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We report a case of coronary artery perforation during diagnostic coronary angiography. No cardiac biomarker elevation was observed. However, the patient suffered acute pericarditis which was treated conservatively.

Aortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile.The annual rates of progression in the peak and mean aortic gradients were 8.5 +/- 3.2 and 6.7 +/- 2.2 mm Hg/year, respectively. We classified the annual rate of progression of peak aortic gradient into 2 groups, group 1 with10 mm Hg ("slow progressors") and group 2 withor =10 mm Hg annual rate of progression ("fast progressors"). The annual rate of progression in group 1 was significantly higher than that in group 2, both in peak and mean aortic gradients (12 +/- 2 mm Hg and 6.4 +/- 1.6 mm Hg; 9 +/- 1.3 mm Hg and 5.2 +/- 1.1 mmHg; P.001 for both). There was a highly significant difference between group 1 and group 2 for total cholesterol/high-density lipoprotein (HDL) cholesterol level ratio (7.1 +/- 1.4 vs 5.2 +/- 1.3, P.001). There was a significant correlation between annual rate of progression in peak gradient and total cholesterol/HDL cholesterol level ratio (r = 0.399, P =.009). Smoking (P =.024, Beta = 0.26), presence of coronary heart disease (P =.011, Beta = 0.31), and total cholesterol/HDL cholesterol level ratio (P =.004, Beta = 1.98) were independently predictive of fast progression of the peak aortic gradient in the regression analysis.In a small group of patients from Turkey with aortic stenosis, there seems to be an association between the rate of progression and total cholesterol/HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios.

Long-term moderate or strenuous physical activity is associated with a considerable reduction in cardiovascular morbidity and mortality. However acute exercise leads to a transient activation of the thrombotic system. Healthy individuals can react this by increasing their fibrinolytic capacity acutely. However, patients with ischemic heart disease, lacking fibrinolytic potential, may be at considerable risk for acute ischemic events if exposed to heavy physical exertion. Platelet size has been shown to reflect platelet activity. The mean platelet volume (MPV) can reflect changes in either the level of platelet stimulation or rate of platelet production.We evaluated Treadmill exercise test (TMET) and compared MPV values (fl) before and after TMET in 63 consecutive patients who, then, underwent coronary angiography and found to have significant coronary artery disease in more than one coronary artery (70% diameter stenosis in left anterior descending, right coronary or circumflex artery and50% diameter stenosis in left main coronary artery). Sixty-three male patients were enrolled as a patient group with a mean age of 52.43 +/- 4.08 years and with strongly positive exercise test (or =2 mm ST segment depression, horizontal or down-sloping). Thirty-five patients without significant coronary artery disease were selected as a control group with a mean age of 52.66 +/- 4.39 years having undergone TMET.In the patient and control groups, mean MPV values before TMET were the same, 8.52 +/- 0.63 and 8.45 +/- 0.58 respectively. Following TMET within 30 minutes, mean MPV were 10.03 +/- 0.96 and 8.50 +/- 0.45 respectively ( p0.001). When pre and post-TMET MPV values were evaluated together, the patient group had a significant increase in the MPV ( p0.001), whereas, the control group had no significant increase in the MPV ( p = 0.379). It was concluded that exercise possibly makes patients with significant coronary artery disease, more susceptible to a thrombotic event through various routes, one of that is platelet activation that could be measured indirectly via MPV. Healthy subjects react this thrombotic process by increasing their fibrinolytic capacity acutely. Patients with ischemic heart disease, particularly those with significantly narrowed coronary arteries, known to lack fibrinolytic capacity and have high shear stress, on the other hand, might face ischemic events, including sudden death following acute exercise.

Objective - Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli.There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis. Methods and results - We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sex-matched control group having dilated cardiomyopathy without left ventricular thrombosis.We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 ′ 0.8 vs. 8.7 ′ 0.6, p < 0.001). Conclusions - Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment.

Agiz yoluyla kisa surede asiri su alimi ciddi norolojik ve kardiyak semptomlara yol acabilir ve su zehirlenmesi olarak adlandirilir. Bu durum psikiyatrik hastalarda siklikla gorulmektedir ancak intihar amacli asiri su alimi oldukca enderdir. Bu olgu sunumunda intihar amacli asiri su aliminin yol actigi elektrolit dengesizligine bagli ventrikuler fibrilasyon gelisen 51 yasindaki hastayi sunuyoruz. Hasta acil klinigimize bilinc degisikligi ve ajitasyon ile basvurdu. Hasta hipertansifti ve norolojik muayenesinde lateralizasyon bulgusu yoktu. Hastanede takibi esnasinda ventrikuler aritmi kardiyopulmoner arrest ve tonik klonik nobet gozlendi. Kan biyokimyasinda hastanin 4 saat icerisinde 12 litre su icmesiyle uyumlu olan hiponatremi ve hipokalemi mevcuttu. Elektrolit bozuklugunun duzeltilmesinden sonra ventrikuler aritmi ve nobet tekrarlamadi. Hasta psikiyatrik degerlendirmeye yonlendirildi ve antidepresan tedavi ile taburcu edildi. Su zehirlenmesi sizofreni gibi psikiyatrik bozukluklarda iyi bilinse de intihar dusuncesi olan depresif hastalarda daha once bildirilmemistir. Bu nadir durumun klinik sunumuna olan farkindalik potansiyel olarak olumcul seyredebilen komplikasyonlari onleyebilir.

