ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 43 (6)
Volume: 43  Issue: 6 - September 2015
EDITORIAL COMMENT
1. Depression is a systemic disease
Mukaddes Ayşın Noyan
PMID: 26363741  doi: 10.5543/tkda.2015.30346  Pages 503 - 504
Abstract |Full Text PDF

ORIGINAL ARTICLE
2. Major depressive disorder in chronic heart failure patients: Does silent cerebral infarction cause major depressive disorder in this patient population?
Güliz Kozdağ, İrem Yaluğ, Nagihan İnan, Gökhan Ertaş, Macit Selekler, Hüseyin Kutlu, Ayşe Kutlu, Ender Emre, Metin Çetin, Dilek Ural
PMID: 26363742  doi: 10.5543/tkda.2015.77753  Pages 505 - 512
OBJECTIVE: Depression frequently occurs in patients with heart failure as similar pathophysiological mechanisms present in both these diseases. Patients with dilated cardiomyopathy (DCM) have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). This study aimed to evaluate the relation between SCI and major depressive disorder (MDD), and between MDD and clinical and biochemical parameters in DCM patients.
METHODS: Patients with ischemic and non-ischemic DCM who had chronic heart failure (CHF) (39 male, 10 female, age 60±10 years) were included in the study. Mean patient ejection fraction (EF) was 34±10%. Patients had no localized neurological symptoms or stroke history. The etiology of DCM was ischemic in 40 and non-ischemic in 9 patients. Twentyfive age-matched healthy volunteers served as a control group for comparison of SCI and MDD prevalence.
RESULTS: Patients had mild to severe CHF symptoms. Prevalence of SCI and MDD was significantly higher in patients with DCM than in the control group; 63% vs 8%; p<0.001, and 52% vs 20%; p<0.001 respectively. Patients with SCI had a higher prevalence of MDD than patients without SCI in DCM (61% vs 27%, p=0.02).
CONCLUSION: CHF patients have an increased prevalence of SCI and MDD. Patients with SCI have a higher prevalence of MDD compared to patients without SCI in CHF.

3. Determinants of iatrogenic femoral pseudoaneurysm after cardiac catheterization or percutaneous coronary intervention via the femoral artery
Fatih Erol, Sakir Arslan, Isa Oner Yuksel, Cagin Mustafa Ureyen, Serkan Serdar, Sinan Inci, Huseyin Senocak
PMID: 26363743  doi: 10.5543/tkda.2015.30356  Pages 513 - 519
OBJECTIVE: This study aimed to define the prevalence and predictors for pseudoaneurysm after coronary angiography, cardiac catheterization and percutaneous coronary interventions (PCIs) performed via the femoral artery.
METHODS: The study included 8469 patients enrolled between January 2007 and December 2009 on whom cardiac catheterization, coronary and/or peripheral angiography and PCIs via the femoral artery were performed. All data, including clinical characteristics and complications, were obtained retrospectively from patient chart records.
RESULTS: Pseudoaneurysm was detected in 65 (0.76%) patients. Pseudoaneurysm was ascertained more frequently in patients with a history of coronary artery disease (0.9% vs. 0.4%; p=0.012), in females than in males (1.4% vs. 0.5%; p<0.001), in patients older than 65 years (1.2% vs. 0.6%; p=0.002), in patients with a history of femoral artery intervention (1.2% vs. 0.6%; p=0.01), in hypertensives than in normotensives (1.3% vs. 0.5%; p<0.001), in patients taking low molecular weight heparin (1.0% vs. 0.2%; p<0.001), in patients taking clopidogrel (1.0% vs. 0.4%; p=0.007), and in patients with chronic renal disease (3.8% vs. 0.7%; p<0.001). There was no statistically significant trend (1.2% vs. 0.7%; p=0.053) towards more pseudoaneurysm formation in emergent interventions than in elective procedures.
CONCLUSION: Patients with a higher risk of pseudoaneurysm development following intervention via the femoral artery should be specified and extra attention given during the intervention. These patients should be informed of the increased risk of this complication and its results, and should be under close follow-up concerning development of iatrogenic femoral pseudoaneurysm.

