Objectives: Nosocomial bloodstream infections (BSI) cause significant morbidity and mortality worldwide. These infections occur two to seven times more often in intensive care unit (ICU) patients than in ward patients. The aim of this study was to determine the frequency of nosocomial BSI pathogens among patients admitted to our 18-bed cardiac surgical ICU (SICU).
Study design: We investigated SICU-acquired BSIs and associated pathogens in 1316 patients (886 adult, 430 pediatric) admitted to the cardiac SICU following cardiac operations between January 2000 and December 2002.
Results: A total of 93 microorganisms of nosocomial BSIs were identified in 60 patients (4.6%), including both primary (38.3%) and secondary BSIs. Of these, 36 were adult patients (60%), and 24 were pediatric patients (40%). Secondary BSIs were due to intravascular devices (23.3%), lower airway tract infections (20%), surgical wound infections (8.4%), urinary tract infections (5%), and other causes (5%). The most frequently isolated species were coagulase-negative staphylococci (30%), Pseudomonas aeruginosa (8.4%), and Acinetobacter baumannii (6.7%). The most common cardiac surgical procedures associated with BSI were congenital cardiac operations (40%), followed by coronary artery bypass grafting procedures (33.3%). The overall mortality rate was 4.5% (59 patients). Mortality was six-fold higher in patients with BSI (14 patients, 23.3%) than those without BSI.
Conclusion: Our study emphasizes the importance of infection prevention and identification of pathogens leading to BSIs in cardiac SICU patients.

Objectives: We investigated the changes in plasma big endothelin (big ET), atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP) levels during carvedilol therapy in patients with congestive heart failure (CHF).
Study design: The study included 20 patients (6 females, 14 males; mean age 57±11 years) with symptomatic CHF. All the patients had sinus rhythm and resting ejection fraction ≤40%. Carvedilol therapy was initiated with a minimum dose (2 x 3.125 mg), which was increased biweekly to reach the maximum tolerable dose. Blood samples were obtained and transthoracic echocardiography was performed before and after three months of a mean carvedilol dose of 42.5±13.6 mg. Big ET, ANP, and BNP levels were assessed and correlations were sought with left ventricular functions and the NYHA (New York Heart Association) functional class.
Results: After three months, significant decreases were detected in heart rate (p<0.001), systolic blood pressure (p<0.05), and left atrial diameter (p<0.001), accompanied by a significant increase in left ventricular ejection fraction (EF) (p<0.001), and a remarkable improvement in NYHA class (p<0.05). Significant decreases were observed in ANP, BNP, and big ET levels with carvedilol treatment (p<0.001). Big ET, ANP, and BNP levels showed significant correlations with left ventricular dimensions and systolic functions, and NYHA functional class. Among these, the best correlation was with LVEF (r= -0.498, p=0.001; r= -0.642, p<0.001; r= -0.656, p<0.001; respectively).
Conclusion: Carvedilol therapy is associated with decreased BNP, ANP, and big ET levels and with improvements in NYHA functional class and left ventricular systolic functions in patients with CHF.

Objectives: Prolonged QRS duration is associated with mechanical dyssynchrony. Ischemic mitral regurgitation (MR) results from geometric changes in left ventricular (LV) shape, which also causes mechanical dyssynchrony. The aim of this study was to define the correlation of QRS duration with echocardiographic parameters reflecting LV function, shape, and mitral deformation in patients with ischemic MR.
Study design: The study included 29 patients (19 males, 10 females; mean age 64±3 years) who had at least moderate ischemic MR and a history of myocardial infarction or coronary revascularization. All the patients underwent echocardiography where LV ejection fraction, LV volumes, effective regurgitant orifice, tethering distance, tethering area, end-systolic sphericity index, and pulmonary artery pressures were measured. The patients were assessed in two groups formed based on the cutoff value of 120 ms for QRS duration.
Results: The mean MR severity was 2.8±0.8. QRS duration was <120 ms in 19 patients, and ≥120 in 10 patients. Prolonged QRS duration (≥120 ms) was accompanied by significantly lower LV ejection fraction and higher LV volumes and mitral valve deformation indices. QRS duration was in correlation with the following: LV ejection fraction (r=-0.62, p<0.001), LV end-systolic volume index (r=0.58, p<0.0001), LV end-diastolic volume index (r=0.46, p=0.014), vena contracta (r=0.37, p=0.016), mitral annulus diameter (r=0.42, p=0.004), tethering distance (r=0.43, p=0.005), tethering area (r=0.44, p=0.003), and end-systolic sphericity index (r=-0.39, p=0.01). Multiple regression analysis showed that LV ejection fraction was the only independent variable affecting QRS duration (ß= -1.1, p=0.025).
Conclusion: QRS duration is closely correlated with LV systolic functions and geometry and mitral apparatus deformation in patients with ischemic MR.

