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Amaç: Safen ven greft hastalığının (SVGH) sıklığı ve klinik prezentasyonu giderek artmaktadır, bu nedenle predispozan faktörlerin ortaya çıkarılması ve risk grubundaki hastaların belirlenmesi önemlidir. Bu çalışmanın amacı, SVGH ile CRP/albümin oranı (CAR), nötrofil/lenfosit oranı (NLR) ve trombosit/hemoglobin oranı (PHR) gibi üç biyobelirtecin değerlendirilmesini sağlayan CRP/Albümin+Nötrofil/Lenfosit+Trombosit/Hemoglobin (CANLPH) skoru arasındaki ilişkiyi araştırmaktır. Yöntem: Çalışmaya hastanemizde 1 Ocak 2018 - 1 Ocak 2020 tarihleri arasında koroner anjiyografi yapılmış ve koroner arter baypas greft (KABG) öyküsü olan toplam 754 hasta geriye dönük olarak dahil edilmiştir. SVG'lerinin en az birinde ve en az ≥%50 darlığı olan hastalar SVGH grubu ve SVG'lerde anlamlı darlığı bulunmayan hastalar kontrol grubu olarak dahil edildi. CAR, NLR ve PHR değerleri hastaların laboratuar verilerinden hesaplandı. You’den indeksi kullanılarak CAR, NLR ve PHR nin limit değerleri belirlendi ve puanlar 0 veya 1 olarak elde edildi. Bu üç skorun puanlarının toplamı ile grupların CANLPH skorları belirlendi. p

Objective: Elective operations had to be postponed due to the COVID-19 pandemic that emerged in the last quarter of 2019 and affected the whole world in a short time. However, for emergencies such as myocardial infarction (MI), unfortunately, this is not possible. We aimed to evaluate the management of ST-segment elevation myocardial infarction (STEMI) before and during the COVID-19 pandemic. Methods: One hundred and eleven consecutive patients with STEMI between April 2020 and May 2020 and 149 patients with STEMI 1 year before the pandemic in the same period were included in the study. Groups were compared in terms of the treatments applied, pre-post-dilatation, duration of the procedure, hospitalization, and the primary end-point. Death due to MI or complications of MI was the primary end-point. Results: The mean age of the patients was 59.7 +/- 123 (n = 195 [75%] male). The two groups were similar in terms of gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, and laboratory results. Although the median duration of the door balloon in the pandemic was similar (39 and 37 minutes, respectively;P = .342), the procedure times were shorter, the mean total hospitalization times were longer, and the differences were statistically significant (P = .022 and

