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Etkin antiretroviral tedaviyi takiben HIV ile infekte hastalarýn saðkalýmý önemli ölçüde artmýþtýr. Günümüzde kardiyovasküler hastalýk (KVH), geliþmiþ ülkelerde HIV ile infekte kiþilerde önemli bir ölüm nedenidir. Viral baskýlanma durumunda bile, major KVH risk faktörleri taþýmayan HIV ile infekte hastalarda MI riski 1.5-2 kat artmýþtýr. HIV+ hastalarda KVH patofizyolojisi karmaþýktýr ve HIV infeksiyonun kendisi, antiretroviral ilaç etkileri ve geleneksel risk faktörlerinin kombinasyonunu içerir. HIV ile infekte hastalar daha fazla oranda yüksek riskli plaklara sahiptir. Genel populasyonda KVH riskini deðerlendirmek için kullanýlan araçlarýn HIV ile infekte hastalarda geçerliði doðrulanmamýþtýr ve bunlar genellikle riski daha düþük kestirirler. Statinlerin geniþ immunomodulatuar etkileri nedeni HIV ile infekte populasyonda kullanýmlarý özellikle faydalý olabilir. Hedef LDL düzeylerine ulaþmak için bir statin seçerken antiretroviral ilaçlarla potansiyel ilaç etkileþimlerine dikkat edilmelidir. Þu anda yürümekte olan çalýþmalarýn bu populasyonda statin tedavisine en iyi yaklaþýmý belirlemesi ümit edilmektedir. HIV ile infekte hastalarda KVH önleme stratejileri multidispliner bir yaklaþým gerektirmektedir.

After effective antiretroviral therapy, the survival of patients infected with HIV has increased substantially. Currently, cardiovascular disease (CVD) is an important cause of death among HIV infected patients in developed countries. Even in the setting of viral suppression, HIV infected patients without major CVD risk factors had 1,5-2 fold greater risk of MI. The pathophysiology of CVD in HIV infected patients is complex and involves a combination of HIV infection itself, antiretroviral drug effects and traditional risk factors. HIV-infected patients are more likely to have high-risk plaques. The tools used for assessing risk of CVD in the general population have not been validated for HIV infected patients and generally underestimate the severity of disease in HIV+ patient. Statins have wide immunomodulatory effects, and their use in the HIV-infected population may be of particular benefit. When selecting a statin to reach target LDL-C levels, potential drug interactions with antiretroviral drugs must be considered. Ongoing studies is expected to define optimal approaches to statin treatment in this population. Strategies to prevent CVD in HIV-infected individuals needs for a multidisciplinary approach.

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Amaç: Spingoliplerin yapýsýný oluþturan seramid ikincil haberci olarak ateroskleroz patogenezinde önemli rol oynamaktadýr. AMPK geninin, düzenlediði genler üzerinden ateroskleroz ve hipertansiyon gibi hastalýklarda koruyucu rol oynadýðý gösterilmiþtir. De novo seramid sentezinde rol alan LASS5 (CERS5) geninin, AMPK genini dolaylý olarak etkilediði de belirlenmiþtir. Bu çalýþmanýn amacý, aterosklerozda LASS5 geninin rolünü belirlemektir.
Yöntemler: HUVEC’de (human umbilical vein endothelial cells) LASS5 genine özgü siRNA aracýlýðý ile gen sessizleþtirilmesi yapýldý. Gen sessizleþtirilmesinin ardýndan kardiyovasküler hastalýklarla iliþkili olan LASS5, AMPK-Alfa ve AMPK-Alfa hedef genlerinin hücresel gen ekspresyon seviyelerindeki deðiþimler araþtýrýldý. LASS5 geninin baskýlanmasý sonucundaki ekspresyon deðiþikliðinin AMPK aktivitesindeki deðiþime baðlý olup olmadýðýný anlamak için, HUVEC kültür ortamýna AMPK aktivatörü eklendi.
Bulgular: LASS5 geninin yeni bir fizyolojik fonksiyonu belirlendi. LASS5 geninin susturulmasý, HUVEC hücre hattýnda AMPK metabolizmasý ile iliþkili genlerin mRNA ekspresyonunu deðiþtirdi.
Sonuç: Bu çalýþma ile ilk defa LASS5 geninin ateroskleroz ile iliþkili olan AMPK-alfa geninin negatif düzenlemesinde yer alabileceði gösterilmiþtir. Bu bulgular, aterosklerozun moleküler mekanizmasýnýn anlaþýlmasýnda bir adým niteliði taþýmakta olup ayrýca aterosklerozun tedavisinde kullanýlabilecek maddelerin geliþtirilmesi için ön çalýþma olarak önem taþýmaktadýr.

