ORIGINAL ARTICLE | |
1. | QT dispersion in patients with rheumatic mitral stenosis and its relation with echocardiographic findings and serum NT-proBNP levels Kadriye Orta Kilickesmez, Gulsum Bulut, Murat Baskurt, Ugur Coskun, Ahmet Yildiz, Serdar Kucukoğlu PMID: 21532293 doi: 10.5543/tkda.2011.01230 Pages 183 - 190 Objectives: We evaluated the value of QT interval dispersion in patients with rheumatic mitral stenosis (MS) in association with echocardiographic parameters and serum N-terminal pro brain natriuretic peptide (NT-proBNP) levels. Study design: The study consisted of 46 patients (39 women, 7 men; mean age 46.9±9.7 years) with moderate-to-severe rheumatic MS. All patients underwent echocardiographic examination. Blood samples for NT-proBNP were collected immediately after ECG recording. QT interval and QRS complex were measured manually on standard 12-lead surface ECGs. Electrocardiographic and echocardiographic findings and serum NT-proBNP levels were compared with those of a control group consisting of 30 healthy subjects (26 women, 4 men; mean age 46.1±7.3 years). Results: Compared to controls, serum NT-proBNP levels were significantly higher in MS patients (284.6±206.5 vs. 70.2±9.3 pg/ml, p<0.001). The mean QT interval, QTc interval, and QT dispersion were significantly prolonged in MS patients compared to controls (378±25 vs. 349±21, 420±22 vs. 401±19, and 61±21 vs. 38±15 msec, respectively; p<0.005). QT and QTc dispersions were negatively correlated with mitral valve area (QT: r=-0.311, p=0.03; QTc: r=-0.327, p=0.02), and positively correlated with serum NT-proBNP level (QT: r=0.583, p<0.001; QTc: r=0.637, p<0.001). QTc dispersion was also an independent predictor of serum NT-proBNP level in regression analysis (β=0.330, p=0.03). Conclusion: Our results indicate that QT dispersion is related to the echocardiographic degree of rheumatic mitral valve disease and serum NT-proBNP levels in rheumatic MS. Being a noninvasive, easy, and inexpensive method, QT dispersion may be used as a complementary tool to the clinical and echocardiographic evaluation of patients with rheumatic MS. |
2. | The relationship between echocardiographic parameters and brain natriuretic peptide levels in acute and chronic mitral regurgitation Ramazan Kargin, Ozlem Esen, Selcuk Pala, Mustafa Akcakoyun, Yunus Emiroglu, Kursat Arslan, Soe Moe Aung, Irfan Barutcu, Ali Metin Esen, Nihal Ozdemir PMID: 21532294 doi: 10.5543/tkda.2011.01273 Pages 191 - 197 Objectives: Plasma brain natriuretic peptide (BNP) level increases with symptoms and severity of mitral regurgitation (MR). We aimed to determine the relationship between plasma BNP levels and echocardiographic parameters in patients with acute and chronic MR. Study design: The study included 55 patients (31 males, 24 females) with isolated moderate-to-severe MR. Of these, 31 patients had acute MR, and 24 patients had chronic MR. All the patients were assessed by transthoracic, transesophageal and Doppler echocardiography and plasma BNP levels were determined. Results: Clinical characteristics and functional capacity were similar in the two groups. Patients with acute MR had significantly higher left ventricular (LV) ejection fraction (EF) (p=0.001), and significantly lower LV end-systolic diameter (p=0.016), end-systolic volume (p=0.027), end-diastolic diameter (p=0.011), left atrial volume (LAV) (p=0.003), and plasma BNP levels (p=0.036). Effective regurgitation orifice area was also significantly higher in patients with acute MR (p=0.038). In multiple linear regression analysis, the natural logarithm of BNP was significantly correlated with E/Ea ratio (β=0.50, p=0.002) and LAV (β=0.38, p=0.015) in patients with acute MR, and with systolic pulmonary artery pressure (β=0.60, p=0.002) and EF (β=-0.36, p=0.039) in patients with chronic MR. Conclusion: Although the echocardiographic degree of MR was more pronounced in patients with acute MR, serum BNP levels tended to be lower in this group. Correlation of serum BNP with E/Ea and LAV in this group may be an important finding. |
