1
|
Yüksel UÇ, Asil S, Yıldırım E, Karpat MS, Görmel S, Fırtına S, Yaşar S, Buğan B, Saatçi Yaşar A, Çelik M, Bolcal C, Barçın C. Endovascular Repair of Ruptured Aortic Aneurysm: A Single-Center Experience. Turk Kardiyol Dern Ars 2024; 52:88-95. [PMID: 38465530 DOI: 10.5543/tkda.2023.91628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Aortic rupture is a rare and catastrophic emergency. Prompt diagnosis and treatment are the primary determinants of mortality. During follow-up, the majority of patients who have been effectively treated die from hypovolemic shock and multiorgan failure. This article describes the clinical and procedural details of sixteen patients with ruptured aortic aneurysms treated endovascularly. In addition, it discusses the main factors contributing to the mortality of these patients. METHOD Patients who underwent endovascular treatment for acute aortic rupture at our center from October 2016 to March 2023 were included in this retrospective study. RESULTS A total of 16 patients underwent endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) for acute aortic rupture. The patients' mean age was 73.06 years (range: 52-92), and 15 of them were male. The ruptures occurred in the abdominal aortic aneurysm in ten patients, in thoracic aortic aneurysm in three patients, in the isolated iliac artery aneurysm in two patients, and there was one case of non-aneurysmal aortic rupture. In our series, patients who presented with an impending, self-limited rupture and stable hemodynamic status had good prognostic outcomes. However, eight patients died due to multiorgan failure, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, or abdominal compartment syndrome. These patients generally had poor admission vital signs and low hemoglobin values. The most critical determinants for the success of the procedure are promptly stopping the bleeding, avoiding general anesthesia, and opting for blood product replacement instead of fluid replacement. CONCLUSION Each patient with ruptured aortic aneurysm should be managed according to the patient's hemodynamics at presentation, the size of the aneurysm, the suitability for percutaneous procedure, logistical factors, and the operator-center's experience.
Collapse
Affiliation(s)
- Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Mehmet Sadık Karpat
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ayşe Saatçi Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Cengiz Bolcal
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
2
|
Adıgözelzade S, Asil S, Keskin ÖF, Erdoğan S, Görmel S, Yaşar S, Fırtına S, Yıldırım E, Buğan B, Çelik M, Barçın C, Yüksel UÇ. Mitral-Tricuspid Regurgitation Change After Transcatheter Aortic Valve Implantation and Its Effect on Mortality and Hospitalization. Turk Kardiyol Dern Ars 2024; 52:10-17. [PMID: 38221830 DOI: 10.5543/tkda.2023.08130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE Moderate to severe mitral regurgitation (MR) and tricuspid regurgitation (TR) are present in approximately 20-60% of patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to evaluate the impact of TAVI on MR and TR, pulmonary hypertension, and reverse cardiac remodeling in these patients. Methods: Out of 240 patients who underwent TAVI, 79 who met the inclusion and exclusion criteria were analyzed. RESULTS In our study, 46.8% (n = 37) of the patients were male. Nineteen (24.1%) patients died within two years. Before TAVI, 34 (43%) patients had moderate-to-severe MR, which decreased to 18 (22.7%) after the procedure (P < 0.05). Similarly, the number of patients with moderate-to-severe TR decreased from 26 (32.9%) before TAVI to 12 (15%) after the procedure (P < 0.05). Of the patients, 50.6% (n = 40) did not require hospitalization after the procedure, while 25 were hospitalized once, 12 twice, and 2 three times. The mean systolic pulmonary artery pressure (sPAP) values of the patients decreased from 44.30 ± 14.42 mmHg before the procedure to 39.09 ± 11.77 mmHg after the procedure (Z=-3.506, P < 0.001). No correlation was found between changes in MR and TR grades after TAVI and mortality or hospitalization during follow-up. Furthermore, there was no statistically significant difference in tricuspid annular plane systolic excursion (TAPSE), free wall annular S' velocity, left atrial volume (LAV), or LAV index (LAVI) before and after TAVI. Conclusion: There was a significant decrease in moderate-to-severe MR and TR after TAVI; however, this did not impact hospitalization or mortality rates. Additionally, no significant differences were observed in right ventricular systolic function or in LAV and LAVI before and after TAVI.
Collapse
Affiliation(s)
- Samir Adıgözelzade
- Central Military Hospital of Ministry Defence of Azerbaijan, Bakü, Azerbaijan
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ömer Faruk Keskin
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Sıddık Erdoğan
- Department of Cardiology, İstanbul Şile City Hospital, İstanbul, Türkiye
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Cem Barçın
- Central Military Hospital of Ministry Defence of Azerbaijan, Bakü, Azerbaijan
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
3
|
Kaya C, Asil S, Cesaretli S, Yavaş Y, Buğan B, Barçın C. Early-Period Coronary Aneurysm Formation After Sirolimus-Eluting Stent Implantation. Anatol J Cardiol 2023; 27:E34-E35. [PMID: 37791772 PMCID: PMC10621614 DOI: 10.14744/anatoljcardiol.2023.3622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Cihad Kaya
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Sude Cesaretli
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Yakup Yavaş
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
4
|
Asil S, Geneş M, Yaşar S, Fırtına S, Görmel S, Yıldırım E, Gökoğlan Y, Tolunay H, Buğan B, Yaşar AS, Çelik M, Yüksel UÇ, Barçın C, Kabul HK. Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA). Cardiovasc J Afr 2023; 34:206-211. [PMID: 36166395 DOI: 10.5830/cvja-2022-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients. METHODS In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology-voltage-Pwave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak-Tend time and Tpeak-Tend/QT interval were used to determine ventricular arrhythmia risk. RESULTS A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak-Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak-Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak-Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA. CONCLUSIONS In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey.
| | - Muhammet Geneş
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Yalçın Gökoğlan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hatice Tolunay
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ayşe Saatçi Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
5
|
Yağcı AF, Asil S, Kaya C, Dinç C, Bozlar U, Barçın C. IGG4-related giant lymphoproliferative-inflammatory left atrial mass. Echocardiography 2023; 40:996-1000. [PMID: 37382184 DOI: 10.1111/echo.15645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
Cardiac masses are rare entities that can be challenging in clinical diagnosis and management. Cardiac masses can be detected incidentally in patients with an asymptomatic course or may cause systemic inflammation findings due to inflammatory cytokine release or symptoms such as shortness of breath, chest pain, syncope, sudden cardiac death, and mortality due to the location of the mass. Cardiac masses associated with systemic inflammatory disorders are uncommon in this disease group. This case report will present a case with an asymptomatic IgG4-related left atrial mass detected in routine echocardiographic control imaging due to rheumatic valve disease.