Objective: Ceramide, the backbone of sphingolipids, is the key component affecting atherosclerotic changes through its important second-messenger role. Previous studies have demonstrated protective role of AMP-activated protein kinase (AMPK) genes in regulating atherosclerosis and hypertension. Ceramide synthase 5 (LASS5 or CERS5) gene has function in de novo synthesis of ceramide, and has indirect effect on AMPK gene. Aim of the present study was to identify role of LASS5 gene in atherosclerosis.
Methods: LASS5 gene-specific small interfering RNA (siRNA)-mediated gene silencing was performed in human umbilical vein endothelial cells (HUVEC) and differential expression of LASS5, AMPK-alpha and AMPK-alpha target genes were analyzed. HUVEC cells were then treated with AMPK activator in order to examine relationship of change in gene expression levels to AMPK activity.
Results: Novel physiological function of LASS5 was identified. Downregulation of LASS5 was found to attenuate ceramide production and increase expression of some AMPK target genes in HUVEC.
Conclusion: This is the first study to demonstrate that LASS5 was involved in negative regulation of atherosclerosis-related genes, such as AMPK-alpha. These preliminary findings provide insight into molecular mechanism of atherosclerosis and are important for development of potential therapeutic agents in the treatment of atherosclerosis.

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Amaç: Güncel farmakoinvaziv tedavi uygulanan ve perkütan koroner giriþime (PKG) alýnan akut koroner sendromlu (AKS) hastalarda intravenöz (ÝV) düþük yükleme dozuna karþýlýk yüksek yükleme dozunda tirofibanýn anjiyografik ölçümler, ST segment rezolüsyonu, enzimatik enfarkt büyüklüðü ve klinik sonlanýmlar üzerine etkilerini belirlemeyi amaçladýk.
Yöntemler: 2009 ile 2015 yýllarý arasýnda PKG sonrasý ÝV tirofiban tedavisi alan AKS’li 271 hasta (%85.6 erkek, ortalama yaþ: 57.9±12.6) geriye dönük olarak incelendi. Tüm hastalar yükleme dozunun ardýndan sürdürme dozunda tirofiban infüzyonu (0.15 μg/kg/dk) ve 600 mg klopidogrel aldý. Ýlaç kaplý stent takýlan hastalarýn oraný %33.5 idi. Tirofiban tüm hastalarda kurtarýcý amaçlý ya da trombotik komplikasyon varlýðýnda PKG’den sonra verildi.
Bulgular: Ýntravenöz yüksek yükleme dozunda tirofiban uygulanan grupta (25 μg/kg, n=140), düþük yükleme dozu alanlara göre (10 μg/kg, n=131) ST-segment rezolüsyonu daha fazla (%66 ve %50, p=0.013) ve pik troponin salýnýmý daha azdý (12.4 ng/dL [daðýlým: 6.5–21.5 ng/dL] ve 16.4 ng/dL [daðýlým: 10.1–27.4 ng/dL], p=0.001). Hastane içi, bir ay ve altý aylýk takiplerde kardiyovasküler olay oranlarý gruplar arasýnda benzerdi (sýrasýyla, p=1.000, 1.000 ve 0.287). Ýþlem sonrasý Thrombolysis in Myocardial Infarction (TIMI)-3 akýmý olan hasta oraný, majör ve minör kanama oranlarý gruplar arasýnda benzerdi (sýrasýyla, p=0.085, 1.000 ve 0.965).
Sonuç: Aspirin ve yüksek doz klopidogrele ilaveten yüksek yükleme dozunda ÝV tirofiban uygulamasýnýn PKG’ye alýnan AKS’li hastalarda düþük yükleme dozuna kýyasla ST-segment rezolüsyonunu iyileþtirme ve enzimatik enfarkt büyüklüðünü azaltmada kanama olaylarýný artýrmaksýzýn daha etkin olduðu gösterildi. Anjiyografik ölçümler ve klinik sonlanýmlar gruplar arasýnda benzerdi.

Objective: Aim of the present study was to determine effects of high-dose versus low-dose intravenous (IV) bolus tirofiban on angiographic measures, ST resolution, enzymatic infarct size, and clinical outcomes in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI) and received current pharmacoinvasive therapy.
Methods: Acute coronary syndrome patients (n=271, 85.6% male; mean age: 57.9±12.6 years) from between 2009 and 2015 who received IV tirofiban therapy following PCI were retrospectively analyzed. All patients had received maintenance tirofiban infusion (0.15 μg/kg/min) after bolus dose and 600 mg clopidogrel. Percentage of patients undergoing drug eluting stent implantation procedure was 33.5%. Tirofiban was administered to all patients in bailout situation or for thrombotic complication after PCI.

