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The sampling of midventricular flow has recently begun to be utilized for the evaluation of diastolic functions. This study was planned to evaluate the changes observed on the midventricular flow pattem in patients with diastoJic dysfunction and symmetric or asymmetric left ventricular hypertrophy (L VH). The groups consisted of patients with symmetric LVH(n=l7), asymmetric LVH (n=13) and the control group (n=lO). The left ventricular end-systolic and end-diastolic diameters, interventricular septum and posterior wall diastolic thickness and left ventricle mass index were measured from echocardiographic recordings whereas E andA wave velocity, E wave deceleration time, RE (time from R wave on the electrocardiogram to peak of the Doppler E wave), RD (time onset early diastolic flow), DE (defined as the time from onset of flow to peak of E wave), the peak velocity of A wave, and the intervals between the peak (RA peak) and end (RA end) of A wave were measured by PW recordings obtained from mitral valve and midventricular level. The differences between E wave velocity, RE and RD intervals for the study groups and the control group were significant (p<0.05) whereas the differences between the symmetric and asymmetric L VH groups were not significant. The intervals RA peak and RA end of mitral valve level and midventricular level were increased in the study groups (p<0.05). There was no significant difference between DT and DE intervals and A wave peak velocity for both levels (p>0.05).Hence, the diastolic flow patterns of mitral valve and midventricular level showed no signifıcant differences in the control group, but at the diastolic dysfunction states such as hypertrophied ventricles with augmented atrial contraction, the Iate diastolic flow velocity and interyals of samples obtained from mitral valve level or midventricular level showed significant differences.

The aim of this study is to compare the efficacy of dobutamine stress echocardiography (DSE) and exercise myocardial perfusion scintigraphy (MPS) for the noninvasive identification of coronary artery disease (CAD) in patients with left bıındle-branch block (LBBB). Thirty-one patients with complete, permanent LBBB (19 men, 12 women, mean age: 59±9) referred with different complaints (chest pain, shortness of breath, palpitation ete.) were evaluated prospectively. Patients with previous myocardial infarction, known to have valvular disease or cardiomyopathy were excluded. DSE, exercise MPS and coronary angiography were performed to all patients within 6 months by examiners who were blinded to other test results. Stress induced wall thickening impairment or worsening of wall motion in a normal or hypokinetic region at rest were regarded as i sche ıni a in DSE. The ischemic region was localized according to the coronary aıtery territo ı-ies. Exercise MPS was perfoı-med with Tc99m tetrofosmin in 20 patients and TI-201 in ll patients by either planar ()r SPECT methods. A reversible defect, more than 15%, at rest was considered as ischemia. The results were compared with the existence of >50% luminal diameter coronary stenosis in the angiographic examination. Eight patients (22%) had CAD in the angiographic study. Others had normal coronary arteries. Two of the normal coronary aıtery group had diffuse left ventı-icular dysfunction and one had segmenter wall motion abnormality. Sensitivity, specificity and diagnostic accuracy were 88%, 91%, and 90% respectively for DSE. Sensitivity, specificity and diagnostic accuracy were 75%, 96%, and 90% respectively forMPS. We conclude that both DSE and exercise MPS are accurate tests for the noninvasive identifıcation of CAD in LBBB patients.

Patients with supraventricular tachyarrhythmias ınediated by accessory pathways (AP) and refractory to medical therapy are treated effectively by radiofrequency (RF) catheter ablation technique. This safe and effective procedure has replaced the surgical interventions and direct current ablation previously used. Results of radiofrequency catheter ablation procedures in ı3ı consecutive patients with APs were here in reported. · Sixty.seven patients were men and 64 women with the ages ranging ı2 to 66 years (37.ı ± ı2.6). All patients had paroxysmal palpitations resistant to antiarrhythmic drugs which deteriorate their quality of the 13ı patients ll O had orthodromic 5 had antidromic AV reentrant tachycardia, ı2 had orthodromic and antidromic tachycardia, 4 had orthodromic taehyeardİa and atrial fıbrillation, ı had orthodromic tachycardia, antidromic tachycardia and atrial fıbrillation, and ı had only atrial fıbrillation. The AP conduction was manifest (WPW syndrome) in 109 patients (82%) and concealed in 24 patients (18%). There was one AP in ı29 patients and 2 APs in 2 patients. Seventy-three of the AP's (55%) were ıocated at the left free-wall, 48 (36%) were posteroseptal, 7 (5%) were right free-wall and 5 (4%) were midseptal. RF ablation w as successful in ı 14 of 13ı patients (87%) and ı ı6 of ı33 AP's (87%). The procedure was performed in one ses s i on in ı ı O patients and in 2 sessions in the remaining 2ı cases. Mean RF application number was 5 ± 4 (range ı-ı5), mean RF duration was 67 ± 43 second (range ı0-240), mean procedure duration was ı22 ± 56 minutes (range 30-240) and mean fluoroscopy duration was 37 ± 23 minutes (range ı0-90). In 3 patients (2.3%) minor complications occurred. These complications were minimal pericardial effusion, fever lasting for 72 hours and lower extremity thrombophlebitis. The patients were followed for 22.5 ± ı2 months. During this elinical recurrence was observed in 3 patients (2.3%) and successful repeat ablation was performed in one of these patients. The other two patients refused the second procedure. These results confırmed that RF ablation treatment is a safe and effective mode of treatment in patients with drug resisıant supraventricular tachyarrhythmias due to accessory pathways. Increasing experience in this area will lead to higher success rates

Life-threatening ventricular dysrhythmias mainly attributed to QTc prolongation have been reported in adults and children using cisapride, a prokinetic agent that facilitates gastrointestinal motility. Recent adult and pediatric case reports have suggested an association of malignant ventricular dysrhythmias with administration of cisapride in conjunction with drugs that inhibit its cytochrome P-450 metabolism. Therefore, we prospectively studied infants and children receiving cisapride without any concomitant drug, to analyze the time-related effects of cisapride on ventricular repolarization. Standard ı2- lead resting ECGs were obtained from 20 patients (mean age: 6.ı±4.ı years) before cisapride (0.8-1.2 mg/kg per day) therapy, and after 3rd, 71h days and ı month of therapy. The corrected QT interval (QTc), dispersion of QT and QTc (QTD, QTcD) were calculated. Data from these study patients were compared with a control group of 372 normal chil dren. There were no elinical adverse effects inciurling palpitations, presyncope and syncope reported during the study. Baseline QTc, QTD and QTcD measurements were not different from control group. Mean QTc values at 7th day and 1 month of cisapride therapy were significantly higher from the control group (p< O.Oı and< O.OOı , respectively). Mean QTc at 7th day and ı month of therapy were also found sig- nificantly higher than that of baseline value (p< 0.05, and < 0.01, respectively). Mean QTD and mean QTcD values during the cisapride treatment were not different from baseline values and controls. The results of this study suggest that cisapride treatment may cause prolongation of ventricular repolarization without causing increased heterogeneity of repolarization (QT dispersion). However, elinical significance of this prolongation is unclear, because all the patients in this study group have been asymptomatic without signs of dysrhythmia.

A 66-year old adult male with known dextrocardia required permanent pacemaker for symptomatic bradyarrhythmia associated with recalcitrant symptomatic congestive heart failure due to dilated cardiomyopathy with four chamber enlargement. Intrahepatic interruption of left-sided inferior vena cava with azygos continuation which made a !oop in the thorax before entering into an abnormally shaped right atrium, right-sided persistent superior vena cava and hepatic veins connected directly to right atrium from below were the associated systemic venous retum abnormalities demonstrated by repeat contrast injections.