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Amaç: Bariatrik cerrahinin obez hastalarýn kalp yapýsý ve fonksiyonlarýný iyileþtirdiði bilinmektedir. Bu çalýþmada ‘sleeve’ gastrektominin (tüp mide ameliyatý) vücut ölçüleri ve diyastolik fonksiyon üzerinde kýsa dönem etkilerini araþtýrdýk.
Yöntemler: ‘Sleeve’ gastrektomi planlanan 41 ardýþýk obez hasta çalýþmaya dahil edildi. Çalýþma baþlangýcýnda ve takipte vücut ölçümleri ve ekokardiyografik ölçümler kaydedildi. Toplam kilo kaybý yüzdesi ve fazla kilonun kayýp yüzdesi hesaplandý.
Bulgular: Hastalarýn ortalama yaþý 42.85±11.47 idi, bunlarýn 21’i (%51.1) kadýndý. Ortalama vücut kitle indeksi (VKÝ) 44.86±5.62 kg/m² idi. Ortalama takip süresi 91.24±44.48 gündü. Katýlýmcýlarda istatistiksel anlamlý olarak kilo kaybý (26.64±10.5 kg), VKÝ’de (8.84±3.93 kg/m²) ve vücut yüzey alanýnda (VYA) azalma (0.27±0.12 m²) saptandý. Mitral E hýzýnda ve mitral annüler e hýzýnda anlamlý artýþ; mitral A hýzýnda, E/e oranýnda, sol ventrikül kitlesinde (LVM) ve sol atriyum hacminde (LAV) anlamlý azalma saptandý. Vücut ölçülerindeki deðiþiklik miktarý ile ekokardiyografik ölçümlerdeki deðiþim miktarlarý arasýnda anlamlý bir iliþki bulunmadý. Sadece fazla kilonun kayýp yüzdesi ile LAV’deki azalma arasýnda orta derecede pozitif korelasyon saptandý.
Sonuç: ‘Sleeve’ gastrektomi ile ameliyat sonrasý kýsa dönemde anlamlý kilo kaybý ve diyastolik parametrelerde anlamlý iyileþme saðlanmýþtýr. Kilo kaybý miktarý ile ekokardiyografik parametreler arasýnda anlamlý iliþki saptanmamýþtýr.

diac structure and function in obese patients. This study was an examination of the short-term effects of sleeve gastrectomy on body measurements and diastolic function.
Methods: A total of 41 consecutive obese patients who were scheduled to undergo a sleeve gastrectomy procedure were included in the study. Baseline body and echocardiographic measurements and the follow-up counterpart data, including total and excess weight loss percentages, were recorded.
Results: The mean age of the patients was 42.85±11.47 years. Of the total, 21 (51.1%) patients were female. The mean body mass index (BMI) was 44.86±5.62 kg/m². The mean duration of follow-up was 91.24±44.48 days. The participants demonstrated statistically significant weight loss (26.64±10.95 kg), as well as a decrease in BMI (8.84±3.93 kg/m²) and body surface area (0.27±0.12 m²). A significant increase in E velocity and mitral annular e velocity were observed, as well as a significant decrease in A velocity, E/e ratio, left ventricle mass, and left atrial volume (LAV). No significant correlations between the body measurement changes and changes in echocardiographic parameters were observed, with the exception that the excessive weight loss percentage was moderately correlated with a change in LAV.
Conclusion: Sleeve gastrectomy led to a significant decrease in body weight and improved diastolic function parameters in the short-term. No significant relationship was found between the amount of weight loss and change in echocardiographic measurements.