3. | C825T polymorphism of the G-protein β3 subunit and its association with essential hypertension in Uzbek males Gulnoz A Khamidullaeva, Marietta R Eliseyeva, Alexander V Nagay, Guzal J Abdullaeva PMID: 21532295 doi: 10.5543/tkda.2011.01103 Pages 198 - 204 Objectives: We investigated the association between the C825T polymorphism of the G-protein β3 subunit (GNB3) gene with essential hypertension (EH) and cardiovascular remodeling markers in Uzbek males. Study design: The study included 174 Uzbek men (mean age 49±10 years) with untreated EH of stage 1-2 and 60 normotensive males. The C825T polymorphism of the GNB3 gene in the patient and control groups was determined by polymerase chain reaction. The patients were assessed with blood pressure measurements, ambulatory blood pressure monitoring, body mass index (BMI), carotid artery intima-media thickness (IMT), flow-mediated dilation (FMD) of the brachial artery, echocardiography, and urinary albumin excretion (UAE) level. Results: The frequencies of the CC, CT, and TT genotypes were 36.8%, 53.5%, and 9.8% in hypertensive men, and 0%, 83.3%, and 16.7% in healthy men, respectively (p=0.0001). The frequencies of the C and T alleles were 63.8% and 36.2% in the hypertensive group, and 41.7% and 58.3% in the control group, respectively (p=0.0001). The CC genotype exhibited a significantly greater risk for hypertension compared to CT and TT genotypes (OR=72.38, 95% CI 4.40-1190.34). The C825 allele showed a higher association with hypertension in comparison to the 825T allele (OR 2.41, 95% CI 1.58-3.68). Compared to patients with the CT+TT genotypes, the CC genotype carriers had significantly higher BMI (p=0.0001), systolic (p=0.0001) and diastolic (p=0.003) blood pressures (SBP/DBP), higher nighttime DBP (p=0.042), a greater nighttime variability in both SBP and DBP (p=0.002), and greater carotid artery IMT (p=0.0001) and UAE (p=0.015) values. Conclusion: Our findings show a significant association between the GNB3/C825T gene polymorphism and EH, with the CC genotype exhibiting higher blood pressure, BMI, and vascular remodeling markers in Uzbek hypertensive men. |
4. | Serum gamma-glutamyltransferase activity: a new marker for coronary artery bypass graft disease Taner Ulus, Aylin Yıldırır, Leyla Elif Sade, Sevket Balta, Bulent Ozin, Atilla Sezgin, Haldun Muderrisoglu PMID: 21532296 doi: 10.5543/tkda.2011.01243 Pages 205 - 213 Objectives: Serum gamma-glutamyltransferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. We evaluated the association between GGT and severe graft disease in patients undergoing coronary artery bypass graft (CABG) surgery. Study design: We evaluated 113 patients (mean age 62±9 years; range 21 to 81 years) who underwent control coronary angiography after a mean of 39 months (range 18 to 84 months) following CABG surgery. A graft was considered patent if there was <70% stenosis or severely diseased if there was ≥70% stenosis on coronary angiography. Preoperative serum GGT levels were measured in all the patients and none had severe systemic or hepatobiliary disease. The association between serum GGT level and severe graft disease was investigated. The grafts were also evaluated separately. Results: Coronary angiography showed severe graft disease involving at least one graft in 65 patients (57.5%). Serum GGT level was significantly higher in patients with severe graft disease (p=0.001). ROC curve analysis yielded a cut-off value of 29.5 U/l for serum GGT level to predict severe graft disease (area under the curve: 0.69) with 48% sensitivity and 82% specificity. While GGT levels were similar for internal mammary artery grafts (p>0.05), radial artery grafts and saphenous vein grafts (SVG) with severe graft disease were associated with significantly higher GGT levels (p=0.003 and p<0.001, respectively). In multivariate analysis, family history of coronary artery disease at a young age (OR 2.46, 95% CI 1.08-5.61, p=0.03) and serum GGT (OR 1.03, 95% CI 1.00-1.07, p=0.05) were independent predictors of severe graft disease. Separate analysis based on the graft types showed that GGT was an independent predictor of severe graft disease for only SVG (OR 1.02, 95% CI 1.00-1.04, p=0.03). Conclusion: Serum GGT level may be an independent marker for the development of severe SVG disease in patients undergoing CABG surgery. |
