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Amaç: Saðlýklý bireylerle yavaþ koroner akmýlý hastalar aras111da endotelin-i (ET-1) düzeylerinin karþý/aþtmlmasý ve ET-1 ile düzeltilmiþ TIM/ kare say/SI (cTFC) iliþkisinin araþtýni masý. Yöntem: 31 yavaþ koroner aktmli hasta (grup A) ve 15 saðlýkli kiþide (grup B) istirahat ET-i düzeyleri gruplar arasmda karþýlaþtmldý. Aym zamanda düzeltilmiþ TIM/ kare sayýst ile ET-i arasýndaki iliþki araþtmldt. Bulgular: Ýstirahat ET-i düzeyleri yavaþ koroner akýnýli hastalarda (grup A) saðlik/ý bireylerle (grup B) karþ tlaþ tý n ldtðýnda anlamlý derecede yüksek bulundu. (4.348±1 .3 pg/ml-2.524±0.5 pg/m/, p0.05). Damar saylSina göre hastalar sýmf/andýn ldt ðmda 3 koroner arterinde yavaþ koroner akmý olan hastalarda ET-1 düzeyleri en yüksek olarak saptandi. (3 damar; 5.779±1 .2 pg/ml, 2 damar; 4.227±1 .16 pg/ml, 1 damar; 3.411±0.7 pg/ml. p

Purpose: The aim of this study is to compaý·e the enclothelin levels between patients with slow coronary flow and normal healthy subjects, anel to investigate the relationship between endothelin-1 levels (ET -1 ) and correctecl TIMI frame co u nt (cTFC) between the two groups. Method: The resting ET- ý levels w ere compareel be tween two groups (in 31 pa tients with s low coronary flow (groupA) and 15 heaýthy subjects (group B). At the same time the relationship between ET -1 and cTFC w as al so investigated. Results: Resting ET-I levels were found significantly high in patients with slow coronary flow when compareel with healthy subj ects (4,35±1.3 pg/ml vs 2.52±0.5 pg/ml, p<0.01). When the coronary vessels were compareel with each other according to the TIMI frame co u nt and ET- ý levels, if the dominant slow coronary flow was especially LAD arte ry (cTFC highest), ET-1 levels were found higher in these patients than in the ones with dominant Cx (p<0.02) or right corona ry artery (p<0.03). (LAD; 5.826±0,75 pg/ml , Cx; 4, 12±1.17 pg/ml, RCA; 3.89±1.49 pg/ml). But if slow coronary flow was dominant in Cx or RCA artery, not signif icant relationship between cTFC and ET-I levels was detected. When patients were classified according to the number of the diseased vessels, ET-1 levels were found highest in patients with 3-vessel d isease (3- vessel; 5,78±1,2 pg/ml, 2-vessel; 4.23±1.16 pg/ml, single vessel; 3.41±0,7 pg/ml. p

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Giriþ ve amaç: Aterosk/erotik pla.~m yý rtý lmasý ile oluþan intrakoroner trombiis akut koroner sendromun (AKS) temel nedenidir. Yýrtýlmaya hassas p/ak/arýn, daha fazla sayýda makrofaj ve T lenfasit ihtiva effið i çeþitli ça lýþmalarla tespit edilmiþtir. Ayrý ca hassas p/ak/ardaki aktive olmuþ makrofajlardan da neopterin salgýsmýn arffýðý bilinmektedir. Bu çalý þma AKS'li ve stabil angina pektarisli olgularda plak inf/amasyonunun bir kriteri olarak serýýný neopterin seviyesinin ölçümü ve bunwý koroner arter lýastalýðýnm (KAH) anjiyografik þiddeti ile iliþkisi olup olmadýðým araþtýrmak amac ý ile yapýldý. Gereç ve yöntem: Çalýþmaya ardýþýk 43 stabil angina (grup /) ve 118 AKS'li (grup ll) lýasta ile kontrol grubu olarak ayný yaþ larda saðlýklý 30 birey (grup lll) almdý. Serýmý neopterin diizeyi "enzym-linked immunosorbeni assay" (ELÝSA) tekniði ile ölçiildii. Tiim olgu/ara se/ekti} koroner anjiyografi yapý ldý. Koroner anjiyografide >%50 darlýk tespit edilmesi önemli koroner lýastalý ðý olara/.: kabul edildi. Anjiyografi/.: olarak KAH'111 þiddeti ise Gensini skorlamasý ile deðerlendirildi. Bulgular: Serum neopterin diizeyi grup 1= 12.33±3.94 nmoi!L, grup ll= 22.46±6.75 nnýoi!L ve grup lll= 9.02±2.57 nnýoi/L bulwýdu . AKS'li olgulardaki serum neopterin dii:eyi lýený stabil angina/i olgulm·a göre (p0.05). Sonuç: AKS'li olgularda lýiicresel inýmiin aktivasyonwýwý 'Jir göstergesi olan serum neopterin seviyesinin önemli i erecede artmýþ olduðu ve plak inflanýasyomýn bir iþareti Jlm·ak kullanýlabileceði kanaatine varýlmýþtýr.

