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Öğe Acute myocardial infarction with normal coronary arteries in a young man with the Behcet's disease(Elsevier Ireland Ltd, 2005) Kosar, F; Sahin, I; Gullu, H; Cehreli, SBehcet's disease (BD) is an inflammatory disorder of unknown origin, which usually presents with mucocutaneous, ocular, articular, vascular, gastrointestinal and central nervous system manifestations. Although cardiac involvement is not infrequent as a manifestation of Behcet's disease, coronary arteritis is very rarely reported. We suggest that the diagnosis of coronary arteritis should be considered in patients presenting acute myocardial infarction especially in young patients as underlying cause. (c) 2004 Elsevier Ireland Ltd. All rights reserved.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(Blackwell Publishing, 2006) Kosar, F; Ermis, N; Erdil, N; Battaloglu, BCoronary artery anomaly has been reported at a rate of 0.6% to 1.3% in routine angiographic series. Moreover, single coronary artery is one of the rarest anomalies among coronary anomalies. Eventhough patients with coronary anomalies are usually asymptomatic, they may also be associated with myocardial ischemia, ventricular fibrillation, syncope, congestive heart failure, and sudden death. In this article, we report 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 case was associated with ischemic heart disease, coronary artery bypass grafting was carried out. He is currently well.Öğe Brain natriuretic peptide and its relationship to left ventricular hypertrophy in patients on peritoneal dialysis or hemodialysis less than 3 years(Taylor & Francis Ltd, 2006) Taskapan, MC; Ulutas, O; Aksoy, Y; Senel, S; Sahin, I; Kosar, F; Taskapan, HAn increase of brain natriuretic peptide (BNP) levels is commonly observed in patients on dialysis. Increased circulating levels of BNP are related to future cardiac events and associated with shorter survival in patients on chronic hemodialysis (HD). During the first I or 2 years on dialysis, patients on peritoneal dialysis (PD) have been shown to have an improvement in left ventricular hypertrophy, blood pressure, and volume status. This study compares BNP levels and cardiac status of PD and HD patients without cardiovascular disease and on dialysis for less than 36 months. The correlation between plasma BNP concentration and findings of echocardiography before HD scans were examined and compared with findings of PD. Twenty-two HD patients (15 men, 7 women; mean age, 52.5 +/- 13.9 years) and 19 PD patients (10 men, 9 women; mean age, 47.6 +/- 11.3 years) were studied. There were no significant differences between HD and PD patients with regard to age, gender, duration of dialysis, left ventricular mass, left ventricular mass index (p > 0.05). Plasma BNP levels were markedly greater in HD patients (467.8 +/- 466.5 pg/ mL) than those of PD patients (143.1 +/- 165.2 pg/mL). Urine output was significantly higher in PD patients compared with HD patients (p < 0.05). A positive correlation between systolic blood pressure, diastolic blood pressure, and plasma BNP in HD patients (r: 0.653, p: 0.001; r: 0.493, p: 0.023, respectively) was detected. Additional studies are needed to investigate whether lower BNP level in PD patients is an advantage.Öğe Cardiac tamponade as initial presentation of Sheehan's Syndrome(Elsevier Ireland Ltd, 2004) Sahin, I; Taskapan, H; Yildiz, R; Kosar, F[Abstract Not Available]Öğe A case of left atrial myxoma associated with atrial septal defect(Wiley, 2005) Kosar, F; Erdil, N; Gullu, H; Sahin, I; Nisanoglu, V; Battaloglu, BCardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-old woman referred to the emergency department with loss of consciousness and finally diagnosed as a pedinculated mobile left atrial myxoma and concomitant occurrence of an ostiurn secundum type atrial septal defect. 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 diagnosis when patients present with neurological consequences of systemic embolization.Öğe A case of vasospastic angina resulting from coronary emboli in a patient with prosthetic valves(Int Heart Journal Assoc, 2004) Kosar, F; Gullu, H; Sahin, I; Acikgoz, N; Topal, E; Erdil, NIn addition to coronary atherosclerotic disease, coronary thromboembolisin can also lead to acute coronary syndromes. However, coronary thromboembolism due to prosthetic heart valves is very rare and not very well-known. It has Only a few cases have been reported. In this paper, we present a rare case with vasospastic angina pectoris secondary to coronary thromboembolism in a patient with prosthetic heart valves.