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Background: Osborn wave, typically associated with hypothermia, is currently referred to as one of the J wave syndromes due to its clinical potential to develop lethal cardiac arrhythmia; it may rarely be observed in a non-hypothermic setting such as cannabis abuse. Case Report: In this paper, we presented two young cases who presented to the emergency services with unconsciousness, drowsiness, and hypoxia, and also J wave on electrocardiography (ECG) due to Bonsai abuse. Conclusion: Osborn wave may be a significant criterion to initiate close monitoring in a coronary care unit, with supportive treatment and mechanical ventilation as necessary in those patients who abuse Bonsai.

Background & objectives: Hyperhidrosis is a pathologic condition of excessive sweating in amounts greater than physiologic needs. Endoscopic thoracic sympathectomy (ETS) is a globally accepted treatment modality for primary palmar and axillary hyperhidrosis. ETS also has distinctive effects on the heart, circulatory and respiratory systems. In this study early effects of ETS on electrocardiographic (ECG) parameters of hyperhidrosis patients were evaluated. Methods: Twelve-lead ECGs were performed on 72 patients who were free from cardiovascular, metabolic, neurological and pulmonary diseases and underwent planned ETS because of hyperhidrosis, before and after the procedure within the first 24 h. Heart rate (HR), PR, QT, corrected QT (QTc), QTc/Tpeak-Tend (TpTe) intervals, P-wave and QTc/TpTe dispersions were compared by ECG. Results: A total of 72 patients (24.1±6.0 yr, 17 female) were included in the study. The pre-operative HR of patients was significantly higher than post-operative HR of patients (73.8±12.8 vs. 68.1±12.6 beats/ min; P

Dear editor,We read with interest the article entitled ‘Chronic kidney disease predicts atrial fibrillation in patients with ST elevation myocardial infarction treated by primary percutaneous coron...

Background The effects of gender difference on cardiac electrophysiology have been well studied. In this study, we aimed to evaluate the effects of estradiol and progesteron changes occuring in physiological menstrual cycle on ventricular premature beats (VPBs) and cardiac repolarization parameters. Methods Women of reproductive age with VPBs were included into the study group and healthy women were recruited as the control group. During the menstruation period, a 12-lead electrocardiography, blood samples, and 24-hour rhythm Holter were applied to the study group. Similarly, all tests were repeated in the estimated ovulation period (12–14 days before menstruation) by all cases. Results The study group consisted of 20 women patients with VPB, and the control group of 18 healthy women. While the number of VPB in the menstruation period was 210 beats/day (interquartile range [IQR]: 1,144), it decreased to 86 beats/day (IQR: 251) in the ovulation period with statistical significance (P < 0.05). Average heart rate in the menstruation period was 81.4 ± 10 beats/min and it significantly increased to 84.6 ± 8 beats/min in the ovulation period (P < 0.05). There were no differences in cardiac repolarization parameters in both menstruation and ovulation periods between the study and control groups. Comparing the menstruation and the ovulation periods, J-Tpeak interval, which reflects early repolarization, was shorter in the ovulation period (193 ± 27.7 ms and 201.1 ± 28.6 ms, respectively; P < 0.05). Other repolarization parameters did not show any significant difference. Conclusion VPB frequency decreases with estradiol peak in the ovulation period. This suggests that estrogen may have protective effects against ventricular arrhythmias.

AIM Sympathetic overdrive is generally the main pathophysiological abnormality in cardiovascular disease. However, its grading is not easy in clinical practice because of its complex interactions and differences in phenotypical expression. We proposed an easy, feasible, and global scaling system for sympathetic activity level. 'Sympathetic activity index' (SAI) is based on scores of heart rate, BMI, and blood pressure categories, which are the major representatives of sympathetic activity. MATERIALS AND METHODS Respectively, 1, 2, and 3 points were determined for heart rate below 69, 70-89, and above 90 bpm; -1, 1, and 2 points for BMI less than 20, 20-24.9, and at least 25 kg/m; and 1, 2, and 3 points for normal, prehypertension, and hypertension categories. Demographic and echocardiographic parameters, and left ventricular (LV) mass and mass indexes (LVMIBSA and LVMIHeight) of 545 young males were compared among groups with SAI 1-8. RESULTS We observed that LVM, LVMIBSA, and LVMIHeight, left atrial diameter were significantly increased in association with SAI (P