Intracoronary thrombus occurring by disruption of atheroscle rotic plague is the cause of acute coronary syndromes. Vulnerable atherosclerotic plaques were found to contain a large number of macrophages and T lymphocytes and that the seeretian of neopterin from activated macrophages increased in vulnerable plaques. Our study aimed to assess serum neopterin concentrations as an indicator of intracoronary plaque inflammation and their re ýation to coronary artery disease severity in patients with acute coronary syndrome (ACS). Consecutive 43 patients with chronic stable angina pectoris (group 1), 118 patients with ACS (group II) and age-matched 30 healthy subjects as a control group (group III) were enrolled in our study. Serum neopterin co ncentration was measu red with "enzyme-linked immunosorbent assay" technique. Selective coronary angiography was performeel all pa tients. Significant coronary artery disease was defined as >50% narrowing on coronary ang iograný. Severity of coronary artery d isease was evaluated using Gensini score. Serum neopterin concentrations were found ý2.33±3.94 nnýol/L in group I, 22.46±6.75 nmol/L in group II, and 9.02±2.57 nnýol/L in group III. Serum neopterin levels were found significantly higher in ACS than in patients with chro nic stable angina pestoý·is (p0.05). We concluded that the !eve! of serum neopterin, an indicator of cellular immune activation in patients wi th acute coronary synd romes, inc reased considerably, and this ýnay be u sed as a s ign of atherosclerotic plaque inflammation.