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Amaç: Biz bu çalýþmada, akut anteriyor miyokart enfarktüslü (ME) hastalarda, yüzeyel elektrokardiyografide aVR derivasyonundaki iskemik deðiþiklikler ile sol ventrikül trombüsü (LVT) veya yüksek dereceli spontan ekokontrastý (SEK) arasýndaki iliþkiyi araþtýrmayý amaçladýk.
Yöntemler: Yüzeyel EKG’de aVR derivasyonunda T dalga polaritesi (TPaVR) ve ST segment sapmasý (STaVR) sayýsal olarak ölçüldü ve mutlak deðerleri hesaplandý. Büyük mutlak deðerin, küçük olana bölünmesiyle ST/TPaVR oraný elde edildi. Ekokardiyografik görüntülerden LVT veya yüksek dereceli SEK varlýðý kaydedildi. Syntax skoru (SS), klinik SS (cSS) ve rezidüel SS’leri (rSS) anjiyografik görüntülerden hesaplandý.
Bulgular: Otuz dört hastada LVT veya yüksek dereceli SEK mevcuttu ve Grup 1 olarak adlandýrýldý. Yüz yetmiþ hastada herhangi bir LVT ya da yüksek dereceli SEK yoktu ve bu hastalar Grup 2 olarak belirlendi. P dalgasý süresi, V2 ST-segment yüksekliði, TPaVR, cSS ve ST/TPaVR oraný, Grup 1’de anlamlý olarak daha yüksek bulundu. EF ve STaVR, grup 2’de anlamlý olarak yüksek bulundu. EF (OO: 0.9, %95 GA: 0.833–0.973, p=0.008), TPaVR (OO: 1.454, %95 GA: 1.074–1.967, p=0.015) ve ST/TPaVR oraný (OO: 1.6, %95 GA: 1.307–1.959, p<0.001) grup 1 için baðýmsýz belirteç olarak tespit edildi.
Sonuç: Anteriyor ME’li hastalarda; yüzeyel EKG’de aVR derivasyonundaki iskemik deðiþiklikler, LVT veya yüksek dereceli SEK ile yakýndan iliþkilidir.

Objective: The aim of this study was to investigate the relationship between ischemic changes in the lead aVR and left ventricular thrombus (LVT) or high-grade spontaneous echo contrast (SEC) in patients with acute anterior myocardial infarction (MI).
Methods: Quantitative T wave polarity in lead aVR (TPaVR) and ST segment deviation in the lead aVR (STaVR) measured from a surface electrocardiogram (ECG), as well as the absolute numerical values, were recorded. The ST/TPaVR ratio was obtained by dividing the larger absolute value by the smaller. The presence of LVT or high-grade SEC was recorded using echocardiograpy. The SYNTAX score (SS),
clinical SS (cSS), and residual SS (rSS) were calculated from angiography results.
Results: A total of 34 patients with LVT or high-grade SEC were included in Group 1. Group 2 comprised 170 patients who did not have any LVT or high-grade SEC. The P wave duration, V2 ST-segment elevation, TPaVR, cSS, and ST/TPaVR ratio were significantly higher in Group 1. The ejection fraction (EF) and STaVR were significantly higher in Group 2. The EF (Odds ratio [OR]: 0.9, 95% confidence interval [CI]: 0.833–0.973; p=0.008), TPaVR (OR: 1.454, 95% CI: 1.074–1.967; p=0.015), and ST/TPaVR ratio (OR: 1.6, 95% CI: 1.307–1.959; p<0.001) were determined to be independent predictors for Group 1.
Conclusion: Ischemic changes in the lead aVR are closely associated with LVT or high-grade SEC in anterior MI patients.

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Amaç: Prolaktin düzeyi, ateroskleroza eðilimi artýran çeþitli durumlarla iliþkilidir. Aterom plaklarýnda prolaktin reseptörleri bulunmuþtur. Ancak serum prolaktin düzeyiyle koroner arter aterosklerozunun yaygýnlýk ve ciddiyeti arasýnda korelasyon henüz çalýþýlmamýþtýr. Bu çalýþma bu iliþkiyi incelemektedir.
Yöntemler: Selektif koroner anjiyografi adayý olan, serum prolaktin düzeyleri normal 414 postmenopozal kadýn çalýþmaya alýndý. Hastalarýn lipit profilleri, serum prolaktin, tiroit uyarýcý hormon, C-reaktif protein, üre, kreatinin ve açlýk kan þekeri düzeyleri ölçüldü. Her bir hastanýn Gensini skoru hesaplandý. Çalýþma popülasyonu serum prolaktin düzeyinin üçte birlik dilimlerine göre 3 gruba ayrýldý.
Bulgular: Tek deðiþkenli analizde 3 grubun Gensini skorlarý arasýnda istatistiksel açýdan anlamlý herhangi bir farklýlýk yoktu (p=0.075). Çok deðiþkenli analizde, serum prolaktin düzeyinin Gensini skoru için baðýmsýz bir belirleyici olmadýðý (p=0.430), buna karþýlýk yaþ, hipertansiyon ve diyabetin baðýmsýz belirleyiciler olduðu saptandý.
Sonuç: Bu çalýþmada, postmenopozal kadýnlarda serum prolaktin düzeyiyle Gensini skoruyla ifade edilen koroner arter aterosklerozu arasýnda istatistiksel açýdan anlamlý bir korelasyon bulunmadý.

