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We reported an effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease in the October 2010 issue of Clinics Journal.1 We read with interest the letter to the editor about our article titled “Diastolic dysfunction in end-stage renal disease patient: what the ticking clock has told us?” by Dr. Chao.2 We thank him and reply to this interesting comments on our article. Firstly, we agree about the shortening of the follow-up period. Long term effects of hemodialysis on left ventricular diastolic functions may be due to left ventricular hypertrophy, myocardial ischemia, and heightened cardiac afterload. However, several studies have shown that a single hemodialysis session is associated with acute deterioration of diastolic and systolic parameters of myocardial function.3,4 This may be related to many factors, such as the ultrafiltration rate, the interdialysis weight gain, change of serum ionized calcium concentration, sympathetic hyperactivity, increased oxidative stress during hemodialysis treatment, and disease of smaller resistance vessels.3 Dr. Chao noted that in several studies, the average length of the follow-up period ranged from just over half a year to four years. Of course the duration of the follow-up period is very important for identifying myocardial remodeling in hemodialysis patients. But we must not ignore the acute effects of hemodialysis. In our study, the median duration of the follow-up period was approximately two months.1 This period is small for myocardial change but it is a relatively long and sufficient time to detect the acute effects of hemodialysis on left ventricular diastolic functions. Secondly, although echocardiography is inherently deficient in determining the echo window and spatial resolution, and suffers from an operator-dependent nature, we know that echocardiographic parameters are useful markers for predicting the development of left ventricular dysfunction.5 Also, to avoid the influence of operator-dependent factors, all echocardiographic evaluations were performed by the same medically qualified operator. Dr. Chao noted that the volume-dependent effect also attenuates diagnostic accuracy. To avoid a volume-dependent effect, the second echocardiographic evaluations were performed after 6-8 hours from the last hemodyalisis session. As Dr. Chao emphasized, cardiac magnetic resonance imaging, left atrium circulation transit time, and late gadolinium enhancement sequence are the newer techniques to detailed depiction of left ventricular geometry and structural variation. However, our study design did not allow us to use these techniques.

Purpose: We aimed to determine the effect of intravenous thrombolytic therapy on QT dispersion (QTd) and its role in the prediction of reperfusion arrhythmias.Materials and Methods: Twenty patients with acute myocardial infarction (MI) were enrolled in the study. Measurements of QTd were carried out prior to thrombolytic therapy and before discharge. The patients were examined for ventricular arrhythmias with 24‑h Holter electrocardiography monitoring after treatment and the relationship between ventricular arrhythmias and the QTd values in the early phase of MI was investigated.Results: The values of QTd were significantly higher during the early phase of MI (60 ± 5.32 ms) than those in the late phase (53.35 ± 4.07 ms) (P = 0.032). There was no correlation between isolated, bigeminal, trigeminal and total ventricular premature beats, accelerated idioventricular rhythm (AIVR) with QTd values. However, the patients with sustained ventricular tachycardia (VT), prolonged VT and sustained AIVR had higher corrected QTd (92 ms1/2, 97.8 ms1/2, 81.7 ms1/2, respectively) than the patients without these arrhythmias (74 ms1/2, 56.3 ms1/2, 58.28 ms1/2, respectively) (P = 0.022, 0.013, 0.018).Conclusion: The values of QTd may be significantly reduced in the 1st week of acute MI and measurement of QTd in the early phase of MI may have a correlation with the following reperfusion arrhythmias: Sustained VT, prolonged VT and AIVR.Key words: Arrhythmia, myocardial infarction, QT dispersion, reperfusion, thrombolytic therapy

OP-094 Percutaneous mitral valve repair using Mitraclip has recently emerged as an alternative to surgery for the treatment of severe mitral regurgitation (MR). The purpose of this study is to describe the initial experiences in Turkey with the MitraClip system. Twenty patients with severe MR

A 19-year-old male patient was presented with a complaint of palpitation. His physical examination and 12-lead electrocardiogram were normal. Transthoracic echocardiography revealed a mobile, chord-like structure, attached to the anterior papillary muscle and ventricular surface of the anterior mitral leaflet moving in the systole into the left ventricular outflow tract (arrow) (Fig. 1). There was no mitral regurgitation. Doppler examination showed a maximal 20 mm Hg gradient in the left ventricular outflow tract area. Transoesophageal echocardiography revealed an accessory mitral valve tissue (arrow), which adheres to the anterior mitral valve leaflet, and ballooning into the left ventricular outflow tract during the systole (Fig. 2). The patient was followed-up with periodical echocardiographic examinations, and without any surgical intervention. Accessory mitral valve tissue is a rare anomaly of embryologic development of the endocardial cushion. It may be associated with complex cardiac congenital malformations, can cause the left ventricle outflow tract obstruction and valve insufficiency.1),2) In patients with accessory mitral valve tissue, surgery is mandatory if there is significant obstruction in the left ventricular outflow tract, severe valvular regurgitation or any complication associated with this accessory tissue.3) Fig. 1 Fig. 2

Objective Elevated mean platelet volume (MPV) has been proposed as a risk factor for coronary artery disease (CAD) and is associated with poor clinical outcome in acute coronary syndrome (ACS). We aimed to evaluate the association of MPV with presence of coronary collateral vessel (CCV) in patients with ACS. Methods A total of 417 patients with ACS were included in the study. All patients underwent coronary angiography on the first day after admission and patients with a greater than or equal to 80% obstruction in at least one epicardial coronary artery were included in the study. The CCVs are graded according to the Rentrop scoring system and a Rentrop grade 0 was accepted as no CCV development (Group 1), Rentrop Grade 1–2–3 were accepted as presence of CCV development (Group 2). Results The median of MPV was 9.1 ± 1.4 fl. Mean age was 60 ± 12 year. Group 1 consisted of 233 (55.9%) patients and Group 2 consisted of 184 (44.1%) patients. Presence of CCV was significantly associated with high levels of MPV (p = 0.005). Presence of CCV was also associated with presence of diabetes and systolic blood pressure. Conclusion High MPV on admission was associated with presence of CCV in patients with ACS.