Dear Editors, We read with great interest the article by Erdogan et al. that was recently published in Clinics (1). In this study, the authors evaluated the role of novel echocardiographic techniques in detecting left ventricular functional recovery after successful percutaneous coronary intervention to treat chronic total occlusion. Their study highlights the benefits of restoring blood flow in symptomatic patients and in patients with detectable ischemia in the territory of the occluded vessel. Although the authors did a great job of providing a broad review of echocardiographic data obtained from a considerable number of patients, there are certain missing points that we wish to emphasize. The authors concluded that the improvements in the strain parameters were more significant in patients with an ejection fraction ≥50% and less significant in patients with diabetes. However, they did not use a multivariate regression analysis to adjust for other potential confounders. If they had performed a regression analysis, the authors would have provided more useful information about the impact of percutaneous coronary intervention on different groups. Without an accurate statistical analysis, it is not possible to draw conclusions about the benefits of this treatment in subgroups such as diabetics or patients with a higher ejection fraction. In previous studies, the duration of the occlusion, collateral circulation, and previous myocardial infarction were found to be predictors of the restoration of systolic function after percutaneous intervention (2-5). None of these parameters was evaluated in this research. In a recent study, the influence of the recanalization of chronic total occlusion on left ventricular function was shown using three-dimensional echocardiography. In that study, left ventricular function improved in patients with rich collateral circulation, but no significant change was found in patients with a previous myocardial infarction. In another study, the recovery of left ventricular function was associated with the transmural extent of the myocardial scar, suggesting the impact of previous infarction (6). Given the heterogeneity of the occluded vessels in the study by Erdogan et al., it would have been valuable to provide additional regional wall motion analyses. In a study by Ermis et al., coronary intervention had a positive impact on both global and regional left ventricular function in patients with chronic coronary artery occlusion (7). In another study, which used magnetic resonance imaging, early and late improvements in regional myocardial function were observed in the territory of the occlusion (6). In conclusion, Erdogan et al. demonstrated the benefits of revascularization for left ventricular function in chronic total occlusion. However, a more detailed history of the patients, additional regional wall motion analyses, and a multivariate regression model would have provided valuable information about selecting appropriate patients for this procedure.

Fractional flow reserve (FFR) assessment is widely used to determine significance of intermediate coronary lesions. Previously, components of the metabolic syndrome (MS) which may affect FFR validity were not tested cumulatively. In this study, we investigate the possible effect of MS on FFR assessment.We retrospectively evaluated 178 consecutive patients who had undergone FFR assessment. Thirty-two patients were excluded. All of the coronary lesions were in the left anterior descending artery. They were evaluated with quantitative coronary angiography (QCA). In 105 patients the MS was present and 41 patients were without the MS. According to the severity of the coronary lesions in QCA, patients were divided into three groups: 40-50%, 51-60% and 61-70% lesions. FFR measurements were compared in each group with respect to MS presence. Coronary artery lesions were accepted as haemodynamically significant if FFRor = 0.80. Age of the population, lesion length, lesion diameter and adenosine dosage performed during FFR assessment were not different between patients with MS or without MS. When the lesions were divided into three categories according to the severity of the luminal narrowing expressed in stenosis percentages as 40-50, 51-60, and more than 61%, the observed FFR values decreased with advancing lesion category (P = 0.04). However, observed FFR values did not differ between the patients with MS and without MS in each category (P = 0.88). After exclusion of the diabetic patients, FFR values still did not differ between the patients with MS and without MS in each category (P = 0.78).Presence of the metabolic syndrome has no significant effect on FFR assessment. This study provides additional data for the reliability of FFR in patients with MS.

Background and aim: The aim of this study was to investigate mean platelet volume (MPV) in patients with rheumatic mitral stenosis (RMS) and to define the determinants of a possible platelet activation reflected as platelet volume enlargement. Methods: Peripheral venous plasma value of MPV was measured in 84 consecutive patients (16 men, 68 women; mean age ± SD = 44 ± 13 years) with RMS who had no left atrial thrombus by transoesophageal echocardiography. The control group consisted of 32 healthy subjects (nine men, 23 women; mean age ± SD = 38 ± 7 years). Results: The patients had significantly higher MPV values (mean ± SD = 10.07 ± 0.58 fL) compared to the healthy subjects (mean ± SD = 8.15 ± 0.60 fL, p < 0.001). Among many clinical and echocardiographic variables, left atrial spontaneous echo contrast-positivity (beta = 0.426, p < 0.001) and severe mitral regurgitation (beta = 0.577, p < 0.001) appeared as significant predictors of platelet enlargement in RMS in multiple linear regression analysis. Conclusions: Patients with RMS have increased platelet activity reflected as elevated MPV; and the coexistence of severe mitral regurgitation and presence of left atrial spontaneous echo contrast are determinants of this increment.