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Bu çalýþmada Wolff-Parkinson-Wiýite (WPW) sendromlu hastalarda aksesuar yolun yerleþimini belirlemek üzere geliþtirilmiþ 7 algoritm (Skeberis ve ark., Xie ve ark., Chiang ve ark. , Fitzpatrick ve ark., Davilla ve ark., Adalet ve ark., ile Arnýda ve ark.) tamsal duyarlý lýk, pozitif öngörii deðeri, gözlemci-içi ve göz lemciler-arasý de,~ iþkenlik/er açýs111dan karþýlaþtýrý ld ý. Çalýþmaya, 12-derivasyon/u elektrokardiyogram111da (EKG) aþikar WPW sendromu saptanan ve elektrofizyolojik inceleme ile yerleþimi kesin olarak belirlenen ve aksesuar yolu (A Y) baþan/ý abiasyon ile ortadan kaldm/an 100 hasta oluþturdu. Tüm EKG'/er 3 deneyimli e/ektrofizyolog hekim tarafmc/an farklý zamanlarda olmak üzere ikiþer kez deðerlendirildi. Algoritmlerin aksesuar yolun yerleþimini göstermedeki duyarlýfýð mill o/o 29-51, pozitif öngörii deðerinin de o/o31- 60 aras ýnda deð iþt(~ i gözlendi. En yüksek duyarlýlýk ve pozitif öngörii deðerinin Clýiang ve ark. 'mn önerdiði algoriflnde olduð u saptandý (sý rasýyla %51 Fe %60). AY yerleþiminde, tüm algoritmler birlikte ele alýndýðýnda sollateral yerleþ imli A Y'lann en kolay tanman AY olduð u (ort.%70), bununla birlikte özellikle sol ya da sað posrerosepta/ yerleþ imi aylrf etme açýsmdan en yiiksek duyarlý lýð ýn Adalet ve aý-k. 'nýn ön erdið i a/gorirnýde olduðu gözlendi (sýrasýyla %75 ve %77). Ayrýca, de/ta dalgasým göz öniine almayan a/goritmlerdeki pozillf öngörii deð erin in, de/ta dalgasým içeren a/goritm/ere göre dalw diiþiik olduðu saptandý (sýrasýyla %34 ve %43.3, p=0.045). Gözlemci-içi ve gözlemciler-arasý deðiþken likle de en güçiii uyumla rýn yine Clýiang ve ark.'mn önerdiði a/gorillnde o ldu,~ u (sýras ýyla kappa=0.78-0.82 Fe kappa= 0.76, [%95 Cl: 0.73-0.79]), en z ayýf uyumlarlll ise Fitzparric ve ark.'mn ön erdiði algoritmde olduðu gözlendi (sýrasýyla kappa=0.56-0.72 ve kappa= 0.40, [%95 CI: 0.36- 0.44]). Sonuç olarak, algoritmlerin genel olarak taný sal duyarlý lýk ve pozitif öngörü deðerlerinin algoritma çalýþmalarýnda bildirilen sonuçlara göre belirgin derecede diiþiik olduðu , riim algoritmlerde sol lareral yerleþimli AY'Iarýn en kolay tamnan AY olduðu ve de/ta dalgasmýn algorirme kafilmasý ile pozirif öngörii deðerinin y iikseldi.~i de gözlenmiþtir. Ayrýca yedi algoritm aras111da genel olarak tanýsa l duyarlýlý k, pozitif öngörii deðeri, gözlemci-içi ve gözlemciler-arasý uyumu en yüksek olan a/gorirmin Clýiang ve ark.'nm önerdiði a/goritm o lduðu saptanmýþtýr. Algoritm kullammýnda ya da yeni a/goritnýlerin öneriminde bu bilgilerin elektrofizyolog lýekimlerce göz önüne a/mmasýnm faydalý olabileceði düþünülmüþtür

The purpose of thi s study was to compare the sensitivity, (+) predictive value (PPY), inter and intraobserver variability of published 7 a lgori thýns (Skeberis et al, Xie et al., Chiang et al. , Fitzpatrick et al. , Davilla et al., Adalet et al., and Arruda et al.) which were developed to localize atrioventricular accessoý·y pathways (AP's) in patients with the Wolff- Parkinson- White (WPW) syndrome. One h undred consecutive patients, diag nosed to have WPW syndrome from 1 2-lead electrocardiogram (ECG), who underwent successful radiofrequency catheter ablation of a single overt AP, were included in the study. The 12-lead ECGs were evaluated for two of each in diffe rent times by three independent and experienced electrophysiologist. The sensitivity and PPY was found to vary between 29-51% and 3 1-60%, respecti vely. Chiang's algorithm was shown to have the highest sensitivity and PPV amongst the 7 a l gorith ýns (5 ý % and 60%, respectively). In general, for localizing the APs, best results were obtained in left lateral APs (mean 70%). Adalet's algorithm had the highest sensit ivity to differentiate the right and left APs (75% and 77%, respectively). The PPY tended to be lower when delta-wave polarity was not included in the algorithm's architecture (34% and %43.3, respectively, p=0.045). The strongest correlation ininter and intraobserver variation was found in Chiang's algorithm (kappa=0.78-0.82 and kappa= 0.76, [%95 CI: 0.73-0.79], respectively), nevertheless Fitzpatrics's algorithm exhibited the weakest intra and interobserver agreement (kappa=0.56-0.72 and kappa= 0.40, [%95 CI: 0.36-0.44], respectively) . In conclusion, the sensitivity and PPY of the included a l g orithýns were clearly lower than those repor ted by the corresponding authors. Left lateral APs were the only pathways that could easily be recognized by all algorithms. The algorithms that included the delta-wave polarity was shown to increase PPY s. In o ur series, consisting of 100 patients with the WPW syndrome, Chiang's algorithýn had the highest PPV and inter and intraobserver agreeýnent aýnong st all a lgorithýns. These findings should be considered when using these a lgorithýns in elinical settings or when building new ones.

