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Amaç: Patent duktus arteriyozus (PDA) insidansý yüksek rakýmda yaþayanlarda artmýþtýr. Bu hasta grubunda, duktus daha geniþtir ve pulmoner hipertansiyon daha sýktýr. Bu çalýþmanýn amacý, orta veya yüksek rakýmlý yerleþim yerlerinde yaþayan olgularda, PDA’nýn morfolojik ve hemodinamik özellikleri ile birlikte, farklý cihazlarla transkateter PDA kapatýlmasýnýn incelenmesidir.
Yöntemler: Mayýs 2010 ile Temmuz 2018 tarihleri arasýnda, 1600 metre rakýmýn üzerinde yaþayan ve izole PDA nedeni ile kalp kateterizasyonu uygulanmýþ 327 hasta geriye dönük olarak incelendi.
Bulgular: Ortalama yaþ 7.33±7.67 yýl idi ve hastalarýn %62.4’ü kýzdý. Ortalama duktus çapý 3.74±2.14 mm idi. Olgularýn %57.8’inde pulmoner hipertansiyon mevcuttu. Hastalarýn 322’sine (%97.3) transkateter PDA kapama iþlemi uygulanmýþtý. Amplatzer duct occluder I en çok kullanýlan cihazdý. Amplatzer vascular plug (AVP) II ve Amplatzer musküler ventriküler septal defekt occluder (AMVSDO) etiket dýþý kullanýlan cihazlardý. Hastalarýn çok büyük bir kýsmýnda kapama iþlemi sonrasý pulmoner arter basýncýnda hýzlý düþüþ izlendi. Ýþlem sonrasý nadir sayýda olguda geçici sol ventrikül disfonksiyonu gözlendi. Ýzlemde tüm olgularda pulmoner hipertansiyon geriledi ve sol ventrikül fonksiyonlarý ek tedavi gerektirmeksizin normale geldi.
Sonuç: Yüksek rakýmlý yerleþim yerlerinde yaþayan olgularda transkateter PDA kapatýlmasý yüksek baþarý oranýna sahiptir. Bu olgularda etiket dýþý cihazlarýn kullanýlmasý gerekebilir. Pulmoner hipertansiyon sýklýkla görülür ancak iþlem sonrasý geriler. Transkateter PDA kapatýlmasý sonrasý geçici sol ventrikül disfonksiyonu nadiren bu hastalarda görülür ve ek tedavi gerektirmeden izlemde düzelir.

Objective: The incidence of patent ductus arteriosus (PDA) is greater among patients living at high altitude. In this po-pulation, the ductal diameter is often larger and pulmonary hypertension is more frequent. The aim of this study was to evaluate the hemodynamic and morphological features of PDA and transcatheter closure procedures performed with various devices in a group of patients living at high altitude in Turkey.
Methods: The data of 327 patients who lived at an altitude of at least 1600 m above sea level and who had undergone cardiac catheterization for isolated PDA between May 2010 and July 2018 were retrospectively analyzed.
Results: The mean age was 7.33±7.67 years, and 62.4% of the patients were female. The mean ductal diameter was 3.74±2.14 mm. Pulmonary hypertension was present in 57.8%. Transcatheter closure was performed in 322 patients, with a 97.3% success rate. The Amplatzer duct occluder I (ADO I) was used most often, as well as off-label use of the Amplatzer vascular plug II (AVP) and the Amplatzer muscular ventricular septal defect occluder (AMVSDO). Pulmonary artery pressure decreased immediately in the vast majority after percutaneous closure. Transient left ventricular systolic dysfunction after ductal closure was seen only rarely. Follow-up was uneventful.
Conclusion: Transcatheter PDA closure can be performed with high success rate in highlanders. Off-label devices may be required for these procedures. Pulmonary hypertension is frequent but regresses after ductal closure. Transient left ventricular dysfunction after transcatheter closure is rarely seen in these patients and resolves without any medication.

