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Öğe Asymptomatic total anomalous pulmonary venous connection with double drainage in a young adult: A case report(FORUM MULTIMEDIA PUBLISHING, LLC, 2007) Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Yilmaz, Mehmet Birhan; Manduz, Sinasi; Karadas, Filiz; Dogan, Kasim; Tandogan, IzzetTotal anomalous pulmonary venous connection is an uncommon congenital anomaly in which all pulmonary venous return drains to the right atrium or one of its tributaries. Survival beyond infancy without surgical palliation is unlikely, so this anomaly is not encountered in the adult population with congenital heart disease. The patient presented here was 22 years old on admission and had no total anomalous pulmonary venous connection-associated symptoms. He underwent transthoracic echocardiographic examination for atypical chest pain. Transthoracic echocardiography along with cardiac catheterization favored the presence of a total anomalous pulmonary venous connection. Surgical correction of pulmonary venous confluence ( draining to both the coronary sinus and right atrium) was performed successfully. This is a rare case of total anomalous pulmonary venous connection with no reported symptoms in contrast to the majority of patients who are symptomatic during the first year of life.Öğe Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure(HEALTH COMMUNICATIONS INC, 2006) Yilmaz, Ahmet; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, IzzetMyocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female, 18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P >.05). Mean EF in the patient group was lower than that in the control group (P <.05). Mean CK-MB and Tn-I in the patient group were significantly higher than in the control group (P <.05). In the patient group, hypertensive patients were found to have significantly higher mean values of CK-MB than were seen in normotensive patients in the same group (P <.05). In the patient group, 52 cases were considered to be class I-II (New York Heart Association [NYHA]) (group 1), and 52 were considered to be class III-IV (group 2). Group 1, group 2, and the control group did not differ significantly from one another with regard to the presence of coronary artery disease, hypertension, and diabetes mellitus (P >.05). The mean EF in group 2 was significantly lower than that in group I and in the control group (P <.05); the mean EF in group I was significantly lower than that in the control group (P <.05). Group 1 values did not differ significantly from those of group 2 or the control group in terms of enzymatic markers (P >.05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P <.05). The uphill course of CK-MB and Tn-I values from the control group to group 2 (NYHA class III-IV) was statistically significant (P <.05). Serum concentrations of CK-MB and Tn-I may become elevated in severely symptomatic patients with CHIF (particularly NYHA class III-IV), demonstrating a relationship between clinical severity of the disease and elevation of myocardial enzymes (CK-MB and Tn-I).Öğe Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure(SPRINGER, 2009) Yilmaz, Mehmet Birhan; Yontar, Can; Erdem, Alim; Karadas, Filiz; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Tandogan, IzzetSevere heart failure represents a major source of morbidity and mortality. Poor right ventricular function is an independent prognostic marker for mortality in patients with chronic heart failure. In this study, levosimendan (L) and dobutamine (D) in patients with severe chronic biventricular failure were compared. Forty consecutive patients, who were judged for inotropic therapy by their primary physicians, with acutely decompensated systolic heart failure and having moderate-to-severe right ventricular dysfunction with right ventricular fractional area change of a parts per thousand currency sign24%m were randomized to L and D in a 2:1 fashion. Echocardiographic parameters including tricuspid annular motion and clinical issues were considered. Mean age and sex distribution were not different between the two groups. After the infusion, ejection fraction improved and systolic pulmonary artery pressure decreased significantly in both arms. Longitudinal systolic function of tricuspid annulus improved significantly better in patients with L compared to patients with D (15% +/- 12% vs. 2% +/- 6% improvement, P < 0.001). Furthermore, L improved both 24-h urine output and creatinine, whereas D showed only a small, but significant improvement in urine output without any improvement in the creatinine levels. Levosimendan seems to offer more beneficial effects compared to dobutamine in a specific group of patients with biventricular failure.