Collapse
Affiliation(s)
- Ahmet Faruk Yağcı
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cihad Kaya
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cemal Dinç
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Uğur Bozlar
- Department of Radiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cem Barçın
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Asil S, Görmel S, Köksal O, Eşki S, Buğan B, Yüksel UÇ. Endovascular Therapy of Aortic Rupture Secondary to a Psoas Abscess. Turk Kardiyol Dern Ars 2023; 51:353-355. [PMID: 37450451 DOI: 10.5543/tkda.2023.63458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common mechanism for secondary aortic infection is a psoas abscess eroding the aortic wall, which rarely results in non-aneurysmal aortic rupture. Primary treatment is surgical aortic reconstruction, but the risk of emergency surgical treatment is high. Endovascular aortic stent-graft implantation can be lifesaving in this setting by stopping the bleeding. However, the crucial question of durability and late infections remains unanswered and warrants long-term antibiotic treatment and follow-up. In this report, we present a case of primary psoas abscess, which resulted in non-aneurysmal aortic rupture and its endovascular treatment.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ozan Köksal
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Selen Eşki
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
7
|
Yıldırım E, Yüksel UÇ, Çelik M, Buğan B, Gökoğlan Y, Yaşar S, Görmel S, Asil S, Murat E, Yener S, Tolunay H, Saatçi Yaşar A, Kabul HK, Barçın C. Evaluation of the Transcatheter Aortic Valve Replacement Results in Patients with Borderline Aortic Annulus and the Impact of Under- or Oversizing the Valve. Anatol J Cardiol 2023; 27:189-196. [PMID: 36995055 PMCID: PMC10098374 DOI: 10.14744/anatoljcardiol.2022.2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing. METHODS Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient. RESULTS Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05). CONCLUSION Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.
Collapse
Affiliation(s)
- Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Yalçın Gökoğlan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ender Murat
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Serkan Yener
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Hatice Tolunay
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Ayse Saatçi Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
8
|
Karabacak K, Kubat E, Kadan M, Asil S, Erol G, Demirkiran T, Firtina S, Doğanci S, Ince ME, Bolcal C. Aortic Valve Neocuspidization Procedure Provides Better Postoperative Outcomes When Compared to Rapid Deployement Aortic Valves. Heart Surg Forum 2023; 26:E013-E019. [PMID: 36856508 DOI: 10.1532/hsf.5149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this study was to compare the early results of rapid deployment aortic valves (RD-AVR) and aortic valve neocuspidization (AVNeo) techniques. METHODS Between December 2019 to May 2022, 104 patients were operated on with aortic stenosis by RD-AVR (N = 52) and AVNeo (N = 52) techniques. Patients with isolated aortic valve stenosis and aortic stenosis concomittant with planned other cardiac surgeries were included. RESULTS The mean age of patients in the RD-AVR and AVNeo groups were 67.4 ± 7.8 vs. 62.9 ± 8.7, respectively. Aortic cross-clamp time in the RD-AVR group was 56.7 ± 23.3 minutes, while it was 104.1 ± 27.9 minutes in the AVNeo group (P < 0.001). Cardiopulmonary bypass time in the RD-AVR group and in the AVNeo group was 89.8 ± 27.6 minutes and 141.8 ± 36.7 minutes, respectively (P < 0.001). Permanent pacemaker become necessary in four patients in the RD-AVR group secondary to type 2 AV block. Paravalvular leak was observed in six patients, who underwent RD-AVR, while grade 2 central aortic regurgitation was observed in one patient in the AVNeo group. Hospital mortality was 8% in the RD-AVR group and 6% in the AVNeo group (P = 0.696). CONCLUSIONS AVNeo procedure is a feasible technique in all age groups of patients with successful hemodynamic results in the early postoperative period and with the advantage of not requiring anticoagulants. It also can be applied with other cardiac surgical interventions.
Collapse
Affiliation(s)
- Kubilay Karabacak
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Emre Kubat
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Murat Kadan
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Serkan Asil
- Health Sciences University, Gülhane School of Medicine, Department of Cardiology, Ankara, Turkey.
| | - Gökhan Erol
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Tuna Demirkiran
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Serdar Firtina
- Health Sciences University, Gülhane School of Medicine, Department of Cardiology, Ankara, Turkey.
| | - Suat Doğanci
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Mehmet Emin Ince
- Health Sciences University, Gülhane School of Medicine, Department of Anesthesiology, Ankara, Turkey.
| | - Cengiz Bolcal
- Health Sciences University, Gülhane School of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey.
| |
Collapse
|
9
|
Asil S, Aytemir K. Conduction Disturbances and Arrhythmia Risk After Septal Reduction Therapy with Alternative Agents: A Pilot Study with EVOH-DMSO and Systematic Review. Turk Kardiyol Dern Ars 2023; 51:40-49. [PMID: 36689282 DOI: 10.5543/tkda.2022.69570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Surgical septal myectomy and alcohol septal ablation are recommended treatment modalities for alleviating Left ventricular outflow tract (LVOT) gradient in obstructive HCM. Alcohol septal ablation offers advantages over surgery in many ways. However, it is associated with some life-threatening complications. For this purpose, our center used alternative agents for septal artery embolization. This study compared and evaluated conduction system defects and arrhythmia risk after EVOH-DMSO septal ablation with other alternative agents and alcohol septal ablation. METHODS Twenty-five patients who received septal reduction therapy with EVOH-DMSO were analyzed retrospectively, and all non-alcoholic agent's septal ablation studies were systematically reviewed and compared. RESULTS Twenty-five patients (52% female; mean age: 55.8 ± 17.1) with symptomatic obstructive HCM were enrolled. The Peak LVOT gradient was significantly reduced after the procedure (68 vs. 20 mmHg; P <0.001). During the 12-month follow-up, no mortality occurred. The complete atrioventricular block was noted in 2 (8%) patients. The incidence of right bundle branch block (RBBB) increased after the procedure (pre-procedural 2 patients (8%), post-procedural 9 patients (36%) P = 0.002). On ECG and Holter monitorization, no sustained ventricular tachyarrhythmia occurred during follow-up, and no change was found in the frequency of atrial fibrillation. We systematically compared EVOH-DMSO to other non-alcohol agents, and we found that EVOH-DMSO can cause conduction system problems more commonly than other non-alcohol agents. CONCLUSION EVOH-DMSO could cause conduction system problems more common than other non-alcohol agents but less than alcohol septal ablation.
