Amaç: Atriyal fibrilasyon (AF), en sýk görülen tedavi gerektiren kronik aritmidir. Kronik obstruktif akciðer hastalýðý (KOAH), AF için risk faktörlerinden biridir, ancak bu iliþki sadece solunumu fonksiyon testi sonuçlarý üzerinden irdelenmiþtir. Çalýþmadaki amacýmýz güncel kýlavuzlarda belirlenen klinik ciddiyete baðlý KOAH sýnýflamasý ile AF arasýndaki iliþkinin aydýnlatýlmasýdýr.
Yöntemler: Kasým 2019 ve Ocak 2017 arasýnda KOAH nedeni ile yatarak tedavi alan hastalar tarandý. Koroner arter hastalýðý, kalp yetersizliði, kalp kapak hastalýðý, diyabet, kronik böbrek hastalýðý, hipertansiyon, tiroid disfonksiyonu ve uyku apne sendromu olan hastalar dýþlandý. 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) kýlavuzuna göre KOAH hastalarý A,B,C ve D gruplarýna ayrýldý ve bu gruplar ile AF iliþkisi araþtýrýldý.
Bulgular: Cinsiyet ve beden kitle indeksi açýsýndan iki grup arasýnda fark yoktu. Yaþ, LVEF, sol atrium, sað atrium, sað ventrikül ve SPAB açýsýnda her iki grup arasýnda anlamlý fark mevcuttu. Klinik ve semptomatik ciddiyete göre KOAH hastalarý sýnýflandýrýldýðýnda, klinik ciddiyet arttýkça AF sýklýðý artmaktaydý.
Sonuç: Solunum testindeki FEV1 deðerinden baðýmsýz olarak, klinik olarak daha ciddi tabloya sahip KOAH olgularýnda AF görülme sýklýðý daha fazladýr.

Objective: The aim of this study was to elucidate the relationship between atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) classification based on clinical severity determined in current guidelines. AF is the most common chronic arrhythmia that requires treatment. COPD is one of the risk factors for AF, but this relationship was only explored through respiratory function test results.
Methods: Patients who received inpatient treatment for COPD between November 2019 and January 2017 were screened. Patients with coronary artery disease, heart failure, valvular heart disease, diabetes, chronic kidney disease, hypertension, thyroid dysfunction, and sleep apnea syndrome were excluded. According to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, patients with COPD were divided into groups A, B, C, and D, and the relationship between AF and these groups was investigated.
Results: There was no difference between the two groups (depending on the presence of AF) in terms of sex and body mass index. There was a significant difference between the two groups in terms of age, left ventricular ejection fraction (LVEF), left atrium, right atrium, right ventricle, and systolic pulmonary artery pressure. When patients with COPD were classified according to clinical and symptomatic severity, the frequency of AF increased as the clinical severity increased.
Conclusion: Regardless of the forced expiratory volume – first second (FEV1) value in the respiratory test, the incidence of AF is higher in patients with COPD with a clinically more severe picture.

