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Introduction:Radiofrequencycatheter ablation therapy has been used to treat arrhythmia such assupraventricular and/or ventricular tachycardia. Increased waist circumferenceis important in assessing central obesity and may be an important factor forradiation injury. Therefore, this article describes the association betweenwaist circumference and fluoroscopic exposure time during cardiacradiofrequency catheter ablation procedures for symptomatic drug-resistanttachycardia.Patientsand Methods: From August 2011 to March 2015, 214 (136 women, 78 men)consecutive patients with symptomatic drug-resistant atrioventricular nodalre-entrant tachycardia (174 patients), atrioventricular re-entrant tachycardia(12 patients), Wolf-Parkinson-White syndrome (5 patients), atrial tachycardia(8 patients), atrial flutter (7 patients), right ventricular outflow tracttachycardia (5 patients), and atrial fibrillation (3 patients) underwent aninvasive electrophysiological study and radiofrequency catheter ablation. Thefluoroscopic exposure time, radiofrequency catheter ablation time, and waistcircumference were measured during the electrophysiological study.Results: Althoughage was significantly higher in women than in men, body weight, body height,waist circumference, and radiofrequency catheter ablation time weresignificantly higher in men than in women. There was a correlation betweenwaist circumference and fluoroscopic exposure time (p= 0.04, r= 0.13).Conclusion: The study showed thatthere was a positive correlation between waist circumference and fluoroscopicexposure time in patients with antiarrhythmic drug-refractory tachycardia whounderwent radiofrequency catheter ablation. This finding could help preventradiation injury, especially increased waist circumference duringradiofrequency catheter ablation., Giriş: Radyofrekans kateter ablasyon tedavisi supraventriküler ve/veyaventriküler aritmilerin tedavisinde kullanılmaktadır. Artmış bel çevresisantral obeziteyi değerlendirmede önemli bir yöntemdir, aynı zamanda radyasyonhasarı için de önemli bir faktör olabilir. Bu nedenle bu makale semptomatikilaca dirençli taşikardi nedeni ile yapılan kardiyak radyofrekans kateterablasyonu sırasındaki floroskopi maruziyet süresi ile bel çevresi arasındakiilişkiyi irdelemektedir.Hastalar ve Yöntem: Ağustos 2011 ila Mart 2015tarihleri arasında semptomatik ilaca dirençli; atriyoventriküler nodalre-entran taşikardi (174 hasta), atriyoventriküler re-entran taşikardi (12hasta), Wolf Parkinson White sendromu (5 hasta), atriyal taşikardi (8 hasta),atriyal flutter (7 hasta), sağ ventriküler çıkış yolu taşikardisi (5 hasta),atriyal fibrilasyon (3 hasta) nedenleri ile invaziv elektrofizyolojik çalışmave radyofrekans ablasyon uygulanan 214 (136 kadın, 78 erkek) ardışık hastaçalışmaya dahil edildi. Floroskopi maruziyet süresi, radyofrekans ablasyonzamanı ve bel çevresi işlem sırasında ölçüldü.Bulgular: Kadınların yaşı anlamlı olarak erkeklerden yüksek olsada vücut ağrılığı, boy, bel çevresi ve radyofrekans ablasyon süresi erkeklerdekadınlara göre daha anlamlı olarak yüksekti. Bel çevresi ile floroskopimaruziyet süresi arasında bir korelasyon mevcuttu (p= 0.04, r= 0.13).Sonuç: Çalışmamız göstermiştirki,antiaritmik ilaç dirençli taşikardi nedenli radyofrekans kateter ablasyonuygulanan hastalarda floroskopi maruziyet süresi ile bel çevresi arasındapozitif bir korelasyon mevcuttur. Bu bulgu özellikle artmış bel çevresi olan hastalardaradyofrekans kateter ablasyon sırasında radyasyon hasarını önlemek için faydalıolabilir.

Introduction: Transcatheter aortic valve implantation (TAVI) is more reliable than surgical valve replacement for high-risk or inoperable aortic stenosis patients. In this study, we aimed to investigate the effects of different femoral access methods on the development of vascular complications and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI. Patients and Methods: In total, 110 patients (aged 78.9 ± 12.2 years; 55 females) who underwent aortic valve replacement by TF-TAVI between June 2013 and April 2015 were included in the study. CIN was defined as an absolute increase in serum creatinine level of > 0.5 mg/dL or a relative increase of > 25% within 48-72 h after TF-TAVI. The patients were classified into two groups according to the femoral access methods: surgical cut-down (SCD) and vascular closure device (VCD) groups. Results: The amount of contrast medium (CM; p< 0.001) and the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline glomerular filtration rate (GFR), baseline creatinine, Mehran score and CM were determined as the predictive factors of CIN development. Receiver operating characteristic analysis revealed that CM, which may predict the development of CIN, was determined as 178.5 mL, and GFR, which may predict the development of CIN, was determined as 48.9 mL/dk/1.73 m2. Conclusion: It may be preferred to perform the femoral arterial procedure using the SCD method instead of VCD in TAVI patients whose GFR is < 48.9; the use of CM may increase due to various reasons.

