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Öğe Malatya ve çevresinde çocukluk çağında akut romatizmal ateş sıklığı(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Almış, Habib; Karakurt, Cemşit; Çelik, Serkan Fazlı; Elkıran, Özlem; Koçak, GülendamAmaç: Akut romatizmal ateş, A grubu beta hemolitik streptokok enfeksiyonuna karşı oluşan immun reaksiyonla bağlantılı multisistemik bir hastalık Sosyoekonomik koşullara bağlı olarak sıklık, morbidite ve mortalitesi değişebilmektedir. Akut romatizmal ateş gelişmekte olan ülkelerde edinilmiş kalp hastalıklarının en önemli nedenidir. Türkiye ile ilgili insidans çalışmaları sınırlı sayıdadır. Gereç ve Yöntemler: Bu çalışmada Malatya ve çevresinde akut romatizmal ateş sıklığını belirlemek amacıyla Ocak 2007-Aralık 2011 yılları arasında İnönü Üniversitesi Tıp Fakültesi Pediatrik Kardiyoloji Bilim Dalında akut romatizmal ateş tanısı alan hastalar retrospektif olarak incelenmiştir. Hastaların tıbbi kayıtları incelenerek, öykü, fizik muayene, akut faz reaktanları, ASO değerleri, boğaz kültürü, elektrokardiyografi ve ekokardiyografi sonuçları kaydedildi. Akut romatizmal ateş tanısı modifiye Jones kriterleri kullanılarak konuldu. Akut romatizmal ateş tanısı alan hastaların çocukluk yaş grubunda hastaneye başvuru içerisindeki sıklığı belirlendi. Bulgular: 132 akut romatizmal ateş tanısı almış hastada kardit (%83,3) en sık majör bulgu olarak saptanmış olup, onu sırasıyla artrit (%47), kore (%13,6) ve eritema marginatum (%0,8) izlemiştir. Mitral kapak (%76,5) en sık tutulan kapak olup, onu aortik kapak tutulumu (%25,8) takip etmekteydi. Akut romatizmal ateşe bağlı kardit sıklığının 100.000'de 42,3 ile 104,8 arasında değiştiği saptanmıştır. Olgularda saptanan minör bulgulardan 110 olguda izlenen (%83,3) ESH yüksekliği ve CRP pozitifliği, 82 olguda (%62,1) ateş yüksekliği saptanırken olguların 48’inde (%36,3) görülen artralji saptandı. PR uzaması ise 14 olguda (%10,6) vardı. Sonuç: Akut romatizmal ateş sıklıkla çocuk yaş grubunu etkileyen, Türkiye'de hala önem koruyan bir hastalıktır. Ülkemizin nispeten geri kalmış bölgelerinde akut romatizmal ateş sıklığının diğer bölgelerden daha da yüksek olduğuna inanmaktayız.Öğe Malatya ve çevresinde çocukluk çağında akut romatizmal ateş sıklığı(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Almış, Habib; Karakurt, Cemşit; Çelik, Serkan Fazlı; Elkıran, Özlem; Koçak, GülendamAmaç: Akut romatizmal ateş, A grubu beta hemolitik streptokok enfeksiyonuna karşı oluşan immun reaksiyonla bağlantılı multisistemik bir hastalık Sosyoekonomik koşullara bağlı olarak sıklık, morbidite ve mortalitesi değişebilmektedir. Akut romatizmal ateş gelişmekte olan ülkelerde edinilmiş kalp hastalıklarının en önemli nedenidir. Türkiye ile ilgili insidans çalışmaları sınırlı sayıdadır. Gereç ve Yöntemler: Bu çalışmada Malatya ve çevresinde akut romatizmal ateş sıklığını belirlemek amacıyla Ocak 2007-Aralık 2011 yılları arasında İnönü Üniversitesi Tıp Fakültesi Pediatrik Kardiyoloji Bilim Dalında akut romatizmal ateş tanısı alan hastalar retrospektif olarak incelenmiştir. Hastaların tıbbi kayıtları incelenerek, öykü, fizik muayene, akut faz reaktanları, ASO değerleri, boğaz kültürü, elektrokardiyografi ve ekokardiyografi sonuçları kaydedildi. Akut romatizmal ateş tanısı modifiye Jones kriterleri kullanılarak konuldu. Akut romatizmal ateş tanısı alan hastaların çocukluk yaş grubunda hastaneye başvuru içerisindeki sıklığı belirlendi. Bulgular: 132 akut romatizmal ateş tanısı almış hastada kardit (%83,3) en sık majör bulgu olarak saptanmış olup, onu sırasıyla artrit (%47), kore (%13,6) ve eritema marginatum (%0,8) izlemiştir. Mitral kapak (%76,5) en sık tutulan kapak olup, onu aortik kapak tutulumu (%25,8) takip etmekteydi. Akut romatizmal ateşe bağlı kardit sıklığının 100.000'de 42,3 ile 104,8 arasında değiştiği saptanmıştır. Olgularda saptanan minör bulgulardan 110 olguda izlenen (%83,3) ESH yüksekliği ve CRP pozitifliği, 82 olguda (%62,1) ateş yüksekliği saptanırken olguların 48’inde (%36,3) görülen artralji saptandı. PR uzaması ise 14 olguda (%10,6) vardı. Sonuç: Akut romatizmal ateş sıklıkla çocuk yaş grubunu etkileyen, Türkiye'de hala önem koruyan bir hastalıktır. Ülkemizin nispeten geri kalmış bölgelerinde akut romatizmal ateş sıklığının diğer bölgelerden daha da yüksek olduğuna inanmaktayız.