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Öğe Anticoagulation strategy and management of patients with mechanical prosthetic heart valves during pregnancy(Elsevier Ltd, 2019) Kalkan, Semih; Güner, Ahmet; Kalçık, Macit; Bayam, Emrah; Özkan, MehmetTo the Editor,We have read with great interest the article by Komatsu et al.entitled “A case of thrombolytic therapy with recombinant tissueplasminogen activator for mechanical valve thrombosis at 9 weeksof pregnancy in a Japanese woman” [1].Öğe Characteristic localization patterns of thrombus on various brands of bileaflet mitral mechanical heart valves as assessed by three-dimensional transesophageal echocardiography and their relationship with thromboembolism(Springer, 2021) Sarı, Munevver; Bayram, Zübeyde; Aytürk, Mehmet; Bayam, Emrah; Kalkan, Semih; Güner, Ahmet; Özkan, Mehmet; Kalçık, Macit; Gürsoy, Mustafa Ozan; Gündüz, SabahattinThree-dimensional transesophageal echocardiography (3D-TEE) provides detailed images of prosthetic valve thrombosis (PVT). However, data regarding PVT localization patterns based on 3D-TEE and their association with clinical findings among various bileaflet mitral prosthetic valve brands is lacking. The locations of thrombi were classified into 4 groups according to hinge and annulus involvement based on 3D-TEE: ring-like PVT involving entire mitral annulus (type-1), PVT involving peri-hinge(s) region and extends through some part of the annulus (type-2), PVT involving mitral annulus without involving hinge(s) region (type-3), and PVT involving only (peri)hinge(s) area (type-4). This study was conducted in 265 patients (male: 71, mean age: 46.3 +/- 12.7 years) with mitral PVT, including 150 St Jude Medical (SJM), 65 Carbomedics, 29 Medtronic ATS open-pivot, and 21 Sorin bileaflet mechanical valves. There was a significant difference in most common PVT localization patterns between different prosthetic valves (type-1 for Carbomedics and Sorin; type-2 for SJM and type-3 for ATS valves; p < 0.001). Additionally, PVT involving only (peri)hinge region(s) (type-4) was mostly observed in patients with SJM valves (18%). (Peri)hinge(s) area involvement was observed in the majority of study patients (78.1%). In patients who presented with thromboembolism, the most common PVT localization pattern was type-1 (53%). Increased age, low international normalized ratio on admission, PVT with a mobile part > 2 mm, type-1 and type-4 PVT were associated with thromboembolic events. In conclusion, thrombus can be displayed in distinct locations in several types of bileaflet mechanical valves due to different design, hinge and pivot mechanisms, which can be complicated with thromboembolic events.Öğe Does low molecular weight heparin really protect against prosthetic valve thrombosis during pregnancy with strict anti-Xa monitoring?(Elsevier Taiwan, 2021) Kalçık, Macit; Güner, Ahmet; Kalkan, Semih; Özkan, MehmetDear Editor,We have recently read with great interest the article by EspiauRomera et al. entitled‘‘Mitral valve thrombosis in term pregnancy:A case report and review of the literature’’[1].Öğe Evaluation of the potential predictors of embolism in patients with left atrial myxoma(Blackwell Publishing Inc., 2019) Kalçık, Macit; Bayam, Emrah; Güner, Ahmet; Küp, Ayhan; Kalkan, Semih; Yesin, Mahmut; Gürsoy, Mustafa Ozan; Gündüz, Sabahattin; Karakoyun, Süleyman; Özkan, MehmetIntroduction: Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. Methods: This single-center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. Results: The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752–0.964; P < 0.001). Conclusion: The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism. © 2019 Wiley Periodicals, Inc.Öğe Evaluation of the relationship between platelet indices and spontaneous echo contrast in patients with mitral prosthetic heart valves(2020) Kalçık, Macit; Sayar, Ahmet Güner; Bayam, Emrah; Yesin, Mahmut; Kalkan, Semih; Gürsoy, Mustafa Ozan; Özkan, Mehmet AkifObjective: Spontaneous echo contrast (SEC) is defined as dynamic, smoke-like echoes within the cardiac cavities with a characteristic swirling motion seen on echocardiography. Clinical studies have demonstrated that SEC is a risk factor for left atrial thrombus formation and an important indicator for potential systemic embolism. Platelet indices have been associated with the presence of SEC in patients with mitral stenosis. The aim of this study was to investigate the relationship between platelet indices and SEC in patients with prosthetic heart valves. Methods: A total of 89 patients [female: 38 (42.4%); median age: 52 years (range: 36-67 years)] with SEC formation in the left atrium, and 257 control subjects [female: 123 (47.5%); median age: 56 years (range: 45-65 years)] without SEC formation were enrolled. All of the patients were evaluated by using transthoracic