1. | Summaries of Articles Pages 532 - 535 Abstract | |
2. | Long-term Survival Following Heart Transplantation Cüneyt KONURALP, Branislav RADOVANCEVIC, Cyndi THOMAS, Reynolds DELGADO, Rajko RADOVANCEVIC, O. Howard FRAZIER Pages 536 - 542 Objectives: The short and midterm success rates of heart transplanlation (HTx) are sufficiently well documented in the literature. However data related with long-term survival are limited. In this study, we reported our experience with adult patients who survived more than 10 yearsafter HTx. Methods: 306 adult patients were transplanred in our center between March 1983 and September 1989. 109 (36%) of them survived more than 10 years. Analysis of multiple factors is listed below. Results: The group included 94 men with 48±10 year-of age. Average survival was 12.2±1.4 y, with 91% still ali ve. Heterotopic HT was done in 7% of the patients and ı ı % were retransplanted. Patients with ischemic cardiomyopathy accounted for 4ı %, and idiopathic cardiomyopathy for 49%, with 19% UNOS (United Nations of Organ Sharing) status I patients. Pre-transplant ineidence of diabetes was 7.6%. Donor age was 2S±8 y. Patient/donor was mismatched for sex in 16.7%, race 40%, and cytomegalo virus (CMV) 43% of cases. Total HLA mismatch was 4.9±0.8 per patient. Ischemic time was 127±61 minutes. 14% of the patients underwent induction therapy with anti -lymphocyte preparation. Ineidence of rejection was 1.0±1.1 with 33.9% rejection-free. Posttransplanı CMV infection ineidence was 14.S% and total infection ineidence w as S3%. Ineidence of TxCAD w as 28.4% (31/109) in the first two years. Conclusion: HTx proves itself as a valuable form of treatment. It is obvious that with continuing advances in perioperative management and the development of more specific, less toxic immunosuppressive agents, satisfactory rates of long-term survival will be achieved. |
3. | Combined Medical and Surgical Treatment for Active Native Valve Infective Endocarditis: Ten-Year Experience Kaan KIRALİ, Mustafa GÜLER, Necmettin YAKUT, Denyan MANSUROĞLU, Suat N. ÖMEROĞLU, Bahadır DAĞLAR, Mehmet BALKANAY, Gökhan İPEK, Ömer IŞIK Pages 543 - 548 The ai m of this study w as to de termine the beneficial effect and outcome of active native valve infective endocarditis treated with combined medical and surgical treatment. This retrospective review involves 66 patients who have undergone operation for the diagnosis of active native valve infective endocarditis between January ı 98S and June ı 999. They were treated with antibiotic therapy before and after surgical procedure. The aortic valve the mitral valve and were each involved in 18 patients (27%) and both valves in 30 patients (4S.6%). Follow-up averaged 4 ± 3.4 years (range, 2 month to 12 years) and totaled 274. ı patients-years. The operative mortality was ı 2% w ith eight patients. The significant risk factors of early mortality were urgent operation, annular abscess, and preoperative shock. Late mortality was 10.3% with 6 patients. 2 patients (4%) required a subsequent reoperation. Actuarial survival was 80.S% ± S.So/o at S years and 64.7% ± 9.So/o at 10 years. Actuarial freedoru from recurrent infection was 94% ± 4.2S% at S years and 80.44% ± 9.79% at 10 years. Although surgical treatment of native valve endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. In active native valve infective endocarditis without severe complications, the optimal time for surgery is the end of antibiotic therapy. Combined medical and surgical treatment for active native valve infective endocarditis is associated with an improved survival. |
4. | Arterial Switch Operation in Transposition of the Great Arteries (Jatene Procedure) Bülent POLAT, Yalım YALÇIN, Kubilay KORKUT, Rıza KARACI, Ali KORKMAZ, Mert YILMAZ, Resmiye BEŞİKÇİ, Füsun BULUTÇU, Osman BAYINDIR Pages 549 - 556 Currently "arterial switch" procedure is the treatment of choice for the transposition of great arteries in most of the major surgical centers dealing with congenital heart disease. In this study we retrospectively examined our results for arterial switch procedure at the Florence Nightingale Hospital between August, 1997 and December, 2000. During this period 60 patients underwent arterial switch operation. The diagnosis was simple transposition in 37 and complex TGA in 23. In the simple transposition group 23 were operated before 15 days of age (early TGA group) and 9 patients underwent surgery between 15 to 45 days (Iate TGA group). Remaining 5 patients in simple TGA group (ages 30 days to 7 years) had two-stage arterial switch procedure. The mean age in complex TGA group was 9 months (18 days to 2 years). The overall hospital mortality was 13%. The mortality in both "early" simple TGA and complex TGA group was similar (9%). There was no mortality in the twostage repair group. However, in the "Iate" simple TGA group the mortality was significantly high (44%). We concluded that arterial switch operation that provides both anatomical and physiologic correction in TGA can be performed with low morbidity and mortality if appropriate preoperative evaluation , timing of surgery and postoperative management is applied. We believe the morta lity significantly increases in patients operated later than 15 days of age especially if the echocardiographic evaluation reveals unfavorable left ventricle morphology to recommend the "two-stage approach" in this patient population. |