Arterial shear stress was generally implicated in the development of atherosclerotic plaque (AP). Atherosclerotic plaque may be associated with myocardial bridging (MB). We evaluated the metabolic abnormalities which could determine the localization of AP at the proximal coronary segment of MB. We analyzed the patients with MB, AP&MB, and AP on left anterior descending (LAD) artery who were diagnosed by multislice computed tomography coronary angiography. Serum levels of metabolic parameters were compared among study groups. Patients with MB&AP and AP were significantly older than those in the MB group. Patients with MB&AP had AP and MB at the proximal and middle segments of LAD artery, respectively. Total cholesterol, low-density lipoprotein (LDL) cholesterol and very LDL, and triglyceride levels were significantly higher in patients with MB&AP and AP compared to only MB. Low-density lipoprotein cholesterol was significantly correlated with the type of coronary artery disease in multiple regression analysis. Myocardial bridging may be an anatomical determinant for the localization of AP proximal to itself in the presence of hypercholesterolemia.

Objective: Carbon monoxide (CO) poisoning leads to cardiac dysrhythmia. Increased heterogeneity in ventricular repolarisation on electrocardiogram (ECG) shows an increased risk of arrhythmia. A number of parameters are used to evaluate ventricular repolarisation heterogeneity on ECG. The aim of our study is to investigate the effect of acute CO poisoning on indirect parameters of ventricular repolarisation on ECG. Methods: Sixty-seven patients were included in this case-control study. Thirty patients with acute CO poisoning were assigned to group 1 (19 females, mean age: 30.8 ± 11.3 years). A control group was formed with patients without known cardiac disease (group 2, n = 37; 25 females, mean age: 26.0 ± 5.2 years). Twelve-lead ECG and serum electrolyte levels were recorded in all patients. Also, carboxyhaemoglobin (COHb) levels were recorded in group 1. Tpeak-Tend (TpTe) interval, TpTe dispersion, TpTe/QT ratio, QT interval and QTd durations were measured as parameters of ventricular repolarisation. Corrected QT (QTc) and QTc dispersion (QTcd) intervals were determined with the Bazett's formula. Results: The mean COHb level in group 1 was 27.6 ± 7.4% and mean duration of CO exposure was 163.5 ± 110.9 min. No statistically significant difference was found in age, gender, serum electrolytes or blood pressure levels between the groups. QRS, QT, QTc, TpTe interval and TpTe/QT ratio were similar between the groups (p > 0.05). QTcd (65.7 ± 64.4 vs 42.1 ± 14.2 ms, p = 0.003) and TpTe dispersion (40.5 ± 14.8 vs 33.2 ± 4.9 ms, p = 0.006) were significantly longer in group 1 than group 2. COHb level was moderately correlated with TpTe dispersion (r = 0.29; p = 0.01). Conclusion: To our knowledge, this is the first study to investigate TpTe interval and dispersion in CO poisoning. Our results showed that TpTe dispersion and QTc dispersion increased after CO poisoning.

OBJECTIVE Coronary artery disease (CAD) is one of the most incapacitating causes at military or civilian aviation. Aircrew population is crowding in number in our country. We aimed to identify the clinical features that could predict CAD in aircrew. METHODS We retrospectively analyzed medical recordings of 26 aircrew (age 43.57±5.2) whose CAD was diagnosed via multislice computerized tomography angiography (MSCT). Clinical features, coronary risk factors and ST segment and T wave changes on resting ECG and treadmill test (TT), and laboratory findings of aircrew were recorded. RESULTS ST depression

