Purpose: The aim of this study is to compaı·e the enclothelin levels between patients with slow coronary flow and normal healthy subjects, anel to investigate the relationship between endothelin-1 levels (ET -1 ) and correctecl TIMI frame co u nt (cTFC) between the two groups. Method: The resting ET- ı levels w ere compareel be tween two groups (in 31 pa tients with s low coronary flow (groupA) and 15 heaıthy subjects (group B). At the same time the relationship between ET -1 and cTFC w as al so investigated. Results: Resting ET-I levels were found significantly high in patients with slow coronary flow when compareel with healthy subj ects (4,35±1.3 pg/ml vs 2.52±0.5 pg/ml, p<0.01). When the coronary vessels were compareel with each other according to the TIMI frame co u nt and ET- ı levels, if the dominant slow coronary flow was especially LAD arte ry (cTFC highest), ET-1 levels were found higher in these patients than in the ones with dominant Cx (p<0.02) or right corona ry artery (p<0.03). (LAD; 5.826±0,75 pg/ml , Cx; 4, 12±1.17 pg/ml, RCA; 3.89±1.49 pg/ml). But if slow coronary flow was dominant in Cx or RCA artery, not signif icant relationship between cTFC and ET-I levels was detected. When patients were classified according to the number of the diseased vessels, ET-1 levels were found highest in patients with 3-vessel d isease (3- vessel; 5,78±1,2 pg/ml, 2-vessel; 4.23±1.16 pg/ml, single vessel; 3.41±0,7 pg/ml. p

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Intracoronary thrombus occurring by disruption of atheroscle rotic plague is the cause of acute coronary syndromes. Vulnerable atherosclerotic plaques were found to contain a large number of macrophages and T lymphocytes and that the seeretian of neopterin from activated macrophages increased in vulnerable plaques. Our study aimed to assess serum neopterin concentrations as an indicator of intracoronary plaque inflammation and their re ıation to coronary artery disease severity in patients with acute coronary syndrome (ACS). Consecutive 43 patients with chronic stable angina pectoris (group 1), 118 patients with ACS (group II) and age-matched 30 healthy subjects as a control group (group III) were enrolled in our study. Serum neopterin co ncentration was measu red with "enzyme-linked immunosorbent assay" technique. Selective coronary angiography was performeel all pa tients. Significant coronary artery disease was defined as >50% narrowing on coronary ang iogranı. Severity of coronary artery d isease was evaluated using Gensini score. Serum neopterin concentrations were found ı2.33±3.94 nnıol/L in group I, 22.46±6.75 nmol/L in group II, and 9.02±2.57 nnıol/L in group III. Serum neopterin levels were found significantly higher in ACS than in patients with chro nic stable angina pestoı·is (p0.05). We concluded that the !eve! of serum neopterin, an indicator of cellular immune activation in patients wi th acute coronary synd romes, inc reased considerably, and this ınay be u sed as a s ign of atherosclerotic plaque inflammation.

The purpose of thi s study was to compare the sensitivity, (+) predictive value (PPY), inter and intraobserver variability of published 7 a lgori thıns (Skeberis et al, Xie et al., Chiang et al. , Fitzpatrick et al. , Davilla et al., Adalet et al., and Arruda et al.) which were developed to localize atrioventricular accessoı·y pathways (AP's) in patients with the Wolff- Parkinson- White (WPW) syndrome. One h undred consecutive patients, diag nosed to have WPW syndrome from 1 2-lead electrocardiogram (ECG), who underwent successful radiofrequency catheter ablation of a single overt AP, were included in the study. The 12-lead ECGs were evaluated for two of each in diffe rent times by three independent and experienced electrophysiologist. The sensitivity and PPY was found to vary between 29-51% and 3 1-60%, respecti vely. Chiang's algorithm was shown to have the highest sensitivity and PPV amongst the 7 a l gorith ıns (5 ı % and 60%, respectively). In general, for localizing the APs, best results were obtained in left lateral APs (mean 70%). Adalet's algorithm had the highest sensit ivity to differentiate the right and left APs (75% and 77%, respectively). The PPY tended to be lower when delta-wave polarity was not included in the algorithm's architecture (34% and %43.3, respectively, p=0.045). The strongest correlation ininter and intraobserver variation was found in Chiang's algorithm (kappa=0.78-0.82 and kappa= 0.76, [%95 CI: 0.73-0.79], respectively), nevertheless Fitzpatrics's algorithm exhibited the weakest intra and interobserver agreement (kappa=0.56-0.72 and kappa= 0.40, [%95 CI: 0.36-0.44], respectively) . In conclusion, the sensitivity and PPY of the included a l g orithıns were clearly lower than those repor ted by the corresponding authors. Left lateral APs were the only pathways that could easily be recognized by all algorithms. The algorithms that included the delta-wave polarity was shown to increase PPY s. In o ur series, consisting of 100 patients with the WPW syndrome, Chiang's algorithın had the highest PPV and inter and intraobserver agreeınent aınong st all a lgorithıns. These findings should be considered when using these a lgorithıns in elinical settings or when building new ones.

