Purpose: Technical demands of the Ross operation and two valves at risk have delayed acceptance. Its inercasing popularity in 90's was due to excellent long term results. The results of 18 consecutive patients who underwent Ross procedure and pericardial collar technique for right ventricular outflow tract reco ns truction (RVOT) was documented in this article. Materials and Methods: Patient's ages ranged from 9 to 37 years (mean 16,2 ± 7,1). Three of them had prior open heart operation. Total root replacement technique was used in all patients. Aortoplasty were done in two patients with aortic root dilatation. Ross 1 Konno procedure was performed in 3 patients with subaortic stenosis and/or aortic root hypoplasia. We used homografts in 6 patients and stentless bio pros thes is in 12 patie nts for R VOT reconstructions. A special pericardial collar technique was employed to control some persistent bleeding from septal dissection site and to avoid damage to first septal artery. Additicnal mitral valve replacement was performed in one patient. Results: One patient died in early postoperative period due to low cardiac output. Comple te atrioventricular block was occurred in one patient and permanent pacemaker implantation was performed. A patient who undergone Ross and MVR, was reoperated owing to endocarditis. Other patients had uneventful postoperative course. Mean follow-up period was 15,2 ± 9 months (1 to 32 months) and all patients were well and in NYHA c lass I or II . Ro utine pos tope rative echocardiographic examinations showed normal aortic valve function or trivial aortic insufficiency (AI) in all but one patient who had mild to moderate Al. Conclusion: The Ross operation could be an alternative procedure for the presthetic aortic valve replacement in selected patients such as children, young adults and females. We think that pericardial collar tec hni que is a useful modif ication and stentless bioprosthesis may be a good alternative to homografts for RVOT reconstruction.

The most important determinant of the suceess of thrombolytic therapy (TT) is the amount of salvaged myoeardial mass rather than aceomplished vessel pateney. It has already been shown that the lack of tissue perfusion in the faee of restored angiographie flow may oecur after thrombolysis in some patients. One of the most important prognostic determinants of myocardial viability and function after thrombolysis is the degree of destruction of distal microvaseulature (DMV). Intraeoronary pressure measurement is a new teehnique to provide quantiative and funeti onal information about the collaterals and DMV. Quantitation and assesment of funetion of DMV are possible by determination of eoronary wedge pressure (CWP), collateral flow index (CFI) and the responsiveness of DMV to hyperemic stimuli (~P) . In this study we investigated the effects of TT on DMV by quanti tative measuring of the perfusion pressure, funetion and patency of DMV in patients with myoeardial infaretion (MI). Material and method. Thirthy patients after AMI with more than 70% stenosis and thrombolysis in myoeardial infaretion (TIMI) grade II flow in infa rct related artery who underwent PTCA and/or stent implantation proeedure w i thin 1 O day s of MI w ere included in this study. Fifteen of them had reeeived TT within 6 hours of their symptom beginning. After angiography fiberoptie pressure ınonito ring guideTiirk wire (Pressure Wire - Radi) was advanced and positioned distal to stenosis. Proximal and distal pressures were recorded simultaneously under basa! and hyperemic conditions. During total occlusion with balloon, distal pressure was recorded as CWP. CFI was determined by the ratio of simultaneously measured CWP to aortic pressure. Capabil ity to increase pressure gradient (achievable t.P) or with an other word, responsiveness of DMV was assessed by substraction of resting pressure gradient from provoked (hyperemic) pressure gradient across the lesi on. Results. Mean CWP, CFI and t.P values were 27.7 ± 9.6 mmHg, 0.29 ± 0.09 and 22.3 ± 7.4 mmHg respectively in the group who had received TT (group I) and 18.2 ± 6.2 mmHg, 0.19 ± 0.07, 12.2 ± 6.8 mmHg in the group without TT (group II). Mean values of CWP, CFI and t.P were s ignificantly higher in the group I. The differences of these mean values were statistically significant (p<0.01, p

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This study aimed to evaluate and compare C-reactive protein (CRP), interleukin-6 (IL-6) and activated T lymphocyte (ATL) levels of 14 patients with unstable angina pectoris (UAP) of Class IIIB (13 male, mean age 62±8 years) within the first 24 h after chest pain (early period), within 3-5 daysafter the control of ischemic pain (in termediate period) and within 14-2 1 days fo llowing the revascularization procedure (Iate period). CRP levels were 3.53±2.83 mg/di, 2 .67±3.28 mg/di and 1.22±1.08 mg/di in the early, intermediate and Iate periods, respectively. The difference between the early and intermediate, the early and Iate, and the intermediate and Iate periods were s ignificant (p<0.04, p0.05). The re w as a good re lation between the CRP and IL-6 leve ls of intermediate period (r=0.73, p<0.001)). Ischemia was controlled with optimal medical therapy in 8 patients (Group I) whereas medical therapy failed in 6 patients (Group II) in whom interventionaJ treatment was preferred. CRP Ievels of Group I and Group II w ere 2.45± 1. 73 mg/d! and 4.98±3.49 mg/d! (p<0.05), respectively in the early period, whereas the levels were 0.90±0.65 mg/d! and 5.05±3.94 mg/d! (p<0.006) in the intermed iate period and finally O. 78±0.46 mg/di and 1.80( 1.43 mg/di (p<0.04) in the Iate period. There was significan t differences in IL-6 levels of Group I and Group II in both the early and intermediate periods (12.3 1±7.72 pg/ml vs 24.26±13.29 pg/ml, p<0.03; and 10.76±5.84 pg/ml vs 26.25±20.50 pg/ml, p=0.03, respectively). However, no signif icant difference w as fo und between groups in the Iate period. A TL levels were comparable between groupsin the early, intermediate and Iate periods. Asa conclusion, these data suggested that; CRP, IL-6 and A TL !eve! s in patients with UAP were increased and there was an association between the increase in CRP and IL-6 levels and the severity of ischemia.

