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Biomedical subjects

Ata Kirilmaz

Publications and source records attributed to Ata Kirilmaz.

At least 19 recordsLinked to original sources
PubMed2006

Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy.

Alternative approaches to the standard posterolateral incision for thoracotomy have been developed to minimize its postoperative pain and wound related side effects. Muscle-sparing (MS) thoracotomy has been a well-known substitution to the standard posterolateral thoracotomy for this purpose; however it has not been studied in the pediatric age group in detail. We studied retrospectively the patients with thoracotomy for non-cardiac, thoracic surgical procedures. Group 1 included the patients with standard posterolateral thoracotomy for the surgery. The patients with MS thoracotomy composed group 2. The related data were collected retrospectively. The early postoperative morbidities (time requiring for regaining shoulder girdle movement, extubation, intensive care unit stay, and hospital stay) and late musculoskeletal anomalies (scoliosis, elevation of the shoulder, winged scapula, asymmetry of the nipples) were compared between groups. A total of 90 patients were included in the study. Group 1 constituted 50 patients with an average age of 4.24 +/- 2.91 years. Group 2 included 40 patients with an average age of 4.20 +/- 2.92 years. Comparison of the demographics and the baseline characteristics of the patients were not different between groups. In comparison of operative characteristics, there was lesser morbidity in group 2 as re-exploration for bleeding, wound infection, wound healing and fewer intensive care unit and hospital stay days. Late follow-up revealed a significant increase in musculoskeletal deformities in group 1. We conclude that muscle-sparing incision should be preferred to the standard posterolateral thoracotomy in pediatric age.

Child↗
PubMed2006

Papillary fibroelastoma of mitral papillary chordae in a young patient.

Our case is a 38-year-old man, admitted to Cardiology Department with shortness of breath. Echocardiography yields a hyperechogenic mass localized to papillary muscle with severe mitral regurgitation. Coronary angiography demonstrated radiopacity localized to the papillary muscle. The excision of the mass was consistent with elastic tumor, which was reported as papillary fibroelastoma attached to the papillary chordae of the mitral valve. A 29 no St-Jude bileaflet mechanical valve was implanted to mitral position. Papillary fibroelastoma (PF) can be found in young age and originate from the papillary muscle, which the radiopaque angiographic appearance of the mass supports the diagnosis.

Adult↗
PubMed2006

Bisoprolol improves echocardiographic parameters of left ventricular diastolic function in patients with systemic hypertension.

Left ventricular (LV) diastolic dysfunction (LVD) is a common complication secondary to hypertension. It has been reported that bisoprolol is effective in reducing blood pressure and has beneficial cardiac effects in patients with hypertension. However, its effect on LV diastolic function has not been studied in detail. In this study, we sought to determine bisoprolol's effect on left ventricle diastolic function. Data from 25 patients were statistically analyzed. Peaks E and A wave, E/A ratio, isovolumetric relaxation time and E wave deceleration time were measured echocardiographically. Doppler echocardiography measurements after bisoprolol treatment revealed an improvement in LV diastolic function. In conclusion, our results show that treatment with bisoprolol, improves echocardiographic parameters of LV diastolic function after 3 months of treatment.

Antihypertensive Agents↗
PubMed2006

The value of 64-slice computed tomography in a patient with an anomalous and atherosclerotic coronary artery.

We report the case of a 64-year-old male presenting with chest pain with a history of hyperlipidemia and smoking. Coronary angiogram was not successful to visualize the right coronary artery. Contrast enhanced 64-slice computed tomography (CT) identified the origin of the RCA from the aorta and distal stenosis of the vessel. Additionally, it revealed that the nature of the stenosis could be consistent with soft plaque or thrombus. Repeated coronary angiogram confirmed the data obtained by 64-slice CT. The confirmatory value of 64-slice CT in the evaluation of coronary abnormalities and stenoses has been addressed by this case report.

Coronary Angiography↗
PubMed2006

Aortic elastic properties in young pregnant women.