5. | Our initial experience with stent implantation for aortic coarctation in adults Hüseyin Uğur Yazıcı, Ömer Göktekin, Taner Ulus, Kerem Temel, Aydın Nadir, Muharrem Nasifov, Alparslan Birdane, Ahmet Ünalır, Necmi Ata PMID: 21532297 doi: 10.5543/tkda.2011.01439 Pages 214 - 218 Objectives: We evaluated the procedural success and short-mid term results of stent implantation for aortic coarctation in adults. Study design: The study included 15 consecutive patients (9 women, 6 men; mean age 27±7 years; range 17 to 45 years) treated with stent implantation for aortic coarctation. Fourteen patients had native, one patient had recurrent coarctation. Nine patients received bare metal and six patients received covered Cheatham-Platinum stents. Covered stents were used in patients with accompanying patent ductus arteriosus (n=2), severe coarctation (n=3), and recurrent coarctation (n=1). Procedural success was defined as the reduction in the pressure gradient across the coarctation site to less than 20 mmHg. The mean follow-up period was 10.4±4.6 months (range 3 to 18 months). Results: Stent implantation was successful in all the patients. Compared to the preprocedure figures, systolic gradient across the aortic coarctation decreased from 37.2±11.3 mmHg to 3.5±2.9 mmHg, the diameter of the coarcted aortic segment increased from 5.4±1.5 mm to 17.2±1.4 mm, and systolic blood pressure declined from 154±9.7 mmHg to 130±7.3 mmHg following stenting (for all, p<0.001). There were no procedure-related major complications. Conclusion: Stent implantation for aortic coarctation in adults is a safe and effective alternative to surgical correction. |
6. | Procedural success and short- and mid-term results of percutaneous closure of persistent arterial duct with the Amplatzer Duct Occluder II Hekim Karapınar, Zekeriya Küçükdurmaz, Sadettin Sezer, İbrahim Gül, Hasan Ali Gümrükçüoğlu, Hidayet Kayançiçek, Müntecep Aşker, Ali Baykan, Ahmet Yılmaz, Mehmet Güngör Kaya, Nazmi Narin PMID: 21532298 doi: 10.5543/tkda.2011.01396 Pages 219 - 223 Objectives: We evaluated the effectiveness and reliability of percutaneous closure of persistent arterial duct (PAD) with the Amplatzer Duct Occluder II (ADO II), together with short- and mid-term results. Study design: The study included 16 patients (10 girls, 6 boys; median age 6 years; range 5 months to 12 years) who underwent percutaneous PAD closure with the ADO II device. The ductus diameter was less than 6 mm in all the cases. According to the Krichenko classification, 10 patients had type A, five patients had type E, and one patient had residual PAD. The patients were assessed by aortography and echocardiography. The mean follow-up was 13.9 months (range 2 to 23 months). Results: Closure of PAD was successfully performed via the arterial approach in all the patients. The median ductus waist diameter was 3 mm (range 2 to 5 mm), the median device waist diameter was 4 mm (range 3 to 6 mm), and the waist length was 4 or 6 mm. The mean fluoroscopy time and the mean procedure time were 10.6 min (range 4 to 39 min) and 30 min (range 18 to 80 min), respectively. Immediate aortography following the procedure showed shunt only through the device lumen. No residual shunt or increases in aortic and left pulmonary flow velocities were observed in echocardiographic examinations. No complications occurred during the procedure and follow-up. Conclusion: In all the cases, the ADO II device was found effective and reliable for closure of PADs of less than 6 mm. |
