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    Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review
    (2017) Altıntaş, Derya Deniz; Altıntaş, Bernas; Baysal, Erkan; Gökdeniz, Tayyar
    Coronary artery fistulae, which are connections between coronary artery branches and cardiac chambers or major vessels, are usually congenital forms of coronary artery anomalies, but rarely may be acquired because of cardiac trauma, neovascularity in association with cardiac neoplasm, mural thrombus formation, or iatrogenic causes. Although half of the patients with coronary artery fistula remain asymptomatic, these fistulae may lead to angina, syncope, congestive heart failure, myocardial infarction, and sudden death. Here we present a case of coronary artery fistula between right coronary artery and left atrium through a large left atrial thrombus in a patient with rheumatic mitral stenosis. The diagnosis was confirmed using echocardiography, conventional and multislice computed tomography, and coronary angiography. To the best of our knowledge, this interesting and unique entity is the first to be reported in the present literature.
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    The effect of resistant hypertension on in-hospital mortality in patients hospitalized with COVID-19
    (Springer Nature, 2021) Işık, Ferhat; Çap, Murat; Akyüz, Abdurrahman; Bilge, Önder; Aslan, Burhan; İnci, Ümit; Kaya, İlyas; Taştan, Ercan; Okşul, Metin; Çap, Neşe Kanbal; Karagöz, Ali; Baysal, Erkan
    Hypertension is a major concomitant disease in hospitalized patients with COVID-19 (Coronavirus disease 2019) infection. The adverse effect of hypertension on prognosis in COVID-19 is known. Nevertheless, it is not known how COVID-19 progresses in resistant hypertensive patients. In this study, we aimed to examine the effect of resistant hypertension (ResHT) on in-hospital mortality in patients hospitalized with COVID-19. In our single-center retrospective study, included 1897 COVID-19 patients. The patients were divided into three groups according to the non-hypertensive (n = 1211), regulated HT (RegHT) (n = 574), and ResHT (n = 112). These three groups were compared according to demographic features, clinical signs, laboratory findings, and follow-up times. The median age of the study population was 62 (50–72 IQR) and 1000 (52.7%) of patients were male. The total mortality of the study population was 18.7% (n = 356). Mortality rates were similar in the hypertensive patient group (27.5% for the RegHT and 32.1% for ResHT, p = 0.321). In a multivariable analysis, ResHT was independently associated with a significantly increased risk of inhospital mortality of COVID-19, while no significant increased risk was observed with RegHT [respectively, Odds Ratio (OR) = 2.013, Confidence Interval (CI) 1.085–3.734, p = 0.026 and OR = 1.194, CI 0.795–1.794, p = 0.394]. Also, age, male gender, chronic renal failure, lymphocyte, procalcitonin, creatinine, and admission SpO2 levels were determined as independent predictors of in-hospital mortality. In our study, it was found that ResHT was an independent predictor of mortality in patients hospitalized with COVID-19; however, this situation was not found in RegHT.