5. | Evaluation of Left Ventricular Function and Myocardial Wall Motion by Using Doppler Tissue Imaging After Arterial Switch Operation Figen AKALIN, Ayşe SARIOĞLU, Tayyar SARIOĞLU Pages 557 - 564 Although arterial switch operation has become the first choice of treatment in patients with tran s pos ı t ı o n of great arteries, left ventricular function and myocardial wall motion abnormalities due to the transportation of coronary arteries are stili under investigation. Doppler tissue imaging can be used for evaluation of myocardial wall motion and contractility in various disease states. We investigated left ventricular size and function by using two dimensional, M-mode, Doppler and color Doppler echocardiography and measured the midmyocardial velocity of interventricular septum and left ventricular posterior wall during systolic ejection phase by Doppler tissue imaging in 21 patients, between 3 and 65 months, who had gone to arterial switch operation and in 16 normal children between 7 and 58 months. Left ventricu lar vo1ume was larger in patients (43.82±1 2.2 ml) than the normal children (37.72±7.76 ml) (p<0.05). Left ventricular mass was 81.5±17.2 g and 59.5±13.49 g in patients and normal children, respectively and the difference was s ignifican t (p<0.0005). T his diffe rence was more striking in patients who had two-stage operation. Left ventricular shortening fraction was within the normal range in most of the patients, and the mean value being 33.7±4.1% which was less than the control group (39±5%) (p<0.005). Ejection fraction and left ventricular circumferential shortening were also Jess than the control group. Accelerat ion time, ejection time, mean acceleration, acceleration time/ejection time ratio measured from the aortic Doppler flow were not different in patients and normal children. Twelve patients had mild and three had moderate neo-aortic valve regurgitation and all the patients with moderate regurgitation had two-stage operation. Interventricular septal motion was fo und to be paradoxical in I O of the patients by Doppler tissue imaging and the velocity of the posterior wall was greater than the normal children. In conclusion, although the elinical results of arterial switch operations are promising, there may be some differences of Jeft ventricular function and myocardial motion compared to normal children. Doppler tissue imaging is beneficial in th is group of patients for detection of myocard ial wall motion abnormalities. |
6. | Effect of the Magnesium Infusion on the Late Potentials in Patients After Acute Myocardial Infarction Sinan DAĞDELEN, Nevnihal EREN, Serdar SOYDİNÇ, Mehmet ERGELEN, Hasan KARABULUT, Nuri ÇAĞLAR Pages 565 - 570 Late potential (LP) in patients after myocardial infaretion (Ml) is widely used to identify patients at risk for malign arrhythmia. This study examined the effect of magnesium treatment on LP in patients after acute MI. Methods: The study group (SG) consisted of 26 patients who received 1 gr/day MgS04 infusion for the first five days, and the control group (CG) consisted of 15 patients who received placebo infusion after acute MI. Signalaveraged ECG and rhythm analysis were recorded on the 1" (first) and the 6'h (second) days after acute MI. Results: In the first and the second records, LP was found to be positive in 10 (38%) and 5 (19%) cases (p=0.13), respectively in SG with a relative reduction ratio of 50%, and 5(33%) and 4 (27%) cases (p=0.69) respectively in CG with a relative reduction ratio of 18%. In the first and the second records, QRS interval, Root Mean Square voltage (RMS40) and the duration of low amplitude signals (LAS40) were found to be 107.4±13.9 vs 99.3±14.2 ms; p=0.043, 32.9±19.4 vs 44.7±20.1 ).IV; p=0.035, 36.8±17.9 vs 27.6±12.8 ms; p=0.037 respectively in SG, and 110.4±12.0 vs 105.4±13.2 ms, 31.8±17.9 vs 39.1±18.7 ).IV, 39.2±14.8 VS 33.7±12.1 ms respectively in CG. Comparison of the SG and CG, shortening ratio in QRS interval (7.6±3.2 vs 4.6±4.4% respectively, p=0.03), increas.ing ratio in RMS40 (52.9±37 .8 vs 30.4±22.0% respectively, p=0.002) and reduction ratio in LAS40 (24.2±11.3 vs 12.6±11.7% respectively, p=0.004) were significantly higher in SG compared to CG. In comparison of the first and the second records, the ineidence of ;;::: grade II ventricular arrhythmia was significantly reduced (20 cases 77% vs 4 cases 15% respectively, p |
