Hasan Sunar - Academia.edu (original) (raw)

Papers by Hasan Sunar

Koşuyolu heart journal, Apr 11, 2016

Post-myocardial infarction (MI) ventricular septal defect (VSD) one of the fatal complications of... more Post-myocardial infarction (MI) ventricular septal defect (VSD) one of the fatal complications of acute coronary syndrome-is a rare clinical situation (incidence, 1-2%) (1). Post-MI VSD is often presented with total left anterior descending artery (LAD) occlusion; it mostly occurs at anterolateral localization and less often at posterior localization after inferior MI (2). A 55 year old male patient came to the emergency room with chest pain. He was diagnosed with inferior MI and was taken to the angiography laboratory for primary percutaneous coronary intervention (PCI). There was ST elevation at the inferior leads on electrocardiogram. On angiography, LAD and circumfl ex artery (Cx) were normal-without critical stenotic lesions and distal RCA was totally occluded (Figure 1A,1B,2A). The stenotic lesion was opened with successful PCI and stent implantation (Figure 2B,C). The patient was discharged with cure. The same patient came with the complaints of fatigue and exertional dyspnea 1 month later. On echocardiography, a ventricular septal defect was seen at the anterior portion of the septum near the baseline segment of the heart. On arrival, his blood pressure was 90/60 mmHg and pulse was 100 bpm. He was immediately admitted to the ICU. After stabilization with inotropic support and intraaortic balloon pump, he was urgently taken to the operating room. The operation was performed under general anesthesia and cardiopulmonary bypass. An incision was made on the diaphragmatic surface of the heart through the left ventricle next to the interventricular septum. The interior of the left ventricle was exposed with this incision, and the septal defect on the anterior surface near the baseline of the heart was repaired with a Dacron patch. Being reinforced with Tefl on felt, the ventriculotomy incision was closed primarily (Figure 3A,B,C). Post-MI VSD is often seen as a complication of anterior MI. It is primarily involved with total LAD occlusion and less often with additional Cx and/or right coronary artery (RCA) lesion(s). In this case, the interesting point is that LAD and Cx were completely normal without critical stenotic lesions while the isolated total RCA occlusion was seen. Post-MI VSD can be seen

Interactive Cardiovascular and Thoracic Surgery, Jun 1, 2011

Arterial tortuosity syndrome (ATS) is a rare connective tissue disease characterized by aneurysms... more Arterial tortuosity syndrome (ATS) is a rare connective tissue disease characterized by aneurysms and stenosis of large elastic arteries. In this case report, we present the case of an eight-year-old with ATS who underwent successful hemi-arch and ascending aortic replacement with tube graft.

Turkish Journal of Thoracic and Cardiovascular Surgery, Oct 22, 2020

Elli bir yaşında kadın hasta, sol üst ekstremitede uyuşma ve his kaybı ile kliniğimize başvurdu. ... more Elli bir yaşında kadın hasta, sol üst ekstremitede uyuşma ve his kaybı ile kliniğimize başvurdu. Sol dirseğin üzerinde ve altında yaygın periferik ödem izlendi. Hastanın semptomları, daha önce yapılan mastektomi ameliyatı sırasındaki aksiler lenfatik nodüler diseksiyon ile ilişkili idi. Hasta lenfatikovenüler anastomoz ile minimal invaziv süpermikrocerrahi tekniği kullanılarak başarılı bir şekilde tedavi edildi.

Van Medical Journal

Ascending aorta aneurysm (AAA) is clinically due to the potential for life-threatening complicati... more Ascending aorta aneurysm (AAA) is clinically due to the potential for life-threatening complications, notably acute aortic syndromes such as aortic dissection and rupture (1,2). The occurrence of combined AAA and aortic dissection has been reported to be 6 to 13 per 100.000 per year, despite this overlooked clinically undetected AAA (3-5). Since there are currently no reliable prevention methods for TAA, early discovery, surveillance, and treatment are essential to enhancing outcomes (1,6). According to research, ascending aortic aneurysms are most frequently caused by idiopathic cystic medial degeneration. Aging is a typical process that causes the elastic fibers in the vascular wall to fragment and degrade. The etiology of the formation of ascending aortic aneurysm, as many diseases still

