This study sought to determine the value of a new method for visual and quantitative assessment of right ventricular involvement (RVI) in patients with inferior acute myocardial infaretion using Tc-99m Sestamibi gated SPECT imaging which allows simultaneous assessment of left ventricular perfusion and function. The study comprised 14 patients with inferior myocardial infaretion suspected of having RVI and 16 normal subjects. Diagnosis of RVI was confirmed with hemodynamic studies and a proximal right coronary artery lesion was detected on angiography in all 14 patients. After normal hemodynamic results were attained (mean 6th day), echocardiography and gated SPECT imaging were performed on the same day. In normal subjects, mean left ventricular end-systolic (ES) maximal counts w as 138± 13/pixel whereas right ventricular ES maximal counts was 48±8/pixel on circumferential profile analysis. The maximal value of color scale, assigned to highest counts of the left ventricle, was set to a value corresponding to the maximal right ventricular activity allowing clear visualisation of right ventricular in all cases. Perfusion was graded on a 5-point score (O=normal; 4=absence of tracer uptake), wall motion on a 4- point score (O=akinesis/dyskinesis; 3=normal) and systolic thickening on a 4-point score (O=absence of thickening; 3=normal) on ES images. A perfusion score ~2 and wall motion abnormality score ::; ı were defined as RVI. This method detected RVI in all 14 patients (100%). Moreover, quantitative analysis of segments with RVI revealed a significant reduction of Sestamibi uptake (m ean 1 9±6 counts/pixel) when compared to the lower limit of normal ES uptake (33 counts/pixel) (p

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This report comprises the analysis of follow-up data pertaining to plasma lipids and blood pressuı·c in the original cohort of the sample population of Turkey' s Marmara region obtained in the 1997 survey of the Turkish Risk Factor Study. Among a total of 518 participants (of which 256 men), plasma cholesterol and triglyceride values were measured by a Reflotron apparatus. Cholesterol concentrations were validated in a group of randam saınples and upward adjusted for the obtained systematic bias of - L.5%. Mean of two blood presslll·e measurcments performed in a standard fashion wcre usecl. Adjustment was made in the parameters for the aging of the cohort by 7 years with the purpose of assessing changes i ncuıTed independent of aging. Compared to baseline values in 1990, nett plas ına total cholesterol levels in 1997 eleclincd by 4.3 mg/eli in men and by 3 mg/eli in women. By contrast, mean fasring plasma triglyceriele levels inercaseel by 13.7 mg/dl in men, whereas this rise was not substantial in women (5.2 mg/di). When age was kept constant, systolic blood pressure rose 4-5 mmHg in cithcr gender. Diastolic pressure rose by 3 mmHg in women, while remaining unchanged among men. Thus, the global risk of the popul ation of the Marmara region appears to exhibit a tendeney to inercasing risk in systolic prcssure anel plasma triglycerides among men, and in systolic and diastolic pressures in women. Among hypertensive individuals, 38% were uneler antihypertensive medication, while only 6% of subjects having total cholesterol levels in excess of 220 mg/dl were using lipid-lowering drugs (all statins) indicating a large gap of treatment.

Single-lead DDD-pacing is possible if stable atrial pacing is achieved without diaphragmatic stimulation. A new pacing mode with "overlapping biphasic impulse" (OLBI) stimulation which significantly reduced atrial pacing threshold has been reported. In this study the performance of OLBI stimulation was evaluated. In 10 patients (5 mal e, age 63± 13 years) w ith complete or seconddegree AV block, single-lead YDD systems w ith an additicnal atrial OLBI stimulation capability were implanted. Temporary OLBI atrial pacing and diaphragmatic stimulation thresholds, P and R wave amplitudes, electrode impedence and ventricular pacing thresholds were determined during implantation, before discharge and during 1, 3, 6- month follow-up period. Mean atrial pacing threshold (2.6±0.6V) did not change significantly during 6-month follow-up. Mean diaphragmatic stimulation threshold was 5.9±2V at implantation, and it was over 4.8V at 6th month which was the highest voltage that the pacemaker could apply for atrial pacing. In conclusion, the feasibility of OLBI stimulation for stable atrial pacing without diaphragmatic stimulation using floating atrial electrodes of single-lead system was verified in 80 percent of patients during 6-month follow-up period.