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Amaç: Bu çalýþmada, valvüler olmayan paroksismal atriyal fibrilasyonu (PAF) olan hastalarda AF nüksü ile ikinci jenerasyon kriyobalon ablasyon (KBA) prosedürü parametreleri arasýndaki iliþkiyi araþtýrmayý planladýk.
Yöntemler: Ýkinci jenerasyon KBA (59 erkek; ort. yaþ 55.2±10.6 yýl) yapýlan PAF tanýsý alan 131 hasta dahil edildi. Nüks, 12 derivasyonlu elektrokardiyografide (EKG) AF görülmesiyle ya da ritim Holter kayýtlarýnda en az 30 saniye süren AF ataklarýnýn saptanmasý olarak tanýmlandý. Bazý KBA prosedür verileri ve ekokardiyografik bulgular kaydedildi ve karþýlaþtýrýldý.
Bulgular: Bir yýl sonra izlemde 27 hastada AF nüks tespit edildi. Nüksü olan hastalar daha yaþlýydý ve daha yüksek hipertansiyon ve diyabet oranlarý vardý (hepsi için, p<0.05). Sol atriyum çapý (SaD), sol atriyum volümü (SaV), sol atriyum volümü indeksi (SaVI) ve ortalama ýsýnma açýsý (en düþük sýcaklýk noktasýný ve balon sýcaklýðýný 20°C noktasýnýn birleþtirilmesi ile elde edilen) nüks grubunda anlamlý olarak artmýþtý. Nüks olmayan grupta balon ýsýnma süresi önemli ölçüde uzamýþtý (p<0.001). Ýkili lojistik regresyon analizinde, ortalama ýsýnma açýsý (OO=1.559, %95 GA: 1.342–1.811, p<0.001) ve sol atriyum volümü (SaV, OO: 1.063, %95 GA: 1.028–1.100, p<0.001) nüks tahmini için baðýmsýz parametreler bulundu. ROC eðrisi analizi ile elde edilen ýsýnma açýsýnýn kestirim deðeri, nüks tahmini için 50° idi (duyarlýlýk: %94.3, özgüllük: %88.5, EAA: 0.909, p<0.001). ROC eðrisi analizi ile elde edilen SaV’nin kesme deðeri, nüks tahmini için 53.5 idi (duyarlýlýk: %77.8, özgüllük: %74.5, p <0.001).
Sonuç: Kriyobalon ablasyon sýrasýnda balon ýsýnma açýsýnýn ölçülmesi ve artan SaV, AF nüksetmesini öngörebilir.

Objective: The aim of this research was to investigate the relationship between atrial fibrillation (AF) recurrence and second generation cryoballoon ablation (CBA) procedural parameters in patients with non-valvular paroxysmal AF (PAF).
Methods: A total of 131 patients with a PAF diagnosis who underwent second-generation CBA (59 male; mean age: 55.2±10.6 years) were enrolled. Recurrence was defined as the detection of AF on a 12-lead electrocardiography (ECG) recording, or an attack lasting at least 30 seconds observed on Holter ECG records. CBA procedural data and echocardiographic findings were recorded and compared.
Results: After 1 year of follow-up, AF recurrence was detected in 27 patients. Patients with recurrence were older and had higher rates of hypertension and diabetes (p<0.05 for both). Left atrial diameter, left atrial volume (LaV), left atrial volume index, and the averaged warming angle (calculated by combining lowest temperature point and balloon temperature at 20°C point) were significantly higher in the recurrence group. Balloon warming time was significantly longer in the non-recurrence group (p<0.001). In binary logistic regression analysis, the averaged warming angle (odds ratio [OR]: 1.559, 95% confidence interval [CI]: 1.342–1.811; p<0.001) and LaV (OR: 1.063, 95% CI: 1.028–1.100; p<0.001) were found to be independent parameters for predicting recurrence. The cutoff value of the warming angle obtained with ROC curve analysis was 50° for the prediction of recurrence (sensitivity: 94.3%, specificity: 88.5%, area under the curve: 0.909; p<0.001). The cutoff value of LaV obtained by ROC curve analysis was 53.5 for prediction of recurrence (sensitivity: 77.8%, specificity: 74.5%; p<0.001).
Conclusion: Measurement of balloon warming angle during CBA and increased LaV may predict the AF recurrence.