Genel Tıp Dergisi

Backround: Dacron, polytetrafluoroethylene, great saphenous vein, and bovine pericardium are the ... more Backround: Dacron, polytetrafluoroethylene, great saphenous vein, and bovine pericardium are the commonly used as patch materials. However, there is no study about autologous pericardial as a patch material in carotid endarterectomy surgery. We aimed to assess the results of the use of autologous pericardial patch in patients undergoing concomitant carotid endarterectomy and coronary artery by-pass graft surgery. Materials and Methods:: The study involved 30 patients who underwent concomitant carotid endarterectomy with patch angioplasty and coronary artery bypass grafting surgery from January 2016 to February 2020. Patchplasty is performed with autologous pericardium for 13 patients and dacron patch for 17 patients during carotid endarterectomy. Results: No statistical difference was found between the groups in terms of reoperation, arterial occlusion, restenosis, operation time, and neurological events. In the postoperative follow-up, it was determined that the amount of drainage ...

Turkish Journal of Thoracic and Cardiovascular Surgery, Jul 1, 2022

Altmış beş yaşında erkek hasta alt ekstremitede şişlik, ağrı ve akıntılı yara ile kliniğimize baş... more Altmış beş yaşında erkek hasta alt ekstremitede şişlik, ağrı ve akıntılı yara ile kliniğimize başvurdu. Diz altında yaygın ödem, cilt enfeksiyonu ve lenfanjite sekonder Evre 3 lenfödem vardı. Konvansiyonel tedavi yöntemlerinin yanı sıra, subkütan silikon tüp implantasyonu ile lenfatik yapay yol oluşturuldu. Sonuç olarak, subkütan silikon tüp implantasyonu ileri evre lenfödem hastalarında uygulanabilecek, kompresyon tedavisinin etkinliğini artıran yeni bir yöntemdir.

Koşuyolu Heart Journal, 2021

Introduction: Vacuum-assisted closure of sternal infected wounds has been reported to improve mor... more Introduction: Vacuum-assisted closure of sternal infected wounds has been reported to improve morbidity and mortality, besides decreasing duration of hospitalization. The aim of this study was to evaluate early outcomes of vacuum-assisted closure of infected sternal wounds after coronary bypass surgery in our clinic. Patients and Methods: Sixty six patients who had sternal wound infection after coronary bypass surgery in our hospital between January 2016 and December 2019 were included in the study. After surgical debridement and removal of foreign materials, vacuum-assisted closure therapy was initiated at a mean postoperative 26.56 ± 5.5 days. After wound healing and negative cultures, treatment was terminated and sternal wounds were closed with appropriate procedures. Results: Fifty six patients (84.84%) had deep sternal infection and 10 patients (15.15%) had superficial sternal infection. Early mortality was 13.63% (nine patients), all having deep sternal infections. The most co...

Marmara Medical Journal, 2012

Amac: Kalp cerrahisi sonrasinda insulin tedavisi verilmesinin uzun donemde mortalite uzerinde olu... more Amac: Kalp cerrahisi sonrasinda insulin tedavisi verilmesinin uzun donemde mortalite uzerinde olumlu etkileri gosterilmistir. Bu calismanin amaci kardiyak cerrahi gecirecek diyabetik hastalarda taburculuk sirasinda duzenlenen 3’lu karisim insulin ve 4’lu bazal-bolus insulin tedavilerinin etkinliklerinin karsilastirilmasidir. Hastalar ve Yontem: Calismaya Kartal Kosuyolu Yuksek Ihtisas Egitim ve Arastirma Hastanesi’nde koroner arter bypass cerrahisi geciren 34 diyabetik hasta dahil edilmistir. Bu hastalarin preoperatif donemde aclik kan sekeri (AKŞ), tokluk kan sekeri (TKŞ), hemoglobin A1c (HbA1c) degerleri ve hemogramlari belirlenmistir. Postoperative1. haftada (taburculukta) ayni kan tetkikleri tekrarlanmis ve hastalara randomize olarak 3’lu veya 4’lu yogun insulin tedavisi baslanmistir. Uc aylik takip suresinin sonunda baslangicta yapilan olcumler tekrarlanmistir. Bulgular: Calismaya alinan 17 kisi (61,5±8,5 yil; K/E:9/8) 3’lu kola (1. Grup), 17 kisi (57,4±9,2; K/E:10/7) ise 4’lu ...

