Person: YILDIZELİ, BEDRETTİN
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YILDIZELİ
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BEDRETTİN
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Publication Metadata only Management of Massive Pulmonary Hemorrhage Following Pulmonary Endarterectomy(GEORG THIEME VERLAG KG, 2014) YILDIZELİ, BEDRETTİN; Yildizeli, Bedrettin; Arslan, Ozgur; Tas, Serpil; Eldem, Barkin; Aksoy, Eray; Kocak, Tuncer; Sunar, HasanMassive pulmonary hemorrhage is a potentially fatal complication of pulmonary endarterectomy. We describe a successful management in which the patient's right lower lobe bronchus was occluded with a Fogarty balloon catheter while on peripheral venoarterial extracorporeal membrane oxygenation.Publication Metadata only Perioperative management of massive pulmonary hemorrhage after pulmonary endarterectomy(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2018) YILDIZELİ, BEDRETTİN; Yildizeli, Sehnaz Olgun; Erkilinc, Atakan; Yanartas, Mehmed; Tas, Serpil; Sunar, Hasan; Gurcu, Emre; Yildizeli, BedrettinBackground: This study aims to evaluate our approaches and outcomes in patients who developed hemoptysis following pulmonary endarterectomy. Methods: Pulmonary endarterectomy was performed in 460 patients at Kartal Kosuyolu Training and Research Hospital between March 2011 and September 2017. Clinical characteristics, perioperative management and postoperative outcomes of 10 patients (2.1%) (4 males, 6 females; mean age 48.3 +/- 16.5 years; range 21 to 76 years) with massive pulmonary hemorrhage following pulmonary endarterectomy were evaluated. Results: Mean period of diagnosis for chronic thromboembolic pulmonary hypertension was 17 +/- 13.6 months. All patients were New York Heart Association functional class II (n=2), III (n=5) or IV (n=3). For the treatment of massive pulmonary hemorrhage, intraoperative extracorporeal membrane oxygenation was used in six patients (60%), while conservative treatments were used in four patients (40%). In-hospital mortality rate was 50% (n=5); the causes for mortality were septic shock in two patients, multiple organ failure in two patients and intracranial hemorrhage in one patient. Survival was achieved in two patients on extracorporeal membrane oxygenation and three patients receiving conservative treatment. Functional and hemodynamic improvement was observed in all surviving patients. Conclusion: Despite the relatively low incidence of massive pulmonary hemorrhage after pulmonary endarterectomy, it is a potentially fatal complication. Our approach focuses on early diagnosis with a multidisciplinary team and management with bronchoscopy, bronchial blockers and use of extracorporeal membrane oxygenation. The choice of treatment depends on the site and origin of the hemorrhage, the availability of equipment and expertise, and the potential short- and long-term advantages and disadvantages.Publication Metadata only Prevalence of Coronary Artery to Pulmonary Artery Collaterals in Patients with Chronic Thromboembolic Pulmonary Hypertension: Retrospective Analysis from a Single Center(GEORG THIEME VERLAG KG, 2018) KEPEZ, ALPER; Kepez, Alper; Mutlu, Bulent; Paudel, Ashok; Ileri, Cigdem; Atas, Halil; Yildizeli, BedrettinBackground Our aim was to determine the prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by retrospectively evaluating coronary angiograms of eligible consecutive patients who had undergone pulmonary endarterectomy (PEA). We also aimed to evaluate predictors and potential clinical associates of these collaterals. Methods Coronary angiograms of 83 consecutive CTEPH patients who had undergone coronary angiography before PEA operation between January 1, 2012 and June 1, 2015 were retrospectively evaluated for presence of coronary artery-pulmonary artery collaterals. Medical records of all patients were also retrospectively reviewed for demographic information, cardiovascular risk factors, preoperative right heart catheterization reports, operation reports, and follow-up data. Data of CTEPH patients with coronary artery-pulmonary artery collaterals were compared with data of CTEPH