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    Electrolyte Imbalance and Its Effect on QTc Interval in PatientsHospitalized with COVID-19
    (2020) Kanbal, Neşe; Çap, Murat; İnci, Ümit; Altındağ, Rojhat; Akyüz, Abdurrahman; Adıyaman, Mehmet Şahin; Baysal, Erkan
    Objective: Studies have shown that electrolyte abnormalities can be seen in Coronavirus disease 2019 (COVID-19) patients and are associated with the severity of the disease. We aimed to investigate the electrolyte imbalance such as hypocalcemia and hypokalemia in patients hospitalized with COVID-19 and its effect on the QTc interval.Materials and Methods: 185 hospitalized patients with COVID-19 whose diagnosis was confirmed by a real-time reverse transcriptasepolymerase chain reaction and/or Computed Tomography of the chest were included in the study. The potassium and calcium measurements on the admission and third day of hospitalization were recorded. The QTc interval measurement was performed on the admission (QTc-B) and the 3rd-day (QTc-AT) electrocardiography.Results: The median age was 43 (31-56 IQR) and 102 (55.1%) of patients were male. Median baseline potassium level was 4.0 mEq/L (3.7-4.3 IQR) and corrected calcium level was 8.48 mg/dl (8.24-8.73 IQR), whereas the 3rd-day median potassium level was 4.2 mEq/L (3.9-4.5 IQR) and corrected calcium level was 8.42 mg/dl (8.16-8.70 IQR).The median QTc-B interval was found as 427 ms (409-447 IQR) whereas the median QTc-AT interval was found as 438 ms (414-459 IQR). Median 9 ms (-5- 28 IQR) prolongation was observed in the QTc interval, which was statistically significant (p <0.001). There was a significant relationship between QTc-AT and baseline potassium level, potassium level on the 3rd day (respectively ? coefficient= -2.083, 95% CI -27.134- -0.577, p value= 0.041, ? coefficient= -2.547, 95% CI -27.925 - -3.385, p value= 0,013 ) but there was no significant relationship with baseline and 3rd day calcium level. (respectively ? coefficient= -0.848, 95% CI -22.102- 8.919, p value= 0.399, ? coefficient= 0.707, 95% CI -8.685 - 20.784, p value= 0.415)Conclusion: Electrolyte disorders such as hypocalcemia and hypokalemia can be seen in patients hospitalized with COVID-19. After treatment, a significant prolongation was observed in the QTc interval and a significant relationship was observed between QTc-AT and potassium levels, but no significant relationship with calcium was observed.
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    Hemogram parameters for predicting pulmonary embolism in patients with deep venous thrombosis reply
    (Dove Medical Press Ltd, 2015) Sevuk, Utkan; Bahadir, Mehmet Veysi; Altindag, Rojhat; Baysal, Erkan; Yaylak, Baris; Ay, Nurettin; Ayaz, Firat
    [Abstract Not Available]
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    Iloprost is a Useful Therapy for Adams-Oliver Syndrome with Eisenmenger Syndrome
    (2017) Altıntaş, Bernas; Baysal, Erkan; Bilge, Önder; Sevük, Utkan; Yaylak, Barış; Altındağ, Rojhat
    Adams-Oliver syndrome is characterized by scalp defects with terminal transverse limb anomalies. Most reports on this syndrome demonstrate autosomal dominant pedigrees. Cutis marmorata telangiectasia congenita accompanies the syndrome in many cases. Here, we describe a case of Adams-Oliver syndrome with cardiac malformation and Eisenmenger syndrome. Because this is a rare case, the detailed case and literature data are presented.
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    Relationship between Nadir Hematocrit during Cardiopulmonary Bypass and Postoperative Hyperglycemia in Nondiabetic Patients
    (Forum Multimedia Publishing, Llc, 2014) Sevuk, Utkan; Cakil, Nevzat; Altindag, Rojhat; Baysal, Erkan; Altintas, Bernas; Yaylak, Baris; Adiyaman, Mehmet Sahin
    Background: Hyperglycemia is common after cardiac surgery in both diabetic and nondiabetic patients and is associated with increased morbidity and mortality. Association between nadir hematocrit levels on cardiopulmonary bypass (CPB) and postoperative hyperglycemia is not clear. This study was carried out to determine the relationship between nadir hematocrit during CPB and postoperative hyperglycemia in nondiabetic patients. Methods: Records of 200 nondiabetic patients undergoing coronary artery bypass grafting operation were retrospectively reviewed. In the first analysis, patients were divided into two subgroups according to the presence or absence of hyperglycemia. Further analysis was made after dividing the patients into 3 subgroups according to nadir hematocrit levels on CPB (less than 20%; 20% to 25%; greater than or equal to 25%). Results: Compared to patients without hyperglycemia, patients with postoperative hyperglycemia had significantly lower preoperative hematocrit levels (p = 0.004) and were associated with lower nadir hematocrit levels during CPB (p=0.002). Peak intensive care unit blood glucose levels and number of blood transfusions were significantly higher in patients with nadir hematocrit levels less than 20. (p<0.001 and p<0.001 respectively). Logistic regression analysis demonstrated that nadir hematocrit levels less than 20% (OR 2.9, p=0.009) and allogenic blood transfusion (OR 1.5, p=0.003) were independently associated with postoperative hyperglycemia. Conclusions: Nadir hematocrit levels on CPB less than 20% and allogenic blood transfusions were independently associated with postoperative hyperglycemia in nondiabetic patients. Patients with a nadir hematocrit levels less than 20 % during CPB should be closely monitored for hyperglycemia in the perioperative period.