The Medical Journal of Okmeydani Training and Research Hospital, 2015

Bulgular literatürdeki çalışma sonuçları ile benzer özellikler gösterdi. Lepra olguları nazal yak... more Bulgular literatürdeki çalışma sonuçları ile benzer özellikler gösterdi. Lepra olguları nazal yakınma tariflemeseler dahi nazal muayene ile değerlendirilmelidirler. Temas öyküsü olan veya endemik yerlerde bulunan olgularda fizik muayenede kurutlanma, ülserasyon, nazal lezyon saptananlarda lepra ön tanısı akla getirilmeli, erken tanı ve multidisipliner tedavinin nazal defortmitelerin oluşumunu engelleyebileceği unutulmamalıdır.

Kosuyolu Kalp Dergisi, 2014

Kosuyolu Kalp Dergisi, 2013

Kardiyak operasyonlar sonrasında cerrahi alan enfeksiyonları önemli bir morbiditedir. Diyabetik h... more Kardiyak operasyonlar sonrasında cerrahi alan enfeksiyonları önemli bir morbiditedir. Diyabetik hastalarda enfeksiyona eğilim artmaktadır. Bu çalışmanın amacı; merkezimizde operasyon sonrası görülen cerrahi alan enfeksiyonlarını, diyabetik olan ve olmayan hastalarda karşılaştırmaktır.

Polish Journal of Cardio-Thoracic Surgery, 2013

Wstęp: Krwawienie pooperacyjne jest istotnym powikłaniem po operacjach na otwartym sercu. Restern... more Wstęp: Krwawienie pooperacyjne jest istotnym powikłaniem po operacjach na otwartym sercu. Resternotomia w celu zatrzymania krwawienia jest istotnym źródłem śmiertelności i chorób. Cel pracy: Celem pracy było zidentyfikowanie częstych miejsc krwawienia po operacjach na otwartym sercu oraz przedstawienie wyników w tym zakresie. Materiał i metody: Pomiędzy styczniem 2003 r. a styczniem 2013 r. autorzy niniejszej pracy przeprowadzili 2286 operacji na otwartym sercu. Reoperacja w celu zatrzymania krwawienia wykonywana była w wypadku krwawienia przekraczającego 3 ml/kg m.c./godz. w ciągu pierwszych 3 godzin, nieustającego krwawienia powyżej 200 ml/godz. lub klinicznych objawów tamponady. Wszystkie reoperacje wykonywano w bloku operacyjnym. Dane dotyczące pacjentów oraz miejsc krwawienia zostały zapisane. Wyniki: Reoperacji ze względu na krwawienie lub tamponadę zostało poddanych 98 pacjentów (4,3%). Przyczyny krawienia inne niż operacyjne zaobserwowano u 44 pacjentów (44,9%). Głównymi miejscami krwawienia były: lewa gałąź boczna tętnicy piersiowej wewnętrznej (17,4%) oraz gałąź boczna przeszczepu żyły odpiszczelowej (13,3%). Zmarło 13 pacjentów (13,3%). Wnioski: Pilne reoperacje ze względu na krwawienie lub tamponadę po operacjach na otwartym sercu stanowią poważny problem. Wysoki odsetek ponownie operowanych wynikał z błędów technicznych przy pobieraniu materiału do przeszczepów. Czynników hematologicznych powodujących krawienie nie da się wyeliminować, ale można zmniejszyć liczbę poprawialnych przyczyn, które zazwyczaj zależne są od chirurga. Powinno to przyczynić się do zmniejszenia śmiertelności oraz występowania chorób po operacjach na otwartym sercu. Słowa kluczowe: kardiochirurgia, krwawienie pooperacyjne, tamponada serca.

