Tayfun Gürol - Academia.edu (original) (raw)
Papers by Tayfun Gürol
Echocardiography, 2018
The development of an aorto‐right ventricular fistula is a rare complication of cardiac surgery. ... more The development of an aorto‐right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four‐dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto‐right ventricular (AO‐RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO‐RV fistula.
Turkiye Klinikleri Cardiovascular Sciences, 2019
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2018
It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, ... more It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, and rivaroxaban increase the risk of bleeding complications during or after coronary catheterization. The aim of this study was to investigate the safety of uninterrupted DOAC treatment during diagnostic radial coronary angiography (CAG). Methods: This study included 160 patients who underwent diagnostic radial cardiac catheterization. The 60 patients in the group who were using a DOAC (apixaban, rivaroxaban, or dabigatran) were enrolled in a Group A. Post-procedure results from patients in Group A were compared with those of an ageand sex-matched control group (Group B) that included 100 patients who underwent radial CAG who did not use a DOAC. Results: There was no significant difference in the procedure and compression times, creatinine level, or presence of hypertension, diabetes mellitus, smoking, alcohol use, vascular disease, or congestive heart failure between the 2 groups. During the 1-month follow-up period, only 1 radial occlusion was registered in the control group (Group B). There was no case of a large hematoma (>5 cm or extending to the forearm), dissection, fistula, perforation, or compartment syndrome. Hematomas smaller than 5 cm were seen in 2 patients (1 in each group). No thrombotic events were observed during follow-up examinations. Conclusion: Performing radial CAG with uninterrupted DOAC treatment appears to carry no risk of increased early or short-term complications. The simple, uninterrupted DOAC strategy is comfortable, easy, and safe.
Balkan Medical Journal, 2017
Background: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pr... more Background: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pressure gradient, which is affected by flow rate. Case Report: We report the first case of a pregnant patient with atrial septal defect (ASD) and pulmonary stenosis that was misclassified by conventional echocardiographic methods. Most importantly, threedimensional transoesophageal echocardiographic assessment of pulmonary stenosis changed the entire treatment strategy. Conclusion: The planimetric calculation of the pulmonary valve (PV) opening area using threedimensional transoesophageal echocardiographic may be helpful, especially in encounters with specialized conditions such as ASD and/or pregnancy, which can cause inaccurate recordings of the transvalvular peak gradient.
The International Journal of Cardiovascular Imaging, 2017
Transplantation Proceedings, 2015
As vascular diseases are becoming more prevalent among renal transplant recipients, complications... more As vascular diseases are becoming more prevalent among renal transplant recipients, complications related to renal artery anastomosis are likely to occur more often. Here we report a renal transplant patient treated with femoro-femoral bypass who had renal allograft dysfunction due to aorto-iliac occlusive disease (AIOD) proximal to renal artery anastomosis. We performed living donor renal transplantation in the left iliac fossa of a 41year-old male. At post-transplant 30 months, he was admitted with hypertension, increase in serum creatinine, and claudication of his left leg. Doppler ultrasonography showed poor flow characteristics of the renal allograft. Total occlusion of the left common iliac artery was diagnosed on angiography. Since endovascular approach was unsuccessful, we performed right-to-left femoro-femoral bypass to provide retrograde blood flow to the renal allograft. The patient was discharged at postoperative day 3 with decreased serum creatinine, normal blood pressure, no claudication, and normal flow characteristics in Doppler ultrasonography. AIOD should be suspected in renal transplant patients in case of hypertension, allograft dysfunction, and ipsilateral leg ischemia. Femoro-femoral bypass is a safe surgical procedure that may be performed in patients who cannot be treated using an endovascular approach.
Cardiovascular Journal Of Africa, 2015
Functional mitral regurgitation may have different haemodynamic consequences, clinical implicatio... more Functional mitral regurgitation may have different haemodynamic consequences, clinical implications and treatment options, such as surgical or percutaneous interventions or implanting a pacemaker. Here we present two cases with haemodynamically significant intermittent functional mitral regurgitation as the underlying mechanism of heart failure. The cases underline the importance of a high index of suspicion in patients with intermittent heart failure, and a careful analysis of echocardiographic images with simultaneous ECG, in order to delineate systolic and diastolic mitral regurgitation.
