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Yayın Allergic myocardial infarction in childhood: Kounis syndrome(Springer Nature, 2009) Biteker, Murat; Ekşi Duran, Nilüfer; Sungur Biteker, Funda; Ayyıldız Civan, Hasret; Kaya, Hasan; Gökdeniz, Tayyar; Yıldız, Mustafa; Özkan, MehmetKounis Syndrome was first described by Kounis as "allergic angina syndrome" progressing to "allergic myocardial infarction". This report describes the first children in the literature presented with Kounis syndrome.Yayın Atriyoventriküler tam blokta kalıcı kalp pili öncesi ve sonrasında kardiyovasküler sistem stabilizasyonunda hemodinamik kompansatuvar değişimler(Türk Kardiyoloji Derneği, 2009) Ekşi Duran, Nilüfer; Astarcıoğlu, Mehmet Ali; Ayhan, Ahmet Çağrı; Karapınar, Hekim; Duran, İbrahim; Ertürk, Emre; Gökdeniz, Tayyar; Kaya, Hasan; Özkan, MehmetAtriyoventriküler (AV) tam blokta kardiyovasküler sistem stabilizasyonu birçok hemodinamik ve hormonal parametrenin kompansatuvar değişimi ile korunmaktadır. Bu çalışmada, AV tam blokta kalıcı kalp pili öncesi ve sonrası hemodinamik parametrelerdeki ve beyin natriüretik peptid (BNP) düzeyindeki değişimler araştırıldı. Çalışma planı: Çalışmaya senkop nedeniyle başvuran AV tam bloklu 25 hasta (14 erkek, 11 kadın; ort. yaş 72±10; dağılım 39-83) alındı. Tüm hastalar başvuru anında hemodinamik olarak stabil durumdaydı ve kalıcı kalp pili takılıncaya kadar yoğun bakımda gözlem altında tutuldu. Kardiyovasküler sistemdeki değişimi karşılaştırmak amacıyla, kalıcı pil öncesi ve pil takıldıktan iki hafta sonraki ortalama kan basıncı (OKB), atım hacmi (AH), kardiyak debi (KD), sistemik vasküler direnç (SVD), sistemik aortik kompliyans (SAK) değerleri ve BNP düzeyleri incelendi. Bulgular: Ortalama kalp hızı, kalıcı pil öncesi ve sonrasında sırasıyla 36±6 vuru/dk ve 65±10 vuru/dk bulundu. Kalıcı pil yerleştirilmesi sonrasındaki değerlerle karşılaştırıldığında, pil öncesinde KD’nin anlamlı derecede düşük (p<0.001), SVD’nin anlamlı derecede yüksek (p=0.001) olduğu görüldü. Kardiyak debideki düşüşü SVD artışı kompanse etmekteydi. Pil uygulaması öncesi ve sonrasında OKB değerleri anlamlı farklılık göstermedi ve her iki dönemde de normal sınırlar içindeydi. Atım hacmi, SAK değerleri ve BNP düzeyi bakımından kalıcı pil öncesi ve sonrasında anlamlı farklılık gözlenmedi. Ayrıca, BNP düzeyinin her iki dönemde de yüksek olduğu izlendi. Sonuç: Atriyoventriküler tam blokta kalıcı kalp pili öncesi ve sonrasında AH, SAK ve BNP değerlerinde kompansatuvar bir değişim gözlenmezken, KD’de görülen azalma SVD artışı ile kompanse edilerek OKB normal sınırlar içinde tutulmaya çalışılmaktadır.Yayın Broken heart syndrome in a 17-year-old girl(Springer Nature, 2009) Biteker, Murat; Ekşi Duran, Nilüfer; Ayyıldız Civan, Hasret; Gündüz, Sabahattin; Gökdeniz, Tayyar; Kaya, Hasan; Özkan, MehmetBroken heart syndrome is characterized by transient left ventricular dysfunction with chest pain, electrocardiographic changes, and release of myocardial enzymes mimicking acute myocardial infarction. Physical and emotional stress usually precede the onset of symptoms. This dysfunction, known as takotsubo cardiomyopathy (TC), has been observed predominantly in women older than 60 years of age but very rarely reported in younger adults or children. Here we describe a 17-year-old girl with TC.Yayın Depicting of a cleft mitral valve by real time three-dimensional transesophageal echocardiography(National Library of Medicine, 2010) Özkan, Mehmet; Kaya, Hasan; Ekşi Duran, Nilüfer; Biteker, Murat; Avcı, Anıl; Yıldız, Mustafa; Tuncer, AltuğWe