Öğe A rare variant of type I truncus arteriosus truncus arteriosus with anterior origin of a main pulmonary artery(Echocardiography, 2015) Çelik, Serkan Fazlı; Karakurt, Cemşit; Elkıran, Özlem; Öztürk, Mehmet; Görmeli, Ayşe CemileTruncus arteriosus (TA ) is an uncommon con-genital cardiovascular anomaly that is character-ized by a single arterial trunk arising from thenormally formed ventricles by means of a singlesemilunar valve. The anomaly is thought to resultfrom incompl ete or failed septation of the embry-onic truncus arteriosus. Truncus arteriosus withanterior origin of a mai n pulmonary arte ry is avery rare condition. In this report we present anewborn who has a truncus arteriosus with ante-rior origin of a main pulmonary artery.Öğe A rare variant of type I truncus arteriosus truncus arteriosus with anterior origin of a main pulmonary artery(Echocardiography, 2015) Çelik, Serkan Fazlı; Karakurt, Cemşit; Elkıran, Özlem; Öztürk, Mehmet; Görmeli, Cemile AyşeTruncus arteriosus (TA) is an uncommon congenital cardiovascular anomaly that is characterized by a single arterial trunk arising from the normally formed ventricles by means of a single semilunar valve. The anomaly is thought to result from incomplete or failed septation of the embryonic truncus arteriosus. Truncus arteriosus with anterior origin of a main pulmonary artery is a very rare condition. In this report we present a newborn who has a truncus arteriosus with anterior origin of a main pulmonary artery.Öğe Serum pentraxin 3 and hs crp levels in children with severe pulmonary hypertension(Balkan Med J, 31(3), 0–0., 2014) Karakurt, Cemşit; Başpınar, Osman; Çelik, Serkan Fazlı; Taşkapan, Çağatay; Şahin, Aydın Derya; Yoloğlu, SaimBackground: Pulmonary arterial hypertension secondary to untreated left-to-right shunt defects leads to increased pulmonary blood flow, endothelial dysfunction, increased pulmonary vascular resistance, vascular remodelling, neointimal and plexiform lesions. Some recent studies have shown that inflammation has an important role in the pathophysiology of pulmonary arterial hypertension. Aims: The aim of this study is to evaluate serum pentraxin 3 and high sensitive (hs)-C reactive protein (hs-CRP) levels in children with severe pulmonary arterial hypertension (PAH) secondary to untreated congenital heart defects and evaluate the role of inflammation in pulmonary hypertension. Study Design: Cross sectional study. Methods: After ethics committee approval and receiving consent from parents, there were 31 children were selected for the study with severe PAH, mostly with a left-to-right shunt, who had been assessed by cardiac catheterisation and were taking specific pulmonary vasodilators. The control group consisted of 39 age and gender matched healthy children. After recording data about all the patients including age, gender, weight, haemodynamic studies and vasodilator testing, a physical examination was done for all subjects. Blood was taken from patients and the control group using peripheral veins to analyse serum Pentraxin 3, N-terminal pro-Brain Natriuretic Peptide (NT-ProBNP) and hs-CRP levels. Serum Pentraxin-3 levels were measured by enzyme linked immunosorbent assay (ELISA) and expressed as ng/mL. Serum hs-CRP levels were measured with an immunonephelometric method and expressed as mg/dL. The serum concentration of NT-proBNP was determined by a chemiluminescent immunumetric assay and expressed as pg/mL. Results: Serum Pentraxin- 3 