Browsing by Author "Simsek, H."

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Anomaly of Left Main Coronary Artery Arising From the Right Sinus of Valsalva
(Elsevier Ireland Ltd, 2011) Simsek, H.; Sahin, M.; Islek, M.; Paker, S.; Gumrukcuoglu, H. A.
Assessment of Vitamin D Levels in Patients With Acute Coronary Syndrome
(Yuzuncu Yil Universitesi Tip Fakultesi, 2016) Simsek, H.; Babat, N.
In recent studies, vitamin D is claimed to have positive effects for acute coronary syndrome (ACS) by decreasing states that are accepted as important risk factors for ACS development such as endothelial damage, high blood pressure, insulin resistance, diabetes development and vascular inflammation. We have investigated the relation between ACS and plasma vitamin D levels in this study. The study was conducted with a total number of 90 patients diagnosed with ACS and 50 individuals with normal coronary artery angiography. No significantly different plasma vitamin D levels of control group was detected compared to the patients with ACS (Mean=15.2±4.8 versus 15.3±6.3ng/ml, p>0.05). Significant difference related to smoking prevalence was detected between the two groups (52.8% versus 20%, p<0.01). We have concluded that Vitamin D insufficiency does not increase the risk for development of ACS significantly, after the corrections related to blood cholesterol elevation, smoking, diabetes, high blood pressure, family history. According to these results, there was no association between the plasma level of vitamin D and the risk of development of ACS. © 2017 Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Asymptomatic Giant Pericardial Cyst Mimicking Dextrocardia on Chest X-Ray
(Urban & Vogel, 2014) Simsek, H.; Gunes, Y.; Akil, M. A.; Bilsel, T.
Brucella Endocarditis Caused by Brucella Melitensis
(2013) Akdag, S.; Akyol, A.; Simsek, H.; Şahin, M.; Yaman, M.
We present a rare case of brucella endocarditis, forming a vegetation on the mitral valve. The definitive diagnosis has been made with clinical suspicion, positive serology, the demonstration of the vegetation with the echocardiography and with the production from the multiple blood culture of brucella melitensis and from the excised valve. Our patient has been successfully treated with specific antibiotherapy and the surgery of replacement of mitral valve. Our aim in presenting the case is to remind the infective endocarditis which is due to this factor in the regions like our country which is endemic for brucellosis.
Comparison of Two Patients With Mitral Stenosis and Importance of Sinus Rhythm: Case Report
(2011) Sahin, M.; Simsek, H.; Gumrukcuoglu, H.A.; Akdag, S.; Ekici, B.
We present two woman patients have rheumatic mitral stenosis (MS). They complained of about shortness of breath and palpitation. First patient, she had had two stroke without any sequela (respectively 7 years and 4 years ago). And she has atrial fibrillation (AF) in electrocardiography (ECG). Another woman patient didn't have any complaint before. Latter patient has sinus tachycardia in ECG. Transthoracic echocardiography (TTE) disclosed severe mitral valve stenosis and left atrial dilatation in both patients. But first patient has multiple thrombus in left atrium. Mitral valve surgery was suggested for both patients. In conclusion maintenance of sinus rhythm, in the patients who had MS, is very important for both the protection of left atrial thrombus and the reduction of the development of systemic embolus related to it.
Effects of Illness Activity on Electrocardiographic Parameters in Patients With Multiple Sclerosis
(Elsevier Ireland Ltd, 2011) Gumrukcuoglu, H. A.; Tuncer, M.; Simsek, H.; Sahin, M.; Akdag, S.; Gunes, Y.; Tombul, T.
Maintenance of Sinus Rhythm and Treatment of Atrial Fibrillation in Mitral Stenosis
(2011) Sahin, M.; Simsek, H.; Ekici, B.; Akdag, S.; Tuncer, M.
Rheumatic fever is the most common cause of mitral stenosis. The most common complication of mitral stenosis is atrial fibrillation (AF). AF precipitates symptoms, greatly increases the risk of systemic embolisation, and reduces cardiac output and exercise capacity. Systemic embolization most often occurs in patients with both AF and mitral stenosis. Maintenance of the sinus rhythm in patients with mitral stenosis is very important because of reduce the risk of cerebral embolism, conservation of cardiac output and exercise capacity, and reduction of symptoms.