Objective: Prolactin is correlated with some conditions that predispose individuals to atherosclerosis. Prolactin receptors have been found in atherosclerotic plaques. However, the correlation between the serum prolactin level and the extension and severity of coronary artery atherosclerosis has yet to be studied.
Methods: In total, 414 postmenopausal women candidated for selective coronary angiography with normal serum prolactin levels were enrolled. The patients’ lipid profile and levels of serum prolactin, thyroid-stimulating hormone, C-reactive protein, urea, creatinine, and fasting blood sugar were measured. The Gensini score for each patient was calculated. The study population was divided into 3 groups according to the tertile of the serum prolactin level.
Results: There was no statistically significant difference in terms of the Gensini score between the 3 groups in the univariate analysis (P = 0.075). The multivariable analysis showed that the serum prolactin level was not an independent determinant of the Gensini score (P = 0.430), whereas age, hypertension, diabetes and dyslipidemia were the independent determinants of the Gensini score.
Conclusions: There was no statistically significant correlation between the serum prolactin level and coronary artery atherosclerosis expressed as the Gensini score in our sample of postmenopausal women.

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Amaç: Bu yazýda, renovasküler (RVH) ve esansiyel hipertansiyon (EH) olan hastalarda nötrofil lenfosit oraný (NLO) ve ortalama trombosit hacmini (OTH) içeren çeþitli hematolojik kan sayýmý parametrelerinin farklýlýðýný deðerlendirdik.
Yöntemler: Renovasküler hipertansiyonlu 51 hasta ve EH’li 173 hastaya eðilim skoru eþleme analizi uygulandý. Eþleþtikten sonra 49 çift hasta karþýlaþtýrýldý.
Bulgular: Eþleþmeden önce, RVH hastalarý anlamlý olarak daha yüksek NLO deðerlerine sahipti [1.35 (aralýk, 1.14–1.76) ve 1.05 (aralýk, 0.81–1.3), (p<0.001)] ve OTH [8.7 (aralýk, 8.3–9.5) ve 8.4 (aralýk, 7.3–9.2), (p=0.002)] deðerlere sahipti. Eðilim skoru eþleme analizi sonrasý (49’a karþý 49 hasta), yaþ, cinsiyet, aterosklerotik risk faktörleri, ateroskleroz sýklýðý, kullanýlan ilaçlar açýsýndan benzer özellikte gruplar elde edildi. Eþleþme sonrasý, RVH olan hastalarda NLO anlamlý olarak yüksek kalýrken [1.00 (aralýk, 0.76–1.40) ve 1.35 (aralýk, 1.15–1.75)] p≤0.001, OTH gruplar arasýnda farklýlýk göstermedi. NLO, çok deðiþkenli lojistik regresyonda RVH ile baðýmsýz olarak iliþkilendirilen tek parametre idi (Odds Oraný=5.563, %95 Güven Aralýðý=2.089–14.814, p<0.001). ROC eðrisi analizinde NLR >1.16, %72 duyarlýlýk ve %60 özgüllük ile RVH’yi tahmin ettirmekteydi [(AUC)=0.724, %95 GA=0.624–0.823, p≤0.001].
Sonuç: Bu çalýþmanýn sonuçlarý, RVH hastalarýnda basit ve klinik bir inflamasyon parametresi olan NLO’nun arttýðýný göstermiþtir.

