Izzet Erdinler

Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Istanbul, Turkey

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Publications (53)74.99 Total impact

  • Journal of cardiology. 06/2014;
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    ABSTRACT: Objectives: The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) in cardiovascular diseases has been shown. Ascending aortic dilatation (AAD) is a common cardiovascular disease and is associated with aortic wall inflammation and cystic degeneration. In this study, we aimed to investigate the relationship between serum levels of RDW, NLR and the presence of AAD. Study design: Two-hundred consecutive patients with AAD diagnosed by transthoracic echocardiography were prospectively recruited and were compared to 170 age-gender- matched subjects with normal aortic diameters. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW and NLR counts, as well as mean corpuscular volume (MCV). If possible, results of CBC tests within the previous two years were also included and the averages were used. Results: RDW [median 13.9, interquartile range (IQR) 1.40 vs. median 13.3, IQR 1.05%, p=0.01], NLR (median 2.04, IQR 1.09 vs. median 1.78, IQR 0.90, p=0.01) and high-sensitive C-reactive protein (hs-CRP) (median 0.60, IQR 0.80 vs. median 0.44, IQR 0.68 mg/L, p=0.01) levels were significantly higher in the AAD group compared to the control group. In univariate correlation analysis, ascending aortic diameters were correlated with RDW levels (r=0.31, p=0.01), NLR levels (r=0.15, p=0.01) and hs-CRP levels (r=0.12, p=0.03). In multivariate logistic regression analysis, increased levels of RDW and hs-CRP remained as the independent correlates of AAD in the study population. Receiver operating characteristic (ROC) curve analysis revealed that a RDW measurement higher than >13.8% predicted AAD with a sensitivity of 49.5% and a specificity of 82.8% (area under the curve [AUC] 0.681, p=0.01). Conclusion: In patients with AAD, RDW and hs-CRP levels are increased, which may indicate the role of inflammation in the pathogenesis of AAD.
    Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 04/2014; 42(3):227-35.
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    ABSTRACT: The interval between the peak and the end of the T wave (Tp-e interval) on 12-lead ECG is a measure of transmural dispersion of repolarization and may be related to malignant ventricular arrhythmias. The objective of this study was to investigate whether the Tp-e interval predicts in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (pPCI). This study included 488 consecutive patients with STEMI treated with pPCI. Electrocardiograms were obtained after pPCI and the Tp-e interval was measured in leads without ST-segment elevation. There were 46 (9.4%) deaths in the population, with a mean follow-up time of 21.1±10.2 months. The Tp-e interval was associated with not only in-hospital ventricular tachycardia/fibrillation, target vessel revascularization, and death but also long-term target vessel revascularization and death. Furthermore, the Tp-e interval measured using the tail method was found to be a significant predictor of long-term mortality in multivariable Cox analyses [odds ratio 1.018, 95% confidence interval (1.004-1.033)]. Findings were similar in the Tp-e interval and the heart rate-corrected Tp-e interval (cTp-e). Tp-e and cTp-e measured using the tail method were found to be predictors of both in-hospital and long-term mortality.
    Coronary artery disease 03/2014; · 1.56 Impact Factor
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    ABSTRACT: Alzheimer's disease (AD) is closely linked to cardiovascular risk factors.
    Clinical Interventions in Aging 01/2014; 9:1115-21. · 2.65 Impact Factor
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    ABSTRACT: Background In patients with acute ST elevation myocardial infarction (STEMI), QRS fragmentation was determined as one of the indicators of mortality and morbidity. The development of fragmented QRS (fQRS) is related to defects in the ventricular conduction system and is linked to myocardial scar and fibrosis. Material and Methods We prospectively enrolled 355 consecutive patients hospitalized in the coronary intensive care unit of our hospital with STEMI between the years 2010 and 2012 and their electrocardiographic features and the frequency of in-hospital cardiac events were evaluated. Results There were 217 cases in the fQRS group and 118 cases in the control group. QRS fragmentation was found to be a predictor for major cardiac events. In the fragmented QRS group, the frequency of in-hospital major cardiac events (MACE) and death were higher (MACE p<0.001; death p<0.003). In the fragmented QRS group, the cardiac enzymes (Troponin-I, CK-MB) were significantly higher than in the control group (p<0.001). In subgroup analyses, apart from the presence of fragmentation, the presence of more than 1 type of fragmentation and the number of fragmented deviations were also found to be related with MACE. A significant negative correlation was observed with the ejection fraction and, in particular, the number of fragmented deviations. Conclusions Fragmented QRS has emerged as a practical and easily identifiable diagnostic tool for predicting in-hospital cardiac events in acute coronary syndromes. Patients who present with a fragmented QRS demonstrate increased rates of major cardiac events, death risk, and low ejection fraction. In patients with STEMI, the presence of fQRS on the ECG and number of fQRS derivations are a significant predictor of in-hospital major cardiac events.
