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Öğe A closed interatrial septal aneurysm mimicking a tumor in the left atrium(Texas Heart Inst, 2006) Akdemir, Ramazan; Duran, Sadık; Bulur, Serkan; Kaya, Ahmet; Sözen, Serhat Bahadır; Bilir, Cemil; Arınç, HüseyinA56-year-old woman presented with a congenital atrial septal aneurysm (ASA) that was found incidentally on routine echocardiographic evaluation. The echocardiographic images mimicked a left atrial tumor. She had hypertension, and she had been taking amlodipine for 5 years. There was no audible murmur. The chest radiograph and electrocardiogram were normal. Two-dimensional echocardiography showed rheumatic valvular disease and a mobile mass in the left atrium that resembled a cyst or cor triatriatum sinister. Further evaluation by other echocardiographic views confirmed the ASA.Öğe Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation(2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Ünlü, Hakan; Bulur, Serkan; Uyan, Cihangir; Arınç, HüseyinThe aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). This new transthoracic Doppler echocardiographic technique is easier and equally or more practical than qualitative and quantitative methods used to grade MR in patients both with normal and low left ventricular ejection fraction (LVEF). Color M-mode echocardiography allows resolution of regurgitant flow propagation along the echocardiography beam inside the left atrium. The characteristics of the velocity of this jet have not been studied in detail before. The present study compares the different qualitative and quantitative methods of MR grading with the RFPV. We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA) and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these 3 methods was determined. The mean RFPV for mild, moderate and severe MR were 26.4±7 cm/s, 43.3±7 cm/s and 60.3±7.3, respectively (p<0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1-64.3% for mild and 100-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC and RJA (p<0.0001, r=.87; p<0.0001, r=-.84; p<0.0001, r=.76, respectively). This results show that RFPV is a reliable and simple semi-quantitative new method that can be used for determining severity of MR.Öğe Color m-mode regurgitant flow propagation velocity: a new echocardiographic method for grading of mitral regurgitation(Blackwell Publishing, 2005) Akdemir, Ramazan; Özhan, Hakan; Bulur, Serkan; Ünlü, Hakan; Gündüz, Hüseyin; Arınç, Hüseyin; Uyan, CihangirPurpose: The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). Methods: We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients, and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA), and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these three methods was determined. Results: The mean RFPV for mild, moderate, and severe MR were 26.4 +/- 7 cm/sec, 43.3 +/- 7 cm/sec, and 60.3 +/- 7.3 respectively (P < 0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1%-64.3% for mild and 100%-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC, and RJA (P < 0.0001, r = 0.87; P < 0.0001, r = -0.84, P < 0.0001, r = 0.76, respectively). Conclusion: This results show that RFPV is a reliable and simple semiquantitative new method that can be used for determining severity of MR.