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Öğe Air gun pellet: cardiac penetration and peripheral embolization(Turkish Assoc Trauma Emergency Surgery, 2016) Isik, Onur; Engin, Cagatay; Daylan, Ahmet; Sahutoglu, CengizUse of high-velocity air guns can to lead to serious injuries. Management options of cardiac pellet gun injuries are based on patient stability, and course and location of the pellet. Presently reported is the case of a boy who was shot with an air gun pellet. Following right ventricular entry, the pellet lodged in the left atrium and embolized to the right iliac and femoral artery. Following pellet localization, right ventricular injury was repaired, and the pellet was removed successfully.Öğe ANESTHETIC MANAGEMENT FOR IMPLANTATION OF TOTAL ARTIFICIAL HEART DEVICE: CASE SERIES(Nobel Ilac, 2016) Sahutoglu, Cengiz; Karaca, Nursen; Kocabas, Seden; Askar, Fatma Zekiye; Ertugay, Serkan; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaThe treatment of end-stage heart failure is heart transplant; however the majority of patients die due to deficiency of organ donation. Total artificial heart implantation made for the purpose of extending the life span and bridging to transplantation in patients with end-stage heart failure is a good option. We present our initial experiences in the anesthetic management of total artificial heart implantation cases performed in our institution. Five out of seven patients (46.8 +/- 8.4 years) were taken to surgery with inotropic support. Four patients were diagnosed as dilated cardiomyopathy. Three patients were subject to cardiac arrest during the preoperative period and mechanical ventilation was applied for one of these patients. Intraoperative ketamine, midazolam, fentanyl, rocuronium were used in doses of 192 +/- 89 mg, 8 +/- 3.5 mg, 335 +/- 157 mu g and 192 +/- 43 mg, respectively. Fresh donor blood, fresh frozen plasma, thrombocyte and erythrocyte suspension requirements were 2.1 +/- 1.6 unit, 2 +/- 1.8 unit, 0.43 +/- 0.5 unit and 0.6 +/- 0.9 unit, respectively. At least one complication developed in all of the patients; four patients who had sepsis and renal failure died and; 3 patients who were not subject to this complication were discharged from the hospital. Total artificial heart implantation made for the purpose of bridging to transplantation for end-stage heart failure patients is a valuable option and its anaesthetic management is challenging. It is important that anesthesiologists have knowledge about the implanted device and the surgical procedure.Öğe Antioxidant response after the operations for congenital heart diseases(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Atay, Yuksel; Atay, Aysenur; Ayik, M. Fatih; Isleten, Figen; Koseoglu, Mehmet; Oguz, Emrah; Engin, Cagatay; Yagdi, TahirBackground: In this study, we investigated total antioxidant response and plasma levels of albumin, total bilirubin, uric acid and high sensitive C reactive protein (hsCRP) in patients with congenital heart disease treated with surgery using on-pump and off-pump techniques. Methods: Thirty-five patients with congenital heart diseases undergoing surgical treatment were divided into two groups: 20 patients were operated with using cardiopulmonary bypass (group 1, on-pump) and 15 patients were operated without cardiopulmonary bypass (group 2, off-pump). Blood samples were collected before surgery and at 1, 24 and 72 hours following surgery. Results: Total antioxidant response was prompt and drew a peak within the first hour following surgery in group I. After 24 hours, it showed a sustained increase (p=0.009). In the group 2, total antioxidant response decreased significantly within the first hour, and then increased to a peak level within the 24 hours (p=0.04). Thereafter, it was gradually reduced. Total antioxidant response, albumin, bilirubin and hsCRP levels remained high in group 1, after 24 hours. Total antioxidant response levels were positively associated with the albumin levels at 24 hours following surgery in group 2 (r=0.669, p=0.01). Conclusion: The plasma levels of albumin may be considered in the assessment of global antioxidant response in patients treated with CPB technique.