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Öğe Acute and long-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center study(AVES, 2011) Korkmaz, Şule; Demirkan, Burcu; Güray, Yeşim; Yilmaz, Mehmet Birhan; Aksu, Tolga; Şaşmaz, HaticeObjective: Percutaneous mitral balloon valvuloplasty (PMBV) is the method of choice in treatment of patients with hemodynamically significant mitral stenosis. We aimed to analyze acute and long-term clinical and echocardiographic consequences of PMBV. Methods: In this retrospective cohort study; 311 patients who underwent PMBV in our Cardiology Clinic at Türkiye Yüksek İhtisas Education and Research Hospital between January 2000 and March 2004 were evaluated for acute procedural outcomes and primary endpoints (death, rePMBV, mitral valve replacement (MVR)). All 311 patients were contacted by phone call or letter at least five years after the procedure. Of the 311 patients, 87 who defined NYHA class II-IV symptoms were invited for a control visit and detailed echocardiographic evaluation. Sixty-three patients out of 87 who completed follow-up were enrolled for long-term consequences. Those 63 patients were subclassified into two groups as those without any negative event (n=26) (Group 1) and those with mitral valve area (MVA) (<1.5 cm2), rePMBV or referral to MVR (n=37) (Group 2) on follow up to 6.4±1.6 years. Results: In the analysis of 311 patients, acute post procedural success, which was defined as mitral valve area (MVA) ?1.5 cm2 without severe mitral regurgitation, was 94% and was only associated with preprocedural MVA (p=0.008). In the logistic regression analysis, preprocedural MVA was the only independent parameter, associated with acute procedural success (Exp?=0.004, 95%CI 0.0001-0.234, p=0.008). In the longterm follow up of 63 patients, the patients with uneventful course (Group 1) had significantly higher MVA (p<0.001), lower mean (p=0.001) and peak (p<0.001) transmitral gradients immediately after the procedure when we compared to the patients in Group 2. It was also noticed that patients with at least 60% improvement in MVA experienced composite end point much less frequently compared to those with less than 60% improvement in MVA (5% vs. 30.4%, p=0.009). Kaplan-Meier analysis yielded significantly diverging cumulative survival curves for those with and without at least 60% improvement in MVA (p=0.003). Conclusion: Concerning long-term follow up data of patients undergoing PMBV in a single center, it seems only acute postprocedural MVA was significantly associated with long-term consequences. © Copyright 2011 by AVES Yayincilik Ltd.Öğe Fate of Internal Mammary Artery Grafted to Left Anterior Descending Artery Is Influenced by Native Vessel Stenosis and Viable Myocardium(SAGE PUBLICATIONS INC, 2009) Yilmaz, Mehmet B.; Guray, Yesim; Altay, Hakan; Demirkan, Burcu; Caldir, Vedat; Guray, Umit; Biyikoglu, Senay F.; Sasmaz, Hatice; Kisacik, Halil L.; Korkmaz, SuleIn this study, factors leading to the failure of internal mammary artery grafting was investigated among patients with coronary bypass. In all, 1323 patients were evaluated. It was found that lower grade diameter stenosis in the native vessel during postoperative angiogram and wall motion score index independently affected the fate of internal mammary artery as a graft. Grafting with internal mammary artery to native vessels with lower grade stenosis and to myocardium with poor wall score might not be a rational approach.Öğe Long-Term Follow-Up of Iatrogenic Atrial Septal Defect after Percutaneous Mitral Balloon Valvuloplasty(TEXAS HEART INST, 2011) Korkmaz, Sule; Demirkan, Burcu; Guray, Yesim; Yilmaz, Mehmet Birhan; Sasmaz, HaticeDuring percutaneous mitral balloon valvuloplasty, the Inoue method leaves patients with an iatrogenic atrial septal defect. In this study, we evaluated the factors affecting the development of iatrogenic atrial septal defect and searched for the possible influence of this defect on long-term outcomes. We reviewed the medical records of 267 patients who had undergone successful percutaneous mitral balloon valvuloplasty for symptomatic moderate or severe mitral stenosis from January 2000 through March 2004. Sixty-three of the 267 patients were enrolled in a face-to-face follow-up study. We noted their clinical and demographic characteristics. All included patients were asked for the endpoints of repeat percutaneous mitral balloon valvuloplasty or mitral valve surgery, cerebro vascular accident or transient ischemic attack, and the need of intervention for the iatrogenic atrial septal defect. They underwent standard 2-dimensional and Doppler echocardiographic examination. The presence of iatrogenic atrial septal defect was evaluated via the color-Doppler technique in the subcostal view and via contrast echocardiography. Patients were subclassified in accordance with the presence (n=15) or absence (n=48) of echocardiographically proven persistent iatrogenic atrial septal defect. When we compared the 2 groups, there were no significant differences in baseline demographic characteristics or in pre- and postprocedural echocardiographic data. We conclude that the presence of persistent iatrogenic atrial septal defects might not be predicted from echocardiographic or demographic data in patients undergoing percutaneous mitral balloon valvuloplasty. Fortunately, these defects are small in size and low in shunt ratio. They appear not to be associated with serious long-term outcomes. (Tex Heart Inst J 2011;38(5):523-7)Öğe Red cell distribution width predicts mortality in infective endocarditis(ELSEVIER MASSON, 2014) Guray, Yesim; Ipek, Esra Gucuk; Guray, Umit; Demirkan, Burcu; Kafes, Habibe; Asarcikli, Late Dinc; Cabuk, Gizem; Yilmaz, Mehmet BirhanBackground. - Infective endocarditis (IE) is associated with significant morbidity and mortality. Red cell distribution width (RDW) is a recently recognized biomarker of adverse outcome in a number of acute and chronic conditions. Aim. - To investigate the relationship between RDW and 1-year survival in patients with IE. Methods. - Clinical records from two tertiary centres were used to analyze data from patients with definite IE. Clinical, echocardiographic and biochemical variables were evaluated along with RDW. One-year survival status after index hospitalization was identified for each patient. Results. - One hundred consecutive patients (mean age 47.8 +/- 16.7 years; 61% men) with definite IE were enrolled. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting mortality was 15.3% (area under the curve 0.70; P=0.001). Forty-one patients (41%) died within 1 year; of these, 88% had ROW results > 15.3%. Univariate Cox proportional-hazards analysis showed that RDW > 15.3%, heart failure, renal failure, cardiac abscess, severe valvular regurgitation and presence of dehiscence were associated with increased mortality. Multivariable Cox proportional-hazards analysis revealed that renal failure (hazard ratio [HR] 3.21, 95% confidence interval [CI] 1.35-7.59; P = 0.008), heart failure (HR 2.77, 95% CI 1.1-6.97; P = 0.03) and RDW > 15.3% (HR 3.07, 95% CI 1.06-8.86; P = 0.03) were independent predictors of mortality in patients with IE. Conclusion. - According to our results, mortality is high in patients with IE. RDW is a promising biomarker for predicting 1-year survival rates in these patients. (C) 2014 Published by Elsevier Masson SAS.Öğe Relationship between TIMI frame count and admission glucose values in acute ST elevation myocardial infarction patients who underwent successful primary percutaneous intervention(AVES YAYINCILIK, 2011) Ege, Meltem; Guray, Umit; Guray, Yesim; Yilmaz, Mehmet Birhan; Demirkan, Burcu; Sasmaz, Ali; Korkmaz, SuleObjective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6- month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to Group 1 (138 [114-165] vs. 123 [97-143] mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (beta=0.04, 95% Cl: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI. (Anadolu Kardiyol Derg 2011; 11:213-7)