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Amaç: Bu çalýþmanýn amacý romatizmal mitral stenozu (MS) olan hastalarda plazma proadrenomedullin (ProADM) düzeylerini saptamak, ProADM konsantrasyonu ile stenoz ciddiyetinin göstergesi olan ekokardiyografik parametreler ve semptom düzeyi arasýndaki iliþkiyi incelemek ve kendini daha önce bu alanda ispatlamýþ N-terminal pro-brain natriuretic peptide (NT-proBNP) ile ProADM’yi kýyaslamaktýr.
Yöntemler: Çalýþmaya izole romatizmal MS tanýsý ile takip ve tedavi altýnda olan ardýþýk 53 hasta ile bu hastalarla benzer yaþ ve cinsiyet özelliklerine sahip 45 gönüllü dahil edildi. MS haslarýnda kendi içinde giriþim endikasyonu olanlar ve olmayanlar olarak iki gruba ayrýldý. Tüm deneklere detaylý ekokardiyografi yapýlýp, NT-proBNP ve ProADM düzeylerinin tespit edilebilmesi için kan örneði alýndý.
Bulgular: Romatizmal MS’i olan hasta grubunda NT-proBNP ve ProADM seviyesi kontrol grubuna göre anlamý düzeyde daha yüksekti. Benzer þekilde romatizmal MS’i olan hastalar içerisinde giriþim endikasyonu olan hastalarda, giriþim endikasyonu olmayanlara göre bu iki parametre daha yüksek saptandý (p<0.001 ve p<0.001). Bunun yaný sýra yapýlan korelasyon analizinde romatizmal MS’i olan hastalarda NT-proBNP ve ProADM seviyeleri hastalýk ciddiyetinin göstergesi olan ekokardiyografik bulgular ile çeþitli derecelerde anlamlý korelasyona sahip olduðu görüldü. Her iki parametrede New York Heart Association (NYHA) sýnýfý arttýkça arttý ve bu artýþ istatistiki bir anlamlýlýða sahipti. Bir diðer bulgumuz ise her iki parametre için hesapladýðýmýz kestirim deðerlerinin (NT-proBNP: 119.9 pg/mL, ProADM: 6.15 nmol/L) yüksek duyarlýlýk ve özgüllük oranlarýyla giriþim endikasyonu olan hastalarý tespit edebiliyor olmasýydý. NT-proBNP bu anlamda az farkla daha etkili görüldü.
Sonuç: Ýzole romatizmal MS’i olan hastalarda artmýþ olan NT-proBNP ve ProADM düzeyleri ekokardiyografiye ek bilgiler saðlayarak giriþim endikasyonu olan hastalarýn ayýrt edilebilmesinde klinisyenlere yardýmcý olabilir.

Objective: In this study, we aimed to determine the plasma proadrenomedullin (ProADM) levels in patients with rheumatic mitral stenosis (MS), to evaluate the relationship between ProADM levels and the echocardiographic parameters that represent the severity of stenosis and symptoms, and to compare the ProADM and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, which is a well-known marker for rheumatic MS.
Methods: Our study included 53 consecutive patients with isolated rheumatic MS and 45 volunteers with similar age and gender features. Patients with MS were divided into two groups based on the presence of an indication for intervention. Detailed echocardiographic examinations were performed on all participants, and blood samples were collected to detect the NT-proBNP and ProADM levels.
Results: NT-proBNP and ProADM levels were significantly higher in the rheumatic MS group compared with the control group. In rheumatic MS groups, patients with an indication for intervention had higher levels of NT-proBNP and ProADM compared with patients without an indication for intervention. Moreover, NT-proBNP and ProADM levels were found to be significantly correlated with echocardiographic parameters, which revealed the severity of stenosis in various degrees. Both parameters increased as the New York Heart Association (NYHA) class increased, and this increase had a statistical significance. Additionally, the cut-off values of both parameters (NT-proBNP: 119.9 pg/mL, ProADM: 6.15 nmol/L) could detect patients with an indication for intervention with high sensitivity and specificity rates. NT-proBNP was found to be slightly more effective in this regard.
Conclusion: The increased NT-proBNP and ProADM levels in patients with isolated rheumatic MS can help clinicians in distinguishing patients with an indication for intervention by providing additional information to echocardiography.

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Amaç: Perkütan koroner giriþimler (PKG) iliþkili miyokardiyal hasar, koroner arter hastalýðý olan hastalarýn prognozunu olumsuz etkileyebilir. Çalýþmamýzýn amacý, uzun süreli statin kullanýmýnýn elektif PKG ile iliþkili miyokardiyal hasar üzerine etkilerini araþtýrmaktýr.
Yöntemler: Çalýþmamýza toplam 102 hasta dahil edildi ve PKG öncesi statin kullanýmýna göre üç grupta deðerlendirildi, ‘’potent statin’’ grubu (n=26), ‘’zayýf statin’’ grubu (n=23) ve ‘’statin içermeyen’’ grubu (n=53). PKG sýrasýnda komplikasyonu geliþen hastalar belirlendi (n=31). Miyokardiyal hasar, iþlemin 0, 2, 4 ve 12. saatlerinde seri yüksek duyarlýlýklý troponin T (hsTnT) testi ile belirlendi.
Bulgular: Potent statin grubunda 2. ve 4. saatlerde hsTnT deðerlerindeki artýþ diðer iki gruba göre anlamlý olarak daha düþüktü (sýrasýyla p=0.008 ve 0.009). Prosedürel komplikasyon yaþanan hastalarda 2., 4. ve 12. saatlerde hsTnT düzeylerindeki artýþ potent statin grubunda diðer iki gruba göre daha düþüktü (sýrasýyla p=0.032, 0.019 ve 0.006). Ayrýca iþlem sýrasýnda komplikasyon yaþanan hastalarda, potent statin grubunda 4. ve 12. saatlerde hsTnT düzeyleri miyokart enfarktüsü sýnýrýný aþan hastalar daha azdý. (p=0.039 ve p=0.006, sýrasýyla).
Sonuç: Bu sonuçlar, yüksek doz statin kullanan hastalarda elektif PKG ile iliþkili miyokardiyal hasarýn daha az sýklýkta olduðunu göstermektedir. Ýþlem sýrasýnda komplikasyon geliþen hastalarda bu sonuç daha belirgindi.