This study aimed to investigate the aortic elastic properties of young pregnant women by comparing them with those of age-matched healthy females. The study group consisted of 21 pregnant women at a mean age of 26 +/- 1 years; 22 healthy women at a mean age of 25 +/- 1 years constituted the control group. Doppler-color echocardiographic variables and serum estradiol (E2) levels were measured from both groups. The blood samples were obtained from the control group in the first week after menstrual bleeding. Diastolic and systolic blood pressure (DBP and SBP, respectively) were measured with a sphygmomanometer. Systolic and diastolic aortic diameters (AOS and AOD, respectively) were measured 3 cm proximal to the aortic valves. Aortic elastic properties were assessed according to the following formulas: 1, Aortic strain = (AOS - AOD)/AOD; 2, Aortic distensibility = 2 x (AOS - AOD)/(PP x AOD); 3, Aortic diameter change = AOS - AOD; 4, Aortic stiffness index = ln(SBP/DBP)/(AOS - AOD)/AOD. The results were expressed as mean +/- standard deviation and compared by t-test between groups. P < 0.05 was considered as statistically significant. All women in the study group were in their first pregnancy and second trimester. The height and weight were 160 +/- 5 vs 164 +/- 6 cm and 60 +/- 9 vs 54 +/- 3 kg in the study vs control groups, respectively (P < 0.05). The AOD was 26 +/- 3 vs 26 +/- 4 mm and AOS 29 +/- 3 vs 28 +/- 4 mm. Pulse pressure was 43 +/- 3 vs 45 +/- 8 mmHg in the study vs control groups, respectively (P > 0.05). The serum E2 level was significantly higher in pregnant women (21 300 +/- 2 300 pg/ml). Derived aortic elastic properties in pregnant women were also increased significantly (P < 0.0005). The indexes of aortic elastic properties are altered and aortic stiffness is decreased among young pregnant women. This may be due to the adaptation mechanisms including high estradiol levels detected in pregnancy.

Adult↗
PubMed2006

Comorbidity of constrictive pericarditis and hemophilia A.

OBJECTIVE: To report a case of comorbidity of constrictive pericarditis and hemophilia A. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old male with hemophilia A was referred to our clinic and was examined with the subsequent evaluation of shortness of breath, leg edema and ascites. Clinical and laboratory examinations were performed. The results were consistent with constrictive pericarditis (CP), and the symptoms were completely relieved following institution of medical therapy. CONCLUSION: Because hemophilia A and pericarditis may be coincidentally present clinical conditions, avoidance of surgical procedures in hemophilic patients is preferable unless the resolution of the symptoms of pericarditis cannot be effected by medical therapy.

Adult↗
PubMed2005

Noncompaction of ventricular myocardium involving both ventricles.

AIM: We aimed to present a case with ventricular myocardial noncompaction involving both ventricles. METHODS AND RESULTS: Noncompaction of ventricle is a rare and unclassified congenital cardiac malformation is due to an arrest in intrauterine endomyocardial morphogenesis. We presented a ventricular myocardial noncompaction case involving both left and right ventricles. The physical examination of this case is consistent with mitral regurgitation and the echocardiographic findings are consistent with noncompaction of ventricular myocardium involving both ventricles with left ventricular systolic failure. CONCLUSION: Transthoracic echocardiography is a useful clinical tool for diagnosing noncompaction of both the right and left ventricular myocardium. The LVNC definition can also be utilized for RVNC, which this diagnosis has never been reported in a Turkish patient.

Adult↗
PubMed2005

Left atrial functions after myocardial infarction.

Acute myocardial infarction results in not only left ventricular but also left atrial dysfunction. Left atrial function is important for optimal filling of the left ventricle. In this study, we aimed at evaluating left atrial functions 6 months after acute myocardial infarction in three different patient groups (thrombolytic therapy, primary percutaneous intervention, or no reperfusion strategies). Between October 2002 and May 2003, 48 patients with ST elevation myocardial infarction who were either administered thrombolytic therapy (group T, n=16), underwent primary angioplasty (group A, n=20), or underwent no reperfusion therapy (group C, n=12) at our unit were enrolled into the study. Echocardiography was performed in these patients 6 months after acute myocardial infarction. Left atrial contractility was assessed by atrial ejection force. Left atrial contribution was assessed by atrial fractional shortening and left atrial volume was calculated. The left atrial volume was significantly higher in group C (P<0.05), but there was no significant difference between groups A and T (P>0.05). Patients in group C had significantly lower atrial ejection force values compared with the other groups (P<0.05). Atrial fractional shortening was not significantly different among the three groups (P>0.05). Atrial ejection force, which is an indicator of left atrial contractility, is better with either angioplasty or thrombolysis. Left atrial volume is higher in patients who were not treated with reperfusion strategies. Further studies are needed to explain the mechanism involved.

