Browsing by Author "Aral, Atilla"

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    İskemik mitral yetmezliğinde cerrahi tedavi yöntemleri ve klinik sonuçları (retrospektif klinik çalışma)
    (Sağlık Bilimleri Enstitüsü, 2004) Uymaz, Barış; Aral, Atilla; Tıp
    Ishemic mitral regurgitation which is one of the complications of the coronary artery diseases, is a pathology that a lot of discussions are made on the treatment options. Surgical treatment of the ischemic mitral regurgitation excist a higher rate of operative mortality compared with normal coronary baypass surgery and surgical treatment of the mitral regurgitations because of other ethiological reasons. Besides its high operative mortality rate, it also contains a high morbidity rate when compared with other pathologies. This study consists of 60 patiens, with mitral insufficiency (grade 2 and more) and coronary artery disease, in Ankara University, Cardiovascular Surgery Department, between December 1999 and December 2003. Three different surgical prosedüre were performed to these patiens. 41 of them (%68.3) were male and 19 of them (% 31.7) female. The mean age was 64.75+6.85. 10 patients (%16.6) have gone under MVR and CABG, 20 patients (%33.4) gone under CABG alone, CABG and Ring Annuloplasty was performed to 30 patients (%50). When we look at mitral insufficiency degrees of the patients, in 30 patients (%50) there was a 2nd degree, in 27 patients (%45) there was 3th degree and in 3 patients (%5) there was 4th degree mitral insufficiency. When we compare the preoperative NYHA classifications of the patiens, 25 patients (%41.6) were in NYHA II, 28 patients (%46.7) were in NYHA III and 7 patients (%11.7) were in NYHA IV. We followed up the patients at a mean time of 704+36 days. Hospital mortality rates were %50 in MVR+CABG, %15 in CABG and %16.6 in CABG + Ring Annuloplasty. When we leave patients who died in the preoperative period, the avarage survival was 116990+86 days, when we compare the survival period of MVR + CABG, CABG and CABG + Ring Annuloplasty, it is 515+194 days, 1163+137 and 1 163 +137 days respectively. When we look at the survivals of three different prosedures, group CABG and group CABG + Ring Annuloplasty haven't got any statistical difference. (p=0.4614) There is statistical difference between group MVR + CABG and group CABG. (p=0.118) When comparing group MVR + CABG and group CABG + Ring Annuloplasty, there is difference statistically (p=0.0368). We searched the effects of preoperative NYHA, mitral insufficiency and risk factors on survival rate. NYHA hasn't got any significant effect, but preoperative mitral insufficiency and serebro vascular events in preoperative risk factors have got great effect on survival. When we look at the differences in ejection fractions at different times, we saw that in group CABG + Ring Annuloplasty, EF has got a significant increase in 4 years period (p=0.0469). When we searched for the changes in NYHA, group CABG + Ring Annuoloplasty and group CABG have got statistical decrease and only group CABG + Ring Annuloplasty has got statistically significant decrease in the forth year (p=0.024). In this new knowledges, coronary bypass and mitral ring annuloplasty is a better and preferable choice in the surgical treatment of the ischemic mitral insufficiency.
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    Kardiyopulmoner bypass uygulanan pediyatrik olgularda modifiye ultrafiltrasyonun sitokinler üzerindeki etkisi
    (Tıp Fakültesi, 2015) Hodo, Bledar; Aral, Atilla; Tıp
    Comparing serum cytokines (IL-1b,IL-6,IL-8,IL-10,TNF-α) and their effect on postoperative term in pediatric patients with congenital siyanotic/nonsiyanotic heart defect who underwent open heart surgery Materials and methods: In this study, we assessed 25 children who underwent pediatric cardiac surgery with cardiopulmonary bypass from September 2013 to August 2014. Patients who had redo cardiac surgery, preoperative organ disfunction, otoimmune disease, genetic disorders, shunt and emergency operations were excluded. Preand postoperative biochemical parameters, postoperativeurine output, chest tube drenaige, diüretic usage, blood and bloodproduct transfusion, dialysis requirement and mortality were compared. Results: İn our study we found that level of IL-6,IL-8,IL-10 an TNF-α was highest after MUF. IL-1b wast highest 1 hour after operation. IL-1b,IL-10 and TNF-α does not effect extubation time. IL-6 and IL-8 effect ekstubation time negatively. (p<0,05) Conclusions: Hemodynamic, pulmonary, hematologic and immunologic effects of modified ultrafiltration are well known. Although our study group was not big enough to get a conclusion, we believe that modified ultrafiltration can not decrease the level of serum cytokines because of hemoconsantration.
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    Konjenital kalp hastalıklarının cerrahi tedavisinde intraoperatif transözofageal ekokardiyografi nin önemi
    (2007) Atalay, Semra; Uçar, Tayfun; Eyileten, Zeynep; Kılıçkap, Mustafa; Aral, Atilla; Uysalel, Adnan; Tutar, H. Ercan