1. | Summaries of Articles Pages 326 - 329 Abstract | English Full Text |
2. | Clinical Value of Serial Transesophageal Echocardiography in Thrombolytic Treatment of Mechanical Prosthetic Valve Thrombosis Kenan SÖNMEZ, Cihangir KAYMAZ, Cevat KIRMA, Nihal ÖZDEMİR, Bülent MUTLU, Mehmet ÖZKAN Pages 330 - 340 Thrombolytic therapy (TT) for thrombosed prosthetic heart valves have been used as an altemative to surgical thrombectomy and valve replacement. However, diagnostic criteria, indications and delivery methods for TT have not been standardized. There do not exist definitive established guidelines for TT of obstructive type (O) prosthetic valve thrombosis (PVT), and may more debatable is whether TT is a reasonable therapy for nonobstructive type (NO) PVT. The aim of this study was to investigate the potential value of_serial transesophageal echocardiography (TEE) guidance for more effective and safer administration of TT in prosthetic valve thrombosis (PVT), and to investigate elinical importance of the morphological characteristics of PVT (obstruction, mobility) determined by TEE and fibrinolytic infusion protocol (fast vs slow) for TT success and complications. The study group consisted of 28 pts (F 18, M 10, mean age 36±12) who underwent 50 TT sessions for the treatment of 32 PVT (mitral 24, aortic 6, mitral and aortic 1, tricuspid ı ) episodes. Patients with obstructive (O) thrombus, and those with nonobstructive (NO) thrombus who either had a history of embolization or had a large thrombus mass (~10 mm base diameter and/or~5 mm mobile segment length) were accepted as candidates for TT. Streptokinase (SK) was the initial agent in all primary PVT episodes. In early experience (n=13) a total of 1.5 million units of SK was adınİnistered in 3 hours. In subsequent patients (n=14) a slow infusion of60.000-ıOO,OOO U/hr for a total of 15-24 hours was given. Urokinase (n=2) or rt-PA (n=7) was chosen for recurrent thrombus or in the case of failure of two subsequent SK sessions. The overall TT success rate was 88% (29/33) in all episodes, and were 88% (22/25) and 85.7 % (6!7) in mitral and aortic PVT episodes, respective1y (p>O.l). Complete TT success was achieved in pts with tricuspid PVT. The overall success rate was found to be unassociated with the valve types, thrombus morphology (obstruction, mobility), NYHA classes, and infusion protocol of SK. Complications of thrombolytic treatment w as see n in 6 ( 18.7%) 326 thrombotic episodes. Major complications included death in ı (3. ı % ), coronary embolization in ı (3. 1%) and cerebral embolization in ı (3. ı %) episode. Minor bleeding was noted in 3 (9.3%) of the episodes. Of interest all major complications occurred in the group that received the rapid infusion of SK as initial treatment. Conclusions: (ı) TEE has greatly improved the recognition of detailed morphologic characteristics of PVT, (2) TT success seems to be not different for the mitral and aortic valve trombosis, (3) prolonged fibrinolytic infusion protocol may decrease the ineidence of embolic ev en ts, ( 4) functional status (NYHA Class III and IV) of pts during TT does not tirnit successful outcome, and (5) not only fixed obstructive PVT, but also NO PVT still constitute an indication for TT because of tendeney for embolic events. |
