The Experts below are selected from a list of 1176 Experts worldwide ranked by ideXlab platform
Mehmet Özkan - One of the best experts on this subject based on the ideXlab platform.
-
status of the epicardial coronary arteries in non st elevation acute coronary syndrome in patients with mechanical Prosthetic heart Valves from the troia acs trial
American Journal of Cardiology, 2018Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Emrah Bayam, Sinan Cersit, Ahmet Guner, Mehmet ÖzkanAbstract:Coronary thromboembolism (CE) is a rare cause of Prosthetic Valve derived complications. This study investigates the diagnosis and treatment strategies for non-ST elevation acute coronary syndrome (NSTEACS) in patients with Prosthetic heart Valves. Forty-eight NSTEACS patients with Prosthetic heart Valves (mitral:27; aortic:14; mitral+aortic:7) were included in this study. All patients underwent transthoracic and transesophageal echocardiographic examination and coronary angiography. Normal coronary angiographic findings, or visible trombus in one of the coronary arteries, international normalized ratio <2, concomitant Prosthetic Valve Thrombosis (PVT) and absence of multivessel atherosclerotic disease favored CE rather than atheroThrombosis. Thrombolytic therapy (TT) with low-dose slow-infusion of tissue type plasminogen activator was used in patients with suspected CE and/or PVT. Coronary angiography demonstrated normal coronary arteries in 26 patients, CE in 16 patients and coronary atherosclerosis in 6 patients. Transesophageal echocardiography revealed obstructive PVT in 9 and nonobstructive PVT in 28 patients whereas 11 patients had normally functioning prostheses. TT was administered to 24 patients with PVT and/or CE. In these patients, TT was successful in 19 patients, partially successful in 4 patients and failed in 1 patient. In conclusion, NSTEACS in patients with Prosthetic heart Valves is more likely to be associated with PVT derived CE rather than atherosclerosis. TT with low-dose slow infusion of type plasminogen activator has proved its efficacy and safety in patients with CE and/or PVT.
-
The Role of Protein Z and Protein Z-Dependent Protease Inhibitor Polymorphisms in the Development of Prosthetic Heart Valve Thrombosis.
Journal of Heart Valve Disease, 2017Co-Authors: Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Emrah Bayam, Mehmet ÖzkanAbstract:BACKGROUND AND AIM OF THE STUDY: Protein Z (PZ) is a vitamin K-dependent factor that is synthesized mainly by the liver. It acts as an activator of serpin, the protein Z-dependent inhibitor (ZPI), which inhibits factor Xa. The potential role of alterations in protein Z and/or ZPI levels in the pathogenesis of thrombotic and/or hemorrhagic diseases has been previously investigated, but results have been conflicting. The study aim was to evaluate the role of PZ/ZPI polymorphisms in the development of Prosthetic Valve Thrombosis (PVT). METHODS: This prospective, observational cross-sectional study included 50 consecutive patients with PVT [non-obstructive Thrombosis (NOT) in 35 patients; obstructive Thrombosis (OT) in 15] and 50 consecutive healthy subjects with normally functioning prostheses. gDNA was extracted from ca. 5 × 106 leukocytes, using the QIAamp DNA Mini Kit (Qiagen), according to the manufacturer's recommendations. For mutational analysis, a minisequencing method was employed. Results of the analyses were compared between the PVT and control groups, and also between the OT and NOT subgroups. RESULTS: The frequency of A allele (mutant type) of PZG79A was equal in all PVT patients and in controls. With regards to PZ-A13G polymorphisms, frequency of the mutant G allele was 22% in PVT patients and 19% in controls. Serpina-R67X polymorphism was observed in 8% of PVT patients and 6% of controls. Normal variant CC was present in 47 controls (94%), whereas a heterozygotic mutation (CT) was detected in four PVT patients (8%). Frequency of the ZPI-R67X mutation was significantly higher in patients with OT than in those with NOT (p = 0.041). CONCLUSIONS: The present study was the first to evaluate the potential impact of PZ (PZ-A13G, PZG79A) and ZPI (R-67X, W303X) polymorphisms in the development of PVT. Based on the results of this small observational case-control study, PZ/ZPI polymorphisms do not appear to play an active role in the development of PVT. Hence, further extensive studies are necessary.
