Objective: The goal of this study was to develop a national database of patients hospitalized in Turkey with acute heart failure (AHF) using evaluations of diagnostic and therapeutic approaches.
Methods: Patient data was collected using an Internet-based survey. Total of 588 patients were enrolled from 36 participating medical centers from across the country.
Results: Mean age was 62±13 years and 38% of the patients were female. Ratio of de novo AHF to study cohort was 24%. Coronary heart disease and hypertension were found in 61% and 53% of the patients, respectively. Valvular heart disease was underlying cause in 46% of heart failure patients. Most frequent factor associated with decompensation was noncompliance with treatment, observed in 34% of patients. Systolic blood pressure was 125±28 mmHg and heart rate was 93±22 beats/minute in the cohort. Most common findings on physical examination were inspiratory fine crackles (84%), peripheral edema (64%), and cold extremities in 34%. Mean ejection fraction (EF) measured at admission was 33±13%. Preserved EF (≥%40) was present in 20% of patients. At admission, 60%, 46%, and 40% of patients were using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, or aldosterone antagonist, respectively. Death, stroke, and myocardial infarction were reported with frequency of 3.4%, 1.6%, and 2%, respectively, as in-hospital events.
Conclusion: Compared to some other research data collected around the world, AHF patients in Turkey were younger, more frequently had valvular heart disease as underlying cause, and were more noncompliant with medical treatment, but overall mortality was lower. Drugs shown to reduce mortality, and which also form the backbone of guideline-directed medical therapy, are still used inadequately.

Objective: Treatment of chronic total occlusion (CTO) with everolimus-eluting bioresorbable vascular scaffold (BVS) is safe and effective at short-term follow-up (FU). The current study investigated clinical and angiographic outcomes after treatment of CTO with BVS at >1 year.
Methods: Thirty patients who underwent successful recanalization of 35 CTOs were included in this study. Quantitative coronary angiography (QCA) was performed at median FU period of 402 days. Clinical endpoints analyzed included all-cause mortality, cardiac death, non-fatal target vessel myocardial infarction, target vessel revascularization (TVR), symptom-driven target lesion revascularization (TLR), and BVS thrombosis.
Results: QCA analysis revealed in-scaffold minimal luminal diameter of 2.14±0.50 mm and late lumen loss (LLL) of 0.38±0.54 mm. One cardiac death, 5 cases with TVR, and 3 cases with TLR were detected at median FU time of 542 days. No BVS thrombosis was observed.
Conclusion: The Absorb BVS was safe and effective in the treatment of CTO with acceptable LLL at mid-term FU, comparable to drug eluting stents.

Objective: Effects of various conditions on coronary artery dimensions is an important research topic, and data regarding effect of aortic valvular diseases are limited. Aim of the present study was to investigate effects of aortic regurgitation (AR) and aortic stenosis (AS) on coronary artery dimensions.
Methods: Coronary dimensions of 95 patients (35 with isolated AR, 30 with isolated AS, and 30 without any valvular disease) were calculated. Patients with severe coronary artery disease and concurrent moderate to severe additional valvular disease were excluded. Mean diameter of major coronary arteries was determined using quantitative coronary angiography.
Results: The 3 study groups were similar in terms of baseline characteristics. Diameter of left main coronary artery was found to be greater in AR group than AS group (2.66±0.57 mm/m2 vs 2.36±0.49 mm/m2; p=0.015). Mean diameter of left anterior descending and left circumflex arteries were found to be similar in AR and AS groups, and greater than control group. Mean diameter of right coronary artery was found to be greater in AR group compared with controls; however, no significant difference was found in same measurement between AS group and controls.
Conclusion: Present study findings indicate that coronary dimensions in AR group tend to be greater than AS group. Further studies investigating factors that affect coronary dimensions would be beneficial in order to demonstrate mechanisms and differences in AR and AS groups.