![Research paper thumbnail of [Cardiac tamponade caused by intrapericardial organized hematoma as a late complication of open heart surgery: magnetic resonance imaging]](https://attachments.academia-assets.com/89710505/thumbnails/1.jpg)
](Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010
A 59-year-old man who underwent a triple coronary bypass operation nine years ago presented with ... more A 59-year-old man who underwent a triple coronary bypass operation nine years ago presented with complaints of dyspnea and malaise. The patient's effort capacity has been continuously worsening in the past year due to the dyspnea, and was reported to experience severe dyspnea even on mild exertion, especially in the past month. Improvement was reported following administration of diuretics at the previous health centers where the patient was evaluated; but has however reported recent increases in his complaints. Physical examination revealed a blood pressure of 100/60 mmHg, heart rate of 120 beats/min, which was rhythmic. Heart sounds were normal. Examination revealed bilateral fine crepitant basilar rales. In addition, transthoracic echocardiography revealed normal ventricular functions. A suspicious mass was identified in the parasternal long axis section, exerting compression adjacent to the posterior wall of the left ventricle, and preventing ventricular filling (the findings were considered nonspecific and were not registered). The cardiac magnetic resonance imaging revealed an intrapericardial mass which was found to compress and partially surround the left ventricle (Figure A-C). No relationship was found with the heart chambers and extracardiac structures. The mass was successfully removed by surgical operation. Histopathological analysis revealed that the mass was an organized
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2003
Myocardial noncompaction (MN) is a rare form of cardiomyopathy due to an arrest in endomyocardial... more Myocardial noncompaction (MN) is a rare form of cardiomyopathy due to an arrest in endomyocardial embryogenesis. It is characterized by multiple prominent trabeculations with deep intertrabecular recesses in ventricular walls. The disease usually affects the left ventricle and may cause cardiac failure, arrhythmias, and systemic embolism. We would like to present two rare cases of MN with a poor long-term prognosis. The first case is an unique case in the literature having bioprosthetic valve implantation and associated with a recovery of heart failure after the operation, the second case is another interesting case because of the association of A-V complete block, and multiple structural cardiac abnormalities.
IJC Heart & Vessels, 2014
Pacing and Clinical Electrophysiology, 2013
Potential interference between implanted cardiac devices and other medical instruments is an impo... more Potential interference between implanted cardiac devices and other medical instruments is an important concern. Therefore, we aimed to investigate the possible device interaction between implantable cardioverter defibrillators (ICDs) and external enhanced counterpulsation (EECP) treatment. Twenty-one patients with an implanted ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were enrolled into the study. EECP had applied as two sessions of 5 minutes. Data from device interrogations before and after the first EECP session and during second EECP session were recorded and analyzed for signs of possible device interaction. There was no sign of inappropriate sensing or noise during EECP session. There was no difference regarding electrode impedance, pacing, and sensing values before and after EECP. There was a statistically significant difference regarding heart rates during EECP therapy between rate response off and on modes (68.69 ± 5.92 beats/min and 90.32 ± 11.05 beats/min, respectively P = 0,001). In four patients with CRT-D and unipolar left ventricular pacing, counterpulsation could not be done because of QRS sensing problems. EECP seems to be a safe treatment modality in patients with implanted ICD and CRT-D devices. It should be kept in mind that in those patients with CRT-D, rate responsive mode is on; inappropriate sinus tachycardia can be seen during EECP therapy. Also in patients with CRT-D using a unipolar sensing mode, problems of QRS complex sensing by the EECP may occur and, therefore, this effects synchronization and success of EECP therapy.
Journal of the American College of Cardiology, 2013
Echocardiography, 2005
We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NH... more We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 +/- 14 cm/sec and 54 +/- 20 cm/sec vs 41 +/- 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic-reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (-11 +/- 30 cm/sec and -13 +/- 38 cm/sec, vs 24 +/- 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =-0.43, P < 0.005). We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy.