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Amaç: ST-yükselmeli miyokart enfarktüs (STYME) hastalarý homojenlik göstermediðinden dolayý ani kardiyak ölümlerin primer korunmasý ihtilaflý bir konudur. T-dalga alternansýnýn (TDA) kardiyak mortalite ile iliþkisi, çoðunluðu ölümcül aritmi riski yüksek olan düþük sol ventrikül ejeksiyon fraksiyonlu (SVEF) hastalar olmak üzere, birçok farklý kalp hastalýklarýnda incelenmiþtir. Çalýþmamýzda, genç yaþ STYME geçirmiþ ve korunmuþ SVEF’ye sahip spesifik bir popülasyonda TDA’nýn prevalansýný ve kardiyak mortalite ile iliþkisini araþtýrmayý amaçladýk.
Yöntemler: Bu ileriye yönelik çalýþmaya, 45 yaþ altý tek damar primer perkütan koroner iþlem uygulanmýþ, korunmuþ kardiyak fonksiyonlu 108 STYME hastasý dahil edildi. Korunmuþ kardiyak fonksiyon, iþlem sonrasý 24–72 saatte yapýlan ekokardiyografide SVEF ≥50 saptanmasý olarak kabul edildi. TDA analizi STYME’den yaklaþýk bir yýl sonra yapýldý. TDA pozitifliði, daha önceki çalýþmalarda tanýmlandýðý gibi, dakikada 125 kalp atýmýnda maksimum voltajýn 64 μV üzeri olmasý þeklinde tanýmlandý. Hastalarýn beþ yýllýk takibi sonucu primer sonlaným noktasý olarak total kardiyak nedenli ölümler kabul edildi.
Bulgular: T-dalga alternansý, 24 hastada (%22.2) pozitifti. TDA pozitifliðine göre oluþturulan iki grup arasýnda; geleneksel risk faktörleri, ilaç kullanýmý ve SVEF açýsýndan fark yoktu. Beþ yýllýk takip sonucunda yedi hasta (%6.5) primer sonlaným noktasýna ulaþtý. Diðer risk faktörlerinden baðýmsýz olarak, TDA pozitifliði olan hastalarda beþ yýllýk kardiyak mortalite, TDA pozitifliði olmayanlara göre 10.7 kat oranýnda artmýþtý.
Sonuç: T-dalga alternansý pozitifliði genç yaþ STYME hastalarýnda artmýþ kardiyak mortalite ile iliþkili olabileceðinden dolayý, klinisyenler bu popülasyonda TDA testini dikkate almalýdýr.

Objective: Primary prevention of sudden cardiac death in ST-elevation myocardial infarction (STEMI) is a complicated issue due to the highly heterogeneous population. The effect of T-wave alternans (TWA) on cardiac mortality has been examined in various populations, most often in patients with a high risk of fatal arrhythmia, such as patients with a low left ventricular ejection fraction (LVEF). The aim of the present study was to investigate the prevalence of TWA and its relationship to cardiac mortality in young STEMI patients with preserved LVEF.
Methods: A total of 108 STEMI patients with preserved cardiac function who were under the age of 45 and underwent single-vessel primary percutaneous coronary intervention were enrolled in this prospective study. Preserved cardiac function was defined as an LVEF of ≥50% as detected with echocardiography 24 to 72 hours after the procedure. The TWA test was performed approximately 1 year after the STEMI occurrence. TWA positivity was defined with a maximal voltage of >64 μV and a heart rate of 125 beats per minute, as in previous studies. The patients were followed up for 5 years and overall cardiac mortality was measured.
Results: There was a positive TWA finding in 24 patients (22.2%). There was no significant difference in the use of medications, traditional risk factors, or LVEF in those with TWA positivity. During a follow-up period of 5 years, 7 patients (6.5%) reached the endpoint. Patients with TWA positivity had 10.7 times greater odds for 5-year cardiac mortality, independent of other risk factors.
Conclusion: Clinicians should consider using the TWA test in young STEMI patients, as TWA positivity may be associated with increased cardiac mortality in this population.