Öğe Assessment of right ventricular systolic function in heart transplant patients: Correlation between echocardiography and cardiac magnetic resonance imaging. Investigation of the accuracy and reliability of echocardiography(Wiley, 2017) Simsek, Evrim; Nalbantgil, Sanem; Ceylan, Naim; Zoghi, Mehdi; Kemal, Hatice Soner; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaBackground: Right ventricular (RV) function has great impact on the survival of heart transplantation recipients; therefore, careful evaluation is of high clinical importance. However, there is no standard conventional echocardiographic parameter to assess RV systolic function. Herein, we evaluated the correlation between echocardiographic parameters of RV systolic function and ejection fraction assessed by cardiac magnetic resonance imaging (MRI RVEF) in heart transplantation recipients. Method and Results: Forty-three patients with at least 6-month heart transplantation history were included in this study. Each patient had conventional echocardiography and cardiac MRI evaluation, followed by endomyocardial biopsy and right heart catheterization, which were performed in six hours. Echocardiographic parameters of RV systolic function, RV fractional area change (RV FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index, and RV global longitudinal strain, were compared with MRI RVEF (P values were < 0.001, < 0.3, < 0.9, and < 0.4, respectively). RV FAC was the only parameter to strongly correlate with MRI RVEF (r=0.747, P < 0.001); and RV FAC 48.5% value had 90.5% sensitivity and 90.5% specificity to predict the pathologic reference value of MRI RVEF <= 50% (AUC: 0.96; 95% CI, 0.908-1.013). Conclusion: To our knowledge, this is the first prospective study to evaluate the correlation between the echocardiographic parameters for RV systolic function and MRI RVEF in heart transplantation recipients. RV FAC is the only parameter to correlate well with MRI RVEF, and its routine use in the follow-up of heart transplantation recipients should be considered.Öğe Association Between Erythrocytosis and Six-Minute Walk Test Distance in Eisenmenger Syndrome Patients(Wiley-Blackwell, 2012) Gungor, Hasan; Ayik, Mehmet Fatih; Karapolat, Hale; Zoghi, Mehdi; Engin, Cagatay; Yagdi, Tahir; Atay, Yuksel; Ozbaran, Mustafa; Nalbantgil, SanemÖğe Association between the low percentage of forced vital capacity and increased mortality after left ventricular assist device implantation(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2020) Ekren, Pervin Korkmaz; Ozturk, Pelin; Ertugay, Serkan; Ozdil, Ali; Nalbantgil, Sanem; Engin, Cagatay; Ozbaran, MustafaBackground: This study aims to investigate the effect of low percentage of forced vital capacity measured in the preoperative period on the 28-day mortality in patients undergoing left ventricular assist device implantation. Methods: A total of 131 patients (111 males, 20 females; median age 54 years; range, 47 to 59 years) who underwent left ventricular assist device implantation with HeartWare (TM) between December 2010 and January 2016 were retrospectively analyzed. the patients were divided into two groups according to the results of pulmonary function test as a forced vital capacity percentage of >= 60% (n=113) and <60% (n=18). Both groups were compared in terms of laboratory and clinical characteristics, and postoperative complications. Risk factors for postoperative 28-day mortality were analyzed. Results: Pre- and intraoperative characteristics were similar in both groups, except for left ventricular end-diastolic diameter. the ventilator-free days up to 28 days was shorter (p= 0.046) and the length of intensive care unit stay was longer (p=0.011) in the low percentage of forced vital capacity group. the 28-day mortality rate was also higher (22.2% vs. 9.7%, respectively; p=0.12) in this group. the history of prior cardiac operation (odds ratio: 4.40; 95% confidence interval 1.19-16.20, p=0.026) and tricuspid valve repair at the time of device implantation (odds ratio: 5.30; 95% confidence interval 1.33-21.00, p= 0.018) were found to be independent risk factors for mortality. Multivariate analysis showed that a forced vital capacity of <60% was not associated with mortality (odds ratio: 3.96; 95% confidence interval 0.95-16.43, p=0.058). Conclusion: the length of intensive care unit stay and duration of mechanical ventilation may be longer in patients with a low percentage of forced vital capacity. Although the association between 28- day mortality and low percentage of forced vital capacity is not significant, the risk of 28-day mortality is higher in this group. Therefore, the patients should be assessed carefully before the left ventricular assist device operation.