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Cüneyt Konuralp

Publications and source records attributed to Cüneyt Konuralp.

11 recordsLinked to original sources
PubMed2006

Cardioprotective effect of aprotinin on myocardial ischemia/reperfusion injury during cardiopulmonary bypass.

BACKGROUND: Aprotinin is a serine protease inhibitor used extensively in cardiac operations to reduce postoperative bleeding. It also has cardioprotective effects in ischemia/reperfusion injury. In this study, the effects of aprotinin on the release of cardiac markers were evaluated in patients who had good ventricular function and were undergoing coronary artery bypass grafting with cardiopulmonary bypass (CPB). METHODS AND RESULTS: Eighty male patients with an ejection fraction >or=40%, were randomized into either an aprotinin (Group-I; n=40) or control (Group-II; n=40) group. Patients in the aprotinin group received the full Hammersmith doses of aprotinin (2 x 10(6) KIU pre-CPB, 2 x 10(6) KIU at pump prime, 500,000 KIU/h during CPB), whereas the patients in the control group received only saline solutions. Cardiac troponin-I (cTnI) levels were measured before surgery, immediately after surgery, and at postoperative 6(th), 12(th), 24(th) h and 5(th) day. Creatine kinase (CK)-MB measurements were performed at the same time except for the postoperative 5(th) day. Cardiac index (CI), mixed venous oxygen saturation and lactate dehydrogenase (LDH) measurements were also performed. CONCLUSION: Although all patients were in reasonable condition, less myocardial enzyme leakage occurred on the aprotinin group, suggesting that aprotinin has a protective effect on the myocardium beyond that achieved with blood cardioplegia and systemic hypothermia. Because of aprotinin's effects on multiple targets of metabolism, its protective value might increase in more complicated cases.

Adult↗
PubMed2005

Could mean platelet volume be a predictive marker for acute myocardial infarction?

BACKGROUND: Platelets play an important role in developing intravascular thrombus, the major cause of acute coronary syndromes. We investigated the clinical value of mean platelet volume (MPV) in coronary atherosclerosis and its possibility of being an independent risk factor for acute myocardial infarction (MI). MATERIAL/METHODS: Two hundred patients who underwent coronary angiography were included in the study. Thirty-five patients were randomly selected for each of the four study groups of stable (SAP) and unstable (USAP) angina pectoris and MI with and without ST-segment elevation. Sixty patients with chest pain having normal coronary angiograms were controls. The groups were compared regarding age, sex, smoking, diabetes, hypertension, positive family history, number of diseased vessels, lipid profile, complete blood count, creatine kinase (CK)-MB, Troponin-I, and MPV. RESULTS: MPV was found to be elevated in MI patients compared with controls (p<0.001) and SAP (p<0.05) and patients with two- (p<0.001) and three-vessel (p<0.001) disease. We observed a significant association between MI and higher MPV (> or = 12 fl). High MPV (p<0.001) and WBC (p<0.001) were independent risk factors, among others. CK-MB, Troponin-I, and higher MPV demonstrate MI risk with 87%, 70%, and 87% specificity, respectively, while higher MPV only demonstrates coronary artery disease with 98% specificity. CONCLUSIONS: Our study shows high MPV is an independent risk factor for coronary atherosclerosis and MI. Because this is a simple, economic, and practical method, we suggest MPV be considered with other conventional risk factors.

Adult↗
PubMed2005

A novel reporting approach to coronary angiography: "segmental coding system".