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Amaç: Günümüzde panik bozukluk (PB), çocuklarda ve özellikle de adölesanlarda sýk görülen, günlük iyilik halini olumsuz etkileyen ve okul baþarýsýný düþüren önemli bir saðlýk problemidir. Bu çalýþmanýn amacý PB tanýsý konulan çocuklar ve adolesanlarda fluoksetin ve psikoterapi tedavisi öncesi ve sonrasý belirtilerin þiddeti ve kalp hýzý deðiþkenliði iliþkisini araþtýrmaktý.
Yöntemler: PB grubu, PB tanýsý konulan 23 çocuktan ve saðlýklý kontrol grubu 27 saðlýklý çocuktan oluþtu. Panik-anksiyete semptomlarý, 6-8 haftalýk biliþsel davranýþ terapisi ve selektif serotonin geri alým inhibitörü (fluoksetin) tedavisinden önce ve sonra iki ölçüm ile deðerlendirildi. Kalp hýzý deðiþkenliði 24-saat Holter incelemesi kullanýlarak deðerlendirildi.
Bulgular: Tüm gün analizlerinde, PB grubunda, yüksek frekans ve parasempatik skor (%) saðlýklý kontrol grubundan düþüktü (p<0.05). PB grubunda, düþük frekans/yüksek frekans oraný ve sempatik skor (%) saðlýklý kontrol grubundan yüksekti (p<0.05). Gündüz analizlerinde, PB grubunda, yüksek frekans saðlýklý kontrol grubundan düþüktü (p<0.05). PB grubunda, çok düþük frekans/yüksek frekans oraný ve düþük frekans/yüksek frekans oraný saðlýklý kontrol grubundan yüksekti (p<0.05). Gece analizlerinde, PB grubunda, ardýþýk gelen normal sinüs iletili NN intervalleri farklýlýklarýnýn ortalama deðerinin karekökü, 50 milisaniyeyi aþan ardýþýk NN intervalleri sayýsýnýn yüzdesel deðeri ve yüksek frekans saðlýklý kontrol grubundan düþük, düþük frekans/yüksek frekans oraný ise saðlýklý kontrol grubundan yüksekti (p<0.05).
Sonuç: PB’li çocuklarda, artmýþ sempatik aktivite bazý kalp hýzý deðiþkenliði parametrelerinde deðiþime neden olmaktadýr. Kalp hýzý deðiþkenliðinde azalmayý gösteren bu deðiþikliklerden bir kýsmý tedavi ile normale dönmektedir.

Objective: Panic disorder (PD) is now recognized as a common and important problem in children, and particularly adolescents, and one that can negatively affect daily well-being and educational performance. The aim of this study was to investigate the relationship between heart rate variability (HRV) and the severity of symptoms before and after treatment with psychotherapy and fluoxetine.
Methods: The PD study group consisted of 23 children diagnosed with PD and the healthy control (HC) group comprised 27 healthy children. Panic-anxiety symptoms were measured using 2 assessments performed before and after treatment. HRV was evaluated with a 24-hour Holter examination.
Results: According to the analysis of the 24-hour, all-day Holter device recordings, the high frequency (HF) and parasympathetic (%) scores in the PD group were lower than those of the HC group (p<0.05). The low frequency (LF)/HF ratio and sympathetic (%) scores in the PD group were higher than those of the HC group (p<0.05). The analysis of daytime readings indicated that the HF values of the PD group were lower than those of the HC group (p<0.05), while the very LF/HF ratio and LF/HF ratio were higher than those of the HC group (p<0.05). Analysis of nighttime Holter results revealed that the rMSSD, pNN50, and HF readings of the PD group were lower than those of the HC group (p<0.05), while the LF/HF ratio in PD patients was higher than that seen in the HC group (p<0.05).
Conclusion: In children and adolescents with PD, increased sympathetic activity can cause changes in some HRV parameters. Some of these changes may return to normal with treatment.

