QT interval dispersion is an attempt to measure noninvasively the propensity of the heart to support reentrant circuits. QT dispersion increases in patients with acute myocardial infarction (MI) and a quicker restoration of blood flow in the infarct related artery decreases QT dispersion. Effects of collateral blood flow on QT dispersion and the occurence of ventricular arrhythmias is controversial. This study addresses the relationship between collateral blood flow, QT dispersion and ventricular arrhythmias. Eighty- two patients admitted within 6 hours and underwent thrombolytic treatment due to acute anterior MI were enrolled in this study. Twenty-five patients with collaterals were compared with age and genderly matched fifty-seven patients without coronary collaterals. Maximum corrected QT interval (QTc max) and corrected QT (QTc) dispersion values were higher in patients without collaterals both on admission and on the 5th day post- MI than those with collaterals. Ventricular arrhythmias were also more common in the patients without collaterals during hospitalization. QTc max on the fifth day post- MI was positively correlated with age, QTc dispersion was positively correlated with age and degree of LAD stenosis. Logistic regression analysis showed that only the collaterals and QT dispersion values affect the development of ventricular arrhythmias. In the patients with acute MI, collateral formation to the infarct related artery leads to decrease in QTc max, QTc disp values. Furthermore, these patients with collaterals had much lower arrhythmic events. All these findings support that the collateralisation at the time of infarct will reduce QTc dispersion and risk of re-entrant arrhythmia. Finally, we suggest that the collateral formation has a protective role on myocardial electrophysiology.

Spontaneous echocardiographic contrast (SEC) is a frequent finding in patients with dilated cardiomyopathy (DCMP) and it is associated with embolic events when it occurs in the left atrium. However, little is known about SEC in the descending aorta (DA-SEC) and its associations with embolic events. In this study, we investigated the frequency and clinical correlates of DA-SEC and its association with peripheral embolic events after 16-months? follow-up. Sixty-seven consecutive patients with DCMP (47 male, 20 female, mean age 60±11 years) underwent transthoracic and transesophageal echocardiography. Spontaneous echocardiographic contrast in the descending aorta was found in 26 patients (38%) and was associated with lower cardiac index (p<0,001), left atrial SEC (p<0.001), left ventricular SEC (p<0.007), larger aortic root (p<0.009), and complex aortic atherosclerosis (p<0.001). Age, gender, presence of coronary artery disease, diabetes mellitus and hypertension were not associated with DA-SEC in this study group. In multivariate analysis, factors that were associated with DA-SEC were aortic atherosclerosis (p=0.04) and cardiac index (p=0.009). Eight of the patients (12%) died due to sudden death or terminal heart failure and 5 patients (7%) experienced non-fatal cerebrovascular embolic events in the follow-up period. Four of the patients with clinical embolic events had DA-SEC, whereas aortic atherosclerosis was present in all of these patients. Other peripheral embolic events were not observed in the study group. Spontaneous echocardiographic contrast in the descending aorta can often be detected by transesophageal echocardiography in DCMP patients and is associated with aortic atherosclerotic plaques, higher frequency of SEC in other cardiac chambers and low cardiac index. Although total number of embolic events is not very high, they seem to be more likely associated with aortic complex or calcific atherosclerotic plaques rather than DA-SEC.

Diastolic dysfunction of hypertrophic or ischemic left ventricle causes an increase in ventricular enddiastolic pressure and left atrial size. In this situation, continuity of sinus rhythm and atrial contractions are of great value for the maintenance of cardiac output. The aim of our study was to investigate the relationship between P wave dispersion, which is easily measured on the surface ECG and used in assessing the risk of atrial fibrillation, and left ventricular diastolic function. In our study, a total of 133 patients were included (73 patients with diastolic dysfunction assessed by transthorasic echocardiography and 60 patients without). P wave dispersions were calculated by measuring the P minimum and P maximum values on the surface ECG. The relation between P wave dispersion and presence of diastolic dysfunction, its etiology, severity and echocardiographic measurements were investigated. P dispersion was 53±9 ms in patients with diastolic dysfunction and 43±9 ms in the control group ( p< 0.01). When the patients were grouped according to the stage of diastolic dysfunction, P dispersion was 48±7 ms in stage 1, 54±8 ms in stage 2 and 58±9 ms in stage 3. It was noted that as the severity of diastolic dysfunction increased, P dispersion also increased without reaching statistical significance (p> 0.05). When the etiology of diastolic dysfunction was considered, P dispersion was 53±8 ms in patients with ischemic heart disease, and 52±9 ms in patients with left ventricular hypertrophy and a significant difference was not present (p> 0.05). Hence, in patients with diastolic dysfunction, P dispersion increases but this increase is not related to the severity of diastolic dysfunction or its etiology. When clinical and echocardiographic parameters are taken into account, there was a weak but significant correlation only between P dispersion and left ventricular ejection fraction.

Magnetic resonance imaging, with its lasting technological development has been widely used in the diagnosis of heart and vessel diseases as a non-invasive imaging method in an increasing manner. Salient data were accumulated in recent years on the characteristics and advantages of this imaging technique in the evaluation of cardiovascular diseases. In this article, the role and practice of MRI in the diagnosis of congenital heart diseases as well as its importance in life-long follow-up and recheck of those patients operated in the early pediatric age were presented with a review of the literature.

A-44-years old man without prior history of cardiac disease was admitted to emergency department due to resting angina and transferred to coronary care unit with the diagnosis of unstable angina pectoris. Early invasive intervention was planned and the patient was transferred to cardiac catheterisation laboratory. Coronary angiographic examination revealed a 95% stenosis in proximal right coronary artery and subsequently coronary angioplasty was applied. After the stent implantation an intracoronary filling defect was observed. Aspiration was applied with a guiding catheter and a thrombus was observed inside of the catheter after pulling back. The filling defect in the coronary artery lumen disappeared at the control coronary angiography. Three days later patient was discharged from the hospital.

Six months ago, a 23-year-old man who involved in an altercation and received a stab wound (SW) to the chest, medial to the left nipple, he was admitted to our clinic with 2-month history of shortness of breath. Transthoracic echocardiography and Doppler color flow imaging showed a large amount of pericardial effusion, aorto-left atrial fistula and a defect in the upper part of the interventricular septum resulting in a left to right ventricular shunt. Successful surgical treatment including pericardial drainage and closure of the defects with Dacron graft was performed. Postoperatively, a complete atrioventricular block was developed, because of its persistance permanent pacemaker was implanted. This present case illustrates delayed presentation of complex cardiac SW that did not cause acute symptoms, optimal diagnosis and surgical management of the defects.