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Cevat Yakut

Publications and source records attributed to Cevat Yakut.

At least 19 recordsLinked to original sources
PubMed2006

Combined approach to a peripheral congenital arteriovenous malformation: surgery and embolization.

A 28-year-old woman with a complex peripheral congenital arteriovenous malformation in the left shoulder and left upper arm was treated by a combination of surgery and embolization. In the consecutive four operations, the major feeding arteries of the arteriovenous malformation were ligated, but as her complaints increased, transcatheter embolization was planned for releaving the symptoms in the first aspect. A total of eight embolization sessions were performed with Onyx during the 3-year period. The arteriovenous communications were occluded by embolization, with approximately more than an 80% decrease in the lesion size angiographically. After these interventions, the patient's symptoms improved clinically and dyspnea was lessened. Peripheral congenital arteriovenous malformation is a rare and therapeutically challenging condition in which a combination of surgery and embolization would be necessary to obtain a good result.

Adult↗
PubMed2006

Multivariate analysis for operative mortality in obstructive prosthetic valve dysfunction due to pannus and thrombus formation.

The objective of the present study was to investigate the risk factors for early hospital mortality in reoperations performed for obstructive prosthetic valve dysfunction. Between January 1994 and April 2005, 63 patients underwent reoperation for obstructive prosthetic valve dysfunction. The mean age of the patients was 40.3 +/- 12.8 years. The mitral valve was replaced in 47 (74.6%) patients, the aortic valve in 6 (9.5%) patients, and both valves in 10 (15.9%) patients. Forty-three (68.2%) patients underwent emergency reoperations. Early hospital mortality occurred in 13 (20.6%) patients. The ethiology of the valve dysfunction was pannus formation in 45 (71.4%) patients and thrombus formation in 18 (28.6%). Pannus and thrombus were localized at the atrial side of the prosthetic valve in 15 (23.9%) patients, at the ventricular side in 13 (20.6%), and at both sides in 35 (55.5%). Inadequate anticoagulation was diagnosed in 28 of 63 (44.4%) patients. The mean INR level in these 28 patients was 1.43 +/- 0.24. In multivariate analysis, the only risk factor for early hospital mortality was left ventricular ejection fraction (P = 0.015; Odds: 0.000, 95% CI: 0.000-0.043). It is concluded reoperations for prosthetic valve dysfunction have a high mortality rate. This study revealed that left ventricular dysfunction is the major determinant of surgical mortality in patients requiring reoperation for valve dysfunction due to pannus or thrombus.

Adolescent↗
PubMed2006

Primary left ventricular angiomatosis: first description of a rare vascular tumor in the left heart.

A 24 year-old male who presented with palpitations and presyncopal attacks had monomorphic ventricular tachycardia and a well-defined huge mass within the inferoposterior wall of the left ventricle proved by transthoracic echocardiography. The mass was completely resected and shown to be proliferative angiomatosis by histopathologic examination. This is the first reported case of primary left ventricular angiomatosis in the literature.

Adult↗
PubMed2006

Pedicled right internal mammary artery for reoperative off-pump revascularization of left anterior descending coronary artery.

In situ right internal mammary artery is the graft of choice in reoperative off-pump coronary artery bypass grafting, as well as in primary on-pump coronary artery bypass grafting, unless the vessel has been used previously. However, there are not enough data about postoperative angiographic findings of the in situ right internal mammary artery in reoperative coronary artery bypass grafting with the off-pump technique. From September 1993 through January 2004, we reviewed the postoperative course and the graft patency of 12 selected patients who underwent off-pump coronary artery bypass grafting reoperation only for revascularization of the left anterior descending artery, by means of a pedicled right internal mammary artery graft. All patients were evaluated clinically and by postoperative coronary angiography. There were no early or late deaths during the mean follow-up period of 33.08 +/- 30.05 months (range, 1-77 months). The mean interval from the 1st operation to the 2nd operation was 74.1 +/- 57.01 months (range, 4.5-171 months). Postoperative coronary angiograms of all patients showed a 100% patency rate for both in situ grafts and composite grafts. We suggest that use of the in situ right internal mammary artery in off-pump coronary artery bypass grafting is a safe and reliable option for revascularizing the left anterior descending artery, especially in reoperation.

