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    Asymptomatic and isolated accessory mitral valve tissue in adult population: three case reports and review of the literature
    (Verduci Publisher, 2012) Cil, H.; Atilgan, Z. A.; Islamoglu, Y.; Yavuz, C.; Tekbas, E. O.
    Accessory mitral valve tissue is a rare congenital cardiac anomaly and commonly it may cause left ventricular outflow tract obstruction (LVOTO). This anomaly occurs as a part of other congenital cardiac anomalies. However, it may be seen isolated. Structures in LVOT such as tumor, vegetation, cysts may have attention for differential diagnosis. The number of cases is increasing with the routinely using of two-dimensional echocardiography. Accessory mitral valve tissue is detected first early in children with symptoms of LVOT and is very rarely diagnosed in adults. One third of cases may asymptomatic, but commonly significant left ventricular outflow tract gradient can be detected in these cases, especially adult period. Optimal treatment of this anomaly is surgery if there is a significant LVOTO. In this report, we presented the three asymptomatic adult cases with accessory mitral valve tissue, without increased gradient in LVOT. Surgical excision was recommended to the first case in another hospital with diagnosis of cardiac cyst. Two cases are presented.
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    Complete resolution of the left ventricular pedunculated thrombus with tirofiban infusion in a patient with severe left ventricular dysfunction
    (Medcom Ltd, 2013) Cil, H.; Yavuz, C.; Atilgan, Z. A.; Gunduz, E.; Soydinc, S.
    A 28-year-old man was admitted with symptoms of heart failure. Echocardiography revealed severe left ventricular dysfunction, apical aneurysm, and a 40 x 11 mm sized mobile thrombus attached to apical septum with a narrow stalk. The patient had anterior myocardial infarction two years ago. Heparin infusion was started at 1000 IU/hour for 48 hours. There was no detected change on the size of the thrombus. Surgery recommended to the patient was refused by him because of the procedural risks. Tirofiban infusion was started. Repeat echocardiography showed significant reduction in thrombus size after 24 hours, and complete resolution of the thrombus after 48 hours. To our knowledge, this is the first case with left ventricular mobile thrombus treated successfully with tirofiban infusion. (Hong Kong j.emerg.med. 2013;20:305-308)
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    Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus
    (Verduci Publisher, 2012) Ariturk, Z.; Islamoglu, Y.; Gunduz, E.; Yavuz, C.; Cil, H.; Tekbas, E.; Soydinc, S.
    Background: Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes. Methods and Results: Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359). Conclusions: This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.
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    Evaluation of pulmonary vein variations in the middle pulmonary lobe with 64-slice multidetector computed tomography
    (Verduci Publisher, 2011) Tekbas, G.; Ekici, F.; Tekbas, E.; Gumus, H.; Onder, H.; Bilici, A.; Yavuz, C.
    Purpose: To evaluate the multi detector computed tomographic (CT) depiction of middle lobe vein variation of the right pulmonary vein and create a diagram for cardiologist and cardiovascular surgeons. Materials and Methods: According to hospital records, between January 2009 and April 2010, 314 consecutive patients underwent pulmonary CT angiography (CTPA) and coronary CT angiography. The CT films from these patients were retrospectively analyzed. Results: Under normal conditions, the middle pulmonary vein (MPV) drains into the left atrium either by the direct or indirect route. Direct (37 patients, 11.8%) drainage means that the MPV does not drain into the upper or lower pulmonary veins but instead drains directly into the right pulmonary vein system. In contrast, indirect (276 patients, 87.9%) drainage occurs when the MPV drains into the upper or lower pulmonary veins. In this study, 12 different variations in drainage patterns were found. Conclusion: Increasing the number of patients may have led to the identification of additional variants. However, clinically important variations are rarely seen. Correct mapping of the MPV is very important for cardiologists and for surgeons in order to provide the best treatment and avoid complications.
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    GUNSHOT INJURY OF THE HEART: AN UNUSUAL LOCALIZATION OF BULLET FRAGMENT
    (Elsevier Ireland Ltd, 2011) Elbey, M. A.; Yavuz, C.; Islamoglu, Y.; Cil, H.; Atilgan, Z.; Tekbas, E.
    [Abstract Not Available]
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    Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion
    (Sage Publications Ltd, 2014) Caliskan, A.; Yavuz, C.; Karahan, O.; Yazici, S.; Guclu, O.; Demirtas, S.; Mavitas, B.
    Objective: Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia. Methods: Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis. Results: Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade 11 myocardial tissue specimens and one grade 1 myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022). Conclusion: Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.
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    The medical approaching to a pellet injury of the heart
    (Verduci Publisher, 2012) Elbey, M. A.; Yavuz, C.; Cil, H.; Islamoglu, Y.
    A 55-year-old man with multiple pellet injuries was brought to the Emergency room. In his physical examination, there were multiple wounds in face, neck, shoulders, arms, thorax and upper abdomen. The therapeutic options include pericardial drainage, conservative treatment, and surgical removal of the pellet. But, he was successfully managed with conservative medical treatment. This case showed that the treatment of heart injuries due to shotgun pellet should be individualized.
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    The predictors of poor outcomes in patients with femoral artery injuries
    (Verduci Publisher, 2013) Yavuz, C.; Demirtas, S.; Caliskan, A.; Ertas, F.; Kaya, H.; Aydin, M.; Benli, E. D.
    PURPOSE: This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries. PATIENTS AND METHODS: The study included 158 patients aged 2-82 (mean age 28.4 +/- 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded. RESULTS: Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.4187.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively. CONCLUSIONS: The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.