CASE REPORT | |
7. | Spontaneous right coronary artery dissection possibly associated with clonidine transdermal patch Mehmet Çilingiroğlu, Shahid Rahman, Tarek Helmy, Puvinarayanan Seshiah PMID: 21532299 doi: 10.5543/tkda.2011.01151 Pages 224 - 227 We report on a 44-year-old female who developed spontaneous right coronary artery dissection associated with the use of a clonidine transdermal patch. The lesion was successfully treated with percutaneous coronary intervention with placement of three bare metal stents. The patient had an uneventful recovery. To our knowledge, this is the first reported case of spontaneous coronary artery dissection associated with clonidine effect. |
8. | Warfarin-induced bilateral renal hematoma causing acute renal failure Nazmi Gultekin, Fatih Akin, Emine Kucukates PMID: 21532300 doi: 10.5543/tkda.2011.01173 Pages 228 - 230 Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal. |
9. | Transcatheter closure of a fistula between the right pulmonary artery and left atrium using the Amplatzer septal occluder Yakup Ergül, Kemal Nişli, Ümrah Aydoğan PMID: 21532301 doi: 10.5543/tkda.2011.01201 Pages 231 - 234 A congenital fistula between the right pulmonary artery (RPA) and left atrium (LA) is a rare condition that results in central cyanosis. An 11-year-old boy was admitted with exertional dyspnea and easy fatigability. He had severe cyanosis of the lips and limbs with clubbing of the fingers. Systemic oxygen saturation was 70%. There was no abnormal finding on electrocardiography, chest radiography, and echocardiography. Agitated saline injection showed early appearance of contrast bubbles in the LA. A pulmonary arteriovenous fistula was suspected and diagnostic cardiac catheterization was performed. Angiography demonstrated a large fistula between the proximal RPA and LA. The narrowest part of the fistula was 13.8 mm in balloon sizing. A 14-mm Amplatzer septal occluder was deployed at the narrowest site; however, the device migrated to the LA and then to the aortic arch. The device was removed and was successfully reimplanted to the fistula. After the procedure, arterial oxygen saturation increased from 70% to 96% and control angiography demonstrated complete occlusion of the fistula. The patient was symptom-free on follow-up evaluations at 6, 12, and 18 months, with a mean oxygen saturation of 96%. This case represents the first pediatric patient in whom a septal occluder was used. |
10. | Simultaneous conduction over the fast and slow pathways during induction of atrioventricular nodal reentrant arrhythmia with a rate of less than 100 bpm and infra-His block after radiofrequency ablation of the slow pathway Basri Amasyalı, Bulent Kokturk, Kiyoshi Otomo, Sedat Kose PMID: 21532302 doi: 10.5543/tkda.2011.01105 Pages 235 - 239 Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal regular supraventricular tachycardia in adults. It is typically induced with an anterograde block over the fast pathway (FP) and conduction over the slow pathway (SP), with subsequent retrograde conduction over the FP. Rarely, a simultaneous conduction of a premature atrial complex occurs over the FP and SP to induce AVNRT and is called “one for two phenomenon”. We present a 46-year-old woman with atrioventricular nodal rhythm with a rate of 95 beats per minute with distinct electrophysiological characteristics showing simultaneous conduction over the FP and SP during induction of tachycardia and an infra-His block after radiofrequency ablation of the SP. |
