Recent observations suggest that the early diastolic velocity of the mitral annulus (Ea) is an index of left ventricular relaxation that is less influenced by left ventricular filling pressure. This study sought to eletermine the applicability of the combineel information obtained from transmitral Doppler flow and Doppler tissue imaging (DTI) for esrimaring left ventricular end-diastolic pressure (LVEDP). We included 85 patients who had coronary artery disease (CAD) in coronary angiography. Standard Doppler variables (E velocity, A velocity, E/A ratio, deceleration time and DTI variables (Early diastolic mitral annulus velocity [Ea], Iate diastolic velocity [Aa], and ratio of trans-mitral E velocity to mitral annulus Ea velocity) were assessed for their accuracy in predicting L VEDP> 15ınmHg. The ratio of E velocity to the other variables derived from the diastolic annular velocity did not provide better res ult than E/Ea. S ignificant corre lat ion was observed between the E/Ea ratio and L VEDP (r= 0.62 p lO detected LVEDP> l5 mmHg, with sensitivitiy of 85% and a specificitiy of 77%. Conclusion: Mitral E velocity, corrected for the influence of relaxation (i.e E/ Ea ratio), relates to L VEDP in CAD patients and m ay be u sed to estimate LV filling pressure.

In symptomatic coronary patients angiographically intermediate Jesions are commonly observed, and the decision to revascularize requires f urther evaluation of these stenoses. Intravasc ular ultiasound imaging is one of the ava ilable techniques to solve this problem. In 50 lesions in which quantitative coronary angiography showeel 78 49,0 ± 6,5 percent diameter stenos is, the quantitative and qualitative lesion assessments were performed using intravascular ultrasound. Percent cross-sectional area stenoses changed from 33% to 87%, and m ean plaque burden was 67 ,O ± 12,4%. As 18 (36%) lesions had plaque burden between 50% and 70%, 26 (52%) lesions showeel plaque burden over 70%. The lesion lumen cross-sectional area <4 mın2 was found in 30 (60%) stenoses. Lower plaque eccentricity index (0.4 ± 0,3) defined the eccentric plaque ınorphol ogy of these lesions. In 25 (50%) les ions the existence of a disease-free are with high eccentricity of the lumen was conspicuous. Soft and mixed plaques were frequently seen. Calcification was observed in 16%. Atherosclerosis was not founcl in 17 (34%) reference segınents, but plaque burden was >40% in 14 (28%) reference segınents. Ineffect ive arterial remodeling was found in 14 (28%) lesions. Compensatory dilation was revealed in 15 (30%). Plaque burden was lower in lesions with inadequate arterial reınodeling than in lesions with coınpensatory dilation. In comparison with the measurements of quantitative coronary angiography, intravascular ultrasound findings showeel hig her minimal lumen diameters (2,1 ± 0,5 ının, 1,8 ± 0,6 mm, p

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A nonsurgical technique to achieve a reduction in septal mass by producing septal infaretion using balloon catheter techniques has been described. We have treated 13 patients by this novel technique and are presenting the results of the procedure in this first series of patients in terın s of the early and midterm period. Between November 1997 and May 13 patients had ev idence of HOCM by echocardiography and symptoms of angina and dyspnea despite optimal medical treatment (Class III). The mean age of the pat ients was 55 ± 12 years. The m ean resting gradient in L VOT decreased from 42 ± 15 mmHg to 9 ± 7 mmHg. M ean follow-up was 10.5 months. SPECT, done 5 to 7 day s after the procedure showed that the mean septal perfusion defect size involved 6.2 ± 2.6 o/o of the left ventricle. The mean septal thickness decreased from 2.6 ± 0.4 mm to 1.9 ± 0.5 ının at one ın on th. Functional class iınproved in all the patients (eleven were in Class I, two in Class II). A coınplete AV block occurred in two patients, which ınade iınplantation of perınanent paceınaker necessary. Induced se ptal infaretion produces signif icant hemodynaınic iınprovement during mediuın-terın follow-up, and is associated with considerable improve ın e nt in sy ınptoıns and quality of life. Since the long-terın effects of these procedures are unknown, patients with severe symptoms should be candidates.

High reocclusion and restenosis rates with pri ınaı·y angioplasty (PTCA) had evoked the idea of primary stenting in acute ın yocard i al infaretion (AMI). In this study we evaluated the efficacy and safety of priınary stenting in AMI. Study group consisted of 82 patients who underwent priınary PTCA between October 1995 and.October 1998 and had subopti ınal or fai led outcome. Acute occlusion or an threatened occlusion or a 2:30% residual narrowing after PTCA was an indication for priınaı·y stenting. 85.3% of the cases were ınale and the mean age was 53.2 ± 7.78. Chest pain to admission time was 197.5 ± 44.9 min, admission to femora l puncture time was 23.5 ± 6. 1 1, admission to reperfusion time was 45.3 ± 29.1 min and duration of stay in catheheterization laboratory was 52.2 ± 25.4 min. Two stents were deployed in 2 cases and one stent in the remaining patients. High press u re (15.5 ± 3.01 mmHg) was u sed for stent deployment in all cases. Reference vessel size was 3.12 ± 0.21 mm, gained vessel size was 3.04 ± 0.22 mm and the residual stenosis was 8.3 ± 4.3 %. TIMI 3 flow was achieved in 81 cases. One patient died who underwent emergency CABG operation due to acute instent thrombosis. Recurrent ischemia or rei nfarction was not recorded during the inhospital period. Two cases required blood transfusion due to the groin hemotoma at the femoral access site. At the predischarge catheterization no restenosis or reocclus ion was recorded. Left ventricular mean ejection fraction was 57.2 ± 9.9 %. In conclusion, primary stenting is a safe procedure with optimal angiographic outcome in AMI. Outcome of primary PTCA was improved and hospital stay period was decreased due to the lower reocclusion, reinfarction and reccurrent ischemia rates.