-
a global perspective on mechanical Prosthetic heart Valve Thrombosis diagnostic and therapeutic challenges
Anatolian Journal of Cardiology, 2016Co-Authors: Mustafa Ozan Gürsoy, Süleyman Karakoyun, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Emrah Bayam, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is one of the major causes of primary Valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of Prosthetic Valve Thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical Prosthetic Valve Thrombosis.
-
bioprostethic mitral Valve Thrombosis due to oral contraceptive drug use and management with ultra slow thrombolytic therapy
Blood Coagulation & Fibrinolysis, 2016Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is a severe complication, which usually occurs in inadequately anticoagulated patients. Mechanical Valve Thrombosis is more common than bioProsthetic Valve Thrombosis (BVT). Oral contraceptive drugs are associated with increased risk of thromboembolism in women. The possible association between oral contraceptive drug use and BVT has never been reported before. We present a case of obstructive BVT occurring after the use of an oral contraceptive drug and successful management with ultra-slow thrombolytic therapy.
-
Serial Fluoroscopy Guided Fibrinolytic Therapy in a Patient with Obstructive Mechanical Aortic Valve Thrombosis
Bilimsel Tip Yayinevi, 2016Co-Authors: Macit Kalçık, Mustafa Ozan Gürsoy, Mahmut Yesin, Mustafa Yildiz, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is a life-threatening complication, which is most commonly seen in patients with poor anticoagulation. Although two-dimensional and real-time three-dimensional transesophageal echocardiography are the gold standard imaging modalities for the diagnosis of Prosthetic Valve Thrombosis, Prosthetic Valves in aortic position may not be evaluated precisely. This is a serious problem during the follow-up of the patients who receive thrombolytic therapy for aortic Valve Thrombosis. Fluoroscopy is an alternative noninvasive imaging method, which provides valuable information about leaflet motion and may be used for such cases with restricted leaflets. Here, we report a case of aortic Valve Thrombosis that was managed with low-dose (25 mg) and ultra-slow (25 hours) infusion of tissue-type plasminogen activator under the guidance of serial fluoroscopy
Macit Kalçık - One of the best experts on this subject based on the ideXlab platform.
-
status of the epicardial coronary arteries in non st elevation acute coronary syndrome in patients with mechanical Prosthetic heart Valves from the troia acs trial
American Journal of Cardiology, 2018Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Emrah Bayam, Sinan Cersit, Ahmet Guner, Mehmet ÖzkanAbstract:Coronary thromboembolism (CE) is a rare cause of Prosthetic Valve derived complications. This study investigates the diagnosis and treatment strategies for non-ST elevation acute coronary syndrome (NSTEACS) in patients with Prosthetic heart Valves. Forty-eight NSTEACS patients with Prosthetic heart Valves (mitral:27; aortic:14; mitral+aortic:7) were included in this study. All patients underwent transthoracic and transesophageal echocardiographic examination and coronary angiography. Normal coronary angiographic findings, or visible trombus in one of the coronary arteries, international normalized ratio <2, concomitant Prosthetic Valve Thrombosis (PVT) and absence of multivessel atherosclerotic disease favored CE rather than atheroThrombosis. Thrombolytic therapy (TT) with low-dose slow-infusion of tissue type plasminogen activator was used in patients with suspected CE and/or PVT. Coronary angiography demonstrated normal coronary arteries in 26 patients, CE in 16 patients and coronary atherosclerosis in 6 patients. Transesophageal echocardiography revealed obstructive PVT in 9 and nonobstructive PVT in 28 patients whereas 11 patients had normally functioning prostheses. TT was administered to 24 patients with PVT and/or CE. In these patients, TT was successful in 19 patients, partially successful in 4 patients and failed in 1 patient. In conclusion, NSTEACS in patients with Prosthetic heart Valves is more likely to be associated with PVT derived CE rather than atherosclerosis. TT with low-dose slow infusion of type plasminogen activator has proved its efficacy and safety in patients with CE and/or PVT.
-
The Role of Protein Z and Protein Z-Dependent Protease Inhibitor Polymorphisms in the Development of Prosthetic Heart Valve Thrombosis.