Objective: To investigate whether or not the CHA2DS2-VASc score predicts left atrial (LA) thrombus detected on pre-cardioversion transoesophageal echocardiography (TEE). Materials and Methods: The medical records of patients who had undergone TEE were reviewed to assess the presence of LA thrombus prior to direct-current cardioversion for atrial fibrillation (AF). The CHA2DS2-VASc score was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with a valve prosthesis or rheumatic mitral valve disease were excluded from this study. Results: A total of 309 patients were identified. The mean age was 70.1 ± 9.8 years and 151 (49%) patients were males and 158 (51%) were females. LA thrombus was seen in 32 (10.3%) of the 309 patients. Fifty (16.2%) patients had a low CHA2DS2-VASc score (0-1), 230 (74.4%) had an intermediate score (2-4) and 29 (9.4%) had a high score (5-9). The incidence of LA thrombus in the low, intermediate and high CHA2DS2-VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA2DS2-VASc scores. On multivariate logistic analysis, the CHA2DS2-VASc score (OR 3.26, 95% CI 2.3-4.65; p = 0.001) and age (OR 0.93, 95% CI 0.88-0.98; p = 0.004) were independent risk factors for LA thrombus in patients with non-valvular AF. Conclusion: A high CHA2DS2-VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF.

Objective: Neutrophil–lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. We aimed to compare NLRs among patients with nonvalvular atrial fibrillation (AF) with or without left atrial (LA) thrombus. Methods: A total of 309 (70.1 ± 9.8 years, 49% male) patients with nonvalvular AF have undergone transoesophageal echocardiography (TEE) to assess the presence of LA thrombus. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. Results: Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, P = .026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59, 95% confidence interval 0.87-4.18; P < .02) was an independent risk factor for the presence of LA thrombus in patients with nonvalvular AF. Conclusion: Neutrophil–lymphocyte ratio, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with nonvalvular AF.

Objective. The aim of our study was to evaluate the relationship between a myocardial bridge (MB) and its effects over the coronary artery hemodynamics by using multislice computed tomography (MSCT). Material and Methods. A total of 412 patients examined with coronary computed tomography (CT) angiography were reviewed retrospectively for an MB of the left anterior descending (LAD) coronary artery. We evaluated the correlation between the depth of an MB and the degree of compression to the MB during end-diastolic and end-systolic phases. Results. 93 (22.6%) MBs were detected in 412 patients, and 81 of the 93 subjects (87.09%) were found in LAD. In 53 (65.43%) of the 81 subjects, the MBs were localized superficially, and 28 (34.57%) of the 81 subjects were deeply in myocardium. A significant difference was found in the luminal narrowing during the end-diastolic phase between the superficial and deep type of MB (p = 0.045), but the narrowing in the end-systolic phase was not correlated with the myocardial thickness over the bridge. Conclusion. We detected a correlation between the luminal narrowing ratio and the myocardial thickness over the tunneled artery in the end-diastolic phase. [Arch Clin Exp Surg 2013; 2(4.000): 219-223]

In an observational study, Zhang et al1 reported the efficacy of long-term β-blocker therapy in 5926 consecutive patients undergoing coronary artery bypass grafting (CABG). They concluded, “in patients with or without previous myocardial infarction undergoing CABG, the consistent use of β-blockers was associated with a lower risk of long-term …

A 21 year-old male patient was admitted with symptoms of exertional dyspnea and palpitation. The physical examination revealed a grade 3/6 systolic murmur, best heard over the left 3-4th intercostal space. Transthoracic echocardiography disclosed a separate chamber (asterisk) in the interventricular septum. The apical portion of the chamber consisted of muscle tissue and the basal portion consisted of membranous and aneurysmatic tissue (Panel A). There was a muscular "tunnel-like" structure connecting the left ventricle and chamber at mid ventricular level. The color and continuous wave Doppler imaging revealed a bidirectional flow across the passage (Panel B, C). The patient underwent three dimensional transthoracic echocardiographic examinations, which revealed two separate septa. Between these septa there was a third chamber (asterisk). It was connected to both left (via the tunnel at the muscular septum) and right ventricles (via the defect in the membranous septal aneurysm). The membranous septal aneurysm was separated from the left ventricle by a thin membrane, without any passage across it (Panel D). MRI findings were consistent with echocardiographic images (Panel E). Ventriculography and coronary angiography were performed. The coronary arteries were normal; the left ventriculography showed the muscular and membranous/aneurysmatic portions of the malformation (Panel F). The patient was advised to undergo a surgical procedure, but he refused and was discharged with recommendations about control visits.

