Muhsin Turkmen

Medipol University, İstanbul, Istanbul, Turkey

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Publications (33)70.99 Total impact

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    ABSTRACT: PurposeTransesophageal echocardiography (TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe.Methods Fifty-eight patients undergoing atrial fibrillation (AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n = 35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n = 23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra-oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared.ResultsOdynophagia frequency was significantly higher in Group 1 (25.7% [n = 9] vs. 0%, P = 0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n = 2] vs. 0%, P = 0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3–1] vs. 1, [1–1], P = 0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.4 ± 1.8 min vs. 3.6 ± 0.9 min, P < 0.001). Midazolam dose was lower in Group 2 (7.0 ± 1.7 vs. 6.2 ± 1.7, P = 0.065).Conclusion Using TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE-associated complication rates and enhanced patient comfort without any negative effect on procedural success.
    Echocardiography 11/2014; · 1.26 Impact Factor
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    ABSTRACT: Pseudoaneurysm of the aortic root is a rare condition and potentially fatal if not treated. It may occur in different etiologies. In this case, we aim to show an aortic pseudoaneurysm arising from the aorta-saphenous vein graft anastomosis.
    Heart Surgery Forum 10/2013; 16(5):E264-5. · 0.56 Impact Factor
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    ABSTRACT: Cilostazol is a pde3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure METHODS: Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI) and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. After cilostazol administration, there were significant increases in the TAPSE (1.9±0.3cm vs. 2.2±0.3cm, p<0.001). Peak longitudinal strain (-18.7±4.5% vs. -21.3 ±3.7 %, p=0.001), isovolumetric acceleration (IVA) (176.6±62.7 cm/sec(2) vs.200.6±61.9cm/sec(2) , p=0.025), right ventricular FAC increased significantly (37.6 ± 8.0% vs 41.5±8.9%, p<0.001). Pulmonary artery pressure decreased significantly (39.9±7.9 vs. 36.6±5.5mmHg, p=0.001) after cilostazol administration. Our study demonstrated that cilostazol improved right ventricular systolic function and reduced pulmonary artery pressure. This article is protected by copyright. All rights reserved.
    Cardiovascular Therapeutics 08/2013; · 2.85 Impact Factor
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    ABSTRACT: Primary percutaneous coronary intervention (P-PCI) is the gold standard treatment for acute coronary syndromes. Plasma levels of catecholamines and other vasopressors are elevated during acute myocardial infarction (AMI) and coronary vasoconstriction is frequent. We aimed to compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after an average of 3 days. Coronary angiography (CAG) was performed on 58 patients with acute ST-segment elevation myocardial infarction (STEMI) and TIMI 3 flow after P-PCI (43 men, 15 women; mean age, 55.5 ± 10 years). TIMI 3 flow was achieved either by simple balloon dilatation and/or thrombus aspiration. Lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis were compared during P-PCI and follow-up CAG. RVD, MLD, and meanD values were significantly higher during the follow-up CAG than after P-PCI (RVD 2.7 ± 0.7 mm vs. 2.9 ± 0.7 mm, p = 0.001; MLD 1.5 ± 0.5 mm vs. 1.7 ± 0.4 mm, p = 0.002; meanD 2.2 ± 0.5 mm vs. 2.4 ± 0.5 mm, p = 0.001). Area of stenosis values were significantly lower during the follow-up CAG than after primary PCI (69.5 ± 16.5 % vs. 62.1 ± 15 %, p = 0.001). Lesion lengths were not statistically significant during the follow-up CAG and primary PCI (lesion length 24.0 ± 10.8 mm vs. 22.1 ± 8.8 mm, p > 0.05). This study showed that RVD was higher at the follow-up CAG a few days after AMI in patients who had TIMI 3 flow after P-PCI with simple balloon dilatation and/or thrombus aspiration. A delay of a few days for stent implantation in P-PCI allows for larger-diameter stent use and may help to reduce stent thrombosis and restenosis rates.
