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Öğe Aberrant right subclavian artery and axillary artery cannulation in type a aortic dissection repair(Ann Thorac Surg, 2013) Battaloğlu, Bektaş; Seçici, Serkan; Çolak, Cengiz; Dişli, Olcay Murat; Erdil, Nevzat; Kutlu, RamazanCurrently, right axillary artery cannulation and unilateral antegrade cerebral perfusion through the same cannula are preferred choices for acute type A aortic dissection repair. However, the existence of an aberrant right subclavian artery can jeopardize cerebral perfusion through the right axillary artery cannula. In this study, we intended to explain the repair of acute type A aortic dissection using right axillary artery cannulation in a patient with aberrant right subclavian artery.Öğe Aberrant Right Subclavian Artery and Axillary Artery Cannulation in Type A Aortic Dissection Repair(Elsevier Science Inc, 2013) Battaloglu, Bektas; Secici, Serkan; Colak, Cengiz; Disli, Olcay M.; Erdil, Nevzat; Kutlu, RamazanCurrently, right axillary artery cannulation and unilateral antegrade cerebral perfusion through the same cannula are preferred choices for acute type A aortic dissection repair. However, the existence of an aberrant right subclavian artery can jeopardize cerebral perfusion through the right axillary artery cannula. In this study, we intended to explain the repair of acute type A aortic dissection using right axillary artery cannulation in a patient with aberrant right subclavian artery. (C) 2013 by The Society of Thoracic SurgeonsÖğe Acute abdominal aorta embolism caused by rupture of a cardiac hydatid cyst(Annals of Vascular Surgery, 2004) Nisanoğlu, Vedat; Erdil, Nevzat; Işık, Burak; Battaloğlu, Bektaş; Alat, İlkerWe report a case of an abdominal aortic embolism due to rupture of a cardiac hydatid cyst. This report emphasizes the diagnostic, preventative, and treatment options for hydatid cyst embolism of abdominal aorta. Echocardiography should be routinely performed in all patients with hydatid disease for possible involvement of the heart. This enables early diagnosis and treatment of cardiac echinococcus before life-threatening complications occur.Öğe Acute abdominal aorta embolism caused by rupture of a cardiac hydatid cyst(Annals of Vascular Surgery, 2004) Nisanoğlu, Vedat; Erdil, Nevzat; Işık, Burak; Battaloğlu, Bektaş; Alat, İlkerWe report a case of an abdominal aortic embolism due to rupture of a cardiac hydatid cyst. This report emphasizes the diagnostic, preventative, and treatment options for hydatid cyst embolism of abdominal aorta. Echocardiography should be routinely performed in all patients with hydatid disease for possible involvement of the heart. This enables early diagnosis and treatment of cardiac echinococcus before life-threatening complications occur.Öğe Anomalous lad and cx artery arising separately from the proximal right coronary artery a case report of single coronary artery with coronary artery disease(Journal of Cardiac Surgery, 2006) Koşar, Feridun; Ermiş, Necip; Erdil, Nevzat; Battaloğlu, BektaşCoronary artery anomaly has been reported at a rate of 0.6% to 1.3% in routine angiographic se-ries. Moreover, single coronary artery is one of the rarest anomalies among coronary anomalies. Eventhoughpatients with coronary anomalies are usually asymptomatic, they may also be associated with myocardialischemia, ventricular fibrillation, syncope, congestive heart failure, and sudden death. In this article, wereport a case of single coronary artery anomaly with the left anterior descending (LAD) and left circumflex(LCx) coronary artery arising separately from the proximal right coronary artery. Since the presented casewas associated with ischemic heart disease, coronary artery bypass grafting was carried out. He is currentlywell.Öğe Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus(Medical Tribune Inc, 2012) Colak, Mehmet Cengiz; Erdil, Nevzat; Disli, Olcay; Kahraman, Ercan; Battaloglu, BektasAnomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.