Turkish Journal of Thoracic and Cardiovascular Surgery, 2014

İnsüline bağlı diyabeti olan hastalarda gerçekleştirilen koroner arter baypas greft cerrahisinde ... more İnsüline bağlı diyabeti olan hastalarda gerçekleştirilen koroner arter baypas greft cerrahisinde serum nötrofil jelatinaz ilişkili lipokalin belirteci böbrek fonksiyonlarındaki bozulmayı erken dönemde belirler mi? Does serum neutrophil gelatinase-associated lipocalin biomarker detect the early deterioration in renal functions in patients with insulin-dependent diabetes mellitus undergoing coronary artery bypass graft surgery?

Balkan Medical Journal, 2001

Infection, 2012

We present a case of community-acquired left-sided Pseudomonas aeruginosa endocarditis in a perso... more We present a case of community-acquired left-sided Pseudomonas aeruginosa endocarditis in a person without intravenous drug use. The patient presented with facial numbness and did not have any predisposing condition for endocarditis. He was treated successfully with valvular surgery, along with combination antibiotics.

Postepy w kardiologii interwencyjnej = Advances in interventional cardiology, 2017

The arteriovenous (AV) loop is recommended when further support is needed during paravalvular lea... more The arteriovenous (AV) loop is recommended when further support is needed during paravalvular leak (PVL) closure. We report the feasibility and safety of mitral PVL closure without constructing an AV loop, based on a single-centre experience. Fourteen patients with mitral valve replacement (MVR) who had New York Heart Association (NYHA) class III-IV dyspnoea or NYHA class II symptoms with significant haemolytic anaemia caused by severe or moderate-to-severe paravalvular regurgitation and who underwent transcatheter PVL closure (TPVLC) between May 2014 and February 2017 were enrolled. In total, 15 PVL procedures and 19 device deployments were performed. The patients had one (= 10), three (= 1) or four (= 1) devices for closure at the time of the procedure; one patient had two devices from two procedures at different times with different access ways. Nineteen devices (10 (66.6%) via transseptal access; 4 (26.6%), transapical access; and 1 (6.6%), retrograde access) were deployed succe...