Collapse
Affiliation(s)
- Serkan Asil
- Gülhane Training and Research Hospital, Department of Cardiology, Ankara, Türkiye
| | - Kudret Aytemir
- Hacettepe University Hospital; Department of Cardiology, Ankara, Türkiye
| |
Collapse
|
10
|
Yasar S, Koksal O, Eski S, Asil S, Tolunay H, Bozlar U, Yuksel UC, Barcin C, Celik M. Incidentally Diagnosed Double Inferior Vena Cava While Being Investigated for Pulmonary Hypertension. Anatol J Cardiol 2022; 26:E8-E9. [DOI: 10.5152/anatoljcardiol.2022.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
11
|
Tolunay H, Yasar S, Asil S, Yildirim E, Yasar AS, Celik M, Yuksel UC, Barcin C. Prognostic Value of Nutritional Indexes in Evaluating the 1-Year Results after Implantation of the Carillon Mitral Contour System. Acta Cardiol Sin 2022; 38:362-372. [PMID: 35673339 PMCID: PMC9121758 DOI: 10.6515/acs.202205_38(3).20211222a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 12/22/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prognostic importance of nutritional indexes has been shown in some diseases. We aimed to examine the prognostic value of these indexes in patients implanted with the Carillon Mitral Contour System (CMCS). METHODS Fifty-four patients who underwent successful CMCS implantation were evaluated. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and controlling nutritional status (CONUT) scores were calculated. The relationships between these indexes and 1-year clinical outcomes including all-cause mortality and re-hospitalization due to heart failure were investigated. RESULTS In Kaplan-Meier analysis, 1-year all-cause mortality rates were significantly higher in the patients with low PNI and GNRI and high CONUT scores (52.0% vs. 0%, p < 0.001; 54.2% vs. 0%, p < 0.001; 52.4%, 6.1%, p < 0.001; respectively). For the composite endpoint, a significant difference was observed between those below and above the cut-off values (70.0% vs. 16.7%, p < 0.001; 75.0% vs. 23.3%, p < 0.001; 66.7% vs. 20.8%, p < 0.001, respectively). In multivariate Cox regression analysis, GNRI was determined to be an independent predictor of 1-year all-cause mortality [hazard ratio: 0.707; 95% confidence interval: 0.510-0.979; p = 0.037]. CONCLUSIONS Nutritional indexes have prognostic value in predicting 1-year all-cause mortality in severe functional mitral regurgitation patients undergoing CMCS implantation. In particular, GNRI can guide the selection of patients who will benefit from CMCS.
Collapse
Affiliation(s)
- Hatice Tolunay
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ayse Saatci Yasar
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Murat Celik
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Cem Barcin
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
12
|
Asil S, Geneş M, Çelik M, Yüksel UÇ, Barçın C. Pseudocoarctation of the aorta: A rare congenital aortic disease. Anatol J Cardiol 2022; 26:69-71. [DOI: 10.5152/anatoljcardiol.2021.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
13
|
Gormel S, Yasar S, Yildirim E, Asil S, Baris VO, Gokoglan Y, Celik M, Yuksel UC, Vurgun VK, Kabul HK, Kose S. Comprehensive assessment of Mahaim accessory pathways' anatomic distribution. J Int Med Res 2022; 50:3000605211069751. [PMID: 35001697 PMCID: PMC8753247 DOI: 10.1177/03000605211069751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To present the authors’ experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. Methods Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. Results Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12–66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). Conclusion MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.
Collapse
Affiliation(s)
- Suat Gormel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Erkan Yildirim
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Veysel Ozgur Baris
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Yalcın Gokoglan
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Murat Celik
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | | | - Hasan Kutsi Kabul
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Sedat Kose
- Department of Cardiology, Liv Hospital, Ankara, Turkey
| |
Collapse
|
14
|
Asil S, Geneş M, Çelik M, Yüksel UÇ, Barçın C. Pseudocoarctation of the aorta: A rare congenital aortic disease. Anatol J Cardiol 2021; 26:63-65. [DOI: 10.5152/anatoljcardiol.2021.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
15
|
Asil S, Barış VÖ, Görmel S, Çelik M, Yüksel UÇ. Giant ventricular pseudoaneurysm and associated eccentric severe mitral regurgitation: Surgery or follow-up? Turk Kardiyol Dern Ars 2021; 49:688-692. [PMID: 34881709 DOI: 10.5543/tkda.2021.21148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A ventricular pseudoaneurysm develops mainly after myocardial infarction complicated by a ventricular free wall rupture contained by localized pericardial adhesions. The risk of rupture in untreated pseudoaneurysms is approximately 30%-45%, and the mortality rate is 50%. Although there is no clear evidence of treatment in the literature, the main suggestion is to perform surgical treatment without delay. However, the age of the patients, additional comorbidities, and the accompanying severe mitral regurgitation and left ventricular systolic dysfunction considerably increase the mortality rate of the surgical procedure. The treatment of left ventricular pseudoaneurysm accompanied by severe mitral regurgitation has not been clarified in the literature, and patient-based individual approaches vary. In this case report, the clinical course of the three patients was explained with different treatment approaches, and we tried to create a resource for treatment approaches in light of the literature.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Veysel Özgür Barış
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
16
|
Yasar S, Gökoğlan Y, Görmel S, Asil S, Kabul HK. A rare case of REM sleep-related bradyarrhythmıa syndrome: 19.5-s asystole during REM sleep. J Interv Card Electrophysiol 2021; 63:227-228. [PMID: 34647220 DOI: 10.1007/s10840-021-01075-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Salim Yasar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey.