Öğe Anomalous origin of the left coronary artery from the right coronary sinus(Annals of Thoracic and Cardiovascular Surgery, 2012) Çolak, Mehmet Cengiz; Erdil, Nevzat; Dişli, Olcay Murat; Kahraman, Ercan; Battaloğlu, BektaşAnomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary arteryÖğe Arterial myocardial revascularization using bilateral radial artery 17years after right pneumonectomy(Texas Heart Instıtute Journal, 2004) Erdil, Nevzat; Nisanoğlu, Vedat; Toprak, Hüseyin İlksen; Erdil, Feray Akgül; Kuzucu, Akın; Battaloğlu, Bektaşfter coronary artery bypass grafting (CABG), patients with a previous pneumonectomy are predisposed to a substantial risk of cardiopulmonary complications. The best surgical strategy for performing CABG on After patient with a single lung is unclear from the literature;1 few such cases have been reported.1-4 To our knowledge, this is the 1st report of arterial myocardial revascularization with use of bilateral radial arteries and fast-track anesthesia in a patient with a previous pneumonectomyÖğe The arteriovenous fistulas for hemodialysis complications in short and long term in department of cardiovascular surgery clinic turgut ozal medical center(Journal of Turgut Ozal Medical Center, 2011) Çolak, Mehmet Cengiz; Dişli, Olcay Murat; Erdil, Nevzat; Cihan, H. Berat; Battaloğlu, BektaşÖğe Aterosklerotik Koroner Arter Hastalığı Tespit Edilenlerde Plazma Homosistein Düzeyi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2001) Battaloğlu, Bektaş; Erdil, Nevzat; Nisanoğlu, Vedat; Koşar, Feridun; Şahin, Kazım; Özerol, Elif; Temel, İsmailAmino asit metabolizması veya homosistein metabolizmasına ait kalıtsal bozukluklar v asküler hastalıkların patogenezinde söz edilmektedir. Biz koroner arter hastalığının (KAH) teşhisinde homosistein seviyesinin saptanmasının klinik önemini araştırdık. Çalışma hastaları (n=80) anjiyografik sonuçlara dayanarak normal koroneri olan grup (n=30) ve koroner arter hastalığı olan grup (n=50) olarak katogorize edildi. Koroner arter hastalığı olan hastalar normal kontrol grubundan daha yüksek homosistein düzeylerine sahipti(19.47 ±7.13’e karşın 9.21 ±5.14 nmol/ml, p<0.001). Koroner arter hastalarında yüksek dansiteli lipoprotein (HDL) düzeyleri daha düşük (31±12‘e karşın 47±16 nmol/ml, p<0.05), ve trigliserit düzeyleri daha yüksek idi (198 ±56’e karşın 142±24 mg/dl, p<0.05). Fakat KAH grubu ile kontrol grubu arasında plazma total kolesterol ve düşük dan siteli lipoprotein düzeyleri açısından önemli bir fark yoktu. Ayrıca KAH grubu ile kontrol grubunda hipertansiyon (HT), diabetes mellitus (DM) ve sigara içiciliğinin yüzdesi açısından önemli bir fark vardı (Hepsi için, p<0.05). Bizim verilerimiz hiperhomosisteineminin ateroskleroz için risk faktörlerine sahip hastalarda yüksek prevalansa sahip olduğunu göstermektedir. Ateroskleroz için risk faktörleri incelemesinde homosistein seviyesine de rutin bakılmalı ve tedavi edilmelidir.Öğe Atrial fibrillation after coronary artery bypass grafting in elderly patients ıncidence and risk factor analysis(The Thoracic and Cardiovascular Surgeon, 2007) Nisanoğlu, Vedat; Erdil, Nevzat; Aldemir, Mustafa; Özgür, Bülent; Cihan, H. Berat; Yoloğlu, Saim; Battaloğlu, BektaşObjective: New-onset atrial fibrillation (AF) is the most frequent arrhythmic complication after coronary artery bypass grafting (CABG). Elderly patients who undergo this operation may have a different risk profile from the general population. The aim of this study was to identify risk factors for post-CABG AF in the elderly population. Methods: Between September 2001 and December 2005, 426 elderly patients (age ≥ 65 years) underwent CABG at our center. Ninety-one developed post-CABG AF (AF group), and the other 335 (no-AF group) did not develop this complication. Multivariate analysis (odds ratio, ± 95 % CI, p value) was used to