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    Cardiovascular risk and coronary atherosclerotic plaques detected by multidetector computed tomography: Framingham and SCORE risk models underestimate coronary atherosclerosis in the symptomatic low-risk Turkish population
    (Lippincott Williams & Wilkins, 2012) Canpolat, Ugur; Yorgun, Hikmet; Aytemir, Kudret; Hazirolan, Tuncay; Kaya, Ergun Baris; Ates, Ahmet Hakan; Dural, Muhammed
    Objective In this study, we investigated the association between cardiovascular (CV) risk factors and coronary atherosclerotic plaque (CAP) burden/subtypes shown by multidetector computed tomography in symptomatic patients free of known coronary artery disease (CAD). Methods In 662 consecutive outpatients (56.9 +/- 10.7 years, 50.8% men) without known CAD, 64-slice multidetector computed tomography coronary angiography was performed for detection of CAD. Risk estimation for CV outcomes was assessed using the Systematic Coronary Risk Evaluation (SCORE) and the Framingham Risk Score (FRS). Logistic regression analysis was used to evaluate the association of CV risk factors with the prevalence/extent of CAP. Results CAP was detected in 318 (48.0%) individuals. Male sex, older age, hypertension, diabetes mellitus, smoking, and dyslipidemia all increased the likelihood of the presence of CAP in univariate analysis (P < 0.001). Older age, male sex, dyslipidemia, and diabetes mellitus independently increased the likelihood of the presence of CAP in multivariate analysis (P < 0.005). Multinominal logistic regression analysis showed an association with older age, male sex, dyslipidemia, and smoking for noncalcified plaques; with older age, male sex, diabetes, and dyslipidemia for mixed plaques; and with older age and male sex for calcified plaque. Patients with low FRS and SCORE showed a large number of CAPs (33.8 and 40.4%), although CAP was more prevalent in the high-risk groups (67 and 78%, respectively). Conclusion CV risk stratification using only risk factor-based scores is a weak discriminator of the overall CAP burden in individual patients. Many patients with low FRS or SCORE with substantial CAP might be undertreated or not treated at all. Coron Artery Dis 23:195-200 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
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    Transcatheter Interatrial Septal Defect Closure in a Large Cohort: Midterm Follow-up Results
    (Tech Science Press, 2013) Aytemir, Kudret; Oto, Ali; Ozkutlu, Suheyla; Canpolat, Ugur; Kaya, Ergun Baris; Yorgun, Hikmet; Sahiner, Levent
    ObjectivesWe evaluated immediate and midterm results of transcatheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO) using various closure devices. Materials and MethodsThe study included four hundred fourteen patients (one hundred eighty-two men, two hundred thirty-two women; mean age 39 12.3 years; range 17-67 years) who underwent transcatheter closure of secundum ASD (n = 193) or PFO (n = 221). All the patients were evaluated by transthoracic echocardiography and transesophageal echocardiography before the procedure. Transcatheter closure was performed by using Amplatzer (n = 184), Occlutech Figulla (n = 209), or BioSTAR (n = 21) devices. Closure of ASDs was performed under general anesthesia with transesophageal echocardiography guidance, and closure of PFOs was performed under local anesthesia with transthoracic echocardiography guidance. Follow-up controls were at 1, 6, and 12 months and annually thereafter. The median follow-up periods of ASD and PFO patients were 43 and 30 months. ResultsThe mean device size was 19.3 +/- 6.2mm for ASD patients and 24.6 +/- 2.6mm for PFO patients. The mean procedural and fluoroscopy times were 22.3 +/- 4.7 and 4.1 +/- 1.9 minutes for ASD closure and 12.4 +/- 3.2 and 3.1 +/- 1.2 minutes for PFO closure, respectively. Procedural device embolization occurred in only two patients (0.48%). During follow-up, recurrent embolic events occurred in four patients (1.8%) after PFO closure, and no residual shunts were seen after ASD closure. Device thrombosis developed in two ASD patients during the procedure and in one PFO patient at 12th month of the follow-up (0.72%). ConclusionTranscatheter closure of PFOs and secundum-type ASDs using the Amplatzer, Occlutech Figulla, and BioSTAR devices is an efficacious and safe therapeutic option.
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    Transthoracic Echocardiography Guidance during Percutaneous Closure of Patent Foramen Ovale
    (Wiley, 2011) Oto, Ali; Aytemir, Kudret; Ozkutlu, Suheyla; Kaya, Ergun Baris; Yorgun, Hikmet; Canpolat, Ugur; Ates, Ahmet Hakan
    Background: Percutaneous closure of patent foramen ovale (PFO) has been increasingly performed for several indications; mostly due to cryptogenic stroke. In this study we aimed to evaluate the safety and efficacy of transthoracic echocardiographic (TTE) guidance during percutaneous closure of PFO in using the Amplatzer and Occlutech Figulla PFO occluder devices. Methods: Between October 2005 and March 2011, 139 patients (74 male, mean age: 40.4 +/- 10.3) underwent transcatheter PFO closure. In all patients transesophageal echocardiography performed subsequently to diagnose, assess the size and evaluate for suitability of the defect for percutaneous closure. During the procedure fluoroscopy and TTE were used for guidance. Results: Among 139 patients, Amplatzer PFO occluder was used in 74 patients and in 65 of them Occlutech Figulla device was selected for occlusion. The indications for PFO closure were ischemic stroke in 98 (70.5%), recurrent transient ischemic attacks (TIA) in 40 (28.7%), peripheral embolism in 1 (0.8%) of the patients. In all patients, percutaneous intervention was performed successfully under TTE guidance. There have been no neurologic (recurrent strokes or TIAs) and cardiovascular complications during the immediate and long-term follow-up period (267 months, median 29). There was significant difference between the mean fluoroscopic time from the beginning which is 8.6 +/- 3.4 min in the former versus 3.4 +/- 1.9 min in the latter (P < 0.05). Conclusion: Our study confirms the efficacy and safety of TTE guidance during percutaneous closure of PFO, which shortens the procedural time and obviates the need for general anesthesia or endotracheal intubation. (Echocardiography 2011;28:1074-1080)