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    A Quadricuspid Aortic Valve with Mild Aortic Regurgitation
    (2019) Karavelioğlu, Yusuf; Ekinözü, İsmail; Yetim, Mücahit; Kalçık, Macit
    A 21-year-old male was admitted to our outpatient clinic with atypical chest pain. He had no history of cardiovascular disease. Physical examination revealed 2/4 diastolic murmur along the right sternal border, and his electrocardiogram was normal. Transthoracic echocardiography revealed mild aortic regurgitation in the parasternal long-axis view. Transaortic gradients were within the normal limits
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    A rare cause of dysphagia and weight loss in a nonagenarian with hypertension: Dysphagia aortica
    (Blackwell Publishing Inc., 2015) Karavelioğlu, Yusuf; Kalçık, Macit; Yetim, Mücahit; Sarak, Taner; Bekar, Lütfü; Doğan, Tolga
    To the Editor: Dysphagia is a subjective awareness of difficulty in swallowing caused by impaired progression of food from the oropharynx to the stomach. An unusual mechanical cause of dysphagia occurs from extrinsic compression of the esophagus by the aorta. This was first described in 1932 as dysphagia aortica, which develops primarily in women and is associated with short stature, old age, hypertension, and kyphosis.1 A 98?year?old woman with dysphagia aortica caused by a dilated archus aorta and uncontrolled hypertension is reported.
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    A rare complication of percutaneous coronary intervention: Coronary pseudoaneurysm formation
    (Akademiai Kiado Rt., 2017) Çelik, Oğuzhan; Bekar, Lütfü; Yetim, Mücahit; Doğan, Tolga; Çağlar, Alp; Kalçık, Macit; Karavelioğlu, Yusuf
    Coronary pseudoaneurysms (CPAs) are rare complications developed after percutaneous coronary interventions. They may cause stent thrombosis, distal embolization, and coronary rupture leading to cardiac tamponade. Therefore, high-risk CPA should be promptly treated after diagnosis. They can be managed with percutaneous or surgical intervention. Herein, we aimed to present a patient who developed CPA 3 weeks after percutaneous coronary intervention and successfully treated with percutaneous intervention using a covered stent. © 2017 The Author(s)
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    Acute myocardial infarction and concomitant ischemic stroke as an unusual presentation of native mitral valve endocarditis
    (Akadémiai Kiadó Zrt., 2018) Karaarslan, Osman; Kalçık, Macit; Çamkıran, Volkan; Eliaçık, Sinan; Alp, Çağlar; Karavelioğlu, Yusuf
    ST-elevation myocardial infarction (STEMI) due to septic coronary embolism is a rare complication of infective endocarditis (IE) and isassociated with high mortality rates. When common signs of IE are often overlooked on admission, the diagnosis may be established throughcomplications, which may cause prominent symptoms. Here, we report a case of native mitral valve endocarditis with an unusual presentation withSTEMI and concomitant ischemic stroke, which was due to multiple coronary and cerebral septic embolisms. © 2018 The Author(s).
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    An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER*-2 study design
    (2015) Ertaş, Faruk; Kaya, Hasan; Yıldız, Abdulkadir; Davutoğlu, Vedat; Kiriş, Abdulkadir; Çil, Habib; Yüksel, Murat; Karavelioğlu, Yusuf
    Objectives: Atrial fibrillation (AF) is one of the most common causes opreventable ischemic stroke and is related to increased cardiovasculamorbidity and mortality. There is a lack of data in Turkey on the use onew oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modalityIn this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. Study design: Four thousand one hundred consecutive adulpatients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, strokesystemic thromboembolism, major bleeding and hospitalization). Results: First results are expected in June 2015. Data about majocardiovascular end-points will be available in January 2016. Conclusion: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 studyIn addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).