| | - Yalçın Gökoğlan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
17
|
Asil S, Murat E, Taşkan H, Barış VÖ, Görmel S, Yaşar S, Çelik M, Yüksel UÇ, Kabul HK, Barçın C. Relationship between Cardiovascular Disease Risk and Neck Circumference Shown in the Systematic Coronary Risk Estimation (SCORE) Risk Model. Int J Environ Res Public Health 2021; 18:10763. [PMID: 34682509 PMCID: PMC8535320 DOI: 10.3390/ijerph182010763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The most important way to reduce CVD-related mortality is to apply appropriate treatment according to the risk status of the patients. For this purpose, the SCORE risk model is used in Europe. In addition to these risk models, some anthropometric measurements are known to be associated with CVD risk and risk factors. OBJECTIVES This study aimed to investigate the association of these anthropometric measurements, especially neck circumference (NC), with the SCORE risk chart. METHODS This was planned as a cross-sectional study. The study population were classified according to their SCORE risk values. The relationship of NC and other anthropometric measurements with the total cardiovascular risk indicated by the SCORE risk was investigated. RESULTS A total of 232 patients were included in the study. The patients participating in the study were analysed in four groups according to the SCORE ten-year total cardiovascular mortality risk. As a result, the NC was statistically significantly lower among the SCORE low and moderate risk group than all other SCORE risk groups (low-high and very high 36(3)-38(4) (IQR) p: 0.026, 36(3)-39(4) (IQR) p < 0.001, 36(3)-40(4) (IQR) p < 0.001), (moderate-high and very high 38(4) vs. 39(4) (IQR) p: 0.02, 38(4) vs. 40(4) (IQR) p < 0.001, 39(4) vs. 40(4) (IQR) p > 0.05). NC was found to have the strongest correlation with SCORE than the other anthropometric measurements. CONCLUSIONS Neck circumference correlates strongly with the SCORE risk model which shows the ten-year cardiovascular mortality risk and can be used in clinical practice to predict CVD risk.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Ender Murat
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Hatice Taşkan
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Veysel Özgür Barış
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, 27010 Gaziantep, Turkey;
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| |
Collapse
|
18
|
Görmel S, Yaşar S, Asil S, Bozkurt E, Fırtına S, Tolunay H, Vurgun VK, Yıldırım E, Gökoğlan Y, Buğan B, Çelik M, Yüksel UÇ, Kabul HK, Amasyalı B, Barçın C, Köse S. Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience. Turk Kardiyol Dern Ars 2021; 49:456-462. [PMID: 34523593 DOI: 10.5543/tkda.2021.90388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature. METHODS We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded. RESULTS Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center's total success rate was 95.5%, and total complication rate was 0.26%. CONCLUSION According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratification and medical management.
Collapse
Affiliation(s)
- Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Erhan Bozkurt
- Department of Internal Medicine, Afyonkarahisar Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hatice Tolunay
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | | | - Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Yalçın Gökoğlan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Basri Amasyalı
- Department of Cardiology, TOBB Economics and Technology University School of Medicine, Ankara, Turkey
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sedat Köse
- Department of Cardiology, Liv Hospital, Ankara, Turkey
| |
Collapse
|
19
|
Balci C, Eşme M, Sümer F, Asil S, Yavuz B, Tuna R, Özsürekci C, Çalişkan H, Ünsal P, Şengül Ayçiçek G, Halil M, Cankurtaran M, Doğu BB. Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR). Blood Press Monit 2021; 26:271-278. [PMID: 33734123 DOI: 10.1097/mbp.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Masked hypertension, defined as nonelevated clinic blood pressure with elevated out of clinic blood pressure, has been associated with increased cardiovascular events, mortality and cognitive impairment. No evidence exists regarding the effect of treating masked hypertension. In this study, we followed-up the patients in the G-MASH-cog study for 1 year and aimed to examine the effect of the management of masked hypertension on cognitive functions. METHODS The G-MASH-cog study participants were followed-up for 1 year. In masked hypertensive individuals, lifestyle modification and antihypertensive treatment (perindopril or amlodipine) were initiated for blood pressure control. Measurements of cognitive tests and ambulatory blood pressure monitoring at baseline and at 1-year follow-up were compared. RESULTS A total of 61 patients (30 in masked hypertension group; 31 in normotensive group) were included. Mean age was 72.3 ± 5.1 and 59% of the participants were female. Compared with baseline ambulatory blood pressure measurement results, patients with masked hypertension had significantly lower ambulatory blood pressure measurement results after 1-year follow-up. The quick mild cognitive impairment test (Q-MCI-TR) score increased with antihypertensive treatment (Q-MCI score at baseline = 41(19-66.5), at 1 year = 45.5 (22-70), P = 0.005) in masked hypertensive patients. In the final model of the mixed-effects analysis, when adjusted for covariates, interaction effect of the masked hypertension treatment with time was only significant in influencing the changes in Q-MCI scores over time in patients aged between 65 and 74 years (P = 0.002). CONCLUSIONS Treatment of masked hypertension in older adults was associated with improvement in cognitive functions.
Collapse
Affiliation(s)
- Cafer Balci
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Mert Eşme
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Fatih Sümer
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Serkan Asil
- Department of Cardiology, Ankara Gülhane Education and Research Hospital
| | - Bünyamin Yavuz
- Department of Cardiology, Ankara Medical Park Hospital, Ankara, Turkey
| | - Rana Tuna
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Cemile Özsürekci
- Department of Cardiology, Ankara Gülhane Education and Research Hospital
| | - Hatice Çalişkan
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Pelin Ünsal
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Gözde Şengül Ayçiçek
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Meltem Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Mustafa Cankurtaran
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| | - Burcu Balam Doğu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine
| |
Collapse
|
20
|
Asil S, Murat E, Barış V, Taşkan H, Yüksel U. Relationship between cardiovascular disease risk and neck circumference shown in the score risk model. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
21
|
Yaşar S, Gökoğlan Y, Görmel S, Asil S, Kabul HK. Left atrial ıntramural hematoma after radiofrequency catheter ablation of left lateral accessory pathway. Int J Arrhythm 2021. [DOI: 10.1186/s42444-021-00041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractWe report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway. A 46-year-old male patient experienced chest pain after radiofrequency ablation. Transthoracic echocardiography and computed tomography revealed the intramural mass consistent with hematoma in the left atrium. He was hemodynamically stable, and conservative approach was decided. Atrioventricular groove is a vulnerable part of left atrium, and ablation of left free wall accessory pathway may require targeting both atrial and ventricular surfaces of the mitral annulus. Avoidance of forceful catheter manipulation during the electrophysiological procedure is important for prevention of this complication. Optimal periprocedural anticoagulation might reduce the risk of procedure-related thromboembolic complications, but electrophysiologists should always pay attention to an intramural hematoma that may occur after radiofrequency catheter ablation.