and transesophageal echocardiography. Laboratory tests including complete blood count and biochemical parameters were analyzed. Results: Patients with SEC formation had more frequent atrial fibrillation, higher left atrial diameter (LAD) and lower left ventriular ejection fraction values. Platelet indices including platelet count, platelet distribution width, mean platelet volume, and plateletcrit did not differ between the groups. Increased LAD was detected as the only independent predictor of SEC development. Conclusion: Platelet indices were not found to be associated with the presence of SEC formation in the left atrium among patients with mitral prosthetic valves. Therefore, the use of platelet indices alongside known echocardiographic and clinical risk factors to predict SEC development in patients with a mitral prosthesis is debatable.Öğe Identification of mechanical prosthetic heart valves based on distinctive cinefluoroscopic and echocardiographic markers(Sage Publications Ltd, 2019) Kalçık, Macit; Güner, Ahmet; Yesin, Mahmut; Bayam, Emrah; Kalkan, Semih; Gündüz, Sabahattin; Özkan, MehmetThe past 65 years have witnessed remarkable progress in the development of safe, hemodynamically favorable mechanical heart valves. Today, there are a large number and variety of prostheses in use and many prostheses have been used for a while and then discontinued. When patients lack reliable information about their heart valve prostheses, identification of valve model becomes difficult even for specialized physicians in this area. A combination of cinefluoroscopy and echocardiography makes it possible to provide accurate and detailed information regarding identification of prosthetic valve models. Fluoroscopic examination is a useful technique to evaluate patients following mechanical heart valve replacement. However, transthoracic echocardiography and transesophageal echocardiography have almost replaced cinefluoroscopy in the evaluation of prosthetic heart valves. Especially, real-time three-dimensional transesophageal echocardiography provides distinctive images of prosthetic heart valves, particularly for those in the mitral position. A large body of literature has been published to familiarize physicians with the radiological appearance of numerous mechanical prostheses. However, there is a lack of data regarding the identification of prosthetic valve models based on echocardiographic appearance. In this review, we aimed to describe distinctive echocardiographic and cinefluoroscopic markers for identifying the type and brand of several commonly used mechanical prosthetic heart valves.Öğe Low Dose and Slow/Ultra-Slow Infusion Thrombolytic Therapy Regimens are Effective and Safe in Patients With Prosthetic Valve Thrombosis(Elsevier Science Inc, 2020) Güner, Ahmet; Kalçık, Macit; Gündüz, Sabahattin; Kalkan, Semih; Gürsoy, Mustafa Ozan; Özkan, MehmetTo the Editor,We have recently read with great interest the article by Milneet al. entitled‘Management and outcomes of prosthetic valvethrombosis. An Australian case series from the NorthernTerritory’[1].Öğe Management of prosthetic valve thrombosis complicated by ischemic stroke in pregnancy(Elsevier Espana Slu, 2019) Güner, Ahmet; Kalçık, Macit; Bayam, Emrah; Kalkan, Semih; Özkan, MehmetTo the Editor, We have recently read with great interest the article by Morgado et al. entitled ‘‘A pregnant woman with a prosthetic mechanical valve’’.1Öğe Noninvasive diagnostic tools available for discrimination pannus from thrombus in patients with prosthetic valve dysfunction(Blackwell Publishing Inc., 2019) Güner, Ahmet; Kalçık, Macit; Gündüz, Sabahattin; Yesin, Mahmut; Bayam, Emrah; Kalkan, Ali Kemal; Kalkan, Semih; Özkan, MehmetWe have recently read with great interest the article by Barroso Freitas?Ferraz et al1 entitled “Prosthetic aortic valve thrombosis: To fibrinolyse or not to fibrinolyse? That is the question!”. The authors reported a case of aortic prosthetic valve dysfunction (PVD), which was successfully treated surgically. We congratulate the authors for achieving a successful outcome in such a high?risk patient. However, we would like to discuss the importance of noninvasive diagnostic tools for differentiation of prosthetic valve thrombus and pannus, which are the major causes of PVD, before surgical treatment.