Journal of Heart Valve Disease, 2017Co-Authors: Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Emrah Bayam, Mehmet ÖzkanAbstract:BACKGROUND AND AIM OF THE STUDY: Protein Z (PZ) is a vitamin K-dependent factor that is synthesized mainly by the liver. It acts as an activator of serpin, the protein Z-dependent inhibitor (ZPI), which inhibits factor Xa. The potential role of alterations in protein Z and/or ZPI levels in the pathogenesis of thrombotic and/or hemorrhagic diseases has been previously investigated, but results have been conflicting. The study aim was to evaluate the role of PZ/ZPI polymorphisms in the development of Prosthetic Valve Thrombosis (PVT). METHODS: This prospective, observational cross-sectional study included 50 consecutive patients with PVT [non-obstructive Thrombosis (NOT) in 35 patients; obstructive Thrombosis (OT) in 15] and 50 consecutive healthy subjects with normally functioning prostheses. gDNA was extracted from ca. 5 × 106 leukocytes, using the QIAamp DNA Mini Kit (Qiagen), according to the manufacturer's recommendations. For mutational analysis, a minisequencing method was employed. Results of the analyses were compared between the PVT and control groups, and also between the OT and NOT subgroups. RESULTS: The frequency of A allele (mutant type) of PZG79A was equal in all PVT patients and in controls. With regards to PZ-A13G polymorphisms, frequency of the mutant G allele was 22% in PVT patients and 19% in controls. Serpina-R67X polymorphism was observed in 8% of PVT patients and 6% of controls. Normal variant CC was present in 47 controls (94%), whereas a heterozygotic mutation (CT) was detected in four PVT patients (8%). Frequency of the ZPI-R67X mutation was significantly higher in patients with OT than in those with NOT (p = 0.041). CONCLUSIONS: The present study was the first to evaluate the potential impact of PZ (PZ-A13G, PZG79A) and ZPI (R-67X, W303X) polymorphisms in the development of PVT. Based on the results of this small observational case-control study, PZ/ZPI polymorphisms do not appear to play an active role in the development of PVT. Hence, further extensive studies are necessary.
-
a global perspective on mechanical Prosthetic heart Valve Thrombosis diagnostic and therapeutic challenges
Anatolian Journal of Cardiology, 2016Co-Authors: Mustafa Ozan Gürsoy, Süleyman Karakoyun, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Emrah Bayam, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is one of the major causes of primary Valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of Prosthetic Valve Thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical Prosthetic Valve Thrombosis.
-
bioprostethic mitral Valve Thrombosis due to oral contraceptive drug use and management with ultra slow thrombolytic therapy
Blood Coagulation & Fibrinolysis, 2016Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is a severe complication, which usually occurs in inadequately anticoagulated patients. Mechanical Valve Thrombosis is more common than bioProsthetic Valve Thrombosis (BVT). Oral contraceptive drugs are associated with increased risk of thromboembolism in women. The possible association between oral contraceptive drug use and BVT has never been reported before. We present a case of obstructive BVT occurring after the use of an oral contraceptive drug and successful management with ultra-slow thrombolytic therapy.
-
Serial Fluoroscopy Guided Fibrinolytic Therapy in a Patient with Obstructive Mechanical Aortic Valve Thrombosis
Bilimsel Tip Yayinevi, 2016Co-Authors: Macit Kalçık, Mustafa Ozan Gürsoy, Mahmut Yesin, Mustafa Yildiz, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is a life-threatening complication, which is most commonly seen in patients with poor anticoagulation. Although two-dimensional and real-time three-dimensional transesophageal echocardiography are the gold standard imaging modalities for the diagnosis of Prosthetic Valve Thrombosis, Prosthetic Valves in aortic position may not be evaluated precisely. This is a serious problem during the follow-up of the patients who receive thrombolytic therapy for aortic Valve Thrombosis. Fluoroscopy is an alternative noninvasive imaging method, which provides valuable information about leaflet motion and may be used for such cases with restricted leaflets. Here, we report a case of aortic Valve Thrombosis that was managed with low-dose (25 mg) and ultra-slow (25 hours) infusion of tissue-type plasminogen activator under the guidance of serial fluoroscopy
Sabahattin Gündüz - One of the best experts on this subject based on the ideXlab platform.