    Medical science monitor: international medical journal of experimental and clinical research 01/2014; 20:913-919. · 1.22 Impact Factor
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    ABSTRACT: Resistin is a peptide hormone that is secreted from lipid cells and is linked to type-2 diabetes, obesity, and inflammation. Being an important adipocytokine, resistin was proven to play an important role in cardiovascular disease. We compared resistin levels in patients with and without atrial fibrillation (AF) to demonstrate the relationship between plasma resistin levels and AF. One hundred patients with AF and 58 control patients who were matched in terms of age, gender, and risk factors were included in the trial. Their clinical risk factors, biometric measurements, echocardiographic work up, biochemical parameters including resistin and high-sensitivity C-reactive protein (hs-CRP) levels were compared. In patients with AF, plasma resistin levels (7.34±1.63ng/mL vs 6.67±1.14ng/mL; p=0.003) and hs-CRP levels (3.01±1.54mg/L vs 2.16±1.28mg/L; p=0.001) were higher than control group. In subgroup analysis, resistin levels were significantly higher in patients with paroxysmal (7.59±1.57ng/mL; p=0.032) and persistent AF (7.73±1.60ng/mL; p=0.006), but not in patients with permanent AF subgroups (6.86±1.61ng/mL; p=0.92) compared to controls. However, hs-CRP levels were significantly higher only in permanent AF patients compared to control group (3.26±1.46mg/L vs 2.16±1.28mg/L; p=0.02). In multivariate regression analysis using model adjusted for age, gender, body mas index, hypertension, diabetes mellitus, and creatinine levels, plasma resistin levels [odds ratio (OR): 1.30; 95% confidence interval (CI): 1.01-1.70; p=0.04] and hs-CRP levels (OR: 1.44; 95% CI: 1.12-1.86; p=0.004) were the only independent predictors of AF. The elevated levels of plasma resistin were related to paroxysmal AF group and persistent AF group, but not to permanent AF group.
    Journal of Cardiology 11/2013; · 2.30 Impact Factor
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    ABSTRACT: Background: Concomitant thyroid and heart disease are frequently encountered in clinical practice. There are many studies evaluating thyroid function in acute and critical conditions. Information on thyroid dysfunction in ST-segment elevation myocardial infarction (STEMI) is limited; its correlation with short and long-term outcome is not fully known. Method: Four hundred and fifty seven patients diagnosed with STEMI in our emergency department were included in the study. Patients were divided into two groups: patients with normal thyroid function (euthyroid) and patients with thyroid dysfunction. STEMI was diagnosed with 12 derivation surface ECG. Thyroid hormone levels (TSH, free T3 and free T4) were measured. Patients with other acute coronary syndromes and endocrine pathologies except diabetes mellitus were excluded. Two patient groups were compared in terms of in-hospital and long-term outcome. Results: Out of 457, 72 patients (15%) with thyroid dysfunction were detected. The other patients were euthyroid and constituted the control group. In-hospital cardiogenic shock (15% vs 3% in the control group; p<0.01) and death (7% vs 1% in the control group; p<0.01) were more frequently observed in the thyroid dysfunction group. In the subgroup analysis, it was observed that patients with sick euthyroid syndrome have the poorest outcome. Other markers for poor outcome were anemia and renal failure. Conclusion: Thyroid dysfunction, particularly sick euthyroid syndrome, was found to be related to in-hospital and long term mortality in patients with STEMI undergoing primary percutaneous intervention.