Objective: Various hematological blood count parameters, including the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), were analyzed to assess differences in patients with renovascular (RVH) and essential hypertension (EH).
Methods: A propensity score analysis was performed to match 51 patients with RVH and 173 patients with EH. After matching, 49 pairs of patients were compared.
Results: Before matching, patients with RVH had significantly higher NLR values [1.35 (range: 1.14–1.76) vs. 1.05 (range: 0.81–1.3); p<0.001] and MPV [8.7 fL (range: 8.3–9.5 fL) vs. 8.4 fL (range: 7.3–9.2 fL; p=0.002]. After propensity score matching was performed (49 vs 49 patients), age, sex, atherosclerosis risk factors, frequency of atherosclerosis, and the medications used were similar between groups. The NLR was significantly greater in patients with RVH [1.00 (range: 0.76–1.40) vs 1.35 (range: 1.15–1.75; p<0.001]. The MPV did not differ significantly between groups. The NLR was the only parameter independently associated with RVH in a multivariate logistic regression [odds ratio: 5.563, 95% confidence interval (CI): 2.089–14.814; p≤0.001]. Receiver operating characteristic curve analysis results indicated that NLR >1.16 predicted RVH with a sensitivity of 72% and a specificity of 60% [area under curve: 0.724, 95% CI: 0.624–0.823; p≤0.001].
Conclusion: The results of the present study demonstrated that NLR, which is a simple, clinical parameter of inflammation, was elevated in patients with RVH.

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Amaç: Akut pulmoner emboli (APE) ciddi bir klinik durumdur ve atriyal fibrilasyon (AF) klinik pratikte en sýk görülen aritmidir. Pulmoner Emboli Ciddiyet Ýndeksi (PESI) APE’de kýsa dönem mortaliteyi öngören skorlama sistemidir. Bu çalýþmada, APE’li hastalarda PESI skoru ile yeni geliþen AF iliþkisini bulmayý amaçladýk.
Yöntemler: Mayýs 2012 ile Aralýk 2015 arasýnda baþvuran 869 hastanýn bilgileri geriye dönük olarak deðerlendirildi. Tüm hastalarýn PESI skorlarý hesaplandý. Hipertansiyon, koroner veya yapýsal kalp hastalýðý, hepatik veya böbrek disfonksiyon, kronik obstrüktif akciðer hastalýðý, tiroit disfonksiyon, diyabet veya uyku apne, enflamatuvar veya enfeksiyon hastalýðý öyküsü, yeni travma veya cerrahi, steroid veya nonsteroid enflamatuvar ilaç kullanýmý bulunan hastalar dýþlandý. Kýrk iki (%4.8) yeni-AF’li hasta dahil edildi.
Bulgular: Yaþ, cinsiyet, sistolik ve diyastolik kan basýncý, kalp hýzý, açlýk glikoz düzeyi, serum kreatinin, sol ventrikül ejeksiyon fraksiyonu, trikuspit anüler düzlem hareket deðeri ve pulmoner arter sistolik basýnç ölçümleri AF olan ve olmayan hastalar arasýnda anlamlý farklýlýk göstermedi (p >0.05).Yeni-AF hastalarýnda daha uzun LVEDD ve LAD deðerleri mevcuttu (p <0.05). Yeni-AF grubunda PESI skoru daha yüksekti (93±23 ve 75±17; p<0.001). LVEDD, LAD, ürik asit, bilirubin, albumin, troponin deðerleri ve PESI skoru Yeni-AF için tek deðiþkenli öngörücüler olarak bulundu.
Sonuç: Çalýþmamýzda yüksek PESI skoru yeni geliþen AF ile iliþkili bulundu. APE hastalarýnda, 82.50’den büyük PESI skoru yeni-AF öngörücüsü olarak kullanýlabilir.