    Herz 07/2013; · 0.78 Impact Factor
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    ABSTRACT: The authors investigated the prognostic relevance of serum carbohydrate antigen 125 (CA125) levels in nonischemic dilated cardiomyopathy (NICMP) and assessed whether increased levels relate to the degree of functional mitral regurgitation (FMR). Seventy-seven patients with NICMP were enrolled and followed-up for 10 ± 2 months in this prospective study. Receiver-operating characteristic analysis established a cutoff CA125 value of 25 U/mL for predicting mortality. Patients were divided into two groups according to their CA125 levels (CA125 <25 U/mL [n=58] and CA125 ≥ 25 U/mL [n=19]). Patients with high CA125 values had statistically worse functional status, higher B-type natriuretic peptide (BNP) levels, higher left ventricular volumes, lower ejection fraction, higher E/Em ratio, higher pulmonary artery systolic pressure, and more severe FMR. On the multivariate analysis, serum CA125 (P=.002) and severe FMR (P=.04) were identified as the independent predictors of mortality. Serum CA125 levels also correlated with BNP levels and FMR severity (P<.001). Serum CA125 is a powerful prognostic biomarker that is associated with the severity of heart failure, serum BNP levels and several echocardiographic parameters including left ventricular volumes, systolic and diastolic functions, pulmonary artery pressure, and the degree of FMR. Serum CA125 was also shown as an independent predictor of mortality during 10 ± 2 months of follow-up.
    Congestive Heart Failure 05/2012; 18(3):144-50.
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    ABSTRACT: It has long been speculated that mobile phones may interact with the cardiac devices and thereby cardiovascular system may be a potential target for the electromagnetic fields emitted by the mobile phones. Therefore, the present study was designed to test possible effects of radiofrequency waves emitted by digital mobile phones on cardiac autonomic modulation by short-time heart rate variability (HRV) analysis. A total of 20 healthy young subjects were included to the study. All participants were rested in supine position at least for 15 minutes on a comfortable bed, and then time and frequency domain HRV parameters were recorded at baseline in supine position for 5 minutes. After completion of baseline records, by using a mobile GSM (Global System for Mobile Communication) phone, HRV parameters were recorded at turned off mode, at turned on mode, and at calling mode over 5 minutes periods for each stage. Neither time nor frequency domain HRV parameters altered significantly during off mode compare to their baseline values. Also, neither time nor frequency domain HRV parameters altered significantly during turned on and calling mode compared to their baseline values. Short-time exposure to electromagnetic fields emitted by mobile phone does not affect cardiac autonomic modulation in healthy subjects.
    Pacing and Clinical Electrophysiology 07/2011; 34(11):1511-4. · 1.75 Impact Factor
  • International Journal of Cardiology 03/2011; 147. · 6.18 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ≥0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 ≤ FFR ≤ 0.85 and CTFC > 28 (n=22), group B: 0.75 ≤ FFR ≤ 0.85 and CTFC ≤ 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC ≤ 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 ≤ FFR ≤ 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests.
    Journal of Interventional Cardiology 10/2010; 23(5):421-8. · 1.50 Impact Factor
  • International Journal of Cardiology 04/2010; 140. · 6.18 Impact Factor
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    ABSTRACT: Several previous studies suggest that myocardial bridging (MB) is associated with ischemia and rhythm disturbances. We sought to examine exercise-induced changes in P wave duration and dispersion (PWD), the markers of atrial conduction abnormalities in patients with isolated MB of left anterior descending artery (LAD) and control subjects. Eighteen patients with MB of LAD (group-I) and 22 subjects with angiographically demonstrated normal coronary arteries (group-II) underwent treadmill exercise testing. Before and after exercise ECG was recorded at a paper speed of 50 mm/s. The change in maximum and minimum P wave duration was measured manually and difference between two values was defined as PWD. There was no difference between two groups in terms of demographic properties. Baseline maximum and minimum P wave duration and PWD durations were similar in both groups and they did not change after exercise. (Group-I: before and after test; 114 +/- 10 vs. 114 +/- 9, 66 +/- 13 vs. 67 +/- 10, and 47 +/- 9 vs. 45 +/- 13 ms, P > 0.05, group-II; 113 +/- 9 vs. 115 +/- 8, 68 +/- 11 vs. 68 +/- 11, 45 +/- 11 vs. 48 +/- 15 ms for each, respectively). In addition there was no significant correlation between PWD and P wave duration and echocardiographic variables. In patients with MB of LAD, PWD and P wave duration were not different than healthy subjects and treadmill exercise testing did not induce atrial conduction abnormalities in both groups.
