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Öğe Atorvastatin Pretreatment Diminishes the Levels of Myocardial Ischemia Markers Early After CABG Operation: An Observational Study(Biomed Central Ltd, 2010) Ege, Erdal; Dereli, Yüksel; Kurban, Sevil; Sarıgül, AliBackground: Statin pretreatment has been associated with a decrease in myocardial ischemia markers after various procedures and cardiovascular events. This study examined the potential beneficial effects of preoperative atorvastatin treatment among patients undergoing on-pump CABG operation. Methods: Twenty patients that had received atorvastatin treatment for at least 15 days prior to the operation and 20 patients who had not received any antihyperlipidemic agent prior to surgery were included in this study. CK-MB and troponin I levels were measured at baseline and 24 hours after the operation. Perioperative variables were also recorded. Results: Twenty-four hours after the operation, troponin I and CK-MB levels were significantly lower in the atorvastatin group: for CK-MB levels, 12.9 +/- 4.3 versus 18.7 +/- 7.4 ng/ml, p = 0.004; for troponin I levels, 1.7 +/- 0.3 versus 2.7 +/- 0.7 ng/ml, p < 0.001. In addition, atorvastatin use was associated with a decrease in the duration of ICU stay. Conclusions: Preoperative atorvastatin treatment results in significant reductions in the levels of myocardial injury markers early after on-pump CABG operation, suggesting a reduction in perioperative ischemia in this group of patients. Further studies are needed to elucidate the mechanisms of these potential benefits of statin pretreatment.Öğe Böbrek Transplantlı Bir Hastada Mitral Kapak Replasmanı(2007) Narin, Cüneyt; Ege, Erdal; Dereli, Yüksel; Sarıgül, AliOrgan transplantlı hastalardaki hayatta kalım süreleri her geçen gün artmaktadır (1). Bu artış, organ transplantlı hastalarda en sık, kardiyak hastalıkların görülmesine neden olmaktadır (2). Bu makalede, mitral kapak replasmanı uygulanan böbrek transplantlı bir hastanın izlemi tartışılmıştır.Öğe Comparison of different dose regimens of enoxaparin in deep vein thrombosis therapy in pregnancy(SPRINGER, 2008) Narin, Cueneyt; Reyhanoglu, Hasan; Tuelek, Baykal; Onoglu, Rasit; Ege, Erdal; Sariguel, Ali; Yeniterzi, MehmetIntroduction: Pregnant women have a higher risk of developing deep vein thrombosis (DVT) and consequent thrombogenic events, including pulmonary embolisms. Low-molecular-weight heparin (LMWH) products have been shown to successfully treat DVT with few significant side effects. The purpose of this study was to compare the effects of two dose regimens of enoxaparin (a LMWH) in the management of DVT in pregnancy. Methods: A total of 35 pregnant patients with DVT were enrolled in this study. As first-line anticoagulation therapy, patients were administered an intravenous unfractionated heparin infusion for 5 days, followed by a subcutaneous injection of enoxaparin 1 mg/kg twice a day until discharge. The enoxaparin therapy continued at home with 1 mg/kg twice a day for 18 patients (group I) and 1.5 mg/kg once a day for the other 17 patients (group II). Enoxaparin was discontinued 12-24 hours before delivery and restarted within 8-12 hours after delivery. Warfarin was given as adjuvant therapy along with enoxaparin in the post-partum period. Enoxaparin was discontinued when an international normalised ratio of 2 or above was reached. Differences between the two groups in terms of therapy response, complications and efficacy were recorded. Results: Thrombophilic disease was observed in three patients in each group. The iliac vein had the highest incidence of DVT in both groups. During therapy, two patients in group I were diagnosed with a mild haemorrhage; one patient (in group II) had abortion. There were no significant differences between groups in terms of recanalisation (measured by venous ultrasonography examination), post-thrombotic symptoms or safety parameters. Results: Enoxaparin can be used safely in DVT therapy during pregnancy. Our results indicate that therapy consisting of a single daily dose of 1.5 mg/kg enoxaparin is as effective as twice-daily administration.