4. The prognostic value of a prominent Q wave in lead (–)aVR in acute anterior wall myocardial infarction
Leili Pourafkari, Nader D Nader, Navid Heydari, Arezou Tajlil, Samad Ghaffari
PMID: 26363744  doi: 10.5543/tkda.2015.42147  Pages 520 - 528
OBJECTIVE: This study aimed to determine the association of a prominent Q wave in lead (–)aVR with clinical, echocardiographic and angiographic findings in anterior ST elevation myocardial infarction (STEMI) and to evaluate the role of this finding in short-term and long-term outcomes.
METHODS: During a one-year period, 150 patients with first time anterior STEMI were screened and 121 patients with no other cardiopulmonary and renal comorbid diagnoses were included in the study. Patients were allocated into two groups based on presence or absence of a prominent Q wave in lead (–)aVR. All clinical, electrocardiographic, echocardiographic and angiographic data were recorded and compared between the groups. In-hospital adverse outcomes and mortality as well as two-year survival were also compared.
RESULTS: Among 121 patients (mean age: 62.8±12.5 years) 26.4% had a prominent Q wave in lead (–)aVR. The prevalence of multi-vessel disease was higher in patients with a Q wave (76.9% vs. 52.8%, p=0.03). ST-segment elevation in lead V6 was significantly more common in those with a Q wave (50% vs. 30.3%, p=0.04). Posterobasal region motion abnormality was more common in the Q wave group. (9.4% vs. 1.2% respectively, p=0.04). Overall, mortality was higher in the Q wave group; however, it was not statistically significant (15.4% vs. 9.3%, p=0.39).
CONCLUSION: In anterior STEMI, presence of a Q wave in lead (–)aVR is associated with occlusion of multiple arteries. Shortand mid-term mortality are not affected by this ECG finding.

5. Transcatheter aortic valve implantation in the presence of hematologic malignancies
Cenk Sarı, Hüseyin Ayhan, Serdal Baştuğ, Hacı Ahmet Kasapkara, Bilge Duman Karaduman, Abdullah Nabi Aslan, Mehmet Burak Özen, Emine Bilen, Nihal Akar Bayram, Telat Keleş, Tahir Durmaz, Engin Bozkurt
PMID: 26363745  doi: 10.5543/tkda.2015.99442  Pages 529 - 535
OBJECTIVE: Cardiac surgery may be performed in patients with hematologic disorders, but carries an increased risk of morbidity. This series describes an experience of transcatheter aortic valve implantation (TAVI) in patients with hematologic malignancies, and highlights the technical considerations to be kept in mind.
METHODS: Between June 2011 and April 2014, 133 consecutive high-risk patients with symptomatic severe aortic stenosis were treated with TAVI at our centre. Based on consensus among the local heart team, five patients with hematologic malignancies (myelodysplastic syndrome [2],chronic lymphocytic leukemia [2], Hodgkin lymphoma [1]) were considered high risk for surgery (Logistic EUROSCORE 17.2±14.0% and STS score 5.8±4.3%). Serial echocardiographic and clinical follow-ups were done pre- and post-procedure, at discharge, and at 1, 3, 6 and 12 months.
RESULTS: Our procedural success rate was 80%. Two heart valves were implanted in one patient due to aortic embolization of the previous valve. Perforation of the right ventricle and cardiac tamponade occurred in the same patient. Mean blood transfusion requirement was 1.0±1.4 U (range: 0 to 3 U). Mean aortic valve gradient was reduced from baseline to 9.2±3.27 mmHg, and the effective orifice area was significantly increased to 1.96±0.29 cm2. Paravalvular aortic regurgitation (AR) was absent-mild in all the patients.
CONCLUSION: This present series demonstrates that TAVI with a balloon-expandable valve can be performed safely and effectively and is technically feasible in high-risk patients with hematologic malignancies.

