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Öğe Accessory mitral valve tissue: anatomical and clinical perspectives(Elsevier Inc., 2021) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Yalta, K.Mitral valve is a complex cardiac structure composed of several components to work in synchrony to allow blood flow into left ventricle during diastole and not to allow blood flow into left atrium during systole. Accessory mitral valve tissue (AMVT) was defined as existence of any additional part and parcel of valvular structure which has an attachment to normal mitral valve apparatus in left-sided cardiac chambers. AMVT may present itself in different clinical circumstances ranging from a silent clinical course to thromboembolic events, heart failure, left ventricular outflow tract obstruction, and severe arrhythmia. This article reviews the clinical perspectives of AMVT in terms of symptoms, diagnosis, and treatment, providing a new anatomical classification regarding the location of AMVT. Briefly type I refers to AMVT having attachments on the supra leaflets level, type II refers to attachments on the mitral leaflets, and type III refers to attachment below the mitral leaflets. Increased awareness and widespread use of echocardiographic techniques would increase recognition of AMVT in patients with heart murmurs but otherwise healthy and in those with left ventricular outflow tract obstruction or tissue which causes subaortic stenosis and with unexplained cerebrovascular events. © 2020Öğe Clinical presentation of paroxysmal supraventricular tachycardia: evaluation of usual and unusual symptoms(2020) Yetkin, Ertan; Öztürk, Selçuk; Çuğlan, Bilal; Turhan, HasanObjective: Clinical presentation of paroxysmal supraventricular tachycardia may vary from asymptomatic occurrence or mild perception of palpitation to severe chest pain or syncope. This variation is the most challenging issue in the diagnostic evaluation of rhythm disturbances and paroxysmal supraventricular tachycardia as well. This study sought to evaluate the symptoms during the tachycardia attack or index event in patients who underwent electrophysiological study and ablation procedure. Methods: This retrospective study included 100 consecutive patients who underwent electrophysiological study and ablation procedures due to supraventricular tachycardia. Structural heart disease, moderate/severe valvular pathology, systemic pathologies, such as connective tissue disease and chronic obstructive lung disease, history of pacemaker implantation was defined as exclusion criteria. In addition, medically managed patients and patients with unsuccessful ablation were not included in the study. Results: Palpitation was the most frequently observed symptom in 84% of patients, followed by chest pain in 47%, dyspnea in 38%, syncope 26%, lightheadedness in 19%, and sweating in 18% of the patients. The most common symptoms after tachycardia event were fatigue and lightheadedness with frequencies of 56% and 55%, respectively. Forty-five percent of the patients reported more than one, unusually frequent urination within the following 1-3 hours after the index event. Conclusions: Paroxysmal supraventricular tachycardia might manifest itself as gastrointestinal, neurological, psychosomatic symptoms, and unusual complaints in association with or without main symptoms, including palpitation, chest pain, syncope, and dyspnea. Symptoms after tachycardia or index event should be questioned systematically.Öğe Comment On "Vein Size and Disease Severity in Chronic Venous Disease" by Radhakrishnan et al Afflicted Vein Diameter or Signs and Symptoms in Chronic Venous Disease: Which One Really Matters?(Thieme Medical Publ Inc, 2019) Özturk, Selçuk; Çuğlan, Bilal; Turhan, Hasan; Yetkin, Ertan[No Abstract Available]Öğe Does golden ratio reside in pulmonary circulation?(Elsevier, 2019) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, SelçukWe have read the recent article in CHEST (May 2019) byChemla et al1with great enthusiasm and interest. Themost astonishing number series and ratio in theuniverse, namely the golden ratio, which arose from theFibonacci series, have been evaluated in pulmonaryhemodynamic and pressure components.Öğe Enhanced external counterpulsation effects on venous leg symptoms(Kare Publishing, 2022) Çuğlan, Bilal; Turhan, Hasan; Yetkin, ErtanBackground: Venous diseases encompass a large spectrum of abnormalities in the venous system with complaints, such as aching and swelling. Enhanced external counterpulsation, proven safe and effective in patients with coronary artery disease and chronic heart failure, is a technique that increases venous return and augments diastolic blood pressure. This study assessed the effects of enhanced external counterpulsation on symptoms of venous disease using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaire. Methods: This study was designed prospectively for evaluating venous symptoms before and after enhanced external counterpulsation treatment. The study population consisted of 30 consecutive patients who were admitted to the cardiology clinic. The Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaire was applied to assess venous symptoms one day before and after enhanced external counterpulsation treatment. Results: The mean age of the patients was 64.62 ± 9.67 years. After 35 hours of enhanced external counterpulsation, 28 patients (93%) had at least 1 New York Heart Association functional class reduction compared with baseline and 43% of patients had 2 New York Heart Association functional classes improvement. The New York Heart Association class significantly decreased after enhanced external counterpulsation treatment (P< .001). There was a significant improvement in their swelling and night cramps symptoms compared with baseline (P< .001 and P = .05, respectively). Also, The left ventricular ejection fraction significantly increased after the enhanced external counterpulsation treatment (P = .02). Conclusions: The