    Cardiology journal 08/2013; · 1.15 Impact Factor
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    ABSTRACT: Red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) have been found to be associated with cardiovascular diseases. Only a few trials have investigated the correlation of these parameters with postoperative atrial fibrillation (AF). However, the correlation of these parameters in non-valvular AF is still unclear. We retrospectively analyzed consecutive AF patients from medical records and included 117 non-valvular AF patients (103 paroxysmal and 14 chronic AF). All subjects underwent physical examination and echocardiographic imaging. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW, neutrophil and lymphocyte counts as well as mean corpuscular volume. Results of CBC tests within the previous year were also included and the averages were used. The demographic and echocardiographic properties of non-valvular AF group were comparable to the control group except for left atrial volumes which were increased in AF (median 33.1, IQR 26.3-41.1 cm(3) vs. median 26.4, IQR 24.2-28.9 cm(3); p = 0.01). RDW levels were significantly higher in the AF group (median 13.4 %, IQR 12.9-14.1 %) compared to the control (median 12.6 %, IQR 12.0-13.1 %; p = 0.01). NLR was not statistically different in the AF group and the controls (2.04 ± 0.94 vs. 1.93 ± 0.64, respectively; p = 0.32). Hs-CRP levels were higher in the AF group compared to the controls (median 0.84, IQR 0.30-1.43 mg/L vs. median 0.29, IQR 0.18-0.50 mg/L, respectively; p = 0.01). Multivariate logistic regression analysis revealed RDW (OR 4.18, 95 % CI 2.15-8.15; p = 0.01), hs-CRP (OR 3.76, 95 % CI 1.43-9.89; p = 0.01) and left atrial volume (OR 1.31, 95 % CI 1.06-1.21; p = 0.01) as the independent markers of non-valvular AF. Multivariate linear regression analysis revealed that hemoglobin levels (standardized β coefficient = -0.252; p = 0.01) and the presence of AF (standardized β coefficient = 0.336; p = 0.01) were the independent correlates of RDW levels. Elevated RDW levels, not NLR, may be an independent risk marker for non-valvular AF.
    Journal of Thrombosis and Thrombolysis 07/2013; · 1.99 Impact Factor
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    ABSTRACT: BACKGROUND: Periprocedural management of antiplatelet or anticoagulant therapy at the time of device implantation remains controversial. METHODS: We reviewed all cases for whom a pacemaker was implanted in our institution between January 2008 and June 2009. In addition, beginning in June 2009, we prospectively collected data from all patients admitted to our institution, for whom a pacemaker was placed. Clinical characteristics and anticoagulant/antiplatelet drug use were evaluated. RESULTS: A total of 574 patients underwent a permanent pacemaker implantation. Of these, 20 patients (3.6%, 9 women) experienced a hematoma on pacemaker pocket site. Patients were aged between 35 and 79 years (mean 60.6±12 years). The frequency of hematoma formation was significantly higher (p<0.001) in those who used warfarin than in those who did not. Aspirin (ASA), clopidogrel, dual antiplatelet therapy (DAT), and bridging to low-molecular-weight heparin (LMWH) did not increase the risk of hematoma formation (p>0.05). Eleven pocket revisions for hematoma evacuation were needed in 9 patients (1.6%), six of whom were on warfarin therapy (p>0.05). Co-morbidities were similar in patients with and without hematoma (p>0.05). CONCLUSION: The frequency of hematoma is within acceptable ranges after pacemaker placement. The use of warfarin seriously increases the risk of hematoma. Bridging to LMWH safely prevents thromboembolism.