Adult↗
PubMed2005

Cost-effectiveness of thrombolytics: a simplified model.

OBJECTIVE OF THE STUDY: To construct a simple model for an internal, retrospective cost-effectiveness analysis and to calculate the incremental cost-effectiveness of tissue plasminogen activator (TPA) over streptokinase (SK) in Turkey. SETTING: Koşuyolu Heart, Education and Research Hospital, Istanbul, Turkey. METHOD: Among patients who were hospitalized for treatment of acute myocardial infarction (AMI), 196 were randomly selected. One-year mortality rates according to the treatment groups (TPA, SK, other) were determined. Among surviving patients, 28 from TPA and another 28 from SK group were randomly selected for the pharmacoeconomic analysis. Patient treatment data were taken from medical records while data regarding to costs were taken from hospital bills. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER). The cost part of the ratio was considered as 'the overall-costs', while the effectiveness part was considered as 'lives saved' per treatment group. RESULTS: With an increased one-year survival rate of 2.37% and an increased cost of euro 1120.8 ($1165.6) per patient in the TPA group, the ICER for the use of TPA instead of SK was euro 47,289 ($49,180.6) per life saved. CONCLUSION: This model can be a guide for similar analyses. The results of our study (the incremental cost-effectiveness of TPA over SK) will be informative for the decision-makers in Turkey, by whom the medical benefit for money spent would be assessed and judged. We believe that our results make a contribution to similar studies in the literature.

Cost-Benefit Analysis↗
PubMed2005

Surgical repair of postoperative left sinus of Valsalva aneurysm dissecting into the interventricular septum.

We describe the dissection of the interventricular septum by unruptured aneurysm of the left sinus of Valsalva in a patient who had undergone aortic valve replacement for rheumatic aortic valve insufficiency 5 years previously. The patient had worn a permanent pacemaker for 1 year to manage complete atrioventricular block. Sufficient information was provided by echocardiography and aortography to confirm the diagnosis. Operative correction consisted of obliteration of the aneurysm sac and closure of the outward orifice with a Dacron patch from the side of the aortic sinus.

Adult↗
PubMed2005

Reversed-J inferior sternotomy for awake coronary bypass.

Many approaches for minimally invasive coronary bypass surgery are available and to further decrease the invasiveness, coronary artery bypass grafting has been performed under high thoracic epidural anesthesia without endotracheal intubation in the last years. Less invasive approach to coronary artery bypass graft operations is possible through combination of the high thoracic epidural anesthesia and a reversed-J sternotomy, and coronary revascularization can be accomplished without any additional technical difficulties and with a good exposure of both the left anterior descending artery and the left internal thoracic artery. This technique is less traumatic for patients and provides practical better oxygenation and shorter hospital stay.

Anesthesia, Epidural↗
PubMed2005

Effects of giant left atrium on thromboembolism after mitral valve replacement.

The aim of this study was to evaluate the incidence of thromboembolic events in patients with giant left atrium ( > 6.5 cm) after mitral valve replacement. From January 2000 to September 2002, a total of 126 patients who had undergone mitral valve replacement were divided into two groups according to the presence or absence of giant left atrium. Group A comprised 34 patients with left atrium over 6.5 cm without compression symptoms and Group B comprised 92 patients. The preoperative variables did not distinguish the patients in each group, except for atrial fibrillation; Group A 85.2% and Group B 61.9% ( p < 0.01). After mitral valve replacement, left atrium mean diameter was significantly decreased in Group A from 8.1 +/- 1.3 mm to 6.2 +/- 1.6 mm ( p < 0.01). There were no significant differences in thrombosis, hemorrhage and thromboembolism rates in both groups. Postoperative clinical and hemodynamic parameters demonstrated a positive clinical response to mitral valve replacement in patients with giant left atrium. During follow-up no direct relationship between thromboembolism and giant left atrium was evident.