Öğe Comparison of low dose DSE and echocardiography during GIK infusion for the detection of myocardial viability after anterior myocardial infarction(W B Saunders Co Ltd, 2002) Yetkin, E; Kubilay, S; Atak, R; Ileri, M; Tandogan, I; Turhan, H; Kosar, F[Abstract Not Available]Öğe Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion for detection of myocardial viability after anterior myocardial infarction(Lippincott Williams & Wilkins, 2002) Yetkin, E; Senen, K; Ileri, M; Atak, R; Tandogan, I; Yetkin, Ö; Kosar, FBackground Low-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) infusion has been shown to increase contraction of the ischemic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability. Methods Thirty-two patients who had first anterior myocardial infarction (MI) without previous MI were included in the study. Echocardiographic evaluation was carried out on the 7th +/- 2 days after MI. During continuous electrocardiographic, blood pressure and echocardiographic monitoring, an intravenous infusion of dobutamine (3 mug/kg body weight/min) was started with an infusion pump, continued for 5 min and then increased to 5 mug/kg/min and 10 mug/kg/min for another 5 min. The GIK protocol consisted of a fixed dose of insulin (100 muU/kg/h intravenously) and a variable glucose/potassium infusion rate. GIK echocardiography was done at baseline and after 60 min of GIK. The detected viable myocardium was defined as one or two scores decreasing in at least two adjacent abnormal segments during LDDSE and GIK echocardiography. Results Under resting conditions 225 segments (44%) were normokinetic, 21 segments (4%) dyskinetic, 117 segments (23%) akinetic and 149 segments (29%) hypokinetic. Viability was detected in 20% (57 segments) of the asynergic segments at baseline with GIK echocardiography and in 22% (62 segments) of those segments with LDDSE (P < 0.05). Left ventricular wall motion score index at baseline was 1.87 and it decreased significantly indicating improvement in left ventricular systolic function during both LDDSE and GIK echocardiography (P < 0.001, versus 1.75 and 1.76 respectively). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 96%. Conclusion We have shown that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography could be used to detect myocardial viability after acute MI.Öğe Comparison of TIMI frame counts of patients with and without coronary artery ectasia(W B Saunders Co Ltd, 2002) Yetkin, E; Atak, R; Turhan, H; Sivri, N; Ileri, M; Kosar, F; Ozdemir, R[Abstract Not Available]Öğe Detection of Chlamydia pneumoniae deoxyribonucleic acid in blood samples taken from coronary sinus after coronary angioplasty(Excerpta Medica Inc-Elsevier Science Inc, 2002) Yetkin, E; Yetkin, G; Tandogan, I; Kocabas, NA; Ileri, M; Ozdemir, R; Kosar, FChlamydia pneumoniae deoxyribonucleic acid was not found in blood samples (0%) taken from the coronary sinus immediately before coronary angioplasty, but C. pneumoniae deoxyribonucleic acid was detected in 4 of 14 patients' blood samples (29%) taken after coronary angioplasty. This finding suggests that coronary angioplasty can cause C. pneumoniae bacteremia.Öğe Does cardiopulmonary bypass alter plasma level of tumor markers? CA 125 and carcinoembryonic antigen(Georg Thieme Verlag Kg, 2002) Battaloglu, B; Kaya, E; Erdil, N; Nisanoglu, V; Kosar, F; Ozgur, B; Yildirim, BBackground: In addition to malignant diseases, acute and chronic inflammations may elevate plasma levels of tumor markers CA 125 and carcinoembryonic antigen (CEA). Cardiopulmonary bypass (CPB) causes a generalized inflammatory response. In this study, we have investigated the effect of CPB on plasma levels of CA 125 and CEA. Methods: We measured plasma levels of CA 125 and CEA in patients undergoing coronary artery bypass grafting (CABG) with CPB (Group 1, n = 21), and in patients who underwent off-pump CABG, that is, without CPB (Group 2, n = 16). Blood samples were collected preoperatively, and on postoperative days 1, 6, and 12. Results: Within both groups, CEA plasma levels were not significantly influenced in any samples. Comparing with preoperative values, CA 125 values elevated significantly on postoperative days 6 and 12 within both groups. It was observed that the elevation of CA 125 plasma levels in these samples were significantly higher in Group 1. Conclusions: The results indicate that CPB elevated plasma level of CA 125. However, clinical importance of this finding needed further evaluation.