    Journal of Cardiology 04/2013; · 2.30 Impact Factor
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    ABSTRACT: To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation. We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (<70 years old) and elderly (≥70 years old) patients. Among 574 patients with a permanent pacemaker, 259 patients (45.1%) were below and 315 patients (54.9%) were above or at 70 years of age. There were 240 (92.7%) and 19 (7.3%) dual-chamber pacemaker (DDD) and single-chamber pacemaker (VVI) implanted patients in the younger group, and 291 (76.8%) and 73 (23.2%) DDD and VVI pacemaker implanted patients in the elderly group, respectively. The complication rate was 39 (15.1%) out of 259 young patients and 24 (7.6%) out of 315 elderly patients. Postprocedural complications were statistically lower in the elderly patients than in younger patients (P = 0.005). A pacemaker implantation performed by an experienced operator is a safe procedure for patients of advanced age. The patients who are above 70 years old may have less complication rates than the younger patients.
    Clinical Interventions in Aging 01/2013; 8:1051-4. · 2.65 Impact Factor
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    ABSTRACT: BACKGROUND: Cardiac device-related endocarditis (CDE) is a major complication of the implantation of a pacemaker and defibrillator. The experience in a single high-volume tertiary center is reported. METHODS: Thirty one years (1980-2011) of cases of CDE were analyzed retrospectively and compared to overall insertion data; the clinical course and management strategies of these patients have been reviewed. RESULTS: A total of 23 cases (16 male, median age 72 years) were identified, 20 of these cases were determined at our institution where 5287 procedures were performed (endocarditis rate 0.38%). Thirteen patients were determined to have a cardiac device pocket infection. Infection in 7 cases (30%) was caused by lead(s). However, in 16 cases (70%) both leads and the pocket of devices were the reason of infection. Median time was 13.5 months for presentation. Patients who had undergone the last procedure within 6 months were admitted earlier than those with longer post procedure time (p<0.05). Transesophageal echocardiography demonstrated lead vegetations in 13 of the 16 cases (81%). Organisms were identified in 18 cases (78%)-78% Staphylococci (56% Staphylococcus aureus). Leads of the device were removed in 17 cases (74%); seven cases by percutaneous simple traction and 10 cases by sternotomy. Six major complications attributable to device-related endocarditis were observed: four deaths (mortality 17.4%); one splenic abscess requiring splenectomy; and one septic pulmonary embolism; median follow-up 49 months. CONCLUSION: A CDE endocarditis rate of 0.38% was demonstrated. It remains a rare but potentially lethal complication of device implantation.
    Journal of Cardiology 11/2012; · 2.30 Impact Factor
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    ABSTRACT: Herein we describe 6 cases of patients with Alzheimer's disease presented with syncope, dizziness, and dyspnea soon after the initiation of cholinesterase inhibitor therapy. All patients had bradyarrhythmia on electrocardiogram (ECG). Two patients had complete atrioventricular block, 2 pateints had 2/1 type atrioventricular block, 1 patient had sinus bradycardia and hypersensitive carotid sinus syndrome, and 1 had sick sinus syndrome. All these patients were treated with pacemaker implantation and the cholinesterase inhibitor therapy continued. At 13-month follow-up, no syncope, dizziness, or dyspnea was reported.
    American Journal of Alzheimer s Disease and Other Dementias 08/2012; 27(5):311-4. · 1.52 Impact Factor
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    ABSTRACT: Hypothyroidism is a reversible cause of atrioventricular (AV) block. Few reports have described reversible AV block caused by hyperthyroidism. However, it is unknown whether patients with AV block are expected to have a benign course after the initiation of appropriate therapy for thyroid dysfunction. The study group consisted of patients with II or III degree AV block and bradyarrhythmia (≤40bpm) excluding patients with myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope. Thyroid dysfunction is diagnosed when thyroid stimulating hormone and thyroxine levels are not in defined normal ranges. AV block was determined by surface electrocardiogram (ECG). The cause and effect relation between AV block and thyroid dysfunction was evaluated. Of 668 patients, 29 (4.3%) had hypothyroidism (19 overt) and 21 (3.1%) had hyperthyroidism (8 overt). The most frequent ECG finding was complete AV block (27 of 50 patients). Ten patients had bradyarrhythmia and 13 had second-degree AV block. Euthyroid state was achieved in 10 hypothyroidic (34%) and in 7 hyperthyroidic patients (33%) with hormone replacement and antithyroid therapy, respectively, during the follow-up period (≤21 days). Thyroid dysfunction was found to be not related with AV block in 40 patients (80%). However, in 4 of 10 patients with AV block related to thyroid dysfunction the resolution of AV block occurred after the placement of pacemaker (>21 days). Overall, 44 of 50 (88%) patients with AV block in association with thyroid dysfunction were implanted with a permanent pacemaker. Of 6 patients who did not receive a pacemaker, 2 had complete AV block and 4 had bradyarrythmia. AV block associated with thyroid dysfunction needs great attention regardless of type of the thyroid disease. Patients with II and/or III degree AV block in the setting of thyroid dysfunction almost always need permanent pacemaker insertion even after normalization of thyroid status.
