ORIGINAL ARTICLE | |
1. | The frequency of silent myocardial ischemia associated with femoral sheath removal and hemostasis after percutaneous coronary intervention: evaluation with 12-lead ST-segment monitoring Muhammet Bilgi, Aylin Yıldırır, Taner Ulus, Haldun Müderrisoğlu PMID: 21206197 Pages 453 - 458 Objectives: Silent myocardial ischemia (SMI) is the objective documentation of ischemia in the absence of angina or anginal symptoms. We aimed to determine the frequency of SMI before and after sheath removal (SR) following elective percutaneous coronary interventions (PCI). Study design: Sixty-six patients (51 men, 15 women; mean age 59.5±10.3 years) were prospectively monitored with 12-lead ST monitoring after elective PCI for six hours. Transient ischemic episode was defined as the detection of transient ST-segment shift of at least 1 mm and lasting for at least 1 min in any lead. The monitoring period was divided into three intervals: two hours before and after SR, and the last two hours. The number of SMI episodes and maximal ST-segment changes were calculated for each interval. Results: Throughout monitoring, SMI was detected in 32 patients (48.5%), during which 44, 121, and 65 SMI episodes were recorded and 11 (16.7%), 20 (30.3%), and 1 (1.5%) patients exhibited de novo SMI episodes in two hours before and after SR, and the last two hours, respectively. The number of patients with SMI was significantly greater in the first two hours after SR compared to two hours before SR (p<0.001) and the last two hours (p=0.022). Moreover, the number of SMI episodes per patient was significantly greater in this period (1.8±3.8) compared to the period before SR (0.7±2.4, p<0.001) and the last period (1.0±3.0, p<0.001). Maximum ST-segment shifts were significantly greater in both the first and second two hours after SR compared to the period before SR (0.82±0.30 mm and 0.77±0.36 mm vs. 0.68±0.32 mm; p<0.001 and p=0.008, respectively). Conclusion: Our data indicate that SMI occurs more frequently during the early hours after SR in patients undergoing elective PCI. |
2. | The relationship between serum sex steroid levels and heart rate variability parameters in males and the effect of age M Tolga Doğru, M Murad Başar, Ercan Yuvanç, Vedat Şimşek, Ömer Şahin PMID: 21206198 Pages 459 - 465 Objectives: We evaluated the relationships between sex steroid levels and heart rate variability (HRV) parameters. Study design: The study included 114 male subjects (mean age 46.6±11.3 years) presenting to our department for cardiologic evaluation. Hormonal analysis included serum levels of luteinizing hormone, prolactin, total testosterone (TT), free testosterone, estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S). Parameters of HRV were derived from 24-hour Holter monitoring. The associations between serum sex steroid levels and HRV parameters were investigated in three age groups (20-39 years; 40-59 years; >60 years). Results: All the participants had normal biochemical results. The three age groups were similar in terms of anthropometric measurements. Among sex steroids analyzed, only serum DHEA-S level was significantly different among the groups (p=0.026), showing a decreasing trend with age. In the evaluation of HRV, all parasympathetic activities decreased (for HFn, pNN50, and rMSDD: p=0.001, p=0.000, and p=0.000, respectively), while only LF/HF among sympathetic activities increased (p=0.000) with age. Partial correlation analysis with control of age and waist circumference showed that TT and DHEA-S were positively correlated with HFn (parasympathetic parameter), and were in negative correlation with LF/HF24 hours and global sympathetic index (GSI) (sympathetic parameters). Serum E2 level was negatively correlated with the parasympathetic parameter of rMSSD, and positively correlated with LF/HF24 hours and GSI. Among serum sex steroids, DHEA-S was the most correlated parameter with autonomic functions. Conclusion: Our results showed positive correlations between androgens and parasympathetic activity and between estradiol and sympathetic activity in men, independent from anthropometric factors. |
3. | Genetic background of left ventricular hypertrophy in Uzbek hypertensive men Dilorom Kurbanova, Marietta Eliseyeva PMID: 21206199 Pages 466 - 472 Objectives: We evaluated the prevalences of ACE/ID, AGT/M235T, AT1R/A1166C, and CYP11B2/C344T genetic polymorphisms and their association with left ventricular hypertrophy (LVH) in Uzbek hypertensive men. Study design: The study included 172 Uzbek men (mean age 47±10 years) with untreated essential hypertension (EH) of grade 1-2 and 60 normotensive subjects (mean age 41±10 years). All subjects underwent complete M-mode echocardiography to determine left ventricular mass (LVM) and LVM index (LVMI). Genomic DNA was extracted from peripheral blood and was analyzed using polymerase chain reaction-restriction fragment length polymorphism