Objectives: We evaluated the efficacy and safety of single high-dose versus double high-dose intracoronary bolus tirofiban in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 80 patients, who were admitted to our clinic and underwent primary PCI, were included in this observational cohort study. The patients were divided into the single high-dose group (n = 40) and the double high-dose group (n = 40) according to the intracoronary bolus tirofiban regime. The primary endpoint was assumed as the incidence of major adverse cardiac event (s) (MACE) defined as all-cause mortality and repeat coronary revascularization (target vessel revascularization [TVR]) at 30 days. MACE and bleeding events were evaluated at 7 and 30 days. Results: The primary endpoint was not significantly different between the single and the double high-dose groups (40.0% vs. 17.5%, p = 0.994). However, a significantly lower 30-day TVR rate was observed in the double high-dose group (27.5% vs. 7.5%, p = 0.019). No significant difference was observed in terms of 30-day all-cause mortality between the two groups (12.5% vs. 10.0%, p = 0.712). Major bleeding events were not observed in any group. Multivariate logistic regression analysis demonstrated that CRUSADE score (Hazard ratio [HR]: 5.721; 95% CI: 2.036 to 16.073, p = 0.001) and platelet count (HR: 1.009; 95% CI: 1.000 to 1.018, p = 0.048) were the independent predictors of bleeding at 7 days. Conclusions: Double high-dose intracoronary bolus tirofiban in STEMI patients undergoing primary PCI was associated with significantly lower 30-day TVR rates without an increase in bleeding events. However, it did not significantly affect MACE and all-cause mortality rates.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a new class of drugs for patients with type 2 diabetes (T2DM) which inhibit urinary glucose reabsorption in the proximal tubule of the nephron and result in glucosuria, natriuresis and diuresis. In large, randomized clinical trials, SGLT-2i have been shown to reduce major cardiovascular (CV) events and heart failure (HF) hospitalizations in patients with T2DM who have atherosclerotic CV disease or CV risk factors. In these trials, SGLT-2i is have their greatest and most consistent effect on reducing the risk of HF hospitalization. The reduction in HF hospitalization was also observed in subgroups of patients with a HF diagnosis at baseline, which raised the possibility of a clinical benefit of SGLT-2i in HF patients, regardless of the presence or absence of T2DM. In very recently published DAPA-HF trial, a SGLT-2i, dapagliflozin treatment on top of standard HF therapy has been shown to have clear clinical benefits in terms of reducing HF hospitalization, CV mortality, all-cause mortality and improving quality of life in HF patients. This compelling evidence suggests that SGLT-2i have a potential to be an effective treatment option in HF, regardless of diabetes. This article provides a comprehensive overview focused on the role of SGLT-2i in the treatment of HF.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Hyperkalemia is a common electrolyte abnormality in heart failure (HF) that can cause potentially life-threatening cardiac arrhythmias and sudden cardiac death. HF patients with diabetes, chronic kidney disease and older age are at higher risk of hyperkalemia. Moreover, hyperkalemia is also often associated with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sacubitril-valsartan. In clinical practice, the occurrence of hyperkalemia is a major concern among the clinicians and often limits RAASi use and/ or lead to dose reduction or discontinuation, thereby reducing their potential benefits for HF. Furthermore, recurrent hyperkalemia is frequent in the long-term and is associated with an increase in hyperkalemia-related hospitalizations. Therefore, management of hyperkalemia has a special importance in HF patients. However, treatment options in chronic management are currently limited. Dietary restriction of potassium is usually ineffective with variable adherence. Sodium polystyrene sulfonate is commonly used, but its effectiveness is uncertain and reported to be associated with intestinal toxicity. New therapeutic options such as potassium binders have been suggested as potentially beneficial agents in the management of hyperkalemia. This document discusses prevalence, predictors and management of hyperkalemia in HF, emphasizing the importance of careful patient selection for medical treatment, uptitration of the doses of RAASi, regular surveillance of potassium and treatment options of hyperkalemia.

OBJECTIVE The structural and compositional changes in the myocardium seem to have a major role in the development of heart failure (HF).Imbalance between production and degradation in extracellular collagen results in increase of collagen synthesis biomarkers in the circulation as the carboxy-terminal propeptide of type I procollagen (PIP). Here we aimed to determine role of PIP in the diagnosis of chronic HF. MATERIAL AND METHODS 87 patients with HF group and 80 healthy subjects were enrolled into the study. Echocardiographic examination was performed.At the beginning of the study, serum B type natriuretic peptide (BNP), PIP, high sensitive C-reactive protein (hs-CRP) were measured . The subjects were followed for one year then after. RESULTS Average PIP value of HF group was significantly higher than that of the control group (p < 0.001). Both hs-CRP and BNP values were well correlated to PIP values (p < 0.001). In the HF group, PIP value of patients who died at the end of one year was similar to that of patients who survived at the end of first year. CONCLUSION PIP may not mirror acute events in follow-up of chronic heart failure but it is a very beneficial biomarker in diagnosis of low-LVEF heart failure with high sensitivity and specificity (Tab. 2, Fig. 1, Ref. 16).

Background: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-? (TNF-?) playing an active role in this process. Aims: This research was to investigate the effects of preoperative steroid use on inflammatory mediator TNF-? and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. Study Design: Controlled clinical study. Methods: This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-? (pg/mL) level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF); at the 5th minute of cross-clamping (Per TNF); 2 hours after termination of cardiopulmonary bypass (Post TNF); and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF). Results: The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05). The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-? levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (0.05). The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-? levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (

Objective: The aim of this study is research relation of serum neopterin level with mortality and morbidity due to systolic HF and also its role in diagnosis of patients with systolic HF.Ma...