PP-375 Atrial septostomy (AS) is a complex technique used during interventions such as; mitral balloon valvotomy, electrophysiological procedures, left atrial appendage closure and MitraClip. Cardiac perforation occurs in 1-5% of cases even in experienced hands. In daily practice, although AS is

OP-068 Renal denervation is a new promising treatment option which is performed in patients with resistant hypertension defined as blood pressure that remains above goal despite lifestyle measures and concurrent use of 3 antihypertensive agents of different classes, prescribed at optimal doses

Bu çalışmada, Denizli İli sınırlarındaki Büyük Menderes Nehri ve yan kolu Çürüksu Çayı'nın su kalitesini belirlemek amaçlı toplam 14 istasyondan, Ocak 2006 ? Aralık 2007 tarihleri arasında aylık olarak fiziksel, kimyasal ve biyolojik veriler toplanmıştır. Su kalitesi tayini için, Saprobi İndeks, BBI, ETBI, Rev. BMWP, CS, Klee (1991) ve Su Kalitesi Kontrol Yönetmeliği (1988) kullanılmıştır. İstasyonlardan alınan biyolojik verilerin Temel Bileşen Analizi ve Kanonik Uyum Analizi ile ordinasyon analizleri yapılmıştır. Biyoindikatör türleri belirleme ve sınıflandırma tekniği olarak İki Yollu İndikatör Tür Analizi (TWINSPAN) kullanılmıştır. Ayrıca fiziko-kimyasal veriler arasındaki korelasyonu belirlemek üzere MINITAB istatistik programı kullanılmıştır.Bu çalışma süresince elde edilen 15661 birey Taban Büyük Omurgasızlarından; Büyük Menderes Nehri (Denizli) ana kolu üzerinde, Mollusca şubesine ait 18 taksa, Platyhelminthes şubesine ait 1 takson, Annelida şubesine ait 8 taksa, Crustacea şubesine ait 7 taksa, Insecta (Hexapoda) sınıfından Pterygota altsınıfına ait ise 6 takım bulunmuştur. Bu takımlardan Ephemeroptera'ya ait 19 taksa, Odonata'ya ait 17 taksa, Hemiptera'ya ait 11 taksa, Trichoptera'ya ait 11 taksa, Diptera'ya ait 58 taksa ve Coleoptera'ya ait 6 taksa olmak üzere toplam 156 taksa tespit edilmiştir. Çürüksu Çayı ve yan kolu Sarıçay üzerinde ise; Mollusca şubesine ait 6 taksa, Annelida şubesine ait 2 taksa, Crustacea şubesine ait 3 taksa, Insecta (Hexapoda) sınıfından Pterygota altsınıfına ait ise 6 takım bulunmuştur. Bu takımlardan Ephemeroptera'ya ait 8 taksa, Odonata'ya ait 8 taksa, Hemiptera'ya ait 4 taksa, Trichoptera'ya ait 7 taksa, Diptera'ya ait 38 taksa ve Coleoptera'ya ait 1 taksa olmak üzere toplam 77 taksa tespit edilmiştir.Bu çalışma sonucunda, Taban Büyük Omurgasızlarından toplam 184 taksa tespit edilmiştir. Bununla birlikte, bu çalışmada 109 tür, Büyük Menderes Nehri için yeni kayıt olarak tespit edilmiştir. In this study, total 14 sampling stations in The Büyük Menderes River (Denizli) and Çürüksu stream have established.to determination of water quality of the Big Menderes River (Denizli) and Çürüksu Stream. The biological and psycho-chemical datas were sampled monthly between the dates January 2006 and December 2007. From among the great variety of indices and scores available, we have selected the Saprobi Index, BBI, ETBI, Rev. BMWP, CS, Klee (1991) and Regulations of Water Pollution Control of Turkish Republic to determination the water quality of The Big Menderes River and Çürüksu Stream. The ordination analyse of the biological datas have established by Principal Component Analysis (PCA) and Canonical Correspondence Analysis (CANOCO). The Two-Way Indicator Species Analysis (TWINSPAN) have used for determine the bioindicator species and classify the stations. In addition to this, MINITAB statistical programme have used to determine the correlations between the physco-chemical datas.At the end of this study, totally 15661 Benthic Macroinvertebrates were collected. Totally 156 taxa have collected from The Big Menderes River. These are, 1 taxon from Platyhelminthes phylum, 18 taxa from Mollusca phylum, 8 taxa from Annelida phylum, 7 taxa from Crustacea phylum and 6 orders from the Pterygota subclass which is belongs to Insecta class have collected. 19 taxa from Ephemeroptera, 17 taxa from Odanata, 11 taxa from Hemiptera, 11 taxa from Trichoptera, 58 taxa from Diptera and 6 taxa from Coleoptera. Totally 77 taxa have collected from Çürüksu Stream. These are 1 taxon from Platyhelminthes phylum, 6 taxa from Mollusca phylum, 2 taxa from Annelida phylum, 3 taxa from Crustacea phylum and 6 orders from the Pterygota subclass which is belongs to Insecta class have collected. 8 taxa from Ephemeroptera, 8 taxa from Odonata, 4 taxa from Hemiptera, 7 taxa from Trichoptera, 38 taxa from Diptera and 1 taxa from Coleoptera. 109 species are new recorded for the Big Menderes River in this study. 143