Results: High-dose IV bolus group (25 μg/kg; n=140) was associated with greater ST segment resolution (66% vs. 50%, p=0.013) and reduced peak troponin release [12.4 ng/dL (range: 6.5–21.5 ng/dL) vs. 16.4 ng/dL (range: 10.1–27.4 ng/dL), p=0.001] compared with low-dose bolus group (10 μg/kg, n=131). Cardiovascular event rates were similar between groups at in-hospital, 1-month, and 6-month follow-up (p=1.000, 1.000, and 0.287, respectively). Percentage of patients with post-procedural Thrombolysis in Myocardial Infarction (TIMI) grade III flow, major, and minor bleeding were similar (p=0.085, 1.000, and 0.965, respectively).

Conclusion: Use of high-dose IV bolus tirofiban in addition to aspirin and high-dose clopidogrel improves ST segment resolution, reduces infarct size, and does not increase bleeding events in patients with ACS undergoing PCI compared with low-dose bolus. Angiographic measures and clinical endpoints were similar between groups.

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Amaç: Koroner arter hastalýðý (KAH) tanýsý ile hastaneye yatýrýlan hastalarda risk faktörleri ve kýlavuzlara uyumun araþtýrýldýðý EUROASPIRE-IV Türkiye kolu verileri ve bulgularý EUROASPIRE-III Türkiye ve EUROASPIRE-IV Avrupa bulgularý ile karþýlaþtýrýldý.
Yöntemler: Çalýþma Türkiye’nin 17 merkez ile dahil olduðu, 24 Avrupa ülkesinde yapýldý. Son 6 ay içinde ve 3 yýl öncesi dönemde koroner (indeks) olay nedeniyle hastaneye yatmýþ 18–80 yaþ arasý hastalar, hastane kayýtlarýndan belirlenerek görüþmeye çaðrýldý. Hastalarýn indeks olay sýrasýndaki bilgileri arþiv kayýtlardan elde edildi. Görüþmede detaylý öykü alýnarak fiziksel muayeneleri ve laboratuvar ölçümleri yapýldý.
Bulgular: Koroner olay sýrasýndaki yaþ ortancasý 58.8 yýl olup, 6 yýl önce ayný merkezlerde yapýlan EUROASPIRE-III çalýþmasýna göre (60.5 yýl) anlamlý olarak düþtüðü gözlendi (p=0.017). Hastalarýn %19.3’ü 50 yaþ altýnda olup ortalama yaþ EUROASPIRE-IV Avrupa’ya (62.5 yýl) göre belirgin olarak düþük bulundu. EUROASPIRE-III ile karþýlaþtýrýldýðýnda EUROASPIRE-IV Türkiye kolunda sigara içme oraný %23.1’den %25.5’e (p=0.499), obezite %35.5’ten %40.7’ye (p=0.211), total kolesterol yüksekliði %48.3’ten %49.6’ya (p=0.767) ve diyabet %33.6’dan %39.7’ye (p=0.139) yükselmiþ olmakla beraber farklar istatistiksel açýdan anlamlý deðildi. Koroner olay sonrasýnda sigara içicilerinin %11.7’si sigarayý býraktý. EUROASPIRE-IV Avrupa’da bu risk faktörleri daha az oranda saptanmýþ olup sigara içme %16, obezite %37.6, diyabet %26.8 oranlarýna idi.
Sonuç: EUROASPIRE IV çalýþmasý Türkiye kolunda koroner arter hastalarýnda ikincil korunmanýn istenilen düzeyde olmadýðý, altý yýl öncesine göre olumsuz yönde ilerlediði, genel Avrupa ortalamasýna göre bazý risk faktörlerinin daha kontrolsüz olduðu ve genç yaþta koroner olaylarýn hâlâ önemli bir sorun olduðu saptanmýþtýr.

Objective: Data from EUROASPIRE-IV Turkey report investigating risk factors and adherence to guidelines in patients hospitalized for coronary artery disease are presented and results are compared with those of EUROASPIRE-III Turkey and EUROASPIRE-IV Europe.
Methods: Study was performed in 24 European countries, including Turkey (17centers).Patients (18–80years old)hospitalized for coronary (index)event during preceding 3 years were identified from hospital records and interviewed ≥6 months later. Patient information regarding index event was acquired from hospital records. Anamnesis was obtained during the interview, and physical examination and laboratory analyses were performed. Results: Median age at the index coronary event was 58.8 years, and it was significantly decreased compared with last EUROASPIRE-III study (60.5 years),which was conducted at the same centers 6 years earlier (p=0.017). Of all patients, 19.3% were under 50 years of age and mean age was lower than that of EUROASPIRE-IV Europe (62.5years).Comparing EUROASPIRE-IV Turkey with EUROASPIRE-IIITurkey, rate of smokers increased to 25.5% from 23.1% (p=0.499), obesity increased to 40.7% from 35.5% (p=0.211), total cholesterol level increased to 49.6% from 48.3% (p=0.767),and diabetes rate increased to 39.7% from 33.6% (p=0.139), however none of the differences reached a level of statistical significance.Only 11.7%of the smokers quit after coronary event. Rates for these factors were lower in EUROASPIRE-IVEurope (16%for smoking, 37.6%for obesity, and 26.8%for diabetes). Conclusion: EUROASPIRE-IVTurkey data revealed that secondary prevention was unsatisfactory and had progressed unfavorably compared with last EUROASPIRE study, some risk factors were more uncontrolled than overall European average, and coronary artery events at young age remain an important problem.