identify independent clinical predictors of post-CABG AF. Results: The incidence of post-CABG AF in elderly patients during the study period was 21.4 %. Multivariate analysis identified age (OR 1.07, p < 0.009), age ≥ 75 years (OR 1.77, p < 0.042), preoperative renal insufficiency (OR 5.09, p < 0.035), EuroSCORE (OR 1.18, p < 0.038), and cross-clamping time (OR 1.02, p < 0.012) as predictors of AF occurrence. The AF group had a significantly longer mean intensive care unit (ICU) stay (3.8 ± 4.7 vs. 2.5 ± 1.3 days for AF vs. no-AF; p = 0.0001), and a significantly higher proportion of patients with prolonged (≥ 6 days) ICU stays (8.8 % vs. 3.2 %, respectively; p = 0.033). Hospital mortality was 3.2 % in the no-AF group and 2.2 % in the AF group (p = 0.74). Conclusion: This study of elderly patients reveals some novel predictors of post-CABG AF, most notably preoperative renal insufficiency and EuroSCORE. It is important to identify risk factors for post-CABG AF in all patient groups as this knowledge might lead to better prevention of this problem and its potential consequences.Öğe Axillary artery perfusion in acute type a aortic dissection repair(Journal of Cardiac Surgery, 2008) Battaloğlu, Bektaş; Erdil, Nevzat; Nisanoğlu, VedatABSTRACTBackground:We evaluated our experience with axillary artery perfusion technique in acutetype A aortic dissection repair.Methods:Between September 2000 and July 2006, 41 consecutive patientswith acute type A aortic dissection underwent surgical repair. In 35 of 41 patients (85.4%), arterial perfusionwas performed through right axillary artery and in the remaining six patients (14.6%), arterial perfusion sitewas femoral artery. Indication for femoral artery perfusion was cardiac arrest and ongoing cardiopulmonaryresuscitation in one and pulslessness of right upper limb in five patients. Mean age was 54.9 ± 15.3 (16to 90 years) and 28 were male. Unilateral antegrade cerebral perfusion (perfusate temperature 22 to 25◦C)through axillary artery was performed in all axillary artery perfused patients and in three patients whohad femoral artery perfusion.Results:Five patients died postoperatively (hospital mortality 12.2%). All ofthem had evidence of single or multiple organ malperfusion preoperatively. We did not experience any newtransient or permanent neurologic deficit after the procedure in the unilateral antegrade cerebral perfusionpatients. Complications related to axillary artery cannulation were observed in two patients (5.3%). Onepatient with femoral artery cannulation experienced femoral arterial thrombosis, postoperatively.Conclu-sions:Right axillary artery cannulation for repair of acute type A aortic dissection is a simple and safeprocedure. In the case of pulslessness of right upper limb, femoral artery is still the choice of cannulationsite.Öğe Axillary Artery Perfusion in Acute Type A Aortic Dissection Repair(Wiley, 2008) Battaloglu, Bektas; Erdil, Nevzat; Nisanoglu, VedatBackground: We evaluated our experience with axillary artery perfusion technique in acute type A aortic dissection repair. Methods: Between September 2000 and July 2006, 41 consecutive patients with acute type A aortic dissection underwent surgical repair. In 35 of 41 patients (85.4%), arterial perfusion was performed through right axillary artery and in the remaining six patients (14.6%), arterial perfusion site was femoral artery. Indication for femoral artery perfusion was cardiac arrest and ongoing cardiopulmonary resuscitation in one and pulslessness of right upper limb in five patients. Mean age was 54.9 +/- 15.3 (16 to 90 years) and 28 were male. Unilateral antegrade cerebral perfusion (perfusate temperature 22 to 25 degrees C) through axillary artery was performed in all axillary artery perfused patients and in three patients who had femoral artery perfusion. Results: Five patients died postoperatively (hospital mortality 12.2%). All of them had evidence