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    Relationship between thyroid function and carotid artery plaque ulceration
    (Springer Heidelberg, 2015) Sevuk, Utkan; Bahadir, Mehmet Veysi; Altindag, Rojhat; Baysal, Erkan; Altintas, Bernas; Yaylak, Baris; Adiyaman, Mehmet Sahin
    Carotid artery plaque ulceration (PU) is known to be associated with cerebrovascular events (CVE). Even within euthyroid ranges, thyroid function has been reported to be associated with carotid atherosclerosis. However, the relationship between thyroid function and carotid PU remains unclear. Our aim was to determine the relationship between thyroid function and PU in patients with internal carotid artery stenosis (ICS). Records of patients with CVE were retrospectively reviewed. A total of 250 consecutive patients with ICS who had computed tomography angiography (CTA) of the carotid arteries following hospitalization were included in the study. CTA was used for the evaluation of carotid artery plaque morphology and ulceration. Plaque morphology was classified as fatty, mixed or calcified. Patients were divided into two groups according to the presence or absence of PU. Subclinical hypothyroidism (SCH) and hypothyroidism were significantly more common in patients with PU (p < 0.001 and p = 0.003, respectively). Patients with PU had higher incidence of low-normal FT4 levels (p = 0.02). Compared with patients who had no PU, patients with PU had decreased FT4 levels and elevated TSH levels (p = 0.001 and p = 0.001, respectively). TSH level (OR 1.33, p = 0.001), SCH (OR 4.2, p = 0.001), hypothyroidism (OR 3.15, p = 0.037), fatty plaque (OR 2.16, p = 0.01) and calcified plaque (OR 0.19, p < 0.001) were independently associated with PU. Our results suggest that SCH and hypothyroidism could be a risk factor for PU and subsequent CVE. Thyroid functions may be useful for risk stratification of patients with ICS.
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    Value of serial platelet indices measurements for the prediction of pulmonary embolism in patients with deep venous thrombosis
    (Dove Medical Press Ltd, 2015) Sevuk, Utkan; Bahadir, Mehmet Veysi; Altindag, Rojhat; Baysal, Erkan; Yaylak, Baris; Ay, Nurettin; Ayaz, Firat
    Background: To date, no validated biomarkers with high sensitivity and specificity have been established for diagnosis of pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). There is a need to develop simple and reliable noninvasive tests that can accurately identify patients with PE, even in small hospitals or clinics. The aim of this study was to investigate the value of mean platelet volume (MPV) and platelet distribution width (PDW) for predicting occurrence of PE in patients with DVT. Methods: Records of acute DVT patients were reviewed retrospectively. Group 1 consisted of 50 patients with acute DVT and group 2 consisted of 50 patients with acute DVT who developed PE during follow-up. The control group consisted of patients with uncomplicated primary varicose veins of the lower limbs. Venous peripheral blood samples for measurement of MPV, PDW, and platelet count were drawn on admission, before the treatment, and at the time of PE diagnosis. Results: MPV and PDW levels at the time of PE diagnosis were higher in group 2 than group 1 (P<0.001 and P=0.026, respectively). Receiver operating characteristics analysis revealed that a 5.2% increase in admission PDW during follow-up provided 70% sensitivity and 82% specificity (area under the curve, 0.80), and a 6.6% increase in admission MPV during follow-up provided 74% sensitivity and 83% specificity (area under the curve, 0.84) for prediction of PE occurrence in patients with DVT. PDW and MPV levels at the time of PE diagnosis were found to be independent risk factors for the occurrence of PE in patients with DVT. Conclusion: Serial measurements of MPV and PDW, and percent change in MPV and PDW appears to be a useful marker for predicting occurrence of acute PE in patients with a first episode of acute proximal DVT.