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Amaç: Çalýþmamýzýn amacý, soldan saða þantlý doðumsal kalp hastalýklarýnda pulmoner arter basýncýný belirlemede bir ekokardiyografik parametre olan Tei Ýndeksi’nin kullanýlabilirliðinin belirlenmesidir.
Yöntemler: Ýzole soldan saða þantlý doðumsal kalp hastalýðý olan ve cerrahi öncesi taný amaçlý kalp kateterizasyonu yapýlan 30 olgu ile 30 saðlýklý çocuk çalýþmaya alýndý. Gruplarýn sað ve sol ventrikül fonksiyonlarý Tei Ýndeksi belirlemek amacýyla doku Doppler ekokardiyografi ile deðerlendirildi. Pulmoner ve sistemik kan akýmlarý hesaplandý. Ortalama pulmoner arter basýncý ≥25 mm Hg ve pulmoner vasküler rezistans indeksi >3 WU/m2 olan olgular pulmoner arteriyel hipertansiyon olarak kabul edildi. Pulmoner/sistemik kan akýmý oraný ≥2 olanlar cerrahiye uygun olgular olarak deðerlendirildi.
Bulgular: Sol ventrikül arka duvar ve sað ventrikül ön duvardan ölçülen Tei Ýndeksi deðerleri pulmoner arteriyel hipertansiyonu olan olgularda (0.68±0.18, 0.67±0.16) pulmoner arteriyel hipertansiyonu olmayan olgulara (0.56±0.16, 0.51±0.12) göre belirgin olarak yüksek tespit edildi (p=0.027, p=0.001). Ayrýca, sol ventrikül arka duvardan elde edilen Tei Ýndeksi ile ortalama pulmoner arter basýncý arasýnda belirgin korelasyon olduðu görüldü (korelasyon katsayýsý: 0.491).
Sonuç: Soldan saða þantlý doðumsal kalp hastalýðý bulunan çocuklarda özellikle sað ventrikülün çeþitli bölgelerinden ölçülen Tei Ýndeksi deðerleri, pulmoner arteriyel hipertansiyon geliþiminin takibinde, bunun erken tanýsýnda ve uygun zamanda cerrahiye karar vermede kullanýlabilir.

Objective: The aim of this study was to determine the usefulness of the Tei Index, an echocardiographic parameter, in the early determination of pulmonary artery pressure (PAP) in congenital heart disease (CHD) with a left-to-right shunt.
Methods: Right and left ventricular functions were evaluated using Tei Index values determined with tissue Doppler echocardiography. Cardiac catheterization was performed in all cases. The presence of pulmonary arterial hypertension (PAH) was defined as a mean PAP of ≥25 mm Hg and a pulmonary vascular resistance index of >3 WU/m2. Patients with a pulmonary/systemic blood flow ratio of ≥2 were considered candidates for surgery.
Results: The Tei Index values measured from the left ventricular posterior wall and the right ventricular anterior wall were found to be significantly higher in the patients with PAH (0.68±0.18, 0.67±0.16, respectively) compared with the patients without PAH (0.56±0.16, p=0.027; 0.51±0.12 p=0.001). A significant correlation was detected between the Tei Index value measured from the left ventricular posterior wall and the mean PAP (correlation coefficient: 0.491).
Conclusion: The right ventricular Tei Index values in children with CHD and a left-to-right shunt can be used as a parameter to follow up on the potential development of PAH, to make a diagnosis in the early period, and to make a timely decision about surgery.

