One of the undesirable long term complications of the superior vena cava-pulmonary artery anasıomosis (Glenn shunt) is the formatian of pulmonary arteriovenous fistulae (PA VF). To dernonsırate the use of contrast echocardiography for the detection of PA VF in patients w ith a previous classical or bidirectional Glenn shunt and examine the prevalence of PAVF in this special population, 12 patients aged 21-38 (mean 28±4.8) years were prospectively evaluated by contrast echocardiography 4-33 (mean 24±9) years after the operation. ll patients had cardiac catheterization and angiography, 6 patients had magnetic resonance imaging, the results were compareel with the echocardiographic findings. Contrast echocardiography showeel evielence of PA VF in 7 of the 12 patients, w ith ap pearan ce of echo contrast in the left atrium 1-8 seconds after an upper extremity peripheral venous injection. Simultaneous appearance of microbubbles in the right atrium was due to residual communication betwPen the superior vena cava and the right atrium in 2 patients and presence of C'() Ilaterals between the superior and inferior venae cavae in one. In patients with PAVF, arterial oxygen saturations at rest (51-94 °t , mean 75±15.3 %) and on exercise (23-91%, mean 53±24.2%) were significantly lower compareel to patients without PAVF (p<0.005). Pulmonary hypertension in the contralateral lung was more common in patients with PAVF (mean left pulmonary artery pressure 22-110 mmHg, p=0.014). In patients with cavopulmonary anastomoses, PA VF occur frequently in the long term and are associated with worsening systemic arterial desaturation. Contrast echocardiography should be included in the regular evaluation of these patients as a simple and sensitive technique for the detection of PA VF, particularly when inercasing cyanosis develops.

Fetal echocardiography has been used in demonstrating fetal heart since 1970. However, the crossectional view of the heart could only be studied since 1980. In this study, intrauterine development of the chambers of the heart and great arteries were analysed. Two hundred-fourty pregnant women whose gestational ages were verified as 16-40 weeks, were included in the study. The cases were divided in 12 groups, showing periods of two consecutive gestational weeks, each including 20 subjects. The length and width of the heart chambers, wall thickness, volumes and sizes of the heart chambers, diameter of the aorta and pulmonary artery of the fetus were evaluated by echocardiography. It was roted that the dimensions of the heart chambers, the wall thickness, the volume and size of heart chambers were increasing increasing linearly but not exponentially during the gestational period. The ratios of the diameters of the right ventricle to the left ventricle, the right atrium to the left atrium. The ratios of the pulmonary artery to aorta and relative wall thicknesses were consistent with the gestational weeks. Right ventricle, right atrium and pulmonary arterial structures were shown to be slightly more dominant than the left side.

Pacemaker system infection is a potentially serious problem throughout long term follow-up after implantation. We report about thirtysix patients with infected pacemaker systems between 1985 and 1995. There were more than 1800 new pace makers implanted and 36 patients treated for a pacemaker infection in this period. Indications for initial implantation of a permanent pacemaker were: total AV block in 24 cases (66 %); sick sinus syndrome in 6 cases (17%); Wenckebach phenomenon in 3 cases (8 %); carotis sinus syndrome in 2 case (6 %); sinus bradycardia in one case (3%). Pocket infections were treated in 24 patients (67%) with immediate implantation of a contralateral new pacemaker (Group A) (lead was removed by simple traction in seven patients (29%) and shortened in all the others (71 %), in one patient with reimplantation an old one in the same pocket. Infected pacemaker systems were removed by cardiopulmonary bypass in eight patients and endovascular techniques in one patient (Group B). In this group, a simultaneous implantation of a new pacing system was performed in seven patients (78%) with a total of one endogenous and six epicardial electrodes. In each group, two patients have not required pacemaker reimplantation anymore. Bacteriological results of patients were: no growth in 17 cases (47 %), Staphylococcus coagulase (-) in 11 cases (31 %), Staphylococcus aureus in 4 cases (11 %), Streptococcus equisimillis in one (3%), Pseudomonas in one, penicillin resistance Staphylococcus in one (3%), mixed infection with Enterobacter, Citrobacter, Klebsiella in one (3%). The length of time from the last pacemaker procedure to onset of infection ranged from 1 month to 11 years (mean 31±36 months); the range from onset of infection to surgical therapy was 1 month to 7 years (mean 7±17 months). Longtime follow-up could be obtained from 35/36 patients (97%) and ranged from 1 month to 10 years (mean 76±50 months), there was no early hospital mortality and the postoperative period was free of complication. Hospital stay was ranged 1 to 49 days (mean 10.9±10 days). Antibiotic treatment was given to nineteen patients (53%) after discharge from the hospital. Six pati ents died due to unrelated causes between 5 weeks and 7 years after implantation. Actuarial survival at 10 years is 81 %. If explantation of leads by closed methods in unsuccessful or contraindicated, surgical intervention (cardiopulmonary bypass, inflow occlusion, purse string technique) is mandatory in patients with persistent infections (septicemia, endocarditis).