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    An unusual coronary pseudo-obstruction image due to competitive blood flow between critical stenosis in proximal LAD and collateral vessels from RCA
    (Akademiai Kiado Rt., 2015) Karavelioğlu, Yusuf; Doğan, Tolga; Kalçık, Macit; Çamkıran, Volkan
    This case illustrates an unusual coronary pseudo-obstruction due to competitive coronary flows from critical proximal left anterior descending (LAD) coronary artery stenosis and collateral vessels from distal right coronary artery. The flow dynamics of both antegrade and retrograde flows counterbalanced each other at the second diagonal branch level of LAD causing a total pseudo-obstruction image. © 2015 Akadémiai Kiadó, Budapest.
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    Anafilaktik Reaksiyonda Epinefrin Aşırı Dozuna Bağlı Miyokard Enfarktüsü
    (2016) Bekar, Lütfü; Sarak, Taner; Yetim, Mücahit; Doğan, Tolga; Çelik, Oğuzhan; Çamkıran, Volkan; Karavelioğlu, Yusuf
    Epinefrin anafilaktik reaksiyonun tedavisinde sıklıkla kullanılan bir ajandır. Anafilaktik reaksiyonlarda epinefrin kullanımına bağlı göğüs ağrısı, miyokardiyal enfarktüs ve aritmi olabileceği bildirilmiştir. Biz bu makalede ciddi anafilaksisi olan bir hastada, subkutan olarak order edilen ancak yanlışlıkla intravenöz olarak uygulalan epinefrinin neden olduğu miyokardiyal enfarktüsü sunduk.
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    Assesment of long term cardiovascular effects of unileteral nephrectomy
    (Oxford Univ Press, 2017) Özkurt, Sultan; Karavelioğlu, Yusuf; Kalçık, Macit; Doğan, İsmail Çağrı; Musmul, Ahmet; Yetim, Mücahit; Karaarslan, Osman; Çelik, Oğuzhan; Ekinözü, İsmail
    [Abstract Not Available]
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    Assessment of long-term cardiovascular effects of unilateral nephrectomy
    (Springer Netherlands, 2017) Özkurt, Sultan; Karavelioğlu, Yusuf; Kalçık, Macit; Musmul, Ahmet
    Purpose: There is conflicting evidence regarding long-term effects of unilateral nephrectomy such as cardiovascular diseases. Excessive increase in blood pressure (BP) during exercise called “hypertensive response to exercise” may be a sign of unborn hypertension and increased cardiovascular risk. Decrease in glomerular filtration rate (GFR) in patients with unilateral nephrectomy may be associated with disturbance of circadian BP changes without affecting the absolute levels of BP. We aimed to investigate the circadian BP changes and hypertensive response to exercise in normotensive patients with preserved renal functions who had undergone unilateral nephrectomy for other causes rather than organ donation. Methods: This study enrolled 32 patients (mean age 43.4 ± 9.9 years, male 15) with unilateral nephrectomy and 40 healthy controls (mean age 47 ± 6.1 years, male 17). All patients were undergone both office and ambulatory BP measurements and treadmill stress test. Results: The median time since nephrectomy was 12 (9–22) years in the patient group. The median GFR of the patient group was lower than that of the controls without significance [85.1 (76.0–97.9) vs. 93.2 (84.5–104.9), respectively; p = 0.14]. There was no significant difference between groups in terms of office BP measurements, night time diastolic and systolic BP, mean arterial pressure (MAP), night/day time ratio of MAP in ambulatory BP measurements. The results of treadmill stress tests and hypertensive response to exercise ratios were also similar between the groups. Conclusion: This study revealed that there was no increase in long-term cardiovascular risks one decade after unilateral nephrectomy based on circadian BP changes and hypertensive response to exercise in normotensive patients. © 2017, Springer Science+Business Media Dordrecht.