Collapse
|
22
|
Görmel S, Yaşar S, Asil S, Yıldırım E, Fırtına S, Taşkan H, Köklü M, Gökoğlan Y, Buğan B, Saatçi Yaşar A, Kabul HK, Çelik M, Yüksel UÇ, Barçın C. Evaluation of percutaneous annuloplasty for treatment of functional mitral regurgitation: A retrospective study. Anatol J Cardiol 2021; 25:505-511. [PMID: 34236326 DOI: 10.5152/anatoljcardiol.2021.54599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The management of severe functional mitral regurgitation (FMR) in patients with heart failure (HF) and low ejection fraction is controversial, but percutaneous transcatheter procedures are promising. In this retrospective analysis, we aimed to assess the efficacy of the Carillon Mitral Contour System in patients with "inoperable" severe FMR. METHODS Seventy three patients (mean age 66.89, range 31-90 years) with congestive heart failure (CHF), severe FMR, and reduced ejection fraction (<35%) who underwent Carillon device implantation were examined. The study group consisted of patients with successfully implanted devices whereas the control group comprised patients in whom the device could not be deployed. The primary endpoint was combined all-cause mortality and first hospitalization for HF (whichever came first). RESULTS The median (Q1, Q3) follow-up was 31 (11-49) months. The device was deployed successfully in 50 patients (implant group) and not in 23 patients (non-implant group). Both the primary endpoint and all-cause mortality were lower in the "implant" group, but the differences were not significant. The median to primary endpoint was 21 [95% confidence interval (CI) 8.8-33.2] and six (95% CI 0.1-11.9) months for the implant group and the non-implant group, respectively (p=0.078). CONCLUSION Carillon Mitral Contour System implantation is a safe procedure and results in the reduction of all-cause mortality and combined endpoint of mortality and hospitalizations for HF in inoperable patients with severe FMR and low ejection fraction, although the difference did not meet the significance level.
Collapse
Affiliation(s)
- Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Hatice Taşkan
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Mustafa Köklü
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Yalçın Gökoğlan
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Ayse Saatçi Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital; Ankara-Turkey
| |
Collapse
|
23
|
Asil S, Tokgözoğlu L, Yorgun H, Kabakçı MG, Aytemir K, Özer N. Correlation of vascular risk age with pulse wave velocity in young patients with low absolute cardiovascular risk. Turk Kardiyol Dern Ars 2021; 49:214-222. [PMID: 33847270 DOI: 10.5543/tkda.2021.25068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The systematic coronary risk evaluation (SCORE) estimates the 10-year risk of fatal cardiovascular disease (CVD), and its application is recommended. The absolute risk of CVD, independent of risk factors, is relatively low in young individuals. Expressing the risk as their "risk age" may aid in understanding the risk. This study aimed to demonstrate a possible correlation between vascular risk age, SCORE risk value, and the level of subclinical atherosclerosis evaluated using a pulse wave velocity (PWV) device. METHODS This work was designed to be a cross-sectional study. The SCORE 10-year fatal CVD risk and vascular risk age were calculated for patients below the age of 50 years and without any previous diagnosis of atherosclerotic disease or equivalents. The PWV of each patient was measured non-invasively using a PWV device. RESULTS The study population included a total of 300 patients with a mean age of 35.1±9.5 years. The mean PWV and mean vascular age of the entire study population were 6.3±1.3 m/s and 44.3±5.5 years, respectively, and the median 10-year risk of fatal CVD score was 0.4 (0.04-2.74). There was a positive correlation between PWV and the 10-year risk of fatal CVD (r=0.613; P<0.001) and vascular risk age (r=0.684; P<0.001). CONCLUSION Despite their young age and low to moderate 10-year risk of fatal CVD (<1%-5%) according to the SCORE chart, patients with a high vascular risk age were found to have high PWV values. These results show that calculations of vascular risk age might be used to assess the risk of fatal CVD in young patients and correlate with subclinical atherosclerosis.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Kudret Aytemir
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Necla Özer
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
24
|
Barış VÖ, Asil S, Çelik M, Görmel S, Yüksel UÇ. Iatrogenic type A aortic dissection during percutaneous coronary intervention: A single-center experience. Turk Kardiyol Dern Ars 2021; 49:108-119. [PMID: 33709916 DOI: 10.5543/tkda.2021.99978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Iatrogenic aortic dissection (IAD) during coronary interventions is a rare but fatal complication. There is not enough experience and trial on this subject. In this study, we report our IAD cases and their acute, short-term, and long-term results. METHODS In this study, we screened 6,096 coronary angiographies performed in our center between February 2016 and February 2019. Ascending aortic dissection developed in 8 patients. A total of 7 patients had computed tomographic angiography images after the event and during the follow-up. We performed 1-month and 1-year follow-up examinations. RESULTS The incidence of IAD was 0.13%. The female sex ratio was as 63%. A total of 37% of the patients had presented with acute coronary syndrome. In 37% of the patients, dissection occured while support catheter use, but in the remaining patients, dissections developed owing to hydraulic pressure. Regardless of the Dunning staging, 7 patients were followed-up with medical treatment, and 1 patient with decreased coronary flow was referred to emergency coronary bypass surgery. Regression was in the first tomography in 4 patients and observed in the control tomography in the remaining patients with medical treatment. The in-hospital 1-month and 1-year mortality rates were 0%. CONCLUSION IAD is a fatal disease, and conservative follow-up is suggested due to lack of clear management recommendations. The findings in our study showed that medical treatment is the first choice for the hemodynamically stable patients when dissection is sealed by stenting; however, surgical treatment is required in patients with the decreased coronary flow.