Öğe The effect of collateral circulation on left ventricular systolic function(LIPPINCOTT WILLIAMS & WILKINS, 2007) Karadas, Filiz; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Yilmaz, Ahmet; Dogan, Kasim; Tandogan, IzzetBackground Conflicting reports exist on the influence of coronary collateral circulation on preservation of left ventricular systolic function. The aim of this study was to assess the effect of coronary collateral circulation on left ventricular systolic function in coronary artery disease. Methods Seventy-one consecutive patients having left anterior descending arteries with proximal or near-proximal stenosis of at least 95% (excluding 100%) were included in the study. The coronary collateral circulation to left anterior descending artery was evaluated with regard to its effects on left ventricular systolic function. Results Among the 71 patients, 46 patients were found to have a coronary collateral circulation grade of >= 1 (group 1), whereas the remaining 25 patients had coronary collateral circulation grade of 0 (group 2). The mean value of left ventricular function score in group 1 was higher than that of group 2 (3.69 +/- 2.34 vs. 2.00 +/- 1.55, P= 0.002), whereas the mean value of left ventricular ejection fraction in group 1 was lower than that of group 2 (44.67 +/- 12.05 vs. 54.32 +/- 10.22, P=0.001). The value of coronary collateral circulation grade was found to be positively correlated with the value of left ventricular function score (P= 0.01, r= 0.3), and negatively correlated with the value of left ventricular ejection fraction (P= 0.01, r= - 0.3). Conclusion Coronary collateral circulation to the severely stenotic left anterior descending artery was not found to have an improving effect on left ventricular systolic function. In contrast with the previous studies demonstrating the coronary collateral circulation-associated preservation of left ventricular systolic function, presence of coronary collateral circulation was found to accompany or be associated with impairment of left ventricular systolic function. The grade of coronary collateral circulation was also found to be positively correlated with the severity of left ventricular systolic dysfunction. Further research on larger patient populations based on a long-term follow-up is warranted to investigate this issue. Coron Artery Dis 18:169-173 (C) 2007 Lippincott Williams & Wilkins.Öğe Evaluation of the patients' level of knowledge about diagnostic and therapeutic procedures in cardiology(Turkish Soc Cardiology, 2006) Yilmaz, Mehmet Birhan; Turgut, Okan Onur; Yilmaz, Ahmet; Karadas, Filiz; Ozyol, Ali; Kendirlioglu, Omer; Bektasoglu, GokhanObjectives: It is sometimes observed that informing patients about cardiovascular procedures is not taken into appropriate consideration. In this study, we assessed the patients' level of knowledge obtained through informing regarding the procedures performed in cardiology. Study design: A 22-item questionnaire was developed to measure the knowledge of patients about cardiovascular procedures. After validation in a group of 10 volunteer patients, the questionnaire was administered to 200 participants (115 males, mean age 53 years; 85 females, mean age 49 years). The patients were inquired about their knowledge of electrocardiography (ECG), Holter, exercise stress test, echocardiography, coronary angiography (CAG), percutaneous coronary interventions (PCI), electrophysiological study, and pacemaker implantation. Results: Of the participants, 33% had hypertension, 7.5% had diabetes mellitus, and 23% had coronary artery disease. Although the majority of the patients (n=159, 79.5%) had a prior electrocardiogram, only 7% (n=14) responded that it gave information about coronary artery disease. Eighty-six percent (n=172) of the participants did not know what Holter was. According to 44%, CAG was performed for visualization, and to 37%, for patency of the coronary arteries. Concerning the PCI procedure, 42% stated that they did not know how it was carried out, and 35% stated that the balloon was blown up during the procedure. Conclusion: Furnishing patients with necessary information about cardiovascular procedures is important for improved health of individuals and the society at large, and there seems to be a considerable gap in this respect.