    The international journal of cardiovascular imaging 02/2009; 25(5):465-70. · 2.15 Impact Factor
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    ABSTRACT: The authors sought to determine left ventricular functions by conventional and tissue Doppler imaging in patients with isolated coronary artery ectasia and controls. Peak early (E) and late (A) mitral inflow velocity, E/A ratio, E deceleration time, and isovolumetric relaxation time were obtained. Peak systolic velocity (Sm), diastolic early (Em), and late (Am) velocities were measured by tissue Doppler imaging. Interventricular septum velocities, including peak systolic (Ss), diastolic early (Es), and late (As) velocities, were recorded. Peak early (E) velocity, E/A ratio, and E deceleration time were different in both groups. Isovolumetric relaxation time was prolonged in patients with coronary artery ectasia than controls. Em and Em/Am ratio were lower in patients with coronary artery ectasia than controls. Diastolic early and Es/As velocities were lower in patients with coronary artery ectasia compared with controls. The authors showed that mitral inflow-lateral annulus and interventricular septum velocities were lower in patients with coronary artery ectasia than controls indicating left ventricular diastolic dysfunction.
    Angiology 05/2008; 59(3):306-11. · 2.37 Impact Factor
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    ABSTRACT: Acute effects of smoking on left and right ventricular function is determined by conventional and tissue Doppler imaging methods in this study. Pulsed-wave Doppler indices of the left and right ventricle diastolic function, including mitral and tricuspid inflow peak early and late velocity and their ratio were obtained from 20 healthy subjects by conventional Doppler and tissue Doppler imaging. Echocardiographic indices of left and right ventricles, including isovolumetric relaxation time, deceleration time, isovolumetric contraction time, ejection time, and myocardial performance index of right ventricle were measured before and 30 minutes after smoking a cigarette. Mitral and tricuspid inflow parameters and right ventricular myocardial performance index significantly altered after smoking a cigarette. Among the tissue Doppler imaging parameters, mitral and tricuspid lateral annulus diastolic, but not systolic, velocities altered after smoking a cigarette. Acute cigarette smoking alters left and right ventricular diastolic functions in healthy nonsmokers.
    Angiology 05/2008; 59(3):312-6. · 2.37 Impact Factor
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    ABSTRACT: Coronary artery ectasia (CAE) is frequently considered as a form of coronary artery disease. Cardiovascular risk factors were determined in a patient population with CAE. The 51 patients with isolated CAE (group 1), 61 patients with CAE coexisting with significant coronary stenosis (group 2), and 62 subjects with significant coronary stenosis (group 3) were included in the study, and the distribution of cardiovascular risk factors was compared. Thirty of 51 patients with isolated CAE had presented with typical angina pectoris, 8 patients with unstable angina pectoris, and 13 patients had atypical chest pain or palpitation. The 21 of 51 patients with isolated CAE had definitive positive treadmill exercise test results. Positive family history was similar in each group. The history of smoking was similar in group 1 and group 2 but higher than group 3. Frequency of hypertension was similar in group 1 and group 2 but higher than that in group 3. Frequency of diabetes mellitus was similar in group 1 and group 2 but lower than group 3. Plasma lipid levels and the number of patients with lipid disturbances were also similar in each group. In addition, C-reactive protein (CRP) levels were above the normal limits and there was no difference among groups with respect to plasma CRP levels. CAE appears to be associated with traditional cardiovascular risk factors such as hypertension, smoking, and hyperlipidemia. In addition, elevated CRP level in patients with CAE may suggest the role of inflammatory process in development of CAE.
    Angiology 01/2008; 58(6):698-703. · 2.37 Impact Factor
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    ABSTRACT: Acute cigarette smoking enhances adrenergic activity and thus may be associated with hemodynamic changes in the cardiovascular system. In this study, the acute effect of cigarette smoking on heart rate variability (HRV) was studied. Fifteen subjects were included in the study. Time domain (the mean R-R interval, the standard deviation of R-R interval, and the root mean square of successive R-R interval differences) and frequency domain (high-frequency, low-frequency ratio, and low-frequency/high-frequency ratio) parameters of HRV were obtained from all participants for each 5-minute segment: 5 minutes before and 5, 10, 15, 20, 25, and 30 minutes after smoking a cigarette. The mean R-R interval, the standard deviation of R-R interval, and the root mean square of successive R-R interval differences significantly decreased within the first 5-minute period compared with baseline, and then the standard deviation of R-R interval increased within the 20- to 30-minute period. The low-frequency high-frequency ratio significantly decreased within the first 5 minutes after smoking and then remained unchanged throughout the study period. Similarly, low-frequency and high-frequency power increased within the first 5 minutes compared with baseline. Acute cigarette smoking alters HRV parameters, particularly within the first 5 to 10 minutes after smoking.