The frequency and the degree of fractionation of intraatrial recordings during atrial fibrillation (AF) have a correlation with the wavelengths and the size of the reentry pathways. We hypothesized that spectral ana lysis might help to explain the mechanism of antiarrhythmic drug- induced termination of AF. The frequency spectrum of monophas ic action potenti als recorded in the right atrium was ana lysed us ing Fast Fourier Transformatian (FFT). The maximal, minimal, first 5 peak frequencies and the width of frequency distribution within each 5 see segments were calculated before and after placebo (group C, n=7), ibut il ide 1.6±0.4 mg (group I, n= IO) or procainamide 1240±221 mg (group P, n= 10) infusion in 24 patients with AF. Age (66±9, 68±6 and 64±7), LA size (40±8, 44±5 and 46±4 mm) and LV EF (44± 11 , 43±7 and 40±11) were s imilar in group I, P and C, respectively (p>0.05). Ibutilide and procainamide decreased the peak AF frequency from 6.2±0.6 and 6.5±1.1 Hz to 4.3±0.3 and 4.5±0.8 Hz, respectively (p<0.00 1), whereas placebo had no effect on FFT. Ibutilide decreased the frequency of the peaks significantly within 30 see after each dose. In 3 patients in group I, AF terminated. Cardioverted patients tented to have a lower frequency at baseline than nonconverters (5.7±.3 vs. 6.4±.6 Hz). Ibutilide decreased the frequency of AF to 3.5±0.1 Hz before cardioversion. Conclusions: Fourier transformatian analysis of AF electrograms is a useful method for evaluation of the effect of drugs on atrial tissue. Ibutilide may decrease the frequency of AF to a critica! level before cardioversion.

Aim: Controversial results for the effect of chronic smoking on platelet aggregation response were found in different studies. In this study, the effect of chronic smoking on in-vitro pl atelet aggregation induced by various agonists were investigated in coronary artery disease patients. Methods and results: 121 patients (Group 1: 53 chronic smokers and Group II: 68 non-smbkers) who had elinical and Iaboratuary data of stable angina pectoris and contro lled unstable angina pectoris were included in the study. Platelet rich plasm of the patients was obtained before coronary angiography and in vitro treated seperately with adenosine diphosphate (10 ı.ım ol/L) , collagen (0.6 ı.ıgm/ml) and epinephrine (20 ı.ımoi/L) . Activation and duration of platelet aggregation slopes were measured and calculated for each agonist by Turbodimetric Method of Bohr. Activation ratios and duration of ADP, collagen, and epineprine induced in-vitro platelet aggregation response were s ignificantly more in Group I (p<0.05, <0.001 , <0.0001 for ratio of activation and p<0.05, p<0.05, p <0.00 I fo r d uration of activation respectively). Conclusion: Clinical studies investigaling effects of more potent antiaggregant drugs added to aspirin are needed in chron ic smoking coronary artery disease patients.

Prevalence of smoking habil was assessed in the 1 Oth year of follow-up survey of the Turkish Adult Risk Factor Study. In this representative sample of adults aged 30 or over, a total of 2455 men and women were evaluated for trends. In the period 1990- 2000, when adjusted for age, a reduction by 20% in men, and an increase by 14% in women was notedin the category of smoking. By comparison, the proportion of current smokers declined by ll% in men and rose by 1% in women. The !eel of HDL-cholesterol among smoking adults were Iower by 2.5 mg/di than nonsmokers, despite the fact that smokers were younger and slimmer. It was considered that, after adjustment for age and waist circumference, s ınaking might induce an HDL-variability by over 10%. Among participants free of coronary heart disease patients at baseline in 1990, in a prospective analysis by logictic regression of 9 baseline variables for coronary mortality, sınaking proved to be an independent determinant of borderline significance among men, exhibiting a relative risk of 1 .52.