findings obtained in the present study suggested that patients treated with enhanced external counterpulsation showed a significant reduction in swelling and night cramps symptoms. Although the total VEIN score did not change after the enhanced external counterpulsation procedure, improvement in swelling and night cramps underlines the beneficial effects of enhanced external counterpulsation through the venous vascular territoryÖğe Golden ratio in congestive heart failure: a promising proportion for prognosis and decompensation(2020) Yetkin, Ertan; Özturk, Selçuk; Çuğlan, Bilal; Turhan, HasanThe article published by Kowalczys et al. [1] was read with great enthusiasm and interest. Briefly, the prognostic value of daytime heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure (BP), and their multiplication products and ratios was assessed in congestive heart failure (CHF) patients. Accordingly, it was found that daytime DBP and products including HR × DBP and HR × SBP may be valuable risk stratification factors for predicting death and decompensation in stable patients [1]. Beyond the prognostic implication of HR, BP and their products in patients with stable CHF, attention was paid to the value of SBP and DBP itself, in terms of the golden ratio. In the study population, Kowalczys et al. [1] found mean daytime SBP and DBP of patients with stable CHF as 114 mmHg and 70 mmHg, respectively. The ratio of SBP to DBP gives 1.62, which is very close to the golden ratio as described previously by the famous mathematicians Euclid and Fibonacci [2]. In addition, it is also noteworthy to calculate the ratio of SBP to DBP in patients with decompensated (107.0/60.7 mmHg) and non-decompensated (115.3/72.1 mmHg) status during the follow-up period. SBP/DBP in patients without decompensation is 1.59; whereas it is 1.76 in decompensated patients, which shows a distinct deviation from the golden ratio.Öğe Ignored identity of age-dependent increase in pulmonary embolism atrial fibrillation(Elsevier, 2019) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, Selcuk; Yetkin, ÖzkanWe read with great interest the article published recently in CHEST (October 2019) by Pauley et al1 in which their goal was to evaluate national trends in admission rates, discharge disposition, and length of stay in patients hospitalized with pulmonary embolism (PE) by assessing patient demographic and hospital characteristics. They found a continued increase in admissions for PE between 2000 and 2015. Elderly patients have been shown to be affected disproportionally and experience higher mortality rates compared with the other age groups. Increased age and comorbidity burden, including congestive heart failure, paralysis, and metastatic cancer, have been found to be independently associated with poor outcomes. The authors also noted that targeted clinical trials designed to improve survival and quality of life in all age brackets are needed.Öğe Improvement of Left Ventricular Function after Renal Transplantation Is Related with Multiple Parameters(Turkish Society of Cardiology, 2022) Şahin, Ahmet Anıl; Uslu, Bora; Göksülük, Hüseyin; Turhan, HasanWe have read with great interest the article titled “Improvement in cardiac function after renal transplantation in four patients with severe left ventricular systolic dysfunction,” which was written by Aslanger et al.1 Authors evaluated preoperative and postoperative echocardiographic results including improvement of systolic and diastolic functions of four patients who underwent kidney transplantation because of kidney failure. We would like to first thank the authors that we do also inspect the improvement of cardiac function and recovery of the ventricular diameters in these patient groups after transplantation as our institution is also a major transplantation center in the country. The authors discussed their findings and they have stated that the improvement might be related to multiple parameters including the correction of volume and pressure overload, the restoration of normal hemoglobin levels, the clearance of uremic toxins, and being able to take heart failure medications. Even though major studies which have been held about this subject by Wali et al2 and Hawwa et al3 found no significant association between urea reduction ratio and body mass index in these patient groups, they have also stated that the change of ejection might be related to volume overload and uremic toxins, similar to your comments. However, there is no information about the hemoglobin levels, urea levels, and weight or body mass index of the patients before and after the transplantation in your cases. We believe that providing this information in your patient group would benefit the discussion and assessment of your findings.Öğe Letter by cuglan et al regarding article, "Characteristics of intracranial aneurysms according to levels of coronary artery calcium"(Lippincott Williams & Wilkins, 2019) Çuğlan, Bilal; Turhan, Hasan; Yetkin, ErtanWe have read with great enthusiasm the article recently published by Cho et al.1 In their retrospective, cross-sectional study they investigated the relationship between the presence of intracranial aneurysms (IAs) and the level of coronary artery calcium (CAC) in 4934 subjects. Briefly, they have found that the prevalence of IA increased with CAC score; 172 (4.8%) subjects with a zero CAC score had IAs, 49 (5.4%) with a low CAC score, 22 (6.4%) with an intermediate CAC score, and 15 (11.1%) with a high CAC score (P for trend, 0.004). Additionally multivariate logistic regression has shown that high CAC score is an independent risk factor for the presence of IA compared with zero CAC score (adjusted odds ratio, 2.16; 95% CI, 1.18–3.95). And they have underlined the role of atherosclerosis in development of IAs.