of single or multiple organ malperfusion preoperatively. We did not experience any new transient or permanent neurologic deficit after the procedure in the unilateral antegrade cerebral perfusion patients. Complications related to axillary artery cannulation were observed in two patients (5.3%). One patient with femoral artery cannulation experienced femoral arterial thrombosis, postoperatively. Conclusions: Right axillary artery cannulation for repair of acute type A aortic dissection is a simple and safe procedure. In the case of pulslessness of right upper limb, femoral artery is still the choice of cannulation site. doi: 10.1111/j.1540-8191.2008.00754.x (J Card Surg 2008;23:693-696)Öğe A case of left atrial myxoma associated with atrial septal defect(Journal of Cardiac Surgery, 2005) Koşar, Feridun; Erdil, Nevzat; Güllü, Hakan; Şahin, İbrahim; Nisanoğlu, Vedat; Battaloğlu, BektaşCardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associ-ated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-oldwoman referred to the emergency department with loss of consciousness and finally diagnosed as a ped-inculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septaldefect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture.The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagno-sis when patients present with neurological consequences of systemic embolization.Öğe A case of left atrial myxoma associated with atrial septal defect(Journal of Cardiac Surgery, 2005) Koşar, Feridun; Erdil, Nevzat; Güllü, Hakan; Şahin, İbrahim; Nisanoğlu, Vedat; Battaloğlu, BektaşCardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associ-ated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-oldwoman referred to the emergency department with loss of consciousness and finally diagnosed as a ped-inculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septaldefect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture.The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagno-sis when patients present with neurological consequences of systemic embolization.Öğe Cerrahi olarak tedavi ettiğimiz sol ventrikül anevrizmalı hastaların erken dönem sonuçları(2003) Erdil, Nevzat; Nisanoğlu, Vedat; Cihan, Hasan Berat; Gülcan, Öner; Ege, Erdal; Alat, İlkerÖz: Amaç: Sol ventrikül anevrizması olan hastalarda anevrizmanın onarımı, yaşam süresi ve kalitesini iyileştiren önemli girişimlerden biridir. Bu çalışmada sol ventrikül anevrizması nedeniyle cerrahi olarak tedavi ettiğimiz olguların erken dönem sonuçlarını sunmaktayız. Materyal ve Metod: Ocak 2001 ile Kasım 2002 tarihleri arasında postiskemik sol ventrikül anevrizması olan 51 hasta cerrahi olarak tedavi edildi. Olguların 45'i erkek (%88.2) olup, yaş ortalaması 58.53 ± 10.78 yıl idi. Hastaların 31'inde (%60.8) yama endoanevrizmorafi, 20'sinde (%39.2) lineer anevrizektomi gerçekleştirildi. Tüm olgulara ek olarak tam koroner revaskülarizasyon yapıldı. Bulgular: Erken dönemde iki hasta (%3.9) kaybedildi. Postoperatif dönemde 2 hastada düşük kalp debisi nedeniyle intraaortik balon pompası ihtiyacı oldu. Hastaların 10'unda (%19.6) atriyal fibrillasyon gelişti ve tümü antiaritmik ajanlarla sinüs ritmine döndürüldü. Hasta başına ortalama 2.59 pm1.04 distal anastomoz yapıldı. Ortalama yoğun bakım ve hastanede kalış süresi sırasıyla 2.83 pm 1.29 ve 7.74 ± 2.14 gün idi. Fonksiyonel kapasitelerin tüm hastalarda belirgin olarak düzeldiği gözlendi. Sonuç: Kullanılan metoda bakılmaksızın tam koroner revaskülarizasyonla kombine edilen sol ventrikül anevrizma onarımları, survi ve fonksiyonel kapasitede düzelme sağlanmakta olup, güvenle uygulanabilir.