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Öğe A rare and subtle etiology of chronic oropharyngeal pain: isolated Internal carotid artery kinking without stenosis(Elsevier, 2020) Öztaş, Didem Melis; Meriç, Mert; Başaran, Bora; Erdinç, İbrahim; Özgür, Eren; Umutlu, Muzaffer Reha; Ünal, Orçun; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Sencer, Serra; Alpagut, Ufuk; U?urlucan, MuratCarotid artery kinking is a frequent finding in duplex ultrasonography. However, isolated morphological changes without significant carotid stenosis are rarely symptomatic. Neck pain is a rare symptom in patients with carotid artery kinks. The vascular etiology in patients with persistent neck pain is usually overlooked. A 58-year-old female patient with chronic neck pain presented to our clinic. Following multidisciplinary team review, the symptoms were found due to the kinking of the internal carotid artery. In this report, we present the clinical presentation of the patient with the kinking of the internal carotid artery without stenosis, surgical management of the pathology, and a brief literature review.Öğe Anxiety and health-related quality of life after cardiac surgery(Termedia Publishing House Ltd., 2020) Güzelhan, Yalçın; Uğurlucan, Murat; Öztaş, Didem Melis; Beyaz, Metin Onur; Ünal, Orçun; Bektaş, Nilüfer; Conkbayır, Cenk; Alpagut, Ufuk; Bozbuğa, NilgünIntroduction: The aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL). Material and methods: One hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up. Results: It was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (? 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety. Conclusions: This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.Öğe Brief review of right aortic arch with aberrant left subclavian artery(Thieme Medical Publishers, Inc., 2019) Öztaş, Didem Melis; Umutlu, Muzaffer; Ertan, Melike; Beyaz, Metin Onur; Badem, Serdar; Erdinç, İbrahim; Ulukan, Mustafa Özer; Ünal, Orçun; Conkbayır, Cenk; Alpagut, Ufuk; Uğurlucan, MuratDevelopment anomalies of the aortic arch and its major branches are rare congenitalcardiovascular disorders. In this article, we present aberrant left subclavian arteryassociated with right aortic arch.Öğe Cardioprotective effects of erythropoietin in diabetic rats determined by CD34 and vascular endothelial growth factor levels(Termedia Publishing House Ltd., 2020) Öztaş, Didem Melis; Meriç, Mert; Beyaz, Metin Onur; Önalan, Mehmet Akif; Sönmez, Kıvılcım; Öter, Kerem; Ziyade, Sedat; Ömer, Beyhan; Alpagut, Ufuk; Uğurlucan, MuratIntroduction: In this study, the effects of diabetes mellitus on the cardiovascular system were investigated by assessing the stem cell levels in serum and heart and compared with the normal population. Additionally, efficacy of erythropoietin, which is known to increase stem cells, was studied in diabetic rats.Material and methods: Twenty-five male Sprague Dawley rats were divided into three groups as a control group (group 1), diabetic group (group 2) and erythropoietin induced diabetic group (group 3). A diabetes model was created with streptozocin. In group 3 rats received 3000 U/kg of erythropoietin. At the end of 1 month blood reticulocyte levels, degree of tissue fibrosis and immunohistochemical assessment of reliable stem cell markers, CD34 and vascular endothelial growth factor (VEGF), were analyzed.Results: The increase in the blood glucose levels resulted in a significant decrease in reticulocyte levels in group 2. The increase in blood glucose levels resulted in a statistically significant increase in tissue level of fibrosis, CD34 and VEGF. When the rats in groups 1 and 2 were compared, the fibrosis, CD34 and VEGF levels were found to increase significantly. When group 2 and group 3 were compared, the amount of fibrosis was lower and the levels of CD34 and VEGF were significantly higher in group 3 than group 2.Conclusions: The results of our study indicated that the amount of CD34 and VEGF which function in cellular protection and tissue regeneration may be enhanced with safely applicable erythropoietin leading to increase in reticulocyte levels in serum, and CD34 and VEGF levels in right atrium, right ventricle, left atrium, and left ventricle as a protective mechanism in diabetic rats.