Objectives: Three-dimensional real-time position management system (RPM) uses an ultrasound technique to display real-time movements of catheters, to construct anatomy of heart chambers, and to obtain activation/voltage mapping. This study presented our initial experience with the RPM system used for the ablation of supraventricular or ventricular tachycardias.
Study design: Ten patients (9 males, 1 female; mean age 30 years; range 20 to 75 years) underwent electrophysiologic studies and radiofrequency ablation using the RPM mapping system for the treatment of arrhythmias. Seven patients had accessory pathways, one patient had a slow pathway, and two patients had ventricular arrhythmias.
Results: RPM-guided radiofrequency ablation was successful in six patients (60%). Failure of ablation was attributed to the RPM system in two patients, due to catheter instability and difficulties in steering to ablate the left lateral accessory pathways, and to the localization and characteristics of arrhythmias in two patients. The mean operation time was 146±45 min (range 60 to 180 min), with a mean fluoroscopy time of 43±22 min. No complications occurred during or after the procedure.
Conclusion: The RPM system provides satisfactory anatomical construction of heart chambers, marking of anatomic and electrophysiologic spots, three–dimensional real-time positioning of the catheters and activation/voltage mapping. It can be used to guide radiofrequency ablation of atrial and ventricular arrhythmias.

Objectives: We evaluated the effectiveness of oral N-acetylcysteine (NAC) in the prevention of contrast nephropathy, when administered three hours before angiography in conjunction with parenteral hydration therapy.
Study design: This double-blind study included 81 patients (58 men, 23 women; mean age 62±10 years) with mildly elevated (1.4 mg/dl to 2 mg/dl) blood creatinine levels. Before elective coronary angiography, the patients were randomized to receive, in addition to hydration therapy (1000 ml 0.9% NaCl), 600 mg NAC before three hours and 600 mg NAC after six hours of the procedure (n=40) or placebo (n=41). Contrast nephropathy was defined as a 25% or 0.5 mg/dl increase in blood creatinine levels measured on Day 2 and Day 7 following the procedure.
Results: There were no significant differences between the two groups with respect to age, sex, risk factors, baseline creatinine levels, and the amount of contrast medium used. Creatinine levels significantly increased in both groups 48 hours after the procedure (p<0.05), but they returned to near-baseline levels on Day 7, at which time 20 patients (50%) in the NAC group, and 17 patients (42%) in the placebo group had the same or lower creatinine levels compared to the baseline. The incidence of nephropathy did not differ significantly (p>0.05); two patients (5%) in the NAC group, and four patients (10%) in the placebo group developed contrast nephropathy, all of which improved in the first week without the need for dialysis.
Conclusion: Hydration therapy is the most efficient way to prevent contrast nephropathy. Administration of NAC on the same day seems to provide no additional benefits.

Objectives: We investigated serum albumin levels and their association with insulin resistance (IR), metabolic syndrome (MS), coronary heart disease (CHD), and traditional risk factors among Turkish adults.
Study design: Serum albumin levels were measured colorimetrically in 1052 subjects representing the population of Western Turkey (Marmara and Central Anatolian regions), and were studied cross-sectionally. Metabolic syndrome was identified by modified criteria of the Adult Treatment Panel III.
Results: The median age was 53 years. Metabolic syndrome was identified in 44.7% of males and in 49.4% of females. The mean serum albumin level was 4.39±0.38 mg/dl in males and 4.34±0.33 mg/dl in females (p=0.01). In univariate analyses, serum albumin concentrations showed positive correlations with apolipoprotein B, HDL-cholesterol, and total bilirubin in both genders, a positive correlation with systolic blood pressure in females, and an inverse correlation with log CRP in males. In a linear regression analysis with 11 variables for serum albumin levels, age showed an inverse, and total cholesterol showed a positive independent effect in both genders. While smoking significantly affected serum albumin levels in females, this relationship was only of near significance in males. Other independent variables were serum creatinine in females (positive), and diastolic blood pressure (positive) and log HOMA (inverse) in males. In age- and sex-adjusted analyses, serum albumin showed no correlations with MS and CHD.
Conclusion: Independent of renal dysfunction, insulin resistance may contribute to low serum albumin levels in Turkish men and, in this context, may be playing a mediating role for oxidative stress and subclinical chronic inflammation.

Objectives: We investigated the alterations in oxidative and antioxidative status during coronary angioplasty and coronary angiography interventions.
Study design: The study included 28 consecutive patients (20 males, 8 females; mean age 58.4 years) who underwent elective percutaneous transluminal coronary angioplasty (PTCA) for a single coronary stenosis. Nineteen patients with normal coronary angiography comprised the control group. Coronary angiography and PTCA were performed according to the standard protocols. Blood samples were taken just before and at 1 to 2 hours after coronary interventions to determine parameters of serum oxidative status including total oxidant status (TOS), lipid hydroperoxide levels, and oxidative stress index (OSI). For antioxidative status, total antioxidant capacity (TAC) and total free sulfhydryl groups were determined.
Results: Before coronary interventions, indicators of oxidative stress (TOS, lipid hydroperoxides, and OSI) were higher (p<0.001, p=0.029, p<0.001, respectively), and TAC (p=0.032) and free sulfhydryl levels (p=0.01) were lower in the PTCA group. After PTCA, TOS, lipid hydroperoxides, and OSI showed significant increases (p=0.016, p=0.002, p=0.003, respectively), whereas TAC (p=0.039) and free sulfhydryl levels (p=0.03) were significantly decreased. However, in the control group, none of the parameters changed significantly following angiography (p>0.05). In the PTCA group, a significant positive correlation was found between changes in OSI and total inflation time (r=0.554, p=0.002).
Conclusion: Our findings demonstrate that PTCA is associated with increased oxidative stress through ischemia-reperfusion effect, whose severity is related with total inflation time.