Objective: Acute pulmonary embolism (APE) is a serious clinical situation and atrial fibrillation (AF) is the most common arrhytmia in clinical practice. The Pulmonary Embolism Severity Index (PESI) is an accepted risk stratification tool used to predict short term mortality in APE. The aim of this study was to evaluate the relationship between the PESI score and new-onset AF in patients with APE.
Methods: The records of 869 APE patients admitted between May 2012 and December 2015 were evaluated retrospectively. The PESI score was calculated for every patient. Clinical variables associated with new-onset AF in APE were assessed after the exclusion of patients with hypertension, coronary or hemodynamically significant valvular heart disease, hepatic or renal dysfunction, chronic obstructive pulmonary disease, thyroid dysfunction, diabetes mellitus, sleep apnea, any history of inflammatory or infectious disease, or recent trauma. New-onset AF was detected in 42 (4.8%) patients.
Results: Age, gender, systolic and diastolic blood pressure, heart rate, fasting glucose level, serum creatinine, left ventricle ejection fraction, tricuspid annular plane systolic excursion value, and pulmonary artery systolic pressure measures were not significantly different between patients with and without AF. New-AF patients demonstrated larger LVEDD and LAD dimensions (p <0.001 for both). The PESI score was higher in the new-onset AF group (93±23 vs.75±17; p <0.001). LVEDD, LAD, levels of uric acid, bilirubin, albumin, and troponin, and PESI score were univariate predictors of new-onset AF.
Conclusion: In patients with APE, the PESI score was positively correlated with new-onset AF. A PESI score greater than 82.50 may be useful to predict new-onset AF in these patients.

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Amaç: Kalp yetersizliði (KY) 21. yüzyýlýn önemli bir saðlýk sorunudur ve ülkemizdeki sýklýðý %2.9’dur. Bu hastalýðýn ülke profili, farklý fenotiplerin sýklýðý ve özellikleri, risk faktörleri net olarak ortaya konulmamýþtýr. Bu çalýþmada, ülkemizi temsil eden bir örnekte KY hastalarý (SELFIE-TR – Snapshot Evaluation of Heart Failure Patients in Turkey) incelenmiþtir.
Yöntemler: Ülkemizdeki 12 NUTS-1 bölgesinden en az iki kardiyoloji uzmanýnýn çalýþtýðý 23 merkez çalýþmaya davet edildi. Merkezler, Ekim veya Kasým aylarýndan tercih ettiði bir tanesinde, tercih edilen ay içindeki 4 haftanýn yine tercih edilen bir gününde, tanýsý kýlavuzlara uygun olarak doðrulanmýþ KY hastalarýný ardýþýk olarak çalýþmaya dahil ettiler.
Bulgular: Tüm grubun (n=1054) yaþ ortalamasý 63.3±13.3 yýl idi (E/K oraný: 751/303, %71.3/%28.7). Tüm kohortta kronik KY/akut KY hasta sayýlarý sýrasýyla 712 ve 342; düþük ejeksiyon fraksiyonlu KY (DEF-KY), sýnýrda ejeksiyon fraksiyonlu KY (SEF-KY) ve korunmuþ ejeksiyon fraksiyonlu KY (KEF-KY) hasta sayýlarý sýrasýyla 801 (%76), 176 (%16.7), 77 (%7.3) olarak tespit edildi. Kronik KY olan hastalar akut KY olan hastalara göre daha gençti (61.1±13.3 yýl ve 67.9±12.1 yýl, p<0.001). Tüm kohortta, KY hastalarýnýn %46’sýnda hipertansiyon, %27.5’inde diyabet (DM), %12.8’inde kronik obstrüktif akciðer hastalýðý ve %45.2’sinde önceden geçirilmiþ miyokart enfarktüsü olduðu görüldü. DEF-KY fenotipi olan kronik KY hastalarýnda ACEi/ARB, beta bloker ve MRA kullaným oranlarý sýrasýyla %74.7, %89.7 ve %60.9 olarak saptandý.
Sonuç: SELFIE-TR çalýþmasý ülkemizdeki KY hastalarýnýn anlýk fotoðrafýný gösteren ilk çalýþma olmasý sebebiyle önemli bilgiler sunmaktadýr. Bu bilgiler, kýlavuza uygun önleyici ve tedavi edici yaklaþýmlarýn geliþtirilmesi açýsýndan faydalý olabilir.