report the usefulness of real time three-dimensional transesophageal echocardiography in comprehensive delineation of cleft mitral valve. This new technique may be a useful supplement to two-dimensional and three-dimensional transthoracic echocardiography in the assessment of this pathology.Yayın Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial(Springer Nature, 2011) Biteker, Murat; Ekşi Duran, Nilüfer; Kaya, Hasan; Gündüz, Sabahattin; Tanboğa, Halil İbrahim; Gökdeniz, Tayyar; Kahveci, Gökhan; Akgün, Taylan; Yıldız, Mustafa; Özkan, MehmetBackground Levosimendan is a promising new inodilator agent but its effectiveness in peripartum cardiomyopathy (PPCM) has not been tested in a clinical trial. The authors sought to evaluate the effect of levosimendan therapy and to determine the predictors of clinical outcome in patients with PPCM. Methods and results The authors prospectively randomized 24 consecutive women with PPCM. Twelve patients (control group) were randomized to conventional heart failure therapy and 12 patients (levosimendan group) were randomized to levosimendan in addition to the conventional therapy. Mean follow-up period was 20.9 ± 9 months (ranged 12–38 months). The two groups did not differ in baseline demographic and echocardiographic characteristics. Eleven patients (45.8%) recovered completely (6 in control group and 5 in levosimendan group, p[0.05), 6 died (25%) (3 in control group and 3 in levosimendan group), and 7 (29.1%) were left with persistent left ventricular dysfunction (PLVD) (3 in control group and 4 in levosimendan group, p[0.05). There were significant differences in baseline characteristics between deceased patients and survivors including left ventricular end-diastolic diameter (7.1 ± 0.6 vs. 6.4 ± 0.5 cm, p = 0.031), left ventricular end-systolic diameter (LVESD) (6.4 ± 0.8 vs. 5.5 ± 0.6 cm, p = 0.027), left ventricular ejection fraction (LVEF) (19.7 vs. 27.4%, p = 0.025), and left atrial diameter (4.9 ± 0.3 vs. 4.3 ± 0.4 cm, p = 0.011). Conclusions Addition of levosimendan to conventional therapy did not improve outcome in patients with PPCM. In patients with PLVD or patients who died, LVEF, LVESD and left atrial diameter were worse than those with complete resolution.Yayın Kounis syndrome secondary to cefuroxime-axetil use in an octogenarian(National Library of Medicine, 2008) Biteker, Murat; Ekşi Duran, Nilüfer; Sungur Biteker, Funda; Gündüz, Sabahattin; Gökdeniz, Tayyar; Kaya, Hasan; Astarcıoğlu, Mehmet Ali; Özkan, MehmetA 90-year-old man who had been hospitalized for urinary tract infection developed chest pain and pruritic skin rashes. His complaints had started approximately 10 minutes after intramuscular injection of 750 mg of cefuroxime-axetil. His physical examination was normal upon admission, and his electrocardiogram showed ST segment elevations in leads II, III, aVF, V4, V5, and V6 (Figure 1). He had no history of coronary artery disease, diabetes mellitus, hypertension, or hyperlipidemia. Transthoracic echocardiography, performed in the coronary intensive care unit, revealed inferior wall hypokinesia. Complete blood count and liver and kidney function tests were normal except for mild leukocytosis. Coronary angiography performed to exclude coronary artery disease revealed noncritical coronary plaques in the left anterior descending and circumflex artery. Troponin-I estimated 4 hours after admission was 4 ng/mL (reference: 0–0.1 ng/mL) and rose to 22 ng/mL. Creatine kinase-MB fraction estimated 4 hours after admission was 42 U/L (reference: 