Öğe Complete dissection of left anterior descending artery in a young woman after myocardial infarction(2012) Özhan, Hakan; Bulur, Serkan; Kayapinar, Osman; Türker, YasinSpontaneous coronary artery dissection (SCAD) is a rare clinical condition that causes acute coronary syndrome and sudden cardiac death. Herein, we report a case of left anterior descending artery dissection after myocardial infarction. On the third day of myocardial infarction after successful thrombolysis, the patient had recurrent chest pain without any ST wave elevation. She was referred to our clinic for coronary angiography which showed completely dissected left anterior descending (LAD) artery. She was referred to a tertiary centre with intravascular ultrasonography (IVUS) capability. Her control angiogram showed restored flow with only minimal dissection (so IVUS was not performed) in the mid LAD. The lesions in the distal and mid LAD were stented. The final angiogram showed TIMI-III flow. Percutaneous coronary intervention is the first choice of treatment in patients with single-vessel spontaneous coronary artery dissection with ongoing signs of ischemia.Öğe Coroner artery disease and heart failure related with rheumatoid arthritis(Duzce Univ, 2013) Bulur, Serkan; Bulur, Şule; Yazıcı, SelmaCardiac involvement is very common in rheumatoid arthritis. It was shown in many studies that cardiovascular mortality increase in these patients and cardiovascular diseases are responsible for 35-50 percent of the deaths. The patients with rheumatoid arthritis, compared with the healthy population. have increased mortality rates as 0,9-3 percent. The main reason for this increase in mortality in rheumatoid arthritis is cardiovascular diseases. In this article. we aimed to summarize the relation between rheumatoid arthritis and cardiovascular disease, especially coronary artery disease and heart failure.Öğe Deer horn image in the liver associated with giant right atrium(Le Jacq Ltd, 2007) Akdemir, Ramazan; Yıldız, Ahmet; Bulur, Serkan; Kaya, Ahmet; Bilir, Cemil; Uyan, CihangirA 65-year-old man was brought to the hospital complaining of massive bilateral leg swellmurmur in the xiphoid and mesocardiac regions. His electrocardiogram revealed atrial fibrillation, while his chest x-ray showed cardiomegaly.Öğe Diyabetik hastalarda egzersiz stres testinde hesaplanan Qt parametrelerine trimetazidinin etkisi(2005) Özhan, Hakan; Yazici, Mehmet; Albayrak, Sinan; Erbilen, Enver; Gülcan, Erim; Bulur, SerkanAmaç: Çalışmamızda normal epikardiyal koroner arterlere sahip tip II diyabetik hastalarda, egzersizle QT parametrelerindeki değişim ve buna trimetazidin tedavisinin etkisi araştırıldı.Gereç ve Yöntem: Çalışmaya koroner anjiografisi normal olan tip II diabetes mellitus (DM) tanısı almış 19 hasta (ortalama yaş; 52±15, erkek/kadın; 9/10) ve 20 sağlıklı birey (ortalama yaş; 51±11, erkek/kadın; 10/10) alındı. Tüm bireylere trimetazidinle 3 aylık tedavi öncesi ve sonrası Bruce protokolü ile semptom-sınırlı treadmill egzersiz testi (EST) uygulandı. Çalışmaya alınan bireylerin klinik, biyokimyasal, ekokardiyografik ve elektrokardiyografik değerleri kaydedildi. EST sırasında belli aralıklarla QT intervalleri, Bazzet formülüyle hıza göre düzeltililen QT dispersiyonu (QTcD) kaydedildi.Bulgular: EST öncesinde, hastaların QTcD değerleri kontrollerden yüksekti. Pik egzersizde ölçülen QTcD'de (pik QTcD) kontrol grubunda anlamlı değişiklik olmazken hasta grubunda belirgin bir artış (sırasıyla; 31.7±6.9 ms; p>0.05, 53.7±9.6 ms; p<0.001) saptandı. EST sonrası QTcD değerleri de azalmasına rağmen kontrollere göre yüksekti (43.4±8.1 ms; p<0.01) . Tedavi sonrasında yapılan EST öncesi, sonrası ve pik egzersizde hesaplanan QTcD değerleri azalmış ve kontrollerinkine benzer bulundu (sırasıyla; 34.7±6.9 ms, 35.9±8.9 ms, 33.9±7.3 ms, p>0.05). Bunlardan pik QTcD değerleri tedavi öncesine göre belirgin olarak azaldı (35.9±8.9 ms; p<0.005).Sonuç: Bu bulgular, tip II DM'li hastalarda QTcD'de özellikle egzersizle belirginleşen artışın ventriküler aritmiyi tetikleyebileceği ve dolayısıyla ani ölüm sıklığındaki artışla ilişkili olabileceğini düşündürmektedir. Trimetazidinle tedavi sonrası pik QTcD'deki belirgin azalma ilacın hücresel düzeydeki anti-iskemik etkisinden kaynaklanan dolaylı bir elektrofizyolojik sonuç olarak görülebilir.