BACKGROUND: A new systematic reporting system for coronary angiography has been developed, which is capable of describing any visible intraluminal or extraluminal conditions with the exact coordinates. METHODS: In this method, called "segmental coding system"(SCS), the part of the artery that is located between its two subsequent branches is considered to be an "angiographic segment". Conditions are localized according to their relationship with these angiographic segments and the anatomic border of the segments (coronary ostiums, primary, secondary and tertiary branches, grafts and proximal and distal anastomosis sites). They are also described by using a special coding system that consists of letters, numbers and signs. SCS can supply the name (stenosis, occlusion, contour deformity, aneurysm, rupture, anatomical variation, existence of stent, etc.) and the exact localization (coordinates) of the condition with its properties; filling direction, and the collateral system that fills the vessel. RESULTS: We applied SCS to more than 500 cineangiograpies. According to our experience, SCS provides more objective, detailed, and even correct information than the current narrative reporting system. SCS also offers many extra advantages. (a) It can describe all imaginable types of lesion combinations. (b) All of the existing conditions can be listed without missing. (c) The definitions are very precise and clear. They can easily be understood by everyone in the same way. (d) It is more advantageous on archiving, searching the database, and comparing the subsequent reports for the same patient. (e) In the future, by using specially tailored software, personal and detailed angiographic images will be reproduced from the SCS data. CONCLUSIONS: By being introduced into clinical practice, we believe, SCS will prove a very useful tool for both surgeons and cardiologists.

Coronary Angiography↗
PubMed2005

Novel approach to aortic cannulation suturing: tangential suture technique.

BACKGROUND: Pursestring suture for ascending aortic cannulation in open heart surgery that requires cardiopulmonary bypass may cause serious events, especially in patients who have a thin or calcific aorta. We introduce a novel suturing method, called the 'tangential suture technique', and submit our clinical experience. METHODS: Adult patients undergoing cardiopulmonary bypass were included in this study. Patients in whom the tangential suture technique was applied (Group A; n = 146) were compared with patients in whom the classic pursestring technique was applied (Group B; n = 152). RESULTS: The age (38 +/- 11 years vs 36 +/- 10 years), sex (males 65.1% vs 62.5%) and operation types were similar in both groups. Although the difference was not significant (P > 0.05), subadventitial haematoma occurred more frequently in Group B (13 patients; 8.6%) than in Group A (3 patients; 2.1%). However, none in Group A required opening the adventitia. No aortic dissection was observed in peri- or postoperative periods in either group. In Group B, seven (4.6%) patients required repair by suture after tying of pursestring sutures following decannulation because of bleeding, while none was required in Group A (P = 0.0156). CONCLUSIONS: Tangential suture technique allows the needle to take a longer segment from the media layer while decreasing the likelihood of entering the lumen. Because the tract of the suture almost perfectly fits to the needle curve, tissue injury is less, even on fragile aortas, and this ensures more stable closure of the hole when the suture is tied following decannulation. By considering both its theoretical advantages and our clinical experience, we believe tangential suture technique should be preferred to the classic method.

Adolescent↗
PubMed2005

Peripheral mycotic aneurysms in infective endocarditis.

BACKGROUND AND AIM OF THE STUDY: Today, infective endocarditis (IE) remains a severe illness, with high mortality and morbidity. Mycotic aneurysms (MAs) are rare complications of IE. For most patients, surgical intervention represents the only hope for radical cure of extracranial MAs, and survival. METHODS: A total of 238 patients with IE was treated at the authors' center between January 1990 and December 2003. Among these patients, 10 underwent surgical intervention due to peripheral MAs. RESULTS: Concomitant surgery for intracardiac and extracardiac pathology was applied in three patients with native valve endocarditis to excise infected material. Aneurysmectomy and revascularization were performed in four patients with native endocarditis, and in three with prosthetic valve endocarditis (PVE). The intracardiac pathologies of these seven patients were treated with antimicrobial agents. Eight patients underwent surgery after completion of three weeks' antibiotic therapy. An autologous saphenous vein interposition was performed in eight patients, but in two cases, due to size discrepancy, a polytetraflouroethylene (PTFE) graft was chosen as the initial conduit to achieve arterial continuity. Saphenous vein graft rupture occurred in one patient; a PTFE graft was used to achieve second revascularization. Limb salvage was achieved in nine patients. Below-knee amputation was necessary in one patient; this was due to prior embolism of the distal arterial tree. Two patients died, one due to cerebral embolism and another to rupture of undiagnosed visceral MA. All other patients remain alive, without complications. CONCLUSION: Complete revascularization should be essential to treat peripheral MA in IE. Adequate resection, appropriate parenteral administration of antimicrobial agents and size discrepancy are far more important factors than the type of graft material in preventing suture-line infection and vessel or graft rupture.