OBJECTIVE The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. METHODS AND RESULTS In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Munster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P < or = 0.001), but all scores had good specificity and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P < or = 0.001), but all scores had good specificity and negative predictive value. CONCLUSION The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

Background: Prolongation of the peak and the end of T wave (Tp-e) has been reported to be associated with ventricular arrhythmias. Tp-e/QT ratio and Tp-e/QTc ratio are used as an index of ventricular arrhythmogenesis. An increased incidence of ventricular arrhythmias has been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess ventricular repolarization in patients with OSA by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Methods: We have studied 72 patients who underwent overnight polysomnography (PSG) between the years 2010–2011 at our institution. Patients with moderate and severe OSA (23 patients; mean age: 45±10), according to the apnea-hypopnea index, constituted the study group. Patients with normal PSG (23 patients; mean age: 42±11) were used as the control group. In all patients, Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio, as well as some other electrocardiogram intervals were measured. Independent samples t-tests were used for comparison of continuous and categorical variables and correlations were calculated by Spearman rank correlation. Results: Although QT and QTc intervals were not different between the groups, mean Tp-e interval (81.6±11.1 msn; 63.9±7.3 msn; respectively; P < 0.001), Tp-e/QT ratio (0.21±0.03; 0.17±0.02; respectively; P < 0.001), and Tp-e/QTc ratio (0.20±0.03; 0.16±0.02; respectively; P < 0.001) were prolonged in the study group compared to the control group. Correlation analysis showed a significant positive correlation between the presence of moderate and severe OSA and Tp-e interval (r = 0.72; P < 0.001), Tpe/QT ratio (r = 0.70; P < 0.001), and Tp-e/QTc ratio (r = 0.70; P < 0.001). Conclusions: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe OSA patients. There is a positive correlation between the presence of OSA and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. (PACE 2012; 35:966–972)

The effects of gender difference on cardiac electrophysiology have been well studied. In this study, we aimed to evaluate the effects of estradiol and progesteron changes occuring in physiological menstrual cycle on ventricular premature beats (VPBs) and cardiac repolarization parameters.Women of reproductive age with VPBs were included into the study group and healthy women were recruited as the control group. During the menstruation period, a 12-lead electrocardiography, blood samples, and 24-hour rhythm Holter were applied to the study group. Similarly, all tests were repeated in the estimated ovulation period (12-14 days before menstruation) by all cases.The study group consisted of 20 women patients with VPB, and the control group of 18 healthy women. While the number of VPB in the menstruation period was 210 beats/day (interquartile range [IQR]: 1,144), it decreased to 86 beats/day (IQR: 251) in the ovulation period with statistical significance (P0.05). Average heart rate in the menstruation period was 81.4 ± 10 beats/min and it significantly increased to 84.6 ± 8 beats/min in the ovulation period (P0.05). There were no differences in cardiac repolarization parameters in both menstruation and ovulation periods between the study and control groups. Comparing the menstruation and the ovulation periods, J-Tpeak interval, which reflects early repolarization, was shorter in the ovulation period (193 ± 27.7 ms and 201.1 ± 28.6 ms, respectively; P0.05). Other repolarization parameters did not show any significant difference.VPB frequency decreases with estradiol peak in the ovulation period. This suggests that estrogen may have protective effects against ventricular arrhythmias.