The median age at start of follow-up was 0.25 years in 69 patients w ith muscular ventricular septal defect (VSD). The duration of follow-up in 80% ranged between 0.1 and 9.7 years. The diameter of the defect ranged between 1-9 mm, and decreased 1.58 mm (±1.60) in 51 patients during the study period. While the ineidence of pulmonary hypertension (PH) and L-R shunt was low, and spontaneous closure ratio was high (54%), in those with defect eliameter ~4 mm, the inverse was true for those with greater defects and non e closed spontaneously. All defects ~4 mm except one, turned to class la or dosed spontaneously, while in those 13 patients with a defect >4 mm, PH continued in 4, shunt remained large in 5 and decreased in 8. Qp: Qs decreased from a mean of 1.77 (±1.04) to 1.34 (±0.80). The most common localisation of muscular defect were apical and midtrabecular, 12 disclosed multiple defects (17.4%). The diameter of the defect was between J- 5.8 mm (mean 3.7) in 29 patients with apical VSD and decreased significantly by 1.60 mm in 23 patients. Qp: Qs decreased from a mean value of I .60 to 1.23 and spontaneous closure occurred in 10 (34.5%). Age at closure ranged between 0.08-13.67 years (median 0.23). On the other hand in 22 patienis with midtrabecular defects , the diameter of the defect ranged between 2-9 mm (mean 3.57) and decreased 1.82 mm. Qp: Qs decreased from 1.45 to 1.16, w hile spontaneous closuı·e occurred in 8 pat ients (36.4%). The age at closuı·e rangecl between 0.08 and 1.25 (median 0.61) years. At onset left-right shunt was mildin 60 out of 69 patients. Both PH and severe shunt were secn in only 7 and none of those closed spontaneously while L-R shunt decreased in 3. The PH in those 29 patients with mild shunting normalised in 13, the defcct dosed spontaneously in 14, and only two reınainccl in the same class. In the 31 patients without PH and mil d shunting, the clefect cl o sed spontaneosly in 1 O, and 21 remained in the same class. Inlet type of defect was observed in two patients in whom the dcfcct was closed surgically. The ineidence of spontaneous closuı·e was 24/69 (34.8%) in the total series. According to median values, the nıuscular defect closed spontaneously in the first 6 months of life. Cunıulative closuı·e ratio was 58% after age 1, 6 1% after age 8 and 64% during adolescence. The dcfcct elianıeter ranged between 1-4 mm in 24 patients whose defect elesed spontaneously (median=3 mm). Qp: Qs was < 1.5 in half of theın and age at closure ranged between 0.08 and 13.67 (median 0.38). It was concluded that prognosis depends not on the the localisation, but on the diameter of the defect.

High plasma levels of low density lipoprotein cholesterol (LDL-C) (>160 mg/dL) and low levels of high density lipoprotein eholesterol (HDL-C) (<35 mg/dL) increase the risk of premature coronary heart disease. The Turkish population appears to be unique in having unusually low levels of HDL-C that may be genetic in origin. In addition, many of the affluent Turkish men and women living in urban areas have elevated cholesterol and LDL-C levels and thus have very detrimental total cholesterol/HDL-C ratios <5. The present pilot study was undertaken to determine if low-dose simvastatin could improve this ratio. Nine Turkish men with HDL-C =35 mg/dL and total cholesterol/HDL-C <5.5 were treated with simvastatin, 10 mg/day, for 8 weeks. The LDL-C levels were dramatically reduced by 42%, a response typically seen only with higher drug doses. In addition, and surprisingly, HDL-C levels increased by 23%, an atypical result for statin therapy at any dose. These highly desirable effects lowered the mean total cholesterol/HDL-C ratio by 43%, from 7.5 at baseline to 4.3 after 8 weeks of drug therapy. These results suggest that low-dose simvastatin is particularly effective in Turks.

