Objective: This study was conducted to evaluate early results of video -assisted minimally invasive atrial septa! defect closure and mitral valve surgery operations. Material and Methods: Between January ,and December 2002.8 atrial sepia/ defect (ASD) closure. 38 mitral valve replacement and 16 antral valve repair operations were performed (n=62). The concomitant procedures vere radiofrequency ablation procedure for the treatment of atrial fibrillation (n=31) and tricuspid valve repair (n=7). The mean age of the patients was 27±10,1 years in ASD group. 51.8±1/ years in mitral valve replacement group. 48.2±12.5 years in mitral valve repair group. The femalehnale ratio was 612 in ASD group. 28/10 in mitral valve replacement group and 1016 in mitral valve repair group. Mean ejection fraction was 45±7 %. Cardiopulmonary bypass was initiated via femoral artery, femoral vein, percutaneous juguler vein cannulation. Procedures were performed through a 4-6 cm. anterolateral right mini thoracotomy incision with the assistance of 5 mm. endoscope. Aorta was cross -clamped using a transthoracic clamp (Chitwood). and cardioplegic arrest was achieved via cmtegrade blood cardioplegia. Results:. Ischemic time was 39.1±14.2 minutes in ASD group. 102.2±29.4 minutes in mitral valve replacement group. and 111.1±23.3 minutes in mitral valve repair group. Total CPB time was 93.3±24.! minutes in ASD group, whereas 158±30.8 minutes in mitral valve replacement group and 166.6±24.1 minutes in mitral valve repair group. haensive care unit and hospital stay were 1 and 5±0.9 days for ASD group. respectively. 1.711.2 and 7.1±1.2 days in mitral valve replacement group and 1.8±1.3 and 8±1.7 days in mitral valve repair group. There was only one mortality due to pulmonary infection (1.6%). Myocardial infarction, neurological event or complication due to canmdation were not observed. There were 2 reoperations due to bleeding (3.2%). There were no procedure related complications. Transesophageal echocardiography at the end of the operation revealed competent mitral valves with no insufficiency in 14 patients and minimal regurgitation in hvo patients in the repair group and no leakage in ASD closure and mitral valve replacement group. Conclusion: Video assisted minimally invasive valve and ASD closure operations could be performed safely and efficiently. This technique provides better cosmetic and reliable surgical results with superior patient satisfaction. We can recommend this technique in selected group of patients.

Objective: In mitral stenosis. higher P wave dispersion has been shown to exist due to atrial dilatation and sympathetic overactivity because of reduced cardiac output. P wave dispersion is also closely related to atrial fibrillation. Our aim was to evaluate the effects of metoprolol and diltiazem on P wave dispersion (PWD), and on maximum and minimum P wave duration in patients with mitral stenosis (MS). Methods: All patients with MS in sinus rhythm were randomized into two groups, one of which was composed of 44 patients (36 women, aged 36±12 years) treated with metoprolol, and the other composed of 40 patients (35 women, aged 40 ±9 years) treated with diltiazem. Left atrial and left ventricular diameters, mean and peak transmitral gradientsdnitral valve area, and left ventricular ejection fractions were measured by transthoracic echocardiographic examination. Before and one month after treatment, P wave durations were measured manually under magnifying glass in twelve -lead ECG. Results: No significant difference was recorded between group I and group II in terms of baseline echocardiographic values. maximum P wave duration. minimum P wave duration. and PWD. In the metoprolol-treatment-group. we observed that maximum P ware duration. mininuun P wave duration. PWD and mean transmitral gradient were significantly reduced (p<0.0I ). In the diltiazem-treatment-group. a significant decrease was detected in PWD. mean transmitral gradient and maximum P wave duration but not in minimum P wave duration (p>0.05). In the two groups, the significant decreases in maximtun P wave duration. PWD and mean transmitral gradient were more pronounced in the metoprolol-treatment-group (p<0.00/). There were no statistically significant differences between the other parameters. Conclusion: Treatment with either diltiazem or metoprolol decreased in PWD and maximum P wave duration in patients with MS significantly, yet, this was more pronounced in the metoprolol-treatment-group

We evaluated the levels inflammatory markers in patients ıl'itlı coronary anery disease (CAD). The re /ationslı ip betı l'een e.rtelll ofatlıerosclerosis and inflammatory activity was also inrestigated in plllients ıı•itlı UliStab/eangina pectoris (AP) . Tlıiny- m1'0 patients ıvitlı unswble AP (Group /). 14 patients ıl'ith stable AP (Group ll) and /0 subject s ıııho had atlgiogropllicaly normal coronary arteries (Group lll) were included in the study. Coronary mıgiog raphy ıı·as petformed in all patients. Eight patients had single-vesse/ /esiom and 24 patients had multi-vessellesiolts in Group/. All ojpatients had multi- re.ue//esions in Group l l. Le ı ·els of eel/ ad!ıesionmolecules (VCAM-1. !CAM- I) and (C-reactire protein) ıı•ere determined as the ittf/annltOtOI"J markers in sennn and compareel mnong the groups. lnflanunatory m1arkers were signijicantly h iglı er in patiem1s ıvitlı coro1ıary anery disease e than normal subjects . In addition, these markers ıve re significantly lıigher im Group ! than Group ll (pOJJ5). In conclu.ı·ion. coronary artery disease. a clı ronic inflanınwtOI)I diJorder. tlı ere is activation oj acute in}7atnntation in patietus witlıtmswble AP. Ce// adlıesion mo/ecu/e.ı· ratlter than CRP uıay be tnore appropriate markers for the prediction of severity of CAD in the early stages of acute coronary syndromes.