Öğe Dizaltı periferik arteriyel hastalığa cerrahi yaklaşım(2008) Narin, Cüneyt; Ege, Erdal; Sarkılar, Gamze; Önoğlu, Raşit; Sarıgül, Ali; Yeniterzi, MehmetAmaç: Bu çalışmanın amacı, dizaltı periferik baypas cerrahisi uygulanan hastalara cerrahi yaklaşımımızı değerlendirmektir. Yöntem: Haziran 2005 ile Ağustos 2007 tarihleri arasında kliniğimizde dizaltı periferik baypas cerrahisi uygulanan 21 hasta cerrahi yaklaşımımız açısından değerlendirilmiştir. Hastaların ikisi bayan, diğerleri erkektir. Yaş ortalaması 6015.4 yıldır. Tüm hastalarda greft olarak otojen safen ven kullanılmıştır. Postoperatif dönemde hastalara Dextran 40 infüzyonu ve düşük molekül ağırlıklı heparin verilmiştir. Postoperatif ilk gün aspirin, klopidogrel ve statin tedaviye eklenmiştir. Greft açıklığı, manyetik rezonans anjiyografi (MRA) ile değerlendirilmiştir. Bulgular: Erkek hastaların tümünde sigara anamnezi mevcuttur. Öyküde, daha önce 11 hastaya uygulanan periferik damar cerrahisi bulunmaktadır ve en sık uygulanmış damar cerrahisi femoral embolektomidir. Hastalar ortalama 12.77.5 ay takip edilmiştir. Distal damar yatağı kötü olan bir hastanın cerrahi uygulanan alt ekstremitesi operasyondan 16 gün sonra dizaltı amputasyona gitmiştir. Diğer hastaların greftlerinin açık olduğu MRA ile gösterilmiştir. Sonuç: Dizaltı revaskülarizasyon yöntemleri için, safen ven greftinin kullanılmasının, etkin postoperatif antitrombotik tedavinin ve epidural anestezinin greft açıklığını sağlamada önemli etkenler olduğu düşünülebilir. MRA, greft açıklığını değerlendirmede değerli bir yöntemdir. (Damar Cer Der 2008;17(l): 1-8).Öğe The Effect of Coronary Revascularization on New-Onset Complete Atrioventricular Block Due to Acute Coronary Syndrome(FORUM MULTIMEDIA PUBLISHING, LLC, 2009) Narin, Cueneyt; Ozkara, Ahmet; Soylu, Ahmet; Ege, Erdal; Duzenli, Akif; Sarigul, Ali; Yeniterzi, MehmetBackground: Coronary artery disease is one of the most common causes of complete atrioventricular block (AVB) in adults. In this study, we evaluated whether prompt revascularization of the coronary artery occlusion can ameliorate newonset complete AVB due to acute coronary syndrome (ACS). Methods: Five patients (4 men and 1 woman) with a mean age of 69.8 +/- 7.1 years with diagnosed new-onset complete AVB and proven coronary artery disease were enrolled in the study. At the time of AVB diagnosis, 3 of the patients had acute myocardial infarction, and the other 2 patients had unstable angina pectoris. All patients underwent complete coronary bypass surgery after the diagnosis of complete AVB. A patient who underwent 2 coronary bypasses also underwent aortic valve replacement. Results: No mortality was observed in the study group. All but one of the patients converted back to sinus rhythm after a mean interval of 30 +/- 13.6 hours following revascularization procedures. Complete AVB persisted in 1 patient, and a permanent pacemaker was implanted. All patients were discharged uneventfully. The mean hospital stay was 11.4 +/- 4.5 days. All patients are still being followed up after surgery; at a mean follow-up of 27.4 +/- 0.9 months, there have been no further problems. Conclusion: Coronary revascularization may ameliorate ACS-related new-onset complete AVB with an acceptable rate of successful reversion to sinus rhythm. An especially appropriate time for surgery, complete coronary revascularization, and management of myocardial protection during surgery might improve the results of coronary bypass procedures in these patients.