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    Cardiac functions and all-cause mortality in kyphoscoliosis patients with chronic respiratory failure using non-invasive ventilation
    (Bilimsel Tıp Yayınevi, 2015) Karavelioğlu, Yusuf; Karapınar, Hekim; Karakurt, Zuhal; Açar, Göksel; Moçin Yazıcıoğlu, Özlem; Adıgüzel, Nalan; Yüksel, Murat; Güngör, Gökay; Esen, Ali Metin
    Introduction: We aimed to evaluate cardiac functions and mortality rate in kyphoscoliosis patients with chronic respiratory failure under long term non-invasive ventilation (NIV). Patients and Methods: Kyphoscoliosis patients, who used NIV, were included in the study. Patients’ characteristics and cardiovascular risk factors were recorded. Ambulatory rhythm monitoring and echocardiography were performed for all patients. Results were compared with 26 age-gender matched volunteers without dyspnea. Patients had been followed for fi ve years. Results: Twenty-three kyphoscoliosis patients (54 ± 13 years, 15 male) were included in the study. Hypertension and paroxysmal atrial fi brillation were more frequent in patients. Left ventricular systolic functions were normal but diastolic functions were worsened. Right ventricular sizes were normal but systolic and diastolic functions were worsened and the mean pulmonary artery pressure was higher in kyphoscoliosis patients. Four patients were died in follow up. Two of patients died due to severe hypoxia and two of them died due to sepsis. Clinical and laboratory properties including cardiovascular risk factors, echocardiographic examination were not different between the survived patients and dying ones. Conclusion: Hypertension and arrhythmia are more frequent. The left ventricle is slightly affected but the right ventricle is severely affected and pulmonary pressure is increased in kyphoscoliosis. Cardiovascular functions do not predict mortality in kyphoscoliosis patients under long term NIV treatment.
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    Cardiac tamponade as the first clinical sign of gastric adenocarcinoma: A rare condition
    (Turkish Society of Cardiology, 2014) Arısoy, Arif; Memiç, Kadriye; Karavelioğlu, Yusuf; Şen, Fatma
    Cardiac tamponade originating from a primary gastric cancer (GC) is a rare condition. Patients are generally asymptomatic until the disease is advanced. We report a rare patient with cardiac tamponade as the first manifestation of primary GC. A 46-year-old male was admitted with progressive dyspnea. Cardiac tamponade was diagnosed on two-dimensional ultrasonographic echocardiography. Pericardiocentesis yielded 1500 ml of bloody fluid. Pericardial cytologic examination was positive for malignant cells. The patient underwent abdominal computed tomography scan, which showed thickening of the gastric wall and several mesenteric lymph nodes. Endoscopic examination of the stomach disclosed malignant ulcer along the lesser curvature, and the biopsy showed diffuse type adenocarcinoma. Chemotherapy was initiated by the Oncology Department, and he had no pericardial effusion after six courses of systemic chemotherapy. In conclusion, this is a rare condition and difficult to diagnosis early. Thus, physicians should be aware of malignancy of the stomach when patients present with unexplained cardiac manifestations. © 2014 Türk Kardiyoloji Derne?i.
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    Comparison of aortic pressures and aortic elastic properties between patients with end-stage renal disease and healthy controls
    (Akademiai Kiado Zrt, 2019) Kalçık, Macit; Yetim, Mücahit; Doğan, Tolga; Doğan, İbrahim; Eser, Barış; Bekar, Lütfü; Karavelioğlu, Yusuf
    Background: Current evidence indicates that vascular calcification plays an essential role in the development of cardiovascular diseases in end-stage renal disease (ESRD) patients. Arterial stiffness is a marker of increased cardiovascular risk in various populations. The aim of this study is to evaluate the elastic properties of ascending aorta in patients with ESRD. Methods: This single-center study enrolled 96 patients (45 females, age: 57.2 +/- 12.8 years) with ESRD and 96 healthy controls (52 females, age: 55.3 +/- 10.1 years). Aortic pressures and aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index, and aortic compliance were calculated using accepted formulae. Results: The hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure, and aortic pulsatility index were significantly higher in patients with ESRD. Systolic and diastolic aortic diameters were similar between the groups. However, pulsatile aortic diameter change, aortic strain, aortic distensibility, and aortic compliance were significantly lower, whereas aortic stiffness index was significantly higher in ESRD group. Conclusions: The results demonstrated that a significant difference was present in terms of aortic blood pressures between patients with ESRD and controls. In addition, the elastic properties of ascending aorta were decreased in patients with ESRD.