Aim: The aim of this study was to evaluate whether left ventricular size was increased in patients with classic bileaflet mitral valve prolapse (MVP) in the absence of significant mitral regurgitation (MR). Method: Patients with classic bileaflet MVP were included as the case group. Two different control groups were established. The first control group was composed of the patients with mild MR caused by the reasons except MVP. The second control group consisted of healthy individuals whose echocardiograms were normal. The patients with moderate or severe MR and having abnormality in the other valves were excluded. Results: There were 20 patients in each group. Systolic and diastolic diameters and volumes of left ventricle (LV) in the MVP group were significantly higher than those in the control groups. In 10 of the patients in the MVP group, LV internal diastolic diameter (LVIDD) values were measured as ≥5.7 cm, whereas increased LVIDD value was detected in only one patient in the other two control groups. There was a significant difference in terms of the presence of increased LVIDD values between the MVP group and the control groups. Despite this enlargement in the LV dimension, the LV ejection fractions were found similar in all groups. Furthermore, it was found that the lengths of both anterior and posterior mitral leaflets in MVP group were significantly higher than those in the control groups. Conclusion: The LV diameters and volumes of patients with classic bileaflet MVP were found to be increased even in the absence of significant MR. These results need to be supported by large-scale clinical studies. (Echocardiography 2012;29:123-129)

Objective: A few studies have shown that elevated CA-125 levels are associated with chronic obstructive pulmonary disease (COPD). However, there are no data concerning the associaton between serum CA-125 levels and right ventricular (RV) function in COPD patients. This study aimed to evaluate the relationship between CA-125 level and RV echocardiographic parameters in COPD patients. Methods: Fifty-two patients with COPD (39 male/13 female, mean age 68.9 ± 5.7 years) were studied. The control group consisted of 30 age-sex matched healthy volunteers (23 male/7 female, mean age 64.2 ± 6.3 years). Patients were divided into two subgroups: patients without pulmonary hypertension (group I, n = 25) and with pulmonary hypertension (group II, n = 27). Conventional echocardiographic parameters, tissue Doppler imaging (TDI) and CA-125 level measurements were performed in all subjects. Results: Patients in group II had significantly higher CA-125 levels than those in group I and controls (P < 0.01). CA-125 levels in group I were also higher than control group (P < 0.05). CA-125 levels were correlated with left ventricle E/A ratio, systolic pulmonary artery pressure (sPAP), RV myocardial performance index, and RV fractional area change (r = 0.37, 0.56, 0.34, and -0.42, respectively, all with P < 0.05). There was an independent correlation between CA-125 levels and sPAP values (β = 0.76, P < 0.001). Conclusions: Our results show an independent correlation between CA-125 levels and systolic pulmonary artery pressure in COPD patients. The clinical utility of these results at this point in time is unknown and deserves future research.

Objectives: This study designed to assess the effect of different positions of head of the bed on myocardial velocity by tissue Doppler echocardiography in healthy subjects. Methods: Thirty-nine healthy subjects (32 males/7 females, mean age 24.7 ± 4.9 years) were studied. Tissue Doppler imaging (TDI) was performed and velocities were recorded during systole (Sm) and early (Em) and late (Am) diastole at the tricuspid annulus, septum, and mitral annulus in the four-chamber view. Measurements were performed from different positions of left lateral decubitus (0°, 30°, and 60°). Repeated-measures general linear models were used to assess the change in myocardial velocities. Results: No significant difference between myocardial velocities was found at the mitral anulus and septal TDI recordings in the different angles of left lateral decubitus positions (P > 0.05). However, there were statistically significant difference among tricuspid anulus myocardial tissue velocities in these positions (P < 0.05). Conclusions: Tricuspid anulus myocardial tissue velocities may be significantly influenced by changing of position in healthy subjects. Effect of position changes should be considered in the assessment of these velocities. (Echocardiography 2011;28:516-519)