Objective: Myocardial injury related to percutaneous coronary interventions (PCI) might adversely affect the prognosis of patients with coronary artery disease. Our study aimed to investigate the effects of long-term statin usage on myocardial injury related to elective PCI.
Methods: In our study, total 102 patients were included and evaluated in 3 groups based on the statin usage before PCI, “potent statin” group (n=26), “weak statin” group (n=23), and “statin free” group (n=53). The occurrence of the procedural complications was identified (n=31). The myocardial injury was determined by serial high-sensitivity troponin T (hsTnT) testing at 0th, 2nd, 4th, and 12th hour of the procedure.
Results: The increase in hsTnT values in the 2nd and 4th hour was significantly lower in the potent statin group than in the other 2 groups (p=0.008 and p=0.009, respectively). In patients with procedural complications, the increase in hsTnT levels at the 2nd, 4th, and 12th hour were also lower in the potent statin group (p=0.032, p=0.019, and p=0.006, respectively). Also, in patients with procedural complications, hsTnT levels exceeding the myocardial infarction limit at the 4th and 12th hour were lower in the potent statin group (p=0.039 and p=0.006, respectively).
Conclusion: These results show that elective PCI related myocardial injury was less frequent in patients who were using high-dose statins. This result was more pronounced in patients who developed complications during the procedure.

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Amaç: Hipertansiyon, yaþlýlarda tedaviye uyum düþük olduðu için yönetimi güç bir hastalýktýr. Çalýþmamýzda yaþlý hipertansiflerde ilaç etkileþim endeksinin (ÝEE) ilaç uyum üzerine etkisini deðerlendirmeyi amaçladýk.
Yöntemler: Kesitsel gözlemsel çalýþmamýza, 01.02.2020 ile 30.09.2020 arasýnda üçüncü basamak hastanenin kardiyoloji polikliniðine baþvuran 65 yaþ ve üzeri, 418 hastayý dahil ettik. Hastalarýn sosyo-demografik özelliklerini, ek hastalýklarýný ve aldýklarý ilaçlarý sorgulayan bir anket hazýrladýk. Ýlaç uyumu için Morisky ilaç uyum skalasý-8 (MMAS-8) kullanýldý. Ýlaç etkileþimleri, Lexicomp® uygulamasý ile deðerlendirildi. Ýlaç uyumunu etkileyen faktörlerin tespiti için tanýmlayýcý testler ve çoklu lineer regresyon analizleri yapýldý. Ýlaç uyum indeksi, klinik iliþkili ilaç etkileþimlerinin toplam ilaç etkileþimlerine oranýndan hesaplanmýþtýr.
Bulgular: Araþtýrma popülasyonunun ortalama yaþý [± standart sapma (SS)] 72.91 (±6.47) idi ve 272/146’ü kadýn/erkekti. En sýk eþlik eden hastalýk diyabetes mellitustu (%23.5). Hastalarýn %39.5’inde polifarmasi mevcuttu, günlük ortalama (SS) 4.27 (±2.57) sayýda ilaç alýyordu. En sýk reçete edilen anti-hipertansifler tiazid ve türevleri (%29.8), anjiyotensin reseptör blokerleri (24.8%), anjiyotensin dönüþtürücü enzim inhibitörü (%14.9) idi. Ortalama MMAS-8 skoru (SS) 4.55±0.98 idi ve katýlýmcýlarýn 321 (%76.8)’inin ilaç uyumu kötüydü. Hastalarýnýn %33.4’ünde klinik iliþkili ilaç etkileþimi vardý. Yeni ilaç etkileþim indeksini ortalama (SS) 0.345±0.017 idi. MMAS-8 skorunu belirlemede ÝEE’nin tahmini için yapýlan receiver operating characteristic (ROC) eðrisi analizinde eðri altý alaný 0.616 saptadýk [95% güven aralýðý (GA): 0.547- 0.686].
Sonuç: Yaþlý hipertansiflerde ilaç etkileþim yoðunluðunu belirlemek için yeni bir endeks tanýmladýk. Bu endeks, ilaç uyumu tahmininde kullanýþlý bir araç olabilir.