Collapse
Affiliation(s)
- Veysel Özgür Barış
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
25
|
Asil S, Murat E, Barış VÖ, Görmel S, Çelik M, Yüksel UÇ, Kabul HK, Bolcal C. Caseous calcification of the mitral annulus; scary image during robotic surgery. J Card Surg 2020; 35:1145-1147. [PMID: 32293048 DOI: 10.1111/jocs.14545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
Caseous calcification of the mitral annulus (CCMA) is a very rare form of mitral annular calcification (MAC). CCMA accounts for 0.63% of all cases and 0.06-0.07% of the total population and usually seen in elderly and female patients. It mostly affects the posterior leaflet of the mitral valve. The pathogenesis of CCMA remains unclear. Hypercholesterolemia and the dissolution of lipid-laden macrophages may be implicated in liquefaction necrosis. CCMA is composed of a mixture of calcium, fatty acid, and cholesterol. The name "caseous" comes from the cheese-like or toothpaste-like consistency of the mass. Cardiac magnetic resonance imaging may help in differentiating MAC from CCMA and should perform. The first treatment option should be conservative treatment because of surgical complications of the procedure. We presented a case report which is about CCMA with preoperative and intraoperative robotic images.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ender Murat
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Veysel Özgür Barış
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Cengiz Bolcal
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
26
|
Esme M, Asil S, Yavuz B, Balci C, Kılıç MK, Kızılarslanoğlu MC, Doğan Varan H, Tuna Doğrul R, Halil M, Cankurtaran M, Yavuz BB. Masked hypertension is associated with end organ damage in geriatric age: Geriatric MASked Hypertension and End organ damage (G-MASH-End organ Study). Blood Press 2019; 29:80-86. [DOI: 10.1080/08037051.2019.1675475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mert Esme
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Bunyamin Yavuz
- Department of Cardiology, Medical Park Hospital, Ankara, Turkey
| | - Cafer Balci
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Kemal Kılıç
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Muhammed Cemal Kızılarslanoğlu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Hacer Doğan Varan
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Rana Tuna Doğrul
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Halil
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Yavuz
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
27
|
Barış VÖ, Adigozalzade S, Taşkan H, Asil S, Yüksel UÇ. [A case of carcinoid tumor diagnosed by a cardiologist]. Turk Kardiyol Dern Ars 2019; 47:244. [PMID: 30982822 DOI: 10.5543/tkda.2018.85068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Veysel Özgür Barış
- Gülhane Research and Education Hospital, Department of Cardiology, Turkey
| | - Samir Adigozalzade
- Gülhane Research and Education Hospital, Department of Cardiology, Turkey
| | - Hatice Taşkan
- Gülhane Research and Education Hospital, Department of Cardiology, Turkey
| | - Serkan Asil
- Gülhane Research and Education Hospital, Department of Cardiology, Turkey
| | | |
Collapse
|
28
|
Esme M, Yavuz BB, Yavuz B, Asil S, Tuna Dogrul R, Sumer F, Kilic MK, Kizilarslanoglu MC, Varan HD, Sagir A, Balci C, Halil M, Cankurtaran M. Masked Hypertension is Associated With Cognitive Decline in Geriatric Age-Geriatric MASked Hypertension and Cognition (G-MASH-cog) Study. J Gerontol A Biol Sci Med Sci 2019; 73:248-254. [PMID: 28958009 DOI: 10.1093/gerona/glx150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions. Methods One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology. Results Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant. Conclusion This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage.
Collapse
Affiliation(s)
- Mert Esme
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Yavuz
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Bunyamin Yavuz
- Department of Cardiology, Medical Park Hospital, Ankara, Turkey
| | - Serkan Asil
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Rana Tuna Dogrul
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Sumer
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Kemal Kilic
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Hacer Dogan Varan
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Aykut Sagir
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Cafer Balci
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Halil
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
29
|
Asil S, Kaya B, Canpolat U, Yorgun H, Şahiner L, Çöteli C, Arat A, Aytemir K. Septal reduction therapy using nonalcohol agent in hypertrophic obstructive cardiomyopathy: Single center experience. Catheter Cardiovasc Interv 2018; 92:557-565. [PMID: 29205803 DOI: 10.1002/ccd.27442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/06/2017] [Accepted: 11/12/2017] [Indexed: 11/09/2022]
Abstract
AIMS Percutaneous septal reduction therapy by either alcohol or nonalcohol agents is an alternative approach to surgery in drug-refractory symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Nonalcohol agents have some advantages and disadvantages over alcohol during the procedure. Nowadays, a novel non-alcohol agent, named as Ethylene-vinyl alcohol (EVOH) copolymer (Onyx® and Squid® ), is used during septal ablation. Thus, in this study, we aimed to evaluate both acute and long-term efficacy and safety profile of EVOH during septal ablation in HOCM. METHODS AND RESULTS A total of 25 patients (52% female; mean age: 55.8 ± 17.1 years) with symptomatic HOCM were enrolled in the study. All subjects underwent clinical and laboratory assessment before and after the procedure. Peak left ventricular outflow tract (LVOT) gradient was significantly reduced just after the procedure (68 vs. 20 mmHg; P < 0.001). Peak serum creatine kinase-myocardial band and troponin I levels were 112 (35-282) ng/ml and 11 (4-93) ng/ml. EVOH embolization to diagonal artery was observed in 1 patient (4%) and the complete atrioventricular block was noted in 2 (8%) patients. During the 12-month follow-up, there was no mortality. There was a significant improvement in New York Heart Association functional class of the subjects P < 0.001). Both interventricular septum thickness and LVOT gradient showed a significant reduction during follow-up (P < 0.05). However, there was no reduction in the LVOT gradient of 3 patients (12%). CONCLUSIONS In conclusion, our small-sized preliminary study results showed that septal reduction therapy using EVOH is an effective alternative option in reducing symptoms and LVOT gradient in HOCM.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Levent Şahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cem Çöteli
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Anıl Arat
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
30
|
Sari A, Sener YZ, Firat E, Armagan B, Erden A, Oksul M, Hekimsoy V, Asil S, Kilic L, Kiraz S, Kaya EB, Tokgozoglu L, Akdogan A. Pulmonary hypertension in Takayasu arteritis. Int J Rheum Dis 2018; 21:1634-1639. [DOI: 10.1111/1756-185x.13354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/19/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Alper Sari