levels were determined to be 1.28±2.12 (0.12-11.43) in the PAH group (group 1) and 0.40±0.72 (0.07-3.45) in group 2. There was a statistically significant difference between the two groups (p<0.01). Serum hs-CRP levels were measured as 2.92±2.12 (0.32-14.7) mg/dL in group 1 and 0.35±0.16 (0.07-3.45) mg/dL in group 2. The hs-CRP level was increased in the PAH group to a significant degree (p<0.01). Conclusion: Our study showed that pentraxin 3 and hs-CRP levels were increased significantly in the PAH group. We consider that inflammation plays an important role in severe pulmonary hypertension and progressive pulmonary arterial hypertension in children with PAH.Öğe Serum pentraxin 3 and hs crp levels in children with severe pulmonary hypertension(Balkan Med J, 2014) Karakurt, Cemşit; Başpınar, Osman; Çelik, Serkan Fazlı; Taşkapan, Mehmet Çağtay; Şahin, Derya; Yoloğlu, SaimBackground: Pulmonary arterial hypertension secondary to untreated left-to-right shunt defects leads to increased pulmonary blood flow, endothelial dysfunction, increased pulmonary vascular resistance, vascular remodelling, neointimal and plexiform lesions. Some recent studies have shown that inflammation has an important role in the pathophysiology of pulmonary arterial hypertension. Aims: The aim of this study is to evaluate serum pentraxin 3 and high sensitive (hs)-C reactive protein (hs-CRP) levels in children with severe pulmonary arterial hypertension (PAH) secondary to untreated congenital heart defects and evaluate the role of inflammation in pulmonary hypertension. Study Design: Cross sectional study. Methods: After ethics committee approval and receiving consent from parents, there were 31 children were selected for the study with severe PAH, mostly with a left-to-right shunt, who had been assessed by cardiac catheterisation and were taking specific pulmonary vasodilators. The control group consisted of 39 age and gender matched healthy children. After recording data about all the patients including age, gender, weight, haemodynamic studies and vasodilator testing, a physical examination was done for all subjects. Blood was taken from patients and the control group using peripheral veins to analyse serum Pentraxin 3, N-terminal pro-Brain Natriuretic Peptide (NT-ProBNP) and hs-CRP levels. Serum Pentraxin-3 levels were measured by enzyme linked immunosorbent assay (ELISA) and expressed as ng/mL. Serum hs-CRP levels were measured with an immunonephelometric method and expressed as mg/dL. The serum concentration of NT-proBNP was determined by a chemiluminescent immunumetric assay and expressed as pg/mL. Results: Serum Pentraxin- 3 levels were determined to be 1.28±2.12 (0.12-11.43) in the PAH group (group 1) and 0.40±0.72 (0.07-3.45) in group 2. There was a statistically significant difference between the two groups (p<0.01). Serum hs-CRP levels were measured as 2.92±2.12 (0.32-14.7) mg/dL in group 1 and 0.35±0.16 (0.07-3.45) mg/dL in group 2. The hs-CRP level was increased in the PAH group to a significant degree (p<0.01). Conclusion: Our study showed that pentraxin 3 and hs-CRP levels were increased significantly in the PAH group. We consider that inflammation plays an important role in severe pulmonary hypertension and progressive pulmonary arterial hypertension in children with PAH.Öğe Sirozlu çocuklarda kalp fonksiyonlarının doku Doppler görüntüleme ile değerlendirilmesi(2017) Çelik, Elif; Karakurt, Cemşit; Çelik, Serkan Fazlı; Selimoğlu, Ayşe; Varol, Fatma İlknurGiriş ve Amaç: Sirotik kardiyomiyopati siroz varlığında oluşan kardiyak disfonksiyon olarak tanımlanmaktadır. Pediatrik yaş grubunda sirotik kardiyomiyopati ile ilgili yapılmış çok az sayıda çalışma vardır. Bu çalış- mada sirozlu çocuklarda kardiyak fonksiyonlar ile pulmoner komplikas- yonları tespit etmek amaçlandı. Gereç ve Yöntem: Bu çalışmada İnö- nü Üniversitesi Tıp Fakültesi Çocuk Gastroenteroloji