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Kareliyak transplantasyon hastalarý postoperalif dönemde aklll rejeksiyon açlSindan yakýn takip gerektirir/er. Transplantasyon sonrasý aklll rejeksiyonwý tanýsmda endomiyokardiyal biyopsi (EMB) temel yönteme/ir. Bununla birlikte sitoinýnýwýolojik monitörizasyon (CIM), akut rejeksiyon tan ýsýnda basit, noninvaziv ve giinlük kullanýma uygun bir metoddur. Bu prospektif ça lýþmada kliniðimizde ortotopik kalp transplantasyonu yapýlan 13 hastada sitoinýnýün olojik nýonitörizasyonwý akut rejeksiyo111111 erken taýHsmdaki etkinliðini saptamayý ve literatür bilgileri ýþýðýnda tartýþmayý amaçladýk. Hastalarýn ilk 6 aylýk takiplerindeki CIM verilerini, EMB ve klinikleri ile karþý/aþ/ýrdýk. Elde edilen sonuçlarla CIM 'in sensivilesi %85,71, spesivitesi %75 ve pozitif tahmin deðer i %85,71 bulunmuþtur. Sonuç olarak CIM kalp transplantasyonu yap ýlan hasta/ann özellikle erken dönem giinliik takibinde EMB'nin sýklýðým azaltýcý ve zamanlamasý için fikir vericidir, ancak akut rejeksiyon tanýsýnda sýnýrlý yardýmý olduðu gözöniine alýnarak diðer tam metodlanyla birlikte kullanýlmalýdýr.

Heart transplant patients need close monitoring of acute rejection in the postoperative period. Histopathological assessment of the endomyocardial biopsy (EMB) is essential for the diagnosis of acute rejection after heart transplantation. However cytoimmunologic monitoring (CIM) is a simple noninvasive method in the diagnos is of acute rejection which can be performed daily. In th is prospective study we investigated the efficacy of CIM in the early diagnosis of acute rejection in 13 cardiac allograft recipients. W e compared the data of CIM, EMB and the clinic status of patients. The sensitiv ity of CIM was calculated as 85,7 percent, the specificity 75 percent and the predictive value 85,7 percent We conclude that CIM helps timing of EMB and allows for reduction of its frequency. However, according to its lim ited help, it should be used together with other methods of rejection diagnosis.

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Amaç: Ýntravenöz nitrogliserinin koroner arter hastalýði (KAH) bulunan bireylerdeki aort elastikiyeti üzerine etki· si ile KAH ciddiyetini saptamak. Materyel ve Metot: Koroner anjiyografi sonuc1mda orta· ya Çikan hasta damar sayýsýna göre 2 hasta grubu oluþturuldu. Birinci grup tek damar patolojisi gösteren 21 hastae/ an , ikinci grup ise çok damar rahatsizliði lýulwtan 22 hastadan oluþturuldu . Aort sertliði parametreleri olarak nab1z basmc1, aortik "strain", esneklik ve aort çap deðiþi· mi incelendi. Anti-iskemik ilaçlar incelemeden 48 saat ön· ce kesildi ve liiz unýu halinde dilalti nitrogliserin önerildi. Hastamn son 3 saat içinde nitrogliserin alnýanuþ olmaSI· 110 dikkat edildi. Biitiin hastalarda ekokardiyografi/.: ince· /enýeler nitrogliserin öncesi ve 5 dakika sonras1 olmak üzere iki kez tekrarlandi. Bulgular:. Nitrog fiserin aort çap deðiþimi iizerinde tek damar grubunda anlamlý artlÞ yaparken (öncesi ve sonraSI Sirasiyla; 1./ ±0.5,1.6±0.6, p=0.002) çok damar grublmda etkisizdi. Nab1z basn1c1 nitrogliserinle tek damar grubunda (önce ve sonra, 59±16 ya karþ111 49±12, p0.05). Sonuç: Nitrogliserin ile aort sertliðindeki düzelme miktarý , KAH yaygýnlýðýnýn saptanmasmda yardýmcý bir faktör olabilir.