3. | A New Approach to Assessment of Aortic Regurgitation; Planimetric Measurement of Diastolic Aortic Valve Malcoaptation Area by Transesophageal Echocardiography Nihal ÖZDEMİR, Cihangir KAYMAZ, Cevat KIRMA, Sibel ENAR, Hakan DİNÇKAL, Mehmet ÖZKAN Pages 341 - 347 Doppler echocardiographic calculation of regurgitant orifice area (ROA) is a different approach in the assessment of the severity of aortic regurgitation (AR), but these Doppler methods are based on indirect calculation of ROA, However, there is no available echocardiographic study in which diastolic coaptation defect of the regurgitant aortic valve measured by planimetry. The aim of this study is to evaluate AR severity by planimetric measurement of diastolic coaptation defect in patients who underwent transesophageal echocardiography (TEE). Diastolic coaptation defect was defined as diastolic aortic valve malcoaptation area (DA VMA). Study population comprised 90 patients (M 38, F 52, mean age 42±26) with AR which were gradedas mild (n=45), moderate (n=3 ı ) and severe (n=ı4) by hemodynamic assessment (HA). Mean values of DA VMA for each groups of AR grade were determined by TEE and cut-of limits which differentiate each corresponding AR grade from other grades were investigated. Mean DA VMA of mild, moderate and severe AR groups were O . ı5±0 . 05 , 0.29±0.08 and 0.68±0.21 cmı, respectively (mil d vs moderate P |
4. | TEE-guided Cardioversion is Feasible and Safe in Patients with Nonvalvular Atrial Fibrillation Zerrin YİĞİT, M.Serdar KÜÇÜKOGLU, Kemalettin ŞİŞLİ, Haşim MUTLU, Nilgün İNCESOY, Sinan ÜNER, Deniz GÜZELSOY, Muzaffer ÖZTÜRK, Vedat SANSOY Pages 348 - 353 Elective cardioversion (CV) of atrial fibrillation is associated with an increased risak for systemic thromboembolic events. The purpose of this study was to determine the feasibility and safety of transesophageal echocardiography (TEE) guided CV with short-term anticoagulation in patients with nonvalvular atrial fibrillation (NV AF). Two-hundred-fifty-two consecutive patients ( ı ı 7 men, ı 35 women, mean age 62.6 ± 10) w ith NV AF were included in the study. The inclusion eriterian was a elinical d uration of atrial fibrillation more than 2 days and less than ı year duration. Seventy-three patients underwent conventional transthorasic echocardiography (TTE) followed by 3 weeks of anticoagulation. Subsegmently 58 of them were converted to sinus rhythm (27 pharmacological, ı 8 electrical and 13 spontaneous). One- hundred and seventy-nine patients underwent conventional TTE followed by TEE. Six patients with evidence of atrial thrombi were excluded and received prolonged warfarin treatment. Patients in whon TEE revealed no atrial or ventricular thrombi underwent pharrnacological or electrical CV under IV heparin therapy followed by warfarin for ı month. Onehundred and sixty-seven patients had successful CV to sin us rhythm ( electrical in 7 ı, pharmacological in 71 , spontaneous in 25). All patients w ere followed up for one month after discharge. There were no documented thromboembolic complications during hospitalization or in the follow-up period. It is concluded that in patients w ith NV AF, TEE guided CV without previous long terrn anticoagulation is a feasible and a safe approach. |
5. | Prognostic Implications of Left Atrial Spontaneous Echo-contrast in Nonvalvular Atrial Fibrillation Zerrin YİĞİT, Serdar KÜÇÜKOĞLU, Haşim MUTLU, Sinan ÜNER, Vedat SANSOY, Muzaffer ÖZTÜRK Pages 354 - 357 Left atrial spontaneous echo-centrast (LASEC) has been shown to be associated with a history of thromboembolism. We studied the influence of LASEC seen by tronseophageal echocardiography (TEE) in patients with nonvalvular atrial fibrillation (NV AF) on subsequent thromboembolic events and on survival. The study group consisted of 172 patients w ith NV AF, mean age 63 ± ll , 8 men and 84 women. Clinical and echocard iographic data were collected at baseline and patients were progressively followed up, and all new thromboembolic events and deaths were documented. LASEC was present at baseline in 75 (% 43) patients. Two patients were excluded because of left atrial thrombus seen by TEE. The remaining 73 patients with LASEC and 97 patients without LASEC were followed up for a mean of ı5.5 ± 5.3 months (6 to 24 months). Groups were comparable by age, sex, risk factors and treatment protocols. LASEC (+) group had more patients with enlarged (>4.0 cm) LA and lo w ( <% 55) left ventricular ejection fraction . During the follow up, new thromboembolic events (8 cerebral, ı mesenteric artery, ı peripheral vessel) were detected in 8 (% ı ı ) patients with LASEC and 2 (% 2) patients without LASEC (p<0.03). There were no deaths during the follow-up. NV AF patients w ith LASEC, have a significantly higher risk of developing new thromboembolic events and may represent a subgroup which must be followed up more intensively. |