Background: White blood cells are reported as important not only in plaque vulnerability but also in thrombus formation and thrombus growth in acute coronary syndromes. Eosinophils contain granules that promote thrombus formation and thrombus growth in some heart diseases. In this study we aimed to investigate the relation of eosinophil count with coronary thrombus formation in patients with non ST-elevated acute coronary syndrome (NST-ACS). Method: A total of 251 consecutive patients were hospitalized in our hospital with a diagnosis of NST-ACS. Venous blood is collected for measurement of hematologic indices in all patients undergoing the coronary angiography. Coronary angiographies were performed in our clinic using the standard Judkins technique and angiographic assessment of the presence of thrombus was made. Results: During coronary angiography, coronary thrombus was not detected in 82 patients (Group 1). In the coronary angiography of 169 patients, coronary thrombus was detected at various grades (Group 2). While the neutrophil count (6.84±1.94 vs. 5.53±1.37; P

AIM The aim of this study was to evaluate the association between an increase in arterial stiffness and the development of left ventricular hypertrophy in essential hypertension patients. MATERIALS AND METHODS One hundred forty essential hypertension patients were included in the study. Patients were divided into two groups based on echocardiographic measurements; with left ventricular hypertrophy (n=70) and without left ventricular hypertrophy (n=70). The criterion for hypertrophy was accepted as an intraventricular septum and posterior wall thickness in diastole of 11 mm or above. Aortic stiffness values of the patients groups were measured noninvasively by arteriography through the brachial artery. Pulse wave velocity (PWV) measurements were used as indicators of arterial stiffness. RESULTS When compared to the group without left ventricular hypertrophy, elevated systolic blood pressure, mean blood pressure, and pulse pressure were located in the left ventricular hypertrophy group at a significant level (p > 0.01). A statistically significant difference was not observed in the diastolic blood pressure and pulse measurements of the groups. Pulse wave velocity, the indicator of arterial stiffness, was elevated to a significant degree in the left ventricular hypertrophy group (p > 0.01). While a positive correlation was found between pulse wave velocity and left ventricle mass index, microalbuminuria, high sensitive C-reactive protein (Hs-CRP), and left ventricle end-diastolic volume, a negative correlation was found between pulse wave propagation velocity and left ventricle E/A. CONCLUSIONS In conclusion, pulse wave analysis is a valuable method for predicting cardiac hypertrophy in essential hypertension (Tab. 6, Ref. 25).

Işık, Turgay (Balikesir Author), Objective: Objective of this study was to investigate the correlation between P wave dispersion and left ventricular diastolic function, which are associated with the increased cardiovascular events in patients with dipper and non-dipper hypertensive (HT). Methods: Eighty sex and age matched patients with dipper and non-dipper HT, and 40 control subject were included in this observational cross- sectional study. P wave dispersion was measured through electrocardiography obtained during the admission. The left ventricular ejection fraction was measured using the modified Simpson #8217;s rule by echocardiography. In addition, diastolic parameters including E/A rate, decelera- tion time (DT) and isovolumetric relaxation time (IVRT) were recorded. Independent samples Bonferroni, Scheffe and Tamhane tests and cor- relation test (Spearman and Pearson) were used for statistical analysis. Results: P wave dispersion was found to be significantly increased in the non-dipper than in the dipper group (56.0±5.6 vs. 49.1±5.3, p

Abnormal communication between the ascending aorta and the cardiac chambers is rare, diverse in origin, and can be congenital or acquired. We report a case of a 10-year-old boy with acquired aorta-to-left atrial fistula associated with an air gun pellet injury and his successful treatment. Electronic supplementary material The online version of this article (doi:10.1007/s40119-014-0026-7) contains supplementary material, which is available to authorized users.