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Amaç: Dislipidemi, antiretroviral tedavinin (ART) sýk görülen komplikasyonlarýndan biridir. Bu çalýþmanýn amacý, HIV pozitif tanýsý konmuþ olan hastalarýn baþlangýçtaki lipit düzeylerini ve kardiyovasküler hastalýk geliþme risklerini belirlemek ve tedavi baþlandýktan sonra bu parametrelerde ortaya çýkan deðiþimi gözlemlemektir.
Yöntemler: Kliniðimize Nisan 2011 ve Aðustos 2012 tarihleri arasýnda baþvuran HIV pozitif hastalar dâhil edildi. Çalýþmaya 19 kadýn (%22.1) ve 67 erkek (%77.9) hasta alýndý (ortalama yaþ: 39.5±10.3). Hastalarýn ilk baþvuru ve son kontroldeki týbbi kayýtlarý geriye dönük olarak gözden geçirildi ve kan basýncý, sigara, alkol tüketimi, serum toplam kolesterol (TK), trigliserit (TG), yüksek yoðunluklu lipoprotein (HDL), düþük yoðunluklu lipoprotein (LDL), glikoz düzeyleri kaydedildi. Baþlangýca göre TK, TG, HDL, LDL ve Amerikan Kardiyoloji Koleji’nin kardiyovasküler hastalýk risk (KVHR) skoru hesaplandý. Takip ve tedavi ile olan iliþkisi irdelendi.
Bulgular: Baþlangýçta 73 (%84.9) olgu hiç ART ilaç kullanmamýþ ya da ilaç kullanmaya baþlamýþ, fakat en ez 3 aydýr kullanmamýþ, 13 olgu da (%15.1) ART kullanmakta idi. Çalýþmaya alýnmadan önceki son ziyaretlerinde ise 74 (%86) olgunun ART kullandýðý, 12 (%14) olgunun hiç ART kullanmadýðý saptandý. Baþlangýçta ve son ziyarette TK düzeyleri sýrasýyla 175.5 (daðýlým: 90–346) mg/dL ve 196.5 (daðýlým: 104–317) mg/dL (p=0.001), HDL düzeyleri 40 (daðýlým: 21–81) mg/dL ve 35 (daðýlým: 10–75) mg/dL (p=0.001), LDL düzeyleri 101.5 (daðýlým: 32–191) mg/dL ve 120.5 (daðýlým: 32–250) mg/dL (p<0.001) ve TG düzeyleri 145.5 (daðýlým: 43–2580) mg/dL ve 152.5 (daðýlým: 67–884) mg/dL (p=0.102) bulundu. Baþlangýçta KVHR skoru %46 (daðýlým: 5–69) iken son deðerlendirmede %50 (daðýlým: 5–69) bulundu (p<0.001).
Sonuç: HIV enfeksiyonunun, lipit profili ve kardiyovasküler risk üzerine olumsuz etkileri vardýr. Bu nedenle hastalar yaþam tarzý deðiþikliði ve lipit düþürücü tedavi için yakýndan izlenmelidir.

