilitates myocardial protection. Late potentials (LP) have prognostic significance following acute myocardial infarction (AMI). It is also well established that thrombolytic therapy reduces the incidence of LP. Our aim was to evaluate the relationship between pre-infarction angina and LP in patients receiving successful thrombolytic therapy. Methods and results - We prospectively studied 55 patients presenting with AMI (<6 hours). All patients received thrombolytic therapy and were evaluated with coronary angiography at predischarge. Signal-averaged recordings (SAECG) were obtained serially prior to thrombolysis, 48 hours after and 10 days later. Pre-infarction angina was present in 14 (25%) patients. There were no significant differences between the clinical characteristics and angiographic findings of the groups. Baseline SAECG parameters of the groups were also similar. After thrombolysis, the 48(th) hour values of LAS (the duration of the terminal low amplitude signals), and both the loth day values of LAS and RMS (root mean square voltage of the last 40 ms of the QRS) were. significantly better in the pre-infarction angina group. The mean filtered QRS duration and RMS 40 values changed significantly at the 10(th) day recordings of patients with pre-infarction angina [QRS duration, 110 +/- 34 ms before to 91 +/- 11 ms after (p = 0.039); RMS 40,40 +/- 17 muV before to 50 +/- 14 muV after (p = 0.02)]. The incidence of LP significantly decreased after thrombolytic therapy in the pre-infarction angina group, however, this change was not observed in patients without angina. Conclusion - Presence of pre-infarction angina reduces the incidence of LP following thrombolysis in AMI. This might be explained by the possible beneficial effect of ischaemic preconditioning on the arrhythmogenic substrate.Öğe The effect of pre-infarction angina on ventricular late potentials in patients with acute myocardial infarction receiving thrombolytic therapy(W B Saunders Co Ltd, 2000) Evrengul, H; Can, L; Kayikcioglu, M; Payzin, S; Kultursay, H; Akin, MÖğe The effect of statin therapy on exercise induced ischaemia and endothelium dependent vasodilation in patients with cardiac syndrome-X(W B Saunders Co Ltd, 2002) Kayikcioglu, M; Can, L; Payzin, S; Kultursay, H; Soydan, IÖğe The effect of statin therapy on ventricular late potentials in acute myocardial infarction(Elsevier Ireland Ltd, 2003) Kayikcioglu, M; Can, L; Evrengul, H; Payzin, S; Kultursay, HAims: To determine whether early statin therapy in acute myocardial infarction has any effect on ventricular late potentials which are considered as a noninvasive tool for evaluation of arrhythmogenic substrate. Methods and results: Study population consisted of prospectively enrolled 72 patients presenting with acute myocardial infarction (<6 h). Thirty-four of the patients were randomized to pravastatin (40 mg/day) on admission irrespective of lipid levels. All patients received thrombolytic therapy. Signal-averaged ECG recordings were obtained serially prior to thrombolytic therapy, 48 h after and 10 days later. Late potentials were defined as positive if signal-averaged ECG met at least two of Gomes criteria: filtered total QRS duration > 114 ms, root mean square voltage of the last 40 ins of the QRS <20 mV, or the duration of the terminal low (<40 mV) amplitude signals >38 ms. Changes observed in signal-averaged ECG recordings after thrombolysis were evaluated statistically with regard to statin usage. There were no significant differences between the clinical characteristics of the two randomized groups. There was a significant decrease in the rates of late potentials between the first and third signal-averaged ECG recordings after thrombolytic therapy in pravastatin group. Pravastatin group also had lower incidence of ventricular arrhythmias compared with control group (26 vs. 63%, P=0.021). The in-hospital cardiovascular event rates were also lower in statin group. Conclusion: Early use of pravastatin reduces the incidence of late potentials following thrombolytic therapy in acute myocardial infarction. Statin therapy also seems to be reducing the incidence of in-hospital ventricular arrhythmias. These beneficial effects of statins might be explained through prevention of new myocardial ischemic episodes due to early plaque stabilization or regulation of endothelial and platelet functions. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe The effect of statin therapy on ventricular late potentials in acute myocardial infarction(Elsevier Ireland Ltd, 2003) Kayikcioglu, M; Can, L; Evrengul, H; Payzin, S; Kultursay, HAims: To determine whether early statin therapy in acute myocardial infarction has any effect on ventricular late potentials which are considered as a noninvasive tool for evaluation of arrhythmogenic substrate. Methods and results: Study population consisted of prospectively enrolled 72 patients presenting with acute myocardial infarction (<6 h). Thirty-four of the patients were randomized to pravastatin (40 mg/day) on admission irrespective of lipid levels. All patients received thrombolytic therapy. Signal-averaged ECG recordings were obtained serially prior to thrombolytic therapy, 48 h after and 10 days later. Late potentials were defined