Aim: In this study, we investigated the relationship of increased inflammatory parameters (C-reactive protein – CRP), oxidative stress markers (serum uric acid – SUA) and red blood cell distribution width (RDW) with non-dipper hypertension (NDHT). Material and methods: Among the individuals who presented to the cardiology clinic, 40 patients (32.5% male, 67.5% female; mean age: 54.4 ±7.1) who had hypertension and were diagnosed with NDHT through ambulatory blood pressure monitoring, 40 age- and sex-matched dipper hypertension (DHT) patients (25% male, 75% female, mean age: 54.2 ±7.0), and 40 normotensive individuals (42.5% male, 57.5% female, mean age: 51.9 ±9.0) were enrolled in the study. Peripheral venous blood samples were collected from all the patients in order to evaluate the hematological and biochemical parameters. All the assessed parameters were compared among the groups. Results: The CRP, RDW and uric acid levels were observed to be significantly higher in the non-dipper hypertension group in comparison to the dipper hypertension patients and the normotensive population (p < 0.05). These parameters were also significantly higher in the dipper HT group compared to the normotensive population (p < 0.05). Conclusions: We found in our study that increased CRP, uric acid and RDW levels, which are indicators of increased inflammation and oxidative stress, are significantly higher in the non-dipper HT patients in comparison to the dipper HT patients and control group.

Aim of the study Atherosclerosis represents active inflammation in which leukocytes play significant role. Coronary collateral development is a response to myocardial ischaemia. In this study we aimed to investigate the association of the leukocytes with coronary collateral development in patients with non ST-elevated acute coronary syndromes (NST-ACS). Material and methods A total of 251 consecutive patients were hospitalized in our hospital with a diagnosis of NST-ACS. The blood samples were collected 1-hour after admission to the hospital and peripheral leukocytes (neutrophils, monocytes and lymphocytes) were examined. All patients underwent coronary angiography. The coronary collateral vessels (CCV) are graded according to the Rentrop scoring system. Results Group 1 consisted of 146 patients with Rentrop 0 and Group 2 consisted of 105 patients with Rentrop 1, 2 and 3. The presence of CCV was significantly associated with neutrophil count, lymphocyte count, monocyte count and neutrophil-lymphocyte ratio (NLR). In subgroup analyses, higher NLR was significantly associated with good CCV development in patients with NST-ACS. Conclusions Higher neutrophil count, monocyte count and NLR and lower lymphocyte count on admission, were associated with the presence of CCV in patients with NST-ACS. High NLR may predict good collateral development in patients with NST-ACS.

Objective: Cardiac myxoma is the most common benign heart tumor. In this study, early and mid-term results of patients who underwent intracardiac myxoma exicision surgery were examined. Methods: Between to 1988 and 2012 years, 31 patients with a median age of 56 years (range, 33 to 78 years) were operated for myxoma. Eighteen female and 13 male underwent surgical excision of primary intracardiac myxomas. Twelve patients (38.7%) presented with congestive heart failure symptoms and 19 patients (61.3%) with mitral obstruction symptoms. Preoperative diagnosis was established by transthoracic two dimensional echocardiography. Nineteen had right atrial (RA) myxomas, 12 patients had left atrial (LA) myxoma. The surgical management was performed by wide excision under cardiopulmonary bypass. Results: One patient with cerebral embolism died during the early postoperative period. Mean follow-up was 9.8±1.4 years. Thirty patients had on regular follow-up in NYHA Class I symptoms with no documented recurrences. Conclusions: All patients with cardiac myxoma have immediate surgical treatement indication. Surgical excision of atrial myxoma gives excellent short and mid-term results. (JAREM 2013; 3: 84-7)

WOS: 000392631500001, PubMed ID: 27665326, Objective: The present objective was to determine frequency of Arginine389Glycine (Arg389Gly) and Cytochrome p450 2D6*10 (Cyp2D6*10) polymorphism in cases of heart failure-reduced ejection fraction (HFREF), and to evaluate the influence of the polymorphisms in response to beta-blocker (BB) therapy. Methods: A total of 206 HFREF patients and 90 healthy controls were prospectively enrolled. Genotypes for Arg389Gly and Cyp2D6*10 polymorphisms of the healthy controls and 162 of the 206 heart failure (HF) patients were measured, identified by polymerase-chain-reaction-and restriction-fragment-length-polymorphism analysis. HFREF patients and healthy controls were compared regarding Arg389Gly polymorphism. The HFREF patients were separated into 2 subgroups based on achievement of maximal target dose (MTD) of BB. Results: When comparing frequency of genotype distribution for Arg389Gly polymorphism in HFREF patients to the healthy controls, a statistically significant association was observed with CC genotype and Glisin-Glisin (GG) genotype (p

Left ventricular pseudoaneurysm is a rare complication of aneurysmectomy. We present a case of a surgically treated left ventricular pseudoaneurysm, which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation, and surgical repair are described.