assays. Results: Left ventricular hypertrophy was detected in 148 hypertensive patients (86.1%). The frequencies of the D-allele of the ACE gene and T-allele of the CYP11B2 gene were higher among hypertensive patients than in the controls. There was a significant association between the AGT/M235T polymorphism and LVH. The 235T-allele of the AGT gene, the D-allele of the ACE gene, and the 344T-allele of the CYP11B2 gene were identified as “damaging” alleles. All the patients had “damaging” alleles, the number being one in only seven patients (4.1%), two in 52 patients (30.2%), and three in 89 patients (51.7%). The severity of LVH significantly increased with the number of “damaging” alleles. Among paired carriage of “damaging” alleles, the combination of the D+235T-alleles was found as the most unfavorable pair associated with the degree of LVH. Conclusion: There is an association between EH and ACE/ID and CYP11B2/C344T gene polymorphisms in Uzbek males, with higher frequencies of the D-allele of the ACE gene and T-allele of the CYP11B2 gene. Our findings provide evidence for the association of AGT/M235T polymorphism with LVH in Uzbek males, combination of the D+235T-alleles being the most unfavorable pair associated with LVH. |
4. | Clinical and laboratory features of patients with pericardial effusion Hasan Ali Gümrükçüoğlu, Aytaç Akyol, Mustafa Tuncer, Yılmaz Güneş, Hüseyin Beğenik, Serkan Akdağ, Musa Şahin, Hakkı Şimşek, Mehmet Ağırbaşlı PMID: 21206200 Pages 473 - 479 Objectives: We reviewed patients who were diagnosed to have pericardial effusion (PE) over a four-year period to determine the causes of PE, clinical and laboratory features, and treatment modalities. Study design: Medical records of 136 patients (81 women, 55 men; mean age 55.8±18.7 years; range 8 to 90 years) admitted to our department with PE from August 2005 to August 2009 were reviewed. The diagnosis of PE was made by transthoracic echocardiography. Medical history, physical examination, electrocardiography, echocardiography, and laboratory findings and treatment methods were recorded. Results: The most frequent complaint was dyspnea (86.8%) and the most common physical examination finding was jugular venous distension (47.1%). The most common electrocardiographic and echocardiographic findings were tachycardia (47.8%) and mild PE (<1 cm) (63.2%), respectively. Chronic renal failure and malignant diseases were the primary causes of PE (25% and 22.8% respectively), followed by idiopathic cases (14%). Pericardial tamponade was detected in 34 patients (25%), of which the majority had malignant diseases (53%). Thirty-eight patients (27.9%) underwent interventional treatment (pericardiocentesis in 27, surgical drainage in 11), while 98 patients (72.1%) were followed-up with medical treatment. Mortality occurred in three patients with pericardial tamponade. Conclusion: The most common causes of PE in our cases were chronic renal failure and malignancies. The incidence of malignant PE is on the incline owing to increased life expectancy. Echocardiography is the primary imaging modality for the evaluation of PE. |
5. | Adaptation of the compliance and belief scales to Turkish for patients with chronic heart failure Sıdıka Oğuz, Nuray Enç, Zerrin Yiğit PMID: 21206201 Pages 480 - 485 Objectives: We evaluated the validity and reliability of the Turkish versions of the Beliefs about Medication Compliance Scale (BMCS), Beliefs about Dietary Compliance Scale (BDCS), and Beliefs about Self-Monitoring Scale (BSMS) for patients with chronic heart failure (CHF). Study design: After language and content validity studies, the Turkish versions of the three scales were administered to 80 patients (47 men, 33 women; mean age 59.3±12.5 years; range 24 to 79 years) with CHF. Internal consistency of the scales was assessed using the Cronbach’s alpha coefficient. Test-retest reliability was assessed using the interclass correlation coefficient measured from two consecutive interviews interspersed by 15 days. Results: There were no significant differences between the two interviews with respect to the total scores of the benefit and barrier subscales of each scale (p>0.05). Cronbach alpha coefficients of the benefit and barrier subscales at the first interview were 0.74 and 0.59 for the BMCS, 0.71 and 0.58 for the BDCS, and 0.77 and 0.68 for the BSMS, respectively. Interclass correlation coefficients for test-retest reliability for the benefit and barrier subscales were as follows: 0.90 and 0.91 for the BMCS, 0.86 and 0.86 for the BDCS, and 0.90 and 0.93 for the BSMS, respectively. Conclusion: Our findings suggest that all three scales have high validity and reliability and can be used as valid and reliable instruments in Turkish patients with CHF. |
CASE REPORT | |