Öğe Effect of reperfusion P-wave duration and P-wave dispersion in acute myocardial infarction: Primary angioplasty versus thrombolytic therapy(2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Tamer, Ali; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Bulur, Serkan; Uyan, CihangirAtriyal fibrilasyon akut miyokard enfarktüslü hastalarda %10-20 sıklıkla görülen bir aritmidir. P dalga süreleri ve dispersiyonu sinus noddan çıkan uyarının atriyal yayılımının bozulmasını incelemede kullanılmaktadır. Bu çalışma akut ön duvar miyokard enfarktüsü geçirmiş hastalarda primer anjioplasti ve trombolitik tedavinin P dalga süre ve dispersiyonuna etkisini araştırmaktadır. Akut ön duvar miyokard enfarktüsü geçiren 24 kadın, 48 erkek toplam 72 hasta çalışmaya alındı. Hastalar primer anjioplasti ve trombolitik tedavi almak üzere randomize edildi. Klinik, ekokardiyografik ve EKG değerleri incelendi. Tedavi öncesi ve sonrası P dalga süreleri ve dispersiyonu karşılaştırıldı. Yaş, cinsiyet, sol ventrikül ejeksiyon fraksiyonu, sol atriyum çapları ve kardiyovasküler risk faktörleri açısından karşılaştırıldıklarında her iki grupta anlamlı istatistiksel farklılık bulunmadı. Primer anjioplasti grubunda tedaviden sonar P dalga süreleri ve dispersiyonu anlamlı olarak azalmış ve her iki grup karşılaştırıldığında p max ve dispersiyon azalması anjioplasti grubunda istatistiksel olarak daha fazla saptandı. Primer anjioplasti, P dalga süreleri ve dispersiyonunu trombolitik tedaviye göre anlamlı olarak azaltır.Öğe Efficacy of olmesartan therapy on fibrinolytic capacity in patients with hypertension(2011) Bulur, Serkan; Ozhan, Hakan; Erden, Ismail; Alemdar, Recai; Aydin, Mesut; Caglar, Onur; Basar, CengizThe efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 ± 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 ± 10.9 to 134.6 ± 12.7 mmHg and from 98.0 ± 6.3 to 83.9 ± 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 ± 41.91 vs. 48.60 ± 33.65 ng/ml, P = 0.001 and 8.09 ± 2.29 vs. 6.92 ± 1.42 ?g/l, P < 0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe Elastic properties of the ascending aorta and left ventricular function in patients with hypothyroidism(Blackwell Publishing, 2005) Özhan, Hakan; Yazıcı, Mehmet; Albayrak, Sinan; Erbilen, Enver; Bulur, Serkan; Akdemir, Ramazan; Uyan, CihangirBackground: We sought to clarify the possible role of elastic properties of the ascending aorta in the development of cardiac disease associated with hypothyroidism (HT). Methods: A total of 37 patients with HT (age: 39.3 +/- 8.9years) and 29 control subjects were studied. AscendingAortic (Ao) diameter, Ao elastic indexes, strain (AoST), distensibility (AoD), stiffness index (AoSI), and pressure strain modulus were calculated from the echocardiographically derived Ao diameters. Myocardial performance index (MPI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) were measured by Doppler echocardiography to assess diastolic LV function. Patients were treated with levothyroxine and followed-up for 6 months. Thyroid function tests and echocardiographic measurement's were repeated at the end of the study. Results: AoD (cm(2) dyn(-1) 10(-3)) and AoST (%) were significantly lower (3.8 vs. 6.1; P < 0.001, 7.4 vs. 12.6, P < 0.001; respectively), whereas AoSI was higher in HT patients (6.2 vs. 3.3; P < 0.001). After treatment, AoD and AoST were increased (5.7; P < 0.001 and 11.8; P < 0. 