Limited data exist on whether evaluation of segmental wall motion in addition to myocardial perfusion provides ineremenral information for identification of ischemic (IC) from nonischemic (NIC) dilated cardiomyopathy. Thus, we performed exercise Tc- 99m sestamibi gated SPECT imaging on 36 patients w ith ejection fraction <35%. Patients having 2:1 epicardial coronary artery with 2:70% reduction of luminal diameter at angiography constituted the ischemic cardiomyopathy group (group 1, n=20). Patients with no significant coronary artery disease constituted the nonischemic group (group2, n=l 6). Perfusion was graded on a 5-point scale (O=n o r ına l ; 4=absent uptake) and wall motion on a 4-point scale (O=akinesia/dyski nesia, 3=normal) us ing the 20- segment model. The sumıned stress score (SSS) was defined as the s um of the 20. segmental sc o res. By univariale analysis, variabtes which were found to be significantly different between IC and NIC were: SSS (25.5±7.6 vs 7.68±1.58, p

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Diabetes mellitus (DM) is a major risk factor for r estenesis after coronary balloon angioplasty (PTCA). Recent studies have shown that coronary stenting significantly reduces restenesis compared with PTCA alone. However, stili limited data exist on the effect of coronary stenting in diabetic patients. Therefore, we designed thi s study to compare the results of intracoronary stenting and PTCA in nat ive coronary vessels with diabetic patients in our clinic. Sixty-three (15.6%) of 404 patients who underwent PTCA had DM (PTCA group); 36 (19.5 %) of 185 who underwent intracoronary stent had DM. There were no significant differences in the baseline elinical and angiographic characteristics between the coronary stent and PTCA group. In the early period, there were no statistically s ignificant differences in procedural and elinical success and in-hospital major complications between the coronary stent and PTCA group. During 8 months elinical follow-up, in the PTCA group ineidence of cardiac events was significantly higher in the than intracoronary stent group (38% vs 13.9% p=0.02). Rates of mortality (3.2% vs 2.8%), nonfatal AMI (3.2% vs 5.6%) were similar in both groups. Rates of revascularization (31. 7 vs 5.6% p=0.005) w ere higher in the PTCA group. In conclusion, DM was found to be a risk factor for untoward cardiac events indicating restenesis at 8 months' follow-up of patients who underwent PTCA alone. However, it was not found to be a risk factor in patients with intracoronary stenting. Thus, intracoronary stent implantation appeared to be more suitable than PTCA in diabetic patients.

Fibrinogen values were measured and associations of fibr inogen levels with several coronary risk factors were investigated in the 1599 men and women of the 2575 adults vis ited in the third follow-up of the TEKHARF cohort. Plasma fibrinogen was measured by Behring turbidometry and validation of the results in a sample were done in a reference laboratory. Median age was 46 for men and 48 for women, respectively. Fibrinogen concentrations w ere independent of age in women but increased with age in men (0.1 g/L for every 5 years; r=0.29, p

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In order to evaluate the efficacy and safety of fenofibrate in Turkish people, 249 primary hyperlipidemic subjects, aged 31 - 74 years (mean 54±7), were treated with onee-a-day 250 mg controlled release fenofibrate following a lipidlowering diet. The efficacy and safety parameters were measured at baseline, on the 8th and the 12th weeks of therapy. After a treatment of 12 weeks, a decrease by 14.8% (p<0.0001), 13% (p

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The aim of our study was to evaluate the short and long-term results and coınplications of permanent pacemaker implantation after cardiac surgery and to analyze the elinical characteristics of the patient group. Fifty-two patients with permanent pacemakers, which were implanted after a cardiac surgery between April 1988 and December 1997, were analyzed retrospectively. Most of the patients, who necessitated permanent pacemaker implantation postoperatively, had preoperative conduction disturbances (90%). In patients over 18 years old, the most common underlying operations were aortic valve replacement and mitral valve replacements with tricuspid valve replacement (17.3%), while in children it was surgery for correction of atrial septal defect, primum type (28.8%). The most common electrocardiographic diagnosis in the patient group was an escape rhythm secondary to an atrioventricular block with a narrow QRS complex (55.7%). At the end of the 1980s, in our hospital, VVI pacemakers and epicardial leads were implanted in these patients for the management of AV blocks occurring after a cardiac surgery. But recently endocardial leads, VVIR, DDDR, and YDD pacemakers have been implanted. Threshold values for epicardial leads were higher than those for endocardial leads, 0.99 V and 0.50 V, respectively, (p<0.002). The pacemaker pocket bernatorna was the most common acute complication (3.7%), whereas ventricular lead complication was the most common chronic complication (13.3 %).

Cardiac hydatid cyst is rare, and the most common involvements are left ventricular wall and septum ( ı ). Surgical exeision is the treatment of choice for cardiac hydatid cyst because of its possible fatal complications (2). Although the diagnostic value of transthoracic echocardiography (TTE) is well established, there are very few reports of the use of transesophageal echocardiography (TEE) as an aid to diagnosis and/or treatment (3-5). In this report, we present 2 unusual cases of cardiac hydatid cyst and discuss the role of TEE in the diagnosis and treatment.