Öğe Ender rastlanan bir tümör: Alt ekstremitede hemanjioperisitoma(Acıbadem Üniversitesi, 2020) Uğurlucan, Murat; Altunyuva, Kaan; Öztaş, Didem Melis; Özgür, Eren; Ümütlü, Muzaffer; Apaydın, Evşen; Bozbuğa, Nilgün; Alpagut, UfukHemanjioperisitomalar, kapiller duvarında yer alan perisitlerden köken alan yumuşak doku tümörlerindendir. Genelde selim seyretmekle birlikte agresif seyreden formları da vardır. İnsan vücudunda her yerde görülebilmelerine rağmen retroperiton en sık görüldüğü yerdir. Tedavi seçenekleri arasında cerrahi yaklaşımlar ilk seçenek olmakla birlikte nadiren radyoterapi ve kemoterapi de kullanılmaktadır. Biz bu yazıda kliniğimizde cerrahi olarak tedavisini uyguladığımız femoral bölgede yerleşimli hemanjioperisitoma olgusunu sunmaktayız.Öğe Follow-up results of aortic arch cervical debranching performed with the help of a temporary crossover external carotid artery bypass for cerebral protection followed by endovascular thoracic aortic aneurysm repair(Oxford University Press, 2020) Öztaş, Didem Melis; Uğurlucan, Murat; Beyaz, Metin Onur; Ulukan, Mustafa Özer; Ünal, Orçun; Önal, Yılmaz; Umutlu, Muzaffer; Acunaş, Bülent; Alpagut, UfukOBJECTIVES: Treating aortic arch aneurysms with conventional open surgical and endovascular stent graft procedures is challenging due to the complex anatomy of the arch and the arteries arising from it that nourish the brain. Cerebral protection is of the utmost importance during the treatment of thoracic aneurysms involving the aortic arch.METHODS: Between May 2014 and November 2018, 7 patients with thoracic aortic aneurysms involving the aortic arch who underwent aortic arch cervical debranching with our technique were reviewed retrospectively. Because all the patients being considered for conventional surgical aortic arch replacement had serious comorbidities, they were selected to receive hybrid therapy. The mean age of the patients was 71.2 +/- 9.4 years. One patient was a woman and 6 patients were men. One patient was given general anaesthesia; the remaining 6 patients had a regional block. A crossover temporary bypass was performed between the external carotid arteries with a 6-mm polytetrafluoroethylene graft for cerebral protection in all patients. Thoracic endovascular aortic repair (TEVAR) was successfully performed in all patients except 1 following debranching.RESULTS: Neurological complications did not occur during the procedures. Patients were followed for a mean of 18.3 +/- 4.9 months. One female patient died of exacerbating chronic obstructive pulmonary disease within the first follow-up year. Three other patients died: 1 died of natural causes; 1 died of pneumonia followed by multiorgan failure; and 1 died of myocardial infarction during the mid-term follow-up period. The remaining patients are still being followed and are event free.CONCLUSIONS: Endovascular treatment of thoracic aortic diseases involving the aortic arch is facilitated when the aortic arch is debranched. Our cerebral protection method with a temporary crossover bypass between the external carotid arteries provides continuous pulsatile blood flow to the brain; hence, neurologically, it is a reliable procedure. The follow-up results of the patients who underwent aortic arch cervical debranching followed by TEVAR depended on their comorbidities.Öğe Follow-up results of endovascular aneurysm repair following abdominal visceral debranching(Sociedade Brasileira de Cirurgia Cardiovascular, 2022) Öztaş, Didem Melis; Uğurlucan, Murat; Sayın, Ömer Ali; Ekiz, Feza; Önal, Yılmaz; Beyaz, Metin Onur; Umutlu, Muzaffer; Meriç, Mert; Acunaş, Bülent; Alpagut, UfukIntroduction: The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods: Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results: Patients’ mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion: Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.