Search

Koroner arter hastalığı tedavisinde yaşanan gelişmelere rağmen koroner arter bypass greft (KABG) cerrahisi tedavisindeki önemli yerini korumaktadır. Yapılan çalışmalarda cerrahiden henüz bir dekad sonra safen ven greftlerinin (SVG) %50' sinden fazlasında dejenerasyon geliştiği görülmüştür.Yapılan çalışmalarla kemik morfogenetik protein-2 (BMP-2)' nin vasküler kalsifikasyon, plak insitabilitesi ve inflamasyon gibi ateroskleroz süreçlerinde rol oynadığı gösterilmiştir.Hipertrofik skar ve keloid; deride yara sınırlarının ötesine uzanan, aĢırı hücre popülasyonu ve ekstraselüler matriks bileşenlerinin birikimiyle karakterize, anormal yara iyileşmesi sonucu oluşan proliferatif skar tipleridir. Hem ateroskleroz hem de proliferatif skarlar sitolojik ve patofizyolojik olarak ortak özelliklere sahiptir.KABG cerrahisi yapılan hastalarda başarıyı belirleyen en önemli faktör greftlerin açıklığıdır, uzun dönemde greft açıklığını belirleyen en önemli etken ise aterosklerozdur. Bu çalışmada safen veni kullanılarak KABG cerrahisi yapılmışolan hastalarda SVG dejenerasyonunun, serum BMP-2 seviyesi ve sternotomideki proliferatif skar varlığıyla olan ilişkisi araştırılmıştır.Çalışmaya, en az bir safen ven bypass grefti olan 74 hasta alındı. Koroner anjiyografi sonucuna göre 26 hasta SVG dejenerasyonu olmayan, 48 hasta SVG dejenerasyonu olan gruba alındı. Serum BMP-2 düzeyi dejenerasyonu olan grupta dejenerasyon olmayan gruba göre anlamlı olarak daha yüksek saptandı (p=0,002). SVG dejenerasyonu olan grupta proliferatif skarı varlığı anlamlı olarak daha yüksekti (p=0,01). Ek olarak proliferatif skarı olan hastalarda serum BMP-2 düzeyi anlamlı olarak daha yüksekti (p=0,019).Bu çalışmanın sonucunda serum BMP-2 düzeyinin, proliferatif skar varlığının, trigliserid düzeyinin ve safen greft yaşının SVG dejenerasyonunun bağımsız belirleyicileri olduğu saptandı. Despite all developments in the management of coronary artery disease, coronary artery bypass graft (CABG) surgery is still an important option in such patients. Studies have shown that > 50% of saphenous vein grafts (SVG) have degeneration after a decade.Bone morphogenetic protein-2 (BMP-2) has been shown to play a role in atherosclerotic process such as vascular calcification, plaque instability, and inflammation.Hypertrophic scar and keloid; are types of proliferative scar that extend beyond the wound margins in the skin and characterized by excessive cell and extracellular matrix accumulation. Atherosclerosis and proliferative scars have similar characteristics both cytologically and pathophysiologically.The most important factor determining the outcome of patients undergoing CABG surgery is the patency of the venous grafts and atherosclerosis has the major influence in the long term follow up. In this study, we aim to investigate the75association between SVG degeneration, serum BMP-2 level and the presence of proliferative scar in sternotomy in patients who underwent CABG.We included 74 patients in the study. 48 patients with and 26 patinets without SVG degeneration were detected. Serum BMP-2 level was significantly higher in degeneration group compare to the group without degeneration (p = 0.002). The presence of proliferative scar was significantly higher in patients with SVG degeneration (p = 0.01). Additionally, serum BMP-2 levels were significantly higher in patients with proliferative scar (p = 0.019).In conclusion, we found that serum BMP-2 level, presence of proliferative scar, triglyceride level and saphenous graft age are independent determinants of SVG degeneration.

Background/aim: Acute rheumatic fever and rheumatic heart disease are major causes of morbidity and mortality in developing countries. Genetic studies have determined that the immune response in rheumatic heart disease is genetically controlled and that there is a close relationship between the gene of concern and the class II human leukocyte antigen (HLA) gene. The aim of this study was to evaluate the relationship of serum HLA-B alleles and tumor necrosis factor alpha (TNF-∝) with rheumatic heart disease. Materials and methods: A total of 50 consecutive patients with rheumatic heart disease and 50 controls were enrolled in the study. HLA alleles were analyzed using sequence-specific primer-polymerase chain reaction and nucleotide sequencing. Results: The HLA-B35 allele was significantly more common in patients with rheumatic heart disease than the control group (P = 0.043). The HLA-B44 allele was significantly more common in control patients than in patients with rheumatic heart disease (P = 0.014). There was a significant inverse correlation between high-sensitivity C-reactive protein and mitral valve area (P = 0.001). There was no correlation between TNF-∝ levels and mitral valve area (P = 0.066). Conclusion: Our findings confirmed the association between HLA-B alleles and rheumatic heart disease.