001; respectively), whereas AoSI was decreased significantly (3.7; P < 0. 001). Also, early / late mitral peak velocity ratio (Emax/Amax) was significantly lower in HT patients (1.19 vs 1.34; P < 0.001), whereas MPI was higher (0.52 vs. 0.42; P < 0.001). MPI showed a strong correlation with aortic root indexes [AoST (r = -0.61/P < 0.001); AoD, (r = -0.57/P < 0.002); AoSI, (r = 0.531P < 0.005)] in the HT group. After 6 months of therapy, MPI significantly decreased P < 0.001) and EIA ratios were normalized (P < 0.001). Conclusions: Ao root functions have an important role on diastolic LV function. Levothyroxine replacement therapy can reverse all of these adverse effects of HT.Öğe Images in emergency medicine: acute severe coronary spasm associated with 5-fluorouracil chemotherapy(Bmj Publishing Group, 2006) Duran, Sadık; Bulur, Serkan; Sözen, Serhat Bahadır; Bilir, Cemil; Uyan, Cihangir; Akdemir, RamazanCardiotoxicity is an uncommon adverse effect of 5-FU treatment. Prevalence of 5- fluorouracil (FU) - induced cardiotoxicity is 2–18%, and represents an interesting clinical challenge.1 A 62 year old male was admitted to our emergency department with severe dyspnea, chest pain, diaphoresis, nausea, and pruritis after the completition of a regimen of 5-FU chemotherapy for gastric adenocarcinoma.Öğe Membranous septal aneurysm causing severe tricuspid regurgitation and ring-like appearance(2005) Akdemir, Ramazan; Özhan, Hakan; Özer, İlker; Ünlü, Hakan; Bulur, Serkan; Uyan, CihangirAneurysm of the ventricular septum is a mechanism for spontaneous closure of ventricular septal defect. Also, it was considered as a benign condition; some valvular dysfunction and a source of systemic emboli might occur associated with aneurysm formation which is associated with VSD.1,2 Here, we report a patient with interventricular septal aneurysm causing severe tricuspid regurgitation and unique “ring-like” appearance associated with perimembranous VSD. A healthy looking female infant on day 10 of life was referred to our Cardiology clinic for echocardiographic evaluation. There was a grade of 3/6-ejection systolic murmur audible most prominent at the right sternal border. During routine neonatal examination chest x-ray and ECG were normal. An echocardiogram revealed defect which was 10 mm in diameter in the left ventricular membranous septal region. Left to right shunting was detected by color flow and spectral Doppler study and Qp/Qs was equal to 1. Any associated structure or significant tricuspid insufficiency was not disclosed. The patient was re-evaluated 1 year later. Echocardiography showed a free-floating circular image within the right ventricle with “ring-like” appearance just located below the tricuspid valve and severe tricuspid regurgitation associated with this image (Fig. 1A and 1B). Inferior Vena Cava was plethoric and peak RV systolic pressure was calculated as 85 mmHg. Multiple parasternal long–short axis, apical four-chamber and modified assessments revealed that the circular image was a cross section of an aneurysm formation associated with a membranous VSD (Fig. 1B and 1C). This is the first case to our knowledge causing this appearance and severe tricuspid regurgitationÖğe Multi vessel coronary artery dissection during primary angioplasty(2013) Aslantaş, Yusuf; Bulur, Serkan; Ça?lar, Sabri Onur; Albayrak, Enver Sinan; Yalçin, Sübhan; Özhan, HakanA 74-year-old man was admitted to our hospital with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation at anterior leads. The patient was taken to the catheterization laboratory for primary percutaneous coronary intervention. ChoICE® PT (Polymer Tip) floppy guide wire crossed the lesion subintimally. Simultaneously the patient had a new onset chest pain. Coronary angiography was proceeded which revealed a dissection in the proximal LAD until first diagonal branch (D1). On the right caudal projection very long dissections were detected in the proximal to distal parts of circumflex and intermediary arteries without any limitation in the distal coronary flow.