Publications (15)29.61 Total impact
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Article: Comparison of Different TEE-Guided Thrombolytic Regimens for Prosthetic Valve Thrombosis: The TROIA Trial.
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ABSTRACT: OBJECTIVES: The aim of this prospective study was to identify the most effective and safest regimen among different thrombolytic treatment strategies. BACKGROUND: The best treatment strategies for prosthetic valve thrombosis have been controversial. METHODS: Transesophageal echocardiography-guided thrombolytic treatment was administered to 182 consecutive patients with prosthetic valve thrombosis in 220 different episodes (156 women; mean age, 43.2 ± 13.06 years) between 1993 and 2009 at a single center. These regimens chronologically included rapid (Group I), slow (Group II) streptokinase, high-dose (100 mg) tissue plasminogen activator (t-PA) (Group III), a half-dose (50 mg) and slow infusion (6 h) of t-PA without bolus (Group IV), and a low dose (25 mg) and slow infusion (6 h) of t-PA without bolus (Group V). The endpoints were thrombolytic success, in-hospital mortality, and nonfatal complication rates. RESULTS: The overall success rate in the whole series was 83.2%; it did not differ significantly among Groups I through V (68.8%, 85.4%, 75%, 81.5%, and 85.5%, respectively; p = 0.46). The overall complication rate in the whole series was 18.6%. Although the overall complication rate was similar among Groups I through IV (37.5%, 24.4 %, 33.3%, and 29.6%, respectively; p > 0.05 for each comparison), it was significantly lower in Group V (10.5%, p < 0.05 for each). The combined rates of mortality and nonfatal major complications were also lower in Group V than in the other groups, with all differences significant except for comparison of Groups IV and V. By multivariate analysis, the predictors of combined mortality plus nonfatal major complications were any thrombolytic therapy regimen other than Group V (odds ratios for Groups I through IV: 8.2, 3.8, 8.1, and 4.1, respectively; p < 0.05 for each) and a history of stroke/transient ischemic attack (odds ratio: 3.5, p = 0.011). In addition, there was no mortality in Group V. CONCLUSIONS: Low-dose slow infusion of t-PA repeated as needed without a bolus provides effective and safe thrombolysis in patients with prosthetic valve thrombosis. (Comparison of Different TRansesophageal Echocardiography Guided thrOmbolytic Regimens for prosthetIc vAlve Thrombosis; NCT01451320).JACC. Cardiovascular imaging 02/2013; 6(2):206-216. · 14.29 Impact Factor -
Article: Case images: Hypertrophic cardiomyopathy associated with mid-ventricular obstruction and apical aneurysm.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 10/2012; 40(6):560. -
Article: Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial.
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ABSTRACT: Levosimendan is a promising new inodilator agent but its effectiveness in peripartum cardiomyopathy (PPCM) has not been tested in a clinical trial. The authors sought to evaluate the effect of levosimendan therapy and to determine the predictors of clinical outcome in patients with PPCM. The authors prospectively randomized 24 consecutive women with PPCM. Twelve patients (control group) were randomized to conventional heart failure therapy and 12 patients (levosimendan group) were randomized to levosimendan in addition to the conventional therapy. Mean follow-up period was 20.9 ± 9 months (ranged 12-38 months). The two groups did not differ in baseline demographic and echocardiographic characteristics. Eleven patients (45.8%) recovered completely (6 in control group and 5 in levosimendan group, p > 0.05), 6 died (25%) (3 in control group and 3 in levosimendan group), and 7 (29.1%) were left with persistent left ventricular dysfunction (PLVD) (3 in control group and 4 in levosimendan group, p > 0.05). There were significant differences in baseline characteristics between deceased patients and survivors including left ventricular end-diastolic diameter (7.1 ± 0.6 vs. 6.4 ± 0.5 cm, p = 0.031), left ventricular end-systolic diameter (LVESD) (6.4 ± 0.8 vs. 5.5 ± 0.6 cm, p = 0.027), left ventricular ejection fraction (LVEF) (19.7 vs. 27.4%, p = 0.025), and left atrial diameter (4.9 ± 0.3 vs. 4.3 ± 0.4 cm, p = 0.011). Addition of levosimendan to conventional therapy did not improve outcome in patients with PPCM. In patients with PLVD or patients who died, LVEF, LVESD and left atrial diameter were worse than those with complete resolution.Clinical Research in Cardiology 01/2011; 100(7):571-7. · 2.95 Impact Factor -
Article: Left atrial myxoma demonstrated by real-time three-dimensional transesophageal echocardiography.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 04/2010; 38(3):222. -
Article: Depicting of a cleft mitral valve by real time three-dimensional transesophageal echocardiography.
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ABSTRACT: We report the usefulness of real time three-dimensional transesophageal echocardiography in comprehensive delineation of cleft mitral valve. This new technique may be a useful supplement to two-dimensional and three-dimensional transthoracic echocardiography in the assessment of this pathology.Echocardiography 03/2010; 27(3):356-8. · 1.24 Impact Factor -
Article: Takotsubo cardiomyopathy mimicking acute high lateral myocardial infarction.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 01/2010; 10(1):E2-3. · 0.44 Impact Factor -
Article: Perfect delineation of the localization and size of the paravalvular leak due to extensive suture loosening.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 07/2009; 9(3):E6-7. · 0.44 Impact Factor -
Article: Prosthetic mitral valve thrombosis demonstrated by real-time 3D transesophageal echocardiography.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 05/2009; 37(3):209. -
Article: Allergic myocardial infarction in childhood: Kounis syndrome.