Cardiology in the Young, 2010
We report here the case of a 27-year-old woman with Noonan syndrome presenting with ventricular f... more We report here the case of a 27-year-old woman with Noonan syndrome presenting with ventricular fibrillation. After successful defibrillation, echocardiography revealed hypertrophic cardiomyopathy associated with left ventricular outflow tract obstruction. Normal echocardiographic cardiac structure and function were reported 11 years ago. This case emphasises the importance of regular follow-up in patients with congenital disorders in which cardiac manifestations might develop in early adulthood or later.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2011
Olağandışı bir koroner arter anomalisi An unusual coronary artery anomaly Elli dokuz yaşında kadı... more Olağandışı bir koroner arter anomalisi An unusual coronary artery anomaly Elli dokuz yaşında kadın, özgeçmişinde hipertansiyon olan hasta eforla gelen göğüs ağrısı ve çarpıntı şikâyetleri ile başvurdu. Fizik muayene ve elektrokardiyogram bulguları normal idi. Yapılan ekokardiyografide sol boşluk boyutları normal, sol ventrikül ejeksiyon fraksiyonu %65 ve segmenter duvar bozukluğu izlenmedi. Sol atriyum çapı 3.6 cm olarak ölçüldü. Efor testinde inferiyor derivasyonlarda ST segment çökmesi olması nedeniyle koroner anjiyografi yapılmasına karar verildi. Yapılan koroner anjiyografide sağ ve sol ön inen koroner arterler anatomik olarak normal ve bu arterlerde kritik olmayan lezyonlar vardı. Fakat sol sirkumflex arter (Cx) orta segmentinde ayrılıp farklı bir seyir izleyen bir yan dal izlendi (Şekil 1, 2. Video 1-4. Video/hareketli görüntüler www.anakarder.com'da izlenebilir). Bunun üzerine hastaya yapılan 16 kesitli bilgisayarlı tomografi anjiyografide Cx'den ayrılan yan dalın farklı bir seyir izleyerek mediyastinumda sonlandığı izlendi (Şekil 3). Hastaya beta-bloker tedavisi başlandı ve tavsiyelerle taburcu edildi. Hastanın bir ay sonraki yapılan kontrolünde şikâyetlerinin olmadığı belirlendi.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2010
Transoesophageal echocardiography (TEE) is an uncomfortable procedure for the majority of patient... more Transoesophageal echocardiography (TEE) is an uncomfortable procedure for the majority of patients. In the current double-blind randomized prospective study, we sought to assess whether ondansetron would improve patient comfort, reduce the need for sedation, and increase tolerance during TEE, and we compared ondansetron, metoclopramide, and placebo. One hundred and fifty-six patients who underwent TEE were randomized into three groups receiving ondansetron HCl, metoclopramide, or placebo. Data concerning additional doses of midazolam, procedural time, recovery time in the outpatient ward, blood pressure values, percutaneous arterial oxygen saturation values, side effects of the medications used, and patient discomfort via a visual analogue scale (VAS) were collected and analysed. The ondansetron group received less additional midazolam than the metoclopramide and placebo groups (ondansetron group: 0.6 ± 0.7 mg; metoclopramide group: 1.9 ± 0.9 mg; and placebo group: 2.1 ± 0.8 mg; P &...
Echocardiography, 2018
The development of an aorto‐right ventricular fistula is a rare complication of cardiac surgery. ... more The development of an aorto‐right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four‐dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto‐right ventricular (AO‐RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO‐RV fistula.
Turkiye Klinikleri Cardiovascular Sciences, 2019
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2018
It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, ... more It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, and rivaroxaban increase the risk of bleeding complications during or after coronary catheterization. The aim of this study was to investigate the safety of uninterrupted DOAC treatment during diagnostic radial coronary angiography (CAG). Methods: This study included 160 patients who underwent diagnostic radial cardiac catheterization. The 60 patients in the group who were using a DOAC (apixaban, rivaroxaban, or dabigatran) were enrolled in a Group A. Post-procedure results from patients in Group A were compared with those of an ageand sex-matched control group (Group B) that included 100 patients who underwent radial CAG who did not use a DOAC. Results: There was no significant difference in the procedure and compression times, creatinine level, or presence of hypertension, diabetes mellitus, smoking, alcohol use, vascular disease, or congestive heart failure between the 2 groups. During the 1-month follow-up period, only 1 radial occlusion was registered in the control group (Group B). There was no case of a large hematoma (>5 cm or extending to the forearm), dissection, fistula, perforation, or compartment syndrome. Hematomas smaller than 5 cm were seen in 2 patients (1 in each group). No thrombotic events were observed during follow-up examinations. Conclusion: Performing radial CAG with uninterrupted DOAC treatment appears to carry no risk of increased early or short-term complications. The simple, uninterrupted DOAC strategy is comfortable, easy, and safe.
Balkan Medical Journal, 2017
Background: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pr... more Background: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pressure gradient, which is affected by flow rate. Case Report: We report the first case of a pregnant patient with atrial septal defect (ASD) and pulmonary stenosis that was misclassified by conventional echocardiographic methods. Most importantly, threedimensional transoesophageal echocardiographic assessment of pulmonary stenosis changed the entire treatment strategy. Conclusion: The planimetric calculation of the pulmonary valve (PV) opening area using threedimensional transoesophageal echocardiographic may be helpful, especially in encounters with specialized conditions such as ASD and/or pregnancy, which can cause inaccurate recordings of the transvalvular peak gradient.