Öğe Evaluation of tumor markers CA-125 and CEA in acute myocardial infarction(HEALTH COMMUNICATIONS INC, 2006) Yalta, Kenan; Yilmaz, Ahmet; Turgut, Okan Onur; Erselcan, Taner; Yilmaz, Mehmet Birhan; Karadas, Filiz; Yontar, Can; Tandogan, IzzetSerum carbohydrate antigen (CA-125) and carcinoembryonic antigen (CEA) have always been of clinical importance in the diagnosis and follow-up of various tumors. This study was devised to investigate the relationship between these tumor markers and acute myocardial infarction (MI). Seventy consecutive cases (59 male patients with a diagnosis of acute ST segment elevation MI and 11 male patients with a diagnosis of non-ST segment elevation Ml; mean age, 57 +/- 8.2 y) were admitted to the University Medical Center and were included in this study as "the patient group." All patients in the patient group underwent transthoracic echocardiographic examination on the third day of hospitalization. On the basis of echocardiographic findings, these 70 patients were grouped according to left ventricular ejection fraction (EF) values; EF < 55% (group 1) (n=40) and EF >= 55% (group 2) (n=30). Other parameters, including systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP), were also measured on transthoracic echocardiography. Serial blood samples (for follow-up of myocardial enzymes (eg, creatine kinase MB [CKMB], troponin I [Tnl], troponin T, and other routine parameters) were drawn from each patient. Serum concentrations of CEA and CA-125 measured at the 72nd hour of hospitalization and peak serum concentrations of CKMB and Tnl in the patient group were collected for comparison between subgroups (groups 1 and 2) and with "the control group," which included 30 subjects (mean age, 54 +/- 7.6 y) with no history or evidence of overt cardiac disease and with normal echocardiographic findings. The presence of any condition characterized by potential elevations in CA-125, CEA, and myocardial enzymes (CKMB, Tnl) was considered an exclusion criterion. Patients included in patient groups 1 and 2 differed significantly in terms of mean EF, mean sPAP, mean mPAP, and mean CA-125 values (P <.001 for CA-125; P <.05 for the other values). EF was found to be negatively correlated with sPAP (r=-0.692, P=.000) and mPAP (r=-0.393, P=.001). EF was also negatively correlated with CA-125 (r=-0.557, P=.000). A positive correlation was noted between CA-125 and sPAP (r=0.396, P=.001) and between CA-125 and mPAP (r=0.754, P=.000). A statistically significant difference was identified between the patient and control groups with regard to values for EF, PAP, CA-125, and myocardial enzymes (CKMB and Tnl) (P <.05 for mPAP; P <.001 for the other values). The serum concentration of CA-125, but not of CEA, may be elevated in those with acute MI compared with normal subjects. Regardless of the presence of pulmonary hypertension, elevations in CA-125 during myocardial infarction were significantly correlated with the severity of left ventricular systolic dysfunction on transthoracic echocardiography.Öğe gamma-Glutamyltransferase is a promising biomarker for cardiovascular risk(CHURCHILL LIVINGSTONE, 2006) Turgut, Okan; Yilmaz, Ahmet; Yalta, Kenan; Karadas, Filiz; Yilmaz, M. BirlianOxidative stress plays a crucial rote in a variety of clinical settings of atherogenesis, and mediates many pathways linked to atherosclerosis and inflammation. gamma-Glutamyttransferase (GGT), an enzyme responsible for the extracellular catabolism of antioxidant glutathione, may directly take part in atherogenesis and evolve as a potential biochemical risk indicator of cardiovascular morbidity and mortality. Classically, GGT has been thought of as a diagnostic tool for hepatobiliary disorders and alcohol abuse. More recently, growing body of data points out that serum GGT levels can aid detection of individuals at high risk for subsequent cardiovascular events, and thus have an application in primary and secondary prevention of cardiovascular disease. Although several investigations have shown that some drugs are effective in decreasing both serum lipids and GGT, and concomitantly the incidence of subsequent cardiovascular events; large-scale randomized trials are required to explore this impact directly. Based on current experimental and epidemiological studies, we postulate here that GGT present in the serum, even within its laboratory reference intervals regarded as physiologically normal, is a promising biomarker for cardiovascular risk. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Left ventricular outflow tract myxoma accompanied by dextrocardia with situs inversus: a case report(SPRINGER, 2007) Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Yilmaz, Mehmet Birhan; Ozyol, Ali; Karadas, Filiz; Tandogan, IzzetMyxoma is the most frequently encountered primary tumour of the heart, comprising more than 50% of all benign cardiac tumours. The case presented here was diagnosed as having dextrocardia with situs inversus and concomitant left ventricular outflow tract myxoma which has been very rarely encountered, particularly consistent with the scarcity of reported cases.Öğe Levosimendan improves renal function in patients with acute decompensated heart failure: Comparison with dobutamine(SPRINGER, 2007) Yilmaz, Mehmet Birhan; Yalta, Kenan; Yontar, Can; Karadas, Filiz; Erdem, Alim; Turgut, Okan Onur; Yilmaz, Ahmet; Tandogan, IzzetBackground Levosimendan is a relatively new cardiac inotropic agent with calcium sensitizing activity. This study was conducted to investigate the effects of levosimendan (L) and dobutamine (D) on renal function in patients hospitalized with decompensated heart failure (HF). Method The present study included 88 consecutive patients hospitalized with acutely decompensated HF (New York Heart Association (NYHA) Class 3-4) requiring inotropic therapy. Patients were randomized 2:1 to either L or D for intravenous inotropic support. Diuretic therapy was kept constant during infusions. Renal function values, including serum creatinine (CR), blood urea nitrogen, 24-h urinary output levels and calculated glomerular filtration rate (GFR) were measured just prior to and 24 h after the infusions in all patients, and 48 and 72 h after the infusions in every second patient in both groups. The pre and post-infusion values of renal function and left ventricular ejection fraction (LVEF) were evaluated. Results LVEF increased significantly in both groups. Those in L showed a significant improvement in calculated GFR after 24 h, whereas those in D showed no significant change (median in change in L:+15.3%, median change in D: -1.33%). Furthermore, in the L group a significant improvement was observed in calculated GFR after 72 h compared to baseline levels, whereas in D no significant change (median change in L:+45.45%, median change in D: +0.09%) was seen. Both agents improved 24-h urinary output. Conclusion Levosimendan seems to provide beneficial effects in terms of improvement in renal function compared to dobutamine in patients with heart failure who require inotropic therapy.Öğe Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?(SPRINGER, 2007) Turgut, Okan; Yilmaz, Ahmet; Yalta, Kenan; Yilmaz, Birhan M.; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, IzzetObjective To investigate the relationship between coronary tortuosity and impaired left ventricular relaxation. Methods One hundred and four subjects who underwent coronary angiography were included in the study. Left anterior descending, left circumflex, and right coronary arteries were traced. Tortuosity was identified by the finding of >= 3 bends (defined as >= 45 degrees change in vessel direction) along main trunk of at least one artery. Study population were divided into tortuosity (n = 54) and no tortuosity (n = 50) groups. Subjects were all submitted to pulsed-wave Doppler and two-dimensional echocardiographic examination to assess left ventricular functions. Results For subjects with tortuosity, early transmitral inflow (E) velocity was lower, late transmitral inflow (A) velocity was higher, E/A ratio was smaller compared with subjects without tortuosity (P < 0.001). Subjects with tortuosity had longer deceleration time of E velocity (DT) and isovolumic relaxation time (IVRT) than did subjects without tortuosity (P < 0.001). End-diastolic interventricular septal and left ventricular posterior wall thicknesses were greater in subjects with tortuosity than those without tortuosity (P = 0.01 and P = 0.005). There was an inverse correlation between total number of arteries with tortuosity and E/A ratio (r = -0.750, P < 0.001). Total number of arteries with tortuosity displayed correlations with DT (r = 0.723, P < 0.001) and IVRT (r = 0.703, P < 0.001). Conclusions This study depicts that coronary tortuosity is associated with impaired left ventricular relaxation.Thus, coronary tortuosity might be an indicator of impaired left ventricular relaxation.