Öğe Choice of medication for radial artery vasodilation in patients awaiting coronary artery bypass grafting(Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2011) Erdil, Nevzat; Nisanoğlu, Vedat; Eroğlu, Tamer; Tüten, Recep; Cihan, Hasan Berat; Kutlu, Ramazan; Battaloğlu, Bektaş; Yoloğlu, SaimBackground: In this study, the vasodilatory effects of calcium antagonists and beta-blockers were investigated. Methods: After obtaining Faculty Ethics Committee approval and written informed consent from the patients, 72 adult patients (50 males, 27 females; mean age 62.9±9.3 years; range 37 to 75 years) who will undergo elective coronary artery bypass grafting (CABG) surgery were included in this study. We evaluated the vasodilatory effect of diltiazem alone (group 1), nifedipine alone (group 2), amlodipine alone (group 3), nebivolol alone (group 4) and nifedipine in combination with metoprolol (group 5). Seventy-seven patients who would undergo isolated CABG using radial artery were prospectively randomized to oral agents four or five days before operation. The dilatation of the lumen diameter and area of the radial artery were evaluated with high-resolution ultrasonography just before and 4-5 days after medical treatment. Results: Diltiazem alone group (p=0.058) and niphedipine in combination with metoprolol group (p=0.067) did not show a significant increase in the lumen diameter and area after medical treatment compared to the pretreatment values. Statistically significant increases in lumen diameter and area were observed in nifedipine (p=0007), amlodipine (p=0.003) and nebivolol (p=0.047) groups. Conclusion: Our results demonstrate that calcium channel antagonists are not equally effective in radial artery vasodilatation. Nifedipine, amlodipine and nebivolol appear to be the most effective agents in reducing radial artery spasm. Nebivolol is a betablocker and also has a potent vasodilatory effect on radial artery vasospasm.Öğe Complete left sided absence of the pericardium in association withbuptured type A aortic dissection complicated by severe left hemothorax(Texas Heart Instıtute Journal, 2005) Nisanoğlu, Vedat; Erdil, Nevzat; Battaloğlu, BektaşWe report an unusual clinical presentation of an acute type A aortic dissection as a left hemothorax in a patient with a congenital pericardial defect. Although the pericardial defect was diagnosed preoperatively, we could not exclude the possibility of a ruptured descending aorta until we discovered the site of the rupture during operation. The presence of a pericardial defect would at first appear to be a fatal disadvantage in such a situation as this, due to massive bleeding into the pleural space; but we believe that in our patient spontaneous drainage of blood into the pleural cavity prevented severe cardiac tamponade. The only reason for his deteriorating hemodynamic status was hypovolemia, which was corrected with volume replacement. (Tex Heart Inst J 2005;32: 241-3)Öğe Complete myocardial revascularization using arterial grafts only in patients with unstable angina ımpact on early outcome(The Thoracic and Cardiovascular Surgeon, 2007) Nisanoğlu, Vedat; Battaloğlu, Bektaş; Erdil, Nevzat; Özgür, Bülent; Cihan, H. BeratObjective: The aims of this study were 1) to assess early clinical outcomes for patients with unstable angina (UA) who undergo urgent/emergent coronary artery bypass grafting (CABG); and 2) to evaluate the feasibility and safety of complete revascularization using strictly arterial grafts in this patient group. Patients and Methods: Between September 2001 and May 2005, a total of 961 patients underwent CABG at our center. One hundred and sixty-seven (17.4 %) of these individuals underwent urgent or emergent CABG because of UA, and 794 (82.6 %) underwent elective CABG for stable angina (SA). Of the 167 patients with UA, 59 (35.3 %) underwent complete revascularization using arterial grafts only (AO subgroup: internal thoracic arteries and radial arteries) and the other 108 received a combination of arterial and venous grafts (AV subgroup: 1 internal thoracic artery plus saphenous vein grafts). Results: The UA group had a significantly higher proportion of women and a significantly higher rate of left main