The International Journal of Cardiovascular Imaging, 2017
Transplantation Proceedings, 2015
As vascular diseases are becoming more prevalent among renal transplant recipients, complications... more As vascular diseases are becoming more prevalent among renal transplant recipients, complications related to renal artery anastomosis are likely to occur more often. Here we report a renal transplant patient treated with femoro-femoral bypass who had renal allograft dysfunction due to aorto-iliac occlusive disease (AIOD) proximal to renal artery anastomosis. We performed living donor renal transplantation in the left iliac fossa of a 41year-old male. At post-transplant 30 months, he was admitted with hypertension, increase in serum creatinine, and claudication of his left leg. Doppler ultrasonography showed poor flow characteristics of the renal allograft. Total occlusion of the left common iliac artery was diagnosed on angiography. Since endovascular approach was unsuccessful, we performed right-to-left femoro-femoral bypass to provide retrograde blood flow to the renal allograft. The patient was discharged at postoperative day 3 with decreased serum creatinine, normal blood pressure, no claudication, and normal flow characteristics in Doppler ultrasonography. AIOD should be suspected in renal transplant patients in case of hypertension, allograft dysfunction, and ipsilateral leg ischemia. Femoro-femoral bypass is a safe surgical procedure that may be performed in patients who cannot be treated using an endovascular approach.
Cardiovascular Journal Of Africa, 2015
Functional mitral regurgitation may have different haemodynamic consequences, clinical implicatio... more Functional mitral regurgitation may have different haemodynamic consequences, clinical implications and treatment options, such as surgical or percutaneous interventions or implanting a pacemaker. Here we present two cases with haemodynamically significant intermittent functional mitral regurgitation as the underlying mechanism of heart failure. The cases underline the importance of a high index of suspicion in patients with intermittent heart failure, and a careful analysis of echocardiographic images with simultaneous ECG, in order to delineate systolic and diastolic mitral regurgitation.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010
A 59-year-old man who underwent a triple coronary bypass operation nine years ago presented with ... more A 59-year-old man who underwent a triple coronary bypass operation nine years ago presented with complaints of dyspnea and malaise. The patient's effort capacity has been continuously worsening in the past year due to the dyspnea, and was reported to experience severe dyspnea even on mild exertion, especially in the past month. Improvement was reported following administration of diuretics at the previous health centers where the patient was evaluated; but has however reported recent increases in his complaints. Physical examination revealed a blood pressure of 100/60 mmHg, heart rate of 120 beats/min, which was rhythmic. Heart sounds were normal. Examination revealed bilateral fine crepitant basilar rales. In addition, transthoracic echocardiography revealed normal ventricular functions. A suspicious mass was identified in the parasternal long axis section, exerting compression adjacent to the posterior wall of the left ventricle, and preventing ventricular filling (the findings were considered nonspecific and were not registered). The cardiac magnetic resonance imaging revealed an intrapericardial mass which was found to compress and partially surround the left ventricle (Figure A-C). No relationship was found with the heart chambers and extracardiac structures. The mass was successfully removed by surgical operation. Histopathological analysis revealed that the mass was an organized
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2003
Myocardial noncompaction (MN) is a rare form of cardiomyopathy due to an arrest in endomyocardial... more Myocardial noncompaction (MN) is a rare form of cardiomyopathy due to an arrest in endomyocardial embryogenesis. It is characterized by multiple prominent trabeculations with deep intertrabecular recesses in ventricular walls. The disease usually affects the left ventricle and may cause cardiac failure, arrhythmias, and systemic embolism. We would like to present two rare cases of MN with a poor long-term prognosis. The first case is an unique case in the literature having bioprosthetic valve implantation and associated with a recovery of heart failure after the operation, the second case is another interesting case because of the association of A-V complete block, and multiple structural cardiac abnormalities.