Aim: The aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE). Methods: Fifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis. Results: In the control group IVA was 2.8±0.2 m/s2, while in the acute PE group, it was 2.0±0.1 m/s2 at the time of diagnosis and 2.9±0.1 m/s2 at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p

Objective: Hypertension (HT) and prehypertension (preHT) were independent predictors of cardiovascular diseases. Urinary albumin leakage is a manifestation of generalized vascular damage. B-type natriuretic peptide (BNP) is a vasoactive peptide secreted by left ventricle in response to myocytic stretch. We aimed to investigate relationship between microalbuminuria (MA) and BNP in untreated elevated blood pressures. Methods: Of 105 untreated prehypertensive subjects (53 men, 52 women), 100 hypertensive subjects (51 men, 49 women) and 57 normotensive subjects (32 men, 25 women) none had history of diabetes. Urine albumin excretion was measured by immunoradiometric assay in morning urine sample. Results: The prevalence of MA was higher in hypertensive group than in prehypertensive group and in normotensive group (Hypertensive group; 33.9%, prehypertensive; 25.9%, normotensive; 10%). Subjects with HT had higher prevalence of microalbminuria; larger body mass index, higher levels of triglycerides, blood glucose and creatinin were more common in subjects with HT than in those with preHT. In hypertensive group; patients with microalbuminuria had higher systolic blood pressure (SBP), BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.361; P < 0.001), LVMII (β: 0.267; P = 0.011) and BNP (β: 0.284; P = 0.005) were independent variables associated with MA in hypertensives. In prehypertensive group; patients with microalbuminuria had higher SBP, BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.264; P = 0.002), LVMI (β: 0.293; P = 0.001) and BNP (β: 0.168; P = 0.045) were associated with MA in prehypertensives. Conclusions: In preHT and HT, SBP, BNP and LVMI are associated with MA. In the evaluation of increased blood pressures, in case of increased BNP and LVMI, MA should be investigated even in prehypertensive stages. The subjects with increased blood pressures should get medical treatment to prevent the effects on vascular structure and myocardium even in prehypertensive phase.

Giriş: Brugada sendromu yapısal olarak normal kalpte sağ prekordiyal elektrokardiyografi (EKG) leadlerde ST segment elevasyonu ve artmış ani kardiyak ölüm riski ile karakterizedir. Klinik olarak atipik göğüs ağrısı, çarpıntı, senkop, supraventriküler taşikardi,ventriküler taşikardi, ventriküler fibrilasyon, ani ölüm şeklinde karşılaşılabilir. Olgu Sunumu: Otuz dokuz yaşında erkek hasta çarpıntı, presenkop şikayeti ile kliniğimize başvurdu. Presenkop, ailede ani ölüm öyküsü ve EKG bulguları bir arada değerlendirilen hastada ön tanı olarak brugada sendromu düşünüldü. Tanıyı doğrulamak için hastaya ajmanil verilerek provakasyon testi uygulandı. Seri çekilen EKG’lerini değerlendirildi ve hastada Brugada sendromu tanısını doğrulayan Tip 1 EKG örneği gözlendi. Sonuç: Amacımız Brugada sendromu düşünülen vakalarda tanı koymaya yardımcı bir yöntem olan sodyum kanal blokerlerinin kullanımını, vaka üzerinden tartışmak ve tanı kolaylığı sağlayacak yöntemi tanıtmaktır., Introduction: The Brugada syndrome is characterized by an STsegment elevation in the right precordial electrocardiography (ECG) leads and a high incidence of sudden death in patients with structurally normal hearts. Clinically, atypical chest pain, palpitations, syncope, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation and sudden death may occur. Case Report: A 39 year old male patient was admitted with presyncope and palpitation symptoms to our clinic. A family history of sudden death presyncope and ECG findings brought the Brugada syndrome as a differential diagnosis to mind. To confirm the diagnosis, a provacation test with ajmanil was done. Serial performed ECGs have been evaluated and a Type 1 ECG sample which confirms the Brugada Syndrome has been observed in the patient.Conclusion: Our goal is to help make the diagnosis of Brugada syndrome cases, a method comprising the use of the sodium channel blockers, and discuss case studies to introduce the method to provide ease of diagnosis