6. | Use of Cyanoacrylate Glue in the Management of Troublesome Cardiovascular Events Murat DEMİRTAŞ, Nuri KARABULUT, Rafet GÜNAY, Bülend KETENCİ, Murat A. KONUK, Murat AKÇAR, Sabri DAĞSALI Pages 358 - 361 We used commercially available cyanoacrylate adhesive in 10 patients for he management of 6 different troublesome situations. In the first case of type II aortic dissection, distal suture line was reinforced and distal false lumen was obliterated by direct topical application of cyanoacrylate glue. In two cases, right ventricular free wall rupture was repaired by gluing a pericardial patch. In another four cases, postoperative sternal union was reinforced by the application of cyanoacrylate to the sternal edges. Femoral artery wall invaded with epidermoid carcinoma was reconstructed by the aid of cyanoacrylate. Bleeding from the left ventriculotomy suture line after cardiac hydatid cyst enucleation was controlled by gluing teflon felts over the suture line. In the last case, abundant bleeding from the aortotomy suture line after aortic valve replacement on a fragile aorta was controlled by gluing a teflon felt areund the aortotomy. All patients recovered uneventfully and were discharged from the hospital in good condition. Commercially available cyanoacrylate is a new adjunct to cardiac surgery in the management of troublesome situations with documented safety and life-saving results with a negligible cost. |
7. | Effects of Ionic Versus Non-ionic Contrast Agents on Dispersion of Ventricular Repolarization Armağan ALTUN, Gültaç ÖZBAY Pages 362 - 367 Ionic versus non-ionic centrast agents are used for cardiovascular diagnostic and interventional procedures, and in general, are well tolerated. However a smail percentage of patients develop transient hypotension, bradyarrhythmias, ventricular tachyarrhythmias, or allergic reactions after injection of centrast agents. Ventricular tachyarrhythmias can be dangerous. QT dispersion in surface ECG reflects inhomogeneity of ventricular repolarization and therefore, as a marker for arrhythmia risk. This study was designed to evaluate the proarrhythmic effects of ionic (Ioxaglate) versus non-ionic centrast (Iopamidol) agents in patient with coronary artery disease (CAD). 33 male patients (age: 55.2±9.8 years) with CAD w ere performed coronary angiography. In all patients left ventriculogram preceded the selective injections in the right and left coronary arteries. Ionic centrast agent (Ioxaglate) was given to 16 patients, non-ionic centrast agent (Iopamidol) was given to 17 patients. Before and after left ventriculogram, all patients ECG's were recorded with simultaneous 6-channel-ECG from standard chest leads. High speed (lOOmm/s) and high gain (20mm/m V) ECG recordings w ere tak en and analysed later. All parameters were corrected for heart rate using Bazett formula. Statistical analysis was performed using paired Student-t test; all results are expressed as mean±SD. QTc dispersion (p=0.003), JTc dispersion (p=0.008), TTc dispersion (Tpeak-Tend) (p=0.014), QT dispersion/RR ratio (p=0.0002), JT dispersion/RR ratio (p=0.0015), JTa dispersion/RR ratio(p=0.033), and TT dispersion/RR ratio (p=0.005) were increased in ionic centrast agent (Ioxaglate) group. In non-ionic centrast agent (Iopamidol)"group; TT dispersion/RR ratio (p=0.043) was increased only. Complex premature beats and nonsustained ventricular tachycardia occured in 3 patients and 1 patient used Ioxaglate, in 2 patients and 1 patient used Iopamidol, respectively. Sustained VT or VF did not occur. These data suggest that the non-ionic centrast agent (Iopamidol) results in significantly fewer effects on electrophysiologic parameters, less increase on ventricular excitability than the ionic centrast agent (loxaglate). |