Aged↗
PubMed2005

Partial atrial standstill: a case report.

Twelve-lead electrocardiograms revealed no atrial activity and a wide QRS escape rhythm at 38 beats/min in a 20-year-old man who presented with syncope. Doppler echocardiography documented the absence of A wave both in the tricuspid and mitral valve flow. The only mechanical activity was documented at the left atrial appendage. An electrophysiologic study demonstrated electrical inactivity in the right atrium and an atrial tachycardia in the left atrium. Atrial pacing with maximum output did not capture the atria. Our case represents an advanced stage of partial atrial standstill, with a mechanical and electrical atrial activity confined only to the left trial appendage. The patient remained asymptomatic after receiving a VVIR pacemaker and anticoagulation therapy.

Adult↗
PubMed2005

Short QT interval syndrome: a case report.

Twelve-lead electrocardiograms revealed fine atrial fibrillation and a short QT interval (SQTI) (<300 milliseconds) with an average ventricular rate of 54/min in a 20-year-old male presented with exertional dyspnea. His echocardiographic evaluation revealed interatrial septal aneurysm and slightly dilated pulmonary artery. An electrophysiologic study revealed atrial fibrillation with a very high frequency, short ventricular effective refractory period (130 milliseconds) and ventricular fibrillation inducible with 3 short coupled extrastimuli. Signs were consistent with the rare SQTI syndrome. Although SQTI syndrome is associated with increased risk for sudden cardiac death, the patient was free of arrhythmia symptoms and denied any syncope or presyncope. Family history was also negative for sudden cardiac death and for any symptom suggestive of arrhythmia. The patient refused implantable defibrillator and was treated with anticoagulation and quinidine therapy.

Adult↗
PubMed2005

Detection of the defibrillation threshold using the upper limit of vulnerability following defibrillator implantation.

OBJECTIVE: This study was designed to test defibrillation threshold (DFT) with the least number of fibrillation inductions using upper limit of vulnerability (ULV) and to describe the most practical set of ICD during DFT following implantation. BACKGROUND: Although the correlation between ULV and DFT has been well described, there has been no uniform DFT testing protocol taking the advantage of ULV after defibrillator (ICD) implantation. METHODS: A total of 26 patients undergoing a new ICD implantation had a DFT induced with scanned T wave shock. The hypothesis that ventricular fibrillation (VF) could be defibrillated with 5 J higher than the highest T wave shock needed to induce VF or with 10 J if the T wave shock needed to induce VF was less than 5 J, was tested and 20 patients fulfilled these criteria. The methodology is improved by detecting peak T wave with 12-lead ECG, applying biphasic T wave shock and scanning the T wave shock in a wider window. RESULTS: Five patients in the first group (n = 15) and one patient in the second group (n = 11) did not fulfill the above hypothesis. The common features of six patients who did not fulfill the hypothesis were that T wave shock needed to induce VF was either under 5 J (5 patients) or high (1 patient). CONCLUSION: This study revealed the importance of methodology in studies regarding ULV and DFT. Following ICD implantation, we propose the first biphasic T wave detected by 12-lead ECG and rescue shock set at 10 and 15 J, respectively. If any of the scanned T wave (40 ms before and 40 ms after the peak T wave with decrements and increments of 20 ms) shocks could not induce VF, then the T wave and the first rescue shock should be set at 5 and 10 J, respectively. If the induction of VF has been unsuccessful with T wave shock at 5 J, then a safe defibrillation with 10 J should be expected in majority.

Adult↗
PubMed2004

A novel method to estimate pulmonary artery wedge pressure using the downslope of the Doppler mitral regurgitant velocity profile.