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    THE RELATIONSHIP BETWEEN QT DISPERSION AND EXAGGERATED BLOOD PRESSURE RESPONSE TO EXERCISE STRESS TESTING
    (Elsevier Ireland Ltd, 2013) Ertas, F.; Yavuz, C.; Kaya, H.; Karahan, O.; Demirtas, S.; Acet, H.; Oylumlu, M.
    [Abstract Not Available]
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    Serum ischaemia-modified albumin level is an irrelevant predictive factor for ischaemic duration in mesenteric ischaemia
    (Sage Publications Ltd, 2014) Caliskan, A.; Yavuz, C.; Karahan, O.; Demirtas, Sinan; Yazici, S.; Guclu, O.; Mavitas, B.
    Background: Acute mesenteric ischaemia is an emergency condition that requires urgent and expeditious diagnosis and immediate surgical or medical intervention. The initial hours are critical for the recovery of the affected bowel segment. Thus, its clinic diagnostic biomarkers are important when it comes to reducing mortality and morbidity rates. Methods: Twenty-four male Sprague-Dawley rats were included in the study. The rats were divided into three equal groups.Those in Group I were sacrificed to determine the basal serum values of ischaemia-modified albumin (IMA) after a simple laparotomy.The superior mesenteric artery (SMA) was clamped in a simple laparotomy in Groups II and III; blood samples were taken at 120 minutes in Group II and 360 minutes in Group III.The serum IMA levels were identified from the blood samples and the results obtained were compared statistically. Results:The serum IMA levels were determined to be 22 +/- 6 (22) mu/L, 34 +/- 7 (34) mu/L and 36 +/- 4 (37) mu/L in Groups I, II and III, respectively.The differences between the groups were not statistically significant. Conclusion: Our results showed that the serum IMA level is not an appropriate biomarker for acute mesenteric ischaemia. Additionally, the IMA level is not an appropriate biomarker for the detection of ischaemia duration. However, future studies should be conducted to clarify the efficacy of serum IMA levels under different ischaemic conditions.
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    Successful embolectomy in a femoral artery thrombosis caused by femoral artery catheterization in a infant
    (Verduci Publisher, 2012) Yavuz, C.; Cil, H.; Demirtas, S.; Yolbas, I.; Benli, E.
    In infants, the most common cause of femoral artery is thrombosis and iatrogenic arterial injuries usually occur after femoral artery catheterization procedures. Management of this complication includes heparin infusion, thrombolytic agents, interventional radiologic procedures, surgical thrombectomy and by-pass surgery. Signs of arterial thrombosis developed after femoral artery catheterization procedure in the right lower extremity of 9-month-old female infant with methyl malonic acidemia. Heparin infusion was started after confirming the diagnosis of femoral artery thrombosis by ultrasonography. Because of there was no response to heparin treatment, thrombolytic therapy (t-PA) was started after 24 hours. Again, because of there was no response to all medication, surgical thrombectomy was performed. Was entered right common femoral artery with 3.0 F Fogarty catheter and fresh thrombus material was removed from the proximal and distal segments of the femoral artery. Antegrade and retrograde blood flow was achieved. After the procedure clinical signs and the symptoms of the thrombosis were resolved rapidly. There were no any complications in the postoperative period. This case encouraged us for using surgical thrombectomy in the treatment of femoral artery thrombosis in infants who do not respond to medication.
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    Using oxidant and antioxidant levels to predict the duration of both acute peripheral and mesenteric ischemia
    (Sage Publications Ltd, 2014) Yazici, S.; Demirtas, S.; Guclu, O.; Karahan, O.; Yavuz, C.; Caliskan, A.; Mavitas, B.
    Objective: The aim of this study was to determine the relationship between oxidative stress markers and the duration of ischemia in rat mesenteric and peripheral ischemia models. Methods: Forty rats were divided into five equal groups, as follows: rats in Group I (control group) were sacrificed to determine the baseline characteristics of the serum markers; the superior mesenteric artery was clamped via a simple laparotomy to induce mesenteric ischemia in Groups II and III; the right common femoral artery was clamped to induce peripheral ischemia in Groups IV and V. Blood samples were taken at 2 (Groups II and IV) and 6 (Groups III and V) hours after these procedures. The serum total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and paraoxonase-I (PON-I) enzyme activities were evaluated in the samples obtained from each group. Results: The OSI level of the control group was 91.00+/-5.46 (mean +/- SD). The OSI levels taken 2 hours after the induction of mesenteric ischemia and peripheral ischemia were significantly higher (194.50+/-11.16 and 301.75+/-19.98, respectively (p<0.05)). However, these levels decreased to 151.88+/-17.02 (mesenteric ischemia) and 108.88+/-9.46 (peripheral ischennia) after 6 hours. The PON-I levels of Group III (mesenteric ischemia at 6 hours) (99.75+/-7.26), Group IV (peripheral ischemia at 2 hours) (96.88+/-4.09), and Group V (peripheral ischemia at 6 hours) (111.25+/-10.33) were slightly elevated over that of the control group (87.38+/-5.31). However, the PON-I level of Group 11 (mesenteric ischemia at 2 hours) (42.88+/-3.14) was lower than that of the other groups (p<0.05). Conclusion: Despite the increment of oxidative markers in early periods of ischemia (2nd hour), which was a hypoxic response of ischemic cells, they have decreased markedly in prolonged ischemia. This might have been caused by the opening of some collateral circulation or the destruction of the ischemic cells.