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Öğe Diagnostic accuracy and effective radiation dose of high pitch dual source multidetector computed tomography in evaluation of coronary artery bypass graft patency(SPRINGER WIEN, 2016) Koplay, Mustafa; Guneyli, Serkan; Akbayrak, Hakan; Demir, Kenan; Sivri, Mesut; Avci, Ahmet; Erdogan, HasanThe aim of the study was to evaluate the diagnostic accuracy and effective radiation dose (ERD) of high pitch dual source multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Fourty-five patients who underwent 128 x 2aEuroslice MDCT angiography with a prospective electrocardiogram-triggering, low-dose, high pitch, dual source, flash spiral acquisition mode after CABG surgery were included in the study. The interobserver agreement of the image quality was evaluated with Cohen kappa value. The image quality was compared to the heart rates (HRs) using Mann-Whitney U test and to the graft segments using chi(2) test. The findings for the CABG patency on MDCT were compared to those determined on catheter coronary angiography. Dose-length product (DLP) and ERD were compared to the gender, HRs, and body mass index (BMI) of the patients using Kruskall Wallis and Mann-Whitney U tests. A total of 110 grafts and 330 vessel segments were evaluated with a good interobserver agreement (kappa = 0.80). The image quality was better in proximal and middle graft segments (p < 0.05), as well as in the patients with low HRs (p < 0.05). High pitch MDCT had the following sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for evaluation of graft patency: 92.8, 99.3, 92.8, 99.3 and 98.8 %, respectively. ERD was correlated to the HRs and BMI. High pitch 128 x 2aEuroslice dual source CT angiography is a noninvasive imaging modality, and it can be safely and effectively used in evaluation of CABG patency with lower radiation dose.Öğe Emergent surgical treatment of lethal valve dysfunction during pregnancy in a last-trimester patient(SAUDI MED J, 2018) Akbayrak, Hakan; Çiçek, Ömer Faruk; Orhan, AtillaA mechanical heart valve thrombosis during pregnancy is one of the most lethal conditions to experience due to its detrimental effects on both mother and fetus. Cardiac surgery during pregnancy is reserved for cases where medical treatment fails due to harmful maternal and fetal effects. A 24-year-old female in the 38th week of pregnancy was admitted to the emergency room with aggravated dyspnea, tachypnea, and palpitations. She had 2 previous cardiac operations in her medical history. A stuck mechanical valve was diagnosed in the mitral position via transthoracic echocardiography, which had resulted from her decision to cease taking warfarin when planning to become pregnant. In pregnant patients who have prosthetic mechanical valve thrombosis, surgical approach should be considered depending on the conditions of the mother and the baby. When emergency delivery of the baby is feasible, emergent surgical treatment should be utilized for patients who are in critical condition.Öğe Evaluation of the Patients Developing Severe Pleural Effusion After Isolated Coronary Artery Bypass Operation(Selçuk Üniversitesi, 2022) Tekümit, Hayrettin; Akbayrak, HakanObjective: In this study, we aimed to determine the causal relationship between isolated coronary bypass surgery development of severe pleural effusion in the early postoperative period. Methods: In this study, 7862 isolated coronary artery bypass surgery cases conducted in our hospital between February 2001 and July 2013 were analyzed retrospectively. 175 (2.2%) patients developed early-severe pleural effusion were included in the study. The findings of 175 cases with early severe postoperative pleural effusion (Group A) were compared with the data of 180 cases (Group B) who had similar demographic findings and did not develop early-serious pleural effusion in the postoperative period. Results: The mean age of these pleural effusion cases was 66.3±9.5 (55-76). 149 (85.1%) of the cases were operated under elective conditions and 26 (14.9%) of them were operated under emergency conditions. The mean cardiopulmonary bypass time of the cases was 70±28 (40-100) minutes. Left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used together in 161 (92%) cases. Patients discharged after operation uneventfully. However, of the cases, 126 (72%) had shortness of breath, 115 (65.7%) dry cough, 28 (16%) productive cough, 50 (28.6%) tachypnea, 22 (12.5%) chest pain. Early severe pleural effusion developed in the left hemithorax in 154 (88%) of the cases. LITA+SVG was used in 148 (96.1%) of these cases, and only SVG was used in 6 (3.9%) cases. Early severe pleural effusion developed in the right hemithorax in 14 (8%) of the cases. LITA+SVG was used in 10 (71.4%) of these cases, and only SVG was used in 4 (28.6%) cases. The cases with bilateral early severe pleural effusion were 7 (4%). LITA+SVG was used in 3 (42.9%) of these cases, and only SVG was used in 4 (57.1%) cases. When the two groups were compared, Group A had significantly higher rates of low EF and atrial fibrillation than Group B. Conclusion: It is known that coronary artery bypass surgery causes deterioration of postoperative pulmonary function. One of the most common complications of coronary artery bypass surgery is pleural effusion. It is known that this postoperative picture is associated with increased hospital readmission, rehospitalization and high postoperative morbidity. It is important to determine preoperative risks in terms of postoperative patient management and morbidity assessment.Öğe Pulmonary thromboendarterectomy in a combined thrombophilia patient(CLINICS CARDIVE PUBL PTY LTD, 2019) Akbayrak, Hakan; Tekumit, HayrettinChronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secondary pulmonary hypertension. Surgical treatment remains the primary treatment for patients with CTEPH. Pulmonary thromboendarterectomy (PEA) with deep hypothermic circulatory arrest is the standard and recommended surgical technique for the treatment of these patients. The prevalence of CTEPH after an acute pulmonary thromboembolism (PTE) has been found in various studies to be between 0.6 and 8.8%. Mortality rates in elective PEA cases with CTEPH are reported to be between 1.9 and 4.5%. We report on a 50-year-old female patient with combined inherited thrombophilia, including protein C and protein S deficiencies, who was diagnosed with CTEPH and was successfully treated with pulmonary thromboendarterectomy.Öğe A rare giant pericardial cyst mimicking a paracardiac mass(CLINICS CARDIVE PUBL PTY LTD, 2016) Akbayrak, Hakan; Yildirim, Serkan; Simsek, Murat; Oc, MehmetPericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomalies. They are induced by an incomplete coalescence of foetal lacunae during the development of the pericardium. Pericardial cysts are usually unilocular, well marginated spherical or teardrop shaped and may be attached to the pericardium directly or by a pedicle. Of all pericardial cysts, 70 to 75% are located at the right cardiophrenic angle. We report a case that was incidentally diagnosed with only chest magnetic resonance imaging because of a paracardiac mass. In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy.Öğe Spontaneous Coronary Artery Dissections: Three Case Reports and Review of Literature(FORUM MULTIMEDIA PUBLISHING, LLC, 2012) Farsak, Bora; Öç, Mehmet; Öç, Bahar; Şimşek, Murat; Akbayrak, Hakan; Avcı, AhmetPrimary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction and is mostly fatal. Previous studies report that it is mostly seen in middle-aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern, and its severity is related to extent and development rate of dissection. Herein we present three cases of primary spontaneous left main coronary artery dissection. Two of the patients are men and the third patient is a nonpregnant 69-year-old woman. The cases were presented and discussed with review of the pertinent literature.