7. | Transcatheter Embolization of Congenital Coronary Arteriovenous Fistula Ümrah Aydoğan, Türkan Tansel Elmacı Pages 571 - 576 Between March, 1994, and J anuary, 2001, transcatheter fistula oc cl usion procedure w as performed in five children with the diagnosis of congenital coronary arteriovenous fistula in whom median age was 5.3 years (range 0.7 to 11.0). Surgical ligation procedure had been performed in one of these patients, but recanalization occurred during follow-up. Dilation of the feeding coronary artery of the fistula, due to increased blood flow, was observed in four of the patients. There was an additicnal aneurysmal sac formatian of the coromı.ry artery in one of these. Occlusion attempt was performed three times in one patient, twice in two patients and once in the other two. Detachable balloon was used for occluding the fistula in two patients and release control coils in the others. Complete occlusion of the fistula was achieved in four of the patients. In the last patient with normal coronary artery diameter, complete occlusion of the fistula was also achieved, which was at the distal end of left anterior descending artery; but attempts for the second one at the distal end of second diagonal artery was unsuccessful. Mild/moderate aortic valve insufficiency developed in this patient due to catheter manipulations for catheterizing this fi stula. As minor complication, femoral artery thrombosis developed in one patient, which was resolved with heparİn infusion. Our experience shows that transcatheter occlusion of congenital coronary arteriovenous fistula is feasible if proper occlusion technique is selected in each case. |
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8. | Pacemaker-related Endocarditis and Therapeutic Approaches İzzet ERDİNLER, Ayşegül KARAHAN, Utku ZOR, Ertan ÖKMEN Pages 577 - 583 Endocarditis related to pacemaker lead infection is a rare but serious complication. Diagnosis should be suspected in the presence of recurrent fever, local signs of infection in the pacemaker pocket and pulmonary lesions after pacemaker insertion. Coagulase- positive and -negative staphylococci are the responsible microorganisms in the majority of these infections. Transesophageal echocardiography is the method of choice for imaging a vegetation on an endocavitary pacing lead. The most efficient treatment to eradicate the infection is complete removal of the pacemaker system, either percutaneously or surgically. |
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9. | Case of Left Ventricular Pseudoaneurysm After Mitral Valve Replacement Melek ULUÇAM, Haldun MÜDERRİSOĞLU, Atılay TAŞDELEN, Muhteşem AĞILDERE, Ünser ARIKAN Pages 584 - 587 Pseudoaneurysm of the left ventricle, as an uncommon complication after mitral valve replacement, needs early surgical repair because of a high prevalance of rupture. Five years after mitral valve replacement, an aneurysmal mass with narrow orifice was determined at the posterolateral wall of the mitral annulus. Cardiac assessment was performed w ith echocardiography, magnetic resonance imaging and cardiac catheterization. The aneurysmal mass was resected by endocardial approach and the defect was closed with primary suture. Pathologic diagnosis was false aneurysm. |
10. | A Large Fusiform Aneurysm of the Left Main Coronary Artery: A Case Report Rasim ENAR, Alev ARAT ÖZKAN, Mustafa ÇALIK, Seçkin PEHLİVANOĞLU, İsmail YÜKSELTAN Pages 588 - 590 Coronary arterial aneurysms defined as dilated coronary arterial segments > 1.5 times the diameter of adjacent normal segments are classifİed as either fusİform or saccular. They may be due to a variety of infectious and inflammatory lesions, but they are most commonly associated with atherosclerotic disease and rarely involve the left main coronary artery. W e report the case of a 62-year-old man with two-vessel disease and a large fusiform aneurysm of the left main coronary artery. |
11. | Myocardial Bridging as Cause of Myocardial Infarction: Report of Case Göksel KAHRAMAN, Ertan URAL, Dilek URAL, Baki KOMSUOĞLU Pages 591 - 593 We present a patient who developed myocardial infaretion and finally left ventricular heart failure due to myocardial bridging. A 65-year-old male patient with diabetes mellİtus was admitted to the emergency department due to acute pulmonary edema. The patient had exertİonaJ dyspnea for 4 years, but did not have typical angina complaints. On ECG there was sİnus rhythm and incomplete left bundle-branch block. Echocardiography revealed lateral h ypokİ n esİa, mid and apİcal anteroseptal akİ nesia and an ap İca l aneurysm wİth probable mural thrombus. At coronary angiography myocardİal bridging was observed in a long segment of the mid-portion of left anterİor descendİng artery. Other coronary arteries were normal. Resting myocardial perfusion scintigraphy w ith Tl-20 1, disclosed a fixed perfusion defect matching with the distal part of the bridging. The patİent recİeved medical treatment for heart fai lure and died a sudden after recurrent hospitalizations. |
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