Adolescent↗
PubMed2003

Systematic approach on postoperative care of the cardiac surgical patients.

With the medical advances and rising expectations among cardiac surgeons and patients, older and sicker patients now undergo ever more complex operations. However, fortunately, postoperative care of cardiac surgical patients also have shown important changes parallel to the surgical improvements. Although, the events within the operating room are accepted as the main determinants for the faith of the patient, some patients, who are very ill upon arrival in the intensive care unit, may have a good long-term prognosis when postoperative care is meticulously provided. Conversely, patients who are doing well as they leave the operating room may be put at significant risk for complications by poor postoperative management. In this paper, we draw an outline of systematical approach of intensive care of cardiac surgical patients and summarize a practical manual for physicians. By applying this approach effectively, it should be expected that, the clinician is able to recognize an impending disaster earlier, initiate the proper treatment timely, and increase patients chances of survival.

Cardiac Surgical Procedures↗
PubMed2002

Creating a bicuspid valve from the aortic wall: a new surgical approach on aortic valve disease (in vitro study).

We described a new technique (called 'bicuspidization'), which is performed by using autogenous material, without replacement of the aortic valves for the surgical treatment of aortic stenosis and/or insufficiency and tested it in in vitro sheep model. Different stress conditions were simulated by applying three different flow patterns (hemodynamic challenge tests) successively by using a centrifugal pump. It was demonstrated that the competency of the new bicuspid valves was excellent (zero insufficiency). There was a 10-11 mm Hg-increase on trans-valvular gradient comparing the normal hearts. The autogenous bicuspid valve has not blocked the way of the coronary flow in the closed position.

Animals↗
PubMed2002

Ellis-van Creveld syndrome associated with thymic hypoplasia.

A 16-month-old girl presented with the classic signs of Ellis-van Creveld syndrome. Mitral clefts were repaired by direct suturing. The single atrium was repaired by creating a new septum with a pericardial patch, leaving the coronary sinus in the left atrium. During perioperative exploration, thymic hypoplasia was recognized.

Ellis-Van Creveld Syndrome↗
PubMed2002

Effects of seasonal variations on coronary artery surgery.

BACKGROUND: In this study, we compared profiles and early results of patients who underwent coronary artery bypass graft surgery (CABG) during the winter season with those who underwent CABG during the summer season. We also investigated whether possible seasonal variations in performance of health care professionals had any effects on surgical outcome. METHODS: The data from patients who had undergone CABG surgery in the winter (group A) and summer (group B) seasons of the period from December 1998 to August 2001 were analyzed retrospectively. Preoperative, perioperative, and postoperative data were compared. Preoperative factors analyzed included sex, age, diabetes mellitus, hypertension, New York Heart Association status, unstable angina pectoris, and left ventricle ejection fraction. Perioperative factors included graft number, internal mammary artery use, cross-clamp time, and cardiopulmonary bypass time. Postoperative factors included mediastinal reexploration, blood use, inotropic support, intraaortic balloon pump support, perioperative myocardial infarctus, cardiac arrest, infection and other complications, duration of hospital stay, and early mortality. RESULTS: The preoperative demographic data were identical in the 2 groups, with the exception of incidence rate of hypertension (26.8% in group A versus 15.7% in group B, P <.01). The incidence rates were higher in group B than group A for postoperative infection (8.8% versus 5.2%, P <.05), mediastinal reexploration for bleeding (6.9% versus 4.2%, P <.05), and transfusion blood use (7.3 +/- 6.2 U/patient versus 6.0 +/- 3.9 U/patient, P <.05). There were no differences between the 2 groups in early mortality rates. CONCLUSION: Despite the fact that frequency and occurrence of cardiovascular events traditionally have been reported to be higher in the winter than the summer, our data show no major differences in early surgical outcome among those patients who had undergone CABG in the winter or summer. We did not encounter any seasonal patterns. However, an interesting finding was that the patients who underwent surgery in the summer had a higher incidence of infection and bleeding.

Adult↗