Maternal, Fetal Outcome, and Anticoagulant Management in Pregnant Women With Prosthetic Heart Valves
(Imr Press, 2018) Akyol, A.; Yuman, M.; Sabin, M.; Simsek, H.; Akdag, S.; Gumrukcuoglu, H. A.; Tuncer, M.
Introduction: Cardiac disease in maternity is a great problem particularly in developing countries. Pregnant patients with prosthetic heart valves (PHV) may suffer therapeutic difficulty, as the need for anticoagulation is fraught with risk of hemorrhagic or thromboembolic complications and structural valve deterioration. The present study aimed to evaluate the maternal, fetal outcome, and anticoagulant management in pregnant women with PHV. Materials and Methods: This study is prospective observational research. The medical archives of pregnant patients with PHV from September 2010 to January 2015 were scanned. Data collected from Yuzuncu Yil University Hospital Cardiology clinics archives included demographic characteristics, anticoagulant, presence or absence of obstructive or non-obstructive thrombus, and maternal-fetal outcome. Results: The authors evaluated the outcomes of 56 pregnant patients with PHV. The age at the time of pregnancy ranged between 19 and 37 (mean 28.7 +/- 8.4) years. Most common preferred anticoagulation therapy was heparin during the first trimester, followed by oral anticoagulation up to the 36th week, with subsequent replacement by heparin until delivery. Most common encountered complication was preterm birth. Death occurred in one patient due to obstructive valve thrombosis. Conclusion: Ideal PHV is not accessible for women during childbearing age. The risk of adverse event during pregnancy depends on valve position, symptoms, valve type, cardiac function, and functional capacity in patients with PHV. The active collaboration among an obstetrician, a cardiologist, and a cardiothoracic surgeon is required for optimal outcome patient with PHV.
A New Echocardiographic Parameter of Arterial Stiffness in End-Stage Renal Disease
(Urban & Vogel, 2014) Sahin, M.; Simsek, H.; Akyol, A.; Akdag, S.; Yaman, M.; Aydin, C.; Gumrukcuoglu, H. A.
Background. Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). Arterial stiffness is an independent predictive parameter of overall and cardiovascular mortality in these patients. However, the defined procedures for the measurement of arterial stiffness are time consuming and not practical in daily practice. Methods. The study population included 50 patients with ESRD who were treated with hemodialysis (HD; n=23) or peritoneal dialysis (PD; n=27) and 70 age-and sex-matched control subjects. Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and color M-mode propagation velocity of the descending aorta (aortic propagation velocity, APV) were measured. Results. Compared to the control group, the patients with ESRD had significantly lower APV (46.4 +/- 12.4 vs. 58.5 +/- 8.5, p<0.01) and higher PWV (10.5 +/- 2.5 vs. 9.2 +/- 1.2, p<0.01) and CIMT (0.66 +/- 0.15 vs. 0.43 +/- 0.06, p<0.01) measurements. There were significant correlations between APV and CIMT (r=-0.769, p<0.001), APV and PWV (r=-0.682, p<0.001), and PWV and CIMT (r=0.564, p<0.001). There were no significant differences in APV and PWV between the PD and HD patients. Conclusion. Arterial stiffness is an important indicator of atherosclerosis and arterial aging in patients with ESRD. The measurement of APV is an easy and practical new echocardiographic method and may be used to identify arterial stiffness in these patients.
Noninvasive Assessment of Subclinical Atherosclerosis in Normotensive Gravidae With Gestational Diabetes
(Urban & Vogel, 2014) Atay, A. E.; Simsek, H.; Demir, B.; Sakar, M. N.; Kaya, M.; Pasa, S.; Sit, D.