6. | Management of sinus node dysfunction with junctional escape rhythm in a case of anorexia nervosa Antoine Kossaify PMID: 21206202 Pages 486 - 488 We report on a 17-year-old female patient with anorexia nervosa (AN), who developed electrocardiographic abnormalities consisting of sinus arrest and junctional escape rhythm. She had complaints of general fatigue, lethargy, sweating, and nausea resulting from voluntary weight loss of more than 30 kg during the past six months. Her body weight was 40 kg, heart rate was 44 bpm, and blood pressure was 90/50 mmHg, and she had signs of dehydration. The electrocardiogram showed a junctional rhythm at 44 bpm, no P wave, QRS width of 60 msec, QT of 440 msec, QTc of 400 msec, and QU of 600 msec. Laboratory findings were normal except for hypokalemia. Management consisted of a multidisciplinary team approach with a re-feeding program together with psychiatric and dietary assistance. Due to the absence of atrioventricular node conduction disease and/or structural heart disease, pacemaker implantation was not considered. This management plan resulted in a successful outcome with return to sinus rhythm within 24 hours of admission. |
7. | Successful lysis of a mobile left ventricular thrombus by slow infusion of low-dose tissue plasminogen activator Yılmaz Güneş, Yemlihan Ceylan, Mustafa Tuncer PMID: 21206203 Pages 489 - 491 There is no consensus on the management of intracardiac mural thrombi. A 59-year-old man underwent echocardiographic examination for right leg pain and pulse deficits in the right lower extremity, which showed severe left ventricular systolic dysfunction and a bell-shaped protruding mobile thrombus in the left ventricular apex. Due to high risk of surgery, 50 mg recombinant tissue-type plasminogen activator (rt-PA) was slowly infused over eight hours. Serial echocardiographic examinations showed a progressive decrease in the size of the thrombus within the first hours of rt-PA infusion, resulting in complete lysis after 24 hours. Low-dose and slow-infusion thrombolytic therapy may be an alternative therapy for left ventricular thrombi when surgery is not feasible. |
8. | Myocardial noncompaction in a patient with kyphoscoliosis Yalçın Velibey, Servet Altay, Mehmet Eren, Neşe Çam PMID: 21206204 Pages 492 - 495 Myocardial noncompaction of the ventricular myocardium is a rare congenital cardiomyopathy characterized by excessively protrusive trabeculae and deep trabecular recesses in one or more segments of the ventricle. A 37-year-old male patient with prominent kyphoscoliosis presented with dyspnea. Transthoracic echocardiography showed trabeculations and deep intratrabecular recesses along the ventricular cavity in the apical and lateral segments of the left ventricle. Color Doppler imaging showed blood flow in these recesses. Diameters of the left ventricle and atrium were increased, with global hypokinesis of the left ventricle (ejection fraction 30%). Severe aortic valve stenosis was noted. Pulmonary function test showed moderate restriction. Due to high perioperative mortality, the patient was scheduled to medical treatment. |
9. | A case of twin circumflex arteries associated with acute myocardial infarction Kanber Öcal Karabay, Ender Uysal, Bayram Bagırtan, Mutlu Vural PMID: 21206205 Pages 496 - 498 A circumflex (Cx) artery originating from the right coronary artery is one of the most common congenital coronary anomalies and is usually thought to be benign. Twin Cx arteries represent a very rare congenital anomaly with only three reported cases. Herein, we present a case of twin Cx arteries originating from the left main and right coronary arteries, respectively. A 50-year old male patient was admitted with chest pain. The electrocardiogram showed ST-segment elevation in leads D2, D3, and AVF, and ST-segment depression in the anterior leads. With the diagnosis of acute inferior myocardial infarction, the patient underwent coronary angiography which showed that the left Cx originating from the left main coronary artery was totally occluded by a thrombus in the mid-portion. There was another Cx arising from the proximal part of the right coronary artery with a significant stenosis in the proximal segment. Balloon angioplasty and stenting were successfully performed for the left Cx lesion, followed by direct stenting of the right Cx lesion one month later. The two Cx arteries were also evaluated by cardiac computed tomography angiography. The right Cx coursed between the pulmonary artery and the aorta and supplied the right part of the lateral wall of the left ventricle. The left Cx was located in the lateral wall and supplied the left part of the lateral wall of the left ventricle. |