as positive if signal-averaged ECG met at least two of Gomes criteria: filtered total QRS duration > 114 ms, root mean square voltage of the last 40 ins of the QRS <20 mV, or the duration of the terminal low (<40 mV) amplitude signals >38 ms. Changes observed in signal-averaged ECG recordings after thrombolysis were evaluated statistically with regard to statin usage. There were no significant differences between the clinical characteristics of the two randomized groups. There was a significant decrease in the rates of late potentials between the first and third signal-averaged ECG recordings after thrombolytic therapy in pravastatin group. Pravastatin group also had lower incidence of ventricular arrhythmias compared with control group (26 vs. 63%, P=0.021). The in-hospital cardiovascular event rates were also lower in statin group. Conclusion: Early use of pravastatin reduces the incidence of late potentials following thrombolytic therapy in acute myocardial infarction. Statin therapy also seems to be reducing the incidence of in-hospital ventricular arrhythmias. These beneficial effects of statins might be explained through prevention of new myocardial ischemic episodes due to early plaque stabilization or regulation of endothelial and platelet functions. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe The effect of type II diabetes mellitus on platelet aggregation in patients undergoing coronary angioplasty(W B Saunders Co Ltd, 2000) Sagcan, A; Kayikcioglu, M; Akin, M; Can, L; Ozerkan, F; Turkoglu, CÖğe Effects of a beta-blocker on ventricular late potentials in patients with acute-anterior myocardial infarction receiving successful thrombolytic therapy(Int Heart Journal Assoc, 2004) Evrengul, H; Dursunoglu, D; Kayikcioglu, M; Can, L; Tanriverdi, H; Kaftan, A; Kilic, MLate potentials (LP) detected on the signal-averaged electrocardiogram (SAECG) predict arrhythmic events after acute myocardial infarction (AMI). It is also well established that successful thrombolytic therapy reduces the incidence of LP. Our aim was to evaluate the effects of a beta-blocker on LP in patients receiving thrombolytic therapy. We Studied 40 patients presenting with anteroseptal AMI (< 6 hours). All patients received thrombolytic therapy and were evaluated with coronary angiography at predischarge. Eighteen patients received metoprolol (5 mg IV on admission followed by 50 mg BID). SAECG recordings were obtained serially using an ART system (40-250 Hz filter, noise < 0.5 mV) prior to thrombolytic therapy, after 48 hours and after 10 days. LP was defined as positive if the SAECG met at least 2 of the Gomes criteria. Changes observed in SAECG recordings after thrombolytic therapy were correlated with angiographic and clinical data with regard to the usage of BB. The frequencies of LP before and after thrombolytic therapy were compared with the McNemar test. There were no significant differences between the clinical characteristics, risk factors, and angiographic findings (including infarct related artery patency and LV functions) of the groups. Baseline SAECG findings were also similar between the groups. The incidence of LP significantly decreased after TT in the BB group, however, this change was not observed in patients who did not receive BB (P = 0.012, McNemar test). Beta-blockers reduce the incidence of LPs following thrombolytic therapy in patients with anterior AMI. This might be explained by the possible beneficial effect of BB on the arrhythmogenic substrate.Öğe Exercise testing induces fatal thromboembolism from mechanical mitral valve(Texas Heart Inst, 2002) Yavuzgil, O; Ozerkan, F; Gurgun, C; Zoghi, M; Can, L; Akin, MThromboembolism is still one of the most important complications of prosthetic heart valves. Embolism to a major coronary branch is rare, but acute proximal occlusions can be fatal, even when the coronary arteries are otherwise normal and intervention is rapid. We report a fatal complication of an exercise test in a patient who had a St. Jude bileaflet mitral valve. After an exercise test, a 42-year-old woman with a mechanical prosthetic valve had a severe hemodynamic collapse with acute ST segment changes. Coronary angiography showed a totally occluded left main coronary artery with TIMI grade 0 to I flow. Rapid injection of contrast material and the passage of a floppy guidewire through the thrombus restored a TIMI grade 3 flow. Angiography showed no coronary atherosclerostic involvement. Despite successful coronary reperfusion, intra-aortic balloon counterpulsation, and intensive medication, the patient died. This case demonstrates that exercise testing should be applied with great caution in patients with prosthetic valves, and only after a careful evaluation of valve function, We recommend transesophageal echocardiography prior to exercise testing in these patients.Öğe Fibrate therapy in diabetic and non-diabetic patients with combined hyperlipidemia(Elsevier Sci Ireland Ltd, 1999) Kayikcioglu, M; Ozerkan, F; Can, L; Kultursay, H; Soydan, I; Turkoglu, CÖğe Occlusion of a large coronary to pulmonary communication with coil embolization technique(Health Management Publicationsinc, 1997) Kultursay, H; Can, L; Memis, A; Akilli, A; Payzin, S; Akin, M; Altintig, A; Turkoglu, C