Objectives: We investigated serum bilirubin levels and their association with insulin resistance (IR), metabolic syndrome (MS) or its components, and coronary heart disease (CHD) among Turkish adults.
Study design: Serum bilirubin concentrations were measured in 1,052 male and female participants of a representative cross-sectional Turkish cohort living in the Marmara and Middle Anatolia regions. Metabolic syndrome was defined by modified criteria of the Adult Treatment Panel III.
Results: The median age of the cohort was 53 years. Metabolic syndrome was identified in 235 males (46%) and 253 females (46.8%). The mean serum bilirubin concentration was 0.59±0.34 mg/dl in males, and 0.53±0.34 mg/dl in females (p=0.004). Serum bilirubin levels showed significant positive correlations with serum protein, albumin, testosterone, age, diastolic blood pressure, creatinine, and folic acid, and inverse correlations with smoking, body mass index, and IR. Serum bilirubin was correlated with HDL-cholesterol only in males. Of these factors, obesity, IR (inversely), and diastolic blood pressure were the main independent covariates of serum bilirubin. Logistic regression analysis showed that IR was significantly associated with the bottom quartile of bilirubin (≤0.34 mg/dl) (OR: 1.91; 95% CI: 1.14-3.18), with a stronger association only in females (OR: 2.43; 95% CI 1.21-4.88). Bilirubin levels were not in significant association with CHD and MS.
Conclusion: Insulin resistance, but not MS components related with central obesity, was associated with low levels of serum bilirubin in Turkish adults. This relation is more prominent among females and supports the hypothesis that serum bilirubin possesses antioxidant function.

Osborn (J) dalgası, elektrokardiyogramda QRS kompleksini izleyen geç delta dalgası olarak veya küçük sekonder R dalgası (R') olarak izlenen kubbe görünümlü bir defleksiyondur. Soğuk ve karlı bir havada bilinci kapalı olarak bulunan 25 yaşında erkek hastanın elektrokardiyogramında normal ventrikül hızlı atriyal fibrilasyon, QRS kompleksi ve QT aralığında uzama ve tüm derivasyonlarda belirgin Osborn (J) dalgası görüldü. Hastanın rektal vücut ısısı 27.1 °C ölçüldü. Ayrıca, kraniyal tomografide sol parietal alanda subdural hematom saptandı. Subdural hematom ve hipotermiye yönelik tedaviler sonucunda 24. saatte çekilen EKG’de normal sinus ritmi sağlandı ve Osborn dalgaları kayboldu. Ancak, intraserebral patolojinin kötüleşmesi nedeniyle 30. saatte hastada beyin ölümü gelişti.

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. A 37-year-old woman who did not have any cardiovascular risk factor other than oral contraceptive use for 15 years developed acute myocardial infarction without ST-segment elevation. Coronary angiography revealed spontaneous coronary artery dissection involving a long segment (>5 cm) of the left anterior descending coronary artery from proximal to distal. Despite treatment, hemodynamic parameters worsened and left atrial pressure continued to increase. An intra-aortic balloon pump was placed and emergency coronary artery bypass grafting was performed. She was discharged on the seventh day of surgery without any complications.

Drug-eluting stents are widely used to prevent restenosis in de novo lesions, and for percutaneous treatment of in-stent restenosis. However, their long-term safety profile is still debatable. A 46-year-old female patient was admitted with acute inferoposterior myocardial infarction due to late stent thrombosis that developed after 168 days of implantation of two sirolimus-eluting stents for a restenotic bare metal stent to the right coronary artery. She had been receiving aspirin and clopidogrel, both of which were discontinued for five days for the preparation of a noncardiac operation. Tissue plasminogen activator with heparin and tirofiban was started immediately, which resulted in ST-segment resolution within 30 minutes. Coronary angiography after the completion of t-PA infusion showed TIMI III flow in the right coronary artery. The stents were fully patent and all the thrombus was lysed. Antiaggregant therapy with aspirin and clopidogrel was resumed. Long-term may imply life-time treatment with antiplatelet agents.

Positive inotropic agents such as beta-adrenergic agonists or phosphodiesterase III inhibitors provide significant hemodynamic benefits in the short-term treatment of decompensated heart failure, but they have unfavorable effects on survival in the long-term. Calcium sensitizer agents represent a new and different class of inotropic agents that increase cardiac contractility without increasing cAMP and intracellular calcium concentrations. Among them, levosimendan is the most potent drug with inotropic and vasodilatory effects. Preliminary studies showed that levosimendan was associated with symptomatic improvement, decreased mortality, and better tolerance in the treatment of both acute decompansation of chronic heart failure and acute heart failure following myocardial infarction. However, the results of larger studies recently published show that levosimendan is superior to placebo only in symptomatic improvement and is not favored over placebo or dobutamine with regard to its effect on mortality. Moreover, an increased incidence of arrhythmias have been reported. These data suggest that further studies are needed regarding the use of levosimendan.

Left intra-atrial supravalvular membrane is an unusual finding on echocardiography. We describe a healthy an asymptomatic male with mitral supravalvular membrane mimics vegetation. Undefined echocardiographic finding was revealed by tranosephageal echocardiography.