From April 1990 to June 1995, 8 patients underwent early surgical repair of infarct-related ventricular septal supture. Mean age was 65.4±5 (range 57-72) and 50 % of the cases were male. One patient had a previous anterolateral and inferior myocardial infarction and apical aneurysm formation. All patients underwent bedside transthoracic echocardiography, cardiac catheterization and coronary angiography. The time period between the admission to the hospital with the diagnosis of acute myocardial infaretion and the operation ranged from 36 to 288 hours, with an average of 101.5±74.2 hours (4.2±3 days). The time interval from the first elinical manifestation of interventricular septal rupture to surgery was 39.5±17 hours (range 16 to 72 hours). The site of rupture was anterior in 5 (62.5 %), and posterior in 3 (37.5 %) patients. IABP was used preoperatively in 5 and postoperatively in all patients. Cardiogenic shock was present in 3 patients an 2 of them could not be weaned from cardiopulmonary bypass. Cancomitant coronary artery bypass grafting was performed in 4 (50 %) patients. The overall hospital mortality was 37.5 %. In a follow-up period of 30±18.4 months (range 7 to 60 months) ı patient was reoperated for residual shunt (20 %). There was no lated death. Early surgical repair of infarct-related ventricular septal rupture, despite its high mortality, is the treatment of choice because it provides acceptable Iongterm survival.

Cardiac rhabdomyomas occur exclusively in infancy and childhood and result in myocardial depression, inflow or outwlow obstruction, rhythm and conduction disturbances. We report a case of cardiac rhabdomyoma in a 42-year-old woman. Her presenting symptom was heart failure. A diagnosis of heart tumor was suspected by two-dimensional echocardiography which showed a left ventricular mass and pericardial effusion. The diagnosis was confirmed by right atrial biopsy.

Intravenous Ieiomyomatosis is considered to be a rare neoplastic disease usually arising from uterine myomata. Mortality from this condition is usually the result of intracardiac involvement. The case of a 42-year-old woman is reported who had undergone hysterectomy for uterine myoma and in whom intravenous leiomyomatosis extended into the inferior vena cava and right atrium. The histologically benign tumor was excised from the right atrium and suprahepatic portion of the inferior vena cava. Though at the subsequent laparotomy the tumor invading the infrarenal inferior vena cava and the right common iliac vein could not be completely extirpated because of adhesions, the patient was asymptomatic at 14 months of follow-up.

Among survivors of the nationwide cardiac survey conducted in the summer of 1990, 1102 women and 1058 men were followed up 5 years later in regard to the smoking habit. The same classification was adhered to during the interview with questionnaire in both surveys: never smoked, ex-smokers, current daily smokers of 1-10, 11-20 and over 20 cigarettes. In the cohort whose median age in 1995 was 44 in women and 45 in men, it was estimated that aging by 5 years would induce 31 men (or 34 women) per 1000 adults to reduce smoking by one category. In fact per I 000 men reduced smoking by a mean of 1.7 category which indicated that, after adjustment for agin, 36 per 1000 Turkish men reduced smoking in the preceding 5 years by 2 categories (equivalent to quitting for someone smoking close to a pack a day). By contrast, 43 per 1000 women started sm o king by a m ean of I .32 categories daily w hi ch, when age-adjusted, implies that 64 per 1000 Turkish 198 women increased smoking by an average of 1.5 categories. This trend was pronounced in the age group of average of I .5 categories. This trend w as pronounced in the age group of 25-34 years. Hence, it is estimated that between 1990 and I 995, total cigarette consumption by adults remained stable, smoking men currently numbering over 8 millions and women 3.6 millions. Among 575 nonsmokers aged 40 or over at baseline, 18 (3 .ı %) di ed from coronary heart disease over the subsequent 5 years, while 603 age-matched smokers and ex-smokers had 80 % excess risk (p<0.04), namely 5.6 percent The magnitude of the relative risk was in conformity with data obtained in industrialized populations.

We examined the effect of l-carnitine (LC) on left ventricular (LV) function in patients (pts) with a first acute anterior myocardial infarction (AMI) treated with trombolytic agents. Twelve pts who were treated with streptokinase (SK) within 6 hours of MI were given L 9 g/day IV for 5 days followed by 3 g/day orally for 3 months (group A). Eighteen pts treated with SK received no LC (group B). Wall motion indices (WMI) and LV diastolic volume indices (DVI) were echocardiographically determined at 5th and 10th days, and 1st and 3rd months. LV ejection fraction (EF) was measured by radionuclide ventriculography at respective times. No significant difference was found between the groups with age, gender, risk factors, the extent of coronary artery disease and the patency rate of infarct-related artery. In group A; WMI was measured 3.08±0.29, 3.41±0.4, 3.75±0.51 and 4.18±0.47 at 5th and 10th days, and 1st and 3rd months respectively. In group B; it was 2.91 was 2.91±0.31, 3.26±0.43, 3.41±0.42 and 3.75±0.51 respectively. There was a significant improvement with WMI at 3 months in both groups (36% increase in group A and 31% in group B), but the difference between the groups at respective times was not significant. In group. A; DVI was 55.5±11.1, 55±10.8, 56.5±14.4 and 54.9±11 ml/m2 and in group B; 58.5±9.8, 58.7±10.1, 59.1±11.4 and 60.7±14.7 ml/mg at 5th and 10th days, and 1st and 3rd months. No difference was observed both in the follow-up period in the groups and between the groups in respective times. EF values in group a were; 39.8±7.97% (5th day), 44.9±6.91 % (10th) day), 45.8±5.45% (1st month) and 52±4.76% (3rd month). In group B, respective EF values were; 37.8±8.11%, 42.5±79%, 45±9.23% and 46.8±9.36% EF at 3 months increased by 31 % in group A and 24% in group B. The difference at each time points in each groups was significant, but no significant difference was found between the groups. In conclusion, LC treatment in pts with MI and treated with SK resulted in no significant improvement in LV function.