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Biomedical subjects

O Tasdemir

Publications and source records attributed to O Tasdemir.

32 records · Page 2Linked to original sources
PubMed1995

Low dose anticoagulation after St. Jude Medical prosthesis implantation in patients under 18 years of age.

Between September 1986 and January 1994, 129 St. Jude Medical prostheses were implanted in 113 patients who were 18-year-old or younger at the Cardiovascular Surgery Clinic of Turkiye Yuksek Ihtisas Hospital. Thirty-seven patients underwent aortic, 60 patients mitral and the remaining 16 patients double valve replacement. Overall hospital mortality was 7.9% (9/113). All patients received 2.5 mg/day warfarin from the first postoperative day, in addition 225 mg/day dipyridamole and 100 mg/day aspirin was given following the removal of mediastinal tubes. This regimen was continued indefinitely thereafter. Follow up period ranged between 2-94 months. Total follow up experience was 276.4 patient-years. There were five late deaths; the cause of death was prosthetic valve thrombosis in two patients, intracerebral hemorrhage in one, cardiomyopathy in one, and sudden death in one. Other late complications included one endocarditis, a further anticoagulant related bleeding and one paravalvular leak. There was no case of cerebral or peripheral embolism reported. Seven-year actuarial survival was 92.4 +/- 6.8% for the entire group, 84.6 +/- 13.8% after mitral and 100% after aortic or double valve replacement. In conclusion, low dose oral anticoagulation after heart valve replacement with St. Jude Medical prosthesis in this age group showed satisfactory clinical results.

Adolescent↗
PubMed1994

Coronary sinus retroperfusion combined with intraaortic balloon pumping to perfuse the acutely ischemic myocardium.

This study was planned to show the effect of retroperfusion and intraaortic balloon pumping (IABP) on myocardial hemodynamic recovery. Twelve dogs entered this study. Half of them received IABP and coronary sinus retroperfusion (CSPR) combination (Group II) and the remaining received IABP alone (Group I). Left anterior descending artery was occluded for a period of three hours. 15 minutes after occlusion IABP and IABP + CSRP were initiated. The average cardiac output was 1.41 +/- 0.18 L/min in the group I and 1.72 +/- 0.24 L/min in the group II (p < 0.03) after 3 hours of occlusion. Mean arterial pressure was 82.1 +/- 4.8 mmHg in the group I and 89.7 +/- 2.6 mmHg in the group II (p < 0.03). On the basis of this study it was concluded that CSRP + IABP could be an alternative treatment to IABP alone during the acutely developing ischemia.

Acute Disease↗
PubMed1993

Low-dose anticoagulant management of patients with St. Jude Medical mechanical valve prostheses.

Between February 1984 and December 1990, 622 St. Jude Medical valves were implanted in 548 patients. There were 382 males (69.7%) and 166 females (30.3%) with a mean age of 32.3 +/- 11.9 years (range 9-68 years). Sixty-eight percent of the patients were referred from rural areas. Three hundred and forty patients underwent aortic valve replacement (AVR), 134 had mitral valve replacement (MVR), and 74 had aortic and mitral valve replacement (DVR). The hospital mortality was 4.7% (16/340) for AVR, 6.7% (9/134) for MVR and 10.8% (8/74) for DVR. Follow-up period ranged from 1.1 to 7.2 years. Total follow-up was 1317.3 patient-years (py). All patients received 2.5 mg warfarin, 225 mg dipyridamole, and 250 mg aspirin daily, regardless of prothrombin time and cardiac rhythm. Thromboembolism was observed in 10 patients (0.75 py); there were 3 mortalities (0.22% py). Valve thrombosis occurred in 4 patients (0.30% py): 3 in the MVR group (0.94% py) and 1 in the AVR group (0.11% py). Hemorrhage occurred in 19 patients (1.44% py) with 11 fatal outcomes (0.83% py). It is concluded that a random daily dose of 2.5 mg warfarin with 225 mg dipyridamole and 250 mg aspirin is sufficient for safe anticoagulation without the need for serial prothrombin-time adjustments.

Adolescent↗
PubMed1992

Surgical approach to pseudoaneurysms with Behçet's disease.

One of the arterial complications of Behçet's disease, arterial false aneurysms, has a sudden onset of symptoms and high mortality risk if left untreated. Four cases with arterial pseudoaneurysms of 3 male patients is reported and the choice of surgical intervention is emphasized. It is underlined that PTFE grafts are the graft of choice in reconstructions for arterial complications of Behçet's disease.

Adult↗
PubMed1989

In vitro thrombolysis of thrombosed valve prostheses: therapeutic considerations of left-sided thrombotic lesions.