The main objective of this study was to investigate the extent of coro nary artery disease by using the effect of nitroglycerin on aortic stiffness. Two study g roups were composed according to coronary angiographic results. 21 patients having single vessel disease and 22 patients multivessel disease. Pulse pressure, aortic diameter change, aortic strain and distensibility were used as aortic sti ffness parameters. Antianginal medications were withheld 48 hours before the study.The patients were allowed to use sublingual nitroglycerin as necessary, but caution was taken that no nitroglycerin medication was performed within 3 hours of its adýninistration . Echocard iographic assessment was performed in all patien ts before and at least 5 ýn inute s after intravenous nitroglycerin administration. Results: Nitroglycerin exerted an increase in aoýtic diameter change ( 1.1±0.5 versus 1.6±0.6 before and after nitroglycerin , respectively; p=0.002) and aortic strain (6±3.51 vs. 9±4 before and after nitroglycerin, respectively; p0.05). As compared to findings before nitroglycerin administration, the improvement of the elasticity properties of the aorta with nitroglycerin may be helpful to d eter ýn ine the extent of coronary artery disease.

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Ventriküler taþiaritmilerden kaynaklanan ani ölümün önlenmesinde etkinliði gösterilmiþ olan inýplanre edilebilir kardiyoverrer defibrilatörlerin (ÝKD) endikasyon/arý özellikle son dekadda giderek arran þekilde geniþlemiþTir. MevcuT cilýazlarm çoðýmda an ritaþikardi "pacing" (ATP) özellið i de bu/unmaktachr. ATP venrrikiiler raþika rdinin venrriküler fibrilasyo1ýa dejenere olmastili ve dolaytsý ile defibrilasyon ilýriyactnt önleyen bau algorirmalar içermekTedir. Sonuç olarak bir çok hasrada erkinfiði ve güvenilirliði kamflannuþ bir redavi yöntemi olan ATP rerapisi, þok redavisine olan ilýriyacý azairarak dalýa iyi bir lýayar kalitesi saðlamost yanmda barm·ya enelyisini de korumaktadýr. Bu makalede ATP'nin en dikasyonlarý ,farkli ATP algorirmalamlln erkinlik ve güvenilirlikleri gözden geçirilmiþtir.

Indications of implantable cardioverter defýbri llator (ICD) implantation, which have been shown to be effective in prevention of sudden death res ul ring form ve ntric ul ar tachyarrh ythmia, were progressively widened especially during the last decade. Most of the avail able ICDs possess "antitachycardia pacing" properties. ATP comprises some algorithms that prevent degeneration of ventricular tachycardia into ventricular fibrillation, and need to defibrillation. As a consequence, ATP therapy, which has been proved to be effective and safe in most patients, provides a better qual ity of life by decreasing the need for shock therapy aside that it sav es battery energy. In this article, usage of ATP, safety and efficacy of different ATP algorithms is reviewed.

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Çift arifisli mirral kapak nadir göriilen konjenital bir anomalidir. Sýklýkla baþka kareliyak anomaliler ile beraber göriiiebi/eceði gibi tek baþma da bulunabilir. Miyokardiyal noncompaction izole ve izole olmayan olarak ikiye aynlmakradtr. i zole olmayan nonconýpaction ASD, VSD, pulmoner stenoz gibi konjenital kalp hastalýklarýnda göriilmektedir. Olgu sununýu izole olmayan noncompaction ile çift arifisli milral kapaðý beraberinde bulundurmasý bakmundan ilktir. Aynca izole olmayan nonconýpactiomn kalp yetersizliðine sebep olabileceðine iþaret ederek ilerde yapýlacak çalýþmalar için fikir vermektedir.