Objective: Hypertension is a challenging problem in the older population because of poor drug adherence (DA). We aimed to determine the DA and examine the drug interaction index (DII) on DA in older patients with hypertension.
Methods: In this cross-sectional, observational study, we enrolled 418 eligible patients aged ≥ 65 years between 1 February 2020 and 30 September 2020 in a tertiary hospital outpatient cardiology clinic. We prepared a questionnaire to record sociodemographic characteristics, morbidities, and drugs used by the population. The Morisky Medication Adherence Scale-8 (MMAS-8) was used for DA assessment. We identified drug interactions using the Lexicomp application. We calculated the DII from a ratio of clinically relevant interaction to total interaction. Descriptive tests and multiple linear regression analyses were performed to find independent factors on DA.
Results: The mean age (± standard deviation [SD]) was 72.91 (±6.47), and 272/146 were female/male in the study population. The most frequent comorbid disease was diabetes mellitus (23.5%). The percentage of patients having polypharmacy was 39.5, and the mean daily drug (±SD) use was 4.27 (±2.57). The most prescribed antihypertensive drugs were thiazide/derivates (29.8%) and angiotensin receptor blockers (24.8%). The mean MMAS-8 (±SD) was 4.55±0.98, and 321 (76.8%) participants had a poor DA. A total of 33.4% of patients had significant drug interaction. The mean DII (±SD) was 0.345±0.017. The area under the receiver operating characteristic (ROC) curve for DII was 0.616 (95% confidence interval [CI]: 0.547-0.686).
Conclusion: We defined a new index for drug interaction intensity. Furthermore, the DII may be a useful tool to study aspects of DA in older patients with hypertension.

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Amaç: Bu çalýþmada koroner arter hastalarýnýn ikincil korunma konusunda farkýndalýklarý ve bu konuda bilgileri hangi kanallar aracýlýðý edindikleri araþtýrýlmýþtýr.
Yöntemler: Kardiyoloji polikliniðine ardýþýk olarak baþvuran koroner arter hastalarýna (n=912) 45 soruluk bir anket uygulanmýþtýr.
Bulgular: Katýlýmcýlarýn 508’i (%55.7) koroner anjiyografi sonrasý damarlarýnýn durumunu bildiðini belirtti. Katýlýmcýlarýn 493’ü hiç egzersiz yapmadýðýný belirtmiþtir (%54.1). Katýlýmcýlarýn 299’u herhangi bir diyet yapmadýðýný belirtmiþtir. Erkekler kadýnlarla karþýlaþtýrýldýðýnda diyet, kan þekeri ve kan basýncý dýþýndaki risk faktörlerinin daha sýk farkýndadýr (p<0.001). Kadýnlar erkeklerle karþýlaþtýrýldýðýnda kan þekeri ve kan basýncýnýn risk faktörü olduðunun daha sýk farkýndadýr (p<0.001). Yüksek gelirli hasta grubu, düþük/orta gelirli hasta grubuna göre kan þekeri dýþýndaki tüm risk faktörlerinin daha fazla farkýndadýr (p<0.001). Eðitim düzeyi arttýkça kan þekeri ve anti-trombositer ilaç farkýndalýk sýklýðý artmaktadýr (p<0.001). Öte yandan okuryazar/ilkokul/ortaokul grubunda kan þekeri ve anti-trombositer ilaç konusunda farkýndalýk sýklýðý daha yüksektir (p<0.001). Ayrýca, hastalarýn cinsel yaþamý ve psikolojik sorunlarýnýn kardiyoloji uzmanlarý tarafýndan nadiren sorgulandýðý görülmüþtür.
Sonuç: Koroner arter hastalarýnýn ikincil korunma konusunda farkýndalýklarý çok düþük bulunmuþtur.