WOS: 000338901900004, PubMed ID: 24923758, Background. - Infective endocarditis (IE) is associated with significant morbidity and mortality. Red cell distribution width (RDW) is a recently recognized biomarker of adverse outcome in a number of acute and chronic conditions. Aim. - To investigate the relationship between RDW and 1-year survival in patients with IE. Methods. - Clinical records from two tertiary centres were used to analyze data from patients with definite IE. Clinical, echocardiographic and biochemical variables were evaluated along with RDW. One-year survival status after index hospitalization was identified for each patient. Results. - One hundred consecutive patients (mean age 47.8 +/- 16.7 years; 61% men) with definite IE were enrolled. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting mortality was 15.3% (area under the curve 0.70; P=0.001). Forty-one patients (41%) died within 1 year; of these, 88% had ROW results > 15.3%. Univariate Cox proportional-hazards analysis showed that RDW > 15.3%, heart failure, renal failure, cardiac abscess, severe valvular regurgitation and presence of dehiscence were associated with increased mortality. Multivariable Cox proportional-hazards analysis revealed that renal failure (hazard ratio [HR] 3.21, 95% confidence interval [CI] 1.35-7.59; P = 0.008), heart failure (HR 2.77, 95% CI 1.1-6.97; P = 0.03) and RDW > 15.3% (HR 3.07, 95% CI 1.06-8.86; P = 0.03) were independent predictors of mortality in patients with IE. Conclusion. - According to our results, mortality is high in patients with IE. RDW is a promising biomarker for predicting 1-year survival rates in these patients. (C) 2014 Published by Elsevier Masson SAS.

The images of persistent left superior vena cava with the absence of the right superior vena cava are presented in a patient with the diagnosis of secundum-type atrial septal defect.

Swyer–James (MacLeod's) syndrome is a rare entity that is characterized by the hyperlucent appearance of one or more lobes of one lung, diminished ipsilateral hilar shadow and hardly visible arterial structure on chest radiography. Ventricular septal defect is the most common childhood congenital heart defect and, if left untreated, this will result to irreversible pulmonary hypertension, reversing of the shunt and Eisenmenger's syndrome. In this case report, we describe a 19-year-old female patient who had diagnosis of VSD and Swyer–James syndrome at the same time.

In this study, we aimed to identify the factors influencing the use of ambulance among patients admitted to two Turkish hospitals with acute coronary syndrome (ACS).Overall, 330 with a mean age of 55±13 years, hospitalized patients with ACS at 2 different hospitals were included in this prospective cohort study. The factors influencing the use of ambulance hospital were investigated through a questionnaire. The comparisons were made between two groups regarding use of ambulance. The predictors of the use of ambulance were determined using multiple logistic regression analysis.Despite the high rate of knowing the emergency service number of "112", of the 330 patents, only 96 (29%) used ambulance. Ambulance users had shorter arrival duration with median of 60 min vs 120 min (p=0.03). Presenting with ST elevation myocardial infarction (OR=3.127, 95% CI: 1.555-6.2877, p0.001), severity of chest pain (OR=2.665, 95% CI: 1.938-3.665, p0.001), presence of accompanying symptoms such as dyspnea (OR= 5.510, 95% CI: 2.614-11.614, p0.001), dizziness (OR=4.172, 95% CI: 1.901-9.154, p0.001) and vomiting (OR=3.756, 95% CI: 1.521-9.272, p=0.004), knowledge of cardiac risk factors (OR=10.512, 95% CI: 4.497-24.572, p0.001) or chest pain related to heart attack and the importance of quickly seeking for medical care by calling ambulance (OR= 4.184, 95% CI: 2.528-6.926, p0.001) are the factors associated with ambulance use.Using ambulance was in a very low rate among our study patients with ACS. Severity of symptoms, type of ACS and knowledge are seemed to be related with increased ambulance use. Informative health educational programs can be organized to achieve a behavioral change in using of ambulance.AMAÇ: Ambulans kullanılması akut koroner sendromlu (AKS) hastaların hastaneye nakli sırasında sadece hızlı değil, aynı zamanda güvenilir ulaşım şeklidir. Bu çalışma AKS tanısı ile iki ayrı merkeze başvuran hastalarda ambulans kullanımını etkileyen faktörlerin belirlenmesi amaçlanmıştır. YÖNTEMLER: Türkiye’de 2 ayrı hastanede AKS tanısı ile hastaneye yatırılan ve yaş ortalaması 55±13 olan toplam 330 hasta bu prospektif kohort çalışmaya dahil edilmiştir. Hastaların hastaneye ulaşım şeklini etkileyen faktörler bir anket formu aracılığıyla araştırılmıştır. Hastalar ambulans kullanıp kullanmadıklarına göre iki gruba ayrılarak karşılaştırmalar yapılmıştır. Ambulans kullanımını belirleyen faktörler çoklu lojistik regresyon analizi ile değerlendirilmiştir.Acil servis numarası “112”nin yüksek oranda biliniyor olmasına rağmen, 330 hastanın sadece 96’sı (%29) ambulans kullanırken, geri kalan 234 (%71) hasta kendi ulaşımını sağlamıştır. Ambulans kullananların hastaneye ulaşım süreleri (ortanca 120 dakikaya karşılık 60 dakika olarak) daha kısa olmuştur (p=0,03). ST yükselmeli miyokart enfarktüsü ile başvurma (OR=3,127, %95 GA: 1,555-6,2877, p0,001), göğüs ağrısının şiddetli olması (OR=2,665, %95 GA: 1,938-3.665, p0,001), eşlik eden dispne (OR=5,510, %95 GA: 2,614-11,614, p0,001), baş dönmesi (OR=4,172, %95 GA: 1.901-9.154, p0,001) ve kusma (OR=3,756, %95 GA: 1,521-9,272, p=0,004) gibi semptomların bulunması, kardiyak risk faktörlerini biliyor olmak (OR=10,512, %95 GA: 4,497-24,572, p0,001) ve kalp krizi ile ilişkili olan göğüs ağrısını ve bu durumda hızlıca tıbbi yardım için ambulans çağrılmasının önemini biliyor olmak (OR=4,184, %95 GA: 2,528-6,926, p0,001) ambulans kullanımını belirleyen faktörlerdir. SONUÇ: Türkiye’de AKS’da hastaların hastaneye ulaşım için ambulans kullanımı oldukça düşük orandadır. Semptomların ciddiyeti, AKS tipi ve bilgi düzeyi ambulans kullanımını arttıran faktörler olarak görülmektedir. Hastalarda ambulans kullanımına yönelik davranışsal değişiklik oluşturmak ve ambulans kullanımını arttırmak için aydınlatıcı sağlık eğitim programları düzenlenebilir.