    Journal of Cardiology 06/2012; 60(4):327-32. · 2.30 Impact Factor
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    ABSTRACT: To identify the frequency of atrioventricular (AV) conduction improvement after discontinuation of the culprit drug in patients with AV block. AV blockers are considered as reversible causes of AV block that do not require pacemaker (PM) implantation. However, controversial reports declared that a major part of these drug-induced AV blocks are persistent or recurrent. Of 668 consecutive patients with symptomatic type II second- or third-degree AV block, 2:1 AV block, atrial fibrillation, and bradyarrhythmia, 108 patients (62 patients enrolled prospectively) using AV blockers without myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope were enrolled into the present study. The level of AV block (AV-nodal or infranodal) was defined according to electrocardiographic characteristics. The most frequent culprit medications were β-blockers followed by digoxin. Drug discontinuation was followed by resolution of AV block in 72% of cases, whereas spontaneous resolution of AV block occurred in only 6.6% of patients who had AV block in the absence of medications. However, 27% of patients with improved AV conduction experienced a recurrence of AV block despite discontinuation of the culprit drug. Twenty-one of 24 carvedilol-induced AV blocks resolved after discontinuation of the drug and never recurred, whereas 24 of 36 metoprolol-induced AV blocks persisted or recurred. A digoxin-induced AV block usually improved (28 of 39) after withdrawal of the drug. Roughly half of the patients with drug-induced AV block underwent permanent PM implantation. Drug-induced AV block is a serious disease that requires a permanent PM for almost half of the patients.
    Pacing and Clinical Electrophysiology 04/2012; 35(7):804-10. · 1.75 Impact Factor
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    ABSTRACT: To evaluate the safety of pacemaker implantation in patients with Alzheimer's disease (AD). We reviewed all cases admitted to our institution between January 2008 and June 2009, with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. Patients with a diagnosis of AD were included in the study. The risks and frequency of complications due to the pacemaker implantation were evaluated. Because of the older age of patients, they were divided into 2 groups to define the effect of age on complication rate. Group 1 consisted of patients aged <75 years, and group 2 consisted of those who are ≥75 years. Among the 574 patients with permanent pacemaker, 20 patients (3.4%) had a diagnosis of AD. Three patients with an AD experienced a complication and all were in group 2. However, the rate of complication was not significant within groups (P = 1.000). Reoperation was needed for all of them, and it was significantly higher in patients with AD than in patients without a concomitant disease (P = .006). Patients in group 2 had 3 times higher rate of complication (21.4%) than those without an AD and aged ≥75 years (7.1%; P = .125). Pacemaker implantation may be of risk in patients with AD, especially in those aged ≥75 years.
    American Journal of Alzheimer s Disease and Other Dementias 04/2012; 27(3):202-5. · 1.52 Impact Factor
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    ABSTRACT: Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angiography to assess their vascularity. A 64-year-old male patient presented with complaints of exertional dyspnea, fatigue, arthralgia, weight loss, intermittent high fever, and palpitation. He had an 18-month history of stent implantation for the left anterior descending coronary artery. Echocardiography showed a mobile mass in the left atrium with regular contours. Coronary angiography was performed with the initial diagnosis of myxoma and vascular supply of the tumor by the proximal branches of the right coronary artery (RCA) was visualized. Re-evaluation of previous angiograms of the patient showed existence of the same mass, in significantly smaller size, and supply from the RCA. The mass which was 5.5x1x0.5 cm in size was removed by surgical resection and the branches of the RCA supplying the tumor were ligated. Histopathologic examination confirmed the diagnosis. During 20 months of follow-up, the patient was asymptomatic and echocardiographic examinations were normal.
    Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2011; 39(2):163-5.
  • International Journal of Cardiology - INT J CARDIOL. 01/2011; 147.
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    ABSTRACT: Cardiac resynchronization therapy (CRT) increases cardiac performance and decreases morbidity and mortality in patients with heart failure. Mean platelet volume (MPV), a marker of platelet hyperreactivity, was found to be increased in both chronic heart failure and thromboembolic events. Systemic and pulmonary thromboembolism is a frequent complication of heart failure.The aim of this study is to determine the effects of cardiac resynchronization therapy on MPV values. Fifty-six heart failure patients with increased QRS duration underwent biventricular pacemaker implantation. Blood samples were collected the morning before implantation and at six months follow-up. Response criteria were: an increase in ejection fraction of more than 10% from baseline at six months or no hospitalization for major cardiac events during the first six months.The mean MPV values were decreased from 9.3 +/- 0.5 fl to 8.3 +/- 0.5 fl. Patients with recorded major cardiac events in the follow-up period had no statistically significant decrease in MPV values. In our study we found that cardiac resynchronization therapy leads to a decreased MPV and clinical improvement in patients with heart failure that is accompanied with a decrease in MPV.
    Acta cardiologica 01/2009; 63(6):735-9. · 0.61 Impact Factor
  • Baris Gungor, Ekrem Ucer, Izzet Celal Erdinler
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    ABSTRACT: Postcardiac injury syndrome (PCIS) is a common complication after cardiac surgery and myocardial infarction which is defined as a late developing pleuropericarditis accompanied by a friction rub, elevated inflammation markers and pericardial or pleural effusion. Although almost all of the cases follow a major cardiac operation or myocardial infarction, and are called as postpericardiotomy syndrome (PPS) and postmyocardial infarction syndrome (PMIS), unusual presentations after minor cardiac insults, have also been reported in the literature. We have described an unusual case of PCIS with typical clinical, laboratory, echocardiographic findings that occurred after a prolonged and complicated stent implantation procedure.
    International journal of cardiology 09/2008; 128(1):e19-21. · 6.18 Impact Factor
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    ABSTRACT: The myocardial performance index (Tei index) is an echocardiographic index of combined systolic and diastolic functions. Brain natriuretic peptide (BNP) and its biologically inactive fragment N-terminal pro-BNP (NT-pro-BNP) are secreted by the heart in response to myocardial stretch. In this study, we investigated Tei index and NT-pro-BNP levels in patients with Wolff-Parkinson-White (WPW) syndrome before and after radiofrequency catheter ablation therapy (RFCA). Thirty patients (19 males, 11 females, aged 35.5 +/- 14.4 years) with WPW syndrome were enrolled in this study. Echocardiographic examination was performed before and 24 hours after RFCA. Tei index was calculated using Doppler echocardiography. Blood samples were taken before and 24 hours after RFCA to detect levels of NT-pro-BNP. Although isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT) did not change, aortic ejection time (ET) was decreased after RFCA (276 +/- 22 ms vs 254 +/- 30 ms, P < 0.01). So Tei index was significantly higher in postablation period (0.36 +/- 0.11 vs 0.42 +/- 0.21, P < 0.05). NT-pro-BNP levels did not change significantly after RFCA. We demonstrated that restoration of normal atrioventricular conduction by RFCA, leads to increase in Tei index but does not effect plasma NT-pro-BNP levels.
    Echocardiography 04/2008; 25(7):692-8. · 1.26 Impact Factor

Publication Stats

163 Citations
74.99 Total Impact Points

Institutions

  • 2002–2014
    • Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center
      İstanbul, Istanbul, Turkey
  • 2008
    • Ahi Evren Göğüs Kalp Damar Cerrahisi Eğitim ve Araştırma Hastanesi
      Atrabazandah, Trabzon, Turkey