Introduction: Less-invasive procedures have gained more widespread adoption among cardiovascular surgeons as a result of continuous advances in the field of cardiac surgical techniques. It has now become clear that even smaller incisions may provide adequate exposure in certain cardiac surgical procedures without compromising the surgeon’s view of the surgical field. Furthermore, a limited incision offers the advantage of cosmetic outcomes, hence an improved quality-of-life after the operation. Herein, we report our experience regarding the use of partial upper sternotomy with limited skin incision for isolated or combined aortic valve operations. Patients and Methods: A total of 34 patients underwent aortic valve surgery via partial J-shaped upper sternotomy in two separate centers between January 2013 and December 2014. Sixteen patients (47%) underwent an isolated aortic valve replacement, while 18 patients (53%) underwent a modified Bentall procedure. Descriptive data included demographic and clinical outcome parameters. Results: Mean age was 54 ± 14 years (range: 19 to 82 years) and there were 11 females (32%). The average duration of surgery was 6.8 ± 1.8 hours, ranging from 4 to 10 hours. Early mortality occurred in 1 patient. Two patients had wound infection and they were re-hospitalized for wound care. Conclusion: Our preliminary result regarding the use of partial upper ministernotomy is encouraging. The technique allows adequate exposure during aortic valve surgery, even in procedures involving the proximal ascending aorta. Further studies are warranted to test the safety and efficacy of this approach.

Introduction: Stress imaging tests are recommended in patients with positive exercise electrocardiography (EECG) and intermediate pretest probability. However the role of coronary computed tomography angiography (CCTA) in young women with intermediate pretest probability and positive EECG is under debate. The aim of this study was to assess the diagnostic value of CCTA in young women patients with low-intermediate pretest probability and positive EECG results. Patients and Methods: From a retrospective registry of 67 young women with positive EECG between January 2011 and January 2014 were included in this study. Of these 67 patients 32 patients underwent CCTA and 35 patients underwent MPS after EECG. Results: There were no statistically significant differences between groups in demographic variables, or cardiovascular risk profile. The exercise test was positive in all patients. Both groups were similar for exercise capacity and Duke treadmill score. Blood chemistry of the patients were similar. The median pre-test probability of obstructive coronary artery disease (CAD) was lower in CCTA group 28% (15-45%) than in MPS group (15-50) (p= 0.045). Overall 3 patients in the CCTA and 7 patients in the MPS group had significant lesions. All patients in the CCTA positive group had significant CAD, while 3 out of 7 patients with positive MPS findings had significant CAD in coronary angiography. Conclusion: CCTA may be a valuable alternative of stress imaging tests in women patients with low-intermediate pretest probability and positive EECG.

Hepatit Cvirüsü (HCV) tedavisinde peginterferon (Peg-IFN)2b ve ribavirin tedavisi konvansiyonel interferon veribavirin tedavisinden daha etkilidir. Peg-IFN ve ribavirin tedavisinin önemlietkilerinin yanında ateş, halsizlik, heyecan, huzursuzluk, nötropeni ve trombositopenigibi bir çok yan etki görülebilir. Ayrıca kardiyak aritmiler ve senkop gibinadir olaylar da Peg-IFNtedavisine bağlı gelişebilir. Bizler bu çalışmada Peg-IFN ve ribavirin tedavisi sırasında presenkop atağı vereenteran taşikardilerin en sık formu olan atriyoventriküler nodal reenterantaşikardi gelişen bir yoğun bakım hastasını sunuyoruz., Thetreatment of hepatitis C virus (HCV) with peginterferon (Peg-IFN) α2b andribavirin is more effective than with conventional interferon and ribavirin.Despite the important effects of Peg-IFN and ribavirin therapy, many sideeffects, such as fever, fatigue, anxiety, irritability, neutropenia andthrombocytopenia, may be observed. In addition, cardiac arrhythmias and syncopeare rare consequences of Peg-IFN therapy. In this study, we report an intensivecare unit patient who developed atrioventricular nodal reentrant tachycardia(AVNRT), which is the most common type of reentrant supraventriculartachycardia, and presyncopal attack during Peg-IFN and ribavirin therapy.