- Department of Rheumatology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Yusuf Z. Sener
- Department of Cardiology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Esra Firat
- Department of Internal Medicine Taskopru State Hospital Kastamonu Turkey
| | - Berkan Armagan
- Department of Rheumatology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Abdulsamet Erden
- Department of Rheumatology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Metin Oksul
- Department of Cardiology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Vedat Hekimsoy
- Department of Cardiology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Serkan Asil
- Department of Cardiology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Levent Kilic
- Department of Rheumatology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Sedat Kiraz
- Department of Rheumatology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Ergun B. Kaya
- Department of Cardiology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Lale Tokgozoglu
- Department of Cardiology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Ali Akdogan
- Department of Rheumatology Faculty of Medicine Hacettepe University Ankara Turkey
| |
Collapse
|
31
|
Yüksel UÇ, Çelik M, Yıldırım E, Yıldırım AO, Karabacak K, İnce E, Adıgözelzade S, Asil S, Keskin ÖF, Görmel S, Barçın C. Percutaneous Closure of a Giant Aortic Pseudoaneurysm with Occlutech Asd Closure Device. Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
32
|
Yüksel UÇ, Yıldırım E, Çelik M, Görmel S, Asil S, Barış VÖ, Yaşar S, Erol G, Barçın C. Percutaneous Treatment of a Patient With Aortoiliac Occlusive Disease. Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Asil S, Canpolat U, Kaya EB, Aytemir K, Kabakçı G. Case series of three different scenarios with drug-induced Brugada patterns: fact or fiction? Turk Kardiyol Dern Ars 2017; 45:650-654. [PMID: 28990948 DOI: 10.5543/tkda.2017.02717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brugada syndrome is an inherited cardiac arrhythmia condition characterized by coved-type ST elevation and J point elevation of at least 2 mm in at least 2 of the right precordial electrocardiogram (ECG) leads (V1-3). An increasing number of noncardiac agents, including psychotropic and anesthetic drugs, have been shown to induce a characteristic Brugada ECG pattern, predisposing the patient to fatal ventricular arrhythmias. However, there are scarce data regarding the clinical significance. In this case series, a typical Brugada pattern was unmasked by lithium, valproic acid, and thiocolchicoside; however, the clinical scenario was different in all 3 cases, ranging from an asymptomatic patient to sudden cardiac arrest.
Collapse
Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
34
|
Sunman H, Özkan A, Yorgun H, Canpolat U, Maharjan N, Asil S, Kaya EB, Bayrak T, Tokgözoğlu L, Özkara A, Aytemir K, Oto A. Vitamin D levels predict the response to cardiac resynchronization therapy in patients with systolic heart failure. Turk Kardiyol Dern Ars 2017; 44:670-676. [PMID: 28045413 DOI: 10.5543/tkda.2016.28848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the relationship between vitamin D levels in patients with heart failure (HF) and response to cardiac resynchronization therapy (CRT). METHODS We studied 57 patients (mean age: 60.47±13.09 years) with New York Heart Association Class II or III heart failure, QRS duration ?120 milliseconds, and ejection fraction <35% (mean: 27.1±4.4%) who underwent CRT. All patients were taking optimal medical treatment for HF. Patients were classified as CRT responders if they had >15% decrease in left ventricular end-systolic volume at 6 months compared with baseline measurements. Vitamin D levels were evaluated before CRT implantation with ELISA. RESULTS Of the 57 patients, 34 patients (59.6%) were classified as responders and 23 patients (40.4%) were classified as non-responders. Baseline features, laboratory findings, and echocardiographic characteristics were nearly the same in both groups. High vitamin D level was detected in responder group compared to non-responder group (26.17±7.5 ng/mL vs 21.15±5.9 ng/mL; p=0.009). Age, hypertension, diabetes mellitus, ischemic cardiomyopathy, QRS morphology and duration, and levels of B-type natriuretic peptide (BNP) and vitamin D were associated with CRT response in our study population. In multivariate regression analysis, preimplantation QRS duration, and BNP and vitamin D levels remained independent predictors (QRS duration Odds ratio [OR]: 1.047, CI: 1.019-1.417, p=0.006; BNP OR: 0.997, 95% CI: 0.994-0.999, p=0.029; vitamin D OR: 1.121, 95% CI: 1.011-1.242, p=0.030). CONCLUSION In the present study, preimplantation level of vitamin D was found to be predictor of response to CRT.
Collapse
Affiliation(s)
- Hamza Sunman
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Sahiner L, Asil S, Kaya EB, Ozer N, Aytemir K. Percutaneous Implantation of the self-expanding valve Prosthesis a patient with homozygous familial hypercholesterolemia severe aortic stenosis and porcelain aorta. Int J Cardiol 2016; 220:661-4. [PMID: 27393846 DOI: 10.1016/j.ijcard.2016.06.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/28/2016] [Indexed: 11/30/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or inappropriate for open heart surgery. However, concerns exist over treating patients who have porcelain aorta and familial hypercholesterolemia, due to the potential complications of aortic root and aortic annulus. In this case report, we present a patient with familial hypercholesterolemia, symptomatic severe aortic stenosis, previous coronary artery bypass grafting and porcelain aorta, who was successfully treated with TAVI using a CoreValve.
Collapse
Affiliation(s)
- Levent Sahiner
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Serkan Asil
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
| | - Ergün Baris Kaya
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Necla Ozer
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| |
Collapse
|
36
|
Asil S, Şahiner L, Özer N, Kaya EB, Evranos B, Canpolat U, Yorgun H, Karagöz H, Aytemir K. Transcatheter aortic valve implantation in patients with a mitral prosthesis; single center experience and review of literature. Int J Cardiol 2016; 221:390-5. [PMID: 27404712 DOI: 10.1016/j.ijcard.2016.07.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Following the encouraging results of several registries and trials, transcatheter aortic valve implantation (TAVI) has been recognized as a valid option in patients with severe aortic stenosis deemed at high or prohibitive risk for surgical treatment. Good procedural success and good clinical outcomes have been showed and very limited data exist on TAVI in the setting of a preexisting mitral prosthesis regarding the technique, potential complications, and outcomes. METHODS Here, we report six cases of transfemoral TAVI with a self-expanding bioprosthesis (CoreValve; Medtronic, Inc) in patients who had previously undergone mitral valve replacement. Preprocedural, intraprocedural ve postprocedural outcome and data were analyzed and a brief literature review is also presented. RESULTS AND CONCLUSION Our experiences show that transfemoral CoreValve implantation can be performed successfully in patients with mechanical and bioprosthetic mitral valves.