-
status of the epicardial coronary arteries in non st elevation acute coronary syndrome in patients with mechanical Prosthetic heart Valves from the troia acs trial
American Journal of Cardiology, 2018Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Emrah Bayam, Sinan Cersit, Ahmet Guner, Mehmet ÖzkanAbstract:Coronary thromboembolism (CE) is a rare cause of Prosthetic Valve derived complications. This study investigates the diagnosis and treatment strategies for non-ST elevation acute coronary syndrome (NSTEACS) in patients with Prosthetic heart Valves. Forty-eight NSTEACS patients with Prosthetic heart Valves (mitral:27; aortic:14; mitral+aortic:7) were included in this study. All patients underwent transthoracic and transesophageal echocardiographic examination and coronary angiography. Normal coronary angiographic findings, or visible trombus in one of the coronary arteries, international normalized ratio <2, concomitant Prosthetic Valve Thrombosis (PVT) and absence of multivessel atherosclerotic disease favored CE rather than atheroThrombosis. Thrombolytic therapy (TT) with low-dose slow-infusion of tissue type plasminogen activator was used in patients with suspected CE and/or PVT. Coronary angiography demonstrated normal coronary arteries in 26 patients, CE in 16 patients and coronary atherosclerosis in 6 patients. Transesophageal echocardiography revealed obstructive PVT in 9 and nonobstructive PVT in 28 patients whereas 11 patients had normally functioning prostheses. TT was administered to 24 patients with PVT and/or CE. In these patients, TT was successful in 19 patients, partially successful in 4 patients and failed in 1 patient. In conclusion, NSTEACS in patients with Prosthetic heart Valves is more likely to be associated with PVT derived CE rather than atherosclerosis. TT with low-dose slow infusion of type plasminogen activator has proved its efficacy and safety in patients with CE and/or PVT.
-
The Role of Protein Z and Protein Z-Dependent Protease Inhibitor Polymorphisms in the Development of Prosthetic Heart Valve Thrombosis.
Journal of Heart Valve Disease, 2017Co-Authors: Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Emrah Bayam, Mehmet ÖzkanAbstract:BACKGROUND AND AIM OF THE STUDY: Protein Z (PZ) is a vitamin K-dependent factor that is synthesized mainly by the liver. It acts as an activator of serpin, the protein Z-dependent inhibitor (ZPI), which inhibits factor Xa. The potential role of alterations in protein Z and/or ZPI levels in the pathogenesis of thrombotic and/or hemorrhagic diseases has been previously investigated, but results have been conflicting. The study aim was to evaluate the role of PZ/ZPI polymorphisms in the development of Prosthetic Valve Thrombosis (PVT). METHODS: This prospective, observational cross-sectional study included 50 consecutive patients with PVT [non-obstructive Thrombosis (NOT) in 35 patients; obstructive Thrombosis (OT) in 15] and 50 consecutive healthy subjects with normally functioning prostheses. gDNA was extracted from ca. 5 × 106 leukocytes, using the QIAamp DNA Mini Kit (Qiagen), according to the manufacturer's recommendations. For mutational analysis, a minisequencing method was employed. Results of the analyses were compared between the PVT and control groups, and also between the OT and NOT subgroups. RESULTS: The frequency of A allele (mutant type) of PZG79A was equal in all PVT patients and in controls. With regards to PZ-A13G polymorphisms, frequency of the mutant G allele was 22% in PVT patients and 19% in controls. Serpina-R67X polymorphism was observed in 8% of PVT patients and 6% of controls. Normal variant CC was present in 47 controls (94%), whereas a heterozygotic mutation (CT) was detected in four PVT patients (8%). Frequency of the ZPI-R67X mutation was significantly higher in patients with OT than in those with NOT (p = 0.041). CONCLUSIONS: The present study was the first to evaluate the potential impact of PZ (PZ-A13G, PZG79A) and ZPI (R-67X, W303X) polymorphisms in the development of PVT. Based on the results of this small observational case-control study, PZ/ZPI polymorphisms do not appear to play an active role in the development of PVT. Hence, further extensive studies are necessary.
-
a global perspective on mechanical Prosthetic heart Valve Thrombosis diagnostic and therapeutic challenges
Anatolian Journal of Cardiology, 2016Co-Authors: Mustafa Ozan Gürsoy, Süleyman Karakoyun, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Emrah Bayam, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is one of the major causes of primary Valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of Prosthetic Valve Thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical Prosthetic Valve Thrombosis.
-
bioprostethic mitral Valve Thrombosis due to oral contraceptive drug use and management with ultra slow thrombolytic therapy
Blood Coagulation & Fibrinolysis, 2016Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is a severe complication, which usually occurs in inadequately anticoagulated patients. Mechanical Valve Thrombosis is more common than bioProsthetic Valve Thrombosis (BVT). Oral contraceptive drugs are associated with increased risk of thromboembolism in women. The possible association between oral contraceptive drug use and BVT has never been reported before. We present a case of obstructive BVT occurring after the use of an oral contraceptive drug and successful management with ultra-slow thrombolytic therapy.