The circulatory system is a complex system containing the heart and vessels. This system, originating from extraembryonic mesoderm, is the first functioning system of the embryo. The formation of the angioblast and primitive placental circulation starts at the beginning of the third week. Plasticity is defined as the ability of a mature cell to differentiate into different cell types. Haematopoietic stem cells can transform into neural, heart muscle, skeletal muscle and liver cells, while the bone marrow stromal cells can transform into heart and skeletal muscle cells. The identification of vessels as artery, venous or capillary is closely related to remodelling. Arteries express ephrin-B2 and D114, while veins express ephrin-B4 and neuropilin-2. With the guidance of these genes, the identification of arteries and veins has started. Besides genes, physical factors, including hemodynamic and cardiac output regulations, affect vessel branching. Flow-mediated vascular plasticity is a crucial link between the genetic and epigenetic factors. The arterial and venous differentiations are controlled by hemodynamic factors. In conclusion, blood flow is important for the formation of a vascular tree and activates arterial markers, including ephrin-B2 and neuropilin-1.

Introduction: Stroke is one of the leading causes of permanent disability and death. Stroke is generally associated with ischemia and carotid artery stenosis is the reason in nearly one third of the cases. The aim of the present study was to investigate the short and mid term results of carotid artery stenting (KAS) procedures performed in high risk patients due to carotid artery disease who were admitted to cardiology clinic of our institution. Patients and Methods: The study group consisted of 14 consecutive high risk patients in whom KAS was performed in the cardiology clinic of our institution due to atherosclerotic carotid artery disease between October 2011 and October 2013. Procedural success, in-hospital and out-hospital stroke, myocardial infarction and all causes of mortality were evaluated. Results: Angiographic success was achieved in all patients. In-hospital and out-hospital acure coronary syndrome was not observed. One patient developed permanent stroke 24 hours after the procedure. This stroke was related with non-intervened carotid artery. This patient died 32 days after the procedure. Procedure related stroke or death was not occurred in any of the patients. Conclusion: KAS is a safe procedure in high risk patients for appropriately equipped experienced operators.

Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI). Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated. Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009). Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted., Giriş: Akut inferiyor miyokart enfarktüsü (AİME) tanısıyla hastaneye yatırılan olguların enfarktüsten sorumlu koroner arterlerinin belirlenmesinde elektrokardiyografi (EKG) bulgularının önemini araştırdık. Hastalar ve Yöntem: Merkezimizde Ocak 2004-Ocak 2009 tarihleri arasında AİME tanısı ile takip edilen 132 hastanın (ortalama yaş; 57.3 ± 11, 118 erkek); hastaneye başvuru sırasında çekilen ilk EKG kayıtları ve demografik özellikleri retrospektif olarak değerlendirildi. Bulgular: Koroner anjiyografi tetkikleri değerlendirildiğinde; olguların %70.4'ünde enfarktüsten sorumlu koroner arterin (ESKA) sağ koroner arter (RCA), %29.6'sında sirkumfleks arter (Cx) olduğu saptandı. Sorumlu arterin RCA olduğu olgularda; DIII derivasyonundaki ST segment yükselmesinin, DII derivasyonundan daha fazla olduğu (%94.6 duyarlılık, %75.9 özgüllük, p= 0.001),aVL ve DI derivasyonlarının her ikisinde de ST segment çökmesinin bulunduğu saptandı (%88.2 duyarlılık, %75.2 özgüllük, p= 0.011). Sorumlu arterin RCA olduğu olgulara aVL derivasyonundaki ST segment çökmesinin, DI derivasyonundaki ST segment çökmesinden daha fazla olmasının istatistiksel olarak anlamlı olduğu belirlendi (%95.7 duyarlılık, %73.6 özgüllük p= 0.016). İnferiyor yüz enfarktüse, sağ ventrikül miyokart enfarktüsünün eşlik ettiği hastalarda sorumlu arter anlamlı olarak RCA idi (p= 0.005). Posterior duvar infarktüsünün eşlik ettiği olgularda sorumlu arterin daha çok Cx olduğu gözlense de bu durum istatistiksel olarak anlamlı değildi (p= 0.3). Sorumlu arterin Cx olduğu olguların EKG'lerinde V1-2 derivasyonlarında ST segment çökmesi saptandı (%84.6 duyarlılık, %36.3 özgüllük p= 0.009). Sonuç: AİME geçiren olguların yüzey EKG'lerinden elde edilen bulgular, enfarktüsten sorumlu koroner arterin tahmin edilebileceğini göstermektedir.