QT and P wave dispersion parameters can indicate abnormalities in autonomic nervous system and cardiac functioning.To determine QT and P wave dispersion in patients with major depressive disorder compared with healthy volunteers.Fifty newly diagnosed patients with major depressive disorder and 50 age- and sex-matched healthy volunteers underwent 12-lead electrocardiography. QT interval, QT dispersion, heart rate-corrected QT dispersion and P wave dispersions were calculated manually by a blinded specialist.Groups were comparable in terms of age, sex, body mass index, smoking status, metabolic diseases and left ventricular ejection fraction. The major depressive disorder group had significantly higher QT dispersion (58.5±9.9 versus 41.7±3.8; P0.001), heart rate-corrected QT dispersion (62.5±10.0 versus 45.2±4.3; P0.001) and P wave dispersion (46.9±4.8 versus 41.5±5.1; P0.001).Increased QT dispersion, heart-rate corrected QT dispersion and P wave dispersion in major depressive disorder patients may be indicative of autonomic imbalance and increased risk of cardiac morbidity and mortality.

The LEOPARD syndrome is a rare hereditary disorder in Asian countries. This syndrome involves complex malformations and other features. Though the LEOPARD syndrome is rare, diagnosis is important since it can be related with serious cardiac ailments. Patients must be followed up regularly in order to reduce the risk of sudden death which is the most severe complication. The study presents the case of a 23-year-old woman who had dyspnoea on daily exercises. She had multiple lentigines, cardiac anomalies (apical hypertrophic cardiomyopathy, left ventricular hypertrophy and pulmonary stenosis), ocular hypertelorism and abnormal electrocardiographic findings. Based on the findings, the patient was diagnosed with the LEOPARD syndrome.

Fundamento: A hipertensao arterial e o fator de risco mais prevalente e modificavel para a fibrilacao atrial. A sobrecarga de pressao no atrio esquerdo induz alteracoes fisiopatologicas que ocasionam alteracoes na funcao contratil e nas propriedades eletricas. Objetivo: Nesse estudo, o objetivo foi avaliar a funcao do atrio esquerdo em pacientes hipertensos para determinar a associacao entre a funcao atrial esquerda e a fibrilacao atrial paroxistica (FAP). Metodo: Foram estudados 57 pacientes hipertensos (idade: 53 ± 4 anos, fracao de ejecao do ventriculo esquerdo: 76 ± 6,7%), incluindo 30 pacientes consecutivos com FAP e 30 individuos de controle pareados por idade. Os volumes do atrio esquerdo (AE) foram medidos atraves do metodo biplano de Simpson modificado. Foram determinados tres tipos de volume do AE: volume maximo do AE (AEVmax), contracao atrial prematura do AE (AEVpreA) e volume minimo do AE (AEVmin). Foram calculadas as funcoes de esvaziamento do AE. Volume total de esvaziamento do AE = AEVmax - AEVmin e a FEtotal do AE = (AEVmax - AEVmin)/AEVmax, volume de esvaziamento passivo do AE = AEVmax-AEVpreA, e a FE do AE = (AEVmax - AEVpreA)/AEVmax, o volume de esvaziamento ativo do AE = AEVpreA- AEVmin e a FE ativa do AE = (AEVpreA - AEVmin)/AEVpreA. Resultados: O periodo hipertenso e maior no grupo de hipertensos com FAP. O AEVmax aumentou significativamente no grupo de hipertensos com FAP quando comparado ao grupo de hipertensos sem FAP (p = 0,010). A FEAE diminuiu significativamente no grupo de hipertensos com FAP em comparacao com o grupo de hipertensos sem FAP (p = 0,020). A' diminuiu no grupo de hipertensos com FAP quando comparado com hipertensos sem FAP (p = 0,044). Conclusao: O volume aumentado do AE e funcao de esvaziamento ativa do AE prejudicada foram associados com a FAP em pacientes hipertensos nao tratados. Um periodo hipertenso mais longo esta associado com a FAP.