-
ultraslow thrombolytic therapy a novel strategy in the management of Prosthetic mechanical Valve Thrombosis and the predictors of outcome the ultra slow prometee trial
American Heart Journal, 2015Co-Authors: Mehmet Özkan, Süleyman Karakoyun, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Ahmet Cagri Aykan, Ozan Mustafa Gursoy, Ali Emrah OguzAbstract:Background Low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator (t-PA) with repetition as needed has been shown to provide effective and safer thrombolysis in patients with Prosthetic Valve Thrombosis (PVT). Further prolonging the infusion time may be rational with regard to reducing complication rates without reducing success rates. We aimed to investigate the efficacy and safety of ultraslow (25 hours) infusion of low-dose (25 mg) alteplase (t-PA) for PVT. Methods and results Transesophageal echocardiography–guided thrombolytic therapy (TT) was administered to 114 patients with PVT in 120 different episodes between 2009 and 2013 in a single center. Prosthetic Valve Thrombosis was obstructive in 77 (64.2%) and nonobstructive in 43 (35.8%) episodes. Ultraslow infusion (25 hours) of low-dose (25 mg) t-PA, as the TT regimen, was used in all patients admitted with PVT. The end points were thrombolytic success, mortality, and complication rates. The overall success rate of TT was 90% (95% CI 0.85-0.95). The univariate predictors of an unsuccessful result were higher New York Heart Association (NYHA) class, thrombus cross-sectional area, duration of suboptimal anticoagulation, lower baseline Valve area, and presence of atrial fibrillation. The NYHA class was the only independent predictor of TT failure by multiple variable analysis. The overall complication rate was 6.7% (3.3% nonfatal major, 2.5% minor, and 0.8% death). The predictors of complications were presence of atrial fibrillation, higher NYHA class, and thrombus area. Conclusion Ultraslow (25 hours) infusion of low-dose (25 mg) t-PA without bolus appears to be associated with quite low nonfatal complications and mortality for PVT patients without loss of effectiveness, except for those with NYHA class IV.
Mehmet Ali Astarcıoğlu - One of the best experts on this subject based on the ideXlab platform.
-
status of the epicardial coronary arteries in non st elevation acute coronary syndrome in patients with mechanical Prosthetic heart Valves from the troia acs trial
American Journal of Cardiology, 2018Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Emrah Bayam, Sinan Cersit, Ahmet Guner, Mehmet ÖzkanAbstract:Coronary thromboembolism (CE) is a rare cause of Prosthetic Valve derived complications. This study investigates the diagnosis and treatment strategies for non-ST elevation acute coronary syndrome (NSTEACS) in patients with Prosthetic heart Valves. Forty-eight NSTEACS patients with Prosthetic heart Valves (mitral:27; aortic:14; mitral+aortic:7) were included in this study. All patients underwent transthoracic and transesophageal echocardiographic examination and coronary angiography. Normal coronary angiographic findings, or visible trombus in one of the coronary arteries, international normalized ratio <2, concomitant Prosthetic Valve Thrombosis (PVT) and absence of multivessel atherosclerotic disease favored CE rather than atheroThrombosis. Thrombolytic therapy (TT) with low-dose slow-infusion of tissue type plasminogen activator was used in patients with suspected CE and/or PVT. Coronary angiography demonstrated normal coronary arteries in 26 patients, CE in 16 patients and coronary atherosclerosis in 6 patients. Transesophageal echocardiography revealed obstructive PVT in 9 and nonobstructive PVT in 28 patients whereas 11 patients had normally functioning prostheses. TT was administered to 24 patients with PVT and/or CE. In these patients, TT was successful in 19 patients, partially successful in 4 patients and failed in 1 patient. In conclusion, NSTEACS in patients with Prosthetic heart Valves is more likely to be associated with PVT derived CE rather than atherosclerosis. TT with low-dose slow infusion of type plasminogen activator has proved its efficacy and safety in patients with CE and/or PVT.
-
The Role of Protein Z and Protein Z-Dependent Protease Inhibitor Polymorphisms in the Development of Prosthetic Heart Valve Thrombosis.