Collapse
Affiliation(s)
- Serkan Asil
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Levent Şahiner
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
| | - Necla Özer
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - E Barış Kaya
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Banu Evranos
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Uğur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Hikmet Yorgun
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Heves Karagöz
- Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| |
Collapse
|
37
|
Şahiner ML, Asil S, Kaya EB, Yorgun H, Evranos B, Canpolat U, Özer N, Oto A, Aytemir K. OP-069 Transcatheter Aortic Valve Implantation With Core Valve Prosthesis: Initial Hacettepe Experience of 108 Prohibitive and High Surgical Risk Patients With Severe Aortic Stenosis. Am J Cardiol 2016. [DOI: 10.1016/j.amjcard.2016.04.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Asil S, Şahiner ML, Kaya EB, Yorgun H, Evranos B, Canpolat U, Özer N, Oto A, Aytemir K. OP-068 Predictors of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Implantation with Self-expanding CoreValve Prosthesis: Hacettepe Experiences. Am J Cardiol 2016. [DOI: 10.1016/j.amjcard.2016.04.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Şahiner ML, Asil S, Kaya EB, Yorgun H, Canpolat U, Evranos B, Özer N, Oto A, Aytemir K. OP-070 Transcatheter Aortic Valve Implantation in Patients with a Mitral Prosthesis; Single Center Hacettepe Experience. Am J Cardiol 2016. [DOI: 10.1016/j.amjcard.2016.04.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Canpolat U, Aytemir K, Yorgun H, Asil S, Dural M, Özer N. The Impact of Echocardiographic Epicardial Fat Thickness on Outcomes of Cryoballoon-Based Atrial Fibrillation Ablation. Echocardiography 2016; 33:821-9. [PMID: 26864458 DOI: 10.1111/echo.13193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Uğur Canpolat
- Department of Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Kudret Aytemir
- Department of Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Hikmet Yorgun
- Department of Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Serkan Asil
- Department of Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Muhammed Dural
- Department of Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Necla Özer
- Department of Cardiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| |
Collapse
|
41
|
Sunman H, Aytemir K, Yorgun H, Canpolat U, Yalçin MU, Maharjan N, Asil S, Şahiner L, Kaya B, Özer N, Oto A. Evaluating the Efficacy and Safety of Internal Cardioversion with Implantable Cardioverter Defibrillator Device for Atrial Fibrillation in Systolic Heart Failure Patients. Ann Noninvasive Electrocardiol 2015; 21:181-8. [PMID: 26084862 DOI: 10.1111/anec.12282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/19/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) commonly observed in patients with heart failure and cardioversion was often needed to restore the sinus rhythm. Previously, there is no study evaluating usefulness of internal cardioversion with implantable cardioverter defibrillator (ICD) device. In this study, we aimed to compare the efficacy and long-term effects of internal cardioversion with ICD devices compared to conventional external cardioversion in patients with AF and heart failure. METHODS Seventy patients with AF and heart failure who underwent electrical cardioversion were enrolled in the study. Forty patients (mean age 65.36 ± 10.37, 35 male) were assigned to undergo internal cardioversion with approximately 35 J shocks delivered through the ICD electrode. Standard external cardioversion was performed for the remaining patients (30 patients; mean age 66.20 ± 11.89; 24 male) that were similar with regard to baseline, and electrocardiographic characteristics. RESULTS Sinus rhythm was restored in 32 of 40 patients (80.0%) assigned to internal cardioversion compared with 25 of 30 patients (83.3%) assigned to external cardioversion (P = 0.725). We did not witness any serious complication during the procedure and hospitalization. On the follow-up, there was no statistically significant difference in recurrence of AF and incidence of major cardiovascular events between the internal and external cardioversion groups. CONCLUSIONS Internal cardioversion with ICD device is an effective and safe method to restore sinus rhythm in heart failure patients with AF.
Collapse
Affiliation(s)
- Hamza Sunman
- Department of Cardiology, Ministry of Health Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Muhammet Ulvi Yalçin
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Naresh Maharjan
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Levent Şahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Barış Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Necla Özer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Ali Oto
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| |
Collapse
|
42
|
Canpolat U, Aytemir K, Yorgun H, Sunman H, Yalçın U, Asil S, Dural M, Şahiner L, Kaya E, Oto A. OP-282 Role of Type I Procollagen C-Terminal to Predict Recurrence after Cryoablation in Lone AF Patients. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Yalcın U, Asil S, Dural M, Gürses M, Canpolat U, Fatihoglu G, Sunman H, Yorgun H, Şahiner L, Kaya B, Özer N, Aytemir K. PP-220 ST SEGMENT ELEVATION MYOCARDIAL INFARCTION IN A PATIENT WITH CHRONIC MYELOMONOCYTIC LEUKEMIA WITH INR OF 4.8. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
44
|
Sunman H, Canpolat U, Dural M, Asil S, Hekimsoy V, Kaghazi Z, Özer N, Aytemir K. PP-228 CORONARY ARTERY ANEURYSM FORMATION AFTER SIROLIMUS-ELUTING STENT IMPLANTATION. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Yalçın U, Asil S, Canpolat U, Yorgun H, Şahiner L, Kaya B, Özer N, Aytemir K. PP-226 GIANT LEFT MAIN CORONARY ARTERY ANEURYSM COMPLICATED WITH ANTERIOR MYOCARDIAL INFARCTION IN BEHCET'S SYNDROME. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
46
|
Oto A, Aytemir K, Canpolat U, Yorgun H, Kaya E, Şahiner L, Asil S, Yalçın U, Dural M, Sunman H, Kabakçı G, Tokgözoglu L. OP-123 CURRENT PRACTICE AND APPLICATIONS OF TRANSVENOUS LEAD EXTRACTION USING EVOLUTION® MECHANICAL DILATOR SHEATH. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|