Carotid artery intima-media thickness (CIMT), hyperhomocysteinemia, microalbuminuria, and nitric oxide reflect subclinical atherosclerosis and predict the risk of future cardiovascular events. We aimed to evaluate the presence of subclinical atherosclerosis and endothelial dysfunction in normotensive patients with gestational diabetes mellitus (GDM) noninvasively. We enrolled 41 normotensive patients with GDM and 44 healthy gravidae in the study. Serum homocysteine and nitric oxide levels, urinary albumin excretion (microalbuminuria), and CIMT were evaluated along with lipid parameters and anthropometric measurements. Patients with GDM had significantly higher levels of serum homocysteine, urinary albumin excretion, and increased CIMT (p < 0.001, p=0.005, and p < 0.001, respectively). Nitric oxide levels were significantly reduced in the patient group (p < 0.001). There was a significant difference between groups in terms of low-density lipoprotein (LDL) but not of high-density lipoprotein (HDL) and triglyceride levels. A significant correlation was observed between CIMT and serum LDL, HDL, homocysteine, nitric oxide levels, and urinary albumin excretion. Microalbuminuria was significantly correlated with serum homocysteine levels (p=0.03) but not with nitric oxide. Independent of elevated blood pressure, subclinical atherosclerosis and endothelial dysfunction exist in normotensive patients with GDM. Further studies with a large number of participants are required to clarify these data.
A Novel Echocardiographic Method as an Indicator of Endothelial Dysfunction in Patients With Coronary Slow Flow
(verduci Publisher, 2013) Simsek, H.; Sahin, M.; Gunes, Y.; Akdag, S.; Akil, M. A.; Akyol, A.; Yaman, M.
BACKGROUND: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been impaired in patients with coronary slow flow (CSF). Recently, color M-mode derived propagation velocity of descending thoracic aorta (aortic propagation velocity-AVP) was shown to be an ultrasonographic marker for atherosclerosis. AIM: To assess endothelial function in patients with CSF and the correlation of AVP with FMD. MATERIALS AND METHODS: FMD and AVP were measured in 90 patients with CSF and 39 patients having normal coronary arteries (NCA) detected by coronary angiography. RESULTS: Compared to patients with normal coronary arteries patients having CSF had significantly lower AVP (39.1 +/- 8.4 vs. 53.7 +/- 12.7 cm/s, p < 0.001) and FMD (5.6 +/- 3.2 vs. 17.6 +/- 4.4 %, p < 0.001) measurements. There were significant correlations between AVP and FMD (r = 0.524, p < 0.001). CONCLUSIONS: Transthoracic echocardio-graphic determination of color M-mode propagation velocity of descending aorta is a simple practical method and correlates well with coronary slow flow and brachial endothelial function.
P Wave Duration and Dispersion in Patients With Hyperthyroidism and the Short-Term Effects of Antithyroid Treatment
(2009) Guntekin, U.; Gunes, Y.; Simsek, H.; Tuncer, M.; Arslan, S.
Background: Prolonged P wave duration and P wave dispersion (PWD) have been associated with an increased risk for atrial fibrillation (AF). Hyperthytodism is a frequent cause of atrial fibrillation (AF). Methods: Forty-two patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12 lead surface ECG and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. Results: Maximum P wave duration (Pmax) (97.4±14.6 vs. 84.2±9.5 msec, p<0.001), PWD (42.9±10.7 vs. 31.0±6.2 msec, p<0.001), deceleration (DT) (190.7±22.6 vs. 177.0±10.2 msec, p=0.013) and isovolumetric relaxation times (IVRT) (90.9±11.2 vs. 79.6±10.5 msec, p<0.001) were significantly higher in hyperthyroid patients compared to control group. Pmax and PWD were significantly correlated with the presence of hyperthyroidism. Pmax (97.4±14.6 to 84.3±8.6 msec, p<0,001) Pmin (54.1±8.6 to 48.1±8.5 msec, p=0.002), PWD (42.9±10.7 to 35.9±8.1 msec, p=0.002) and DT (190.7±22.6 to 185.5±18.3, p=0.036) were significantly decreased after achievement of euthyroid state in patients with hyperthyroidism. Diastolic dyfunction was seen in 5 patients at hyperthroid state but only in one patient at euthyroid state. Conclusions: Hyperthyroidism is associated with prolonged P wave duration and dispersion. Achievement of euthyroid state with propylthiouracil treatment results in shortening of P wave variables. Diastolic function may have a partial effect for the increased Pmax and PWD. Shortening of Pmax and PWD may be a marker for the prevention of AF with the anti-thyroid treatment.