Journal of Heart Valve Disease, 2017Co-Authors: Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Mahmut Yesin, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Emrah Bayam, Mehmet ÖzkanAbstract:BACKGROUND AND AIM OF THE STUDY: Protein Z (PZ) is a vitamin K-dependent factor that is synthesized mainly by the liver. It acts as an activator of serpin, the protein Z-dependent inhibitor (ZPI), which inhibits factor Xa. The potential role of alterations in protein Z and/or ZPI levels in the pathogenesis of thrombotic and/or hemorrhagic diseases has been previously investigated, but results have been conflicting. The study aim was to evaluate the role of PZ/ZPI polymorphisms in the development of Prosthetic Valve Thrombosis (PVT). METHODS: This prospective, observational cross-sectional study included 50 consecutive patients with PVT [non-obstructive Thrombosis (NOT) in 35 patients; obstructive Thrombosis (OT) in 15] and 50 consecutive healthy subjects with normally functioning prostheses. gDNA was extracted from ca. 5 × 106 leukocytes, using the QIAamp DNA Mini Kit (Qiagen), according to the manufacturer's recommendations. For mutational analysis, a minisequencing method was employed. Results of the analyses were compared between the PVT and control groups, and also between the OT and NOT subgroups. RESULTS: The frequency of A allele (mutant type) of PZG79A was equal in all PVT patients and in controls. With regards to PZ-A13G polymorphisms, frequency of the mutant G allele was 22% in PVT patients and 19% in controls. Serpina-R67X polymorphism was observed in 8% of PVT patients and 6% of controls. Normal variant CC was present in 47 controls (94%), whereas a heterozygotic mutation (CT) was detected in four PVT patients (8%). Frequency of the ZPI-R67X mutation was significantly higher in patients with OT than in those with NOT (p = 0.041). CONCLUSIONS: The present study was the first to evaluate the potential impact of PZ (PZ-A13G, PZG79A) and ZPI (R-67X, W303X) polymorphisms in the development of PVT. Based on the results of this small observational case-control study, PZ/ZPI polymorphisms do not appear to play an active role in the development of PVT. Hence, further extensive studies are necessary.
-
bioprostethic mitral Valve Thrombosis due to oral contraceptive drug use and management with ultra slow thrombolytic therapy
Blood Coagulation & Fibrinolysis, 2016Co-Authors: Mahmut Yesin, Süleyman Karakoyun, Mustafa Ozan Gürsoy, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Mehmet ÖzkanAbstract:Prosthetic Valve Thrombosis is a severe complication, which usually occurs in inadequately anticoagulated patients. Mechanical Valve Thrombosis is more common than bioProsthetic Valve Thrombosis (BVT). Oral contraceptive drugs are associated with increased risk of thromboembolism in women. The possible association between oral contraceptive drug use and BVT has never been reported before. We present a case of obstructive BVT occurring after the use of an oral contraceptive drug and successful management with ultra-slow thrombolytic therapy.
-
ultraslow thrombolytic therapy a novel strategy in the management of Prosthetic mechanical Valve Thrombosis and the predictors of outcome the ultra slow prometee trial
American Heart Journal, 2015Co-Authors: Mehmet Özkan, Süleyman Karakoyun, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Ahmet Cagri Aykan, Ozan Mustafa Gursoy, Ali Emrah OguzAbstract:Background Low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator (t-PA) with repetition as needed has been shown to provide effective and safer thrombolysis in patients with Prosthetic Valve Thrombosis (PVT). Further prolonging the infusion time may be rational with regard to reducing complication rates without reducing success rates. We aimed to investigate the efficacy and safety of ultraslow (25 hours) infusion of low-dose (25 mg) alteplase (t-PA) for PVT. Methods and results Transesophageal echocardiography–guided thrombolytic therapy (TT) was administered to 114 patients with PVT in 120 different episodes between 2009 and 2013 in a single center. Prosthetic Valve Thrombosis was obstructive in 77 (64.2%) and nonobstructive in 43 (35.8%) episodes. Ultraslow infusion (25 hours) of low-dose (25 mg) t-PA, as the TT regimen, was used in all patients admitted with PVT. The end points were thrombolytic success, mortality, and complication rates. The overall success rate of TT was 90% (95% CI 0.85-0.95). The univariate predictors of an unsuccessful result were higher New York Heart Association (NYHA) class, thrombus cross-sectional area, duration of suboptimal anticoagulation, lower baseline Valve area, and presence of atrial fibrillation. The NYHA class was the only independent predictor of TT failure by multiple variable analysis. The overall complication rate was 6.7% (3.3% nonfatal major, 2.5% minor, and 0.8% death). The predictors of complications were presence of atrial fibrillation, higher NYHA class, and thrombus area. Conclusion Ultraslow (25 hours) infusion of low-dose (25 mg) t-PA without bolus appears to be associated with quite low nonfatal complications and mortality for PVT patients without loss of effectiveness, except for those with NYHA class IV.
