ÖZET Amaç: İskemik kalp hastalığına bağlı gelişen mitral yetmezlik, halen operatif mortalitesi yüksek seyirli bir hastalıktır. Cerrahi prosedür olarak halen bir fikir birliği sağlanmamıştır. Bu çalışmada İskemik Mitral Yetmezlikte (İMY), mitral kapak replasmanı (MVR) ve tamir sonuçlarının karşılaştırılarak, birbirlerine üstünlüklerini ortaya koymak amaçlanmıştır. Materyal ve Metod: 2007 ve 2011 yılları arasında Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde, İMY nedeniyle opere edilen 36 hasta incelenmiştir. Hastaların (38.9%) kadın, 22’si (61.1%) erkekti. 20 hastaya MVR, 16 hastaya mitral rekonstrüksiyon yapıldı. Her iki grupta bütün vakalarda koroner bypass mevcuttu. Hastalarda preoperatif risk faktörleri, mitral yetersizliğin derecesi, sol ventrikül ejeksiyon fraksiyonları, prepostoperatif fonksiyonel klasifikasyonları, aort kros klemp ve kardiyopulmoner bypass süreleri, yoğun bakım ve hastane kalış süreleri belirlendi. Bulgular: MVR yapılan grupta preoperatif diyastolik çap ve kontrol diyastolik çap arasında anlamlı olarak fark saptanmıştır (p=0.016). Bu grupta diyastolik çaptaki düzelme tamir grubuna göre istatistiksel olarak daha iyi çıkmıştır. Ayrıca preoperatif fonksiyonel kapasite (FK) ve kontrol FK arasında, düzelme yönünde anlamlı fark bulunmuştur (p=0.008). Erken dönem mortalite görülen hastalar incelendiğinde MVR yapılan grupta 6 hasta, tamir grubunda 5 hasta exitus oldu. Mortalite görülen 11 hasta ile sağ kalan hastalar preoperatif ejeksiyon fraksiyonu (EF) yönünden karşılaştırıldığında anlamlı bir fark bulunmamıştır (p=0.986) Sonuç: İMY‘de öncelikle mitral tamir önerilse de, son zamanlarda bazı çalışmalarda da önerildiği gibi, MVR yapılması mitral yetmezliğin tam giderilmesini sağlayıp, reoperasyon riskini azaltmaktadır. Anahtar Sözcükler; İskemik Mitral Yetmezlik, Koroner Arter ByPass, Mitral Kapak Replasmanı, Mitral Tamir ABSTRACT Objective: Mitral insufficiency due to ischemic heart disease is still a disease with high operative mortality. There is still no consensus as surgical procedure. In this study, it is aimed to reveal the superiority of ischemic mitral insufficiency (IMI), mitral valve replacement (MVR) and repair results. Materials and Methods: 2007 and High-Turkey Training and Research Hospital between the years of 2011, 36 patients were operated for IMI was examined. The patients (38.9%) were female and 22 (61.1%) were male. MVR was performed in 20 patients and mitral reconstruction was performed in 16 patients. There was coronary bypass in all cases. Preoperative risk factors, degree of mitral regurgitation, left ventricular ejection fractions, pre-postoperative functional classifications, aortic cross clamp and cardiopulmonary bypass duration, intensive care and hospital stay were determined. Results: There was a significant difference between preoperative diastolic diameter and control diastolic diameter in the MVR group (p = 0.016). In this group diastolic diametric improvement was statistically better than the repair group. Furthermore, there was a significant difference between the preoperative functional capacity (FC) and control FC in terms of improvement (p = 0.008). When the patients with early mortality were examined, 6 patients in the MVR group and 5 patients in the repair group died. There was no significant difference between 11 patients with mortality and the survivors in terms of preoperative ejection fraction (EF) (p = 0.986). Conclusion: Although mitral repair is recommended in IMI, as recently suggested in some studies, MVR provides complete removal of mitral insufficiency and reduces the risk of reoperation. Keywords: Ischemic Mitral Insufficiency, Coronary Artery By-Pass Grafting, Mitral Valve Replacement, Mitral Repair

Pneumoconiosis is defined as, a tissue reaction developed in lung parenchyma due to the accumulation of inorganic dust and fibers. Pneumoconiosis, especially silicosis and coal worker’s pneumoconiosis, is still a major occupational disease issue in developing countries such as Turkey. There is no effective and specific treatment approach for pneumoconiosis. Prevention of the disease is primarily based on workplace exposure management and health management practices, which are regulated with relevant legal framework. Overcome of pneumoconiosis problem requires effective occupational health and safety practices and administrative commitment. In Japan, the third largest country of the world economy, pneumoconiosis wasthe most important cause of work-related mortality and morbidity until 1980s. However, due to the Pneumoconiosis Law, which put into effect in 1960, and continuous improvement on workplace health management, the prevalence of pneumoconiosis has declined %17,4 to 1%. The statistics on occupational diseases in Turkey is inadequate, however recent studies indicate that the prevelance of pneumoconiosis in dental technicians is 5.6 -11.1%. With detailed assessment of occupational health and safety models of countries where pneumoconiosis was an important cause of morbidity and mortality in the past, it is possible to develop an appropriate model for Turkey. In this article, the legislation and applications of Occupational Health and Safety for pneumoconiosis in Japan have been evaluated and some recommendations for our country have been established.