Aim: The present study was designed to investigate mean platelet volume (MPV) values in coronary artery ectasia (CAE) patients in comparison with individuals with coronary artery disease and normal coronary angiograms. Material and methods: Patients with stable angina pectoris and scheduled for angiography were included in the study. Those with isolated coronary ectasia were evaluated in the coronary angiography. Mean platelet volume was measured in 126 patients (mean age: 57.2 ±11.3 years) with isolated CAE, 126 patients (mean age: 56.3 ±10.4 years) with coronary artery disease (CAD) and 122 control subjects (mean age: 58.1 ±11.1 years). Coronary artery ectasia was defined as lack of stenotic lesion, on visual assessment, of the coronary arteries with a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. Mean platelet volume values were recorded in all patients. Ectasia severity was evaluated and categorized in accordance with the Markis categorization. Results: A significant difference with respect to age, sex, hypertension, diabetes mellitus, and cigarette use between the study groups was not found (p > 0.05). Mean platelet volume was significantly higher in patients with CAE and CAD than in the control group (9.8 ±3.8 fl and 9.7 ±3.9 fl vs. 8.8 ±3.3 fl, p < 0.001). There were no statistically significant differences between CAE and CAD groups. When type I and type IV subgroups were compared in patients with coronary artery ectasia, MPV was detected as statistically high in the type I subgroup (p = 0.026). Conclusions: It was shown that patients with CAE and CAD have higher MPVs than subjects with normal coronary angiograms. Moreover, it was detected that in coronary artery ectasias, the increase in MPV is related to both the atherosclerotic process and severity of the disease.

Background. Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI).Methods. Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph.Results. Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure(P=0.007). There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE.Conclusions. Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI.

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients’ ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of 16.5±9.7. Group II comprised 14 female and 3 male patients with an average age of 18.5±9.8 showing similar features and pathologies. The cases were in Class I?II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was 1.8±0.2. The average pulmonary artery pressure was 35±10 mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients’ extraportal circulation, cross-clamp and surgery (p＞0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p＞0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

Adana, Turkiye Phone: +90 505 279 74 42 e.mail: serkansagay01@hotmail.com Received / Gelis Tarihi: 17.10.2011 Accepted / Kabul Tarihi: 07.02.2012 ©Copyright 2012 by Emergency Physicians Association of Turkey Available on-line at www.akademikaciltip.com ©Telif Hakki 2012 Acil Tip Uzmanlari Dernegi Makale metnine www.akademikaciltip.com web sayfasindan ulasilabilir. doi:10.5152/jaem.2012.026 Evaluation of the Cases Who Underwent Thoracotomy after Penetrating Chest Trauma

OP-179 Serum levels of neopterin, an immune modulator secreted by activated macrophages. The relationship between neopterin and the risk of HF has yet to be investigated on a large scale. The level of neopterin elevated in patients with advanced systolic heart failure compared with control subjects

Introduction: brucella endocarditis is a rare but severe complication of brucellosis. Although it is observed in less than 2% of the brucellosis cases, it is the main cause responsible for up to 80% of infection-related deaths in brucellosis. case report: Herein, we present a case of brucella endocarditis that developed on a native aortic valve. the diagnosis was proven by positive blood cultures and isolation of Brucella melitensis from the excised valve. conclusion: Although endocarditis associated with brucella infection is rare, it may be more frequently observed in the regions where brucellosis is endemic. therefore, especially in these regions, brucella endocarditis must be considered during the diagnosis of infective endocarditis.