-
real time three dimensional transesophageal echocardiography in the assessment of mechanical Prosthetic mitral Valve ring Thrombosis
American Journal of Cardiology, 2013Co-Authors: Mehmet Özkan, Süleyman Karakoyun, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Beytullah Cakal, Ozan Mustafa Gursoy, Gokhan Kahveci, Nilufer Eksi Duran, Mustafa YildizAbstract:Although 2-dimensional (2D) transesophageal echocardiography (TEE) is the gold standard for the diagnosis of Prosthetic Valve Thrombosis, nonobstructive clots located on mitral Valve rings can be missed. Real-time 3-dimensional (3D) TEE has incremental value in the visualization of mitral prosthesis. The aim of this study was to investigate the utility of real-time 3D TEE in the diagnosis of mitral Prosthetic ring Thrombosis. The clinical outcomes of these patients in relation to real-time 3D transesophageal echocardiographic findings were analyzed. Of 1,263 patients who underwent echocardiographic studies, 174 patients (37 men, 137 women) with mitral ring Thrombosis detected by real-time 3D TEE constituted the main study population. Patients were followed prospectively on oral anticoagulation for 25 ± 7 months. Eighty-nine patients (51%) had thrombi that were missed on 2D TEE and depicted only on real-time 3D TEE. The remaining cases were partially visualized with 2D TEE but completely visualized with real-time 3D TEE. Thirty-seven patients (21%) had thromboembolism. The mean thickness of the ring Thrombosis in patients with thromboembolism was greater than that in patients without thromboembolism (3.8 ± 0.9 vs 2.8 ± 0.7 mm, p
Ahmet Cagri Aykan - One of the best experts on this subject based on the ideXlab platform.
-
ultraslow thrombolytic therapy a novel strategy in the management of Prosthetic mechanical Valve Thrombosis and the predictors of outcome the ultra slow prometee trial
American Heart Journal, 2015Co-Authors: Mehmet Özkan, Süleyman Karakoyun, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Zübeyde Bayram, Beytullah Cakal, Ahmet Cagri Aykan, Ozan Mustafa Gursoy, Ali Emrah OguzAbstract:Background Low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator (t-PA) with repetition as needed has been shown to provide effective and safer thrombolysis in patients with Prosthetic Valve Thrombosis (PVT). Further prolonging the infusion time may be rational with regard to reducing complication rates without reducing success rates. We aimed to investigate the efficacy and safety of ultraslow (25 hours) infusion of low-dose (25 mg) alteplase (t-PA) for PVT. Methods and results Transesophageal echocardiography–guided thrombolytic therapy (TT) was administered to 114 patients with PVT in 120 different episodes between 2009 and 2013 in a single center. Prosthetic Valve Thrombosis was obstructive in 77 (64.2%) and nonobstructive in 43 (35.8%) episodes. Ultraslow infusion (25 hours) of low-dose (25 mg) t-PA, as the TT regimen, was used in all patients admitted with PVT. The end points were thrombolytic success, mortality, and complication rates. The overall success rate of TT was 90% (95% CI 0.85-0.95). The univariate predictors of an unsuccessful result were higher New York Heart Association (NYHA) class, thrombus cross-sectional area, duration of suboptimal anticoagulation, lower baseline Valve area, and presence of atrial fibrillation. The NYHA class was the only independent predictor of TT failure by multiple variable analysis. The overall complication rate was 6.7% (3.3% nonfatal major, 2.5% minor, and 0.8% death). The predictors of complications were presence of atrial fibrillation, higher NYHA class, and thrombus area. Conclusion Ultraslow (25 hours) infusion of low-dose (25 mg) t-PA without bolus appears to be associated with quite low nonfatal complications and mortality for PVT patients without loss of effectiveness, except for those with NYHA class IV.