    Angiology 09/2007; 58(5):620-4. · 2.37 Impact Factor
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    ABSTRACT: The slow coronary flow (SCF) phenomenon is often considered to be an incidental angiographic finding; however, several reports have shown it to be associated with cardiac events. In this study we aimed to assess P-wave duration and dispersion (PWD) in patients with SCF and to compare it with that of healthy subjects. Thus, 40 patients with angiographically proven SCF and otherwise normal coronary arteries (group 1) and 36 sex-age-matched healthy subjects (group 2) were included in this study. A 12-lead surface ECG, recorded at a paper speed of 50-mm/s and 2 mV/cm standardization, was obtained from each subject. P-wave duration was measured manually by use of a caliper. The difference between the maximum (Pmax) and minimum P (Pmin)-wave duration was calculated and defined as PWD. All subjects had undergone echocardiographic examination to exclude valvular disorders and wall motion abnormalities. There was no significant difference between the 2 groups in demographies of age, sex, heart rate, or blood pressure. Maximum P-wave duration and PWD were significantly higher in group 1 than in group 2 (120 +/-7 vs 115 +/-5, p = 0.003; 44 +/-12 vs 38 +/-9, p = 0.01, respectively). However, there was no significant difference in Pmin duration (75 +/-9 vs 78 +/-7, p = 0.4). In conclusion; SCF and otherwise normal epicardial coronary artery was found to be associated with prolonged P-wave duration and increased PWD. This may result from microvascular ischemia and/or altered autonomic control of cardiovascular system observed in this group of patients.
    Angiology 09/2007; 58(4):408-12. · 2.37 Impact Factor
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    ABSTRACT: Myocardial bridging (MB) is a congenital anomaly of coronary arteries and its functional significance remains controversial. Using the TIMI frame count (TFC) method, the authors investigated whether the coronary blood flow velocity is decreased in MB. The study included 18 patients (group 1; 12 men and 6 women; mean age 50 +/-6 years) who had angiographically proven MB and otherwise normal coronary arteries and 20 subjects (group 2; 13 men and 7 women; mean age 50 +/-7 years) with normal-appearing coronary arteriograms. TFC of each group was determined and correlation between TFC and various factors including percent systolic narrowing, age, gender, body mass index, blood pressure, and echocardiographic parameters (ejection fraction, left-right ventricle wall thickness, and diameters) was investigated. Baseline characteristics were similar in the groups. All of the MB was localized to the left anterior descending (LAD) artery. Corrected TFC(LAD) frame count (CTFC) was significantly higher in group 1 than in group 2 (24.7 +/-2.1 vs 22.1 +/-1.9 frames/s, p = 0.001). Circumflex and right coronary artery frames counts were similar in the groups (22.4 +/-2.4 vs 21.3 +/-2.3 frames/s, p = 0.18, 23.1 +/-2.2 vs 23.4 +/-2.1 frames/s, p = 0.7) On correlation analysis, there was no correlation between TFC and the factors investigated. CTFC of patients with MB was higher than of those with normal coronary arteries, irrespective of the degree of systolic narrowing. This may suggest that coronary blood flow is decreased in patients with MB compared to patients having normal coronary arteries.