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Amaç: Bu çalýþmada üçüncü basamak bir kardiyoloji merkezine akut koroner sendrom (AKS) tanýsý ile yatýrýlan hastalarýn geriye dönük incelenmesi sonucunda gerçek yaþam verileri üzerinden lipit profili, demografik, klinik, laboratuvar özelliklerinin deðerlendirilmesi ve mortalite hýzlarýnýn belirlenmesi amaçlandý.
Yöntemler: Ýndeks AKS olayý sonrasý en az iki yýllýk sonlaným verisi saðlanacak þekilde hasta bilgileri hastane elektronik veri kayýt sisteminden elde edildi. Yeterli takip verisi olmayan hastalar telefonla aranarak bilgileri alýndý. Hastalarda ailevi hiperkolesterolemi (AH) varlýðýný belirlemek için modifiye “Dutch lipit network” kriterleri kullanýldý. Ýki yýllýk izlem döneminde mortalite ile iliþkili olabilecek risk faktörleri Cox regresyon analizi ile deðerlendirildi.
Bulgular: Çalýþmaya 21–93 yaþ aralýðýnda ardýþýk 985 AKS olgusu (215’i kadýn) alýndý. Kadýn hastalar, erkeklere göre daha yaþlý olup daha az oranda sigara içiyordu. Kadýn hastalarda obezite öyküsü, hipertansiyon öyküsü ve diyabet oraný erkeklere oranla daha yüksekti. Hastalarýn %95.6’sýnda hastaneye yatýþýnda lipit parametreleri ölçülmüþtü. Kadýn ve erkekler hastalarda dislipidemi sýklýklarý açýsýndan fark saptanmadý. Hastalarýn %7.6’sýnda AH mevcuttu. Lipit düþürücü ilaçlarýn kullaným oraný yatýþ sýrasýnda <%20 iken taburculukta %90’ýn üzerine çýktýðý, izlem görüþmelerinde ise %50’lere düþtüðü gözlendi. AKS hastalarýnda mortalite hýzý (n=901) hastane-içi dönemde %3.8, iki yýllýk izlemde (n=867) %8.1 olarak saptandý.
Sonuç: AKS hastalarýnda mortalite hýzý hastane içi dönemde %3.8, iki yýllýk izlem döneminde %8.1 saptanmýþtýr. AKS popülasyonunda LDL-kolesterol yüksekliði hastalarýn %89.5’inde görülürken taburculukta %90’ýn üzerinde olan lipit düþürücü ilaç kullaným oranlarýnýn izlem döneminde %50’lere düþtüðü görülmüþtür. Üçünü basamak bir merkezde bile AKS sonrasý ikincil korunmanýn yeterli yerleþtirilemediðini göstermektedir. AH sýklýðý %7.6 olup, AH olanlarýn olmayanlara göre daha genç yaþta AKS ile baþvurduklarý görülmüþtür.