-
thrombolytic therapy for the treatment of Prosthetic heart Valve Thrombosis in pregnancy with low dose slow infusion of tissue type plasminogen activator
Circulation, 2013Co-Authors: Mehmet Özkan, Süleyman Karakoyun, Macit Kalçık, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Beytullah Cakal, Cihan Cevik, Ozan Mustafa Gursoy, Ali Emrah Oguz, Ahmet Cagri AykanAbstract:Background—Prosthetic Valve Thrombosis during pregnancy is life-threatening for mother and fetus, and the treatment of this complication is unclear. Cardiac surgery in pregnancy is associated with very high maternal and fetal mortality and morbidity. Thrombolytic therapy has rarely been used in these patients. The aim of this study is to evaluate the safety and efficacy of low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator for the treatment of Prosthetic Valve Thrombosis in pregnant women. Methods and Results—Between 2004 and 2012, tissue-type plasminogen activator was administered to 24 consecutive women in 25 pregnancies with 28 Prosthetic Valve Thrombosis episodes (obstructive, n=15; nonobstructive, n=13). Mean age of the patients was 29±6 years. Thrombolytic therapy sessions were performed under transesophageal echocardiography guidance. The mean dose of tissue-type plasminogen activator used was 48.7±29.5 mg (range, 25–100mg). All episodes resulted in complete thrombus lys...
-
comparison of different tee guided thrombolytic regimens for Prosthetic Valve Thrombosis the troia trial
Jacc-cardiovascular Imaging, 2013Co-Authors: Mehmet Özkan, Sabahattin Gündüz, Mehmet Ali Astarcıoğlu, Murat Biteker, Cihan Cevik, Evren Kaynak, Mustafa Yildiz, Emrah Oguz, Ahmet Cagri Aykan, Emre ErturkAbstract:Objectives The aim of this prospective study was to identify the most effective and safest regimen among different thrombolytic treatment strategies. Background The best treatment strategies for Prosthetic Valve Thrombosis have been controversial. Methods Transesophageal echocardiography–guided thrombolytic treatment was administered to 182 consecutive patients with Prosthetic Valve Thrombosis in 220 different episodes (156 women; mean age, 43.2 ± 13.06 years) between 1993 and 2009 at a single center. These regimens chronologically included rapid (Group I), slow (Group II) streptokinase, high-dose (100 mg) tissue plasminogen activator (t-PA) (Group III), a half-dose (50 mg) and slow infusion (6 h) of t-PA without bolus (Group IV), and a low dose (25 mg) and slow infusion (6 h) of t-PA without bolus (Group V). The endpoints were thrombolytic success, in-hospital mortality, and nonfatal complication rates. Results The overall success rate in the whole series was 83.2%; it did not differ significantly among Groups I through V (68.8%, 85.4%, 75%, 81.5%, and 85.5%, respectively; p = 0.46). The overall complication rate in the whole series was 18.6%. Although the overall complication rate was similar among Groups I through IV (37.5%, 24.4 %, 33.3%, and 29.6%, respectively; p > 0.05 for each comparison), it was significantly lower in Group V (10.5%, p Conclusions Low-dose slow infusion of t-PA repeated as needed without a bolus provides effective and safe thrombolysis in patients with Prosthetic Valve Thrombosis. (Comparison of Different TRansesophageal Echocardiography Guided thrOmbolytic Regimens for Prosthetic Valve Thrombosis; NCT01451320 )
-
successful treatment of renal artery thromboembolism with low dose prolonged infusion of tissue typed plasminogen activator in a patient with mitral mechanical heart Valve Thrombosis under the guidance of multimodality imaging
Blood Coagulation & Fibrinolysis, 2012Co-Authors: Ahmet Cagri Aykan, Mehmet Özkan, Mustafa Yildiz, Ozan Mustafa Gursoy, Gokhan Kahveci, Zulal UsluAbstract:This case report describes the use of low-dose prolonged infusion of tissue-typed plasminogen activator in the treatment of renal artery thromboembolism secondary to Prosthetic Valve Thrombosis, under the guidance of multimodality imaging. Thromboembolic occlusion of renal arteries is a rare disorder with serious consequences. It is generally associated with cardiac diseases and arrhytmias. Four consecutive doses of low-dose prolonged infusion of tissue-typed plasminogen activator [25 mg tissue-typed plasminogen activator (tpa) in 6 h] were administered to the patient. This case of renal artery thromboembolism secondary to mitral mechanical Prosthetic Valve Thrombosis was successfully treated with low-dose prolonged infusion of tPA under the guidance of multimodality imaging with renal artery Doppler ultrasonography, multislice computerized tomographic angiography, renal angiography, two-dimensional and real-time three-dimensional transesophageal echocardiography. This case has demonstrated that low-dose prolonged infusion of tissue-typed plasminogen activator may be effective and well tolerated in the treatment of renal embolism.