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    Complete regression of primary epicardial leiomyosarcoma with single agent doxorubicin in an elderly patient
    (2013) Karavelioğlu, Yusuf; Arısoy, Arif; Şen, Fatma
    Soft tissue sarcomas are uncommon malignant mesenchymal neoplasms; however, they remain the second most frequent primary tumours of the heart. The most common of which is angiosarcoma, representing about 37% of cardiac sarcomas, whereas leiomyosarcoma is an extremely rare mesenchymal tumour of the heart and accounts for only 9% of all cardiac sarcomas.1 Nearly 75% of cardiac leiomyosarcomas originate from the atria and/or pulmonary vessels, with only 7.4% being epi/pericardial in origin.2 Dyspnoea, pericardial effusion, arrthythmia, syncope, chest pain, embolism, and fever are often encountered as presenting signs and symptoms of cardiac leiyomyosarcomas. Currently in literature, there are no wellestablished management guidelines for this, particularly in elderly patients. Surgical interventions may palliate symptoms related to obstruction and embolism, and may prolong survival.3,
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    Coronary embolism in a patient with massive left atrial thrombus and mechanical valve thrombus: Hybrid treatment with surgery and percutaneous intervention
    (Turkish Anaesthesiology and Intensive Care Society, 2013) Karavelioğlu, Yusuf; Yanartaş, Mehmet; Sarak, Taner; Bakal, Ruken Bengi; Özkan, Mehmet
    [No abstract available]
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    Dunbar syndrome as an unusual cause of exercise-induced retrosternal pain
    (Turkish Society of Cardiology, 2015) Karavelioğlu, Yusuf; Kalçık, Macit; Sarak, Taner
    The median arcuate ligament is a fibrous band connecting the left and right diaphragmatic crura across the aortic hiatus at the level of the T12/L1 vertebral bodies. The low insertion point of this ligament causes significant stenosis of the proximal portion of the coeliac artery in a small group of patients, and contributes to ischemic symptoms known as coeliac artery compression syndrome (CACS). It is also referred to as median arcuate ligament syndrome or Dunbar syndrome. Symptoms include especially postprandial epigastric or retrosternal pain, weight loss, nausea, vomiting, diarrhea and reduced appetite. In severe cases, exercise related abdominal pain may be caused by steal phenomenon, whereby blood is shunted to the skin and relevant muscles during exercise. Computed tomographic angiography and mesenteric angiography are the gold standard diagnostic modalities to confirm diagnosis of CACS. Surgical therapy with release of the median arcuate ligament usually is the primary treatment of choice. Here, we present a 46-year-old male CACS patient with postprandial and especially exercise-induced retrosternal pain radiating to the epigastric region, which may be misperceived as a coronary symptom. © 2015 Turkish Society of Cardiology.
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    Echocardiographic assessment of right ventricular functions in nondiabetic normotensive hemodialysis patients
    (Akademiai Kiado Rt., 2015) Karavelioğlu, Yusuf; Özkurt, Sultan; Kalçık, Macit; Karapınar, Hekim; Arısoy, Arif
    Purpose: Heart is affected structurally and functionally in end-stage renal disease (ESRD). However, the data available about adverse effects of ESRD on right ventricle (RV) is scarce. We aimed to evaluate echocardiographic parameters of RV in nondiabetic, normotensive patients with ESRD undergoing hemodialysis (HD). Methods: A total of 45 (24 women; mean age 52.4 ± 12.4 years) consecutive nondiabetic, normotensive patients with ESRD undergoing HD and 39 healthy age and sex-matched control subjects (22 women; mean age 50.3 ± 6.6 years) were enrolled in the study. M-mode and two dimensional images, color, pulsed and continuous wave Doppler, and tissue Doppler measurements were acquired from all subjects. Echocardiographic evaluation was performed in the days between HD dates of the patients. Results: RV fractional area change, tricuspid annular plane systolic excursion, tricuspid E velocity, E/A ratio, tricuspid annular E´ velocity, and E´/A´ ratio were lower in patients than controls (p < 0.001, p = 0.003, p = 0.007, p = 0.005, p < 0.001, and p = 0.034, respectively). However, RV diastolic area, RV myocardial performance index, E/E´ ratio, and mean and systolic pulmonary artery pressure were higher in patients than controls (p < 0.001, p = 0.007, p = 0.005, p < 0.001, p = 0.006, respectively). Conclusions: RV systolic and diastolic functions of nondiabetic, normotensive HD patients are deteriorated as compared to healthy controls. © 2015 Akadémiai Kiadó, Budapest.