Öğe THE EFFECT OF ILOPROST ON RENAL DYSFUNCTION AFTER RENAL I/R USING CYSTATIN C AND beta(2)-MICROGLOBULIN MONITORING(LIPPINCOTT WILLIAMS & WILKINS, 2009) Sahsivar, M. Orkun; Narin, Cueneyt; Kiyici, Aysel; Toy, Hatice; Ege, Erdal; Sarigul, AliThe purpose of this study was to investigate the effect of iloprost, a cytoprotective prostacyclin analog, on renal injury during unilateral renal I/R in rats and to determine whether the levels of serum cystatin C (CyC) and beta(2)-microglobulin (B2M), as markers of glomerular function, might denote this injury. Thirty-two Wistar rats were randomized into four groups (n = 8) as follows: control (sham laparotomy), renal I/R (60-min left renal ischemia and 120-min reperfusion), renal I/R + iloprost (20 ng kg(-1) min(-1) infusion during renal I/R period, i.v.), and control + iloprost. Blood and kidney tissue samples were obtained for biochemical and histological analysis from all rats. Serum urea, creatinine, CyC, and B2M levels were evaluated for biochemical analysis. Histopathological changes in renal structure were examined for histological analysis. Serum urea, creatinine, and CyC levels were significantly increased in the renal I/R group. Iloprost treatment decreased these three markers in the renal I/R + iloprost group. beta(2)-Microglobulin levels were not significantly changed in any group. Histological analyses showed that renal I/R elicited significant renal injury, whereas iloprost significantly decreased I/R-induced renal injury. Serum CyC level is one of the good indicators of acute renal damage due to I/R produced by renal artery occlusion. In contrast, we have shown that there are no significant changes in the levels of serum B2M levels that would make it an accurate diagnostic tool for detecting acute changes in renal injury subject to renal I/R in rats.Öğe Effect of preoperative atorvastatin therapy on paraoxonase activity and oxidative stress after coronary artery bypass grafting(SAGE PUBLICATIONS LTD, 2009) Kurban, Sevil; Mehmetoglu, Idris; Ege, ErdalThe aim of this study was to examine the influence of preoperative atorvastatin therapy on oxidative stress in coronary artery bypass grafting (CABG) patients. Forty patients who underwent elective CABG were enrolled into the study. Of these patients, 20 received atorvastatin (Group I) for 15 days prior to surgery and 20 patients did not use any antihyperlipidemic agents preoperatively (Group II). Serum paraoxonase 1 (PON1) and arylesterase activities, and total antioxidant status (TAS) and total oxidant status (TOS) were measured before surgery and at 1, 6 and 24 hours after the operation. Paraoxonase 1 and arylesterase activities (p<0.001) and TAS levels (p<0.001 for 1(st) hour and p<0.05 for 6th hour) in Group II were significantly reduced at the 1(st) and 6(th) hours after the operation, whereas the activities of the enzymes (p<0.01) and TAS levels (p<0.05) were significantly reduced only at the 1(st) hour after the operation in Group I. The total oxidant status of both groups was significantly increased at the 1(st) hour after operation (p<0.05 for Group I and p<0.01 for Group II). In conclusion, 15 days of preoperative atorvastatin therapy does not significantly change either the serum PON1 activity or the oxidative stress after CABG.Öğe İnaortik Balon Pompasına Bağlı Damar Komplikasyonlarını Önlemede Dekstran 40 Kullanımı(2007) Narin, Cüneyt; Özkara, Ahmet; Sarkılar, Gamze; Can, İlknur; Ege, Erdal; Sarıgül, Ali; Yeniterzi, MehmetAmaç: Intraaortik balon pompası (IABP), dolaşım desteği sağlamak amacıyla, kardiyoloji ve kalp cerrahisinde yaygın olarak kullanılmaktadır. IABP kaynaklı tromboembolik damar komplikasyonlarını önlemek amacıyla, antitrombotik ajanlardan Dekstran 40 kullanılması araştırılmıştır. Gereç ve yöntemler: Kasım 2004 ile Ekim 2006 tarihleri arasında, koroner bypass operasyonu olan 37 hastaya IABP yerleştirilmiştir. Böbrek yetmezliği ve aşırı cerrahi drenaj tanısı alan hastalar dışındaki tüm hastalar, kateterin çekilmesinden 0.5 saat öncesine kadar Dekstran 40 infüzyonu almışlardır. Bu grupta heparin kullanılmamıştır. Bulgular: Olguların 26'sı (%70) erkek, 11'i (% 30) kadındır. Ortalama yaş, 63.4 + 8.4 yıl ve ortalama IABP kullanma süresi, 56.3 saat (6 ile 162 saat arası) bulunmuştur. Yirmidokuz hastaya (% 78.4) sadece koroner bypass operasyonu (CABG), 8 hastaya da (% 21.6) CABG'ye eşlik eden diğer açık kalp operasyonları uygulanmıştır. Hiçbir hastada Dextran 40 kullanımına bağlı yan etki görülmemiştir. Üç olguda (%8) bacak iskemisi gelişmiş olup, 2 olguda kateterin çekilmesi ile iskemi düzelmiş, I olguda Fogarty kateteri ile tromboembolektomi gerekli olmuştur. Hiçbir hastada büyük cerrahi girişim gereksinimi olmamıştır. Kateterin giriş yerinde belirgin kanama görülmemiştir. Olguların hiçbirinde trombositopeni gözlenmemiştir. Sonuç: Dekstran 40, IABP ilişkili damarsal yan etkileri azaltmak için güvenle kullanılabilir. Bu çalışma, IABP kaynaklı damar komplikasyonlarını önlemek açısından Dekstran 40 ile heparinin karşılaştırılacağı yeni çalışmalara öncülük edebilir.