Objectives: Beta-blockers are widely used in the treatment of hypertension. Although decrease in heart rate has a major role in beta-blocker treatment, data are limited on the association between heart rate and the effectiveness of beta-blockers. This study was designed to evaluate the effect of basal heart rate on the efficiency of beta-blocker treatment in patients with essential arterial hypertension.
Study design: This prospective study included 20 patients (13 males, 7 females, mean age 53±10 years) with grade I/II essential hypertension, who did not receive any antihypertensive drugs and did not have any disease affecting the heart rate. Following 24-hour ambulatory blood pressure monitoring for daytime and nighttime systolic, diastolic, and arterial blood pressures, and mean heart rates, oral metoprolol succinate treatment (50 mg/day) was started. At the end of 20 days, 24-hour ambulatory blood pressure monitoring was repeated.
Results: There were significant decreases in mean daytime systolic, diastolic, and arterial (p<0.001) blood pressures (p<0.001) with corresponding decreases in nighttime blood pressures (p=0.021, p=0.039, and p<0.001, respectively). Changes in daytime and nighttime mean heart rates were also significant (p<0.001). There was a significant correlation between the daytime basal heart rate and the decline in daytime arterial blood pressure (r=0.666, p=0.001). ROC (receiver operating characteristics) curve analysis showed that patients with a daytime basal heart rate of 72/min or higher had a significantly greater reduction in arterial blood pressure (p=0.04).
Conclusion: Our results suggest that patients with higher basal heart rates benefit more from beta-blocker treatment for arterial hypertension.

Mitral annular calcification (MAC) is a common echocardiographic finding in geriatric population and is usually seen in the posterior atrioventricular groove. In general, MAC does not affect mitral valve functions. Intramyocardial extension is rare. A 67-year-old woman presented with shortness of breath and palpitation. She had a history of hypertension. Physical examination was unremarkable except for arrhythmia and raised blood pressure. The electrocardiogram showed atrial fibrillation with a ventricular rate of 80/min and an incomplete right bundle branch block. A chest radiogram showed a moderately enlarged heart silhouette, transthoracic echocardiography demonstrated a round echogenic mass in the posterior periannular region between the base of the posterior mitral leaflet and contiguous left ventricular wall, suggestive of a cardiac tumor. There were no findings of mitral stenosis or regurgitation in 2D, color and spectral Doppler imaging. Unenhanced cardiac magnetic resonance imaging (MRI) revealed involvement of the posterior mitral annulus and posterobasal myocardial wall, and calcified nature of the mass with no signal intensity. Contrast-enhanced MRI showed no perfusion of the mass. The mass was diagnosed as MAC extending from the posterior mitral annulus to the adjacent myocardial wall.

A 20-year-old male was examined because of the suspicion of a residual ventricular septal defect (VSD) shunt following a VSD repair of a 10-year history. On physical examination, there was a grade 2/VI systolic and a mild diastolic murmur over the left lower sternal border. Transthoracic echocardiography showed a dilated left atrium and moderate mitral and mild aortic regurgitation. Color Doppler echocardiography showed a mosaic-colored jet near the aortic valve that appeared to be a residual VSD shunt. The jet was the flow of the right coronary artery (RCA). Coronary angiography and cardiac catheterization revealed an aneurysm of the RCA, 11 mm in size, pseudocoarctation of the aorta, and moderate mitral and mild aortic regurgitation. No residual VSD was detected. It was concluded that the jet was associated with the aneurysmal RCA. Medical treatment with aspirin was scheduled for the patient.

The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are right bundle branch block, T wave, and ST-segment changes. Complete atrioventricular (AV) block has hitherto been reported in only one patient with PTE. A 63-year-old female patient presented with recurrent syncope and sudden-onset dyspnea. There was complete AV block in the admission ECG. She never had similar complaints before and an ECG taken three months before was completely normal. A temporary pacemaker was placed through the femoral vein. Physical and laboratory findings were suggestive of acute pulmonary embolism. Pulmonary artery angiography demonstrated nearly total occlusion of the proximal right pulmonary artery. Her coronary arteries were normal. Thrombolytic therapy with streptokinase infusion followed by standard heparin infusion resulted in clinical improvement and resolution of complete AV block. The patient was discharged on the 15th day with oral warfarin treatment.

The coronary sinus (CS) has a complex structure and notable electrophysiologic properties. Its close proximity to the atrioventricular nodal complex, situation below the interatrial septum, and vicinity of the right and left atria, and its electrical characteristics could play an important role in cardiac arrhythmias. Cannulation of the CS has enabled mapping, identification, and ablation therapy of arrhythmias arising from the left atrium and left ventricle. More recently, the CS has become a gateway to the left ventricle for biventricular pacing. This review revisits the anatomy and clinical importance of the CS.

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48-year-old female patient presented with the complaints of shortness of breath and abdominal distention. Transthoracic echocardiography revealed a large thrombus settled on pulmonary artery bifurcation which extended through left pulmonary artery.