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    Echocardiographic evaluation of epicardial adipose tissue in non-diabetic, non-hypertensive hemodialysis patients
    (2013) Özkurt, Sultan; Karavelioğlu, Yusuf; Musmul, Ahmet
    Purpose: It has been found out that the epicardial adipose tissue (EAT) measured by echocardiography is related with various metabolic parameters. Being accepted as the new cardiovascular risk indicator, there have been few studies on EAT in relation to the patients with end-stage renal failure. In our study, we aim to evaluate EAT and carotid intima media thickness (CIMT) in non-diabetic, non-hypertensive hemodialysis (HD) patients. Methods: Our study recruited 47 non-diabetic, non-hypertensive HD patients (22 males, 25 females, median age 54 (44.3-60.8) years) and an age-gender matched control group consisting 41 healthy subjects (17 males, 24 females, median age 52 (48-56) years). In all patients, EAT was measured by echocardiography and CIMT by ultrasonography; and routine laboratory parameters were studied. Results: In our study, we obtained laboratory findings matching with the profiles of uremic patients among HD patients and CIMT values of HD patients are significantly higher than that of the control group [0.79 (0.64-0.93) vs. 0.6 (0.53-0.68) p < 0.001], and EAT values are similar [0.5 (0.33-0.6) vs. 0.4 (0.4-0.53) p > 0.05]. Conclusions: EAT is not a cardiovascular risk indicator in HD patients without diabetes mellitus and hypertension. Besides, echocardiographic measurement of EAT is easy, non-invasive, cheap and credible method. © 2013 Informa Healthcare USA, Inc.
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    Echocardiographic measurement of epicardial adipose tissue thickness in patients with microvascular angina
    (Akademiai Kiado Zrt, 2019) Kalçık, Macit; Yesin, Mahmut; Güner, Ahmet; Bayam, Emrah; Yetim, Mücahit; Doğan, Tolga; Karavelioğlu, Yusuf
    Introduction: Impaired coronary microcirculation, inflammation, and endothelial dysfunction were reported etiological factors for microvascular angina (MVA). Recently, increased epicardial adipose tissue (EAT) thickness has been associated with hypertension, metabolic syndrome, and coronary artery disease in general population. In this study, we aimed to evaluate the EAT thickness in patients with MVA. Methods: This study enrolled 200 patients (83 males; mean age: 55.4 +/- 8.2 years) who have been diagnosed with MVA and 200 controls (89 males; mean age: 54.4 +/- 8.5 years). All patients underwent transthoracic echocardiography, and EAT thickness was measured from a parasternal long-axis view as the hypoechoic space on the right ventricular free wall. Results: The mean EAT thickness was significantly higher in MVA patients than the controls (5.5 +/- 1.1 vs. 4.9 +/- 0.7 mm; p < 0.001). Multiple logistic regression analysis showed that increased EAT thickness was an independent predictor of MVA (OR = 1.183, 95% CI = 1.063-1.489; p = 0.023). In receiver operating characteristic curve analyses, EAT thickness above 5.3 mm predicted MVA with a sentivity of 68% and a specificity of 63% (AUC = 0.711, 95% CI = 0.659-0.762; p < 0.001). Conclusions: The EAT thickness was observed significantly higher in MVA patients as compared to controls. Increased EAT thickness may be associated with mechanisms that play a major role in the pathogenesis of MVA.