Öğe Carotid Endarterectomy versus Carotid Artery Stenting(Texas Heart Inst, 2009) Engin, Cagatay; Posacioglu, Hakan; Apaydin, Anil ZiyaÖğe Carotid Endarterectomy versus Carotid Artery Stenting Findings in Regard to Neuroclinical Outcomes and Diffusion-Weighted Imaging(Texas Heart Inst, 2008) Posacioglu, Hakan; Engin, Cagatay; Cinar, Celal; Apaydin, Anil Z.; Oran, Ismail; Parildar, Mustafa; Calli, Cem; Oguz, Emrah; Memis, AhmetThe purpose of our study was to evaluate prospectively the frequency and significance of brain lesions after elective carotid endarterectomy (CAE) and carotid artery stenting (CAS) by using diffusion-weighted magnetic resonance imaging (DW MRI) and then to correlate imaging findings with neuroclinical outcomes. From February 2003 through March 2005, 95 consecutive patients underwent surgical endarterectomy or CAS (with a cerebral protection device) at our institution. A total of 59 CAE procedures were performed in 46 consecutive patients (mean age, 65.8 +/- 9 yr), and 56 CAS procedures were performed in 49 consecutive patients (mean age, 66.3 +/- 9 yr). Diffusion-weighted magnetic resonance imaging of the brain was performed in all patients within 24 hours of the procedure, both before and after. The post-procedural stroke rate was slightly higher in the CAS group, but this difference was not significant (5.4% vs 0). One early and I late death occurred in the stent group. Although the incidence of ischemic lesions was similar in both groups (surgery group, 12.5%; stent group, 73.5%), new DIN MRI lesions were higher in the endarterectomy group (27.1% vs 12.5%, P=0.041). This difference was due chiefly to nonischemic lesions such as hemorrhage and watershed ischemia. In the analysis of patients with embolic ischemia, incidences of symptomatic stroke (P=0.046) and large infarct (P=0.013) were higher in the stent group. When we used protective devices during CAS, the incidence of embolic complications was similar to that of surgical enarterectomy. On the other hand, the clinical results of CAS need improvement. (Tex Heart Inst J 2008;35(4):395-401)Öğe Changes in the obstructive sleep apnea symptoms in heart transplantation patients(Wiley-Blackwell, 2012) Ayik, Sibel; Gungor, Hasan; Ayik, Mehmet Fatih; Karakula, Sultan; Akhan, Galip; Engin, Cagatay; Yagdi, Tahir; Nalbantgil, Sanem; Zoghi, Mehdi; Ozbaran, MustafaÖğe Circumferential intimal flap prolapsing into the left ventricle(Texas Heart Inst, 2007) Oguz, Emrah; Apaydin, Anil Z.; Nalbantgil, Sanem; Engin, Cagatay; Ayik, FatihA 54-year-old man with a history of chest pain and dyspnea for 15 days was admitted to our hospital. Diagnostic evaluation, which included transthoracic echocardiography and computed tomographic scanning, revealed an ascending aortic aneurysm (6 cm in diameter), severe aortic valve insufficiency, and possible aortic dissection. The coronary arteries could not be seen, because the catheter could not be placed in their orifices. The patient was taken to the operating room. Intraoperative transesophageal echocardiography revealed an intimal flap in the ascending aorta. The proximal part of the flap was attached to the aortic wall at the level of the coronary Ostia, and its distal part was circumferentially free (Fig. 1). The flap was prolapsing into the left ventricular outflow tract through the aortic valve leaflets at every diastole (Fig. 2A) and moving back to the aortic lumen at systole (Fig. 2B). The patient underwent aortic root replacement by means of the Bentall procedure. During surgical exploration, we saw that the dissection involved the commissures and the orifice of the right coronary ostia and that it ended just proximal to the aortic clamp, which did not necessitate the use of hypothermic circulatory arrest (Fig. 3). The patient was discharged from the hospital 6 days after the operation without complication.Öğe Clinical and hemodynamic features of Eisenmenger syndrome patients at the time of first admission: a tertiary referral-center experience(Aves Yayincilik, 2012) Gungor, Hasan; Ertugay, Serkan; Ayik, Mehmet Fatih; Demir, Emre; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa; Atay, Yuksel; Nalbantgil, SanemObjective: In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed. Methods: The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6 +/- 9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission. Results: The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9 +/- 33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112 +/- 6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV1 (forced expiratory volume), FEV1/FVC values were respectively, 3.1 +/- 0.4, 2.5 +/- 0.4 L and 76.7 +/- 3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 +/- 1.0 ml / kg/min and VE/VCO2 rate was 53.9 +/- 3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low. Conclusion: The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters. (Anadolu Kardiyol Berg 2012; 12: 11-5)Öğe Comparison Of Continuous And Pulsatile Flow Pump Results Of Cases "Crushing And Burning"(Wiley-Blackwell, 2012) Erkul, Sinan; Baysal, Bora; Kultayev, Ilyas; Ertugay, Serkan; Nalbantgil, Sanem; Zoghi, Mehdi; Kocabas, Seden; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaÖğe Comparison of