Adolescent↗
PubMed2005

Sequential radial artery grafting three-vessel coronary artery disease.

Our objective was to compare the results of revascularization by sequential radial artery (RA) grafting with a left anterior descending left internal mammary artery (LIMA)-RA t-composite grafting technique. Patients were grouped as those with proximal anastomoses performed on the ascending aorta (Group A; n = 38), and those with proximal anastomoses performed on the LIMA as t-grafts (Group T; n = 13). Neither of the two groups revealed any mortality. The average number of grafts was lower in Group T (2.23 +/- 0.43 in group T and 2.85 +/- 0.69 in group A, p < 0.05). The results of the control coronary artery angiographies were superior in Group A. The patency rate of the RA grafts was 96.8% in Group A. Of the 20 distal anastomoses performed with RA grafts in 8 patients from Group T, nine (45%) were found to be patent. The patency rates of RA grafts with sequential distal anastomoses were found to be better when the proximal anastomosis was performed on the ascending aorta rather than on the LIMA. In conclusion, sequential distal anastomosis of RA grafts seem to be safe and effective when proximal anastomoses are performed on the ascending aorta.

Adult↗
PubMed2005

Operative mortality after valvular reoperations.

BACKGROUND: To determine the incidence and risk factors of mortality and morbidity in valvular reoperations. METHODS: Between January 1993 and December 2003, 309 valvular reoperations were performed. The reasons for reoperations were reconstructive surgery in first operation (110 patients, 35.5%), prosthetic valve endocarditis (12 patients, 3.8%), periprosthetic leakage (32 patients, 10.3%), new valve degenerations (12 patients, 3.8%), bioprosthetic dysfunction (92 patients, 29.7%), acute thrombotic stuck valve (30 patients, 9.7%), and pannus formation (21 patients, 6.7%). Mitral valves were replaced in 235 patients, aortic valves were replaced in 32 patients, 24 patients had aortic and mitral valve replacements, 2 patients had mitral and tricuspid valve replacements, and reconstruction of periprosthetic leakage was held in 16 patients. 264 patients had elective surgery, whereas 45 were operated on emergency basis. RESULTS: Hospital mortality was 14.23%. Mortality rate was found to be 10.6% for elective cases and 35.5% for emergency cases. Permanent pacemaker was required in 12 patients, 3 patients had cerebrovascular events, and mediastinitis was observed in 1 patient. Multivariate analysis demonstrated that age > 60 (P = .006; OR 7.3, 95% CI 1.7-30.1), emergency surgery (P = .001; OR 8.1, 95% CI 2.4-27.7), preoperative cerebrovascular accident (P = .003; OR 11.8, 95% CI 2.458.7), and concomitant ascending aorta replacement (P < .001; OR 27.4, 95% CI 6-127) were independent risk factors. CONCLUSION: Valvular reoperations can be carried out with acceptable morbidity and mortality in elective operations but mortality rates are still very high in emergent cases.

Adult↗
PubMed2005

Using the bilateral internal mammary artery in the left or right coronary artery system: 5-year comparison of operation techniques and angiographic results.

OBJECTIVE: Using the bilateral internal mammary artery (IMA) in coronary artery bypass grafting (CABG) surgery has prolonged survival, improved functional capacity, and reduced the rate of reintervention without increasing postoperative early morbidity and mortality. METHODS: Between January 1996 and December 1997, 94 CABG operations were performed using the bilateral IMA. In Group A (n = 45), the right IMA was anastomosed to the left coronary artery system; in Group B (n = 49), the right IMA was anastomosed to the right coronary artery system. The left IMA was always anastomosed to the left coronary artery system in both groups. RESULTS: There was 1 death (Group A) (1.06%), and 1 late death (Group B) (1.07%). One patient in Group A underwent balloon angioplasty, and 1 patient in Group B underwent reoperation after the follow-up. Pre- and postoperative data were similar between both groups, except for off-pump CABG, which was higher in Group B (2.2% versus 36.7%; P <.001). Twenty-three randomized patients in each group underwent control angiography until May 2002. Angiographic results showed that the patency of the right IMA to the right or left coronary artery system was similar (78.26% versus 82.6%; P = .7). But the left IMA had a better patency rate than the right IMA (95.65% versus 80.43%; P = .02). The patency rates of the left and right IMA anastomosis on the beating heart in Group B were not significantly different (92.3% versus 76.9%; P = .27). The patency of right IMA anastomosis with or without off-pump technique in Group B was similar (76.9% versus 80%; P = .84). CONCLUSIONS: Bilateral IMA can be used with low morbidity and mortality. The angiographic and clinical results of off-pump CABG show that bilateral IMA can also be used in off-pump surgery with similar results.

