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Öğe Bilateral Spontaneous and Isolated Dissection of the External Iliac Arteries: Report of A Case(2005) Engin C.; Calkavur T.; Apaydin A.Z.; Durmaz I.Spontaneous dissection of the external iliac artery without involvement of the aorta is extremely rare, especially, if bilateral. We report a case of a 41 year-old man complaining of sudden onset left lower limb and groin pain. Digital subtraction angiography showed dissection of both external iliac arteries. Patient was initially managed with medical treatment consisting of heparin and ß blocker. One week later his symptoms worsened. Endovascular treatment was not deemed appropriate since the dissection involved long segments of both arteries. The patient underwent aortobifemoral bypass by using a Dacron Y graft and remained free of symptoms with good distal pulses 2 months after surgery. To the best of our knowledge, this is the second reported case of bilateral and spontaneous external iliac artery dissection. © 2005 Elsevier Ltd. All rights reserved.Öğe Composite graft endocarditis: Repair with a mechanical prosthesis(2004) Apaydin A.Z.; Posacioglu H.; Islamoglu F.; Degirmemiciler K.; Durmaz I.We report the case of a 64-year-old man who developed a mediastinal pseudoaneurysm due to severe endocarditis, 2 years after aortic root replacement with a prosthetic composite graft containing a mechanical valve. After a short period of stabilization and antibiotic therapy, the patient underwent surgery. The coronary buttons and the sewing ring of the composite graft were found to be detached from the graft and the annulus, respectively. Re-replacement with a prosthetic composite graft (Dacron graft with a mechanical valve) by the Cabrol procedure was performed. Although the homograft is considered by many surgeons to be the best graft for aortic root replacement, the synthetic composite graft can also be used to treat composite graft endocarditis successfully. The technical aspects of homograft versus synthetic aortic root replacement in patients with endocarditis are discussed briefly.Öğe Continuous retrograde cerebral perfusion supplies substrates for brain metabolism during hypothermic circulatory arrest(1995) Buket S.; Alayunt A.L.P.; Discigil B.; Apaydin A.; Yuksel M.; Durmaz I.Ten patients underwent replacement of ascending aorta and/or aortic arch with aneurysm or dissection, using hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP). RCP was administered through the superior vena cava cannula continuously during HCA (15°C to 20°C). Mean HCA time was 32 minutes (range, 18-45 minutes). To assess the metabolic changes during RCP, blood samples were taken from carotid arteries and the superior vena cava cannula simultaneously, five minutes after the onset and five minutes prior to termination of continuous retrograde cerebral perfusion (CRCP) for analysis of blood gas and glucose level. One patient died intraoperatively due to left ventricular failure. Nine patients survived their operations and all except one with stroke due to partial intimal flap obstruction of innominate artery awoke neurologically intact within four to six hours. One patient died on the postoperative fifth day due to septic shock following resection of ischaemic bowel due to dissection involving the mesenteric artery. Oxygen saturation, pH and glucose level were all found to be lower in blood back-bleeding from the carotid arteries than in blood perfused through the superior vena cava cannula at all sampling times during HCA and CRCP (p < 0.05). Although oxygen and glucose extraction is not only from brain tissue, these data demonstrate the efficacy of CRCP in supplying substrates for brain protection. CRCP is a reliable method as an adjunct to HCA for brain protection. © 1995, Sage Publications. All rights reserved.Öğe Coronary artery bypass re-operations: basic principles [Koroner bypass reoperasynolari: temel prensipler.](2001) Yagdi T.; Calkavur T.; Durmaz I.Mortality and major complications during primary coronary artery bypass operation has decreased substantially during the past 20 years. However, patients undergoing reoperative myocardial revascularization still face markedly elevated perioperative mortality and morbidity. On the other hand, the incidence of reoperative coronary bypass surgery continues to increase. Aggressive perioperative care and optimal myocardial protection is mandatory in these patients. In this article we reviewed the patient profiles, indications for operation, operative techniques and their impact on the surgical results for patients undergoing reoperative coronary artery bypass surgery.