Continuous-Flow and Pulsatile-Flow Blood Pumps on Reducing Pulmonary Artery Pressure in Patients With Fixed Pulmonary Hypertension(Wiley, 2013) Ozturk, Pelin; Engin, Aysen Yaprak; Nalbantgil, Sanem; Oguz, Emrah; Ayik, Fatih; Engin, Cagatay; Yagdi, Tahir; Erkul, Sinan; Balcioglu, Ozlem; Ozbaran, MustafaPulmonary hypertension (PH) is considered as a risk factor for morbidity and mortality in patients undergoing heart transplantation. Recently, left ventricular assist device (LVAD) implantation has been increasingly used in reducing pulmonary artery pressure (PAP) in patients with PH unresponsive to medical therapy. Herein, we aimed to compare the efficacy of continuous-flow and pulsatile-flow blood pumps on the improvement of PH in mechanical circulatory support patients. Twenty-seven patients with end-stage heart failure who underwent LVAD implantation surgery were enrolled. Fifteen of them (55.6%) had continuous-flow pump (HeartWare Ventricular Assist System, HeartWare, Inc., Miramar, FL, USA), and 12 of them (44.4%) had pulsatile pump (Berlin Heart EXCOR ventricular assist device, Berlin Heart AG, Berlin, Germany). The efficacy of LVADs on the improvement of PH was compared between continuous-flow and pulsatile pumps by the evaluation of systolic PAP, tricuspid annular plane systolic excursion (TAPSE), right ventricular systolic motion (RVSM), right ventricular ejection fraction (RVEF), and grade of tricuspid insufficiency (TI) for each of the study participants. All of the 15 patients who underwent continuous-flow blood pump implantation surgery (Group 1) were male with a mean age of 46.9 +/- 11.7 years, and in pulsatile-flow blood pump implanted participants (Group 2), the mean age was 40.6 +/- 16.8 years, all of whom were also male (P=0.259). Mean follow-up was 313.7 +/- 241.3 days in Group 1 and 448.7 +/- 120.7 days in Group 2 (P=0.139). In Group 1, mean preoperative and postoperative systolic PAP were measured as 51.7 +/- 12.2mmHg and 22.2 +/- 3.4mmHg, respectively, while those in Group 2 were 54.5 +/- 7.5mmHg and 33.9 +/- 6.4mmHg, respectively. A significantly greater decrease in systolic PAP was noticed in patients with continuous-flow blood pumps (P=0.023); however, no statistically significant difference was found when we considered the change in TAPSE between study groups (P=0.112). A statistical significance in the alteration of RVEF, RVSM, and the grade of TI during study visits was not found between the study groups (P=0.472, P=0.887, and P=0.237, respectively). Although the two studied types of LVADs were found to be effective in reducing PAP in heart transplantation candidates with PH, lesser postoperative systolic PAP values were achieved in patients who underwent continuous-flow pump implantation surgery.Öğe Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices(Wiley-Blackwell, 2012) Ozbaran, Burcu; Kose, Sezen; Yagdi, Tahir; Engin, Cagatay; Erermis, Serpil; Yazici, Kemal Utku; Noyan, Aysin; Ozbaran, MustafaOzbaran B, Kose S, Yagdi T, Engin C, Erermis S, Yazici KU, Noyan A, Ozbaran M. Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices. Abstract: VADs have been used to provide treatment for end-stage heart failure. Parents may feel overwhelmed with the VAD regimes responsibility and be affected from this process beside children. In this study, we aimed to evaluate the depressive and anxiety symptoms of mothers of the first eight children equipped with a VAD in Turkey. The mothers of eight pediatric patients living with VADs were filled BDI and STAI at first month of VAD implantation (E.I) and secondly six months after their first evaluation (E.II). In E.I, the BDI mean score of mothers was 20.87, in E.II 14.37. STAI-S mean score was 53.37 in E.I and 43.62 in E.II. The Wilcoxon nonparametric-paired t-test revealed significant difference between baseline and end-point STAI-S scores (Z: -2.035; p: 0.042), and for BDI scores (Z, -1.965; p, 0.049). Prolonged usage of VAD may increase distress in parents. Psychiatric evaluation and support of the primary caregiver is important for the well-being of the pediatric patients.