Öğe Effect of ectasia size or the ectasia ratio on the thrombosis in myocardial infarction frame count in patients with isolated coronary artery ectasia(Springer, 2005) Kosar, F; Acikgoz, N; Sahin, I; Topal, E; Aksoy, Y; Cehreli, SCoronary blood flow was quantified using the thrombosis in myocardial infarction (TIMI) frame-count method. This measurement has been significantly correlated with flow velocity measured invasively by use of a Doppler flow wire. Coronary artery ectasia or aneurysm (CEA) is thought to be present in patients with a slow blood flow. In this study, we aimed to assess the relationship between the ectasia size or ectasia ratio and TIMI frame count in patients with CEA. The study population included 58 patients with isolated CEA of the right coronary artery. In patients with CEA, an ectasia ratio was calculated as diameter of the ectatic segment/diameter of the adjacent normal segment. According to the ectasia ratio, ectatic vessels were divided into two groups: ectasias with a 1.5- to 2.0-fold increase (group A) and more than 2.0-fold increase (group B) in normal vessel diameter. Patients with a significant stenotic lesion (> 50%) in the ectatic vessel were excluded. The control group was formed from a matched population of 35 patients with angiographically proven normal coronary arteries. Characteristics of the ectasia and control groups are similar. The TIMI frame counts for the right coronary artery (RCA) were significantly higher in the ectasia group as compared with the control group (43 +/- 12 vs 23 +/- 8, P < 0.001). The ectasia group had 38 patients in group A and 20 patients in group B. The TIMI frame counts were significantly higher in group B than in group A (43 +/- 10 vs 51 +/- 15, P < 0.05). The TIMI frame count of the RCA showed a significant correlation with the ectasia ratio and the maximum diameter of the ectatic segment (r = 0.578, P < 0.001 and r = 0.435, P < 0.001, respectively). Our data suggest that TIMI frame count measurement depends on the ectasia size or ectasia ratio, and an increased ectasia ratio is markedly associated with decreased TIMI frame counts in patients with CEA.Öğe Effect of obesity on P wave duration and P wave dispersion(Nature Publishing Group, 2004) Ari, F; Sabin, I; Kosar, F; Taskapan, H; Gunen, H; Yildiz, R[Abstract Not Available]Öğe Effect of posterior pericardiotomy on early and late pericardial effusion after valve replacement(Blackwell Publishing, 2005) Erdil, N; Nisanoglu, V; Kosar, F; Erdil, FA; Cihan, HB; Battaloglu, BObjective: Pericardial effusion (PE) after cardiac surgery is frequent. It is more frequently seen after valve replacement or other types of heart surgery. Oral anticoagulants and antiplatelet agents may induce effusion development after open heart surgery. Our objective was to determine the efficiency of posterior pericardiotomy (PP) after cardiac valve operation for reducing the incidence of early and late PE and tamponade. Methods: This prospective randomized study was carried out in 100 consecutive patients undergoing mechanical valve replacement between August 2001 and May 2003 in our institution. Patients were divided into two groups; each group consisted of 50 patients. Longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in Group 1. Posterior pericardiotomy was not done in Group 2. Results: Early PE was detected in four patients (8%) and in 19 patients (38%) in Group 1 and Group 2, respectively (p < 0.001). No late PE effusion was developed in Group 1 despite nine (18%) late PE developing in Group 2 (p < 0.003). The rate of delayed pericardial tamponade was lower in Group 1, but this difference was not statistically significant (0% vs 10%; p < 0.056). Conclusion: These findings suggest that PP is an easy, feasible, and beneficial technique for reducing both the occurrence of early and late PE or pericardial tamponade in patients undergoing valve replacement.Öğe Effects of co-existence of coronary stenosis and the extent of coronary ectasia on the TIMI frame count in patients with coronary artery ectasia(Int Heart Journal Assoc, 2005) Kosar, F; Acikgoz, N; Sahin, I; Topal, EU; Gunen, H; Ermis, N; Cehreli, SThe measurement of the thrombosis in myocardial infarction (TIMI) frame count is a simple method for evaluating coronary blood flow. Although it is well known that slow coronary flow is present in patients with coronary artery ectasia (CAE), the effects of coexisting stenosis and the severity of ectatic involvement on coronory flow have not been adequately studied. Thus, we examined (1) the effect of coexistence of obstructive coronary artery disease on TIMI frame count (TFC) and (2) the relation between the severity of ectatic involvement and TFC in patients with CAE. Ninety-seven study patients with CAE were examined in two steps to determine if they were appropriate in terms of the aim of this study. In the first step, ectasias were divided into three groups: an isolated CAE group, a CAE group with coexisting nonsignificant