6. Evaluation of depression and anxiety in parents of children undergoing cardiac catheterization
Ahmet Üzger, Osman Başpınar, Feridun Bülbül, Sibel Yavuz, Metin Kılınç
PMID: 26363746  doi: 10.5543/tkda.2015.28928  Pages 536 - 541
OBJECTIVE: This study aimed to determine pre-procedure depression and anxiety levels among a group of parents whose children had congenital heart disease and were undergoing angiography.
METHODS: The study comprised parents of 73 congenital heart disease patients undergoing angiography. The Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to evaluate the depression and anxiety scores.
RESULTS: Sixty-one patients (83.6%) had acyanotic congenital heart disease, and 25 patients (34.2%) were undergoing diagnostic angiography. BDI scores among the mothers determined that 8 (11%) had mild, 14 (19.2%) moderate, and 10 (13.7%) severe depression. Their BAI scores showed that 16 (21.9%) had mild, 8 (11%) moderate, and 13 (17.8%) severe anxiety. BDI scores for the fathers showed that 12 (16.4%) had mild, 10 (13.7%) moderate, and 8 (11%) severe depression. Their BAI scores showed that 12 (16.4%) had mild, 10 (13.7%) moderate, and 8 (11%) severe anxiety. A comparison of mothers of cyanotic patients and those of acyanotic patients in terms of depression and anxiety levels revealed a statistically significant difference (p=0.050 and 0.043, respectively).
CONCLUSION: Angiography was associated with increased levels of depression and anxiety in parents of children with congenital heart diseases. In comparison to parents of patients with acyanotic congenital heart disease, mothers of patients with cyanotic congenital heart disease had significantly higher levels of depression and anxiety.

7. Pulmonary and ventricular functions in children with repaired tetralogy of Fallot
Savaş Demirpençe, Barış Güven, Murat Muhtar Yılmazer, Taliha Öner, Önder Doksöz, Rahmi Özdemir, Hikmet Tekin Nacaroğlu, Timur Meşe, Vedide Tavlı, Demet Can
PMID: 26363747  doi: 10.5543/tkda.2015.52498  Pages 542 - 550
OBJECTIVE: This study aimed to evaluate biventricular function, brain natriuretic peptide levels, respiratory function test and 6 minute walking test (6MWT) in children with repaired tetralogy of Fallot (TOF), and analyse the correlation between these variables and clinical status.
METHODS: Twenty-five children (14 boys, 11 girls; aged 6 to 17 years) with repaired TOF (Group 1) and 25 age-sex matched healthy controls (Group 2) were enrolled in the study. Tissue Doppler echocardiography, respiratory function test, 6MWT distance and brain natriuretic peptide levels were measured.
RESULTS: Mean ages of the children at TOF corrective surgery and at study time were 5.1±3.5 years and 11.6±2.7 years respectively. The duration between palliative operation and corrective surgery was 4.3±2.0 years, and the follow-up period after corrective surgery was 6.3±3.0 years. The right ventricular and left ventricular myocardial performance indices (MPIs), and isovolumic relaxation and contraction times were significantly higher in Group 1 than in Group 2 (p<0.01). Spirometry displayed significantly reduced forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow 25–75% (FEF25–75) and inspirational capacity in Group 1 compared to Group 2 (p<0.01). In Group 1, 6MWT distances were significantly lower than in Group 2 (p=0.001). Right ventricular MPI is correlated with FEV1, FVC and 6MWT distance in the current study.
CONCLUSION: The children with repaired TOF had impaired ventricular and pulmonary functions. Hence, right ventricular MPI along with FEV1, FVC and 6MWT distance may be useful in the follow-up of children with repaired TOF.

CASE REPORT
8. A rare coronary anomaly with masked diagnosis: Anomalous left circumflex artery from right pulmonary artery
Doğukan Aktaş, Abdullah Erdem, Nida Çelik, Hacer Kamalı, Turkay Sarıtaş
PMID: 26363748  doi: 10.5543/tkda.2015.94399  Pages 551 - 553
Anomalous origin of the circumflex coronary artery from the pulmonary artery is a rare congenital coronary anomaly. While it generally follows an asymptomatic course, if undiagnosed it may lead to severe clinical outcomes, including sudden death. The condition can be masked by associated defects, so when it is clinically suspected, diagnosis must be confirmed by conventional and/ or magnetic resonance angiography, even if echocardiography clearly shows coronary roots. This report describes a patient who underwent neonatal surgery for aortic coarctation and was diagnosed with coronary artery anomaly at 15 months old.

