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Aim:We aimed to investigate whether C-reactive protein-to-albumin ratio (CAR) predicts postoperative delirium (POD) development in patients undergoing transcatheter aortic valve replacement (TAVR) procedure.Methods:Data of 78 patients with the mean age of 76.3±8.4 years, who underwent TAVR, were retrospectively analyzed. The CAR, neurophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio values were calculated in all patients. Presence of delirium was determined by using the Richmond Agitation-sedation scale and the Confusion Assessment Method for the Intensive Care Unit.Results:As compared with the nondelirious group, delirious patients had significantly higher EuroSCORE II (p=0.03) and TAVR score (p=0.009) and more frequent major bleeding (p=0.005), major vascular complications (p=0.018) and acute kidney injury (AKI) (p=0.002). The main independent predictors of POD were CAR value (p=0.02), AKI (p=0.02), major bleeding (p=0.005), and TAVR score (p=0.04). The area under the curve of CAR for POD development was 0.718 (95% confidence interval: 0.605-0.814; p=0.002) with 82% sensitivity and 56% specificity.Conclusion:CAR is a promising inflammatory parameter in predicting POD and may help identify subgroups of individuals at risk for POD.

Aim: Mean platelet volume (MPV) is an indicator of platelet activation and is associated with inflammation and thrombus cascade. In this study, we aimed to compare platelet count and MPV levels in patients with infrarenal abdominal aortic aneurysm (IAAA) with and without thrombosis in the aneurysm. Methods: In this cross sectional study, we included 76 consecutive patients who were diagnosed with IAAA. The patients were divided into two groups according to the presence or absence of thrombus in the aneurysm and, clinical and laboratory values were compared. Results: Twenty-seven (35.5%) patients with IAAA had thrombus and 49 (64.5%) did not have thrombus. There was no statistically significant difference in demographic characteristics, symptoms, additional diseases and laboratory findings between the groups. There was also no significant difference in MPV values between patients with and without thrombus in aneurysm (9.30±1.0 vs. 9.84±1.4; p=0.09). Conclusion: There was no difference in platelet count and MPV values between patients with and without thrombus in aneurysm. It may be more appropriate to evaluate a larger number of markers together to identify the prothrombotic state in thrombotic and nonthrombotic IAAA patients.

Objective: Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for urinary tract calculi. While serious side effects are rare, transient cardiac arrhythmias may occur. New electrocardiographic (ECG) parameters, such as P wave dispersion (PWD), QT dispersion (QTd), T peak to T end (Tp-e) interval, Tp-e interval/QT ratio, and Tp-e interval/corrected QT ratio have been defined to help predict atrial and ventricular arrhythmias. However, effect of ESWL on these ECG parameters has not been previously investigated. The present study was an examination of the effect of ESWL on ECG parameters. Methods: Total of 40 consecutive patients who underwent ESWL were prospectively enrolled in the study. Pre-procedure ECG parameters were compared with post-procedure ECG parameters. Results: PWD values were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.017). Corrected QT duration and QTd were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.046 and p=0.008, respectively). In addition, Tp-e interval, Tp-e interval/QT ratio, and Tp-e interval/QTc ratio were significantly longer post procedure (p=0.035, p=0.045, and p=0.022, respectively). In univariate correlation analysis, duration of procedure was significantly correlated with post-procedure PWD, QTc, and QTD values. Conclusion: Clinical use of ECG parameters may be helpful in monitoring of patients receiving ungated ESWL in order to detect cardiac dysrhythmia.

Initial presentation in almost half of the patients with chronic ischemic heart disease (IHD) is chronic stable angina. Despite recent improvements in diagnosis and treatment, IHD still appears to be the most important cause of morbidity and mortality in our country and industrialized countries. The main aim of the treatment of chronic stable angina is to increase life expectancy and to improve quality of life by reducing the frequency and severity of angina. Beta-blockers, calcium channel blockers and nitrates constitute the main stones of anti-ischemic and antianginal treatment; new antianginal agents should be considered in patients with resistant angina despite usage of traditional agents. It is essential to add lifestyle modifications to pharmacological treatment and patients should be informed firmly. Even though revascularization therapy has not been shown to be superior to the optimal medical therapy in prognosis and mortality in chronic stabil angina, it reduces angina and necessity to anti-anginal medications and improves exercise capacity and quality of life in patients who are symptomatic despite optimal medical therapy. In this review, we summarized the current approach to chronic stable angina in the light of the American College of Cardiology and European Society of Cardiology guidelines for the diagnosis and assessment of chronic stable angina.

A 52-year-old man complaining of persistent recurring chest pain at night underwent coronary angiogram at another institution. Normal coronaries were observed and he was discharged with muscle spasmolytic prescription. Since symptoms had continued, 24-hour Holter monitoring was ordered at our facility and results revealed huge ST elevation and polymorphic ventricular tachycardia. Cold pressor test performed in catheterization laboratory also resulted in ventricular tachycardia. Nifedipine was prescribed and follow-up Holter monitoring revealed no further vasospastic episodes. Utility of 24-hour Holter rhythm monitoring and cold pressor test in patients with recurrent chest pain at night is demonstrated in this report.

Totally subcutaneous intravascular portacath provide safe and reliable vascular access and is widely utilized for venous access for long-term parenteral administration of medications. Catheter fracture and/or embolization of the catheter fragment in to the heart and or pulmonary artery is a rare and potentially serious complication. When it occurs, a prompt surgical or percutaneous extraction of the embolized foreign body is necessary. We present an asymptomatic case of metastatic colon adenocarcinoma in a patient who had fragmentation of catheter from the connection of the port and migration to left pulmonary arteries. We successfully removed the 10-cm long and 6-Fr diameter fractured catheter segment from the left pulmonary artery via the right femoral vein using a snare catheter with triple loop without complication. Post-procedure course was uneventful and the nature of the vascular access made early ambulation possible. Compared to surgery, percutaneous approach is a less invasive, safe, reliable and effective technique. Therefore, we suggest that percutaneous transcatheter technique for retrieval of embolized or broken catheter fragments should be considered as the first-choice treatment.

A 61-year-old man underwent successful percutaneous revascularization of both lower limbs with multiple stent implantations. Paralysis of right lower limb was noticed after completion of procedure when transferring the patient from angiography table. Since hematoma compressing lumbosacral neural plexus could be a fatal complication, computed tomography (CT) image was taken. CT showed bulge of distended bladder compressing stent struts. Following placement of Foley catheter, condition improved and he was subsequently discharged uneventfully.