10. | Prominent mitral L wave in a patient with partial pericardiectomy: a possible new etiology Mustafa Aparci, Ömer Yiginer, Ejder Kardesoglu, Ömer Uz PMID: 21206206 Pages 499 - 501 The middiastolic flow of mitral L wave may result from pathologies that impair the diastolic function of the heart. Echocardiographic examination of a 48-year-old female patient with a three-year history of partial pericardiectomy showed mild left ventricular hypertrophy, mild mitral regurgitation, and mitral annular calcification. During pulse-Doppler examination, a prominent forward transmitral flow (mitral L wave) was noted. The patient developed supraventricular tachycardia attacks on simultaneous electrocardiographic monitoring, during which the mitral L wave disappeared, but E and A waves sustained. Variations in the velocities of the forward transmitral flow were less than 25% during deep inspiration. Tissue Doppler imaging showed equal velocities (0.06 m/sec) of the E’ and A’ waves recorded at the lateral mitral annulus. |
11. | Percutaneous retrieval of an interatrial septal occluder device embolized into the aortic arch Selçuk Pala, Göksel Açar, Kürşat Tigen, Cevat Kırma PMID: 21206207 Pages 502 - 504 Percutaneous closure of secundum atrial septal defects (ASD) may be complicated by immediate embolization. We report on a 35-year-old woman who underwent percutaneous device closure for a secundum ASD. The diameter of the defect was measured as 4 mm by two-dimensional transesophageal echocardiography and a 7-mm Figulla ASD occluder device was implanted without prior balloon sizing of the defect. Immediate embolization was noted into the aortic arch. Attempts to pull the devices into the sheath with a loop snare failed even after replacing the delivery sheath with a bigger one. Finally, a bioptome was used to grab and place the screw mechanisms in the sheath and percutaneous retrieval of the embolized ASD occluder was achieved. Balloon sizing was performed after removal, yielding a stretched diameter of 12 mm and a 15-mm device was deployed with success. |
REVIEW | |
12. | Coronary collateral circulation Turgay Çelik, Murat Çelik, Atila İyisoy PMID: 21206208 Pages 505 - 514 There is a circulatory network in the heart consisting of multiple small-diameter vascular structures between the coronary arteries, connecting the coronary arteries to each other. These vascular structures which are the precursor of coronary collateral circulation are not visible in those having normal coronary arteries or mild-to-moderate coronary artery occlusions because they are too small in diameter to be seen on coronary angiograms and also have minimal blood flow. They have been observed only in postmortem studies. The sensitivity of tissues to ischemia is important as well as the extent and severity of atherosclerosis. The presence of well-developed coronary collateral circulation renders the myocardial tissue more resistant to ischemia and the patients less symptomatic. Considering the fact that coronary collateral circulation develops in response to severe coronary artery disease, it remains unknown why there are major differences among patients with the same degree of coronary artery disease and which factors are responsible for these differences. |
CASE IMAGE | |
13. | Large right coronary artery aneurysm Servet Altay, Yalçın Velibey, Sait Terzi, Murat Akçar PMID: 21206209 Page 515 Abstract | |
CASE REPORT | |
14. | Pacemaker lead fracture in a patient with tricuspid mechanic prosthetic valve Murat Yüce, Murat Sucu, Vedat Davutoğlu PMID: 21206210 Page 516 Abstract | |
CASE IMAGE | |
15. | Aorto-coronary fistula as a complication of coronary artery bypass graft operation Murat Yüce, Vedat Davutoğlu, Süleyman Ercan PMID: 21206212 Page 517 Abstract |
16. | A rare complication of percutaneous coronary intervention: iatrogenic aortic dissection Mehmet Ergelen, Uğur Filizcan, Özer Soylu, Hüseyin Uyarel PMID: 21206211 Page 517 Abstract | |
17. | Grapes in the heart: pacemaker lead endocarditis treated with surgery Zekeriya Nurkalem, Cevdet Dönmez, Şebnem Çetemen, Sabri Dağsalı PMID: 21206213 Page 518 Abstract | |
LETTER TO EDITOR | |
18. | Letter to the Editor: Acute myocardial infarction in a young patient with bicuspid aortic valve Andreas Yiangou Andreou PMID: 21206214 Pages 519 - 520 Bicuspid aortic valve (BAV) disease is associated with a primary aortopathy with the histopathological phenotype of cystic medial degeneration that leads to complications such as aneurysm and dissection. Yet, dissections in other arterial beds may be a feature of this disease. Aortocervical and spontaneous coronary artery dissections have been reported in such a setting. The present report discusses aspects of the pathophysiology of the arterial complications of BAV disease as well as how this disease process could potentially involve the coronary arteries and lead to complications, specifically spontaneous dissection. |
19. | Letters to the Editor Musa Çakıcı, Zuhal Arıtürk Atılgan, Vedat Davutoğlu PMID: 21206215 Pages 521 - 522 letter to editör |
OTHER ARTICLES | |
20. | Notice of Retraction Page 523 Abstract |
21. | Erratum PMID: 21206216 Page 523 Abstract | |
22. | Comment on cardiology publications Ertan Ural Page 524 Abstract | |
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