Nowadays, situations associated with high altitude such as mountaineering, aviation increasingly draw the attention of people. Gas pressure decreases and hypoxia is encountered when climbing higher. Physiological and pathological responses of human body to different heights are different. Therefore, physiological and pathological changes that may occur together with height and to know the clinical outcomes of these are important . Acute mountain sickness caused by high altitude and high altitude cerebral edema are preventable diseases with appropriate precautions. Atmospheric oxygen decreasing with height, initiates many adaptive mechanisms. These adaptation mechanisms and acclimatization vary widely among individuals because of reasons such as environmental factors, exercise and cold. High altitude causes different changes in the cardiovascular system with various mechanisms. Although normal individuals easily adapt to these changes, this situation can lead to undesirable results in people with heart disease. For this reason, it should be known the effective evaluation of the people with known heart disease before traveling to high altitude and the complications due to the changes with height and the recommendations can be made to these patients. [TAF Prev Med Bull 2011; 10(2.000): 211-222]

Air pollution is one of the environmental problems that threaten the public health. The air is a gas mixture. Air pollution is defined as the existence in the amount of pollutants harmful to humans and other organisms in the atmosphere as a result of the natural or human activity thereby changing to the gas rates in the air. The negative effects of pollution-causing particles on the health are closely related to the chemical structure of particles, whether causing a fibrotic reaction, whether having an amorphous shape and the aerodynamic diameters of particles. The particles larger than 10 microns in aerodynamic diameter can not reach up to the alveoli, and can be removed by mucociliary system. If the particles are smaller than 10 microns, these particles can reach to the alveoli, and are closely associated with the cardiovascular mortality and morbidity. The concentration of these particles (PM10) is used as an indicator of pollution, and creates the basis for air quality index. Air pollution has several negative effects such as blood pressure changes, atherosclerosis, endothelial dysfunction, autonomic dysfunction, inflammation, oxidative stress etc. In this review, the effects of air pollution on the cardiovascular system will be examined, and the importance of this issue will be emphasized. [TAF Prev Med Bull 2011; 10(1.000): 97-106]

Objective: This study was designed to investigate the validity of brain natriuretic peptide (BNP) levels for the estimation of the shunt size in young adults with atrial septal defect (ASD), and to determine the relationship between BNP levels and echocardiographic parameters of right heart chambers. Methods: Fifty-six patients with ASD (mean age 22.9 ± 2.0 years) were studied. The control group consisted of 31 age-gender matched healthy volunteers (mean age 22.7 ± 1.9 years). Coventional echocardiography, tissue Doppler imaging (TDI) and plasma BNP level measurement was performed in all participants. The ratio of pulmonary to systemic blood flow (Qp/Qs) was measured noninvasively using transthoracic echocardiography. Results: Plasma BNP levels were significantly higher in ASD patients than in controls (42.9 ± 29.4 vs. 8.3 ± 2.6 pg/mL, P < 0.05). Pulmonary artery pressure (PAP) (P = 0.0001), right atrium (RA) volume (P = 0.0001), and right ventricular end-diastolic volume (RVEDV) (P = 0.0001) values were higher in ASD patients. There was a powerful correlation between plasma BNP levels and Qp/Qs ratio (r = 0.71, P < 0.0001). The plasma BNP levels significantly correlated with PAP (r = 0.61, P < 0.0001), RA volume (r = 0.54, P < 0.0001), RVEDV (r = 0.55, P < 0.0001), and right ventricular myocardial performance index (r = 0.50, P < 0.0001). Conclusion: This study shows that there is a significant correlation between right heart echocardiographic parameters and concentrations of BNP in the plasma of young adults with ASD. BNP levels may provide a supplemental data to predict of shunt size in these patients. (Echocardiography 2011;28:243-247)