Six thrombosed Bjørk-Shiley mitral valve prostheses which had been removed in emergency reoperations between November 1985 and December 1986 underwent in vitro thrombolysis with urokinase. After a mean period of 14 +/- 3 h of in vitro fibrinolysis, lysis of thrombus was observed, but large fragments of organized thrombus were released into the medium, suggesting that thrombolytic therapy should not be used for thrombotic occlusions on the left side of the heart, as the risk of systemic embolization is high.

Heart Valve Prosthesis↗
PubMed1989

Congenital coronary artery fistulas. Diagnostic and surgical considerations.

Between 1974 and April, 1988, 9 patients with congenital coronary artery fistulas underwent surgical repair. Of these, 4 were female and 5 male, ranging in age from 6 to 50 years (mean 28.2 +/- 18.9). Seven patients were symptomatic (congestive heart failure and/or angina), whereas in 2 patients the diagnosis was established through the investigation of an asymptomatic continuous murmur. The origin of the fistula was the left main coronary artery in 1, left anterior descending artery (LAD) in 2, circumflex artery (Cx) in 3, Cx + LAD in 2 and LAD + right coronary artery in 1 patient. The sites of termination of the fistulous tract were the pulmonary artery in 6, the right atrium in 1, the right ventricle in 1 and the left ventricle in 1 patient. In 2 cases the fistulous tracts were ligated without utilizing cardiopulmonary bypass (CPB). In 7 cases CPB was instituted and in 6 of these the fistulous communications were closed from within the termination chamber, in 1 patient the fistula was closed through a coronary arteriotomy during elective ventricular fibrillation. There was no operative mortality and long term follow-up was uneventful after a mean follow-up of 5.4 +/- 5.2 years, with 8 patients still completely asymptomatic. Surgical therapy is recommended for patients having coronary artery fistulas in order to prevent fistula-related complications. In those cases requiring CPB, closure of the fistula from the involved chamber only is suggested.

Adolescent↗
PubMed1989

The association of lower extremity peripheral vascular disease in patients undergoing coronary bypass surgery.

The association of lower extremity peripheral vascular disease (PVD) in patients undergoing coronary artery bypass (CAB) has been studied in two groups of patients who have been operated upon between January and May 1987. Group 1 consists of 125 cases in which only resting ankle-arm pressure index (AAPI) were evaluated. Group 2 consists of 50 cases where both resting and after exercise AAPI were recorded. In total, 17 cases of one extremity and in 10 both lower extremity resting AAPI were below 0.9 (15.4%). In Group 2 comparison of resting and after exercise AAPI on both sides showed no statistically significant difference. However in Group 2, 13 cases (26%) had after exercise AAPI below 0.9 and in 26 (52%) cases after exercise AAPI were lower than the resting AAPI. This study showed that, although the coexistence of PVD in patients undergoing CAB is not as high as the coexistence of CAD in patients undergoing peripheral vascular procedures, this percentage can increase when the presence of PVD is evaluated with an exercise test whenever possible.

Adult↗
PubMed1986

Fistulous communication of aortic sinuses into the cardiac chambers. Fifteen years surgical experience and a report of 23 patients.

Over the past 15 years 23 patients, aged 14-50, with aortic sinus-cardiac chamber fistulous communication have been operated upon. All were symptomatic and had angiographic evaluation before surgery. The last 5 were diagnosed by two-dimensional echocardiography. The origin of the fistula was the right aortic sinus in 22 and the non-coronary sinus in 1. The involved cardiac chamber was the right ventricle in 18, right atrium in 3 and left ventricle in 2. Associated lesions were ventricular septal defect (VSD) in 9, ventricular septal defect + atrial septal defect (VSD + ASD) in 1, ventricular septal defect + pulmonary stenosis (VSD + PS) in 1, atrial septal defect (ASD) in 3 and congenital aortic stenosis (AS) in 1. At surgery both the aorta and involved cardiac chamber were opened. No recurrence was encountered when the fistula was repaired using teflon felts on both ends. Three patients, 2 of whom had been operated upon before the use of cardioplegic arrest, died (13%).

Adolescent↗
PubMedDate not supplied

Effects of carnitine on preconditioned latissimus dorsi muscle at different burst frequencies.

Exercise and electrical stimulation may result in a decrease in carnitine levels associated with preconditioned latissimus dorsi muscles. Therefore, the effects of exogenous carnitine were studied in a model of latissimus dorsi muscle contraction. Twelve dogs were studied. Under anesthesia, the latissimus dorsi was placed around an implantable mock circulation system. The muscle was made fatigue-resistant with the aid of chronic low-frequency electrical stimulation. Six animals received carnitine 0.15 mmol/kg; the other six served as control. The muscles were stimulated with 20, 43, and 85 Hz pulse training. During the 90-minute stimulation period, the pressure that developed in the mock circulation was measured at 15 minute intervals. The changes in ATP and lactate levels were measured every 30 minutes. Stimulations at 20 and 43 Hz did not result in any change in pressure or metabolic data over the course of 90 minutes of stimulation. When the 85 Hz burst was applied, ATP levels decreased, while lactate levels increased, with an associated drop in pressure in the control group. ATP and lactate levels were, respectively, 13.8 +/- 1.4 mumol/g and 15.0 +/- 4.0 mumol/g in the carnitine group and 10.3 +/- 1.1 mumol/g and 23.0 +/- 3.0 mumol/g in the control group at the end of 90 minutes (p < 0.06). The pressure at the same time interval was 74 +/- 4 mmHg in the control group, and 85 +/- 3 mmHg in the carnitine group (p < 0.05). In this study, we demonstrated that carnitine administration enhances muscle performance in terms of metabolic and pressure changes during high-frequency electrical stimulation at 85 Hz.