Objectives: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. Study design: A total of 540 patients (350 male, 190 female; mean age: 59.6+-11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. Results: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5+-0.1 fl, 8.5+-1.2 fl, 8.6+-0.9 fl and 8.6+-0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. Conclusion: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

Left persistent superior vena cava occurs in f0.3% of the general population and 4.3% in patients with congenital heart disease. Left-sided inferior vena cava has been welldescribed and occurs in f0.2–0.5% of the general population. In most cases left inferior vena cava crosses over to the right via the left renal vein or more inferiorly and crossover is usually anterior but rarely posterior to the aorta [1]. Entire transposition of the inferior vena cava to the left with hemiazygos continuation is extremely rare although it has been previously described [2]. We report a case of a leftsided (transposed) inferior vena cava communicating with the hemiazygos vein which is draining into the dilated coronary sinus via persistent left superior vena cava.

Atrial myxomas are rare tumors. They occur in less clinical history. In her neurological examination, no than 0.05% of the population, but they constitute persisting deficit was noticed. She was, then, conapproximately 50% of primary cardiac neoplasms [1]. sulted to the neurology department for differential They are true neoplasms thought to be derived from diagnosis of severe headache. At her contrast-enpluripotential subendocardial mesenchymal cells [2]. hanced computerized tomographic examination of the These tumors present with systemic embolization in cranium, she was noticed to have many commaup to 45% of cases [3,4], with the cerebral circulation shaped enhancing lesions one of which was a giant being involved in one-half of these instances [5]. aneurysm on the left side. She was, then, referred to Cerebral ischemia resulting from direct tumor emthe neurosurgery department on an urgent basis. bolization is the most common neurological preFollowing her hospitalisation in the neurosurgery sentation [6]. Other rare neurological manifestations department, she underwent cerebral angiography in include parenchymal brain metastasis [7], intracerebrwhich there were multiple fusiform aneurysms on al hemorrhage [5] and oncotic aneurysm formation both carotid artery territories, one of which was a [1,8]. With rare exceptions, neurological symptoms giant aneurysm on the left middle cerebral artery related to atrial myxomas occur before or at the time artery locus (Fig. 1) of primary tumor diagnosis. We describe a patient Treatment with coil embolization of the aneurysm who presented with transient neurological symptoms was decided due to localisation of the giant 25 years after complete resection of left atrial myxaneurysm. Before the procedure, since she was oma as initial finding of late recurrence. known to have resection of myxoma, an echocardiogA 38-year-old woman was admitted to our raphy was performed and a mass lesion originating emergency department with chief complaints of from the posterior wall of the left atrium with severe headache and episodes of right sided weakmultiple, mobile, papillary extensions towards mitral ness. She was normotensive having 115/75 mmHg valve was noted (Fig. 2). Following coil embolization systolic /diastolic blood pressures and known to have of the giant aneurysm, she was referred to our left atrial myxoma resection 25 years ago in her department and operated successfully for the mass lesion. Pathology confirmed our diagnosis and the diagnosis for the late recurrence of the myxoma at the first site was established. She has been followed up *Corresponding author. SSK Bloklari 70 /7 06170, Yenimahalle /Anby our clinic uneventfully for both recurrence and kara, Turkey. Tel.: 190-312-346-9401. E-mail address: cardioceptor@ttnet.net.tr (M.B. Yilmaz). progression or regression of cerebral aneurysms.