patients without such collaterals. Results There were 15 patients (18.1%) with definite and 4 patients (4.8%) with probable coronary artery-pulmonary artery collaterals among the study population. CTEPH patients with collaterals had higher preoperative pulmonary artery pressures, higher pulmonary vascular resistance (PVR) and lower cardiac index values compared with CTEPH patients without collaterals. However, CTEPH patients with collaterals displayed higher amount of reduction in PVR after PEA compared with patients without collaterals. There were no significant differences between groups regarding incidence of reperfusion injury or mortality. Conclusion Prevalence of coronary artery-pulmonary artery collaterals seems to be increased in our CTEPH patients compared with the general population. The presence of coronary artery-pulmonary artery collaterals is often combined with proximal disease with the possibility of increased reduction of PVR after PEA operation.Publication Metadata only Is There Any Role of Pulmonary Endarterectomy in Pulmonary Arterial Hydatidosis?(2021) YILDIZELİ, BEDRETTİN; Erkilinç, Atakan; Ermerak, Nezih Onur; Zengin, Ahmet; Olgun Yildizeli, Şehnaz; Mutlu, Bu Lent; Karakoç, Ayşe Zehra; Yanartaş, Mehmed; Taş, Serpil; Bozkurtlar, Emine; Sunar, Hasan; Yildizeli, BedrettinBACKGROUND: Hydatid Cyst is a zoonosis caused by Echinococcus granulosis. Pulmonary artery involvement is a rare condition. The aim of this study was to review our experience in the surgical treatment of pulmonary arterial hydatidosis. METHODS: Data were collected prospectively for consecutive patients who underwent pulmonary endarterectomy and had a diagnosis of hydatidosis at or after surgery. RESULTS: Eight patients (two male, six female, mean age, 31.25±13.68 years) with hydatidosis were defined. Only one patient presented with hemoptysis, while the rest of the patients reported exertional dyspnea as their main symptom. Cardiac hydatidosis associated with pulmonary arterial involvement was noted in one patient. The mean time interval for duration of disease was 12±24.29 months before PEA. Mortality was observed in two patients due to massive hemoptysis in one and right heart failure in one. No anaphylactic reaction was observed. Significant difference was detected in mean pulmonary vascular resistance as decline from 442.38±474.20 to 357.25±285.34 dyn/s/cm-5 following surgery (p: 0.011). Two patients had recurrence of the disease following a median follow-up of 9.1 months All survivors improved to New York Heart Association functional class I and II. CONCLUSIONS: Pulmonary arterial hydatidosis may mimic chronic thromboembolic pulmonary hypertension and these patients can be diagnosed with pulmonary endarterectomy. Surgery may be a therapeutic option for patients who do not respond to medical therapy if the cystic lesions are surgically accessible. Pulmonary endarterectomy should be performed only in expert centers because of the high risk of perioperative morbidity, mortality, and postoperative recurrence.Publication Metadata only Outcomes of Patients with Behcet's Syndrome after Pulmonary Endarterectomy(GEORG THIEME VERLAG KG, 2018) YILDIZELİ, BEDRETTİN; Yildizeli, Sehnaz Olgun; Yanartas, Mehmed; Tas, Serpil; Direskeneli, Haner; Mutlu, Bulent; Ceyhan, Berrin; Yildizeli, BedrettinBackground Behcet's syndrome (BS) is a multisystem disorder and is not known as a risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), for which the treatment of choice is pulmonary endarterectomy (PEA). The aim of this study was to review our experience in the surgical treatment of CTEPH in patients with BS. Methods Data were collected prospectively for consecutive patients with BS who underwent PEA over a 6-year period. Results We identified nine patients (seven males, two females, mean age: 34.79.9 years) with BS. The mean disease duration before PEA was 88.0 +/- 70.2 months. All patients but one received immunosuppressive therapy before the surgery. Exercise-induced dyspnea presented symptoms in six patients. One patient had associated intracardiac thrombosis. PEA was bilateral in five patients, unilateral in three, and