Non-invasive esrimation of pulmonary artery pressure (PAP) by echocardiography is an important tool in routine elinical practice. The aim of the study was to investigate the application of color M-mode Doppler echocardiography in measurement of pulmonary artery pressure as a complementary method. We studied 68 patients (38 F, 30 M) who have normal right ventricular systolic function with a mean age of 36.2± 15.8 years. Of 68 patients, 44 were in sinus rhythm and rest of them in atrial fibrillation. During echocardiographic examination color baseline shift was adjusted to produce color aliasing and M-mode cursor was adjusted at the tips of the pulmonary valves to be as parallel the pulmonary flow as possible. After that, color Mmode Doppler (flow propagation velocity (FPV) cm/see) was measured as the slope of the aliasing velocity of the pulmonary flow. FPV measurement was successfully performed 59 of 68 (%87) patients from pulmonar artery. Pulmonary artery pressure were measured using tricuspid regurgitation jet (TRJ), and pulmonary flow acceleration time (PAT) me thods by ech ocardio graph y. Cardiac catheterization (CA TH) w ere al so performed to all patients for P AP measurement. As a result, mean PAP were obtain 33.0±14.2 mmHg, 37.2±12.7mmHg, and 32.9±16.2 mmHg by FPV, PAT and CATH methods, respectively. Also reasonable coefficients were obtained between FPV and TRJ, PAT, CATH methods (r=-0.71 , p

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It is well known that women (F) with acute myocardial infaretion (AMI) have a relatively higher risk for inhospital complications and mortality than men (M). But there are few prospective studies comparing the elinical characterist ics and prognosis of women and men with unstable angina pectoris (UAP). To evaluate the impact of fema le gender on elinical characteristics and prognosis of patients w ith UAP data (demographic and bas ic elinical characteri stics, in hospital and 30-day prognos is (mortal ity, nonfatal MI, recurrent 1 refractory ischemia and revascularization procedures)) of 81 consecutive UAP patients admitted to the emergency deparment of a tertiary cen ter were evaluated prospectively. 29,6% (n=24) of the patient population were female and avarage age was 58.2 in both groups. Sınaking (37 .5% vs 64.9%, p=0.03), hypercholesterolaemia (20.8% vs 47.4%; p=0.05) and prior revascularization (12.5% vs 43.9%, p=0,009) were less comman among women, prior MI was not different between the groups. Hospital admission rates after risk stratification was similar (F:75% vs M:78.9%). In hospit ilized patients inı urK 1\aratyot uer11111~ ~vv ı . L7 . .,vv -..,.v ..,. hospital ischemia (F:44.4% vs M:31.7%), coronary angiography (F:70.8% vs M:86%), multivessel disease (F:52.9% vs M:55.1 %) and in-hospital revascularization rates (F:27.8% vs M:24.4%) showed no difference among the groups. Women had less non-Q wave MI (5 .6% vs 15.6%), but the difference was not statistically significant. There were no deaths during the in-hospital phase. 30-day follow-up rates of both groups were similar (F:70.9% vs M:87.8%), as well as ischemia (F:41.2% vs M:26%) and revascularization rates (F: I 1.8% vs M:8%). There were no MI or death among groups. In conclusions, in our unstable angina population, women had lower rates of smoking, hyperlipidemia and prev ious revascularization rates compared to men and inhospital non-Q MI rates were lower in this group. Women in our patient population had a better prognosis regarding coronary morbidy compared with MI studies. This result can be related to the younger and better ri sk profile of the study populations as well as to different pathophysiologic and anatomic characteristics in UAP.

Publications in cardiovascular medicine originating from Turkey were identified from the data of Science Citation Expanded in the Web of Science with the purpose of assessing the progress of the output Meeting abstracts and Jetters to the editor, as well as journals only covered by the on-line version were excluded. A weighted credit system was utilized for articles publi shed jointly with a nonmedical or noncardiovascular institution. Publications in cardiovascular medicine consisted of 68 articles with full text, of which 8 involved pediatric cardiology and ll cardiovascular surgery. In addition 42 publications appeared in journals included in SCI Expanded only. Cardiologic publications from Turkey made up this year again an estimated world share of 5.3 per mille leading to the inference of a stabilization as compared to the performance in the 1 990s.

In patients with a family history of Marfan syndrome, the ineidence of recurrent aneurysm and dissection that involves the previous anastomotic site and /or ınore distal segments are higher than normal population. In our institution, during the last 6 years, 10 of 42 patients who underwent a surgical intervention because of aortic dissection and /or thoracoabdoıninal aneurysm had the diagnosis of Marfan syndrome. Two of them were sisters. The first patient previously operated due to infrarenal aneurysm was referred to our institution with the diagnosis of Crawford type IV thoracoabdominal aneurysm. The operation was performed by s iınpl e clamp and using autotransfusion techniques. The second patient with chronic type III dissecting aneurysın underwent to thoracic aorta replacement. Operation was conducted under partial femorofemoral cardiopulmonary by-pass for distal perfusion. During the early and Iate follow-up, we did not notice any neurological deficit or visceral organ ınalperfus ion. The first patient was presented with a sacculer aortic aneurysın 18 ınonths after first operation. However, we los t the patient perioperatively because of the rupture.We believe that the high risk of rec urrent aneurysm in this population necessitates close follow-up after the operation.