    Angiology 06/2007; 58(3):283-8. · 2.37 Impact Factor
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    ABSTRACT: Results of experimental and clinical studies suggest that both coronary artery disease (CAD) itself and its traditional risk factors lead to endothelial dysfunction. The aim of the present study was to determine which CAD risk factors sustain their contribution to endothelial dysfunction despite the presence of established CAD. The study group comprised 150 patients with CAD. Using a high-resolution ultrasound, the diameter of the brachial artery at rest and during reactive hyperemia (flow-mediated dilatation, FMD%: endothelial-dependent stimulus to vasodilatation), as well as after sublingual administration of nitroglycerin (NTG%: endothelium-independent vasodilatation), was measured. The relationship between FMD% and coronary risk factors [diabetes mellitus (DM), total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, age, family history of premature atherosclerosis, smoking, hypertension (HT), body mass index (BMI)] was investigated. In univariate analysis there was an inverse relationship between FMD% and age (r=-0.300, p<0.001), and BMI (r=-0.230, p<0.005) and FMD% was significantly lower in diabetic patients when compared to non-diabetic patients (p<0.001). In stepwise multivariate regression analysis; FMD still correlated with DM and advanced age, but not with BMI (beta=0.065, p<0.001, beta=-0.001 p=0.002, beta=-0.087, p<0.284, respectively). FMD% was found to be not associated with hypercholesterolemia, family history of premature atherosclerosis, HT and smoking. Only aging and DM were independently associated with endothelial dysfunction in patients with established CAD.
    Circulation Journal 05/2007; 71(5):698-702. · 3.69 Impact Factor
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    ABSTRACT: Isolated coronary ectatic but otherwise normal epicardial coronary arteries are an infrequent angiographic finding. We sought to determine whether coronary artery ectasia (CAE) may alter QT-interval duration and dispersion. The study population consisted of 24 patients with isolated CAE and otherwise normal epicardial coronary arteries (group 1) and sex- and age-matched subjects with atypical chest pain and otherwise normal coronary flow (group 2). Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distribution of sex, age, body mass index, and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 +/- 10 vs 70 +/- 7, P > .05). In group 1, QTd, QTcd, and QTc were significantly higher than those of group 2 (QTd, 40 +/- 17 vs 29 +/- 10 milliseconds [P < .05]; QTcd, 43 +/- 19 vs 30 +/- 10 milliseconds [P < .05]; QTc, 410 +/- 21 vs 397 +/- 19 milliseconds [P < .05]). In conclusion, CAE was found to be associated with prolonged QT interval and increased QTd. Microvascular dysfunction and/or ischemia may be responsible mechanisms.
    Journal of electrocardiology 04/2007; 40(2):203-6. · 1.36 Impact Factor
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    ABSTRACT: The aim of this study was to compare left atrial appendage (LAA) functions by Doppler tissue imaging (DTI) before and after percutaneous balloon mitral valvuloplasty (PBMV). Twenty patients with symptomatic rheumatic mitral stenosis who underwent PBMV were included in this study. LAA functions were measured before and after PBMV. To determine LAA functions, LAA late filling (LAALF) velocity, LAA late emptying (LAALE) velocity, and area change of LAA percent were measured. In the DTI records, the first positive wave identical to the LAALE wave after the P wave was accepted as LAA late systolic wave, and the second negative wave identical to the LAALF flow was accepted as late diastolic wave. There was no difference in LAALF velocity and area change of LAA percent after PBMV. LAALE velocity increased after PBMV compared with baseline (P = .005). Late emptying, systolic, and diastolic wave values measured by DTI were found to be increased after PBMV compared with baseline (P = .023, P = .002, and P = .002, respectively). LAALE velocity measured by standard Doppler was increased after PBMV compared with baseline (P = .005), but there was no change in area change of LAA percent or LAALF. Spontaneous echocontrast was present in 7 of the 20 patients before procedure. It completely disappeared (4 patients) or decreased (3 patients) after procedure. In patients with spontaneous echocontrast, LAALE and late emptying, systolic, and diastolic wave values measured by DTI were found to be increased after PBMV compared with baseline. Our results suggest that PBMV improves LAA functions and, thereby, may have a favorable influence on future thromboembolic complications.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 05/2006; 19(4):434-7. · 2.98 Impact Factor

Publication Stats

268 Citations
70.99 Total Impact Points

Institutions

  • 2014
    • Medipol University
      İstanbul, Istanbul, Turkey
  • 2013
    • Lutfi Kirdar Kartal Education and Research Hospital
      İstanbul, Istanbul, Turkey
  • 2004–2013
    • Koşuyolu Kalp ve Araştırma Hastanesi
      İstanbul, Istanbul, Turkey