9. An unusual thrombolytic therapy decision in prosthetic valve thrombosis during early pregnancy
Erkan Köklü, İsa Öner Yüksel, Zehra Erkal, Selçuk Küçükseymen, Şakir Arslan
PMID: 26363749  doi: 10.5543/tkda.2015.68327  Pages 554 - 557
Pregnancy is among the risk factors for mechanical valve thrombosis, and even though thrombolytic therapy is contraindicated during pregnancy, it may be used in the treatment of this life-threatening complication. This case report describes a pregnant patient, whose echocardiogram showed evident gradient increase on her mechanical prosthetic mitral valve, and who was treated successfully with tissue plasminogen activator for mechanical valve thrombosis.

10. Acute coronary syndrome due to midazolam use: Kounis syndrome during a transurethral prostatectomy
Ahmet Hakan Ateş, Selim Kul
PMID: 26363750  doi: 10.5543/tkda.2015.44567  Pages 558 - 561
Developments in the drugs industry are leading to more rare drug side effects being encountered in clinical practice. Of these side effects, allergic reactions and hypersensitivity are seen in the usage of a large group of drugs such as antibiotics, analgesics, antineoplastics, contrast agents, corticosteroids, intravenous anesthetics, nonsteroidal anti-inflammatory drugs, and proton pump inhibitors. One important result of these reactions is acute coronary syndrome, which may have serious life-threatening results. This syndrome was first described in 1991 by Kounis as an ‘allergic angina syndrome progressing to acute myocardial infarction’, and thereafter called ‘allergic myocardial infarction’. This case report presents a 70-year-old male who had angina and dyspnea after administration of midazolam at the beginning of a transurethral prostatectomy operation.

11. Percutaneous transcatheter closure of a descending aorta to vertebral venous plexus fistula using an Amplatzer Vascular Plug 2: a case report
Mustafa Orhan Bulut, İlker Kemal Yücel, Şevket Ballı, Ahmet Çelebi
PMID: 26363751  doi: 10.5543/tkda.2015.72317  Pages 562 - 564
A descending aorta to vertebral venous plexus fistula is an extremely rare form of arteriovenous fistula. A 10-month-old infant was referred to the hospital for evaluation of a murmur. On examination, a continuous murmur was heard in the entire back. Transthoracic echocardiography revealed left heart chamber dilatation in the presence of preserved left ventricle systolic function. Computerized tomography angiography with 3-dimensional reconstruction, and lateral projection aortography revealed a descending aorta-vertebral venous plexus fistula measuring 4.8 mm in the aortic orifice. The fistula was embolized using an Amplatzer Vascular Plug 2.

12. Non-surgical treatment of a right ventricle puncture during diagnostic pericardiocentesis
Ekrem Güler, Gamze Babur Güler, Gültekin G Demir, Filiz Kızılırmak
PMID: 26363752  doi: 10.5543/tkda.2015.49060  Pages 565 - 567
Pericardiocentesis is a life-saving procedure performed in cardiac tamponade cases occurring in infective, inflammatory or malignancy conditions, or following percutaneous coronary intervention, cardiac device implantation or catheter ablation. In spite of advanced imaging methods, a substantial risk of complication persists. Emergent surgical intervention may be required, in particular during advancement of the catheter into the heart chambers or in cases of wall rupture. Furthermore, in all these cases, patients have a high risk of surgery because of existing comorbidities. This case presents a patient suspected of tuberculous pericarditis who underwent diagnostic pericardiocentesis complicated by right ventricular puncture. The catheter in the right ventricle was withdrawn via a second catheter placed in the pericardial cavity. Spontaneous blood control was established, and with no increase in pericardial effusion surgical intervention was not required. This method can be applied in certain conditions, including cardiac injury caused by pericardiocentesis or intracardiac manipulations, thus eliminating the need for high-risk surgical intervention.

13. Catheter ablation of ventricular arrhythmia originating in the tricuspid annulus in a patient with biventricular noncompaction: a case report
Ahmet Taha Alper, Barış Güngör, Ahmet Ilker Tekkeşin, Ceyhan Türkkan
PMID: 26363753  doi: 10.5543/tkda.2015.80921  Pages 568 - 571
It is rare for ventricular tachycardia arising from the right ventricle to originate in the tricuspid annulus, and the clinical presentation and cardiac abnormalities associated with this type of arrhythmia have not been clearly established. This report describes a case of biventricular noncompaction presenting with ventricular arrhythmia originating in the tricuspid annulus and successfully treated with radiofrequency ablation.