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8. | Transcatheter Radiofrequency Perforation in Pulmonary Valve Atresia with Intact Ventricular Septum in a Newborn Ümrah AYDOĞAN, Aygün DİNAR, Resmiye BEŞİKÇİ, Zeynep İNCE, Talat CANTEZ Pages 368 - 371 In a 4-day-old newbom with valvular pulmonary atresia with intact ventricular septum an open right ventricular outflow tract was created by means of interventional cardiological methods. Following an inadvertant perforation without sequelae or elinical symptoms, radiofrequency perforation and supsequent balloon dilation were performed. Because of severe right ventricular hypoplasia and residual pulmonary stenosis he needed subsequent systemic-pulmonary arterial shunt and reballooning of the pulmonary valve, respectively. The baby was discharged uneventfully after one month. |
9. | Primary Cardiac Rhabdomyosarcoma in Childhood: Case Report Ali Rahmi BAKİLER, Erhun KASIRGA, Esra ÖZER, Serap AKSOYLAR Pages 372 - 374 Primary, malignant cardiac tumors are extremely rare in childhood. These tumors are fibrosarcomas rhabdomyosarcomas, malignant teratomas and neurogenic sarcomas. The case of an ı ı -year-old boy with the elinical findings of cardiac tamponade is reported in whom a cardiac tumor was diagnosed by echocardiogram and cardiac magnetic resonance imaging. The tumor proved to be rhabdomyosarcoma on histopathologic examination. |
10. | Echocardiographic Detection of Thrombus in Pulmonary Arteries in Three Patients with Pulmonary Hypertension Secondary to Atrial Septal Defee! Cihangir KAYMAZ, Cevat KIRMA, Nihal ÖZDEMİR, Sibel ENAR, İlyas AKDEMİR, Mehmet ÖZKAN Pages 375 - 378 There are limited numbers of case reports canceming pulmonary arterial (PA) thrombus (THR) detected by transesophageal echocardiography (TEE), and these reports include cases with PATHR due to pulmonary embolism and primary pulmonary hypertension. In this paper, we report three (2 F,ı M, ages 6ı ,28 and 49) cases who had pulmonary hypertension secondary to atrial septal defect (ASD) and THR associated with spontaneous echo contrast (SEC) in abnormally dilated pulmonary arteries. Large ostium seeunduru type ASD was detected in two cases, and leakage of the sutured atrial septal patch in a third patient. Pulmonary artery systolic pressure of cases were calculated as ı70, 120 and 70 mm Hg, respectively. Thrombus was detected in right PA of first two cases, and in both right and left branches of PA of the third case. Concomitant SEC was also observed in all cases. To our knowledge, this is first report of thrombus in dilated pulmonary artery secondary to PHT associated with atrial septal defect. |
11. | Aneurysms of the Right Ventricular Outflow Tract After Tetralogy of Fallot Repair:Reconstruction with Pulmonary Allograft in 2 Cases E. Alp ALAYUNT, Tahir YAĞDI, Mustafa ÖZBARAN, Yüksel ATAY, Şenol COŞKUN, Ruhi ÖZYÜREK Pages 379 - 382 The right ventricular outflow tract aneurysm is an uncommon Iate complication of repair of tetralogy of Fallot Its development is primarily related to persistently high right ventricular pressure after repair. Two cases with residual ventricular septal defect and right ventricular outflow tract aneurysm after repair were herein reported. |
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