51 cases of abrupt occlusion who had undergone PTCA at the Invasive Cardiology Laboratory of the TYIH between January 1984 and March 1993 were retrospectively studied. Decrease of coronary flow was graded in accordance with TIMI classification. Once an abrupt closure was noted during PTCA, intracoronary nitrate and heparin infusion was started immediately in addition to the main procedure, and long-term dilation (>120 sec) was carried out using the same balloon. If insufficient, a long-term autoperfusion balloon catheter was utilized. Streptokinase was used in only one case. Directional coronary atherectomy was performed in a patient because of intimal flap. In one further case we used Palmaz-Schatz stent. Twelve patients (23 percent) in whom ischaemic findings could not be relieved were treated with coronary artery bypass grafting. In 18 of the 51 cases (35 per cent), successful backflow was realized. No successful result was obtained in 33 patients. Best results were seen in Cx lesions in 5 of nine patients. LAD lesions, in contrast, displayed the least success rate: in 5 of 23 patients. Non-Q MI developed later in four of the 18 patients who were categorized initially as successful cases. While the acute occlusion rate was 6.6 per cent and successful backflow was 18.2 per cent between October 1984 and October 1990 in 333 patients in whom old technologic instruments were used; with subjected to PTCA developed technologies, these were 3.4 per cent and 48.3 per cent, respectively in 842 patients between October 1990 and March 1993. Though new technologic instruments are increasingly used in invasive cardiology with high success rates, further work is clearly necessary to reduce morbidity and mortality in abrupt coronary occlusion.

In order to evaluate changes in the cardiac shape, structure, and function (remodeling) caused by aging, we analyzed the echocardiographic and Doppler findings of 42 patients, aged 90 years or older (mean 92 years, range 90-98; 14 men). Of the 42 patients, 19 (45 %) had hypertension, 9 (20 %) had coronary artery disease, 5 (14 %) had a history of myocardial infarction, 10 (23 %) had clinically significant valvular heart disease, and 3 (7 %) had hypertrophic cardiomyopathy. Left ventricular (LV) mass index was above normal in 34 (81 %) patients. The angle between the septum and the aorta was 87±17 degrees and 108±14 degrees in end-diastole and end-systole, respectively. In 21 (50 %) patients It was seen that a proximal septal bulge protruded into the left ventricular outflow tract. There was LV outflow tract obstruction in two patients. Aortic regurgitation was detected in 25 patients (60 %). It was 3+ in one patient. Mitral regurgitation was detected in 19 patients (45 %). It was 3 or 4+ in six patients. Tricuspid regurgitation was noted in 17 patients (40 %). It was 3 or 4+ in three patients. Aortic stenosis was detected in 18 patients (43 %), in seven patients the instantaneous gradient was >50 mmHg. Stenotic or regurgitant lesion was present in one valve in 12 patients, two valves in 15 patients, and three valves in 11 patients. There was no valvular lesion in four patients. Our data suggest that advancing age causes structural changes in the cardiac valves and alterations in the cardiac shape. However, these changes are not functionally significant in most of these elderly cases.

In this study, occlusive changes in pulmonary arteries in mitral valve disease were evaluated as an organic component of pulmonary hypertension, and effect of these changes on preoperative clinical findings and on reversibility of pulmonary hypertension was investigated. In 20 patients with mitral valve disease, hypertensive histopathologic changes in the pulmonary arteries were assessed with lung biopsies according to Heath and Edwards' classification, and the patients were divided to grade-0, grade-1, grade-2 and grade-3 groups. Hemodynamic measurements were performed in the preoperative and postoperative periods and postoperative regressions in pulmonary vascular changes were investigated in each group. A significant increase in cardiac output and cardiac index (p<0.01) was observed in all cases postoperatively. Significant decreases were observed in left atrial pressure (p<0.001), pulmonary artery mean pressure (0.001), pulmonary capillary wedge pressure (p<0.001), pulmonary vascular resistance (p<0.05) in the patients whose pulmonary arterial changes were grade-2 or less. No similar improvement occurred in pulmonary hemodynamic parameters in grade-3 group. Pulmonary hypertension and high pulmonary capillary wedge pressure persisted postoperatively in the 2 patients with grade-3 pulmonary artery pathologies.

To determine the presence of "myocardial stunning" and to identify its relative value in the diagnosis of coronary artery disease (CAD), resting electrocardiographic and echocardiographic examinations were performed in 47 cases (with 44 males, mean age 56±8 years) admitted with typical and atypical angina pectoris, postinfarction angina and nonanginal chest pain. This was followed by recording of echocardiographic images immediately after the bicycle exercise testing and at the 15th and 30th minutes to determine whether persistent left ventricular wall motion abnormalities had developed as compared to the pre-exercise period. Wall motions were scored as 1: normal, 2: hypokinetic, 3: akinetic, 4: dyskinetic. Coronary angiograms were then performed in all patients. In 30 of 35 patients (85,7%) in whom CAD was found by coronary angiography, significant increases in the wall motion scores of all left ventricular regional walls were found immediately after exercise compared with resting values (p<0,01 -p<0.0005). The score rise continued significantly 15 and 30 minutes after exercise (p<0,0005 and p<0,0005, respectively). Localisation of the narrowings found by coronary angiography was related with the wall motion changes. We concluded that exercise echocardiography is a reliable noninvasive test (cheaper than invasive techniques) which provides valuable information on the existence, extent and intensity of CAD and myocardial stunning.