IJC Heart & Vessels, 2014
Pacing and Clinical Electrophysiology, 2013
Potential interference between implanted cardiac devices and other medical instruments is an impo... more Potential interference between implanted cardiac devices and other medical instruments is an important concern. Therefore, we aimed to investigate the possible device interaction between implantable cardioverter defibrillators (ICDs) and external enhanced counterpulsation (EECP) treatment. Twenty-one patients with an implanted ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were enrolled into the study. EECP had applied as two sessions of 5 minutes. Data from device interrogations before and after the first EECP session and during second EECP session were recorded and analyzed for signs of possible device interaction. There was no sign of inappropriate sensing or noise during EECP session. There was no difference regarding electrode impedance, pacing, and sensing values before and after EECP. There was a statistically significant difference regarding heart rates during EECP therapy between rate response off and on modes (68.69 ± 5.92 beats/min and 90.32 ± 11.05 beats/min, respectively P = 0,001). In four patients with CRT-D and unipolar left ventricular pacing, counterpulsation could not be done because of QRS sensing problems. EECP seems to be a safe treatment modality in patients with implanted ICD and CRT-D devices. It should be kept in mind that in those patients with CRT-D, rate responsive mode is on; inappropriate sinus tachycardia can be seen during EECP therapy. Also in patients with CRT-D using a unipolar sensing mode, problems of QRS complex sensing by the EECP may occur and, therefore, this effects synchronization and success of EECP therapy.
Journal of the American College of Cardiology, 2013
Echocardiography, 2005
We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NH... more We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 +/- 14 cm/sec and 54 +/- 20 cm/sec vs 41 +/- 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic-reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (-11 +/- 30 cm/sec and -13 +/- 38 cm/sec, vs 24 +/- 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =-0.43, P < 0.005). We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy.
Cardiology in the Young, 2010
We report here the case of a 27-year-old woman with Noonan syndrome presenting with ventricular f... more We report here the case of a 27-year-old woman with Noonan syndrome presenting with ventricular fibrillation. After successful defibrillation, echocardiography revealed hypertrophic cardiomyopathy associated with left ventricular outflow tract obstruction. Normal echocardiographic cardiac structure and function were reported 11 years ago. This case emphasises the importance of regular follow-up in patients with congenital disorders in which cardiac manifestations might develop in early adulthood or later.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2011
Olağandışı bir koroner arter anomalisi An unusual coronary artery anomaly Elli dokuz yaşında kadı... more Olağandışı bir koroner arter anomalisi An unusual coronary artery anomaly Elli dokuz yaşında kadın, özgeçmişinde hipertansiyon olan hasta eforla gelen göğüs ağrısı ve çarpıntı şikâyetleri ile başvurdu. Fizik muayene ve elektrokardiyogram bulguları normal idi. Yapılan ekokardiyografide sol boşluk boyutları normal, sol ventrikül ejeksiyon fraksiyonu %65 ve segmenter duvar bozukluğu izlenmedi. Sol atriyum çapı 3.6 cm olarak ölçüldü. Efor testinde inferiyor derivasyonlarda ST segment çökmesi olması nedeniyle koroner anjiyografi yapılmasına karar verildi. Yapılan koroner anjiyografide sağ ve sol ön inen koroner arterler anatomik olarak normal ve bu arterlerde kritik olmayan lezyonlar vardı. Fakat sol sirkumflex arter (Cx) orta segmentinde ayrılıp farklı bir seyir izleyen bir yan dal izlendi (Şekil 1, 2. Video 1-4. Video/hareketli görüntüler www.anakarder.com'da izlenebilir). Bunun üzerine hastaya yapılan 16 kesitli bilgisayarlı tomografi anjiyografide Cx'den ayrılan yan dalın farklı bir seyir izleyerek mediyastinumda sonlandığı izlendi (Şekil 3). Hastaya beta-bloker tedavisi başlandı ve tavsiyelerle taburcu edildi. Hastanın bir ay sonraki yapılan kontrolünde şikâyetlerinin olmadığı belirlendi.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2010
Transoesophageal echocardiography (TEE) is an uncomfortable procedure for the majority of patient... more Transoesophageal echocardiography (TEE) is an uncomfortable procedure for the majority of patients. In the current double-blind randomized prospective study, we sought to assess whether ondansetron would improve patient comfort, reduce the need for sedation, and increase tolerance during TEE, and we compared ondansetron, metoclopramide, and placebo. One hundred and fifty-six patients who underwent TEE were randomized into three groups receiving ondansetron HCl, metoclopramide, or placebo. Data concerning additional doses of midazolam, procedural time, recovery time in the outpatient ward, blood pressure values, percutaneous arterial oxygen saturation values, side effects of the medications used, and patient discomfort via a visual analogue scale (VAS) were collected and analysed. The ondansetron group received less additional midazolam than the metoclopramide and placebo groups (ondansetron group: 0.6 ± 0.7 mg; metoclopramide group: 1.9 ± 0.9 mg; and placebo group: 2.1 ± 0.8 mg; P &...