Objective: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey.
Methods: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015.
Results: The mean age of the entire cohort was 63.3±13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1±13.3 years vs 67.9±12.1 years; p<0.001). Among the whole cohort, hypertension was observed in 46%, diabetes mellitus was present in 27.5%, chronic obstructive pulmonary disease was present in 12.8%, and previous myocardial infarction was noted in 45.2%. In patients with HFrEF, the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a beta blocker, or a mineralocorticoid receptor antagonist was noted in 74.7%, 89.7%, and 60.9%, respectively.
Conclusion: The SELFIE-TR findings provide important insight, since it is the first study to make a snapshot of HF patients in our country. These data may help to create standardized prevention and treatment strategies.

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Amaç: Dilate kardiyomiyopati (DKM) sol ventrikül iþlevlerinde bozukluk ve kalp yetersizliði ile seyreden ve prognozu kötü olan bir hastalýktýr. Tanýsal ve terapötik geliþmelere raðmen etiyoloji hala bilinmemektedir. Çalýþmamýzda idiyopatik DKM tanýsýyla izlenen hastalarýmýzýn yaþam süresini etkileyen faktörleri deðerlendirmek istedik.
Yöntemler: Ekim 2005–Ekim 2017 tarihleri arasýnda idiyopatik DKM tanýsý konulan 79 hasta geriye dönük olarak deðerlendirildi. Hastalarýn demografik özellikleri, klinik bilgileri, sol ventrikül fonksiyonlarý, tedavi ve izlemleri hastane kayýtlarýndan incelendi. Prognoza etki edebilecek faktörlerden; semptomlarýn baþlama yaþý, cinsiyet, anne-baba akrabalýðý, telekardiyogramda kardiyomegali varlýðý, ekokardiyografide azalmýþ ejeksiyon fraksiyonu (EF), kýsalma fraksiyonu (KF), mitral yetersizlik derecesi ve intrakardiyak tromboz geliþimi deðerlendirildi.
Bulgular: Hastalarýn yaþlarý 20±60 ay, erkek/kýz oraný ise 1.02/1 idi. Hastalarýn en sýk kalp yetersizliði semptom ve bulgularý (n=59, %74.7) ile baþvurduðu görüldü. En sýk görülen fizik muayene bulgusu üfürüm (n=53, %67.1) ve taþikardi (n=48, %60.8) idi. Olgularýn %73.4’ünde telekardiyografide kardiyomegali vardý. Ekokardiyografi deðerlendirmesinde EF ve KF deðerleri sýrasýyla %35.7±1.3 ve %17.3±6.5 iken 42 (%53.2) hastada 2. derece ve üzerinde mitral yetersizlik olduðu görüldü. Ýzlem süresi 20±38.1 (1–156) ay idi. Dört olguda (%5.1) intrakardiyak tromboz saptandý. Mortalite oraný %36.7 olarak bulundu. Sað kalým sürelerine göre prognostik faktörlere bakýldýðýnda; anne baba arasýnda akrabalýk olmasý, EF ve telekardiyografide kardiyomegali olmasýnýn saðkalým süresini anlamlý derecede kýsalttýðý görüldü.
Sonuç: Anne baba arasýnda akrabalýk olmasý, taný anýnda telekardiyografide kardiyomegali olmasý ve EF deðerlerinin düþük olmasý DKM hastalarýnda saðkalým sürelerini etkileyen en önemli belirteçlerdir.

Objective: Dilated cardiomyopathy (DCM) is a disorder featuring left ventricular dysfunction, heart failure, and a poor prognosis. The etiology is still unclear, despite diagnostic and therapeutic developments. This study was an evaluation of factors affecting the life span of a group of idiopathic DCM patients.
Methods: A total of 79 patients from between October 2005 and October 2017 with a diagnosis of idiopathic DCM were evaluated retrospectively. Demographic characteristics, clinical information, left ventricular function, treatment, and follow-up of the patients were reviewed based on hospital records. Age, gender, parental consanguinity, cardiomegaly on telecardiography, reduced ejection fraction (EF) and shortening fraction (SF), degree of mitral regurgitation, and intracardiac thrombosis were determined to affect prognosis.
Results: The patients were aged 20±60 months, and the male/female ratio was 1.02/1. The patients most frequently presented with heart failure signs and symptoms (n=59, 74.7%). The most common physical examination findings were a murmur (n=53, 67.1%) and tachycardia (n=48, 60.8%). Cardiomegaly was observed on telecardiography in 73.4% of the patients. The EF and SF values were 35.7±12.6% and 17.3±6.5%, respectively. In all, 42 (53.2%) patients had mitral regurgitation of grade 2 or higher. The duration of follow-up was between 1 and 156 months (20±34.9 months). Intracardiac thrombosis was detected in 4 (5.1%) patients. The mortality rate was 36.7%. When the prognostic factors were compared according to survival time, it was determined that survival was reduced in cases of parental consanguinity, low EF, and cardiomegaly.
Conclusion: The most important negative markers affecting the length of survival of DCM patients were parental consanguinity, cardiomegaly detected on telecardiography, and a reduced EF level.