Objective: Transcatheter aortic valve implantation (TAVI) has shown promising results in patients with severe aortic stenosis (AS) at high risk for open heart surgery. We aimed to evaluate outcomes of patients who underwent TAVI with Edwards SAPIEN 3 Transcatheter Heart Valve (S3), a second-generation TAVI device.
Methods: Between November 2014 and June 2016, 31 high-risk patients received balloon-expandable S3 valve at Atatürk Training and Research Hospital that has the largest case series in Turkey.
Results: Mean age of the patients was 76.1±12.6 years. Mean Society of Thoracic Surgeons and logistic European System for Cardiac Operative Risk Evaluation scores were 7.8%±3.1 and 31.4%±17.6, respectively. S3 valve was implanted in 27 patients via transfemoral approach and via trans-subclavian approach in 4 patients under local (n=29) or general (n=2) anesthesia. Procedural success rate was 100% (23 mm, n=7; 26 mm, n=16; 29 mm, n=8). Paravalvular aortic regurgitation (PAR) was absent or trivial in 29 (93.6%) patients and mild in 2 (6.4%) patients. Permanent pacemaker implantation (PPI) was required in 2 (6.4%) patients during the procedure, and in-hospital mortality occurred in 1 (3.2%) of those 2 patients.
Conclusion: S3 valve is associated with higher rate of device success and lower incidence of PAR, peripheral vascular complications, and need for new PPI.

Objective: The aim of this study was to examine the relationship between vitamin D levels in patients with heart failure (HF) and response to cardiac resynchronization therapy (CRT).
Methods: We studied 57 patients (mean age: 60.47±13.09 years) with New York Heart Association Class II or III heart failure, QRS duration ≥120 milliseconds, and ejection fraction <35% (mean: 27.1±4.4%) who underwent CRT. All patients were taking optimal medical treatment for HF. Patients were classified as CRT responders if they had >15% decrease in left ventricular end-systolic volume at 6 months compared with baseline measurements. Vitamin D levels were evaluated before CRT implantation with ELISA.
Results: Of the 57 patients, 34 patients (59.6%) were classified as responders and 23 patients (40.4%) were classified as non-responders. Baseline features, laboratory findings, and echocardiographic characteristics were nearly the same in both groups. High vitamin D level was detected in responder group compared to non-responder group (26.17±7.5 vs 21.15±5.9; p=0.009). Age, hypertension, diabetes mellitus, ischemic cardiomyopathy, QRS morphology and duration, and levels of B-type natriuretic peptide (BNP) and vitamin D were associated with CRT response in our study population. In multivariate regression analysis, preimplantation QRS duration, and BNP and vitamin D levels remained independent predictors (QRS duration Odds ratio [OR]: 1.047, CI: 1.019–1.417, p=0.006; BNP OR: 0.997, 95% CI: 0.994–0.999, p=0.029; vitamin D OR: 1.121, 95% CI: 1.011–1.242, p=0.030).
Conclusion: In the present study, preimplantation level of vitamin D was found to be predictor of response to CRT, independent of BNP.