Papillary Muscle Rupture Due To Myocardial Infarction in a Patient Presenting With Clinical Features of Acute Pulmonary Oedema
(Elsevier Ireland Ltd, 2011) Simsek, H.; Sahin, M.; Gumrukcuglu, H. A.; Caglayan, C. E.; Akdag, S.; Dogan, A.
Percutaneous Transluminal Angioplasty in Haemodialysis Patients With Central or Peripheral Venous Stenosis
(Ondokuz Mayis Universitesi, 2016) Yaman, M.; Sahin, M.; Simsek, H.; Gumrukcuoglu, H.A.; Tuncer, M.; Gunes, Y.; Akdag, S.
Dysfunction of arteriovenous fistulae (AVF), which result from peripheral or central venous occlusive illness, occurs very often in haemodialysis patients. In therapy, endovascular open procedures are prefered. Our study illustrated the clinical success of percutaneous transluminal angioplasty (PTA) for the treatment of these patient. A retrospective analysis was applied on patients presenting during a 2-years term with haemodialysis failure and ipsilateral arm swelling coherant with peripheral and/or central venous stenosis. PTA was performed as clinically and angiografically indicated. Technical success of PTA was defined less than 30% residual stenosis and clinical success was illustrated by resolution of pain and edema along with preservation of the AVF. Our study shows a subgroup of 26 patients that presented with symptomatic peripheral or central venous occlusive disease. Mean follow-up was 12.4 months (range, 3-24 months). PTA was successful in 26 patients 11 of whom were with central lesions and 15 of whom were with peripheral lesions. We were stated for central lesions PTA had a priority patency rates of 81.8%, 60%, 37.5% and supported primary patency rates of 90.9%, 70%, 62.5% at 3, 6, 12 months. For peripheral lesions, primary patency rates of 86.7%, 78.5%, 66.6% at 3, 6 and 12 months and assisted primary patency rates of 93.3%, 85.7% and 75%, separately. PTA for central and peripheral venous stenosis is be a successful and safe procedure in hemodialysis patients. In patients with lesions that are responsible for dilation, continuous functional access in the affected extremity is sustained, especially for patients with peripheral venous stenosis. © 2016 OMU.
Recurrence of Primary Cardiac Rhabdomyosarcoma Without Methastasis Two Years After Surgery
(TIP ARASTIRMALARI DERNEGI, 2012) Simsek, H.; Sahin, M.; Gumrukcuoglu, H.A.; Tuncer, M.; Gunes, Y.
Primary malignant cardiac tumors are rare. Rhabdomyosarcoma is the most common of these lesions. These tumors usually arise from the ventricular walls. They sometimes arise from the atrial walls and mimic atrioventricular valve stenosis. A case of recurrence of primary cardiac rhabdomyosarcoma without metastasis to other organs in a 34 year old woman is presented. The tumor arose from the posterior wall of the left atrium and extended to the posterior mitral valve leaflet. Histopathology confirmed recurrence of the cardiac rhabdomyosarcoma. Although cardiac rhabdomyosarcomas are highly lethal, operation indicated. Clarify diagnosis, relieve symptoms and improve survive intracardiac mass must be excision as as extensively as possible in these cases in order to prevent recurrence of tumor.
Regional Functions of the Left Ventricle in Patients With Coronary Slow Flow and the Effects of Nebivolol
(2009) Gunes, Y.; Tuncer, M.; Guntekin, U.; Ceylan, Y.; Sahin, M.; Simsek, H.