Objective: In this study, we aimed to investigate the awareness of patients with coronary artery disease (CAD) about secondary prevention and the channels through which they obtained information on this issue.
Methods: A standard questionnaire including 45 questions was given to the patients (n=912) who were admitted to the cardiology outpatient clinics to investigate their secondary prevention awareness and lifestyle.
Results: Of the participants, 508 (55.7%) stated that they knew the condition of their vessels after coronary angiography; 493 (54.1%) stated that they did not exercise; 299 stated that they did not follow any specific diet. Men were more frequently aware of all risk factors except diet, blood glucose, and blood pressure compared to women (p<0.001). Women were more frequently aware that blood glucose and blood pressure are risk factors for CAD compared to men (p<0.001). The high-income patient group was more aware of all the risk factors, except blood glucose compared to the low/medium income patient group (p<0.001). The frequency of awareness, except for blood glucose and antiplatelet drugs, increased as the education level increased (p<0.001). However, the frequency of awareness of blood glucose and antiplatelet drug use was higher in the literate/elementary school/secondary school group (p<0.001). In addition, it was concluded that patients’ sexual life and psychological problems after being diagnosed with the disease were rarely questioned by cardiology specialists.
Conclusion: Awareness of patients with CAD about secondary prevention was found to be very low.

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Amaç: Bu çalýþmanýn amacý subakut alt ekstremite iskemisi olan hastalarda alteplaz ile kateter aracýlý intra-arteriyel trombolitik tedavinin erken sonuçlarýný yayýnlamak ve CONUT (Controlling Nutritional Status) skoru ile deðerlendirilen malnütrisyonun trombolitik tedaviye yanýt ve kanama ile iliþkili olup olmadýðýný belirlemektir.
Yöntemler: Bu, 2007-2020 yýllarý arasýnda, infraaortik subakut trombotik oklüzyon nedeniyle Rutherford sýnýf 3 (%34.7), sýnýf 4 (%40.7) ve sýnýf 5 (%24.6) semptomlarý olan ve kateter aracýlý tromboliz ile tedavi edilen 118 hasta ile yürütülen retrospektif bir çalýþmadýr.
Bulgular: Hemen tromboliz sonrasý teknik baþarý (TIMI grade 2/3) oraný %56, ilave tüm giriþimlerden sonra genel teknik baþarý oraný %83.9 olarak görüldü. Hastalarýn %74.5’inde klinik baþarý elde edildi. Major kanama %11.8’inde meydana geldi. Ancak, giriþ yeri hematomlarýný çýkardýðýmýzda major kanama oraný %5.1 idi. Hastane içi ölüm oraný %5.1 ve 30 günluk amputasyon oraný %12.7 idi. CONUT skoruna göre (≥2) hastalarýn %48.3’ünde malnütrisyon tespit edildi. Herhangi bir seviyedeki malnütrisyon, baþarýsýz tromboliz yanýtý ve kanama ile iliþkiliydi. Diðer faktörler için ayarlama yapýldýktan sonra bile, CONUT skoru yetersiz litik yanýtý öngördü, ancak serum CRP veya nötrofil/lenfosit oraný litik tedaviye yanýt ile iliþkili bulunmadý. Yetersiz litik yanýtýn diðer belirleyicileri semptom süresi, Rutherford sýnýf 4/5 semptom ve kötü pedal akým olarak saptandý.
Sonuç: Subakut bacak iskemisi olan hastalarda, kateter aracýlý intra-arteriyel trombolitik tedavi tek baþýna olmasa da ek müdahalelerle birlikte, önemli kanama ve ölüm riskine karþýn birçok hastada etkiliydi. Malnütrisyon, yetersiz litik yanýt ve kanama ile iliþkiliydi. Hekimler uygun tedaviyi seçerken malnütrisyonun farkýnda olmalý ve ekstremite iskemisi olan hastalarýn beslenme durumunu dikkate almalýdýr.