coronary artery disease than the SA group (p = 0.016 and p = 0.0001, respectively). Cardiopulmonary bypass time was significantly longer in the UA group (p = 0.01). Higher proportions of the UA group required inotropic support (p = 0.001), intra-aortic balloon pump support (p = 0.001), and re-exploration for bleeding or cardiac tamponade (p = 0.005). This group also had a significantly longer mean time on mechanical ventilation (p = 0.001) and a longer mean intensive care unit stay (p = 0.01). The rates of operative mortality (first 30 days) in the SA and UA groups were 1.8 % and 6 %, respectively (p = 0.001). There were no statistical differences between the AO and AV subgroups with respect to any of the preoperative or intraoperative findings. The AO group had a significantly shorter mean intensive care unit stay than the AV group (p = 0.05). The AV group had a roughly fivefold higher operative mortality than the AO group (8.3 % vs. 1.7 %, respectively), but this difference was not statistically significant (p = 0.17). Conclusion: Urgent or emergent CABG in the setting of UA is associated with increased but acceptable rates of mortality and morbidity. Complete myocardial revascularization using arterial grafts only (combinations of internal thoracic and radial arteries) is feasible and safe in this patient group.Öğe Complete myocardial revascularization using arterial grafts only in patients with unstable angina ımpact on early outcome(The Thoracic and Cardiovascular Surgeon, 2007) Nisanoğlu, Vedat; Battaloğlu, Bektaş; Erdil, Nevzat; Bülent, ÖzgürOBJECTIVE: The aims of this study were 1) to assess early clinical outcomes for patients with unstable angina (UA) who undergo urgent/emergent coronary artery bypass grafting (CABG); and 2) to evaluate the feasibility and safety of complete revascularization using strictly arterial grafts in this patient group. PATIENTS AND METHODS: Between September 2001 and May 2005, a total of 961 patients underwent CABG at our center. One hundred and sixty-seven (17.4 %) of these individuals underwent urgent or emergent CABG because of UA, and 794 (82.6 %) underwent elective CABG for stable angina (SA). Of the 167 patients with UA, 59 (35.3 %) underwent complete revascularization using arterial grafts only (AO subgroup: internal thoracic arteries and radial arteries) and the other 108 received a combination of arterial and venous grafts (AV subgroup: 1 internal thoracic artery plus saphenous vein grafts). RESULTS: The UA group had a significantly higher proportion of women and a significantly higher rate of left main coronary artery disease than the SA group ( P = 0.016 and P = 0.0001, respectively). Cardiopulmonary bypass time was significantly longer in the UA group ( P = 0.01). Higher proportions of the UA group required inotropic support ( P = 0.001), intra-aortic balloon pump support ( P = 0.001), and re-exploration for bleeding or cardiac tamponade ( P = 0.005). This group also had a significantly longer mean time on mechanical ventilation ( P = 0.001) and a longer mean intensive care unit stay ( P = 0.01). The rates of operative mortality (first 30 days) in the SA and UA groups were 1.8 % and 6 %, respectively ( P = 0.001). There were no statistical differences between the AO and AV subgroups with respect to any of the preoperative or intraoperative findings. The AO group had a significantly shorter mean intensive care unit stay than the AV group ( P = 0.05). The AV group had a roughly fivefold higher operative mortality than the AO group (8.3 % vs. 1.7 %, respectively), but this difference was not statistically significant ( P = 0.17). CONCLUSION: Urgent or emergent CABG in the setting of UA is associated with increased but acceptable rates of mortality and morbidity. Complete myocardial revascularization using arterial grafts only (combinations of internal thoracic and radial arteries) is feasible and safe in this patient group.