Double-o rifice mitral valve is a rare congenital anoýnaly . Although it is more frequently associated with other cardiac abnormalities, it may occur as an isolated lesion. There are two forms of ýn yocardial noncompaction: isolated and non- isola ted myocardial noncompaction_ Nonisolated myocardial noncompactions are occasiona lly re ported postnatally in association with congenital heart anomalies such as VSDs, pulmonic stenosis, and ASDs. To our knowledge, this is the first case reporting a double orifice mitral valve associated with nonisolared myocardial noncompaction.

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Acil servise kann aðnsý þikayetiyle baþvurmuþ ve akut ko/ esistit tamsýyla genel cerrahi servisinde tedavi görmiiþ 52 yaþmdaki erkek lýastamn EKG'si baþka bir retrospektij araþtýrma nedeniyle incelenirken inkonýplet sað dal bloku ve V 1-V3 derivasyon/annda ST segment yiikselnýesi bulundu,~ u saptandý. Bu bulgularla "Brugada Sendromu" ön tanýsýyla olgu yeniden deðerlendirildi ve çeþitli incelemelerde bulýmuldu. Propafenon ile uyan testi son ucwýda EKG'de ek bir deðiþiklik gözlenmedi, elektrofizyolojik incelellýe ile hastada ventriküler aritmi indiiklemnedi. Aile bireylerinili EKG kayýtlarmda benzer bulgulara rastlanmadý. Bu olgu, oldukça nadir olan Bl'llgada Sendromu'mm EKG bulgulan saptanan asenýpt omatik bireylerde yapýlabilecek incelemelerin tartýþýlmasý amacýyla sunuldu.

A 52-year-old man who had an acute abdeminal pain was hospitalized and treated at the department of general surgery with the diagnosis of "acute cholecystitis". His ECGs, recorded during his first admission in the emergency service, was evaluated retrospectively for a study project_ An incomplete right bundle-branch block and ST segment elevation in V ý-3 leads were found. The patient underwent a detailed investigation considering a possible diagnosis of the Brugada syndrome. No change was observed in the ECG f indings during the provocation test with propafenone infusion and no ventricular tachycardia was induced during electrophysiological study. There were no similar find ings in the ECGs of the family members. This case is reported because of the rarity of the Brugada syndrome, and the possible diagnostic investigations in asymptomatic cases with the ECG findings of th is rare elinical situation were discussed. Key words:

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Pulmoner arteriyovenöz fistiiller nadir görülen bir anomalidir ve çoðunlukla herediter hemorajik telenjektazili hastalarda bulwýur. Tan ý konulmamasi veya tedavi edilmemesi durumunda yaþamý tehdit edecek komplikasyonlara neden olabilir. Çoð unlukla herediter hemorajik te/enjekta: inin klinik bulg ularý gö:e çmpmaktadýr. Bu yaz ýda bilateral pulmoner arteriyovenöz fistiil saptanan ve herediter hemorajik telenjektazi bulunmayan bir olgu sunulmaktadýr.

Pulmonary arteriovenous fistu la is a rare anomaly, almost always assoc iated with hered itary hemorrhagic telangiectasia. It can le ad to 1 ifethreatening co ýnplica tion s if und iagnosed or untreated. The most striking elinical findings for diagnos is are due to hered itary hemorrhagic telangiectasia which acco ýn pan ies pulmo nary arteriovenous fistulas. W e report bilateral pulmonary arteriovenous f istulas in a case without hereditary hemorrhagic telangiectasia.

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Ýntakt ventriküler septumlu pulmoner atrezi tam sý konulan 2160 gr aðýr/ýðmdaki 51 günlük bebekte kýlavuz: telin sert ucu ile atretik kapak perfare edildikten sonra pulmoner valvuloplasti uygulandý. Bu yazýda küçük bir bebekte ülkemi: de ilk kez: uygulanan bir kapak pelforasyon tekniði anlatýlmaktadýr.

Pulmonary valvuloplasty was performed in a 51- day-old, 2 160-g baby wi th the diagnosis of pulmonary atresia with intact ventricular septuýn after perforating the pulýnonary valve with the stiff end of a guide-wire. This type of technique and perforation of pulmonary valve in such a smail baby has not been reported before in Turkey.

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