Objective: Present study is an evaluation of left atrial (LA) mechanical and conduction function in patients with bicuspid aortic valve (BAV) without significant valve dysfunction, and an investigation of relationship between LA function and aortic elasticity.
Methods: Study population consisted of 34 isolated BAV patients (mean age: 34±13 years) and 29 healthy, age- and sex-matched volunteers (mean age: 30±10 years). LA volume was measured using biplane area-length method and LA active and passive emptying volume and fraction was calculated. Intra- and interatrial atrial conduction time (ACT) was measured with tissue Doppler imaging. Aortic elasticity parameters were calculated including aortic strain, aortic stiffness index, aortic distensibility, and aortic elastic modulus.
Results: LA diameter, LA maximum volume, LA volume before atrial systole, and LA active emptying fraction were significantly higher in patients with BAV (33.2±3.2 mm vs 34.9±2.8 mm, p=0.030; 16.2±4.6 mL/m2 vs 19.8±4.8 mL/m2, p=0.004; 10.2±3.7 mL/m2 vs 12.1±4.9 mL/m2, p=0.029; and 30.4±12.0% vs 39.9±11.8%, p=0.003, respectively). ACT was similar between groups. Aortic distensibility was significantly lower and aortic stiffness index and aortic elastic modulus were significantly higher in patients with BAV (8.1±4.6 [10-6cm2dyn-1] vs 5.1±3.6 [10-6cm2dyn-1], p=0.006; 4.1±2.8 vs 7.3±4.9, p=0.003; 3.6±2.8 [dyn.cm-2106] vs 5.9±3.9 [dyn.cm-2106], p=0.010, respectively). In correlation analysis, LA active emptying fraction was significantly correlated with aortic stiffness index and mitral A- velocity (r=0.431, p<0.001; r=0.304, p=0.016, respectively).
Conclusion: Present study demonstrated that LA mechanical function and aortic elasticity parameters were disrupted, while atrial conduction time was preserved in patients with isolated BAV. Furthermore, LA mechanical function parameters were significantly correlated with aortic elasticity parameters and mitral inflow A-wave.

Iatrogenic femoral artery pseudoaneurysm at the level of the hip joint in a 52-year-old patient was treated by ultrasound-guided percutaneous thrombin injection, while a balloon was inflated at the neck of the pseudoaneurysm under fluoroscopy, to prevent thrombin leakage to the arterial system.

Presently described is a case of subacute subclavian artery thrombosis treated with rheolytic thrombectomy, using the AngioJet system and direct stenting, in addition to double antiembolic filter protection of both the vertebral and brachial arteries.

Presently described is the case of a 55-year-old man who developed localized pain, allodynia, hyperpathia, and swelling over the right ankle joint following coronary balloon angioplasty, which had been performed via right femoral arterial access. Bone scan confirmed the diagnosis of complex regional pain syndrome. Various analgesics were administered, along with physiotherapist-assisted exercise. The present is the first reported case of complex regional pain syndrome presenting as remote postprocedural complication of transfemoral coronary balloon angioplasty.

A 56-year-old female patient was transferred due to the presence of a left supraclavicular pulsatile mass. Further work-up was performed to confirm diagnosis. Angiography and computed tomography were also performed. The anatomy of the thoracic aorta suggested an unknown and untreated aortic coarctation. A second aortic narrowing was identified at the aortic arch, a result of elongation of the aorta. Endovascular approach was not possible, due to complexity of the aortic anatomy, and tortuosity. Open surgical repair was successfully performed. A primary coarctation-related isthmus aneurysm is an exceptional finding in adults, and is a life-threatening condition when diagnosis is delayed. Management and treatment are controversial and challenging.

A 28-week-old preterm infant with a birth weight of 1250 g had a broken segment of umbilical vein catheter (UVC) lodged in the right atrium. It was observed that a 7-cm fragment of catheter had migrated to the right atrium through the inferior vena cava. The catheter was successfully retrieved by fluoroscopically guided percutaneous cardiac catheterization, using a cobra catheter and snare wire, without complication. Fracture and embolization of UVC is a rare but serious complication. Presently described was a case of fractured and embolized UVC in a very low-birth-weight preterm infant, and its successful retrieval via percutaneous endovascular approach.

Tracheal bronchus includes a variety of bronchial anomalies arising in the trachea or main bronchus and directed toward the upper-lobe territory. Reported incidence varies from 1–3% in the pediatric population. It is generally associated with other congenital malformations, including costovertebral anomalies, congenital airway and lung anomalies, vascular anomalies, and congenital heart defects. Presently described was the case of a 14-year-old female with tracheal right-upper-lobe bronchus, right aortic arch with mirror image, and abnormal left upper pulmonary venous return to innominate vein.