stenosis, and CAE with coexisting significant stenosis. In the second step, ectasias were subdivided into three groups: CAE with one segment, two segments, and three segments (or diffuse) involvement. The TIMI frame counts for the right coronary artery (RCA), the left circumflex coronary artery (LCx), and the left anterior descending artery (LAD) in the ectasia,roup were significantly higher than that of the control group (P < 0.001 P < 0.05, P < 0.05, respectively). The presence of coexisting nonsignificant stenosis or coexisting significant stenosis in patients with CAE did not influence TFC (P > 0.05, For all). In addition, the severity of ectasia involvement, regardless of the localization of ectatic segments and the type of the affected vessel. did not change the TFC (P > 0.05, for all). These results suggest that neither the coexisting stenosis nor the extent of involvement significantly affect TFC in patients with coronary ectasia.Öğe Effects of coronary revascularization and concomitant aneurysmectomy on QT interval duration and dispersion(Churchill Livingstone Inc Medical Publishers, 2006) Kosar, F; Nisanoglu, V; Aksoy, Y; Colak, C; Erdil, N; Battaloglu, BA reduction in QT dispersion (QTd) has been previously shown in patients receiving thrombolytics and undergoing coronary artery bypass grafting (CABG). The purpose of the present study was to investigate changes occurring in corrected QT intervals or QT dispersion after CABG and concomitant aneurysmectomy in the same session. The study population included 43 patients with coronary artery disease with left ventricular aneurysm (LVA). The control group included 32 patients with coronary artery disease without LVA. The study patients underwent CABG and aneurysmectomy in the same surgical session. Corrected maximum and minimum QT interval duration (QTcmax and QTcmm) and corrected QT dispersion (QTcd) were measured in the study patients before and after surgery. QTcmax and QTcd in the patients with LVA were significantly higher than in the patients without LVA (P < .001 and P < .001, respectively). QTcmax and QTcd in the patients with LVA were significantly shortened after surgery (P < .001 and P < .001, respectively). This study showed that QTcmax and QTcd values are significantly reduced after CABG and concomitant aneurysmectomy. We have suggested that coronary revascularization and left ventricular reconstruction in the same session have beneficial effects on QT interval duration and dispersion. (c) 2006 Elsevier Inc All rights reserved.Öğe Elevated plasma homocysteine levels in patients with isolated coronary artery ectasia(Lippincott Williams & Wilkins, 2006) Kosar, F; Sincer, I; Aksoy, Y; Ozerol, IObjective Coronary artery ectasia is a variant of coronary atherosclerosis. Hyperhomocysteinemia has emerged as a major, independent risk factor for cardiovascular diseases. The purposes of this study were to determine plasma hyperhomocysteine levels in patients with coronary artery ectasia, and to compare patients with coronary artery ectasia, coronary artery disease, and controls with normal coronary angiogram. Method The study population included 37 patients with coronary artery ectasia and 36 patients with coronary artery disease. The control group consisted of 32 patients with angiographically proven normal coronary arteries. Plasma hyperhomocysteine levels were measured in all study patients with an enzyme-linked immunosorbent assay. Results Plasma homocysteine levels were significantly higher in patients with both coronary artery ectasia and coronary artery disease than in the controls (14.8 +/- 1.1 and 15.9 +/- 0.8 vs. 2.5 +/- 0.6 mu mol/l; P < 0.001 and P < 0.001, respectively). No significant differences in plasma homocysteine levels were found among CAE and CAD groups (P > 0.05). Conclusions We have demonstrated that patients with coronary artery ectasia and coronary artery disease have increased plasma hyperhomocysteine levels compared with the controls. These findings suggest that hyperhomocysteinemia may play an important role in the pathogenesis of coronary artery ectasia as in coronary artery disease.