Objective: In this study, we aimed to report early outcomes of catheter-directed thrombolysis (CDT) with alteplase in patients with subacute limb ischemia and to assess whether there is a link between malnutrition (determined by Controlling Nutritional Status [CONUT] score) and response to thrombolysis and bleeding.
Methods: This was a retrospective study conducted between 2007 and 2020 with 118 patients with Rutherford class 3 (34.7%), class 4 (40.7%), and class 5 (24.6%) symptoms owing to infraaortic subacute thrombotic occlusion who were treated with catheter-directed thrombolysis.
Results: Immediate technical success (Thrombolysis in Myocardial Infarction [TIMI] grade 2/3) was achieved in 56%, overall technical success after all adjunctive procedures was seen in 83.9%. Clinical success was obtained in 74.5% within 30 days. Major bleeding occurred in 11.8%. When we excluded access site hematomas, the rate of major bleeding was 5.1%. In-hospital mortality rate was 5.1%, and the amputation rate within 30 days was 12.7%. Any-degree malnutrition was detected in 48.3% according to CONUT score (≥2). Any-degree malnutrition was associated with failed thrombolysis and bleeding. The CONUT score predicted insufficient lytic response even after adjustment for confounding factors; however, serum C-reactive protein or neutrophil/lenfosit ratio did not. Other predictors of immediate technical failure after thrombolysis were symptom duration, Rutherford class 4/5 symptoms, and worsened distal runoff.
Conclusion: In patients with subacute limb ischemia, CDT combined with adjunctive interventions was effective in many patients at the expense of a substantial risk of bleeding and death. Malnutrition was associated with insufficient lytic response and bleeding. Physicians should be aware of malnutrition and consider the nutritional status of patients with limb ischemia when selecting appropriate treatment.

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Kardiyak amiloidoz (KA), katlanmasý bozulan endojen proteinlerin amiloid fibriller þeklinde kalpde ekstrasellüler birikimi ile ortaya çýkan nadir, ilerleyici, infiltratif ve restriktif bir kardiyomiyopatidir. En sýk gözlenen KA tipleri, transtretin (TTR) ve immunglobulin hafif zincir (AL) amiloidozudur. TTR-KA, doðal (wild type) TTR (wtTTR) veya mutasyonel TTR (mTTR) KA þeklinde görülebilir. KA bugüne kadar nadir görülen bir hastalýk olarak düþünülmüþtür. Klinik uygulamada taný sýklýkla atlansa da, korunmuþ ejeksiyon fraksiyonlu kalp yetersizliði (KEF-KY) etiyolojik nedeni olarak giderek daha fazla tanýnmaktadýr. TTR-KA olgularý kötü prognoza sahiptir. Erken taný ve tedavi yaklaþýmlarý ile prognozun anlamlý düzeltilebildiði gösterilmiþtir. Nükleer sintigrafi gibi yeni tanýsal teknikler biyopsi gerektirmeden erken taný konmasýný saðlamaktadýr. Bu olgu raporunda, KEF-KY ve sol ventrikül hipertrofisinin sýklýkla atlanan ve nadir bir etiyolojik nedeni olan wtTTR-KA olgusu sunulmaktadýr.

Cardiac amyloidosis (CA) is a rare, progressive, infiltrative and restrictive cardiomyopathy characterized by extracellular deposition of insoluble amyloid fibrils in the form of misfolded endogenous proteins in the heart. The most common types of CA are transthyretin (TTR) and immunoglobulin light chain (AL) amyloidosis. TTR-CA is further subdivided into wild-type (wtTTR-CA) and mutant (mTTR-CA) forms. CA has long been thought to be a rare disease. However, in clinical practice, it is frequently overlooked, but increasingly recognized as the cause of heart failure with preserved ejection fraction (HFpEF). Patients with CA show poor prognosis. Early diagnosis and novel therapeutic options have been shown to significantly improve prognosis. Novel diagnostic modalities such as nuclear scintigraphy allow the earlier diagnosis of TTR-CA without a biopsy. In this report, we present a case of wtTTR-CA as a rare and overlooked underlying etiology of HFpEF and left ventricular hypertrophy.