WOS: 000310540400013, PubMed ID: 22699995, Background. Acute heart failure (AHF) with systolic dysfunction is associated with increased morbidity and mortality, and optimal therapy is not well established, despite the findings of evidence-based medicine. Beta blockers provide a mortality and morbidity benefit in patients with chronic systolic HF, and are currently indicated in all stages of patients with systolic HF. We evaluated therapies before discharge, in particular beta blockers, in patients hospitalized with AHF with and without accompanying chronic obstructive pulmonary disease (COPD). Methods. The hospital discharge records of 959 consecutive de novo AHF patients, hospitalized and treated for systolic HF (ejection fraction < 45%), were retrospectively reviewed in three cardiovascular institutions. Results. The presence of accompanying COPD was associated with significantly lower prescription of beta blockers before discharge (p < 0.001). Furthermore, with regard to the type of beta blocker, patients with accompanying COPD were less frequently prescribed nonselective beta blockers (29% vs. 48%, p < 0.001). The presence of accompanying COPD among AHF patients increased the risk of omitting (not prescribing) beta blockers before discharge by a factor of 1.785. Conclusion. Beta blockers, a proven life-saving therapy in the setting of chronic systolic HF, were found to be less frequently prescribed before discharge in the presence of de novo AHF with accompanying COPD.

Infection is a serious complication of cardiac devices. We aimed to describe predisposing factors and outcome of permanent pacemaker (PPM) and implantable cardioverter/defibrillator (ICD) infections.We reviewed cardiac device infections diagnosed at the Yuksek Ihtisas Hospital Ankara, Turkey, between 2004 and 2010 retrospectively. Demographic and clinical data were collected, descriptive analysis was performed.From 2004 to 2010, a total of 1916 devices were implanted. Thirty-four cases of confirmed device infections were identified giving an infection rate of 1.7%. Seventy-three percent of the cases were men. Mean age was 58 +/- 19 years. Twenty-two patients had a PPM, 12 had an ICD or cardiac resynchronization therapy (CRT). Diabetes mellitus, hypertension, cardiac failure, anaemia and immune suppression were prominent comorbidities. Previously, 6 (17%) patients had a history of replacement, 6 (17%) had revision, 3 (8%) had haematoma. Ten (29%) patients reported a history of long hospital stay and 13 (38%) patients had multiple hospitalizations. Pocket infection (70%) was the most common clinical presentation. Ninety-one percent of patients were cured with both device removal and antibiotic administration. Complications of cardiac device infections included septic emboli, acute renal failure, inotropic infusion requirement which were mostly seen among patients with endocarditis. Five patients suffered relapsing infection.Three patients died, among them two had infective endocarditis.Cardiac device infections have been encountered more often in recent years. Cure of device infections is achievable in a majority of patients treated with antimicrobial treatment and complete device removal although device-related endocarditis can have an aggressive course.

The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters. This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5 ± 8.5 years, with a mean MVA of 1.1 ± 0.2 cm2) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4 ± 6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values. The maximum P-wave duration (138 ± 15 vs. 101 ± 6 ms, p

Platelets are involved in the pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in red blood cell distribution width (RDW) and platelet distribution width (PDW) values. Therefore, in this study we aimed to investigate whether PDW and RDW are associated with the patency of saphenous vein graft in patients at least 1 year after coronary artery bypass graft (CABG) surgery. Patients who had undergone CABG surgery at least 1 year previously with at least one saphenous vein graft were included in the study population. Patients were referred to cardiac catheterization for stable anginal symptoms or positive stress test results. Before coronary angiography, all patients referred had routine blood tests including RDW and PDW values. Saphenous vein grafts were found to be patent in 69 patients and occluded in 40 patients. Although RDW levels were similar between patients with patent and occluded grafts (13.1 ± 1.1% and 13.2 ± 0.7% respectively, p = 0.37), PDW levels were significantly different between the two groups (13.1 ± 1.3% and 14.1 ± 1.1 respectively, p = 0.03). Although time after CABG operation differs significantly between the two groups (p

There is no doubt that appropriate use of thrombolytic drugs improves survival in patients with acute myocardial infarction. Streptokinase, one of the most commonly used thrombolytic drugs in large clinical trials, is not fibrin-specific and brings about a lytic state with potential for bleeding. We report a case of spontaneous rectus muscle hematoma following streptokinase therapy for acute myocardial infarction and review the relevant literature. To our knowledge, this is the first case reported in the literature. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