Öğe Öğe Detachment of the mitral valve anterior leaflet: As a complication of aortic valve replacement(2006) Islamoglu F.; Apaydin A.Z.; Degirmenciler K.; Gurgun C.; Durmaz I.Mitral regurgitation after aortic valve replacement is generally reported as a complication of a Manouguian's procedure for annulus enlargement. However, even if no annular enlargement procedure is performed, this complication may be encountered after isolated aortic valve replacement because of either extensive decalcification of the aortic annulus or progressive tension on the anterior leaflet of the mitral valve, caused by aortic valve sutures placed adjacent to firm or heavily calcified valve tissue. Routine transthoracic echocardiography may be inadequate for diagnosis of this condition; transesophageal echocardiography should be used both for preoperative diagnosis and for intraoperative management. We report the case of a patient who had severe mitral regurgitation that occurred after aortic valve replacement with a mechanical valve. © 2006 by the Texas Heart® Institute.Öğe Effect of pulsatile flow during cardiopulmonary bypass on thyroid hormone metabolism(1994) Buket S.; Alayunt A.; Ozbaran M.; Hamulu A.; Discigil B.; Cetindag B.; Ozkilic H.; Balkan Z.; Bilkay O.; Durmaz I.Changes in thyroid hormone levels during and after cardiopulmonary bypass (CPB) are well documented. However, little is known about the effects of pulsatile flow during CPB on thyroid hormone metabolism. To examine the effect of flow pattern, a prospective study was carried out using 30 patients undergoing coronary artery bypass grafting. Fifteen patients had pulsatile flow during CPB and 15, nonpulsatile flow. Serum samples were obtained preoperatively, during bypass, and at 2 and 24 hours postoperatively. Thyroid-stimulating hormone, thyroxine (T4), triiodothyronine (T3), free T4, and free T3 levels were measured by radioimmunoassay. All measured hormone levels except free T4 and thyroid-stimulating hormone decreased after the initiation of CPB. There were no differences in preoperative values between the two groups. However, levels of T3 and free T3 during and after CPB showed a significant difference between the two groups, with a smaller decrease in patients in whom pulsatile flow was used during bypass (p < 0.05). Thyroxine, and thyroid-stimulating hormone free T4 values showed no difference between the two groups at any sampling time. These data provide support for the use of pulsatile flow during CPB to establish a more physiologic state and maintain better thyroid hormone metabolism. © 1994.Öğe Effects of pleurotomy on respiratory sequelae after internal mammary artery harvesting(2006) Iyem H.; Islamoglu F.; Yagdi T.; Sargin M.; Berber O.; Hamulu A.; Buket S.; Durmaz I.The preservation of pleural integrity during mammary artery harvesting may decrease atelectasis and pleural effusion during the postoperative period. We designed this retrospective study to evaluate the effects on postoperative pulmonary function of pleural integrity versus opened pleura, in patients who receive a left internal mammary artery graft. The study group consisted of 1,141 patients who underwent elective coronary artery bypass grafting. The patients were retrospectively evaluated and divided into 2 groups: those who underwent internal mammary artery harvesting with opened pleura (n=873) or with pleural integrity (n=268). To monitor pleural effusion and atelectasis, chest radiography was performed routinely 1 day before operation and on the 2nd, 5th, and 7th postoperative days. The preoperative, after extubation, and 1st postoperative day values of partial oxygen pressure (PaO2), partial carbon dioxide pressure (PaCO2), and oxygen (O2) saturation were recorded for comparison, as was the hematocrit. The mean age of the patients was 57.4 ±8.81 years. There were no significant differences between the groups in mean values of PaO2, PaCO2, O 2 saturation, and hematocrit after extubation or on the 1st postoperative day. Atelectasis on the 5th and 7th postoperative days, pleural effusion on the 2nd, 5th, and 7th days, and postoperative bleeding were significantly less in the group with preserved pleural integrity. We showed that preservation of pleural integrity during internal mammary artery harvesting decreases postoperative bleeding, pleural effusion, and atelectasis. We conclude that preservation of pleural integrity, when possible, can decrease these postoperative complications of coronary artery bypass grafting. © 2006 by the Texas Heart® Institute.