Browsing by Author "Ozkara, Cenap"

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A Case Report of Coronary Subclavian Steal Syndrome in a Young Woman
(Blackwell Publishing, 2007) Guler, Niyazi; Ozkara, Cenap; Akyuz, Aydin; Sahin, Musa
A 41-year-old woman presented with complaints of increasing angina pectoris and coldness of her left arm for 1 month. Six months ago, she had undergone triple coronary artery bypass grafting (CABG) including left internal mammary artery (LIMA) to left anterior descending artery (LAD) and two saphenous vein grafts to the diagonal branch of LAD and obtuse marginal branch of the circumflex artery. Coronary angiography revealed that contrast media injected into the saphenous vein graft coursing down the diagonal branch flowed up to LAD and drained into the LIMA opacifying the left subclavian artery. Arch angiography documented a total occlusion of the left subclavian artery. A polytetraflouraethylene graft was anastomosed between the left common carotid and axillary artery. After operation, the symptoms disappeared and blood pressure in her left arm recovered. This complication could be prevented by identification of subclavian artery stenosis during coronary angiogram or CABG. This study may suggest that subclavian artery angiography should be performed in patients who will undergo CABG even for a young woman such as our case.
A Case Report of Surgical Septal Myectomy of Hypertrophic Cardiomyopathy With Concomitant Left Ventricular Outflow Tract and Mid-Ventricular Obstructions
(Blackwell Publishing, 2006) Guler, Niyazi; Ozkara, Cenap; Gumrukcuoglu, Hasan Ali; Simsek, Hakki
A 27-year-old female presented with dyspnea, fatigue, and exertional angina is found to have hypertrophic cardiomyopathy with marked hypertrophy of the papillary muscles, apex, septum, and lateral wall of the left ventricle. Also, small left ventricular cavity and systolic anterior movement of anterior mitral leaflet were observed at the echocardiography. The Doppler echocardiography revealed severe peak gradients at the left ventricle outflow tract (105 mmHg) and mid-ventricle (80 mmHg). At the operation, septal myectomy and anterior papillary muscle resection in addition to mitral valve replacement was performed. Surgical treatment gave an excellent clinical result. Control Doppler echocardiograms revealed no left ventricular outflow tract gradient, although mid-ventricular gradient was persistent. The good results were still present 18 months after the operation.
Do Cardiac Neuropeptides Play a Role in the Occurrence of Atrial Fibrillation After Coronary Bypass Surgery
(Elsevier Science inc, 2007) Guler, Niyazi; Ozkara, Cenap; Dulger, Haluk; Kutay, Veysel; Sahin, Musa; Erbilen, Enver; Gumrukcuoglu, Hasan Ali
Background. One of the potential mechanisms to explain the occurrence of postoperative atrial fibrillation (AF) is imbalance of autonomic nervous system tone. The myocardium is innervated not only by cholinergic and adrenergic nerves but also by peptidergic nerves that synthesize and secrete neuropeptides. To investigate the possible role of cardiac neuropeptides in the development of AF after coronary artery bypass grafting (CABG), we analyzed the plasma levels of substance P (SubP), neuropeptide Y (NPY), and angiotensin II (Ang II) in patients who underwent elective on-pump CABG. Methods. This prospective study group included 83 consecutive patients scheduled for elective, on-pump CABG. Depressed left ventricular (LV)function ( ejection fraction [EF]less than 0.30), concomitant cardiac procedures, history of atrial fibrillation, second or third degree atrioventricular block, implanted pacemaker, postoperative myocardial infarction, use of class I or III antiarrhythmic drug, and hemodynamic deterioration were exclusion criteria. Preoperative and postoperative serum levels of SubP, NPY, and AngII were measured by radioimmunoassay technique. Results. Postoperative AF occurred in 27 patients (32.5%). Using multivariate logistic regression analyses, only a decrease in SubP level ( odds ratio [ OR] = 1.87, 95% confidence interval [CI] = 0.767 to 0.99, p = 0.031) and an increase in AngII level ( OR = 2.61, 95% CI = 1.002 to 1.021, p = 0.023) after CABG were found to be independently associated with AF. Increased age ( p = 0.02), diabetes mellitus ( p = 0.023), preoperative use of beta blocker ( p = 0.024), proximal right coronary artery involvement ( p = 0.024), low preoperative sodium levels ( p = 0.023), low LVEF ( p = 0.013), and increased mitral E wave deceleration time ( p = 0.044) were also associated with AF. Conclusions. These results indicate that the increase in AngII and the decrease in SubP after CABG may play a role in the occurrence of postoperative AF. Further studies are needed to define the physiologic and pathologic relevance of these substances at the occurrence of AF in patients who undergo CABG. (c) 2007 by The Society of Thoracic Surgeons.
Interpolated Bigeminy Ventricular Premature Contractions Due To Cardiac Compression of Left Pleural Effusion: a Case Report
(Modestum Ltd, 2006) Akyuz, Aydin; Ozkara, Cenap; Guler, Niyazi; Ozkara, Hasibe
We described interpolated bigeminy ventricular premature contractions due to cardiac compression by a large left pleural effusion during exercise test. A 68-year-old man was admitted to the hospital for further examination of chest oppression. His history included a rheumatoid arthritis for more than 20 years and multiple admissions to the hospital. He had been on indomethacin (75 mg/daily) in partial remission for more than 1 year. Laboratory findings of thoracentesis fluid revealed that the cause of pleural effusion was rheumatoid arthritis. He had no diabetes mellitus, thyrotoxicosis, myopericarditis, ischemic or valvular heart disease.
Left Ventricular Outflow Tract Obstruction After Bioprosthetic Mitral Valve Replacement With Posterior Mitral Leaflet Preservation
(Texas Heart inst, 2006) Guler, Niyazi; Ozkara, Cenap; Akyol, Aytac
We present a case of transient left ventricular outflow tract obstruction after mitral valve replacement with a high-profile bioprosthesis; only the posterior native mitral valve leaflet was preserved. A 76-year-old woman was admitted to our institution with pulmonary edema. Two weeks earlier, she had undergone mitral valve replacement at our hospital due to severe mitral stenosis and 2+ mitral regurgitation complicated by cardiac failure and atrial fibrillation. The patient was taking digoxin, furosemide, and warfarin at the time of readmission. Echocardiography showed a narrowed left ventricular outflow tract. Doppler echocardiography revealed a peak 64-mmHg gradient between the septum and the strut of the bioprosthesis. The patient was successfully treated medically This case indicates that the risk of left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement is not always eliminated by removal of the anterior mitral valve leaflet when the posterior mitral leaflet is preserved.
Ruptured Abdominal Aortic Aneurysm After Resection of an Infected Cardiac Myxoma
(Texas Heart inst, 2007) Guler, Niyazi; Ozkara, Cenap; Kaya, Yuksel; Saglam, Enis
A 12-year-old girl with a high fever underwent echocardiography and was found to have a myxoma that arose from the atrial side of the anterior mitral valve leaflet The tumor was successfully excised. Histologic examination of the tumor showed myxoma cells and an organized thrombus with bacterial colonization. The patient was discharged from the hospital on antibiotic treatment After remaining asymptomatic for 3 weeks, she was readmitted with acute abdomen. Ultrasonography and magnetic resonance angiography detected intra-abdominal hemorrhaging and a saccular aneurysm of the abdominal aorta. The patient underwent successful emergency surgery. To our knowledge, no other report has been published concerning an abdominal aortic aneurysm secondary to bacterial infection of a cardiac myxoma. Although complications this severe are rarely observed in patients who have endocarditis, early recognition and treatment can be life-saving.