Öğe Mitral valve replacement in a renal transplant patient(GALENOS YAYINCILIK, 2007) Narin, Cueneyt; Ege, Erdal; Dereli, Yueksel; Sarigul, Ali[Abstract not Available]Öğe Renal Arter Anevrizmalı Bir Hastanın Başarılı Cerrahi Tedavisi: Olgu Sunumu(2007) Özkara, Ahmet; Ege, Erdal; Narin, Cüneyt; Şahsıvar, Mehmet Orkun; Sarkılar, Gamze; Paksoy, Yahya; Sarıgül, Ali; Yeniterzi, MehmetRenal arter anevrizması viseral anevrizmalar içerisinde oldukça ender rastlanmaktadır. Hızla ilerlemekte olan görüntüleme teknikleri sayesinde birçok renal arter anevrizmasının sessiz kaldığı saptanmıştır. Yirmisekiz yaşında ve yeni teşhis edilmiş hipertansiyonu olan erkek hastada yapılan incelemede sol renal arterde, aortadan ayrıldığı yerin 3 cm distalinde yaklaşık 3 cm genişliğinde anevrizma belirlenmiştir. Yapılan cerrahi müdahalede; sol renal arter bağlanıp, anevrizma rezeke edildikten sonra safen ven bypass operasyonu uygulanmıştır. Anevrizma dokusunun patolojik incelenmesinde, aterosklerotik zeminde geliştiği saptanmıştır. Hasta, operasyon sonrası 5. günde düşük doz beta blokerle taburcu edildi. iki ay sonra yapılan kontrol manyetik rezonans (MR) anjiografik incelemede safen greftin patent olduğu saptanmıştır. Renal arter anevrizmalarında perkütan girişime uygun olmayan vakalarda, safen ven grefti ile bypass operasyonları kabul edilir tedavi seçeneği olabilir.Öğe Repair of Coarctation-Related Aortic Arch Aneurysm and Ventricular Septal Defect in an Adolescent(TEXAS HEART INST, 2008) Narin, Cuneyt; Ege, Erdal; Orhan, Atilla; Yeniterzi, MehmetA saccular aortic arch aneurysm that is secondary to aortic arch coarctation and that is accompanied by a ventricular septal defect is a rare combination in the adolescent patient. Total simultaneous repair of all of these conditions is desirable, because of the higher morbidity and mortality rates of staged procedures-particularly when resection of the saccular aneurysm is delayed. Herein, we discuss the case of a 16-year-old boy who underwent simultaneous surgical correction of these malformations. With the aid of cardiopulmonary bypass on the beating heart, the coarctation and the aneurysmal segment were resected, and a tubular Dacron graft was interposed. The ascending aorta and femoral artery were both then cannulated to ensure whole-body perfusion during cardiopulmonary bypass. The ventricular septal defect was closed with the patient under cardioplegic arrest. After 70 days, he was discharged from the hospital without sequelae. We conclude that single-staged repair of cardiac abnormalities and of an aortic arch aneurysm that is secondary to coarctation of the aortic arch can be performed safely and effectively in adolescent and adult patients by use of our technique. (Tex Heart Inst J 2008;35(4):466-9)Öğe Successful Mitral Valve Surgery in a Patient with Myasthenia Gravis(WILEY-BLACKWELL PUBLISHING, INC, 2009) Narin, Cueneyt; Sarkilar, Gamze; Tanyeli, Omer; Ege, Erdal; Yeniterzi, MehmetMyasthenia gravis (MG) is an autoimmune disease characterized by a weakness of the muscles with remissions and exacerbations due to antibodies against acetylcholine receptors. Most of the patients die because of a respiratory failure toward the end of the disease. A 49-year-old male patient with MG in whom a thymectomy operation had been performed five years ago had dyspnea, palpitation, and chest pain during his admission. After his examination, a severe mitral regurgitation was detected, and he underwent a successful mitral valve replacement. A general anesthesia management was performed using sufentanyl and propophol without any muscle relaxant agent. He was extubated seven hours after the surgery. He had difficulty in swallowing at postoperative day three, and his medication doses were increased. He was discharged from the hospital at postoperative day seven without any complication. MG is a rare disease and may cause morbid complications during the cardiac surgery, but can be successfully managed. (J Card Surg 2009;24:210-212).