Continuous-wave (CW) Doppler recording of mitral regurgitation (MR) is a reflection of the left ventriculoatrial pressure gradient. Accordingly, this jet may yield information about pulmonary artery wedge pressure (PAWP). In this study, we derived and then evaluated a novel method for prediction of PAWP. Patients (n=80) with moderate to severe MR and left ventricular dysfunction were included in the study. Transthoracic echocardiography was performed in patients during pulmonary artery pressure monitoring. A satisfactory CW Doppler recording of MR was obtained in 63/80 (78%). On the late descending portion of the CW recording, the time from a velocity of 4 m/sec to the end of the jet was defined as t1, and from 3 m/sec to the end of the jet as t2. Mathematical derivation of t1/t2 as a predictor of PAWP, was performed based on Weiss' derivation. If t1/t2 was <1.30, the PAWP was normal. If t1/t2 > 1.44, the PAWP was > 16 mmHg. With this new mathematical derivation, it appears that the downslope of the CW Doppler MR waveform may be able to distinguish a normal from elevated PAWP.

Algorithms↗
PubMed2004

Impedance cardiographic monitoring during pericardiocentesis: comparison with echocardiography.

OBJECTIVE: Thoracic impedance cardiography (TIC) is a noninvasive method which has proved to be useful in monitoring the haemodynamic status of the patients. In this study, we evaluated the TIC findings in patients with pericardial effusion and cardiac tamponade. METHODS AND RESULTS: The study consisted of patients with pericardial effusion with (group A) or without (group B) cardiac tamponade (CT). The stroke volume, cardiac output and ejection fraction was measured by both echocardiography and TIC. The measurements were done at baseline in both groups and following pericardiocentesis in group A. The variables were compared by linear regression analysis, paired sample's t test and chi-square test. The study included 32 patients. Group A consisted of 16 patients and group B of 14 patients. Two patients were excluded from comparisons because of insufficient quality of the echocardiographic examination. There were no significant differences between group A and B with regard to demographic features. Both echocardiographic and TIC measurements at baseline revealed decreased cardiac output, EDV and SV in group A and EF was not different. Linear regression analysis revealed that echocardiography and TIC were in significant correlation with regard to cardiac output, enddiastolic volume, stroke volume (p < 0.01) but not ejection fraction (p = 0.8910). The correlation was also present after pericardiocentesis. CONCLUSIONS: TIC can be safely used in patients with pericardial effusion. It provides suggestive data for the diagnosis of CT and can be used as a means of monitoring the results of the pericardiocentesis.

Adult↗
PubMed2003

Effects of chronic alcohol consumption on myocardial ischemia in rats.

The effects of chronic alcohol consumption on myocardial ischemia and gas perfusion with 95% O(2)-5% CO(2) were investigated in isolated rat heart. Eighteen adult male Wistar rats were used. Rats were assigned into six groups for each group to contain three rats: normal, alcoholic, normal ischemic, alcoholic ischemic, normal ischemic and 95% O(2)-5% CO(2) perfused, alcoholic ischemic and 95% O(2)-5% CO(2) perfused, respectively. Alcohol (7.2%, v/v) was given to rats by a modified liquid diet for 21 days. Rats were anaesthetized with ketamine (1-2mg kg(-1)). Hearts were quickly isolated. Normal and alcoholic rat hearts were directly sent to the electron microscopic preparation. The other hearts were cut into small pieces and put into Krebs solution. The solution was continuously bubbled using 95% N(2)-5% CO(2) 20 min for ischemia. After removal of normal ischemic and alcoholic ischemic heart specimens for electron microscopic examination, the remaining hearts of the last two groups were bubbled with 95% O(2)-5% CO(2) for another 20 min for the purpose of reperfusion and then were also prepared for electron microscopic examination. The hearts were investigated with a transmission electron microscope (Jeol 100 CXII TEM). Twenty-one days of chronic alcohol consumption was found to have no significant effect on myocardial ischemia determined by transmission electron microscopic examination. Our results suggest that there is no significant relationship between 21 days of alcohol consumption by a liquid diet and myocardial protection.

Alcohol Drinking↗