AIM: It was documented that smoking was a significant atherosclerotic risk factor for adults. However reality of the initiation of atherosclerosis at childhood guided us to evaluate the probable effects of smoking on other atherosclerotic risk factors at young ages. METHODS: One hundred sixty four young subjects (age 21.14± 2.06) were enrolled. Participants were grouped as not smoking (n=48), ex-smoking (n=30), 1-3 cigarettes/day (n=26), a half package/day (n=26), a package/day (n=34). Body mass index (BMI) of subjects were calculated. Systolic and diastolic blood pressures (SBP, DBP) were measured. Carotid intima media thickness (IMT) was measured by Logic5 pro Colour Doppler Device. Total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels of subjects were measured from the serum obtained at 12 hour fasting state. IMT and IVSd were measured by transverse and 3S probes using. Statistical analysis was performed by One-way ANOVA test using SPSS 11.0 for Windows. RESULTS: BMI, SBP, and DBP were not different between groups (p=0.16). HDL cholesterol was significantly lowered whereas LDL cholesterol was significantly increased in group smoking one package/day. Also carotid IMT was increased in patients smoking one package/day compared to others but data was not statistically significant. Triglyceride level group. CONCLUSION: Smoking effects atherosclerotic risk factors unfavorably even at young ages. Thus smoking should be eradicated since earlier ages in order to reduce the prevalence of cardiovascular diseases. [TAF Prev Med Bull 2009; 8(3.000): 193-198]

AIM: Carotid intima media thickness (IMT) is proposed to be an earlier predictor of subclinical atherosclerosis. Currently risk management of atherosclerosis at earlier ages gains importance. In this study we evaluated the carotid intima media thickness of young individuals and any possible changes due to the geographic region in which the individuals lived in. METHOD: Totally, 164 young individuals (age 21.14± 2.06) were enrolled to the study. Geographic regions in which they have been living for at least 10 years were documented. Measurements of IMT were performed by Logic5 Pro Color Doppler Device using transverse probe. Measurements of IMT, systolic and diastolic blood pressures, and levels of total cholesterol, HDL, LDL, and triglyceride were compared between the groups designed according to the geographic regions. Statistical analysis was performed by Oneway ANOVA test using SPSS 11.0 for Windows. RESULTS: Carotid IMT was significantly lower in subjects living in Mediterranean (0.416±0.02 mm) and South East Region (0.428±0.04), whereas it increased in subjects living in Marmara Region (0.468±0.06 mm) and Mid-Anatolian Region (0.473±0.04). CONCLUSION: We can propose that individual changes in carotid intima media thickness may develop at younger ages. Differences in dietary habits and its content, also cultural, and environmental differences due to geographic region in which the individuals lived in may contribute those changes. Measurement of IMT could be used as a screening test to detect young individuals with subclinical atherosclerosis in geographic region at risk for atherosclerosis in the future. [TAF Prev Med Bull 2009; 8(2.000): 119-124]

Bentall operation is the complete replacement of the aortic valve and the ascending aorta. Pseudoaneurysm seen after the Bentall procedure is frequently associated with surgical technique. Especially in the early postoperative period, patients undergoing such major surgery should be evaluated more carefully. Serial echocardiographic and radiological examinations have a vital role to detect life-threatening pseudoaneurysm developing after Bentall procedure.

The most prevalent tumours of the heart are the metastatic tumours. The lung carcinoma is the most frequent metastatic tumour of the heart and it rarely causes symptoms. The symptoms vary according to the localization of the metastasis. In this paper, we present a case, in whom bronchogenic lung carcinoma caused cardiac tamponade by severely compressing the right ventricle via metastasis into the pericardium.

