Browsing by Author "Tuncer, M"

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Aneurysm of Sinus of Valsalva Dissecting Into Interventricular Septum
(Blackwell Futura Publishing, inc, 2004) Güler, N; Eryonucu, B; Tuncer, M; Asker, M
A 43-year-old man who had a Carbomedics prosthetic aortic valve replacement in 1997 was admitted to our hospital with complaints of shortness of breath and dyspnea on exertion in 2000. The patient was hospitalized due to atrioventricular (AV) complete block and a permanent pacemaker was implanted. At that time echocardiography indicated an aneurysm at the left sinus of Valsalva. In 2003, the patient was re-admitted to our clinic with complaints of shortness of breath and fatigue. Echocardiography showed a sinus of Valsalva aneurysm dissecting into interventricular septum. Operation confirmed dissection of the interventricular septum and communication between this cavity and the aneurysm of the left sinus of Valsalva. The postoperative course was uneventful and the patient was discharged in a satisfactory condition. This is the first reported case of aneurysm of the sinus of Valsalva dissecting into interventricular septum late and complicating aortic valve replacement.
Clinical and Echocardiographic Predictors of Left Atrial Appendage Dysfunction in Patients With Mitral Stenosis in Sinus Rhythm
(Mosby, inc, 2004) Güler, N; Demirbag, R; Özkara, C; Eryonucu, B; Günes, A; Tuncer, M; Agirbash, M
Background: Mitral stenosis (MS) causes left atrial (LA) appendage (LAA) dysfunction resulting in reduced LAA flow velocities. Low LAA peak emptying velocity (PEV), determined by transesophageal echocardiography, is a risk for thrombus formation and systemic embolism. Objective: We sought to investigate various clinical and echocardiographic predictors of low LAA blood flow velocities. Methods: A total of 44 patients with newly diagnosed MS were classified into two groups on the basis of the presence of high (PEV greater than or equal to 46 cm/s) or low (PEV < 46 cm/s) LAA flow profile on Doppler transesophageal echocardiography. LAA flow velocities were measured to be 27.38 +/- 8.17 cm/s in patients with LAA dysfunction and 70.75 +/- 16.71 cm/s in high-flow profile (P < .0001). Simultaneous 12-lead electrocardiogram was used to measure P waves. Results: P maximum, P dispersion, and LA diameter were significantly higher in patients with low LAA PEV (n = 32) than in those with high LAA PEV (111.87 +/- 16.93 vs 96.66 +/- 14.97, P = .0084; 73.12 +/- 20.7 vs 49.16 +/- 9.96, P < .0001; 46.06 +/- 4.384 vs 38.08 +/- 7.42 mm, P = .004; respectively). Patients with MS and low LAA blood flow had smaller mitral valve area compared with those with high LAA blood flow velocity (1.48 +/- 0.431 vs 1.85 +/- 0.442 cm(2), P = .02). Male sex, spontaneous echocontrast, and thrombus were more frequent in patients with low LAA PEV (7 [21.87%] vs 5 [41.66%], P = .026; 21 [65.62%] vs 4 [33.3%], P = .088; 4 [12.5%] vs none; respectively). Mild MS was more frequent in patients with high blood flow velocity {6 [27.2%] vs 14 [63.6%], P = .03}. Conclusion: At linear regression analysis, only P-wave dispersion and LA diameter predicted the LAA mechanical dysfunction reflected as low LAA PEVs.