Background: Microvascular and endothelial dysfunction have been implicated for coronary slow flow (CSF). Nebivolol, besides its beta-receptor blocking activity, causes an endothelium-dependent vasodilatation through increased nitric oxide release. Methods: This study included 27 patients with CSF and 27 subjects with normal coronary arteries. Segmental functions of the left ventricle (LV) were assessed using myocardial tissue Doppler velocities before and 3 months after treatment with nebivolol 5 mg/day. Results: Compared with the control group, mitral deceleration time (DT) was significantly longer, and E/A ratio, systolic velocity of lateral mitral annulus (Sm) and regional myocardial peak systolic and early diastolic velocities (Vs, Vd) were significantly lower in patients with CSF. The reason for coronary angiography was typical angina in 21 (77.8%) and positive treadmill test in six (22.2%) CSF patients. There were significant correlations between presence of CSF in left anterior descending artery (LAD) with Sm (r =-0.404, p =0.002) and Vs in anterior (r =-0.531, p < 0.001 ) and lateral (r =-0.495, p < 0.001 ) segments and between presence of CSF in RCA and Vs in posterior segments (r =-0.501, p < 0.001). Treatment with nebivolol significantly decreased blood pressures (128.5±12.5/82.5±8.8 to 119.8± 12.6/76.4± 7.4 mmHg, p < 0.001), DT (252.3±53.6 to 222.0±41.0 ms, p < 0.001 ) and IVRT (115.7±19.9 to 103.3±17.0 ms, p <0.001), and increased exercise capacity (8.7±1.3 to 10.4±0.9 METs, p < 0.001), E/A ratio (0.87±0.26 to 1.08±0.23, p <0.001) and myocardial velocities (p < 0.001). All the patients were free of angina after treatment. Patients with CSF had impaired diastolic and regional LV functions. Conclusions: Nebivolol may therefore be useful in improving angina, exercise capacity and LV functions in patients with CSF. © 2009, SAGE Publications. All rights reserved.
Resolution of Atrial Thrombus With Adjusted Dose Warfarin Therapy in Patient With Nonvalvular Atrial Fibrillation
(Elsevier Ireland Ltd, 2011) Simsek, H.; Dogan, A.; Sahin, M.; Gumrukcuoglu, H. A.; Akdag, S.
Retrospective Analysis of Cardiac Manifestations of Our Patients With Marfan Syndrome
(2011) Simsek, H.; Sahin, M.; Gumrukcuoglu, H.A.
Marfan syndrome (MS) is an autosomal dominant connective tissue disorder affecting mainly cardiovascular system, eyes and skeleton. However, the most serious complication in patients with MS is progressive aortic root dilatation, aortic dissection or regurgitation. We have reviewed all patients with MS in our hospital over a six year period to determine the symptoms, clinical aspects, treatment modalities and long term follow-up. The medical records of all patients with MS in Yuzuncu Yil University Department of Cardiology from January 2004 to May 2010 were reviewed. MS was defined by Ghent criteria. Individuals without a family history of MS require major criteria in at least two different organ systems and involvement of a third organ. Individuals carrying an FBN1 mutation known to cause MS or cases with a positive family history require one major criterion and involvement of an additional organ to diagnosis of MS. Eleven patients have diagnosis of MS according to Ghent criteria. Patients with mean age of 37.5 years. In our patient group wasn't a presence woman. Main complaint of patients was dispnea. Primary findings in physical examination were apical systolo-diastolic murmur, mediastinal enlargement at chest X-ray. Aortic root dilatation, aortic regurgitation was seen echocardiographically. Mean follow-up time was 3.8 years. During follow-up six patients died. Main cause of die was aortic complication. Early detection and close monitoring of the MS are very important for prevent complications. MS patients should be followed closely especially in terms of cardiovascular complications.
Severe Mitral and Aorta Insufficiency in Patient With Acute Rheumatismal Fever
(Elsevier Ireland Ltd, 2011) Akdag, S.; Sahin, M.; Simsek, H.; Gumrukcuoglu, H. A.; Tuncer, M.
Treatment of Gigantic Left Ventricular Thrombus: Case Report
(Elsevier Ireland Ltd, 2011) Sahin, M.; Simsek, H.; Gumrukcuoglu, H. A.; Akdag, S.; Ekici, B.