Öğe The detection of cardiac tamponade by hemodynamic transesophageal echocardiography after left ventriculer assist device implantation(Turkish Soc Cardiology, 2015) Kursun, Mustafa; Nalbantgil, Sanem; Ertugay, Serkan; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaÖğe The detection of cardiac tamponade by hemodynamic transesophageal echocardiography after left ventriculer assist device implantation(Turkish Soc Cardiology, 2015) Kursun, Mustafa; Nalbantgil, Sanem; Ertugay, Serkan; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaÖğe The detection of cardiac tamponade by hemodynamic transesophageal echocardiography after left ventriculer assist device implantation(Turkish Soc Cardiology, 2015) Kursun, Mustafa; Nalbantgil, Sanem; Ertugay, Serkan; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaÖğe Diagnostic Performance of Late Gadolinium Enhancement Analysis of Cardiac Magnetic Resonance Imaging in Monitoring Acute Cardiac Allograft Rejection(Elsevier Science Inc, 2013) Simsek, Evrim; Nalbantgil, Sanem; Ceylan, Naim; Zoghi, Mehdi; Nart, Deniz; Kursun, Mustafa; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaÖğe Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation(Turkish Soc Cardiology, 2016) Şimşek, Evrim; Nalbantgil, Sanem; Ceylan, Naim; Zoghi, Mehdi; Kemal, Hatice Soner; Engin, Cagatay; Yagdi, Tahir; Ozbaran, MustafaObjective: Allograft rejection is still an important cause of morbidity and mortality after heart transplantation (HTx). Many techniques in cardiac magnetic resonance imaging (CMR) were investigated to diagnose acute cellular rejection (ACR). However, there is not enough information about late gadolinium enhancement (LGE) in the myocardium and ACR. Methods: We prospectively analyzed our consecutive 41 heart transplant recipients who were admitted for routine endomyocardial biopsies. CMR was performed maximum 6 h before the scheduled endomyocardial biopsy. Correlation between LGE in the myocardium and ACR was investigated. Results: Twenty-seven patients showed no rejection, and nine of them had LGE in the myocardium. Fourteen patients had LGE in the left ventricle (LV), and two patients had LGE also in the right ventricle (RV). There was no correlation between LGE and ACR (p = 0.879). There was no difference in the left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), and cardiac ischemic time between the groups (p = 0.825, p = 0.370, and p = 0.419, respectively). LGE in the myocardium could be due to previous rejection episodes; therefore, all patients were retrospectively searched for previous rejection grades and number of episodes. Thirty-eight of the 41 patients had a history of one ACR episode, but none of them had a statistically significant correlation with LGE (for grade 1R, p = 0.964 and grade 3R, p = 1) There was also no correlation between number of rejection episodes history and LGE. Conclusion: LGE is not suitable to detect ACR in heart transplant patients. LGE and the history of ACR have no correlation.Öğe Does harvesting of an internal thoracic artery with an ultrasonic scalpel have an effect on sternal perfusion?(Mosby-Elsevier, 2007) Pektok, Erman; Cikirikcioglu, Mustafa; Engin, Cagatay; Daglioz, Gozde; Ozcan, Zehra; Posacioglu, HakanObjectives: Despite many animal and clinical studies to date, there is still debate on the effect of internal thoracic artery harvesting on postoperative sternal perfusion and thus healing. We performed a prospective clinical study to assess the postoperative sternal perfusion in patients who underwent surgical coronary revascularization by means of unilateral internal thoracic artery harvesting and to evaluate the effect of 2 harvesting methods, namely electrocautery and use of an ultrasonic scalpel. Methods: Between November 2004 and March 2005, 30 consecutive patients (25 male patients; age, 58.34 +/- 9.42 years; mean New York Heart Association class, 1.90 +/- 0.76) scheduled for conventional coronary surgery were enrolled in this study. After obtaining informed consent, they were randomized into 2 groups. The left internal thoracic artery was harvested as a pedicle graft in all patients by using the corresponding method. All patients underwent 99mTc-methylene diphosphonate bone scintigraphy preoperatively to evaluate baseline sternal perfusion. Control scintigraphy was performed on postoperative day 7. Results: Sternal perfusion showed a significant increase on postoperative scans compared with that at baseline (1067 +/- 191 counts/pixel vs 919 +/- 102 counts/pixel for the right half, P < .001; 1064 +/- 179 counts/pixel vs 905 +/- 107 counts/pixel for the left half, P < .001). There was no significant difference between the right and left sternal halves postoperatively. The method used for harvest had no significant effect on postoperative sternal perfusion (electrocautery = 1037 +/- 121 counts/pixel vs scalpel = 1097 +/- 109 counts/pixel for the right half, P > .05; electrocautery = 1040 +/- 126 counts/pixel vs scalpel = 1089 +/- 130 counts/pixel for the left half, P > .05). Conclusions: Sternal perfusion increases soon after coronary bypass surgery, probably as a consequence of the healing process, but the source of perfusion for harvest side remains unclear. Harvesting of internal thoracic arteries with an ultrasonic scalpel has no advantageous effects on postoperative sternal perfusion.