Heart transplant patients need close monitoring of acute rejection in the postoperative period. Histopathological assessment of the endomyocardial biopsy (EMB) is essential for the diagnosis of acute rejection after heart transplantation. However cytoimmunologic monitoring (CIM) is a simple noninvasive method in the diagnos is of acute rejection which can be performed daily. In th is prospective study we investigated the efficacy of CIM in the early diagnosis of acute rejection in 13 cardiac allograft recipients. W e compared the data of CIM, EMB and the clinic status of patients. The sensitiv ity of CIM was calculated as 85,7 percent, the specificity 75 percent and the predictive value 85,7 percent We conclude that CIM helps timing of EMB and allows for reduction of its frequency. However, according to its lim ited help, it should be used together with other methods of rejection diagnosis.

The main objective of this study was to investigate the extent of coro nary artery disease by using the effect of nitroglycerin on aortic stiffness. Two study g roups were composed according to coronary angiographic results. 21 patients having single vessel disease and 22 patients multivessel disease. Pulse pressure, aortic diameter change, aortic strain and distensibility were used as aortic sti ffness parameters. Antianginal medications were withheld 48 hours before the study.The patients were allowed to use sublingual nitroglycerin as necessary, but caution was taken that no nitroglycerin medication was performed within 3 hours of its adıninistration . Echocard iographic assessment was performed in all patien ts before and at least 5 ın inute s after intravenous nitroglycerin administration. Results: Nitroglycerin exerted an increase in aoıtic diameter change ( 1.1±0.5 versus 1.6±0.6 before and after nitroglycerin , respectively; p=0.002) and aortic strain (6±3.51 vs. 9±4 before and after nitroglycerin, respectively; p0.05). As compared to findings before nitroglycerin administration, the improvement of the elasticity properties of the aorta with nitroglycerin may be helpful to d eter ın ine the extent of coronary artery disease.

Indications of implantable cardioverter defıbri llator (ICD) implantation, which have been shown to be effective in prevention of sudden death res ul ring form ve ntric ul ar tachyarrh ythmia, were progressively widened especially during the last decade. Most of the avail able ICDs possess "antitachycardia pacing" properties. ATP comprises some algorithms that prevent degeneration of ventricular tachycardia into ventricular fibrillation, and need to defibrillation. As a consequence, ATP therapy, which has been proved to be effective and safe in most patients, provides a better qual ity of life by decreasing the need for shock therapy aside that it sav es battery energy. In this article, usage of ATP, safety and efficacy of different ATP algorithms is reviewed.

Double-o rifice mitral valve is a rare congenital anoınaly . Although it is more frequently associated with other cardiac abnormalities, it may occur as an isolated lesion. There are two forms of ın yocardial noncompaction: isolated and non- isola ted myocardial noncompaction_ Nonisolated myocardial noncompactions are occasiona lly re ported postnatally in association with congenital heart anomalies such as VSDs, pulmonic stenosis, and ASDs. To our knowledge, this is the first case reporting a double orifice mitral valve associated with nonisolared myocardial noncompaction.

A 52-year-old man who had an acute abdeminal pain was hospitalized and treated at the department of general surgery with the diagnosis of "acute cholecystitis". His ECGs, recorded during his first admission in the emergency service, was evaluated retrospectively for a study project_ An incomplete right bundle-branch block and ST segment elevation in V ı-3 leads were found. The patient underwent a detailed investigation considering a possible diagnosis of the Brugada syndrome. No change was observed in the ECG f indings during the provocation test with propafenone infusion and no ventricular tachycardia was induced during electrophysiological study. There were no similar find ings in the ECGs of the family members. This case is reported because of the rarity of the Brugada syndrome, and the possible diagnostic investigations in asymptomatic cases with the ECG findings of th is rare elinical situation were discussed. Key words:

Pulmonary arteriovenous fistu la is a rare anomaly, almost always assoc iated with hered itary hemorrhagic telangiectasia. It can le ad to 1 ifethreatening co ınplica tion s if und iagnosed or untreated. The most striking elinical findings for diagnos is are due to hered itary hemorrhagic telangiectasia which acco ın pan ies pulmo nary arteriovenous fistulas. W e report bilateral pulmonary arteriovenous f istulas in a case without hereditary hemorrhagic telangiectasia.

Pulmonary valvuloplasty was performed in a 51- day-old, 2 160-g baby wi th the diagnosis of pulmonary atresia with intact ventricular septuın after perforating the pulınonary valve with the stiff end of a guide-wire. This type of technique and perforation of pulmonary valve in such a smail baby has not been reported before in Turkey.