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Transkateter aort kapak implantasyonu (TAVI), orta ve hatta düþük riskli hastalarda cerrahi kapak replasmanýna güvenli ve etkili bir alternatiftir. Doðrudan aortik (DAo) yol, þiddetli periferik vasküler hastalýðý olan hastalarda kullanýlabilir. Biz, 88 yaþýnda kardiyojenik þok ile hastanemize baþvuran bir hastayý sunuyoruz. Ekokardiyografide aort kapak alaný 0.5 cm², ortalama gradiyent 55 mmHg ve pik gradiyent 92 mmHg olan ciddi aort kapak stenozu görüldü. Kurumumuz Kalp Ekibi tarafýndan TAVI önerildi. Çok kesitli Bilgisayarlý tomografide (ÇKBT) þiddetli periferik vasküler hastalýk, abdominal aortanýn kalibrasyonunda azalma ve çok sayýda hassas aterosklerotik plaklar görüldü. Hastaya Dao ile TAVI planlandý. Median sternotomi yapýldý. Önce predilatasyon yapýlýp sonra 26 mm Medtronic CoreValve Evolut R kapak implante edildi. Hasta 96 saat sonra taburcu edildi. TAVI için varsayýlan yaklaþým olarak transfemoral (TF) yaklaþým kullanýlsa da, hastamýzda þiddetli periferik vasküler hastalýk, çok sayýda hassas aterosklerotik plaklar, abdominal aortun kalibrasyonunun azalmasý ve en dar noktada 4,5 mm olmasý nedeniyle hastamýzda kontrendikedir. Prosedür öncesi dikkatli ÇKBT deðerlendirmesi önemlidir ve prosedürün baþarýsýný doðrudan etkiler. ÇKBT, baþarýlý DAo TAVI için mutlaka olmasý gereken en iyi kanülasyon bölgesini doðrulamak için de zorunludur.

Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical valve replacement in intermediate and even in low‐risk patient cohorts. Direct aortic (DAo) route may be used in patients with severe peripheral vascular disease. Here, we present an 88-year old patient hospitalized with cardiogenic shock. Echocardiography revealed severe aortic valve stenosis with aortic valve area 0.5 cm², mean gradient of 55 mmHg, and peak gradient 92 mmHg. TAVI was considered by the Institutional Heart Team. Multislice computed tomography (MSCT) revealed severe peripheral vascular disease, decreased calibration of abdominal aorta, and multiple large vulnerable atherosclerotic plaques. The patient was scheduled for a DAo TAVI. A 26-mm Medtronic CoreValve Evolut R valve was implanted after predilatation with median sternotomy. The patient was discharged after 96 hours. Although transfemoral (TF) access is used as the default approach for TAVI, it was contraindicated in our patient owing to severe peripheral vascular disease and decreased calibration of the abdominal aorta at its narrowest point (4.5 mm) with multiple large vulnerable atherosclerotic plaques. Careful preprocedural MSCT evaluation is essential and directly affects the success of the procedure. MSCT is also mandatory to confirm the best cannulation zone that must be met for a successful DAo TAVI.

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Patent duktus arteriozusa (PDA) stent implantasyonu iþlemi, duktus baðýmlý pulmoner dolaþýmý olan yenidoðanlarda cerrahiye alternatif olarak uygulanan palyatif bir iþlemdir. Ancak aortik ark anomalili hastalarda halen oldukça zorlu bir yöntemdir. Bu yazýda sað aortik arkusu olan ve PDA’sý sol innominate arterden köken alan pulmoner atrezili bir yenidoðandaki deneyimimizi paylaþtýk. PDA uzun ve kývrýmlý olduðu için tek bir uzun stent yerine üç kýsa stent yerleþtirmeyi tercih ettik. Prosedür, arter yaralanmalarýný azaltmak için Glidesheath kýlýf ile femoral arter yaklaþýmý ile uygulandý. Atipik morfolojilerdeki PDA’larda stent implantasyonu, birden fazla kýsa stent ve Glidesheath kýlýf kullanýlarak baþarýyla gerçekleþtirilebilir.

The procedure of stenting the patent ductus arteriosus (PDA) is a palliative procedure applied as an alternative to surgery in newborns with ductus-dependent pulmonary circulation. However, it is still a very challenging method in patients with aortic arch anomalies. We describe our experience with a newborn with right atrial isomerism and dextrocardia, complete atrioventricular septal defect, aortic outlet right ventricle with pulmonary atresia, right aortic arch, and a PDA from the left innominate artery. Because the PDA was long and tortuous, we preferred placing three short stents instead of a single long stent. The procedure applied the femoral artery approach with a Glidesheath Slender to decrease arterial injuries. PDA stenting in challenging morphologies can be performed successfully using multiple short stents and via Glidesheath Slenders.

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