Objective: The aim of this retrospective study based on real-life data was to evaluate the lipid profile and demographic, clinical, and laboratory features of patients with acute coronary syndrome (ACS) at a tertiary center and to examine the mortality rate.
Methods: Information including endpoint data for at least 2 years following the index ACS event was retrieved from hospital records. Patients without sufficient follow-up data were called by phone. Modified Dutch Lipid Clinic Network criteria were used to identify the presence of familial hypercholesterolemia (FH). Factors affecting mortality in the 2-year follow-up period were evaluated using Cox regression analysis.
Results: A total of 985 ACS patients (215 females) between 21 and 93 years of age were included. The females were older and had a lower smoking rate than the males. In females, the history of obesity and hypertension, the diabetes rate, and the thyroid-stimulating hormone level were higher than those of the males. In 95.6% of the patients, lipid parameters were measured upon hospital admission. No significant difference in dyslipidemia frequency was observed between genders. The frequency of FH was 7.6%. The rate of lipid-lowering drug use was <20% at admission, >90% at discharge, and decreased to 50% in the follow-up period. The mortality rate was 3.8% in the in-hospital period and 8.1% during the 2 years of follow-up.
Conclusion: The mortality rate in ACS patients was 3.8% in the in-hospital period and 8.1% in the 2-year follow-up period. The frequency of hypercholesterolemia was 89.5% and the rate of lipid-lowering drug use was insufficient. Secondary prevention after ACS was not adequately employed even at a tertiary center. The FH frequency was 7.6% and those with FH were observed to have ACS at a younger age than those without.

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Objective: Our study aimed to estimate the impact of addressing modifiable risk factors on the future burden of cardiovascular diseases (CVD) in the general population and in two high-risk populations (heterozygous familial hypercholesterolemia and secondary prevention) for Turkey.
Methods: One model investigated the impact of reaching the World Health Organization (WHO) voluntary targets for tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity in the general population. Another model estimated the impact of reducing LDL-cholesterol in two high-risk populations through increased access to effective treatment. Inputs for the models include disease and risk factor prevalence rates, a population forecast, baseline CVD event rates, and treatment effectiveness, primarily derived from the published literature. Direct costs to the public health care system and indirect costs from lost production are included, although the cost of programs and pharmacological interventions to reduce risk factors were not considered.
Results: The value of reaching WHO risk factor reduction targets is estimated at US$9.3 billion over the next 20 years, while the value of reducing LDL-cholesterol is estimated at up to US$8.1 billion for high-risk secondary prevention patients and US$691 million for heterozygous familial hypercholesterolemia patients.
Conclusion: Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to treatment for high-risk patients are projected to greatly reduce the growing clinical and economic burden of CVD in Turkey.

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Sinüs Valsalva anevrizmalarý ender doðumsal anomalilerdir. Valsalva sinüs anevrizmasý rüptürü nedeniyle sistemik akým ile pulmoner akým arasýnda oluþan þant, biventriküler yetersizliðe yol açar. Cerrahi onarým, bu anevrizmalarýn standart tedavisidir. Son dönemde, uygun hastalara perkütan tedavi baþarýyla uygulanmaktadýr. Sinüs Valsalva anevrizma rüptürü olan ve patent duktus arteriosus okluder cihazý ile katetere dayalý bir yaklaþýmla baþarýyla tedavi edilen 36 yaþýnda bir erkek hastayý sunuyoruz.

Sinus of Valsalva aneurysms are rare congenital anomalies. Sinus of Valsalva aneurysm rupture, leads to biventricular failure due to systemic to pulmonary shunting. Surgical repair has been the traditional treatment for these aneurysms. Recently, percutaneous treatment has been successfully performed to selected patients. We present a 36-year-old man who had ruptured sinus of Valsalva aneurysm, that was successfully treated with using a catheter-based approach with the patent ductus arteriosus occluder device.

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Shone kompleksi sol kalpte birçok düzeyde bir dizi obstrüktif lezyonla karakterize seyrek görülen bir doðuþtan kardiyak malformasyondur. Burada çarpýntý ve artan nefes darlýðý olan bir eriþkin erkek hastaya ait olaðandýþý bir olgu sunuyoruz. Ekokardiyografik deðerlendirme sol ventriküler nonkompaksiyon kardiyomiyopatiyle iliþkili Shone kompleksi lehineydi. Bildiðimiz kadarýyla bu kompleksle nonkompaksiyon kardiyomiyopatinin iliþkisi daha önce tanýmlanmamýþtý.