Öğe Endoaneurysmorrhaphy for left ventricular aneurysm: Follow-up in 69 patients(1996) Hamulu A.; Discigil B.; Özbaran M.; Atay Y.; Yagdi T.; Buket S.; Yüksel M.; Durmaz I.We reviewed the cases of 69 consecutive patients who underwent physiologic reconstruction of the left ventricular cavity with an endoventricular patch (endoaneurysmorrhaphy) after aneurysmectomy. Eight patients had isolated endoaneurysmorrhaphy, 60 patients had concomitant coronary artery bypass grafting, and 1 patient had concomitant closure of an atrial septal defect The primary indications for operation were angina pectoris (New York Heart Association functional class I or II) in 42 patients and dyspnea (functional class III or IV) in 27 patients The preoperative left ventricular election fraction evaluated with ventriculography was 28.95% ± 7.27% (mean ± standard error of the mean) The global perioperative mortality rate was 2.8%. Total follow-up was 139.3 patient-years. The late mortality rate was 4.3% per patient-year. A marked increase was found in the mean postoperative left ventricular ejection fraction of the patients: 41.91% ± 11.83%. Survivors were interviewed in person, their functional status was class I or II in 58 patients and class III in 3 patients. We conclude that left ventricular endoaneurysmorrhaphy results in satisfactory functional improvement and can be performed with relatively low early and late mortality rates.Öğe A gold standard method for early detection of transplant vasculopathy after heart transplantation: Intravascular ultrasound [Kalp transplantasyonu sonrasi transplant vaskülopati erken tanisinda altin standart: İntravasküler ultrason](2008) Saygi S.; Zoghi M.; Nalbantgil S.; Yagdi T.; Akin M.; Özbaran M.; Durmaz I.[No abstract available]Öğe Indicators of mortality in patients who are placed on the heart transplant waiting list because of end-stage heart failure [Son dönem kalp yetersizligi nedeniyle kalp nakli bekleme listesine alinan hastalarda mortalite belirleyicileri](2005) Duygu H.; Zoghi M.; Nalbantgil S.; Yagdi T.; Akin M.; Özbaran M.; Durmaz I.Objectives: This study was designed to compare clinical, electrocardiographic, echocardiographic, and hemodynamic features of patients with end-stage cardiac failure, who died or were alive while on the heart transplant waiting list. Study design: Sixty patients (47 men, 11 women; mean age 56±11 years) who were on the waiting list were studied in two groups. Group I included those who died (n=26; 17 men, 9 women; mean age 44±17 years) and group II included those who were alive (n=34; 30 men, 4 women; mean age 46±5 years) while waiting for a suitable donor. The two groups were compared with regard to demographic and clinical (United Network for Organ Sharing - UNOS - status) characteristics, medical therapies, risk factors for coronary artery disease, electrocardiographic (QT dispersion, QRS duration) and echocardiographic findings, and hemodynamic parameters. Results: No significant differences existed between the two groups with regard to age, risk factors for atherosclerosis, atrial fibrillation, etiologies of heart failure, and the cardiac index. However, the following parameters differed significantly in group I: the number of female patients (p=0.04); the number of patients with IB status according to the UNOS criteria (p=0.01); both the QT dispersion interval and corrected QT dispersion (p<0.001); right ventricular ejection fraction (p=0.002); pulmonary artery systolic pressure (p=0.002) and right ventricular end-diastolic diameter (p=0.01); and transpulmonary gradient (p<0.03). Conclusion: Consideration of significant determinants of mortality in patients awaiting heart transplantation may contribute to decreases in mortality due to heart failure.