0–25 U/L) and rose to 85 U/L on the second day. Total immunoglobulin E estimated on arrival was 54 IU/mL (reference: 0–100), and serum tryptase was 43.5 mg/L (reference: 5.6–13.5 mg/L). Subsequent daily estimations of serum tryptase were within normal limits. The patient was diagnosed to have Kounis syndrome type I variant, secondary to cefuroxime-axetil. He was treated with oral antihistamines and 8 mg of prednisolone every 6 hours for 5 days. Cefuroxime-axetil was stopped, and he was treated with levofloxacin for urinary tract infection. Five days later, the repeated cardiac markers were within normal limits, with resolution of electrocardiographic abnormalities and inferior wall motion echocardiographic changes. The man was discharged from hospital in excellent condition and was doing well at a 3-week follow-up visit.Yayın Kounis syndrome: first series in Turkish patients(KARE Publishing, 2009) Biteker, Murat; Ekşi Duran, Nilüfer; Biteker, Funda; Ayyıldız Civan, Haster; Gündüz, Sabahattin; Gökdeniz, Tayyar; Kaya, Hasan; Özkan, MehmetAfter the first report of acute myocardial infarction during a prolonged allergic reaction to penicillin was published in 1950 (1), the concurrence of allergic reactions and acute coronary syndromes called Kounis syndrome (KS) has gained acceptance as a new cause of coronary artery spasm (1-3). Kounis Syndrome was firstly described in 1991 as “the allergic angina syndrome” which could progress to acute myocardial infarction, which was named “allergic myocardial infarction” (2-4).Yayın Prosthetic mitral valve thrombosis demonstrated by real-time 3D transesophageal echocardiography(Türk Kardiyoloji Derneği, 2009) Özkan, Mehmet; Kaya, Hasan; Biteker, Murat; Ekşi Duran, NilüferA 46-year-old man presented with dyspnea four years after mitral valve replacement. The INR was 1.2 on presentation. Cardiac auscultation revealed loss of valve sounds. On transthoracic echocardiography, the mean diastolic mitral transvalvular gradient was 20 mmHg and mitral valve area was 0.7 cm2 (Fig. A).Yayın Takotsubo cardiomyopathy mimicking acute high lateral myocardial infarction(KARE Publishing, 2010) Biteker, Murat; Ekşi Duran, Nilüfer; Gökdeniz, Tayyar; Gündüz, Sabahattin; Güler, Ahmet; Kaya, Hasan; Yıldız, Mustafa; Özkan, MehmetA 47-year-old-woman was admitted to emergency department because of severe chest pain of an one hour in duration. The patient had no coronary risk factors. As a remarkable fact, her son had died that day. On admission, physical examination revealed no pathological findings. Electrocardiogram (ECG) showed 1 mm ST elevation in leads I and aVL.Yayın Thrombolysis of an acute prosthetic mitral valve thrombosis presented with cardiogenic shock under the guidance of continuous transoesophageal monitoring(National Library of Medicine, 2009) Biteker, Murat; Ekşi Duran, Nilüfer; Gündüz, Sabahattin; Gökdeniz, Tayyar; Kaya, Hasan; Ayhan, Ahmet Çağrı; Özkan, MehmetThrombotic occlusion of prosthetic valves continues to be an uncommon but serious complication. Intravenous thrombolytic treatment has been proposed as an alternative to surgical intervention. Due to the lack of a generally accepted standard regimen, various infusion protocols and thrombolytic doses were used for the management of prosthetic heart valve thrombosis. However, rapid thrombolytic infusion, especially in the presence of large thrombus, may increase the risk of embolization. Continuous transoesophageal echocardiography may provide monitoring the efficacy of thrombolysis especially in critically ill patients.
