Browsing by Author "Alat, I"

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    The role of brain natriuretic peptide in the prediction of cardiac performance in coronary artery bypass grafting
    Saribulbul, O; Alat, I; Coskun, S; Apaydin, AZ; Yagdi, T; Kiliccioglu, M; Alayunt, EA
    The relationship between brain natriuretic peptide and cardiopulmonary bypass has not been examined sufficiently In this study, we prospectively examined brain natriuretic peptide levels in the plasma of 26 patients undergoing coronary artery bypass grafting. Brain natriuretic peptide measurements were carried out at 4 times: preoperatively, 3 hours after institution of cross-clamping, 24 hours after institution of cross-clamping, and on the 5th postoperative day. In addition, we measured individual variables and compared them to brain natriuretic peptide levels. Mean preoperative brain natriuretic peptide levels were significantly higher in patients with histories of myocardial infarction (P = 0.0047) and heart failure (ejection fraction less than or equal to0.40) (P = 0.0001). There was a significant correlation between preoperative brain natriuretic peptide levels and cross-clamp times (P = 0.028), and an inverse correlation between those levels and preoperative cardiac indices (P = 0.001). The preoperative brain natriuretic peptide level also correlated inversely with left ventricular ejection fraction before (P = 0.001) and 5 days after (P = 0.01) operation. When the Clinical Severity Scoring System was applied, preoperative brain natriuretic peptide plasma concentrations in 19 patients with risk scores of 0-2 were significantly lower than in the 7 patients whose risk scores were 3-6 (P = 0.006). There was also a significant relationship between preoperative brain natriuretic peptide plasma concentrations and the postoperative requirement for inotropic agents (P = 0.027). This study suggests that plasma brain natriuretic peptide concentration could be one of the predictors of risk in patients undergoing coronary artery bypass grafting.
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    Changing pH of Bronchoalveolar Lavage Fluid in Patients Undergoing Extracorporeal Circulation
    Alat, I; Bayindir, Ü; Özkisacik, E; Tasbakan, S; Saribülbül, O; Büket, S; Yagdi, T; Yüksel, M
    Since bronchoalveolar lavage (BAL) fluid can give a dynamic impression of what is present or developing in situ on the air exchange surface, we worked with BAL fluid to solve the etiopathogenesis of pulmonary complications due to cardiopulmonary bypass (CPB). Forty BAL fluid samples were obtained in 10 patients, undergoing coronary artery bypass grafting (CABG) surgery. Samples were obtained at the following time periods: 1. preoperatively; 2. at the end of the first hour after anesthetic induction; 3. at the conclusion of 30 min. of crossclamp on CPB; 4. 20 h after CPB. Neither calcium nor potassium ions were detectable in any sample. Mean pH of preoperative bronchoalveolar lavage fluid was 6.361 (SD +/- 3,55.10(-2)) and the other mean pH values were 6.375 (SD +/- 0.44), 6.567 (SD +/- 0.165), 6.470 (SD +/- 9,29.10(-2)), respectively. There was not any significant change between the first two steps (p=0.241). Likewise, the change between the third and fourth samples was not statistically significant (p=0.074). However, the change between the second and third studies was statistically significant (p=0.005). And also, the change between preoperative and final studies was statistically significant (p=0.007). The mean recoveries of lavage fluids was about 64% in the first samplings, 75% in the second, 73.4% in the third, and 56% in the fourth. This study reveals that CPB alters one of the main favorable conditions of ecosystem in bronchoalveolar space, namely the pH. Besides, excessive mucous secretion in an involved lung due to CPB which limits making BAL is the reason for atelectasis. As reported in the previous studies, since bronchoalveolar pH changes affect substances like surfactant, this study will set the baseline for further studies.