Concomitant tricuspid valve surgery with mitral valve surgery is recommended for patients with severe functional tricuspid regurgitation (TR). However, the treatment for 2+ TR (mild TR) remains controversial. Here, we evaluated the long-term results of untreated 2+ TR in patients undergoing mitral valve surgery.We retrospectively reviewed the records of 96 patients with untreated 2+ TR among 885 patients who underwent mitral valve surgery from 2003 to 2010. Exclusion criteria were tricuspid valve surgery (TVS), emergency surgery, primary TR and pacemaker lead through the tricuspid valve. We assessed survival and freedom from heart failure. The freedom from 3+ (moderate) or 4+ (severe) TR was investigated by echocardiographic data at pre- and postoperative week 1, then at 1, 3, 5, 7 and 10 postoperative years, which were compared with those in patients who had 2+ TR preoperatively and underwent concomitant TVS in the same period (n = 47).The mean follow-up was 7.1 ± 2.7 years. There was no 30-day mortality. The survival rate was 97.5% at 5 years and 87.5% at 10 years. The independent risk factors for mortality were age (OR 1.2, P = 0.03) and left ventricular ejection fraction (OR 0.9, P = 0.03). Untreated 2+ TR improved transiently within the first postoperative year (P0.001), but progressed again in the mid- to long term. Freedom from ≥3+ TR was 64.2% at 5 years and 46.7% at 10 years, which was significantly lower than that from ≥3+ TR in patients who underwent concomitant TVS (P = 0.006). The independent risk factors for TR progression (≥3 + TR) were age (OR 1.1, P = 0.005), atrial fibrillation (OR 2.2, P = 0.04) and tricuspid annular diameter (TAD) index (mm/m(2); OR 1.1, P = 0.02). Receiver operating characteristic curves showed that the optimal TAD index cut-off value was 21.0 for long-term survival [area under the curve (AUC) = 0.72] and 21.2 for TR progression (AUC = 0.64).Although untreated, 2+ TR significantly improved after mitral valve surgery, it then progressed again in the mid- to long term. Therefore, concomitant TVS should be considered in patients with 2+ TR who have dilated tricuspid annulus or atrial fibrillation, if feasible.

Either transcranial color-coded Doppler (TCCD) or contrast echocardiography (CE) is the bests of clinically applicable and reproducible methods to evaluate the functionality of right-to-left shunts that can be found in different localization on atrial septum. As the anatomical features of right-to-left shunts could vary in many forms, detection of RLS by functional tests may aid the clinician to do risk prediction and management of patients. Sensitivity of TCDD or CE can be increased by performing effective Valsalva maneuvering during the test procedure. Timing of RLS during the cardiac cycles may help interpreting about the etiology of RLS, atrial septum or intrapulmonary shunts. Intrapulmonary shunts have been recently reported to be associated with RLS and frequently overlooked unless the tests prolonged up to 10th cardiac beat. Migraine, cryptogenic strokes, and paradoxic embolism are closely associated with RLS which should be evaluated by the collaboration of cardiologists and neurologists. Success of diagnostic procedure depends on high suspicion of index for RLS and application of contrast-enhanced tests that are effectively performed at each step.

A 20-year-old male patient with dyspnea complaint was referred to our hospital. On physical examination there was grade 2/6 systolic murmur, which is best heard at the second left intercostal space and fixed split S2. ECG revealed sinus rhythm with complete right bundle brunch block. Transthoracic echocardiography demonstrated a secundum atrial septal defect (ASD) and Qp/Qs ratio was 1.6. The right ventricle was severely dilated, inconsistent with the size of the defect. Two-dimensional and color Doppler transesophageal echocardiographic examination confirmed the secundum type ASD (asterisk) and revealed an additional sinus venosus type ASD between the right atrium and the superior vena cava (SVC)(Figures 1A, ​,1B,1B, ​,1C;1C; Video 1). Three-dimensional transesophageal echocardiography verified both septal defects (Figure 1D). The patient underwent cardiac tomography for further anatomical outlining the. Figures 1E and ​and1F1F clearly show the secundum ASD (asterisk), sinus venosus ASD (arrow) and anomalous drainage of the right superior pulmonary vein to the SVC (star). The patient underwent surgery. Figures 1G and ​and1H1H show intraoperative images of the defects. Figure 1 Multimodality and intraoperative images of a mixed atrial septal defect. Video Access the video through the link: http://www.arquivosonline.com.br/2016/english/10602/pdf/i10602013.pdf The interatrial septum is anatomically divided into 5 septal zones. A mixed atrial septal defect involves 2 or more of the 5 septal zones and accounts for 7 of all atrial septal defects.1 In patients with severely dilated right ventricle and high Qp/Qs ratio, inconsistent with defect size, physicians should consider the presence of additional septal defects. These patients must be evaluated with advanced imaging modalities.