Öğe Nitrate-Induced Headache Response in Patients with Coronary Artery Disease and Coronary Artery Ectasia: A Retrospective Case-Control Study(Wolters Kluwer Medknow Publications, 2024) Aksu, Ekrem; Çuğlan, Bilal; Öztürk, Selçuk; Eren, Ali; Yalta, Kenan; Turhan, Hasan; Atmaca, Hasan; Yetkin, ErtanBackground: Coronary artery ectasia (CAE), while being considered a variant of atherosclerosis, harbors distinct features that significantly differ from atherosclerosis in terms of pathophysiological mechanisms. On the other hand, headache appears to be the most common side effect of nitrates that have been used traditionally for decades. In this context, we aimed to compare the frequency and temporal characteristics of nitrate-induced headache (NIH) between subjects with sole coronary artery disease (CAD) and subjects with CAD and coexisting CAE. Materials and Methods: Two hundred and forty-four patients who had undergone coronary angiogram (CAG) and received a single dose of sublingual isosorbide dinitrate during the procedure comprised in this retrospective study population. CAG is performed in the indications due to guidelines. All patients who had undergone CAG were held under close supervision, at least, for 6 h following CAG (and administration of sublingual nitrate); duration and emergence time of NIH were recorded for all patients. Of these 244 patients, 225 patients having sole CAD were assigned to Group I, whereas 19 patients having both CAD and CAE were assigned to Group II. Results: NIH was observed in 19 out of 225 patients (8%) with sole CAD and in 9 out of 19 patients (56%) with CAD and CAE (P = 0.003). The mean interval between the administration of sublingual isosorbide dinitrate and NIH onset was significantly lower in Group II in comparison to Group I (44 ± 14 min vs. 87 ± 63 min, respectively, P = 0.018). However, the duration of NIH was comparable between the two groups (Group I: 203 ± 53 min vs. Group II: 173 ± 61 min, P = 0.24); logistic regression analysis revealed an independent association between NIH and CAE (odds ratio: 11.5, 95% confidential interval: 3.9-33.8, P < 0.001). Conclusion: We have demonstrated that sublingual nitrates might induce NIH more frequently in subjects with CAE and CAD in comparison to those with sole CAD. Furthermore, NIH has been demonstrated to be independently associated with CAE. © 2024 Heart and Mind.Öğe A novel strategy to reduce the readmission rates in congestive heart failure: intermittent empirical intravenous diuretics(Lippincott Williams & Wilkins, 2020) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, SelçukImprovements in the medical management of heart failure have changed the course of the disease. However, mortality rates, hospitalization rates, and treatment costs are not at desired levels. Diuretics have been widely used in the treatment of congestion in heart failure patients. The following case reports represent a special patient group treated and followed by cardiology clinic. Treatment approach of each case report has been tailored on an individual basis depending on the clinical course and hospitalization rates of patients. Authors have highlighted and discussed the common aspects and future perspectives of their cases in which post-discharge intermittent empirical intravenous diuretic administration dramatically improved the clinical status and readmission number due to decompensated congestive heart failure. This is a relatively new and promising approach, which has been thought to cease the recycle of diuretic resistance and silent increase of fluid congestion in patients with congestive heart failure and frequent hospitalization. Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.Öğe Sodium restriction, water intake, and diuretic regimen in patients with congestive heart failure(Mosby-Elsevier, 2019) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, SelçukWe have read the article published by Riegel et al.1 with great interest and enthusiasm. Briefly, the behavioral adherence of patients with chronic congestive heart failure (HF) to dietary salt, fluid restriction and diuretic use has been prospectively evaluated. The overall adherence rates have been found to be 29% for low sodium diet, 45% for fluid restriction and 72% for diuretic regimen at the end of the 3 month follow up period. Although the restriction level of dietary sodium is not so meticulously judged by self-report, it has the lowest adherence rate among the behavioral adherence patterns as reported by the authorsÖğe Symptoms in dilating venous disease(Bentham Science Publishers, 2020) Yetkin, Ertan; Öztürk, Selçuk; Çuğlan, Bilal; Turhan, HasanLower extremity venous diseases or insufficiency include clinically deteriorating condi-tions with morphological and functional alterations of the venous system, including venous hyper-tension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruri-tis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.Öğe Venous failure and beyond(Wiley, 2019) Öztürk, Selçuk; Çuğlan, Bilal; Turhan, Hasan; Yetkin, ErtanWe have read the report of Gupta et al1 with great interest. Briefly, they have reported successful treatment of pigmented purpuric lesions by venoactive drugs in a male patient. Indeed, it is really an encouraging and promising approach to treat such lesions by venoactive drugs.Öğe Where cystatin C acts: inside or outside of the plaque(Springer-Verlag Italia Srl, 2020) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Yalta, KenanWe have read the impressive article recently published by Ren et al. evaluating the plasma cystatin C (Cyst C) in patients with acute ischemic stroke (AIS) and carotid stenosis [1]. Briefly, they have divided the patients into two groups based on their plasma Cyst C levels and assessed their relation with the degree of carotid stenosis, plaque burden, and morphology. The degree of atherosclerosis, the severity of plaques, and stenosis of the common carotid artery (CCA) of patients with AIS have been found to be significantly higher in the patients with high cystatin C levels. They have concluded that Cyst C levels are strongly correlated with symptomatic CCA stenosis and the rate of unstable plaques