Turkiye Klinikleri Cardiovascular Sciences, 2014

Akut ekstremite iskemisi tedavisi sonrası gelişen reperfüzyon hasarı ciddi mortalite ve morbidite... more Akut ekstremite iskemisi tedavisi sonrası gelişen reperfüzyon hasarı ciddi mortalite ve morbiditeye yol açabilen klinik bir durumdur. Ekstremitenin reperfüzyonu tam olarak sağlansa bile ekstremite kaybına, akut böbrek ve solunum yetmezliğine yol açabilir. Bu çalışmada, sıçan infrarenal abdominal aortunda oklüzyon-reperfüzyon sonrası böbreklerde oluşan iskemi/reperfüzyon hasarı üzerine C vitamini ve papaverinin etkisi araştırıldı. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Otuz iki adet Sprague-Dawley cinsi dişi sıçan randomize olarak, eşit sayıda (n=8) dört gruba ayrıldı. Tüm sıçanlara aynı cerrahi prosedür uygulandı. İnfrarenal aortaya mikrovasküler klemp konularak 60 dakika iskemi oluşturuldu, ardından klemp kaldırılarak 120 dakika reperfüzyon uygulandı. Kontrol grubu ve iskemi reperfüzyon grubuna ek bir ilaç verilmezken, diğer iki gruba C vitamini ve papaverin HCL verildi. Alınan böbrek dokuları formaldehit ile fikse edildi ve kesitler alınarak Hematoksilen-Eozin ile boyandı. Preparatlar ışık mikroskobunda değerlendirildi. B Bu ul lg gu ul la ar r: : Histopatolojik incelemede kontrol grubu ile iskemi/reperfüzyon grubu arasında anlamlı patolojik değişiklik tespit edildi. C vitamini grubunda Bowman kapsül dilatasyonu, tübül epitel dejenerasyonu, tübüler dilatasyon, damar konjesyonu istatistiksel olarak anlamlı iken, interstisyel inflamatuar infiltrasyon anlamsızdı. Papaverin grubunda Bowman kapsül dilatasyonu, tübül epitel dejenerasyonu, tübüler dilatasyon istatistiksel olarak anlamlı iken, damar konjesyonu, interstisyel inflamatuar infiltrasyon anlamsızdı. S So on nu uç ç: : C vitamininin serbest radikal temizleyici etkisi ve papaverinin vazodilatatör etki ile mikrosirkülasyonu koruyarak akut alt ekstremite iskemilerinde reperfüzyon sonrası böbrekte gelişecek hasarı azaltabileceğini gözlemledik. A An na ah ht ta ar r K Ke el li im me el le er r: : İskemi; reperfüzyon; akut böbrek hasarı; papaverin; askorbik asit A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The reperfusion injury that occurs after the treatment of acute extremity ischemia, is a clinical manifestation causes serious morbidity and mortality. Even if extremity reperfusion is totally provided, it may cause extremity loss, acute renal and respiratory failure. In this experimental study, the effect of vitamin C and papaverine on ischemia-reperfusion injury in kidneys occuring after occlusion-reperfusion of rat infrarenal abdominal aorta was investigated. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 32 Spraque-Dawley female rats were randomly divided into four equal groups (n=8). The same surgical procedure was applied to all rats. The microvascular klamp was put on infrarenal aorta and 60 minutes of ischemia was applied, then the klamp was removed and 120 minutes of reperfusion was supplied. The control and the ischemia-reperfusion groups were not given any drug and the other two groups were given vitamin C and papaverine. The incised renal tissues were fixed with formaldehyde then the samples were stained with Hematoxylin-Eosin. The samples were examined by light microscopy. R Re es su ul lt ts s: : Meaningful pathological alterations were found out between ischemia and reperfusion group and control group. In vitamin C group, while dilatation of Bowman's capsule, tubular epithelial degeneration, tubular dilatation, and vascular congestion were statistically significant, interstitial inflammatory infiltration was meaningless. In papaverine group, dilatation of Bowman's capsule, degeneration of tubular epithelium, and tubular dilatation were statistically significant, vascular congestion and interstitial inflammatory infiltration were meaningless. C Co on nc cl lu us si io on n: : We observed that the radical scavenging effect of vitamin C and vasodilatatory effect of papaverine may reduce the renal injury after the reperfusion in the acute lower extremity ischemias by preserving the microcirculation.

Case Reports in Vascular Medicine, 2015

A 45-year-old male being otherwise healthy presented acute onset of right upper extremity ischemi... more A 45-year-old male being otherwise healthy presented acute onset of right upper extremity ischemia. On physical examination, axillary artery could be palpated whereas the brachial artery could not be palpated below the level of the antecubital fossa, including radial and ulnar artery pulses. Pulses were also inaudible with pocket-ultrasound below the level of the brachial artery bifurcation. The patient was initially diagnosed to have acute thromboembolic occlusion and given 5000 IU intravenous heparin. The patient was taken to the operating room. We noticed that the ischemic symptoms disappeared within a couple of minutes just before we began the operation. However, ischemic symptoms reappeared six hours later and computed tomography angiography showed lack of enhancement below the elbow crease. We were taking the patient to the operating room for the second time when the symptoms recovered in a few minutes, again. The operation was not canceled anymore. In the operation, the brach...

Hippokratia, 2013

Vascular complications of cardiac catheterization have increased in line with increasing number o... more Vascular complications of cardiac catheterization have increased in line with increasing number of percutaneous interventions. Open repair is the standard method of treatment for true and false aneurysms of femoral artery. We report results of patients operated due to femoral artery pseudoaneurysm after cardiac catheterization. Data from 12,261 patients who underwent percutaneous intervention for cardiac catheterization between January 2003 and January 2013 were evaluated. Diagnosis of pseudoaneurysm was established mainly by doppler ultrasonography in patients with complaints of pain and hematoma at the intervention site. Pseudoaneurysms less than 2 cm in diameter were treated non-operatively and were followed up by regular ultrasonographic examination at the outpatient clinic. Pseudoaneurysms with a diameter of 2 cm or more underwent primary repair. All patients were followed up for one year. We detected 55 (0.44%) patients with femoral artery pseudoaneurysm and 42 of them were op...