Objective: Dyslipidemia is a major complication of antiretroviral treatment. Aim of the present study was to screen baseline lipid levels and cardiovascular disease risk in HIV-positive patients and analyze change in those parameters after initiation of antiretroviral treatment (ART).
Methods: HIV-positive patients who presented at our clinic between April 2011 and August 2012 were included. Study included 19 female (22.1%) and 67 male (77.9%) patients (mean age 39.5±10.3 years). Blood pressure, smoking habit, alcohol consumption, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glucose level, and antiretroviral treatment status data were reviewed retrospectively. Changes in lipid profile and lifetime risk for atherosclerotic cardiovascular disease (ASCVD) according to the American College of Cardiology guidelines were compared with baseline data and analyzed.
Results: At baseline, 13 (15.1%) patients were already receiving ART and 73 (84.9%) patients were treatment-naive or had stopped therapy ≥3 months prior to enrollment. At last visit, 73 (84.9%) patients were taking ART. Results of baseline and final visit TC levels were 175.5 mg/dL (range: 90–346 mg/dL) and 196.5 mg/dL (range: 104–317 mg/dL), respectively (p=0.001). HDL levels were 40 mg/dL (range: 21–81 mg/dL) and 35 mg/dL (range: 10–75 mg/dL; p=0.001), and LDL levels were 101.5 mg/dL (range: 32–191 mg/dL) and 120.5 mg/dL (range: 32–250 mg/dL; p<0.001). TG levels were 145.5 mg/dL (range: 43–2580 mg/dL and 152.5 mg/dL (range: 67–884 mg/dL; p=0.102). Baseline ASCVD risk score was 46% (range: 5–69%) while last visit ASCVD risk score was 50% (range: 5-69%; p<0.001).
Conclusion: HIV infection has adverse effects on lipid profiles and cardiovascular risk of HIV-positive patients. Therefore, patients should be closely monitored for lifestyle interventions and lipid-lowering agents.

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Amaç: Bu çalýþmada amacýmýz, kararlý anjina pektoris (KAP) ile baþvuran ve koroner arter hastalýðý (KAH) saptanan hastalarda, SYNTAX skoru (SXskoru) ile hesaplanan anjiyografik lezyon yaygýnlýðý ve ciddiyeti ile iki boyutlu (2D) speckle tracking ekokardiografi (STE) yöntemi ile deðerlendirilen sol atriyum deformasyonu paremetreleri arasýnda iliþki olabileceðini göstermektir.
Çalýþma planý: Çalýþmaya KAP tanýsý konmuþ 60 hasta (40 erkek 20 kadýn) ve bazal özellikleri yönünden benzer 30 saðlýklý bireyden oluþan kontrol grubu alýndý. Konvansiyonel ekokardiyografik parametrelerle birlikte ventrikül ve atriyal sistolleri sýrasýnda pik sol atriyal strain (sýrasýyla, LA-RES ve LA-PUMP), ventrikül sistolü sýrasýnda pik sol atriyal strain oraný (LA-SRS), erken diyastol sýrasýnda pik sol atriyal strain oraný (LA-SRE) ve atriyal sistolü sýrasýnda pik sol atriyal strain oraný (LA-SRA) ölçümleri elde edildi.
Bulgular: Hastalar SXskoru <20 (grup I) ve yüksek SXskoru ≥20 (grup II) olmak üzere iki gruba ayrýldý. Sol ventrikül (SV) diyastolik fonksiyonlar SXskoru yüksek grupta bozulmuþ olup, SV dolum basýnçlarýnda anlamlý artýþ saptandý. LA-RES (kontrol grubu: 42.3±7.9, grup I: 36.4±8.2 grup II: 27.5±8.1 p<0.001) ve LA-PUMP (kontrol grubu: 17.6±3.4, grup I: 15.7±2.5 grup II: 13.1±3.2 p<0.001) yüksek SXscore grubunda düþük SXscore grubuna göre anlamlý olarak daha düþüktü. Üç grup arasýnda LA-SRS, LA-SRE, LA-SRA açýsýndan anlamlýlýk saptanmadý. SXskoru seviyesi ile LA-RES fonksiyonu arasýnda ise negatif iliþki olduðu saptandý (r: -0.49, p<0.001).
Sonuç: Kararlý koroner arter hastasý SXskoru yüksek kiþilerde 2D-STE’ye iliþkin sol atriyal deformasyon parametreleri anlamlý derecede bozulmaktadýr. KAP’li hastalarda, LA-RES ve LA-PUMP deðerleri, KAH’nýn yaygýnlýðý ve ciddiyetini öngörmede kullanýlabilir.

Objectives: Aim of the present study was to investigate correlation between left atrial (LA) deformation parameters assessed using 2-dimensional (2D) speckle tracking echocardiography (STE) and complexity of coronary artery disease according to SYNTAX score (SXscore) in patients with stable coronary artery disease (SCAD).
Study design: Total of 60 moderate-risk SCAD patients (40 men, 20 women) who underwent coronary angiography and 30 healthy controls were included. Measurements of conventional echocardiographic parameters as well as peak LA strain during ventricular systole (LA-RES), peak LA strain during atrial systole (LA-PUMP), peak LA strain rate during ventricular systole (LA-SRS), peak LA strain rate during early diastole (LA-SRE), and peak LA strain rate during atrial systole (LA-SRA) were obtained.
Results: Patients were categorized into 2 groups: low SXscore of <20 (Group I) and high SXscore of ≥20 (Group II). Left ventricular (LV) diastolic functions were significantly impaired and LV filling pressure was significantly higher in high SXscore group. LA-RES (Control Group: 42.3±7.9, Group I: 36.4±8.2, Group II: 27.5±8.1; p<0.001) and LA-PUMP (Control Group: 17.6±3.4, Group I: 15.7±2.5, Group II: 13.1±3.2; p<0.001) were significantly lower in high SXscore group compared with low SXscore group. There was no statistical difference in LA-SRS, LA-SRE, or LA-SRA between the 3 groups. Correlation analysis indicated negative correlation between SXscore level and LA-RES function (r=-0.49; p<0.001).
Conclusion: 2D-STE-based LA deformation parameters are significantly impaired in patients with SCAD who have high SXscore. In addition, evaluation of LA-RES and LA-PUMP functions might be useful in estimating severity of disease in patients with SCAD.