Öğe Evaluation of autonomic activity in patients with subclinical hypothyroidism(Springer, 2005) Sahin, I; Turan, N; Kosar, F; Taskapan, C; Gunen, HIt has been shown that impaired cardiac autonomic activity is closely related with lethal arhythmias. Heart rate variability (HRV), analysis of beat-to-beat variations, is an important and widely used non-invasive method to assess autonomic function. Impaired cardiac autonomic activity and altered sympathovagal balance were previously documented in patients with hypothyroidism. However, the effect of subclinical hypothyroidism (SH) on autonomic function has not been studied yet. We aimed to investigate the effect of SH on sympathovagal balance using the HRV method. The study included 31 patients with SH and 28 healthy volunteer controls. Patients with cardiac, metabolic, neurological disease or any other systemic disease that could affect autonomic activity were excluded from the study. HRV time domain and frequency domain parameters were determined over a period 24 h. All time and frequency domain measures of HRV in patients with SH were not significantly different compared to those of healthy control group (p > 0.05). Additionally, we compared SH subgroups (TSH level >= 10 and TSH level < 10 mU/l) with each other and the controls. A statistically significant difference was observed only in time domain parameters of SD of normal-to-normal intervals (SDNN) and SD of all 5-min mean normal NN intervals (SDANN) between subgroup with TSH level >= 10 and controls (p < 0.05, p < 0.05, respectively). In correlation analysis with TSH, there was positive relationship between TSH and the root mean square of successive differences between adjacent R-R intervals (rMSSD). These findings indicate that SH may affect cardiac autonomic activity in correlation with TSH levels. (c) 2005, Editrice Kurtis.Öğe Evaluation of right and left ventricular function using pulsed-wave tissue Doppler echocardiography in patients with subclinical hypothyroidism(Springer, 2005) Kosar, F; Sahin, I; Turan, N; Topal, E; Aksoy, Y; Taskapan, CPrevious studies showed that subclinical hypothyroidism (SH) was associated with cardiovascular disorders, such as endothelial dysfunction, atherosclerosis and myocardial dysfunction. Only one study investigated left ventricular (LV) function using pulsed tissue Doppler echocardiography (TDE) in patients with SH. However, no study has used this technique in the identification of right ventricular (RV) function in these patients. We aimed to investigate the effect of SH on RV and LV function using TDE technique. The present study included 36 newly diagnosed SH patients and 28 healthy controls. For each subjects, serum free T-3 (FT3), free T-4 (FT4), total T-3 (TT3), total T-4 (TT4), TSH, peroxidase antibody (TPOab) and thyroglobulin antibody (TGab) levels were measured, and standard echocardiography and TDE were performed. In patients with SH, TSH levels were significantly higher, and TPOab and TGab levels were significantly higher when compared to healthy controls. TDE showed that the patients had significantly lower early diastolic mitral and tricuspid annular velocity (Ea) and early/late (Ea/Aa) diastolic mitral and tricuspid annular velocity ratio (p < 0.05, p < 0.05 and p < 0.001, p < 0.001, respectively), and significantly longer isovolumetric relaxation time (IRT) of left and right ventricles (p < 0.001 and p < 0.001, respectively). However, Aa, Sa, and isovolumetric contraction time (ICT) and ET (ejection time) of left and right ventricle did not significantly differ (p=ns for all). In addition, a negative correlation between TSH and TD-derived tricuspid Ea velocity and Ea/Aa ratio, and a positive correlation between TSH and IRT of right ventricle were observed. Our findings demonstrated that SH is associated with impaired RV diastolic function in addition to impaired LV diastolic function.Öğe Factors affecting survival of hospitalised patients with COPD(European Respiratory Soc Journals Ltd, 2005) Gunen, H; Hacievliyagil, SS; Kosar, F; Mutlu, LC; Gulbas, G; Pehlivan, E; Sahin, IFactors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AECOPD. Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AECOPD were prospectively assessed. Patients were followed-up for 3 yrs. Factors determining short- and long-term mortality were analysed. In total, 17 patients (8.3%) died in hospital. In-hospital mortality was significantly associated with lower arterial oxygen tension (Pa,O-2), higher carbon dioxide arterial tension, lower arterial oxygen saturation and longer hospital stay. The overall 6-month mortality rate was 24%, with 1-, 2- and 3-yr mortality rates of 33%, 39% and 49%, respectively. Cox regression analysis revealed that long-term mortality was associated with longer disease duration (relative risk (RR)=1.158), lower albumin (RR=0.411), lower Pa,O-2 (RR=0.871) and lower body mass index (RR=0.830). When the model was run for the time elapsed since first hospitalisation, it also appeared as statistically significant (RR=1.195). These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival. Prediction of survival status may be enhanced by considering arterial oxygen tension, albumin, body mass index, disease duration and time elapsed since the first hospitalisation.