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Týp uygulamasý içerisinde retrospektif dosya araþtýrmalarý önemli oranda yapýlmaktadýr. Ancak yeni yasal düzenlemeler ýþýðýnda her türlü genetik veriye iliþkin araþtýrma için özel onam gerektiði gibi, prospektif nitelik taþýmayan dosya araþtýrmalarý için de gönüllü/hasta/katýlýmcý onam formu alýnmasý gerekmektedir. Makalede kiþisel saðlýk verilerinin korunmasýna iliþkin temel baþlýklar olan aydýnlatýlmýþ onam, mahremiyetin korunmasý, iyi anonimizasyon uygulamalarý araþtýrma etiði ve týp hukuku açýsýndan ele alýnacaktýr.

Retrospective file research is very common in daily medical practice. Approval is required under current law for the review of personal genetic data, and the informed consent of all research subjects is necessary before conducting non-prospective research. In this article, the protection of personal data will be reviewed within the context of informed consent, the protection of confidentiality, the use of good anonymization techniques, research ethics, and medical law.

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Transkateter aort kapak, dejenere mitral biyoprotez kapak iþlev bozukluðu olan ve tekrar ameliyat riski yüksek olgularda dünyada yüzlerce hastada baþarýlý bir þekilde kullanýlmýþtýr. Transseptal yaklaþým teknik olarak daha zor olsa da transapikal yaklaþýma kýyasla daha az invaziv, muhtemel daha düþük mortaliteye sahip olup hastanýn daha hýzlý toparlanmasý ile iliþkilidir. Burada, dejenere biyoprotez kapaða sahip bir olguda transseptal yaklaþýmla baþarýlý mitral kapak deðiþimini anlatan ülkemizdeki nadir uygulanmýþ olan olguyu bildiriyoruz. Bu yazýda, dejenere biyoprotez mitral kapak varlýðýnda güvenli ve etkin bir þekilde perkütan kapak içi kapak implantasyonundan bahsedilmiþtir.

The implantation of aortic transcatheter heart valves has been successfully performed throughout the world in hundreds of patients with severe dysfunction of a degenerated mitral bioprosthesis or those at high surgical risk for re-operation. The transseptal approach may be more technically challenging, but is a less invasive procedure and may have a lower mortality rate compared with a transapical approach, and also offers a quick patient recovery. This report is a description of a rare case in Turkey: a successful transseptal mitral valve replacement in a case of a failed bioprosthetic valve. This case illustrates the feasibility and safety of percutaneous valve-in-valve implantation to treat a degenerated bioprosthesis.

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Safen venöz greftte (SVG) koroner arter bifurkasyon hastalýðý oldukça nadirdir. Safen venöz greftte hastalýðý, tekrarlayan koroner arter baypas greft cerrahisi (KABG) ile artan morbidite ve mortalite, yüksek prosedürel komplikasyon oranlarý ve stent restenozu veya perkütan koroner giriþimle tekrar revaskülarizasyon gerektiren oklüzyon nedeniyle tedavide zorlu bir lezyon olmaya devam etmektedir. Burada, KABG öyküsü olan ve akut koroner sendrom tanýsý alan bir hastada ters Y SVG bifurkasyon hastalýðýnda simultane ‘kissing stent’ tekniði kullanýlan bir olgu bildirdik.