A 74-year-old male patient presented with complaints of fatigue, fever, and worsening health status. He had a 34-month history of cardioverter-defibrillator (ICD) implantation due to ischemic cardiomyopathy. Transthoracic and transesophageal echocardiography showed a mobile mass, 24 x 11 mm in size, consistent with a vegetation attached to the right ventricular ICD lead. Surgical removal of the electrode was considered to be highly risky for the patient, thus percutaneous removal was decided. Due to adhesions, manual traction of the lead with a standard stylet was ineffective. Complete lead extraction was accomplished using the Evolution Mechanical Dilator Sheath, which is a new mechanical sheath with a stainless steel bladed tip. No complications occurred during or after the procedure. Following a histopathologic diagnosis of vegetation, the patient received a six-week antibiotic therapy, after which a new ICD was implanted on the contralateral side. To our knowledge, this case represents the largest lead vegetation extracted by this new device. Although its safety should be validated by increasing number of cases, it seems that its simple use would make this device a new interesting tool among the instruments available for lead extraction.

Late stent thrombosis is a well-known complication of drug eluting stents. The recognized risk of late stent thrombosis associated with bare metal stents is too low. In this report, we present a 60 year old male patient who had an acute inferior myocardial infarction due to very late thrombosis (>10 years) of a bare metal stent. Intracoronary thrombus aspiration was performed and thrombus was extracted from the coronary artery with subsequent restoration of TIMI 3 distal flow. Very late stent thrombosis is an extremely rare complication of bare metal stents. With this case report we would like to emphasize the possibility of very late stent thrombosis with bare metal stent despite ongoing aspirin therapy. Keywords: Bare metal stent, very late stent thrombosis Özet Çok geç stent trombozu ilaç kaplı stentlerin iyi bilinen bir komplikasyonudur. Çıplak metal stent ile ilişkili bilinen geç stent trombozu riski çok düşüktür. Bu vakada çıplak metal stentin çok geç trombozuna (>10 yıl) bağlı akut inferiyor miyokard infarktüsü tanısı konulan 60 yaşında bir erkek hastayı sunduk. İntrakoroner trombüs aspirasyonu yapıldı ve koroner arterden trombüsün temizlenmesi ile TIMI 3 akım elde edildi. Çok geç stent trombozu çıplak metal stentlerin çok nadir bir komplikasyonudur. Bu vaka ile biz devam eden aspirin tedavisine rağmen çıplak metal stent ile çok geç stent trombozu olasılığını vurgulamak istedik. Anahtar sözcükler: Çıplak metal stent, çok geç stent trombozu, Çok geç stent trombozu ilaç kaplı stentlerin iyi bilinen bir komplikasyonudur. Çıplak metal stent ile ilişkili bilinen geç stent trombozu riski çok düşüktür. Bu vakada çıplak metal stentin çok geç trombozuna (>10 yıl) bağlı akut inferiyor miyokard infarktüsü tanısı konulan 60 yaşında bir erkek hastayı sunduk. İntrakoroner trombüs aspirasyonu yapıldı ve koroner arterden trombüsün temizlenmesi ile TIMI 3 akım elde edildi. Çok geç stent trombozu çıplak metal stentlerin çok nadir bir komplikasyonudur. Bu vaka ile biz devam eden aspirin tedavisine rağmen çıplak metal stent ile çok geç stent trombozu olasılığını vurgulamak istedik

Objective Coronary artery ectasia (CAE) is defined as local or generalized aneurysmal dilatation of the coronary arteries. We aimed to determine the frequency of CAE at our center and to compare clinical and angiographic characteristics between patients with isolated CAE and CAE with coronary artery disease (CAD). Methods From February 2004 to December 2005, 12.514 patients were retrospectively analyzed by two independent operators who underwent coronary angiography. Coronary artery diameters were measured using qualitative computed angiography. CAD risk factors were recorded for all patients. Unpaired Student's t-test and Chi-square test were used for statistical analysis. Results CAE was diagnosed in 201 patients (1.59%). The majority (78%) were male. The mean age was 61±10.8 years (range, 25 to 82 years). The cases were divided into 2 groups as isolated CAE (Group 1) (14.9%) and CAE with CAD (Group 2) (85.1%). The risk factors of CAD were similar between two groups. The frequency of arterial involvement was: the right coronary artery (RCA) 54.3%; circumflex artery (Cx), 48.3%; the left anterior descending artery (LAD), 40.4%. CAE affected only one major vessel in 64.2% of cases and all 3 vessels in 9%. Isolated CAE was most commonly detected in Cx (47%). The type of CAE was determined according to Markis and Harikrishnan classification. The most prevalent involvement was Markis type 4 and Harikrishnan type 4a. Although atypical angina was the most common clinical presentation in both groups, acute coronary syndrome was more frequent in Group 2 (p=0.018). Conclusion The risk factors of CAD and the manner of clinical presentation were considerably similar in both groups and this situation was consistent with similar etiopathogenesis of two diseases.