Adult↗
PubMed2005

Simultaneous Carotid Endarterectomy and Coronary Revascularization is Safe Using Either On-Pump or Off-Pump Technique.

The appropriate surgical strategy for patients with combined carotid and coronary artery disease remains controversial. We retrospectively compared our surgical results for 2 types of approaches in this disorder. The records of 76 patients consecutively operated on for carotid and coronary artery disease between August 1993 and October 2004 were reviewed. There were 18 males (66.6%) and 9 females (33.3%) in group I. Group II consisted of 35 males (71.4%) and 14 females (28.5%). The patients were divided into two groups: patients with combined off-pump coronary artery bypass and carotid endarterectomy (group I, n = 27), and those with one-stage on-pump coronary artery bypass and carotid endarterectomy (group II, n = 49). Surgical mortality and morbidity and late outcome were compared among the two groups. The average number of grafts was 1.2 +/- 0.4, with the average operative time of 3.3 +/- 0.3 hours in group I, and 2.3 +/- 0.5 grafts with operative time of 4.6 +/- 0.4 hours in group II (P < 0.001 and P < 0.001, respectively). There was 1 death (3.7%) in group I and 2 deaths (4.8%) in group II (P = 0.937). No patient from either group I or group II had postoperative stroke. Mean hospital stay was 7.4 +/- 1.9 days in group I and 11.3 +/- 1.7 days in group II (P < 0.001). At a mean follow-up of 5.5 +/- 3.3 years in group I, 1 patient had contralateral carotid endarterectomy (3.7%). Group II had a mean follow-up of 5.2 +/- 3.0 years and contralateral carotid endarterectomy was performed in 1 patient (2.0%). There were no late strokes or deaths in either group. Combined coronary artery bypass grafting and carotid endarterectomy using 2 different types of technique is a safe and effective procedure in patients with significant concomitant monolateral carotid and coronary artery disease.

Cardiac Surgical Procedures↗
PubMed2005

[Cardiovascular manifestations and treatment in Marfan syndrome].

Marfan syndrome is a dominantly inherited connective tissue disease characterized by cardiovascular, skeletal and ocular manifestations, which was firstly described by Antoine Marfan in 1896. The underlying disorder is a mutation, which impairs fibrillin synthesis and is associated with the FBN-1 gene on the 15th chromosome. Ghent Nosology is used for diagnosis. The progressive dilatation of the proximal aorta leading to dissection and rupture is the typical feature of the disease. Aortic aneurysm and aortic rupture are the lethal complications of the disorder. Increased life expectancy depends on the control and the prevention of the cardiovascular complications. The most frequent cardiovascular manifestation is the mitral valve involvement. The principal pathologic findings on the mitral valve are annular dilatation, fibromyxomatous changes of the leaflets and chordae, elongation and rupture of chordae and deposition of calcium. Prolapsus occurs in 80% of the cases. Elective surgery with optimal timing is associated with increased survival. In the follow-up of patients after surgery for aortic aneurysm and dissection, serial imaging studies in order to detect a new onset aneurysm or dissection on different sites of the aorta are essential.

Cardiovascular Diseases↗
PubMed2005

Intracardiac extension of intravenous leiomyoma.