Öğe Pregnancy in patients with prosthetic heart valve: ongoing challenges(SAGE Publications Ltd, 2019) Kalçık, Macit; Güner, Ahmet; Kalkan, Semih; Gürsoy, Mustafa Ozan; Özkan, Mehmet[No abstract available]Öğe Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome(Urban & Vogel, 2021) Bayam, Emrah; Yıldırım, Ersin; Kalçık, Macit; Karaduman, Ahmet; Kalkan, Semih; Güner, Ahmet; Uyan, CihangirBackground. Early diagnosis of non-ST elevation acute coronary syndrome (NSTEACS) and prediction of the severity of current coronary artery disease (CAD) play a major role in patient prognosis. Electrocardiography has a unique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between P wave peak time (PWPT) and the severity of CAD in patientswith NSTE-ACS. Methods. A total of 132 consecutive patients (female: 35.6%; mean age: 60.1 +/- 11.6 years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the P wave, and R wave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the R wave. Results. There were 59 (44.6%) patients in the high-GS group (GS =25) and 73 (55.3%) patients in the low-GS group (GS <25). Presence of diabetesmellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of a high GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p= 0.573). Conclusion. The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.Öğe Sequential combination of different thrombolytic therapy regimens in the management of patients with prosthetic valve thrombosis and stuck valves(Oxford Univ Press, 2019) Kalçık, Macit; Güner, Ahmet; Bayam, Emrah; Kalkan, Semih; Yesin, M.; Gürsoy, Mustafa Ozan; Özkan, Mehmet[Abstract Not Available]Öğe The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction(Taylor & Francis Ltd, 2021) Bayam, Emrah; Kalçık, Macit; Öztürkeri, Burak; Yıldırım, Ersin; Karaduman, Ahmet; Kalkan, Semih; Uyan, CihangirBackground The Synergy between Percutaneous Coronary Intervention (SYNTAX) score, has been used to estimate the extent and complexity of coronary artery disease (CAD). The H2FPEF score enables robust discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac aetiologies of dyspnea. In the present study, we aimed to investigate the relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). Method Two hundred eighty two consecutive patients with NSTEMI who underwent coronary angiographic examination were enrolled in this study. The H2FPEF score was calculated for each patient on admission. All patients underwent coronary angiography within 2 days following their admission. The SYNTAX scoring system was used to evaluate the severity and extent of CAD. Results The mean H2FPEF Score [3(2-4) vs 1(0.5-1.5),p < .001] and the frequencies of diabetes mellitus, hypertension and, atrial fibrillation were significantly higher and LVEF was significantly lower in patients with high SYNTAX score. High H2FPEF Score (OR: 3.61, 95%CI: 2.64-4.93;p = .001) and low left ventricular ejection fraction (OR: 0.94, 95%CI: 0.89-0.98;p = .013) were found to be independent associates for high SYNTAX score. H2FPEF Score above a cut-off level of 2.5 predicted high SYNTAX score with a sensitivity of 80% and a specificity of 82.5% (AUC: 0.890; 95%CI: 0.848-0.931;p < .001). There was a significant and moderate positive correlation between H2FPEF and SYNTAX Scores (r = 0.694,p < .001). Conclusion High H2FPEF score may be associated with high SYNTAX score and may be used to estimate the extent and complexity of CAD in NSTEMI patients.Öğe Twenty-seven-year durability of St. Jude Medical Biocor bovine bioprosthesis in mitral position(Turkish Soc Cardiology, 2020) Kalkan, Semih; Güner, Ahmet; Bayam, Emrah; Kalçık, Macit; Özkan, MehmetA 67-year-old female patient had undergone mitral valve replacement 27 years earlier with a 29-mm St. Jude Medical Biocor bovine bioprosthesis valve (St. Jude Medical Inc., St. Paul, MN, USA) due to mitral stenosis.Öğe Type I brugada pattern associated with diabetic ketoacidosis in a patient with type II diabetes mellitus(Turkish Society of Cardiology, 2019) Kalkan, Semih; Güner, Ahmet; Kalçık, Macit; Geçmen, Çetin; Özkan, MehmetA 42-year old male with known insulin-dependent diabetes mellitus and otherwise unremarkable medical history presented with nausea, vomiting, and atypical chest pain for 2 days. His initial vital signs were remarkable for sinus tachycardia (101 bpm) and tachypnea (20 breaths per minute). He did not have a personal or family history of arrhythmia-related symptoms, ventricular tachycardia or fibrillation (VT/VF), or premature sudden cardiac death (SCD). Electrocardiography (ECG) revealed ST elevations (V1–V2) with associated T wave inversions (Fig. 1a). A baseline ECG performed 6 months ago showed no abnormalities. Serial troponin T measurements were normal. His initial laboratories were notable for hyperglycemia, hyponatremia, hyperkalemia, ketonuria, and metabolic acidosis (Table 1). Upon further questioning, it was found that he had no history of referable cardiac symptoms. There was no family history for SCD, recurrent syncope, or arrhythmia. He was diagnosed with and treated for diabetic ketoacidosis. His clinical status stabilized with normalization of electrolytes and pH (Table 1). After the medical treatment, ECG (Fig. 1b) showed improvement, and he had a negative provocative testing with a sodium channel blocker (ajmaline). He had an uneventful discharged and, at 10 months after treatment, he is doing well.