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Amaç: Daha önce kardiyak sorunlar için spor yarýþmalarýna katýlmaya uygun olduklarý bildirilen çocuklarý, kalp araþtýrmasý protokolü kullanarak yeniden inceledik.
Yöntemler: Yaþlarý 8–17 arasýnda olan, sportif etkinliklere daha önce veya yeni baþlamýþ 250 çocuk (224 erkek [%89.6] ve 26 kýz [%10.4]) çalýþmaya dahil edildi. Katýlýmcýlar detaylý bir fizik muayeneden geçirildi ve bir çocuk kardiyoloðu tarafýndan deðerlendirildi. Öykü, fizik muayene veya 12 derivasyonlu elektrokardiyografi’nin (EKG) herhangi birinde kalp hastalýðýný düþündürecebilecek bulgusu olan hastalar ekokardiyografi, 24 saatlik Holter kaydý ve egzersiz testi ile araþtýrýldý.
Bulgular: Spor faaliyetlerine ortalama katýlým süresi 13 ay idi. Tüm katýlýmcýlarýn %10.4’ünde EKG patolojisi mevcuttu. Ekokardiografi katýlýmcýlarýn birinde kardiyomiyopati, ikisinde mitral valv prolapsusu ve birinde mitral yetersizliði ortaya koydu. Holter moniterizasyonu katýlýmcýlarýn bir tanesinde süreksiz ventriküler taþikardi ve birinde supraventriküler taþikardiyi açýða çýkardý. Üç katýlýmcý profesyonel spor aktivitelerinden uzaklaþtýrýldý.
Sonuç: Spor ve týp komiteleri atletler için spor etkinliklerini daha güvenli yapmak, spora baðlý ani ölümleri engellemek için birlikte çalýþarak çalýþma programlarý oluþturmalýdýrlar. Genç sporcularýn spor faaliyetlerine baþlamadan önce çocuk kardiyolojisi konsültasyonu yapýlmasý gerekir.

Objective: We re-examined children who had previously been declared eligible to participate in competitive sports activities for cardiac disorders, using cardiac investigation protocol.
Methods: Total of 250 children (224 males [89.6%], and 26 females [10.4%]) between the ages of 8 and 17 years who had just started or were already engaged in sports activities were included in the study. Participants had detailed physical examination evaluated by a pediatric cardiologist. Those with findings suggesting cardiac disorder in their history and/or physical examinations, and/or 12-channel electrocardiography (ECG) were examined with echocardiography (ECHO), 24-hour Holter monitoring, and exercise test.
Results: Mean duration of participation in sports activities was 13 months. Among all, 10.4% of the children had abnormalities on ECG. ECHO demonstrated cardiomyopathy in 1, mitral valve prolapse in 2, tricuspid insufficiency in 2, and mitral insufficiency in 1 participant. Holter monitoring revealed non-sustained ventricular tachycardia attacks in 1, and supraventricular tachycardia in another child. Three were ultimately disqualified from partaking in competitive sports.
Conclusion: Sports and medical communities must work together to establish study protocols to prevent sudden death related to sports and to make these activities safer for athletes. Pediatric cardiology consultation for young athletes before they start sports activities is needed.

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Eriyebilen vasküler çatý (BVS) stentleri son zamanlarda koroner arter hastalýðýnýn tedavisinde mükemmel bir teknoloji olarak önerilmektedir. Ancak bu “eriyebilir” stentlerin yakýn bir gelecekte geniþ bir klinik durum spektrumunda ve hasta kategorisinde geleneksel metal stentlerin yerini alacaðý þeklinde görüþe sahip uzmanlarýn sayýsý, ihmal edilemez sýklýktaki stent trombozu (ST) nedeniyle azalmýþtýr. Strut kalýnlýðý ve tam olmayan stent açýlmasý (malapozisyon) gibi mekanik faktörler BVS’de ST riskinin artýþýndan sorumludur. Burada mekanik bir sorundan ziyade iþlemle ilgili teknik bir sorundan kaynaklanan kýsmi BVS’de acil ST saptanan bir genç erkek olgu sunuldu. Antikoagülasyonla birlikte glikoprotein IIB/IIIa inhibitörlerinin kullanýlmasý trombüsün tamamen çözülmesiyle ve hasta prognozunun iyileþmesiyle sonuçlandý.