Bölümü'nde, Ekim 2011-Aralık 2013 tarihleri arasında retrospektif olarak iki yıllık süreçte izlenen 52 sirozlu çocuk hasta ile yaş ve cinsiyetleri benzer 30 sağlıklı çocuk konvansiyonel, renkli Doppler ve doku Doppler ekokardiyorafik görüntüleme yöntemleriyle değerlendirildi. Bulgular: Çalışmaya alınan 52 olgunun yaş ortalaması 6.5±4.6 yıl, 28'i erkek (%53,3), 24'ü kız (%47,7) idi. Kontrol grubunun yaşlarının ortalaması 6.88±3.04 yıl, 16'sı erkek (%53,3), 14'ü kız (%46,6) olmak üzere toplam 30 idi. Hastaların M-mod değerlendirmelerinde sol ventrikül arka duvarı kontrol grubun- dan daha kalındı (5.9±1.7 mm ve 5.1±1.8 mm, p:0.03). Renkli Doppler- le mitral kapaktan ölçülen E/A oranı hasta grubunda anlamlı derecede düşüktü (1.46±0.43 ve 1.61±0.46, p: 0.01). Hasta grubu daha uzun izovolümik relaksasyon süresine (48.5±12.5 ms ve 42.6±11.64 ms, p: 0.001) ve daha kısa izovolümetrik kontraksiyon süresine (43.6±9.5 ms ve 48.6±11.6 ms, p: 0.001) sahipti. Hasta grubunda sol ventrikü- lün miyokard performans indeksi anlamlı olarak yüksekti (0.57±0.13 ve 0.50±0.67, p: 0.02). Hastaların 8 tanesine (%15) hepatopulmoner sendrom tanısı kondu. Hepatopulmoner sendromlu hastaların ekokar- diyografik değerlendirilmelerinde, hepatopulmoner sendromu olmayan hasta grubuna göre interventriküler septum diastolik kalınlığı (6,9±1.2 mm ve 6.4±1.8 mm, p: 0.04) ve yavaşlama süresi (154.1± 35.6 ms ve 140.4±39.8 ms, p: 0.03) daha fazla idi. Sonuç: Sirotik çocuklarda başta diyastolik disfonksiyon olmak üzere kardiyak disfonksiyon vardır. hepa- topulmoner sendromlu grupta bu etkilenme daha fazladır. Çalışmamız doku Doppler ekokardiyografinin, hastalık progresyonunun saptanması ve izlenmesi için yararlı bir yöntem olduğunu göstermektedirÖğe Strain and strain rate echocardiography in children with Wilson s disease(Cardiovascular Journal of Africa, 2016) Karakurt, Cemşit; Çelik, Serkan Fazlı; Selimoğlu, Mukadder Ayşe; Varol, İlknur; Karabiber, Hamza; Yoloğlu, Saimn this study, 21 patients with Wilson's disease and a control group of 20 age- and gender-matched healthy children were included. All the patients and the control group were evaluated with two-dimensional (2D) and colour-coded conventional transthoracic echocardiography by the same paediatric cardiologist using the same echocardiography machine (Vivid E9, GE Healthcare, Norway) in standard precordial positions, according to the American Society of Echocardiography recommendations. 2D strain and strain rate echocardiography were performed after the ECG probes of the echocardiography machine were adjusted for ECG monitoring. Longitudinal, transverse and radial strain, and strain rate were assessed from six basal and six mid-ventricular segments of the left ventricle, as recommended by the American Society of Echocardiography.Öğe Strain and strain rate echocardiography in children with Wilson s disease(Cardiovascular Journal of Africa, 2016) Karakurt, Cemşit; Çelik, Serkan Fazlı; Selimoğlu, Mukadder Ayşe; Varol, İlknur; Karabiber, Hamza; Yoloğlu, SaimObjective: This study aimed to evaluate strain and strain rate echocardiography in children with Wilson’s disease to detect early cardiac dysfunction. Methods: In this study, 21 patients with Wilson’s disease and a control group of 20 age- and gender-matched healthy children were included. All the patients and the control group were evaluated with two-dimensional (2D) and colour-coded conventional transthoracic echocardiography by the same paediatric cardiologist using the same echocardiography machine (Vivid E9, GE Healthcare, Norway) in standard precordial positions, according to the American Society of Echocardiography recommendations. 