We present 5 cases that could not be diagnosed by chest X-ray and computerized thorax tomography (CTT), but which were diagnosed by echocardiography. Three patients underwend surgery. Sufficient findings were absent in the chest X-ray and CTT in the first patient, as well as in the chest X-ray in the second, fourth and fifth patients for diagnosis. The mass, considered to be calcified periardium by echocardiography in the first patient, was confirmed by surgery. The endodermal sinus tumor causing pericardial tamponade was visualized by echocardiography in the second patient, and the patient underwent emergency surgery. Consistent findings suggesting a cardiac hydatid cyst existed in echocardiography and CTT in the third patient. A paracardiac mass with pleural effusion in the fourth patient, which proved to be pleural malignant mesothelioma was visualized by echocardiography. Pericardial malignant mesothelioma was visualized by means of echocardiography in the fifth patient who was subjected to surgery urgently. Transesophageal echocardiography (TOE) was performed in one and CTT in 3 of these patients. In conclusion, transthoracic echocardiography (TTE) is a method which assists in the diagnosis of intracardiac and paracardiac masses to other methods. It plays an important role not only in the diagnosis but also in the localization of the mass and its preoperative assessment.

Medical publications originating from Turkey in 1993 and included in the Science Citation Index (SCI) database were evaluated quantitatively. Of all 1492 Turkish scientific publications listed in the CD-ROM SCI compact disk, 627 were identified as medical which represented a rise by 14% over the preceding year. Among them 366 were articles in full text; references to these articles are appended. Significant shifts were not noted in the distribution of the various medical fields. Cardiovascular medicine exhibited a level slightly above the mean with a total of 22 full-text articles. The relative performance of medical institutions in the three-year period 1991-93 showed that Hacettepe University led by far the universities of Istanbul and Ankara. Medical faculties of the universities of Gazi, Marmara and September 9th were the notable emerging institutions. Hospitals not affiliated with universities held a share of 13% in the publications.

An asymptomatic 8-year-old girl with measles was referred to the pediatric cardiology department with the suspicion of congenital heart disease. Doppler echocardiography revealed single atrium, mitral cleft and interrupted vena cava inferior. These were confirmed by cardiac catheterization. The cleft in the anterior mitral leaflet was repaired and an atrial septum was constructed with synthetic graft (PTFE). The case is reported because of the concomitant interrupted vena cava inferior and its relevance during operation.

In this article, we reported two patients with WPW syndrome treated by radiofrequency catheter ablation (RFA). The computerized BARD 24-lab system was used for electrophysiologic study (EPS) and atrial mapping. The catheter ablation was performed using radiofrequency energy delivered as a continuous, unmodulated sine wave at 350 kHz (Model RFG 3D, Radionics) between the distal electrode of the ablation catheter and a large skin electrode position on the chest. Case 1: A 43-year old male patient was admitted due to attacks of supraventricular tachycardia (SVT) resistant to medical treatment. The ECG showed WPW syndrome. The EPS revealed that the patient had orthodromic atrioventricular reentrant tachycardia (AVRT) using the left free wall accessory pathway. Utilizing a steerable quadripolar 4 mm tip electrode ablation catheter (7F, Mansfield), endocardial mapping localized earliest point of retrograde atrial activation to be in the mitral annulus during the orthodromic AVRT and right ventricular pacing. The local ventricular electrogram to delta wave interval was also used to determine the target area of the ablation. Fourteen 10-second 25 W applications of RF energies were unsuccessful. However, during the 15th energy application, the AVRT suddenly returned to sinus rythym and the delta wave disappeared, PR and QRS intervals returned to normal. Thirty minutes after ablation of the accessory pathway, the EPS findings confirmed the absence of conduction through the accessory AV connection. The echocardiogram was normal after the procedure. Case 2: A 36 year old male patient was admitted due to attacks of SVT resistant to medical treatment. The ECG showed WPW syndrome. The EPS revealed that the patient had orthodromic AVRT using the right free wall accessory pathway. Utilizing a streerable quadripolar 4 mm tip electrode ablation catheter (7F, Mansfield), endocardial mapping localized earliest point of retrograde atrial activation to be in the free wall of the right atrium during the orthodromic AVRT and right ventricular pacing. The local ventricular electrogram to delta wave interval was also used to determine the target area of the ablation. Five 10-second 25 W applications of RF energies were unsuccessful. However, during the 6th energy application, the delta wave disappeared, PR and QRS intervals returned to normal. Thirty minutes after ablation of the accessory pathway, the EPS findings confirmed the absence of conduction through the accessory AV connection. The echocardiogram was normal after the procedure. No complication occured in both patients. During the 6 months of follow-up, the patient has not had symptoms of tachycardia, and the 12-lead ECG was normal. We confirmed that the radiofrequency catheter ablation of the accessory pathway may be an effective and safe method in the treatment of patients with WPW syndrome.

A 21-year-od woman who was pregnant for 4 months and had thrombosed single-disk tricuspid valve was treated with rtPA with a total dose of 100 mg infused over two hours in November 1993 in our department. Upon completion of the infusion clinical symptoms improved, and the tricuspid valve gradient diminished to a mean of 2 mmHg from 7-12 mmHg. The patient, discharged 14 days later asymptomatically, delivered on the 85th day of therapy a premature infant of 6-month gestational age with sectio who died 24 hours later. Necropsy confirmed ablatio placenta and prematurity without evidence suggesting an effect of fibrinolytic therapy. Thrombolytic therapy may materialise favorable results (as an alternative to surgery) in patients with thrombosed tricuspid prostethic valve.