Bioresorbable vascular scaffold (BVS) stents have been proposed recently as an elegant technique for treatment of coronary artery disease. However, perspective that these “dissolvable” stents will replace conventional metallic stents in broad spectrum of clinical conditions and patient categories in the near future has been moderated by non-negligible incidence of stent thrombosis (ST). Mechanical factors, such as strut thickness and malapposition have been implicated in increased risk of BVS ST. Presently described is case of immediate partial BVS ST in a young male related to technical procedural problem, rather than mechanical problem. Glycoprotein IIb/IIIa inhibitors associated with anticoagulation resulted in complete resolution of thrombus and facilitated successful patient outcome.

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Gemsitabin bir kemoteropi ilacýdýr. Bu ilaç genellikle doza baðýmlý iyi tolere edilebilen miyelosüpresyon (özellikle trombositopeni) yan etkisi görülebilen, bir nükleozid analoðudur. Hafif-orta düzeyde görülebilen diðer yan etkileri alopesi, kusma, bulantý, döküntü ve ateþtir. Gemsitabinin en sýk görülen kardiyotoksik etkisi koroner iskemisidir ki bunun bu ilacýn antimetabolitlerine baðlý olduðu düþünülür. Koroner iskemisinin altýnda yatan neden belirsiz olmakla beraber, endotel fonksiyon bozukluðu ve koroner trombozu oluþumu olasý açýklamalardýr. Bizim bilgilerimize göre gemsitabin ile iliþkili kardiyovasküler yan etki bildirimi sýnýrlý sayýdadýr. Bu yazýda gemcitabin alan bir kadýn hastada geliþen bir akut inferiyor miyokart enfarktüsü olgusu sunuldu.

Gemcitabine is a chemotherapy drug. It is a nucleoside analogue that is usually well tolerated by patients, with myelosuppression (especially thrombocytopenia) as dose-limiting side effect. Other mild to moderate side effects include alopecia, vomiting, nausea, rash, and fever. Coronary ischemia is the most common cardiotoxic effect of gemcitabine, which is due to its antimetabolites. While underlying cause of coronary ischemia following use of gemcitabine is uncertain, endothelial dysfunction and coronary thrombosis are potential explanations. To our knowledge, there are few published case reports of adverse cardiovascular side effects associated with gemcitabine. Presently described is case of acute inferior myocardial infarction in a female patient caused by gemcitabine.

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Spontan ekokardiyografik kontrastlanma kalp boþluklarýnda ve büyük damarlarda gözlenen hiperekojen görünümde yansýmalar olarak tanýmlanan bir durumdur. Mikro kabarcýk oluþumu veya düþük kan akýmý ile iliþkili bir çok durumda gözlenebilir. Bu yazýda, duktus venozus ile iliþkili spontan ekokardiyografik kontrastlanma saptanan bir yenidoðan sunuldu.

Spontaneous echocardiographic contrast is defined as a phenomenon of discrete reflections appearing in the cardiac chambers or great vessels. It has been associated with several conditions leading to microbubble formation or low blood flow. This is a report of a neonate with spontaneous echocardiographic contrast related to patent ductus venosus.

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Nonkompaksiyon kardiyomiyopatiye kalp yetersizliði sýklýkla eþlik eder. Bu hastalýkta görülen kalp yetersizliði tedavisinde, dilate kardiyomiyopatiye benzer þekilde týbbi tedavi ya da týbbi tedaviye dirençli olgularda kalp nakli uygulanabilir. Bu yazýda, kliniðimize kalp nakli planýyla yönlendirilen son dönem kalp yetersizliði olan nonkompaksiyon kardiyomiyopatili bir pediyatrik olguda, PDA’nýn kapatýlmasý ile düzelme saðlandý ve kalp nakiline ihtiyaç kalmadý.

Although heart failure is managed medically most of the time, heart transplantation is still last resort for selected end-stage heart failure patients with noncompaction cardiomyopathy. Presently described for the first time is case of pediatric patient with noncompaction cardiomyopathy who was initially referred to our hospital for heart transplant but underwent PDA repair and improved clinically without need for heart transplant.