Shone’s complex is a rare congenital cardiac malformation characterized by serial obstructive lesions of the left heart at multiple levels. Presently described is an unusual case of an adult male patient who presented with palpitations and worsening dyspnea. An echocardiographic evaluation revealed Shone’s complex associated with left ventricular non-compaction cardiomyopathy (NCC). To our knowledge, an association between NCC and Shone’s complex has not been previously described.

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Miyelodisplastik sendrom, koroner arter hastalýðý, hipertansiyon ve kronik atriyal fibrilasyon öyküsü olan 77 yaþýnda erkek hasta nefes darlýðý, yorgunluk sýrt ve göðüs aðrýsý ile hematoloji kliniðine baþvurdu. Ekokardiyografik incelemede ileri derecede perikardiyal sývý saptanarak tanýsal amaçlý perikardiyosentez uygulandý. Sývýnýn kültüründe Erysipelothrix rhusiopathiae izole edildi. Ýzlemde solunum yetersizliði, böbrek yetersizliði ve triküspid kapakta vejetasyon geliþen hastanýn kan, perikard ve plevra kültüründe Acinetobacter baumannii üremesi üzerine antibiyotik tedavisi düzenlendi. Kardiyoloji ve enfeksiyon hastalýklar kliniði ile multidisipliner bir tedavi yaklaþýmý bu olgunun baþarýyla tedavisinde kritik önemdeydi.

A 77-year-old man with a past medical history of myelodysplastic syndrome, coronary artery disease, hypertension, and chronic atrial fibrillation presented at the hematology outpatient clinic with progressive shortness of breath, weakness, and chest and back pain. Echocardiography was performed and the patient was diagnosed with severe pericardial effusion near the right ventricle. Pericardial drainage was performed. Erysipelothrix rhusiopathiae was isolated from the pericardial fluid. Complications of respiratory and renal failure developed during follow-up. The clinical and laboratory findings of vegetation on the tricuspid valve, pericardial effusion, and atrial fibrillation with a low heart rate suggested possible pancarditis. A multidisciplinary treatment approach with the cardiology and infectious disease departments was critical to successful management of this case.

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Masif pulmoner embolizm eriþkin popülasyonda tanýmlanmýþ ani kalp durmasý nedenlerinden biridir. Sistemik fibrinoliz hayat kurtarýcý bir seçenektir. Travmatik olmayan ani kalp durmasýnda nörolojik komplikasyonlarýn sýnýrlanmasý amacýyla terapötik hipotermi uygulanmasý þiddetle önerilmektedir. Buna karþýlýk, sistemik fibrinoliz ile tedavi edilen masif pulmoner emboli durumunda geliþen ani kalp durmasýnda terapötik hipotermi kullanýmý ile ilgili veriler kýsýtlýdýr. Hipotermi iliþkili koagülopati ve olasý kanama eðilimi hakkýndaki endiþeler soðutma tedavisinin sistemik fibrinoliz uygulanmýþ kardiyak arrest hastalarýndaki kullanýmýný sýnýrlandýrmaktadýr. Bu yazýda, masif pulmoner embolizme baðlý ani kalp durmasý geliþen, sistemik fibrinoliz ve terapötik hipoterminin birlikte kullanýmý ile baþarýlý þekilde tedavi edilen hasta sunuldu.

Massive pulmonary embolism is a well-known cause of sudden cardiac arrest in the adult population. Systemic fibrinolysis can be a life-saving option. Therapeutic hypothermia is highly recommended for nontraumatic sudden cardiac arrest victims to minimize neurological complications. However, there are limited data about the use of therapeutic hypothermia for sudden cardiac arrest victims also treated with systemic fibrinolysis. Concerns about hypothermia-related coagulopathy and a possible tendency to bleeding have limited the use of cooling therapy in such cases. Presently described is a case of sudden cardiac arrest due to a massive pulmonary embolism that was successfully treated with the concomitant usage of systemic fibrinolysis and therapeutic hypothermia.

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