Öğe Neoplastic diseases after heart transplantation: Clinical experience and review of the literature [Kalp transplantasyonu sonrasindaki neoplastik hastaliklar: Klinik deneyim ve literatürün gözden geçirilmesi](2004) Yagdi T.; Engin Ç.; Nalbantgil S.; Nart D.; Hamulu A.; Durmaz I.; Özbaran M.Increased risk of malignancy is a well-known complication of heart transplantation. In this report the incidence and the clinical presentation of post-transplant malignancy were evaluated. Between February 1998 and March 2003, 27 patients underwent heart transplantation. Heart transplantation recipients with more than 2 months follow-up were investigated for neoplastic disorders. Neoplastic diseases developed in three of 22 patients (13.6%) who survived more than 2 months. Post-transplant lymphoproliferative disease in 2 patients and Kaposi's sarcoma in 1 patient were the underlying malignancies. Mean age at transplantation was 51 years. The median time between transplantation and detection of a malignancy was 14 months with a range of 2 to 30 months. Macroscopic involvement of the allograft by lymphoma occurred in one patient. The diagnosis was made at postmortem examination in this patient. The other two patients have no evidence of tumor recurrence after treatment at follow-up. Although the majority of post-transplant tumours occur after a relatively long period of follow-up, some malignancies, especially lymphoproliferative disorders, may appear in the early post-transplant period.Öğe Open surgical technique for thoracic and thoraco-abdominal aortic aneurysms and aortic dissections(1998) Buket S.; Tokat Y.; Alayunt A.; Atay Y.; Apaydin A.; Calkavur T.; Durmaz I.Between June 1994 and August 1995, 15 patients were operated on for thoracic and thoraco-abdominal aortic aneurysms in our clinic. The open technique was used in all patients. In three patients, aortocoronary bypass grafting was carried out before aneurysm surgery. The mean spinal cord ischaemia time was 20 minutes (range, 8-38 minutes) and the mean visceral ischaemia time was 31 minutes (range, 16-50 minutes). There was no paraplegia or oliguric renal failure as a postoperative complication. Two patients died, one as a result of duodenal necrosis and sepsis in the early postoperative period, the other of unknown causes. The other 13 patients were followed up for between one and 13 months. One patient had an anastomotic false aneurysm repair two months after surgery. In conclusion, surgery can be performed safely and with acceptable mortality in patients with thoracic and thoraco-abdominal aortic aneurysms. Open surgical technique decreases the chance of the postoperative development of paraplegia and acute renal failure and increases the success of the operation.Öğe Predictors of outcome after coronary artery bypass grafting in patients older than 75 years of age(2003) Islamoglu F.; Reyhanoglu H.; Berber Ö.; Özbaran M.; Buket S.; Yüksel M.; Telli A.; Durmaz I.Background: This study was designed to identify risk factors affecting mortality and morbidity in patients older than 75 years who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Material/Methods: The preoperative, perioperative, and postoperative data of 116 patients older than 75 years who underwent isolated CABG from January 1997 through April 2002 were evaluated retrospectively, peoperatively, 82 patients (70.7%) were in CCS class III-IV and 65 (56%) were in NYHA class III-IV. Besides mortality, morbidity and survival rates, the statistical significance of predictors of outcome were investigated. Results: Overall mortality and hospital mortality rates were 12.9% (15 patients) and 4.3%, (5 patients), respectively. Postoperative complications were observed in 56 patients (48.3%). In 25.1±17.6 months of follow-up, 96 (86.5%) and 101 (91%) of the surviving 111 patients (95.7%) were in NYHA class I and CCS class I, respectively. Prolonged cross-clamp time (>50 min) (p=0.018), COPD (p=0.028), and emergency operation (p=0.001) were found to be the determinants of postoperative complications. The cumulative 5-year survival rate was 77.2±0.8%. Conclusions: Elective CABG in older patients with shorter bypass and cross-clamp times, after the management of comorbid diseaes, such as COPD, is a safe procedure with low mortality and morbidity rates, showing postoperative improvements in functional capacity and angina class.Öğe Predictors of outcome after coronary bypass surgery in patients with left ventricular dysfunction(2002) Islamoglu F.; Apaydin A.Z.; Özbaran M.; Yüksel M.; Telli A.; Durmaz I.Objective: The aim of this study was to determine the risk factors affecting the mortality and morbidity after coronary artery bypass grafting (CABG) in patients with LV dysfunction and without any viability assessment. Methods: The preoperative, perioperative, and postoperative early and mid-term follow-up data of 252 patients with left ventricular ejection fraction (LVEF) of ?30% who underwent isolated CABG from 1995 through 2000, were evaluated. No preoperative viability study was performed for patient selection. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. As preoperatively, 229 (90.87%) patients were in NYHA class III or IV, and the mean LVEF was 26.58±3.66%. Results: Overall mortality and late mortality rates were 16.27% and 5.16%, respectively. Postoperative complications were observed in 61 (24.21%) patients. During 49.06±15.17 months of follow-up, 185 (93.43%) of 198 (78.57%) survived patients were in NYHA class I or II and the mean LVEF was 39.64%±5.68%. Advanced age, diabetes, hypertension, cross-clamp time >60 min, bypass time>120 min, severity of angina and functional classes (class III-IV of NYHA and CCS) were found to be the determinants of mortality. However, by multivariate analysis only older age and class III-IV of NYHA and CCS were detected as predictors of mortality. Conclusion: The low mortality and morbidity rates as well as postoperative improvements in functional capacity and in LVEF support the use of CABG without the need of any viability assessment in patients with left ventricular dysfunction. Advanced age, severe angina and functional symptom status seem to be the predictors of poor prognosis in these patients after CABG.Öğe Quality of life and functional status in congestive heart failure [Kalp yetersizliginde yaşam kalitesi ve fonksiyonel durum](2006) Karapolat H.; Durmaz B.; Nalbantgil S.; Durmaz I.Objective: To assess health related quality of life of patients with congestive heart failure (CHF), to correlate quality of life with other functional parameters; maximal oxygen uptake (peak VO2) with submaximal tests (two minute walking test and shuttle walk test) and New York Heart Association (NYHA) with other clinical variables. Methods: We evaluated 35 stable congestive heart failure patients (NYHA II-III). Functional status was assessed by NYHA classification, maximal oxygen uptake (peak VO2) and submaximal tests (two minute walk test and shuttle walk test). Health related quality of life was measured with short form 36 health survey (SF 36). Results: NYHA functional class was correlated with social functioning of SF 36, peak VO2 and shuttle walk test. Peak VO2 was correlated with most of the parameters of SF 36. On the other hand 2 minute walk test and shuttle walk test were correlated with social functioning of SF 36. There was a correlation between peak VO2 and submaximal test, but there was no correlation between left ventricular ejection fraction, peak VO2 and NYHA class. Conclusion: Social functioning is impaired in patients with congestive heart failure. There is a correlation between maximal and submaximal tests. The maximal and submaximal tests can explain some degree of quality of life. Functional status can be explained with peak VO2 and shuttle walk test apart from NYHA class.Öğe Reexploration in the intensive care unit and open heart surgery [Açik Kalp Ameliyatlari ve Yogun Bakimda Re-Eksplorasyon](2004) Durmaz I.[No abstract available]Öğe The role of 99tcm-tetrofosmin myocardial perfusion scintigraphy in the assessment of patients with previous myocardial infarction a comparative study with 201t1(1998) Burak Z.; Akin H.; Argon M.; Duman Y.; Atay Y.; Durmaz I.; Buket S.; Sagcan A.The aim of this study was to determine the utility of 99Tcm-tetrofosmin cardiac imaging in patients with previous myocardial infarction and with significant coronary artery disease (CAD) compared with that of 201T1 cardiac imaging. Sixteen patients (14 males, 2 females) were studied by same-day exercise-rest 99Tcm-tetrofosmin imaging and exercise, rest and reinjection 201T1 cardiac imaging. For each study, semi-quantitative visual analysis was performed in 20 segments using a 4-point scale. The regional distribution and defect reversibility with the two tracers were compared with the results of coronary angiography. A total of 320 segments were analysed.There was a statistically significant concordance between the numbers of fixed and reversible segments in both studies in myocardial segments supplied by totally occluded coronary arteries (Group 1), as well as in segments supplied by significantly stenosed coronary vessels (Group 2). The exercise and rest uptake of both 99Tcm-tetrofosmin and 201T1 in myocardial segments supplied by totally occluded coronary arteries with poor collateral flow was significantly lower compared with segments supplied by totally occluded coronary arteries with efficient collateral flow (P ? 0.05). When the uptake of both tracers was analysed according to each major vascular territory, the mean exercise and rest uptake grades of 99Tcm-tetrofosmin and 201T1 were similar. There was also no significant difference in defect reversibility between the two tracers. Discordant results were observed in the territory of the right coronary artery in Group 1 (mean exercise grade of 99Tcm-tetrofosmin = 2.26 ± 0.7 and of 201T1 = 1.92 ± 0.8; P ? 