Coronary artery bifurcation disease of a saphenous vein graft (SVG) is extremely rare. SVG disease remains a challenging lesion to treat because of increased morbidity and mortality with repeated coronary artery bypass graft (CABG) surgery, a high rate of periprocedural complications, and in-stent restenosis or occlusion requiring repeat revascularization with percutaneous coronary intervention. Presently described is use of the simultaneous kissing stent technique to treat inverted Y SVG bifurcation disease in a patient with a prior CABG and new-onset acute coronary syndrome.

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Sekonder hipertansiyon tüm hipertansiyon olgularýnýn %5–10’unu oluþturmaktadýr ve renal arter darlýðý sekonder hipertansiyonun en sýk görülen nedenlerinden biridir. Her ne kadar aterosklerotik damar hastalýðý ve fibromusküler displazi renal arter darlýðýnýn en sýk nedenleri olsa da, vaskülit ve travma gibi diðer nadir etiyolojik nedenler rol oynayabilir. Erken evre renal karsinom tedavisinde parsiyel nefrektomi standart tedavi yaklaþýmýdýr, bu cerrahi giriþim esnasýnda travmatik renal arter darlýðý geliþebilir. Çok nadir görülen istenmeyen yan etki olsa da, literatürde sadece birkaç olgu sunumu mevcuttur. Bu nedenle, bu yazýda parsiyel nefrektomi sonrasý travmatik renal arter darlýðýna ikincil akselere hipertansiyon geliþen bir hastanýn baþarýlý perkütan tedavisi sunulmuþtur.

Secondary hypertension accounts for 5% to 10% of all hypertensive cases, and renal artery stenosis is one of the most common causes of secondary hypertension. Although atherosclerotic vascular disease and fibromuscular dysplasia are the leading causes of renal artery stenosis, there are other, rare etiologies, such as vasculitis and trauma. A partial nephrectomy is the standard of care treatment option for early stage renal carcinoma patients. Traumatic renal artery stenosis can occur during this surgical intervention, though it is a very rare adverse event, and only a few case reports have been reported in the literature. This report is the description of successful percutaneous treatment of accelerated hypertension secondary to traumatic renal artery stenosis after a partial nephrectomy.

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Ýleri derecede romatizmal kalp kapak tutulumu olan hastaya aort ve mitral kapak replasmaný ile birlikte triküspit halka anuloplastisi uygulandý. Hastada geniþlemiþ sað ventrikülün (SaðV) ön yüzeyi boyunca seyreden sað koroner arterden (SaðKA) köken alan çýkýþ anomalili bir sol sirkumfleks koroner arter (SSKA) mevcuttu. Ameliyattan hemen sonra, inferiyor ve lateral miyokart iskemisi belirtileri geliþti. Acilen yapýlan koroner anjiyografi sol sirkumfleks koroner arterin sýkýþtýðýný gösterdi. Aortotomi sýrasýnda aort kökünün açýnmýný optimize etme amacýyla SaðV çýkým yoluna yerleþtirilmiþ ilave bir sütürün koroner arteri sýkýþtýrdýðý belirlendi. Daha önce SSKA oklüzyonu saptanan benzer bir olgu bildirilmemiþtir. Burada bu komplikasyonun baþarýlý bir þekilde tedavisi anlatýlmýþtýr.

A patient with advanced rheumatic heart valve disease underwent aortic and mitral valve replacement with tricuspid ring annuloplasty. There was an anomalous left circumflex coronary artery (LCCA) arising from the right coronary artery (RCA) running along the anterior surface of an enlarged right ventricle (RV). During the immediate postoperative course, signs of inferior and lateral myocardial ischemia developed. An emergent coronary angiography revealed LCCA entrapment. An additional suture placed in the RV outflow tract used to optimize exposition of the aortic root during the aortotomy was determined to be the origin of the coronary entrapment. No similar case of LCCA occlusion has previously been reported. This is a description of successful management of this complication.

Makale Özeti | Tam Metin PDF | Video

Makale Özeti | Tam Metin PDF | Video

Makale Özeti | Tam Metin PDF | Video

Makale Özeti | Tam Metin PDF

Makale Özeti | Tam Metin PDF | Video

Makale Özeti | Tam Metin PDF

Makale Özeti | Tam Metin PDF