A Comparison of Heart Rate Variability in Patients With Multiple Sclerosis Undergoing Immunomodulating Therapy or No Such Treatment
(Elsevier, 2005) Tombul, T; Tuncer, M; Eryonucu, B; Anlar, O
Comparison of the Effects of Nitroglycerin and Nitroprusside on Transmitral Doppler Flow Parameters in Patients With Hypertensive Urgency
(Sage Publications inc, 2005) Eryonucu, B; Güler, N; Güntekin, O; Tuncer, M
Background: Sodium nitroprusside (NIP) and nitroglycerin (NIT) are frequently selected agents for acutely reducing blood pressure. However, it is not clear which agent is more efficacious in improving left ventricular filling pressure in hypertensive crises. OBJECTIVE: To compare the acute effects of nitroglycerin (NIT) and nitroprusside (NIP) on transmitral Doppler filling parameters in patients with hypertensive urgency. METHODS: We identified 37 patients from our emergency department with hypertensive urgency and left ventricular filling abnormalities. Hypertensive urgency was defined as a severe blood pressure elevation without evidence of progressive end-organ injury. Patients were randomized to receive an infusion of NIT or NIP. NIT was infused at a starting dose of 10 mu g/min; NIP was infused at a starting dose of 0.25 mu g/kg/min. The infusion rates were adjusted to decrease mean arterial pressure by 25%, and this reduction was obtained within 2 hours in all patients. Diastolic filling parameters were measured by using echocardiography before and after treatment. Pulsed-wave Doppler transmitral flow velocities were used. Early diastolic flow, atrial contraction signal, early diastolic flow/atrial contraction signal, deceleration time, and isovolumetric relaxation time (IVRT) were measured. RESULTS: There were no differences between groups in baseline demographic and echocardiographic parameters. Blood pressure decreased significantly in both treatment groups. In posttreatment echocardiographic examinations, atrial contraction signal, deceleration time, and IVRT were significantly decreased in both treatment groups. Early diastolic flow was significantly decreased in the NIT group. There were no significant differences between the groups in terms of posttreatment early diastolic flow, atrial contraction signal, deceleration time, and IVRT values. CONCLUSIONS: In hypertensive urgency with left ventricular filling abnormalities, reduction of blood pressure associated with NIT or NIP treatment may improve transmitral Doppler filling parameters. There were no differences demonstrated between the 2 agents.
The Effects of Short Term (3 Weeks) Testosterone Treatment on Serum Inflammatory Markers in Men Undergoing Coronary Artery Stenting
(Elsevier Ireland Ltd, 2006) Guler, N; Batyraliev, T; Dulger, H; Ozkara, C; Tuncer, M; Aslan, S; Agirbasli, M
Objective: Inflammation markers can predict restenosis after successful intracoronary stenting. There is evidence that testosterone suppresses the expression of the inflammatory cytokines. We hypothesized that testosterone therapy after coronary stenting can reduce the inflammation markers. Methods: We selected 41 men with coronary artery disease who underwent successful stent implantation for a > 70% diameter stenosis of a major coronary artery. Patients, who had stable angina and positive exercise test results, were recruited after diagnostic coronary angiography. Twenty-five men were treated with 3 doses of i.m. testosterone administration once a week for 3 weeks following diagnostic angiography. Sixteen patients were recruited as a control group and they received standard therapy. First venous blood samples were obtained after angiography. Stents were implanted 3 weeks after diagnostic angiography. Second venous blood samples were taken 24 h after the coronary stenting. Results: Baseline biochemical or hematological parameters were similar between the control and treatment groups. After coronary stenting, free testosterone, total testosterone, and sex hormone binding globulin were significantly elevated in the testosterone group (P < 0.0001, P < 0.0001 and P=0.02; respectively). After coronary stent implantation, there was a significant increase in IL-6 and CRP levels in the control group only (P=0.02 and P=0.038), while TNF-alpha levels were increased significantly in both groups (P=0.016 and P=0.014; respectively). Statistical analysis revealed that testosterone treatment prior to stent implantation attenuated IL-6 and hs-CRP levels significantly (P=0.042 and P=0.043; respectively). Conclusions: The present study shows that 3 weeks testosterone treatment prior to intracoronary stenting results in a significant suppression in hs-CPP and IL-6 levels after the stent implantation. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
Effects of Trimetazidine on Submaximal Exercise Test in Patients With Acute Myocardial Infarction
(Springer, 2003) Güler, N; Eryonucu, B; Günes, A; Güntekin, Ü; Tuncer, M; Özbek, H
Background: It was demonstrated that the novel metabolic agent, trimetazidine, could lessen the incidence and severity of angina, whether used in monotherapy or combination. Although the animal studies demonstrated that trimetazidine reduces myocardial infarct size and improves recovery of mechanic function after ischemia, little is known on the potential benefits of trimetazidine in patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the efficacy of trimetazidine on AMI by sub-maximal exercise test. Methods: A double-blind crossover trimetazidine versus placebo trial was carried out in 44 patients with AMI. Patients were randomly allotted into trimetazidine (23 patients) or placebo (21 patients) for 5 days and underwent an initial sub-maximal exercise test. Exercise tests according to the modified Bruce protocol were performed. Exercise end points included completion of stage II or 75% of maximum predicted heart rate whichever came first. An averaged 12-lead ECG was obtained at rest, every minute during exercise, at the onset of anginal symptoms, at the onset of 1-mm ST segment depression, at peak exercise and every 2-minute during recovery. After the initial exercise tests, study groups resumed the drugs in the opposite order for 4 to 5 days and underwent a second sub-maximal exercise test. Results: Exercise induced ST segment depression was noted in 17 patients (38.6%) receiving placebo. However, exercise induced ST-segment depression was observed in 8 patients (18.1%) taking TMZ. Positive exercise test results were significantly higher in placebo group than TMZ group (p=0.018). Additionally, trimetazidine prolonged the time to 1-mm ST-segment depression (6.1+/-0.5 vs 4.9+/-0.4, p<0.031) and exercise duration (7.2 +/- 0.9 vs 5.8 +/- 0.9, p<0.025). Conclusion: Trimetazidine therapy improves the exercise capacity and reduces evidence of ischemia derived from sub-maximal post-infarction exercise testing.