WOS: 000290468600005, PubMed ID: 21421510, Objective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6- month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to Group 1 (138 [114-165] vs. 123 [97-143] mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (beta=0.04, 95% Cl: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI. (Anadolu Kardiyol Derg 2011; 11:213-7)

OBJECTIVES: We aimed to analyze acute clinical, echocardiographic, and hemodynamic results and long-term event-free survival of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of hemodynamically significant mitral stenosis (MS). STUDY DESIGN: We retrospectively reviewed 577 patients (454 females, 123 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS. Acute procedural success was defined as the achievement of mitral valve area (MVA) >1.5 cm2 and absence of grade 3-4 mitral regurgitation. In addition, 489 patients were interrogated by phone calls for event-free survival (death, redo PMBV, mitral valve replacement) after at least one year (mean 54 months) of the procedure. RESULTS: The procedure was successful in 547 patients (94.8%) and unsuccessful in 30 patients (5.2%). Among baseline echocardiographic and hemodynamic parameters, MVA was significantly lower (p=0.0001) and moderate/severe tricuspid regurgitation was significantly more common (p=0.031) in patients with failure. The mean Wilkins scores were similar in the two groups (p>0.05). Failure was related to suboptimal valve opening (MVA

Serum gamma-glutamyltransferase (GGT) activity has been shown to be associated with progression of atherosclerosis. We evaluated the relationship between serum GGT levels and saphenous vein bypass graft disease at least one year after coronary artery bypass graft (CABG) surgery.The study included 125 consecutive patients who had undergone CABG surgery with at least one saphenous vein graft (SVG) and were referred to cardiac catheterization for stable anginal symptoms or positive stress test results at least one year after CABG surgery. Laboratory parameters including serum GGT levels were measured before angiography. Occluded grafts were defined as a luminal stenosis of ≥70% or absence of distal TIMI 3 flow. Thus, SVGs were found to be patent in 53 patients (42.4%; 40 males, 13 females; mean age 65±8 years) and occluded in 72 patients (57.6%; 62 males, 10 females; mean age 64±9 years).The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, family history of coronary artery disease, smoking, and alcohol consumption. The mean time from CABG to angiography was similar in patients with a patent and occluded SVG (6.8±4.3 vs. 8.1±3.7 years; p0.05). Waist circumference was greater (p=0.02) and serum levels of total cholesterol (p=0.001), triglyceride (p=0.02), uric acid (p0.001), hs-CRP (p0.001), GGT (p0.001) and fibrinogen (p0.001) were significantly higher in patients with occluded veins. Serum GGT level was moderately but significantly correlated with waist circumference (r=0.2, p=0.04), uric acid (r=0.3, p=0.008), and hs-CRP (r=0.3, p=0.002). In logistic regression analysis, total cholesterol (OR=1.012, 95% CI 1.002-1.023, p=0.03), hs-CRP (OR=1.968, 95% CI 1.17-3.311, 0.01), uric acid (OR=1.57, 95% CI 1.1-2.208, p=0.01), and GGT (OR=1.047, 95% CI 1.002-1.1, p=0.04) were found to be significant predictors of SVG occlusion.Our results suggest that serum GGT activity is associated with higher occlusion rates of venous bypass grafts.

Amaç: Renal bozukluğun kardiyovasküler olaylar için yüksek riskle bağlantılı olduğu gösterilmiştir. Kreatinin yüksekliğinin hafif formları bile kötü kardiyovasküler sonuçlarla ilişkilidir. Aşikar renal bozukluğun olmadığı hastalarda kreatinin düzeyleri ile koroner arter hastalığının anjiyografik yaygınlığının ilişkisini araştırmak için retrospektif bir çalışma tasarlandı. Yöntemler: Tipik kararlı anjina pektoris ile Türkiye Yüksek İhtisas hastanesine başvuran ve diyaliz öyküsü olmadan kreatinin düzeyi ?3 mg/dl olan 892 ardışık hasta (ortalama yaşı 62±10 yıl olan 311’i kadın ve ortalama yaşı 56±11 yıl olan 581 erkek) retrospektif olarak tarandı. Aşikar renal hastalığı olmayan hastalar kreatinin düzeyine göre 3 gruba ayrıldı (Grup A: Kr50%) ve düşük skor gruplarına ayrıldılar. Yüksek darlık ve yaygınlık skorlarının klinik öngördürücülerini belirlemek amacı ile lojistik regresyon analiz yapıldı. Bulgular: Kreatinin düzeyine göre ayrılan her bir grubun koroner arter hastalığının anjiyografik yaygınlığı farklıydı (p, Objective: Renal dysfunction has been shown to be linked to high risk for cardiovascular events. Even milder forms of creatinine elevation are associated with poor cardiovascular outcomes. We designed a retrospective study and searched the association of angiographic extent of coronary artery disease and creatinine levels in patients without overt renal dysfunction. Methods: We retrospectively reviewed 892 consecutive patients with typical stable angina pectoris (311 female with mean age of 62±10 years, 581 male with mean age of 56±11 years) at Türkiye Yüksek İhtisas Hospital and creatinine level ≤3 mg/dl without history of hemodialysis. Patients without overt renal disease were divided into 3 groups according to level of creatinine (Group A: Cr level 50%) versus low stenosis and low extension scores. Logistic regression analysis was performed to establish the clinical predictors of high total stenosis and high extension scores. Results: Each group of patients according to level of creatinine showed marked difference in terms of angiographic extent of coronary artery disease (p