HOW TO?
14. How to perform an endomyocardial biopsy?
Carsten Tschöpe, Behrouz Kherad, Heinz-peter Schultheiss, Carsten Tschöpe, Carsten Tschöpe
PMID: 26363754  doi: 10.5543/tkda.2015.91298  Pages 572 - 575
Abstract |Full Text PDF | Video

CASE IMAGE
15. A case of Gerbode-type ventricular septal defect and mitral anterior valve cleft with severe regurgitation
Hacı Ahmet Kasapkara, Abdullah Nabi Aslan, Hakan Süygün, Engin Bozkurt
PMID: 26363755  doi: 10.5543/tkda.2015.88894  Page 576
Abstract |Full Text PDF | Video

16. Concomitant presence of blood cyst and atrial septal defect: A rare association
Turhan Turan, Ahmet Çağrı Aykan, Ali Rıza Akyüz, Tayyar Gökdeniz
PMID: 26363756  doi: 10.5543/tkda.2015.46805  Page 577
Abstract |Full Text PDF | Video

17. An unusual cause of syncope: Mitral valve myxoma
Mehmet Yaman, Hasan Öztürk, Ugur Arslan
PMID: 26363757  doi: 10.5543/tkda.2015.86727  Page 578
Abstract |Full Text PDF | Video

18. Common atrium: A rare congenital heart anomaly
Selami Demirelli, Serdar Fırtına, Emrah Ermiş, Sinan Inci
PMID: 26363758  doi: 10.5543/tkda.2015.93027  Page 579
Abstract |Full Text PDF | Video

19. One sinus, three arteries: An unexpected coronary anomaly
Alejandro Quijada Fumero, Luis Álvarez Acosta, Raquel Pimienta González, Marcos Farrais Villalba, Marcos Rodríguez Esteban
PMID: 26363759  doi: 10.5543/tkda.2015.94831  Page 580
Abstract |Full Text PDF

LETTER TO EDITOR
20. Where are we standing in occupational cardiology?
Uğur Nadir Karakulak
PMID: 26363760  doi: 10.5543/tkda.2015.10270  Page 581
Abstract |Full Text PDF

21. Letters to the editor: An elderly patient with atresia of the left main stem
İsa Öner Yüksel, Erkan Köklü
PMID: 26363761  doi: 10.5543/tkda.2015.87262  Page 582
Abstract |Full Text PDF

22. Author's reply
Mustafa Topuz, Yücel Çölkesen, Mehmet Coşgun, Murat Çaylı
PMID: 26363762  Pages 582 - 583
Abstract |Full Text PDF

23. Is balloon sizing still necessary in the era of real-time 3D transesophageal echocardiography?
Uğur Canpolat
PMID: 26363763  doi: 10.5543/tkda.2015.77670  Pages 583 - 584
Transcatheter closure of secundum type atrial septal defects (ASD) has become a safe and effective method. However, various technical differences exist during selection of device size in between centers performing transcatheter ASD closure like balloon sizing, and echocardiographic guidance using transoesophageal (TEE), 3-dimensional (3D) and intracardiac echocardiography (ICE). However, there has been no international consensus regarding defect sizing issue.

24. Does occupation refer to an advantage or obstacle before transradial cardiac catheterization?
Uğur Canpolat
PMID: 26363764  doi: 10.5543/tkda.2015.15685  Pages 584 - 585
Because of the predefined complications of transradial approach, occupational factors should be considered for all the patients undergoing cardiac catheterization.

25. Left ventricular hypertrabeculation/noncompaction in hyperoxaluria
Josef Finsterer, Sinda Zarrouk-mahjoub
PMID: 26363765  doi: 10.5543/tkda.2015.55156  Pages 585 - 586
Abstract |Full Text PDF

26. Author's reply
Nurcan Arat, Murat Akyıldız, Gürkan Tellioğlu, Yaman Tokat
PMID: 26363766  Pages 586 - 587
Abstract |Full Text PDF

OTHER ARTICLES
27. Comment on cardiology publications

Page 588
Abstract |Full Text PDF



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