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    Echocardiographic predictors of interatrial block in patients with severe chronic kidney disease
    (Springer, 2020) Kalçık, Macit; Yetim, Mücahit; Doğan, Tolga; Eser, Barış; Doğan, İbrahim; Bekar, Lütfü; Karavelioğlu, Yusuf
    Background Interatrial block (IAB), defined as a conduction delay between the right and left atrium, is manifested on the electrocardiogram as a prolonged P-wave duration. Large number of studies recently have been published regarding the prevalence of IAB and its associations with the risk of atrial fibrillation and ischemic stroke. Cardiovascular diseases are the leading causes of mortality in chronic kidney disease (CKD). In this study, we aimed to investigate echocardiographic predictors of IAB in patients with severe CKD. Methods This study enrolled a total of 155 patients [male: 95 (61.3%), mean age: 56.3 +/- 12.8 years] with severe CKD (glomerular filtration rate < 30 mL/min). All patients were evaluated by electrocardiography and transthoracic echocardiography. IAB was defined as P wave duration of >= 120 ms on electrocardiography. Results Electrocardiography revealed IAB in 54 patients. The baseline demographic characteristics of the patients were similar in both groups with and without IAB. Left atrial diameter (LAD), left ventricular end-systolic and end-diastolic diameters, interventricular septal thickness, posterior wall thickness, left ventricular mass, left ventricular mass index (LVMI), and the prevalence of left ventricular hypertrophy were found to be significantly increased in patients with IAB. Increased LAD (OR = 1.119; 95% CI 1.019-1.228; p = 0.019) and LVMI (OR = 1.036; 95% CI 1.003-1.070; p = 0.031) were found to be independent predictors of IAB. Conclusion A significant association exists between the presence of IAB and echocardiographic parameters related to left ventricular hypertrophy and left atrial dilatation. Presence of IAB may be an additional and easy diagnostic marker for risk stratification of patients with severe CKD.
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    Effectiveness of High-Intensity Interval Training vs Moderate-Intensity Continuous Training in Patients With Fibromyalgia: A Pilot Randomized Controlled Trial
    (W B Saunders Co-Elsevier Inc, 2020) Atan, Tuğba; Karavelioğlu, Yusuf
    Objective: To compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) combined with strengthening and stretching exercises in patients with fibromyalgia. Design: Interventional, single-blind, randomized controlled trial. Setting: Outpatient rehabilitation center. Participants: Women with fibromyalgia (N=60) were randomized to HIIT, MICT, and control groups. Interventions: HIIT included a 5-minute warm-up at 50% of peak heart rate and 4 cycles of 4 minutes at 80%-95% of peak heart rate followed by 3-minute recovery intervals at 70% of peak heart rate. MICT consisted of 45 minutes at 65%-70% of peak heart rate. Each aerobic training session was followed by standardized strengthening and stretching exercises. The programs performed using cycle ergometers for 5 sessions per week for 6 weeks. The control group did not participate in any supervised exercise sessions. Main Outcome Measures: The primary outcome measure was the Fibromyalgia Impact Questionnaire (FIQ). The secondary outcome measures were visual analog scale for pain, Short Form-36 Health Survey (SF-36), cardiopulmonary exercise test (CPET), and body composition parameters. Results: Fifty-five participants completed the study. There was no significant difference in FIQ between HIIT vs MICT (1.03; 95% CI, -9.67 to 11.75) after treatment. Group-time interactions were significant for the FIQ between interventions and control (HIIT vs control, -16.20; 95% CI, -27.23 to -5.13 and MICT vs control, -17.24; 95% CI, -28.27 to -6.22) (all P<.001). There were significant group-time interactions for the pain, SF-36, and CPET parameters between treatments and control (all P<.05). Body weight, fat percentage, fat mass, and body mass index improved significantly (all P<.05) only in the MICT group after treatment. Conclusions: The HIIT plus strengthening and stretching exercises and MICT plus strengthening and stretching exercises interventions showed significant improvements for the effect of fibromyalgia, pain degree, functional capacity, and quality of life compared with the control group. HIIT was not superior to MICT. Furthermore, body composition parameters were improved significantly only for the MICT group. (C) 2020 by the American Congress of Rehabilitation Medicine