Amaç: Akut miyokart enfarktüsü ile başvuran hastalarda hiperglisemi olumsuz prognozla ilişkilidir. Primer perkütan koroner girişim (PKG) yapılan hastalarda, enfarkttan sorumlu arterin işlem sonu Miyokart Enfarktüste Trombolizis (TIMI) kare sayıları başarılı reperfüzyona rağmen önemli oranda farklılık gösterebilmektedir. Bu prospektif gözlemsel çalışmada ST yükselmeli miyokart enfarktüsü (STYMİ) sebebi ile başarılı primer PKG uygulanan hastalarda başvuru glikoz değerleri ile işlem sonucunda sorumlu koroner arter TIMI kare sayılarının ilişkisi araştırılmıştır. Yöntemler: Altı aylık zaman süresi içerisinde, STYMİ ile başvuran ve PKG ile TIMI 3 akım sağlanan ardışık 73 diyabetes mellitusu olmayan hasta çalışmaya dahil edilmiştir. Hastalar TIMI kare sayılarına göre iki gruba bölünmüştür. Grup 1 (n=53), enfarkttan sorumlu koroner arter TIMI kare sayıları daha önceden belirlenmiş değerlerin iki standart sapması içine giren hastalardan, Grup 2 (n=20) ise yüksek TIMI kare sayısına sahip hastalardan oluşmuştur. İstatistiksel analiz Ki-kare, Mann-Whitney U testleri ve çoklu doğrusal regresyon analizi ile gerçekleştirildi. Bulgular: Benzer açlık glikoz değerlerine rağmen, başvuru kan şekeri değerleri Grup 2 hastalarında Grup 1’e göre anlamlı şekilde daha yüksekti (138 [114-165]’e karşılık 123 [97-143] mg/dl, p=0.03). Tüm grupta başvuru glikoz değerleri ile sorumlu koroner arter düzeltilmiş TIMI kare sayısı arasında anlamlı pozitif korelasyon izlendi (r=0.30, p=0.01). Aynı zamanda, başvuru glikoz değeri ile hem zirve kreatin kinaz-MB (r=0.36, p=0.007) hem de sol ventriküler ejeksiyon fraksiyonu arasında anlamlı korelasyon saptandı (r=-0.43, p=0.009). Çoklu lineer regresyon analizinde incelenen parametrelerden (başvuru glikozu, beyaz küre sayısı, zirve kreatin kinaz-MB ve sol ventrikül ejeksiyon fraksiyonu), sadece başvuru glikozu infarkt arterinin nihai TIMI kare sayısı ile ilişkili olduğu saptandı (?=0.04, %95 GA:0.02-0.085, p=0.04). Sonuç: Yüksek başvuru kan şekeri değerleri, başarılı primer PKG uygulanan diyabetes mellitusu olmayan hastalarda bile işlem sonrası bozulmuş koroner akım ile ilişkilidir., Objective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6- month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to Group 1 (138 [114-165] vs. 123 [97-143] mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (β=0.04, 95% CI: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI.

Objective: Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS. Methods: Forty patients with PCOS and 20 age-matched controls were included. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). Results: Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms p

Due to the increasing use of cardiac rhythm devices, infective endocarditis secondary to these devices is becoming more common. In this case report, we present a patient with a giant right atrial vegetation (2.3 cm x 2.0 cm) located on a transvenous implantable cardioverter-defibrillator lead and protruding into the right ventricular cavity during diastole. With appropriate, prolonged parenteral antibiotic therapy and complete surgical removal of hardware, the patient was managed successfully without complication. In these kinds of patients, prompt application of transthoracic and transesophageal echocardiography is required for accurate diagnosis and determining the most appropriate management strategy.

WOS: 000265432300009, PubMed ID: 18413331, In this study, factors leading to the failure of internal mammary artery grafting was investigated among patients with coronary bypass. In all, 1323 patients were evaluated. It was found that lower grade diameter stenosis in the native vessel during postoperative angiogram and wall motion score index independently affected the fate of internal mammary artery as a graft. Grafting with internal mammary artery to native vessels with lower grade stenosis and to myocardium with poor wall score might not be a rational approach.

Despite their proven efficacy at reducing mortality in selected patients, implantable cardioverter-defibrillators have some proarrhythmic effects. In this report, we present a case of a patient with recurrent ventricular tachycardia degeneration to ventricular fibrillation by appropriate low-energy implantable cardioverter-defibrillator shocks.