11. | Fistula between the left internal mammary artery and pulmonary artery: a rare cause of recurrent angina after coronary bypass grafting Begüm Yetiş, Bahadır Gültekin, Dalokay Kılıç, Aylin Yıldırır PMID: 21532303 doi: 10.5543/tkda.2011.01180 Pages 240 - 243 Left internal mammary artery (LIMA) to pulmonary vasculature fistula is a rare complication after coronary artery bypass surgery. In most cases, the duration between bypass grafting and fistula formation ranges from 2 to 5 years. We present a 62-year-old man who presented with anginal symptoms five years after bypass surgery. On coronary angiography, selective catheterization of the LIMA showed fistula formation to the pulmonary artery, which probably led to coronary steal syndrome and myocardial ischemia. He underwent surgery and the connection between the LIMA and pulmonary artery was terminated. After surgery, his anginal complaints improved and echocardiography showed improvement in the wall motion abnormality detected before surgery. |
12. | An effective and safe alternative to epicardial pacemaker placement for permanent pacemaker implantation in a patient with mechanical tricuspid valve: stimulation of the left ventricle through the coronary sinus Ahmet Duran Demir, Nihat Şen, Ali Rıza Erbay, Ramazan Atak PMID: 21532304 doi: 10.5543/tkda.2011.01322 Pages 244 - 247 Implantation of a transvenous endocardial pacemaker is contraindicated in patients with a mechanical tricuspid valve. An epicardial left ventricular pacemaker lead was placed by a transvenous route through the coronary sinus into the lateral cardiac vein in a 58-year-old woman with mechanical aortic, mitral, and tricuspid valves, for permanent pacing due to chronic atrial fibrillation with a slow ventricular rate accompanied by syncope. This lead was then connected to a single-chamber pacemaker. The patient had no problem in the following three months. Placement of an epicardial pacing lead through the coronary sinus provides a safe and effective pacing in patients with a mechanical tricuspid valve, thus obviating major cardiac surgery. |
REVIEW | |
13. | Heart Health Policies of European Union and Turkey Sibel Gögen PMID: 21532305 doi: 10.5543/tkda.2011.01214 Pages 248 - 253 Cardiovascular diseases cause 4.3 and 2 million deaths in Europe and the European Union countries each year, respectively, ischemic heart diseases and stroke being the leading causes of death. This review aims to present a brief appraisal of heart health policies of the European Union and Turkey. |
CASE IMAGE | |
14. | Massive lipomatous hypertrophy of the interatrial septum Özgül Uçar, Hülya Çiçekçioğlu, Müslüm Şahin, Sinan Aydoğdu PMID: 21532306 doi: 10.5543/tkda.2011.01346 Page 254 Abstract | |
15. | Anomalous right coronary artery originating from the pulmonary artery Mustafa Paç, Mehmet Burhan Oflaz, Sevket Balli, Feyza Aysenur Paç PMID: 21532307 doi: 10.5543/tkda.2011.01385 Page 255 Abstract | |
16. | A huge noncoronary sinus of Valsalva aneurysm in a patient with Marfan syndrome Erkan İlhan, Şennur Ünal Dayı, Hakan Barutca, Sinan Şahin PMID: 21532308 doi: 10.5543/tkda.2011.01351 Page 256 Abstract | |
17. | Twiddler’s syndrome in an asymptomatic case Esra Gücük, Ali Rıza Erbay, Gökhan Keskin PMID: 21532309 doi: 10.5543/tkda.2011.01373 Page 257 Abstract | |
18. | Thoracic outlet syndrome presenting as a pseudostenosis image of the right subclavian artery Yusuf Karavelioğlu, Hekim Karapınar, Zekeriya Küçükdurmaz, Atila Bitigen PMID: 21532310 doi: 10.5543/tkda.2011.01320 Page 258 Abstract | |
LETTER TO EDITOR | |
19. | Is it now or when? Serkan Bulur, Hakan Özhan, Enver Sinan Albayrak, Yasin Türker PMID: 21532311 Pages 259 - 260 We read with interest ‘’Turkey's publication output in cardiovascular medicine declined in 2010 both in quantity and quality’’ [1] published in the Turkish Society of Cardiology Archives January issue. We thought that the success of Duzce ü was underscored. Appreciation of successes will motive the academicians for their best and will add value to Turkish cardiovascular medicine. |
OTHER ARTICLES | |
20. | Erratum PMID: 21532313 Page 260 Abstract | |
21. | Comment on cardiology publications Ertan Ural Page 261 Abstract | |
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