2D strain and strain rate echocardiography were performed after the ECG probes of the echocardiography machine were adjusted for ECG monitoring. Longitudinal, transverse and radial strain, and strain rate were assessed from six basal and six mid-ventricular segments of the left ventricle, as recommended by the American Society of Echocardiography. Results: Left ventricular wall thickness, systolic and diastolic diameters, left ventricular diameters normalised to body surface area, end-systolic and end-diastolic volumes, cardiac output and cardiac index values were within normal limits and statistically similar in the patient and control groups (p > 0.05). Global strain and strain rate: the patient group had a statistically significant lower peak A longitudinal velocity of the left basal point and peak E longitudinal velocity of the left basal (VAbasR) point, and higher global peak A longitudinal/ circumferential strain rate (GSRa) compared to the corresponding values of the control group (p < 0.05). Radial strain and strain rate: end-systolic rotation [ROT (ES)] was statistically significantly lower in the patient group (p < 0.05). Longitudinal strain and strain rate: end-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05). Segmental analysis showed that rotational strain measurement of the anterior and lateral segments of the patient group were statistically significantly lower than the corresponding values of the control group (p < 0.05). Segmental analysis showed statistically significantly lower values of end-systolic longitudinal strain [STSR (ES)] of the basal lateral (p < 0.05) and end-systolic longitudinal strain [SLSC (ES)] of the basal septal segment (p < 0.05) in the patient group. End-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05). Segmental analysis showed statistically significantly lower values of endsystolic longitudinal strain [SLSC (ES)] of the mid-anterior and basal anterior segments (p < 0.05), end-systolic longitudinal strain [STSR (ES)] measurements of the posterior and mid-posterior segments, end-systolic longitudinal displacement [DLDC (ES)] of the basal posterior, mid-posterior and mid-antero-septal segments in the patient group. Conclusion: Cardiac arrhythmias, cardiomyopathy and sudden cardiac death are rare complications but may be seen in children with Wilson’s disease due to copper accumulation in the heart tissue. Strain and strain rate echocardiography is a relatively new and useful echocardiographic technique to evaluate cardiac function and cardiac deformation abnormalities. Our study showed that despite normal systolic function, patients with Wilson’s disease showed diastolic dysfunction and regional deformation abnormalities, especially rotational strain and strain rate abnormalities.Öğe Subclinical diastolic dysfunction in children with Wilson s disease assessed by tissue Doppler echocardiography a possible early predictor of cardiac involvement(Acta cardiologica, 2013) Elkıran, .Özlem; Karakurt, Cemşit; Selimoğlu, Mukadder Ayşe; Karabiber, Hamza; Koçak, Gülendam; Çelik, Serkan Fazlı; Çolak, CemilBackground The aim of this study was to evaluate the left ventricular systolic and diastolic functions and cardiac rhythm problems for the early detection of myocardial dysfunction in children with Wilson’s disease. Methods We compared patients who had Wilson’s disease (n = 22) with age- and sex-matched healthy control subjects (n = 21). The diagnosis of Wilson’s disease was based on clinical symptoms and laboratory tests (serum ceruloplasmin, urinary and hepatic copper concentrations). Standard echocardiographic examination, as well as pulsed-wave Doppler, tissue Doppler echocardiography examinations of all patients were performed. 