0.001) and in Group 2 (mean grade of 99Tcm-tetrofosmin = 0.79 ± 0.65 and of 201T1 = 0.95 ± 0.65; P ? 0.05).The results of the present study indicate that the overall diagnostic utility of 99Tcm-tetrofosmin in the identification of individual stenosed vessels is comparable with 201T1 in both patients with totally occluded coronary arteries and those with significantly stenosed vessels. The regional distribution of both tracers was lower in myocardial segments supplied by totally occluded coronary arteries with poor collateral flow. © 1998 Chapman and Hall Ltd.Öğe The role of99Tcm-tetrofosmin myocardial perfusion scintigraphy in the assessment of patients with previous myocardial infarction: A comparative study with201T1(1998) Burak Z.; Akin H.; Buket S.; Sagcan A.; Argon M.; Atay Y.; Durmaz I.; Duman Y.The aim of this study was to determine the utility of 99Tcm-tetrofosmin cardiac imaging in patients with previous myocardial infarction and with significant coronary artery disease (CAD) compared with that of 201T1 cardiac imaging. Sixteen patients (14 males, 2 females) were studied by same-day exercise-rest 99Tcm-tetrofosmin imaging and exercise, rest and reinjection 201T1 cardiac imaging. For each study, semiquantitative visual analysis was performed in 20 segments using a 4-point scale. The regional distribution and defect reversibility with the two tracers were compared with the results of coronary angiography. A total of 320 segments were analysed. There was a statistically significant concordance between the numbers of fixed and reversible segments in both studies in myocardial segments supplied by totally occluded coronary arteries (Group 1), as well as in segments supplied by significantly stenosed coronary vessels (Group 2). The exercise and rest uptake of both 99Tcm-tetrofosmin and 201T1 in myocardial segments supplied by totally occluded coronary arteries with poor collateral flow was significantly lower compared with segments supplied by totally occluded coronary arteries with efficient collateral flow (P < 0.05). When the uptake of both tracers was analysed according to each major vascular territory, the mean exercise and rest uptake grades of 99Tcmtetrofosmin and 201T1 were similar. There was also no significant difference in defect reversibility between the two tracers. Discordant results were observed in the territory of the right coronary artery in Group 1 (mean exercise grade of 99Tcm-tetrofosmin = 2.26 ± 0.7 and of 201T1 = 1.92 ± 0.8; P 0.001) and in Group 2 (mean grade of 99Tcm-tetrofosmin = 0.79 ± 0.65 and of 201T1 = 0.95 ± 0.65; P 0.05). The results of the present study indicate that the overall diagnostic utility of 99Tcm-tetrofosmin in the identification of individual stenosed vessels is comparable with 201T1 in both patients with totally occluded coronary arteries and those with significantly stenosed vessels. The regional distribution of both tracers was lower in myocardial segments supplied by totally occluded coronary arteries with poor collateral flow. © 1998 Chapman and Hall Ltd.Öğe Surgical treatment of aortic coarctation in adults: Mid-term results and effects on the systolic blood pressure(2002) Apaydin A.Z.; Posacioglu H.; Nalbantgil S.; Islamoglu F.; Özbaran M.; Büket S.; Durmaz I.Objective: To evaluate the outcome and the systolic blood pressure changes after surgical treatment of aortic coarctation in adults. Methods: Between February 1995 and January 2001, 12 adult patients with a mean age of 29±10 years, underwent repair of aortic coarctation in our clinic. The diagnostic and operative data of these patients were retrospectively analyzed. Follow-up was complete in all hospital survivors. Results: The mean systolic blood pressure of 8 hypertensive patients decreased from 155±7 mmHg to 115±9 mmHg after surgical intervention. One patient with a dilated cardiomyopathy died one day after the operation due to an intractable ventricular fibrillation (mortality 8.3%). Four patients had been operated for coexisting cardiovascular pathologies during a mean follow-up period of 32±26 months. Conclusion: Surgical treatment of aortic coarctation in adults can be safely performed with an acceptable mortality and morbidity, both resulting from coexisting cardiovascular disorders in our patient group. The systolic blood pressure may decrease significantly after the operation.