Adenosine Triphosphate↗
PubMedDate not supplied

Aortic valve replacement with the St. Jude Medical prosthesis and fixed dose anticoagulation.

Over a 10-year period, between 1986 and 1996, 865 patients underwent primary aortic valve replacement (AVR) with the St. Jude Medical mechanical prosthesis. Patients who had undergone valve replacement with a different type of prosthesis previously were excluded from this study. Patient age ranged from 11 to 79 years. The mean age was 42.9 +/- 14.54. The gender distribution was 396 men (45.8%) and 469 women (54.2%). All patients received 2.5 mg/day Coumadin after extubation. A combination of the antiaggregant therapy (Dypridamole 3X 75 mg/day, Asprine 100 mg/day) was added after removal of the chest tubes. The dosage of Coumadin was maintained constant regardless of the prothrombin time (PT) or cardiac rhythm. There were 101 valve-related complications (4.2% per patient year [ppy]) occurring in the late follow-up period. Of these complications; 38 were anticoagulant-related hemorrhage (1.58% ppy), 3 were paravalvular leak (0.12% ppy), and 36 were thromboembolism (1.4% ppy). There were 24 reoperations (0.99% ppy) and 17 late deaths. The linearized late mortality rate was 0.7% ppy. Long-term survival estimates at 5 and 10 years were 97.14 +/- 0.82% and 94.86 +/- 1.54%, respectively. We conclude from the data that the St. Jude Medical valve may allow the use of a low level of anticoagulation. This study shows that fixed dose oral anticoagulation does not increase the rate of thromboembolism in patients with the St. Jude aortic valve. This protocol does not result in reduction of bleeding complications, however.

Adolescent↗
PubMedDate not supplied

Heparin need of the patients with cyanotic congenital heart disease during cardiopulmonary bypass. Comparison of cyanotic, acyanotic, rheumatic and atherosclerotic subjects.

Four groups of patients were studied. Group I: Congenital cyanotic heart disease (CCHD), consisting of 24 subjects aged 5 to 28 (1.4); 18 males and 4 females. Group II: Acyanotic congenital heart disease (ACHD), consisting of 34 patients aged 5 to 42 (20.1); 17 males and 17 females. Group III: Rheumatic heart disease (RHD), consisting of 30 patients aged 11-54 (42.4); 9 males and 21 females. Group IV: Atherosclerotic heart disease (AHD), consisting of 35 patients aged 36 to 65 (49.2); 33 males and 2 females. The haematocrit value (Hct) was the highest in the CCHD group. Total amount of heparin (mg/kg) used during cardiopulmonary bypass was 5.4 in CCHD, 4.66 in ACHD, 4.8 in RHD and 4.6 in AHD group. Mean protamine values was 4.02; 4; 4.03; and 4 respectively. Although the difference of Hct value was statistically different between CCHD and RHD group (p less than 0.001), heparin need was not (p less than 0.1). One-way analysis of variance (F test) showed no difference for heparin need between the four groups (F3.119 = 0.64). Prothrombin time (PT) and activated partial thromboplastin time (aPTT) showed a positive correlation (r = 0.36 and r = 0.25) with heparin need in CCHD group but no correlation was found in RHD group.

Adult↗
PubMedDate not supplied

Surgical treatment of Ebstein's anomaly: valve replacement and reconstruction.

Because of the relative infrequency of Ebstein's anomaly the type of effective surgical treatment remains controversial. Various authors have reported different results depending upon the type of surgical treatment involved. In TYIH between 1974-1987, 30 cases with Ebstein's anomaly have been operated upon; 12 cases underwent surgical repair and in the remaining 18 cases a tricuspid valve replacement was performed. Four out of the 12 reconstruction cases remained on cardiopulmonary by-pass (CPB) because of the failure of the right ventricle and artificial valves were implanted in these cases. One of these patients died. In all, 3 patients died as a result of annuloplasty and the postoperative courses of these patients were eventful. Among the remaining 18 patients with artificial valve replacement only one patient died and the remainder of the tricuspid valve replacement group had an uneventful postoperative period.

Adolescent↗