24-hour ECG Holter monitoring was also performed in all subjects. Results All patients were asymptomatic on cardiological examination and had sinus rhythm on electrocardiography. Left ventricular ejection fraction, fractional shortening, wall thickness and left ventricular mass were similar in both groups. In comparison to healthy subjects, children with Wilson’s disease had signifi cantly lower mitral E velocity, mitral E/A ratio (P = 0.046, P= 0.021, respectively) and longer isovolumetric relaxation time values (P = 0.015) as estimated by pulsed wave Doppler echocardiography. Wilson patients had longer isovolumetric relaxation time (IVRT) values estimated by tissue Doppler echocardiography (P = 0.006) compared to the controls. On 24-hour ECG Holter monitoring, none of the Wilson patients showed life-threatening cardiac arrhythmia. Conclusion Our study showed results that might be consistent with subclinical diastolic dysfunction in cardiologically asymptomatic Wilson’s disease children which probably represents an early stage of cardiac involvement. Therefore it may be useful to monitor these signs in the follow-up of the patients.Öğe Transcatheter closure of a large patent ductus arteriosus with severe pulmonary arterial hypertension in a child(Herz, 2013) Karakurt, Cemşit; Elkıran, Özlem; Çelik, Serkan Fazlı; Koçak, GülendamPatent ductus arteriosus (PDA) is one of the first congenital heart diseases to have been treated via the transcatheter technique. The first reported interventional closure was performed by Porstmann et al. [1] in 1971, followed by that of Rashkind and Cuaso. Since then, various devices have been used, such as the Gianturco coils, detachable coils, Flipper coils, Duct-Occlud coils, and Nit-Occlud coils. Over the last decade, clinical experience with transcatheter device closure of PDA has increased with various devices. In 1998, the Amplatzer duct occluder (ADO; AGA Medical Corp., MN, USA) was introduced, which has become the most frequently used device for closure of moderate to large PDAs. However, transcatheter closure of large PDAs with severe pulmonary hypertension still remains problematic. Treatment decision and device choice should be made after angiographic evaluation of the PDA, hemodynamic assessment, vasoreactivity testing, or transient balloon occlusion. In this report, we present a problematic transcatheter closure of a large PDA with severe pulmonary hypertension in an 8-year-old girl.Öğe Transcatheter closure of anomalous systemic arterial supply in a child with pulmonary hypertension(Gazi Medical Journal, 2014) Karakurt, Cemşit; Çelik, Serkan Fazlı; Sığırcı, AhmetAnomalous systemic arterial supply is a rare condition and it’s commonly seen in patients with Scimitar syndrome. A systemic arterial supply to a normal lung without anomaly is a rare variant of bronchopulmonary sequestration and it is characterized by normal pulmonary parenchymal tissue and bronchial connection. The lesion was classified by Pryce as type 1.Common clinical symptoms are chest pain, dyspnea, frequent lower respiratory infection, pulmonary hypertension, hemoptysis, and heart failure. The treatment may be surgical or transcatheter embolization. In this report we described a patient, a 6-year-old boy with Down syndrome and pulmonary hypertension, who had anomalous systemic artery supply to the left lower lob of the lung and its treatment with transcatheter closure by using a vascular plug II.Öğe Ventriküloperitoneal şant kateter migrasyonuna bağlı gelişen pürülan perikardit ve kardiyak tamponad olgusu(2014) Karakurt, Cemşit; Çelik, Serkan Fazlı; Dişli, Olcay Murat; Yakıncı, CengizÖz: Ventriküloperitoneal (VP) şant hidrosefali tedavisinde başvuru- lan bir yöntemdir. Bu yazıda, daha önce hidrosefali nedeniyle VP şant takılan ve kliniğimize dispne ve kardiyomegali nedeniyle sevk edilen dört yaşında bir kız hasta sunuldu. Ekokardiyografi incelemesinde kardiyak tamponad ve perikardiyal efüzyon sap- tandı. Ventriküloperitoneal kateterin perikard içerisine göç etti- ğinden şüphelenildiği için çekilen toraks bilgisayarlı tomografi- de, VP kateter ucunun perikard içerisinde olduğu görüldü. Tüp drenaj sonrası perikardiyal konstriksiyon gelişmesi nedeniyle perikardiyektomi yapıldı ve VP şant kateteri kısaltılarak batın içerisine alındı.