Introduction: Radiofrequency ablation of tachyarrhythmia is effective in the treatment of tachycardia. In this study, we evaluated the results of radiofrequency catheter ablation of tachyarrhythmia. Patients and Methods: From December 2010 to January 2012, 114 consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia, 17 patients with atrioventricular reentrant tachycardia (five Wolf Parkinson White syndrome), eight patients with atrial tachycardia, seven patients with atrial flutter, five patients with right ventricular outflow tract tachycardia and three patients with atrial fibrillation underwent an invasive electrophysiology study and radiofrequency ablation. Results: The 154 patients (age: 39.1 ± 17.2 years, body mass index: 24.3 ± 5.2 kg/m2, waist/ hip ratio: 0.88 ± 5.2, systolic blood pressure: 128.3 ± 22.4 mmHg, diastolic blood pressure: 75.30 ± 9.0 mmHg, resting heart rate: 76.10 ± 8.2 beat/minute) with tachycardia (89 women, 65 men) were ablated. Procedure and fluoroscopy times were 57.5 ± 19.0 and 14.4 ± 4.1 minute respectively. The mean follow up period was 10.2 ± 4.3 months. During follow up period three patients with atrioventricular nodal reentrant tachycardia, two patients with atrioventricular reentrant tachycardia, one patient with right ventricular outflow tract tachycardia and one patient with atrial fibrillation had recurrence. Conclusion: The transvenous radiofrequency ablation therapy is a safe and effective approach for the treatment of tachyarrhythmia under experienced hands.

Introduction: Atrioventricular nodal reentrant tachycardia is the most common regular supraventricular arrhythmia in humans. This study investigated the admission hemoglobin levels and gender differences in transvenous radiofrequency ablation therapy for the treatment of the slow pathway of atrioventricular nodal reentrant tachycardia. Patients and Methods: Nineteen consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia underwent an invasive electrophysiology study and performed radiofrequency ablation of slow conduction pathway within atrioventricular node. Blood samples were taken between 08.30 and 09.30 a.m. from the antecubital vein for complete blood count. Results: Nineteen consecutive patients with slow-fast atrioventricular nodal reentrant tachycardia (12 female, 7 male) were ablated. Mean admission hemoglobin and hematocrit (%) levels were significantly increased in male patients as compared with female patients (15.38 ± 1.21 mg/dL, 12.72 ± 1.36 mg/dL, p < 0.001; 45.41 ± 3.26, 37.90 ± 2.88, p < 0.001 respectively). There was not gender differences in the radiation exposure time, fluoroscopy time, complication rate (0%) and acute success rate (100%). Conclusion: There was not gender differences in the radiation exposure time, fluoroscopy time, complication rate and acute success rate at the transvenous radiofrequency ablation therapy for the treatment of atrioventricular nodal reentrant tachycardia. Mean admission hemoglobin and hematocrit levels were significantly decreased in female patients as compared with male patients.

Introduction: We aimed to develop a classification method to discriminate ventricular septal defect and atrial septal defect by using severalhemodynamic parameters.Patients and Methods: Forty three patients (30 atrial septal defect, 13 ventricular septal defect; 26 female, 17 male) with documentedhemodynamic parameters via cardiac catheterization are included to study. Such parameters as blood pressure values of different areas,gender, age and Qp/Qs ratios are used for classification. Parameters, we used in classification are determined by divergence analysismethod. Those parameters are; i) pulmonary artery diastolic pressure, ii) Qp/Qs ratio, iii) right atrium pressure, iv) age, v) pulmonary arterysystolic pressure, vi) left ventricular sistolic pressure, vii) aorta mean pressure, viii) left ventricular diastolic pressure, ix) aorta diastolicpressure, x) aorta systolic pressure. Those parameters detected from our study population, are uploaded to multi-layered artificial neuralnetwork and the network was trained by genetic algorithm.Results: Trained cluster consists of 14 factors (7 atrial septal defect and 7 ventricular septal defect). Overall success ratio is 79.2%, andwith a proper instruction of artificial neural network this ratio increases up to 89%.Conclusion: Parameters, belonging to artificial neural network, which are needed to be detected by the investigator in classical methods,can easily be detected with the help of genetic algorithms. During the instruction of artificial neural network by genetic algorithms, boththe topology of network and factors of network can be determined. During the test stage, elements, not included in instruction cluster, areassumed as in test cluster, and as a result of this study, we observed that multi-layered artificial neural network can be instructed properly,and neural network is a successful method for aimed classification.

Heparin gibi antikoagulan ilac kullanan hastalar bu ilaclara bagli ciddi komplikasyonlarla karsilasabilirler. Burada kronik bobrek yetersizligi olan bir hastada gelisen bukkal mukoza hematomu olgusu sunulmaktadir

Cardiac tamponade is a life-threatening condition requiring urgent intervention. It may either be drained surgically or percutaneously. Percutaneous drainage of pericardial effusion bears the risk of laceration and perforation of the myocardium and the coronary vessels, air embolism, pneumothorax, dysrhythmias, puncture of the peritoneal cavity and abdominal viscera, internal mammary artery fistula, acute pulmonary edema, and purulent pericarditis. Here, we report an easy and safe approach for pericardiocentesis under the guidance of agitated saline contrast injection through a Seldinger needle before inserting guidewire and catheter. This cheap, easy, feasible, and comfortable method of injection of agitated saline contrast before the insertion of guidewire and catheter may prevent the undesired complications.