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Middle aortik sendrom (MAS) distal torasik ve abdominal aortanýn darlýðý ile seyreder. Genellikle ilk dekattan sonra taný konan nadir bir hastalýktýr. Middle aortik sendromun klinik yansýmasý sýklýkla hipertansiyon ve alt ekstremitelerde klaudikasyon þeklindedir. Etiyolojisi tam bilinmemekle birlikte doðumsal veya akkiz hastalýklara eþlik ettiði bilinmektedir. Malign hipertansiyonla seyreden bu patoloji, çoðunlukla týbbi tedaviye yanýt vermemektedir. Middle aortik sendromlu hastalarda hipertansiyon, kalp yetersizliði, intrakraniyal kanama, aort rüptürü gibi komplikasyonlarý önlemek için cerrahi tedavi birinci sýrada önerilmektedir. Bu yazýda, herhangi bir þikayeti olmaksýzýn rutin muayene sýrasýnda tansiyon yüksekliði saptanan, ekokardiyografi ve geleneksel anjiyografi ile abdominal aortada uzun segment darlýðý belirlenen çocuk olgu, bu hastalýða dikkat edilmesi için sunuldu.

Middle aortic syndrome (MAS) follows a course with distal thoracic and abdominal aorta stenosis. It is a rare disease that is usually diagnosed after the first decade of life. Clinical reflection of MAS is often in the form of hypertension and claudication in the lower extremities. Its etiology is unclear, but is known to be associated with congenital or acquired diseases. This pathology, which is accompanied by malignant hypertension, often does not respond to medical treatment. In patients with MAS, surgical treatment is first line recommendation to prevent complications such as hypertension, heart failure, intracranial bleeding, or aortic rupture. In order to draw attention to this disease, presently described is case of high blood pressure detected during routine examination of a child who had no complaint, and discovery of long-segment stenosis in the abdominal aorta identified with echocardiography and conventional angiography.

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Bu yazýda, kor triatriyatum sinister, çift giriþli mitral kapak, çift çýkýþlý fonksiyonel tek ventriküle neden olan geniþ ventriküler septal defekti olan ve uzun süreli bosentan tedavisi altýndaki gebe bir Eisenmenger sendromlu hastada baþarýlý sezaryen doðum sunuldu. Sezaryen doðum gebeliðin 27. haftasýnda anne veya fetal morbidite olmadan gerçekleþti. Bebekte herhangi bir doðumsal kalp anomalisi ya da gebelik boyunca bosentan kullanýmýna baðlý teratojenik etki yoktu.

Presently described is successful cesarean delivery in a pregnancy superimposed on long-term bosentan treatment in an Eisenmenger syndrome patient with cor triatriatum sinistrum, double-orifice mitral valve, and large ventricular septal defect resulting in single functioning ventricle with double outlets. Cesarean delivery was performed at 27th week of gestation without maternal or fetal morbidity. The infant had no congenital cardiovascular abnormality or any probable teratogenic effect of bosentan treatment during pregnancy.

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Annede taþiaritmi, hamile kadýnlarda önceden var olan aritmileri arttýran veya doðuþtan kalp defektleri varlýðýnda yeni aritmileri baþlatan hormonal deðiþikliklere baðlý olarak sýk görülen bir komplikasyondur. Gebelik sýrasýnda taþiaritminin varlýðý anne ve fetüs için risk oluþturmakta ve ilaçlarla uygun tedaviyi gerektirmektedir. Teratojenik yan etkilerini de göz önüne alarak maternal taþiaritmide antiaritmik ilaçlarýn kullanýlmasý düþünülmelidir. Gebelik sýrasýnda antiaritmik ilaçlarýn kullanýlmasý iyice incelenmiþ olup bazýlarý minimal fötal hasara yol açacak bazýlarý hiç zararlý olmayacaktýr. Kardiyak ablasyon gibi yeni teknikler de fetüs veya anneyi minimal (veya hiç) radyasyona maruz býrakmadan uygulanmýþtýr. Antiaritmik ilaçlarla giderek artan deneyim ve yeni prosedürel tekniklerdeki ilerleme sayesinde gebe kadýndaki taþiaritmiler baþarýyla ve geliþmekte olan fetüse çok az (veya hiç) etkiyle tedavi edilmektedir.

Maternal tachyarrhythmia is a common complication during pregnancy due to hormonal changes that enhance pre-existing arrhythmias or induce new arrhythmias in the presence of congenital heart defects in pregnant females. Presence of tachyarrhythmia during pregnancy poses risk to the mother and fetus, calling for proper treatment with medications. Use of antiarrhythmic drugs in cases of maternal tachyarrhythmia must give due consideration of potential teratogenic side effects. Utilization of antiarrhythmic drugs during pregnancy has been well studied; some result in minimal fetal harm or none at all. New techniques, such as cardiac ablation, have also been implemented with minimal or no radiation exposure to the fetus or mother. Pregnant women with tachyarrhythmia have been successfully treated with little to no impact on the developing fetus as result of increasing experience with antiarrhythmic drugs and progress of new procedural techniques.

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