Balloon atrial septostomy (BAS) is a standard palliative procedure in neonates with d-transposition of the great arteries (TGA) and it has traditionally been performed in the cardiac cathetcrization laboratory. The cross-sectional echocardiography (echo) has been used to help during the procedure. During a period of 9 months, 12 patients, ll of thcm with TGA, admitted to our Clinics, underwent BAS under echo guidance. Their ages ranged 1- 55 days, and they weighed 2500-4400 gr. The intervention was realized in neonatal intensive care unit (ICU). Under local anesthesia and sedation with midazolam, 4 Fr. arterial sheath was inserted to femoral vein, thereafter was exchanged with 7 Fr. arterial sheath. BAS was realized with standard technic using 5 F Miller BAS catheter. While the diaınete r of interatrial co mınun icat i on ranged I -3 .2 mm. before septostomy, it reached 6.5 mm. on average and Oı saturation increased from 47% to 78 % in patients with TGA. The sheath was in the feınoral artery instead of vein in two patients, but no arterial coınplication was observed in both of tlıese cases. We observed nodal rhythın in one paticnt, and a supraventricular tachycardia in another. Both of them reverted spontaneously. The baby with TGA may need ınanagemen t in the ICU. Transferring the baby who is mechanically ventilated to the catheteri sation laboratory takes time and can be harınful for him. Moreover, it carries risk of ex tubation and heat loss. BAS und er echocardiographic guidance is an c ffcctivc alternative to the classical fluoroscopic proccdurc and is less time consuming under special circuınstances.

The role of high plasına total cholesterol and LDLcholesterol !eve! is well established in the process of atherosclerosis but this is not the same for triglycerides. The main lipids that acc uınulate in plasma in the postprandial state are triglyceride-rich lipoproteins_ Postprandial state is about 3/4 of a day and important interactions between lipoproteins occur at this time. Triglyceride-rich lipoproteins are chylomicrons, VLD and remmants of these lipids. Postprandial lipemia period involves the period during which the metabolism of these lipoproteins occur. It has been more than 40 years, since extensive research began on the role of these lipoproteins in the atherogenesis process. The data obtained from these studies show that postprandial lipids are associated with atheroma deposition and coronary events. Theoretically, in the presence of an erroneous metabolism of these lipids, the latter can i ntcracı with the vessel wall more closely and promote atherogenesis. They have close interactions with other lipoproteins and HDL, and they can directly promote atherogenesis by penetrating the arterial wall. Despite significant amount of knowledge obtained in this fie ld, further research is needed to belter elucidate the existing relationship between dietary intake, postprandial response and pathological events.

Pulmonary circulation of the blood was first deseribed by lbn al-Naphis (1210- 1288). He disputed Galen's view that the blood passes direetly from the right to the left side, because he found no poresin the septal wall (1268). He further added that after mixing with air in the lungs, the blood returns through the pulmonary veins to the left side of the heart and forms the vital spirit. After medical studies in Damascus, he practiced as Chief of physicians in Cairo and in Nureddin Hospital, Damascus. His notes on the "Canon" were translated to Latin for the Spanish Royal Library and probably have influenced Miguel Servetus (1511-1553) who mentioned in "Christianismi restitutio" that the blood is drivcn from the right ventricle over a long course through the lungs, is made flavus and thence passes from the arterial vein into the venous artery (1553). As proof against blood's nutrition function alone, he stated that the caliber of the arterial vein would not be so large, nor carry such a big aınount of blood. A later version of the pulmonary circulation was given by Andrea Cesalpino (1524-1603) prof. of medicine and botany at the Pisa University, Italy. Thesc three scientists were honored postally and the stamps are shown in the text.