Intracardiac Extension of Intravenous Leiomyoma
(Texas Heart inst, 2005) Kutay, V; Tuncer, M; Harman, M; Ekim, H; Yakut, C
Intravenous leiomyoma with intracaval and intracardiac extension is a rare benign neoplasm affecting women. We report a case in which an intravenous leiomyoma originated from the right iliac vein and extended through the inferior vena cava into the right atrium. The correct diagnosis was made intraoperatively after resection of the intracardiac extension of the tumor, which was 28 cm in length. At the 2nd stage of the operation, a right common iliac venotomy enabled the removal of all residual tumor from the inferior vena cava.
Management of Primary Venous Aneurysms
(Saudi Med J, 2004) Ekim, H; Kutay, V; Tuncer, M; Gultekin, U
Objective: Venous aneurysms are a relatively rare abnormality. Unlike arterial aneurysms, venous aneurysms are a much less frequent abnormality. The purpose of our study was to review our experience in the management of venous aneurysms. Methods: Nine patients with venous aneurysms, who had undergone operation in the Department of Cardiovascular Surgery, Yuzuncu Yil University Medical School, Van, Turkey, during the period September 1997 through to May 2003, were included in this study. There were 5 female and 4 male patients, ranging in age from 16-47-years with a mean age of 31 +/- 7 years. They were diagnosed by color flow duplex imaging. Eight patients had saccular aneurysm; the remaining one patient with basilar vein aneurysm, had fusiform aneurysm. Results: Aneurysms were located the lower extremities in 4 cases, the upper extremity in 4, and external jugular vein in one. Aneurysms size ranged from 2, 3 to 5, 5 cm (mean 3, 6 cm). There were no symptoms in 2 patients (cephalic vein aneurysm in one patient, short saphenous vein aneurysm in one). These patients were operated on for cosmetic purposes. Six patients complained of pain associated with a subcutaneous swelling. The remaining one patient with popliteal vein aneurysm complained of extremity pain, associated with deep venous thrombosis. All patients underwent surgery under local anesthesia. In 7 patients, aneurysms were resected and venous continuity with a graft was found unnecessary. End to end anastomosis was performed in 2 patients (popliteal vein aneurysm in one and axillary vein aneurysm in one). During follow up period, there were no recurrences. Conclusion: Venous aneurysms may cause thrombophlebitis, thrombus formation, pulmonary embolism and theoretical complication of spontaneous rupture. Varicose veins, hemangiomas, lymphocele, hernias, hygromas, arteriovenous fistulas and similar subcutaneous swellings located subcutaneous venous spaces should be considered in the differential diagnosis. Consequently, we suggest that surgical treatment be performed to prevent subsequent complications in all cases.
Repetitive Profound Thrombocytopenia After Treatment With Tirofiban: a Case Report
(Springer, 2004) Eryonucu, B; Tuncer, M; Erkoc, R
The GPIIb/IIIa inhibitors are used in the acute coronary syndromes and interventional cardiology as antiplatelet agents. These drugs induce thrombocytopenia in approximately 1 - 5% of patients. Thrombocytopenia is rapid in onset and antibody mediated. Abciximab is associated with higher incidence of thrombocytopenia than eptifibatide and tirofiban. Profound thrombocytopenia has reportedly been an issue with abciximab, but not with tirofiban. We reported a case of acute profound thrombocytopenia due to on tirofiban treatment in the same patient at two different times.