Öğe Sağ atriuma uzanım gösteren renal tümörlerde infrarenal vena kava inferior kanulasyonu - hipotermik dolaşım durdurulmasını engelleyen yöntem(İstanbul Üniversitesi, 2019) Uğurlucan, Murat; Öztaş, Didem Melis; Erdem, Selçuk; Ekiz, Feza; Sungur, Zerrin; Erginel, Başak; Şanlı, Öner; Özcan, Faruk; Ander, Ali Haluk; Nane, İsmet; Alpagut, UfukAmaç: Vena kava trombektomisi ile birlikte yapılan radikal tümör eksizyonu, kavoatrial tümör trombozlarının tedavisinde sonderece önemlidir. Bu yazıda sağ atriuma uzanım gösteren renaltümörlerde uyguladığımız hipotermik dolaşım durdurulmasınıengelleyen infrarenal vena kava inferior kanülasyon tekniğini anlatmaktayız.Yöntemler: Haziran 2013 - Aralık 2017 tarihleri arasında intrakardiak uzanım gösteren böbrek kaynaklı tümör saptanan 5 hastatarafımıza konsülte edilmiştir. Hastaların yaş ortalaması 43,2 yılidi. Pediatrik ve 1 yetişkin hasta erkek, diğer 3 yetişkin hasta kadındı. Operasyonlarda vena kava superior, infrarenal vena kavainferior ve two-stage venöz kanüller takılı olan üçlü venöz kanülasyon sistemi kullanıldı. Vena kava süperior ve infrarenal venakava inferior kanülasyonlarını takiben tümör trombüsü çıkarıldı.Atriotomi kapatılırken two-stage venöz kanül sağ atriuma yerleştirildi. Prosedüre usulünce devam edildi.Bulgular: Operasyon sırasında ya da sonrasında mortalite gözlenmedi. Ortalama operasyon süresi 465 dk, kardiyopulmonerbypass süresi 48 dk ve myokardial iskemi süresi 27 dk idi. Hepatikve renal iskemi süreleri ortalama 15,4 dk oldu. Ortalama yoğunbakım ve hastanede kalış süreleri sırasıyla 28,4 saat ve 9,3 gün hesaplandı.Toplam takip süresi 12 ay idi. Hiç bir hastada uzundönem takiplerde mortalite ile karşılaşılmadı.Sonuç: Tümörün tamamen çıkarılması ve rezidü trombüs bırakılmaması bu hasta grubunun mortalitesini belirleyen en önemlietkenlerdendir. Uyguladığımız teknikle birlikte hastalarda hipotermik dolaşıma gereksinim duyulmadan orta hipotermide tambir tümör eksizyonu sağlanmış ve trombüs dokusu bırakılmadığından emin olunmuştur.Öğe Silikon protez kullanılarak rekonstrüktif meme cerrahisi uygulanmış hastada minimal invaziv sinüs venozus defekti onarımı(2019) Öztaş, Didem Melis; Yetüt, Doğan; Duman, Salih; Berköz, Hayri Ömer; Sayın, Ömer Ali; Uğurlucan, Murat; Alpagut, UfukAtriyal septal defekt erişkinde en sık rastlanan doğumsal kalp anomalilerinden biridir. Minimal invaziv cerrahi tekniklerdeki gelişmeler, seçilmiş uygun vakaların bu yöntemle daha yaygın olarak tedavi edilmesini artırmıştır. Sağ anterior torakotomi ile minimal invaziv olarak atriyal septal defekt onarımı güvenilir sonuçları, yüksek hasta memnuniyeti nedeniyle özellikle genç bayan hastalarda ilk sıralarda tercih edilecek yöntemlerden biridir. Biz bu yazıda yaklaşık 3 yıl önce silikon meme protezi ameliyatı olan hastada uyguladığımız minimal invaziv teknik ile sinüs venozus defekti onarımını anlatmaktayız. Mevcut kompleks atrial septal defekt ve cerrahi alanda silikon meme protezi bulunmasına rağmen sağ anterolateral mini torakotomi yaklaşımı sayesinde uygulanan tedavi başarılı ve kozmetik olarak sorunsuz olmuştur.Öğe The geometrical modeling of aortic root complex(2019) Uğurlucan, Murat; Beyaz, Metin Onur; Öztaş, Didem Melis; Öztürk, Adnan; Şahinoğlu, Kayıhan; Alpagut, Ufuk; Bozboğa, NilgünBACKGROUND: This study was designed to investigate the anatomical relationship of the different levels of aortic root. MATERIALS AND METHODS: The morphological features of the aortic root were examined using of 12 adult hearts from fixed male cadavers who had expired due to noncardiac causes by magnetic resonance imaging and applied mathematical analyses to the results. The measurements of the aortic root were done at four levels: at the ventriculoarterial junction (annulus), at the largest level of the Valsalva sinuses (sinus), at the level of commissures (sinotubular junction [STJ]), and at 1 cm above the STJ (aorta ascendens). We derived an equation that allows calculation of the appropriate diameter of the aortic root from four levels. Statistical analysis among the variation of the diameters at the four levels of aortic root was achieved using test one-way analysis of variance. RESULTS: The data showed a geometric pattern of the aortic root. The comparison of the values from four levels showed that the narrowest at the sinotubular junctional level and the widest at the sinus level. CONCLUSION: The analysis of our data shows that the aortic root has a consistent shape with varying size and that is a definable mathematical relationship between root diameter.Öğe The revascularization of the left subclavian artery with a cross over axilloaxillary bypass for the hybrid repair of thoracic aortic aneurysms(Mexican Academy of Surgery, 2022) Öztaş, Didem Melis; Önalan, Mehmet Akif; Ekiz, Feza; Beyaz, Metin Onur; Önal, Yılmaz; Erdinç, İbrahim; Uğurlucan, Murat; Acunas, Bülent; Alpagut, UfukAim: We present our subclavian artery revascularization experiences in the patients with thoracic aortic aneurysm who underwent hybrid repair. Materail and Methods: Between May 2015-December 2018,4 patients underwent TEVAR procedure following axilloaxillary bypass grafting.The mean age of the patients was 72.5 +/- 3.01 years.One patient was female and 3 patients were male.Patients had thoracic aortic aneurysms including the left subclavian artery or aberrant right subclavian artery. Results: All patients underwent endovascular stent graft repair following axilloaxillary bypass grafting in the same day.Mortality did not occur in the perioperative period.One patient had graft infection at 8th month of the operation and the graft was removed.He was lost due to pneumonia following the operation.The control computed tomographies of the other 3 patients revealed patent grafts together with successful endovascular interventions and they have been following uneventfully a mean of 27 +/- 6.2 months (range:24-32,median:29). Conclusion: The risk of stroke,spinal cord ischemia, and upper extremity ischemia are found higher in the patients who underwent coverage of the left subclavian artery without revascularization.The axilloaxillary bypass grafting may be performed in the patients with high risk to prevent carotid artery manipulation and clamping during carotid-subclavian bypass with long term promising patency rates.Öğe Torasik aort patolojili hastalarda stent greft uygulamaları ve sonuçları(İstanbul Üniversitesi Yayınevi, 2020) Önal, Yılmaz; Samancı, Cesur; Acunaş, Bülent; Uğurlucan, Murat; Alpagut, UfukAmaç: Bu çalışmada, torasik stent greft uygulanmış hastaların uzun dönem sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde sadece stent greft ile ya da hibrid yöntem (cerrahi sonrası endovasküler girişim) ile tedavi edilmiş torasik aort patolojili, yaş ortalaması 67,1 (20-82) olan 25 hastayı retrospektif olarak değerlendirdik. Bulgular: Hastalardan 23’ü elektif olarak tedavi edilirken, 2’si acil olarak işleme alınmıştır. Kontrol görüntülemelerde 5 hastada tip 1A endoleak izlenmiştir. Bu hastalardan 3’üne ek girişim uygulanmıştır. Hastalardan birisinde endoleak takip sırasında kendiliğinden regrese olmuştur. 1 hastada ise post-op 6. günde MI nedeniyle ex olmuştur. Toplam 7 hastada hibrid işlem uygulanmıştır. Debranching uygulanan hastalardan bir tanesinde endovasküler işlem sırasında majör komplikasyon gelişmiştir. Hibrid girişim uygulanan 7 hastadan 1’i olan tip B diseksiyon hastasında işlem sonrası kontroller sırasında nörolojik komplikasyon izlenmiştir. Sonuç: Endovasküler torakal stent greft işlemi torakal aort patolojilerinde yüksek teknik başarı ve sağ kalım oranları ile uygulanmaktadır. Tek başına TEVAR’a uygun olmayan anatomiye sahip hastalarda hibrid girişim tercih edilmektedir.