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ABSTRACT: Kounis Syndrome was first described by Kounis as "allergic angina syndrome" progressing to "allergic myocardial infarction". This report describes the first children in the literature presented with Kounis syndrome.European Journal of Pediatrics 04/2009; 169(1):27-9. · 1.88 Impact Factor -
Article: Kounis syndrome: first series in Turkish patients.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 03/2009; 9(1):59-60. · 0.44 Impact Factor -
Article: Thrombolysis of an acute prosthetic mitral valve thrombosis presented with cardiogenic shock under the guidance of continuous transoesophageal monitoring.
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ABSTRACT: Thrombotic occlusion of prosthetic valves continues to be an uncommon but serious complication. Intravenous thrombolytic treatment has been proposed as an alternative to surgical intervention. Due to the lack of a generally accepted standard regimen, various infusion protocols and thrombolytic doses were used for the management of prosthetic heart valve thrombosis. However, rapid thrombolytic infusion, especially in the presence of large thrombus, may increase the risk of embolization. Continuous transoesophageal echocardiography may provide monitoring the efficacy of thrombolysis especially in critically ill patients.European Heart Journal – Cardiovascular Imaging 03/2009; 10(3):468-70. · 2.32 Impact Factor -
Article: Broken heart syndrome in a 17-year-old girl.
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ABSTRACT: Broken heart syndrome is characterized by transient left ventricular dysfunction with chest pain, electrocardiographic changes, and release of myocardial enzymes mimicking acute myocardial infarction. Physical and emotional stress usually precede the onset of symptoms. This dysfunction, known as takotsubo cardiomyopathy (TC), has been observed predominantly in women older than 60 years of age but very rarely reported in younger adults or children. Here we describe a 17-year-old girl with TC.European Journal of Pediatrics 02/2009; 168(10):1273-5. · 1.88 Impact Factor -
Article: [Compensatory hemodynamic variations for cardiovascular stabilization in complete atrioventricular block before and after pacemaker implantation].
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ABSTRACT: Stabilization of the cardiovascular system is maintained by variations in hemodynamic and hormonal parameters in complete atrioventricular (AV) block. We investigated the variations in hemodynamic parameters and brain natriuretic peptide (BNP) levels before and after permanent pacemaker implantation for complete AV block. We evaluated 25 patients (14 men, 11 women; mean age 72+/-10 years; range 39 to 83 years) who presented with a complaint of syncope due to complete AV block. All the patients were hemodynamically stable on presentation and were monitored in the coronary care unit until permanent pacemaker implantation. Variations in the cardiovascular system were determined before and two weeks after pacemaker implantation, including mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), systemic aortic compliance (SAC), and BNP levels. The mean heart rates were 36+/-6 beat/min and 65+/-10 beat/min before and after pacing, respectively. Compared to the pacing period, CO was significantly lower (p<0.001) and SVR was significantly higher (p=0.001) before pacemaker implantation, suggesting a compensatory rise in SVR. The mean arterial pressure did not show a significant difference and remained within normal ranges before and after pacing. There were no significant differences in SV, SAC, and BNP levels before and after pacemaker implantation, with BNP exhibiting increased levels in both periods. While no compensatory alterations occur in SV, SAC, and BNP before and after pacemaker implantation, decreased CO in complete AV block seems to be balanced by increased SVR, which results in maintenance of MAP within the normal range.Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2009; 37(2):107-11. -
Article: The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement.
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ABSTRACT: Two-dimensional (2D) echocardiographic approaches are not sufficient to determine the origin of paravalvular leak (PVL) that occurs after prosthetic mitral valve replacement (MVR). In this study, we investigated the role of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in detecting the origin and size of PVL occurring after prosthetic MVR. The study included 13 patients (7 females; 6 males; mean age 56+/-10 years; range 37 to 71 years) who developed PVL within a mean of 8.3+/-3.8 years following mechanical prosthetic MVR. Nine patients (69.2%) had atrial fibrillation, and four patients (30.8%) had normal sinus rhythm. Four patients (30.8%) had hemolysis. Paravalvular leak was mild, moderate, and severe in two, six, and five patients, respectively. Real-time 3D TEE was performed using a 3D matrix-array TEE transducer immediately after detection of PVL on 2D TEE examination. Localization of PVL was made using a clock-wise format in relation to the aortic valve and the size of dehiscence was measured. The mean PVL width measured by 2D TEE was 3.00+/-0.92 mm. The mean length of dehiscence was 13.6+/-8.8 mm, and the mean width was 3.88+/-2.04 mm on RT-3D TEE. The PVLs were mainly localized in the posterior and anterior annular positions between 12 to 03 hours (n=7) and 06 to 09 hours (n=3) on RT-3D TEE, respectively, which corresponded to the posteromedial or anterolateral sectors of the posterior annulus. Considering that only the width of the PVL defect can be assessed by 2D TEE, delineation by RT-3D TEE includes the localization of PVL together with the length and width of the defect.Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2009; 37(6):371-7. -
Article: Kounis syndrome secondary to cefuroxime-axetil use in an octogenarian.
Journal of the American Geriatrics Society 10/2008; 56(9):1757-8. · 3.74 Impact Factor -
Article: Kounis syndrome: first series in Turkish patients Kounis sendromu: Türk hastalardaki ilk olgu serisi
Top co-authors
Top Journals
Institutions
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2012
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Dicle University
- Department of Cardiology
Batman, Batman, Turkey
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2008–2011
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Koşuyolu Kalp ve Araştırma Hastanesi
İstanbul, Istanbul, Turkey
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