Öğe Pulmonary embolism during echocardiography: Thrombus in transit(2006) Özhan, Hakan; Kaya, Ahmet; Yazıcı, Mehmet; Albayrak, Sinan; Erbilen, Enver; Bulur, Serkan[No Abstract Available]Öğe Relation between indices of end-organ damage and mean platelet volume in hypertensive patients(2012) Bulur, Serkan; Önder, Halil Ibrahim; Aslantas, Yusuf; Ekinozu, Ismail; Kiliç, Aliça?r; Yalcin, Sübhan; Bulur, ŞuleMean platelet volume (MPV) has been recognized as an independent risk factor of hypertension. Hypertensive end-organ damage worsens the prognosis in hypertensive patients. We aimed to investigate the relationship between MPV levels and subclinical end-organ damage in hypertensive patients. One hundred and sixteen hypertensive patients (81 women, 35 men, with a mean age of 53 ± 11) were included in the study. There was no correlation between MPV and left-ventricular mass index (LVMI) (r = 0.145; P = 0.14) or albuminuria (r = 0.009; P = 0.93). Among the individuals that had grade I and grade II retinopathy, MPV levels (8.3 ± 2 fL, 8.2 ± 1.3 fL; P = 0.28) were similar either. We concluded that there was no correlation between MPV and markers of end-organ damage in hypertensive patients. Copyright © 2012 Lippincott Williams & Wilkins.Öğe TEKHARF 2006 taramasında ölüm ve koroner olaylar: Kadınlarda mortalitede azalma, koroner kalp hastalığı genel prevalansında artma(2007) Onat, Altan; Albayrak, Sinan; Karabulut, Ahmet; Ayhan, Erkan; Kaya, Zekeriya; Küçükdurmaz, Zekeriya; Bulur, SerkanAmaç: TEKHARF Çalışması’nın temelde Marmara ve İç Anadolu dışındaki bölgelerde oturan ve 2006 yazında taranan kohortunda tüm-nedenli, koroner kökenli ölüm ve koroner kalp hastalığına (KKH) ait insidans ve prevalans verileri incelendi. Çalışma planı: Taramada toplam 1585 kişi (776 erkek, 809 kadın; ort. yaş 55.3±11.8) izlendi; bunlar ülke genelinde hayattaki TEKHARF kohortunun %49’unu oluşturuyordu. Ölüm konusunda birinci derece akraba ve/veya sağlık ocağı personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12 derivasyonlu EKG kaydı yapıldı. Yeni koroner olay, son taramadan beri gelişen, ölüme yol açan veya açmayan miyokard infarktüsü, yeni stabil angina ve/veya miyokard iskemisi şeklinde tanımlandı.Bulgular: Örneklemden 946’sı muayene edildi, 599 kişi hakkında bilgi edinildi ve 27 erkek ile 13 kadının öldüğü belirlendi. Yeni takip olarak eklenen 2842 kişi-yılı ile, 1990 yılından beri izlemede 45490 kişi-yılına ulaşıldı. Ölümlerden 15’i KKH kökenli sayıldı. Son tarama döneminde yıllık tüm ölüm oranı bin yetişkinde 14.1, koroner mortalite binde 5.1 düzeyinde bulundu. Kırk beş ile 74 yaş arası kesimde toplam yıllık mortalite son Türkiye taramasında binde 10.9’a (p=0.09), KKH’den ölüm prevalansı binde 5.6’ya geriledi. Gerilemeler kadınlarda belirgindi. Ortalama ölüm yaşının erkeklerde 67.1’ye, kadınlarda 75.9’a uzadığı görüldü. Koroner kalp hastalığı prevalansı 39-49 yaş grubunda %3, 50-59 yaş grubunda %11, 60 yaş ve üzerinde %27 bulundu. Bu prevalansın ülkede 2.75 milyon erkek ve kadını kapsadığı tahminine varıldı. Sonuç: Kırk beş ile 74 yaş arası kesimde tüm ölümler ile koroner kökenli ölümlerin özellikle kadınlarda azalma eğilimi içinde olduğu ve ortalama ölüm yaşının uzadığı görülmektedir. Buna karşılık, yaş gruplarına özgü KKH prevalansı hızla artma eğilimindedir.