Intravenous leiomyoma with intracaval and intracardiac extension is a rare benign neoplasm affecting women. We report a case in which an intravenous leiomyoma originated from the right iliac vein and extended through the inferior vena cava into the right atrium. The correct diagnosis was made intraoperatively, after resection of the intracardiac extension of the tumor, which was 28 cm in length. At the 2nd stage of the operation, a right common iliac venotomy enabled the removal of all residual tumor from the inferior vena cava.

Female↗
PubMed2005

Surgical treatment of aortobronchial and aortoesophageal fistulae due to thoracic aortic aneurysm.

We present a review of our single-institution experience, over 19 years, with aortobronchial and aortoesophageal fistulae due to descending thoracic aortic aneurysm. We conducted a retrospective chart review of 10 cases involving surgery for aortobronchial and aortoesophageal fistulae in our clinic from February 1985 through October 2004. Pathologic or predisposing conditions associated with aortobronchial fistula were descending thoracic aortic aneurysm (n=8), previous aortic surgery (n=1), and concomitant aortoesophageal fistula (n=1). Three patients presented emergently with aortobronchial fistula (n=2) and aortoesophageal fistula (n=1). Ages of the 10 patients ranged from 42 to 74 years (median, 63 years). The median cross-clamp time was 34 minutes (range, 27-41 min). Repairs, in 9 patients, involved an inlay of prosthetic tube graft using the clamp-and-sew technique, and in 1 patient repair involved patch aortoplasty. The operative mortality rate was 20%:1 patient had acute concomitant aortoesophageal and aortobronchial fistulae, and another had chronic aortobronchial fistula. There was no embolic stroke or paraplegia. During follow-up (median, 2.5 years), there were no deaths or postoperative morbidity We conclude that repair of aortobronchial and aortoesophageal fistulae using the clamp-and-sew technique can be performed with acceptable operative mortality and long-term results. However, the mortality rate continues to be highly significant in patients with acute bleeding aortobronchial fistula or with aortoesophageal fistula, despite rapid surgical intervention.

Adult↗
PubMed2004

Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease.

BACKGROUND: The encouraging results of valve repair in the atrioventricular valves have influenced a decision about aortic valve (AV) reconstruction. We report our experience with pericardial cusp extension to repair rheumatic AV disease. METHODS: From 1993 to 1998, 46 patients (25 women, 21 men) with a mean age of 31.5 +/- 12.2 years (range, 15 to 58 years) underwent AV repair. Twenty-two (47.8%) patients had moderate and 24 (52.2%) had severe aortic insufficiency (AI). Severe cusp retraction was repaired with glutaraldehyde-treated autologous pericardium. Twenty-one patients had more than one maneuver (mean, 1.8) to attain competence besides augmentation, which consisted of the release of stenotic commissures (in 11 cases), thinning of the AV cusps (in 10 cases), and resuspension of the cusps (in 17 cases). Simultaneous mitral valve repair was performed on 17 patients. Eight patients received triple valve reconstruction. RESULTS: There was no early mortality. Thirty patients no longer had AI with any significant transvalvular gradients. Five patients were followed with mild residual AI, and 2 patients with moderate AI not requiring reoperation. Nine patients developing severe AI required AV replacement with a reoperation rate 19.6% (4.26%/patient-year). The mean interval between repair and reoperation was 28.2 +/- 18.3 months (range, 3 to 58 months). The mean observation time was 4.6 +/- 3 years (211.6 patient-years). Late mortality rate was 2.2% with 1 patient. The significant negative predictors of aortic reoperation determined by univariate analysis were preoperative New York Heart Association class (p = 0.002) and postoperative severe AI (p < 0.001). Cox hazard studies identified that all risk factors were insignificant for aortic reoperation. The actuarial rate of freedom from aortic reoperation was 76.1% +/- 7% at 7.5 years. CONCLUSIONS: Although AV repair by extension with pericardium is worth considering with an acceptable solution to achieve a good geometry from unequal cusps, especially in young rheumatic patients for preservation of the native AV, the patients should be followed periodically for reoperation risk.

Adolescent↗