lobar in one. No perioperative mortality was observed; however, one patient died four weeks after PEA due to massive hemoptysis. Morbidity was observed in two patients. The systolic pulmonary artery pressure fell significantly from 59.0 +/- 22.7mm Hg to 30.0 +/- 6.5mm Hg after surgery ( p =0.031). Pulmonary vascular resistance also improved significantly from 611.8 +/- 300.2 to 234.7 +/- 94.9 dyn/s / cm (5) ( p =0.031). After a median follow-up of 29.4 months, all patients improved to the New York Heart Association (NYHA) functional class I and II. Conclusion Patients with BS may suffer recurrent pulmonary embolism and develop CTEPH. In patients who do not respond to anticoagulation or immunosuppressive therapy, PEA may be a therapeutic option when thrombotic lesions are surgically accessible. Due to the high risk of perioperative mortality, the procedure should be undertaken in centers with experience.Publication Metadata only Transatrial balloon atrial septostomy to facilitate weaning off venoarterial ECMO after pulmonary endarterectomy(2022-10-01) AK, KORAY; TİRE, YAKUP; KARARMAZ, ALPER; YILDIZELİ, BEDRETTİN; AK K., Arslanhan G., TİRE Y., Tosun S., KARARMAZ A., HANTA İ., YILDIZELİ B.Atrial septostomy has been the last resort in the management of patients with the right ventricular failure related to pulmonary hypertension before lung transplantation. In this paper, we present a simple and safe technique (transatrial approach) for balloon atrial septostomy in a patient who required central venoarterial extracorporeal membrane oxygenation after pulmonary endarterectomy.Publication Metadata only Evaluation of Improvement in Exercise Capacity after Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension: Correlation with Echocardiographic Parameters(GEORG THIEME VERLAG KG, 2014) KEPEZ, ALPER; Kepez, Alper; Sunbul, Murat; Kivrak, Tarik; Eroglu, Elif; Ozben, Beste; Yildizeli, Bedrettin; Mutlu, BulentBackgroundThe study evaluates the alterations in exercise capacity of chronic thromboembolic pulmonary hypertension (CTEPH) patients after pulmonary endarterectomy (PEA) and investigates the echocardiographic parameters associated with the degree of functional recovery. MethodsThirty consecutive patients with the diagnosis of CTEPH (17 males; mean age, 45.915.1 years) who had been referred for PEA operation were included in the study. Each patient underwent transthoracic echocardiography and 6-minute walk test (6-MWT) before and 6 months after PEA. ResultsAfter PEA, 6-MWT distances significantly increased (242.8 +/- 112.8 m vs. 423.6 +/- 89.1 m, p<0.001), whereas systolic pulmonary artery pressures and right ventricular dimensions significantly decreased (86 +/- 25.1mm Hg vs. 41.9 +/- 15.6mm Hg, p<0.001 and 42.1 +/- 10.1mm vs. 35.3 +/- 5.6mm, p<0.001, respectively). Magnitude of change in 6-MWT distance (-6-MWT) was found to be correlated with concomitant change in tricuspid annular plane systolic excursion and left ventricular myocardial performance index (r: 0.518, p: 0.004 and r: -0.385, p: 0.043, respectively). Linear regression analysis revealed preoperative 6-MWT distance as an independent negative predictor of delta-6-MWT (beta: -0.89, t: -3.97, p: 0.001). ConclusionCTEPH patients with more severely depressed exercise capacity at baseline displayed relatively greater degree of functional recovery after PEA in our study. Improvement in functional capacity was found to be correlated with improvement in parameters reflecting right ventricular functions rather than improvement in pulmonary artery pressure after PEA operation.Publication Metadata only Extracellular matrix collagen biomarker levels in patients who underwent pulmonary endarterectomy(2023-04-01) OLGUN YILDIZELİ, ŞEHNAZ; MUTLU, BÜLENT; YILDIZELİ, BEDRETTİN; Zengin A., Kalkan R., Aydin K. Y., OLGUN YILDIZELİ Ş., MUTLU B., Karakoc A. Z., Tas S., Sunar H., Kilic U., Yanartas M., et al.OBJECTIVES: The role of extracellular matrix collagen biomarkers in chronic thromboembolic pulmonary hypertension (CTEPH) is not well known. Our goal was to investigate the matrix metalloproteinase (MMP)-2 and -9 protein levels in patients with CTETH.