Öğe Surgery of left atrial myxoma as a second primary tumor in a patient previously treated for breast cancer(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012) Narin, Cuneyt; Ege, Erdal; Onoglu, Rasit; Yazici, Mehmet; Sarigul, AliA rising level of experience and advances in cardiac surgery are leading to more operations being performed on elderly patients with other complicated diseases. But cardiac surgery in patients with malignant diseases remains a problem. Although most malignant diseases are curable, surgeons are usually reluctant to perform open heart surgery in patients with advanced tumors and a short life expectancy. Among patients undergoing open heart surgery, the incidence of malignancy is 1.2%. In this article, we present a successful atrial myxoma excision in an elderly patient with treated breast cancer using cardiopulmonary bypass and cardiac arrest.Öğe Surgical treatment of postinfarction pseudoaneurysms of the left ventricle(WILEY, 2008) Narin, Cueneyt; Ege, Erdal; Ozkara, Ahmet; Tanyeli, Omer; Sarkilar, Gamze; Soylu, Ahmet; Sarigul, AliBackground: Left ventricular pseudoaneurysm is a rare and frequently fatal complication of acute myocardial infarction. It occurs as a consequence of rupture of the ventricular free wall that gets confined by a portion of the pericardium. The purpose of this study was to present our surgical experience of postinfarction left ventricular pseudoaneurysms and to evaluate mid-term results. Methods: The study population comprised five symptomatic patients diagnosed with left ventricular pseudoaneurysm and treated surgically in a short period of time. There were three males and two females. The mean age of the patients was 66.8 +/- 10.8 years. The diagnosis was made initially by echocardiography and subsequently confirmed by angiography. An additional cardiac magnetic resonance imaging study was performed in three patients. Surgical resection of the pseudoaneurysm was combined with an endoaneurysmorrhaphy procedure in all patients. Associated cardiac operations were performed in three patients. Definitive diagnosis of pseudoaneurysm was confirmed by histopathological evaluation of the excised wall in all patients. Results: All patients survived the operation and were discharged to home care. The mean duration of hospital stay was 11.6 +/- 4.6 days. Patients were either in class I or II of New York Heart Association classification at discharge. All patients are still being followed after surgery with a mean follow-up period of 10.4 +/- 6.6 months with no further problems. Conclusion: Surgical repair is indicated in left ventricular pseudoaneurysm as it carries a high risk of rupture and sudden cardiac death. Surgical repair combined with an endoaneurysmorrhaphy procedure carries a low mortality risk and improves functional capacity.Öğe Total Anormal Pulmoner Venöz Dönüş Anomalili Bir Hastada Cerrahi Tamir Sonrası Oral Sildenafil(2007) Sarıgül, Ali; Özkara, Ahmet; Narin, Cüneyt; Sarkılar, Gamze; Ege, ErdalÜç aylık kız çocuğunda, total anormal pulmoner venöz dönüş anomalisi nedeniyle tam düzeltme yapıldıktan sonra, nitrogliserin perfüzyonuna rağmen ameliyat sonrası ikinci gün pulmoner hipertansif kriz gelişti. Nazogastrik tüp yoluyla oral sildenafil tedavisi 0.5 mg/kg/24 sa dozuyla başlanıp, doz kademeli olarak artırılarak 2 mg/kg/24 sa dozuna kadar yükseltildi. Sildenafil pulmoner basıncı düşürdü ve hasta mekanik ventilasyon desteğinden pulmoner hipertansif kriz olmaksızın başarıyla ayrıldı. Komplike bir ameliyat sonrası döneminin sildenafile başlandıktan sonra düzelmesi pulmoner basıncın düştüğünü dolaylı olarak göstermektedir. Hastada sildenafile bağlı herhangi bir yan etki gelişmedi. Bu ilacın açık kalp cerrahisi geçirmiş bebeklerde pulmoner hipertansif profilaksisinde güvenli bir şekilde kullanılabileceğini ve etkin bir rol oynayabileceğini düşünüyoruz.
