Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2003
It has been shown that repeated brief coronary occlusions increase myocardial resistance towards ... more It has been shown that repeated brief coronary occlusions increase myocardial resistance towards prolonged episodes of ischemia. This phenomenon, which renders the heart more tolerant to ischemia with subsequent limitation of infarct size, has been termed ischemic preconditioning. Ischemic preconditioning also protects the heart against postinfarction left ventricular dysfunction and ventricular arrhythmias. Ischemia induced activation of adenosine receptors, and opening of ATP-sensitive potassium channels and stress protein synthesis are thought to be the potential mechanisms of this phenomenon. The exploration of the exact mechanisms of ischemic preconditioning might improve the treatment strategies for acute myocardial infarction in the future.
Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult populatio... more Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery–pulmonary artery fistulas detected by coronary angiography. D 2005 Elsevier Ireland Ltd. All rights reserved.
This article presents a patient with an arteriovenous fistula between the brachiocephalic trunk a... more This article presents a patient with an arteriovenous fistula between the brachiocephalic trunk and superior vena cava, a site not otherwise reported in the literature so far. The fistula was presumably the result of an accidental gunshot wound 8 years previously. Following the diagnosis, the fistula was repaired without any complication and the patient's symptoms disappeared.
Introduction: The percutaneous catheterization of various arteries is used in visualization of co... more Introduction: The percutaneous catheterization of various arteries is used in visualization of coronary arteries. Aim: We aimed to determine whether arterial blood samples withdrawn from femoral arteries during standard Judkin's technique in patients evaluated with coronary angiography can also be used to determine some biochemical parameters. Material and methods: In 50 controls (25 males and 25 females) and 73 coronary artery disease (CAD) patients (10 females and 63 males) paraoxonase-1 (PON1) activity, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were measured using colorimetric methods. Lipid peroxidation marker levels (conjugated dienes (CD) and thiobarbituric acid-reactive substances (TBARS)) were measured manually.
To evaluate the clinical significance of body fat distribution in childhood obesity, we investiga... more To evaluate the clinical significance of body fat distribution in childhood obesity, we investigated the associations of subcutaneous and intraabdominal (preperitoneal and visceral) fat, estimated by ultrasonography, with metabolic risk factors. Fifty-one obese (age 11.5+/- 2.6 years) and 33 non-obese (age 12.2+/- 2.7 years) children. Case control study. Ultrasonographic measurements of fat thickness [maximum and minimum preperitoneal fat thicknesses (Pmax, Pmin), maximum and minimum subcutaneous fat thicknesses (Smax, Smin), visceral fat thickness (V), triceps (Tr) and subscapular (Ss) skin fold thicknesses] were documented. Blood pressures, lipid profiles, fasting insulin levels, glucose/insulin ratio and HOMA IR (homeostasis model assessment for insulin resistance) were evaluated in both groups and these parameters were correlated with body fat distribution. In the obese group, fasting insulin level was correlated to Smin, Smax, and Pmin. HOMA, accordingly, was also correlated to...
Background: Acute alcohol consumption can cause atrial fibrillation in patients with, and without... more Background: Acute alcohol consumption can cause atrial fibrillation in patients with, and without, heart disease. Increased atrial electromechanical delay (EMD) has been associated with atrial fibrillation. We evaluated the atrial conduction properties by tissue Doppler imaging (TDI) echocardiography in healthy men following acute alcohol intake. Methods: Thirty healthy male volunteers were included in this study. Baseline ECG, heart rate, blood pressure, and TDI echocardiographic findings were compared to readings taken one hour after drinking six 12-oz cans of beer (76.8 g of ethanol).
Background: Altered cardiovascular autonomic nerve function with impaired sympathovagal balance i... more Background: Altered cardiovascular autonomic nerve function with impaired sympathovagal balance is found in rheumatoid arthritis (RA). Heart Rate Variability (HRV) analysis is an important tool for assessment of autonomic nerve activity. Objective: To assess cardiac autonomic nerve function status in patients with Rheumatoid arthritis (RA) by time domain measures of HRV. Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January to December 2010. Sixty female RA patients, age range 18-50 years were constituted study group enrolled from the Outpatient Rheumatology Wing, Department of Medicine, BSMMU. Age matched thirty apparently healthy females were studied as control. Time domain measures of Heart Rate Variability (HRV) such as Mean RR intervals, Mean HR, SDNN, RMSSD, NN50% and PNN 50% were recorded for 5 minutes by a Polygraph machine to observe cardiac autonomic nerve function activity. Data were analyzed by independent sample t test. Results: Mean R-R interval, SDNN, RMSSD, PNN50%, NN50% were significantly lower (p<0.001) but heart rate was significantly (P<0.001) higher in rheumatoid arthritis patients. Conclusion: Cardiac autonomic nerve function is impaired and characterized by reduced resting parasympathetic activity in female Rheumatoid Arthritis patients.
This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(29... more This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(298)Asp gene polymorphism and hemorheological parameters. Red blood cell (RBC) deformability, aggregation were measured using an ectacytometry, whole blood, plasma viscosities were determined by a viscometer. Restriction fragment length polymorphism was used to detect polymorphism. Plasma nitrite, nitrate concentrations were determined by Griess method. The genotype distribution of the control group was as follows: 50 (67.5%) GG, 21 (28.4%) GT, 3 (4.1%) TT. A 48 (57.8%) of the patients with CAD had GG, 28 (33.7%) GT, 7 (8.5%) of them TT genotype. RBC aggregation index of CAD patients with G allele was higher and t lower compared to controls carrying the same allele. The amplitude of RBC aggregation of healthy subjects with T allele, who are under increased cardiovascular risk was lower compared to control subjects with G allele. The results of this study indicate that, alterations in RBC aggregation seem to be a consequence of CAD, more than being a preexisting cause. Additionally, some compensatory mechanisms by causing decrements in RBC aggregation, may help regulation of circulation in healthy individuals with high cardiovascular risk.
Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias,... more Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias, ventricular tachycardia may be resistant to treatment. A case of cardiac hemochromatosis complicated with ventricular tachycardia that did not respond to intravenous lidocaine, procainamide or propafenone, nor to DC cardioversion, was successtully treated with amiodarone. Amiodarone, a class III antiarrhythmic drug, may be highly effective in similar cases.
Background: Atrial electromechanical delay (EMD) parameters predict the development of atrial fib... more Background: Atrial electromechanical delay (EMD) parameters predict the development of atrial fibrillation. We investigated the effect of telmisartan treatment on atrial EMD parameters in patients with newly diagnosed essential hypertension. Methods: Thirty-six patients with essential hypertension were treated with telmisartan (80 mg/day) for 6 months. Baseline electrocardiographic P-wave measurements and echocardiographic atrial EMD parameters were compared with the 6-month follow-up.
Objective: Decrease of left ventricular ejection fraction after mitral valve replacement is a com... more Objective: Decrease of left ventricular ejection fraction after mitral valve replacement is a common problem in cardiac surgery. The aim of this study was to retrospectively evaluate mitral valve replacement with preservation of both mitral valves according to the early postoperative clinical results and left ventricular performance. Methods: Sixteen patients who underwent mitral valve replacement with bileaflet preservation between October 2009 and January 2010 were analysed. There were ten males and six females and the mean age was 64.1±6.5. The majority of patients were in NYHA functional class III preoperatively. Eleven patients had CABG + MVR, two had CABG + MVR + Tricuspid annuloplasty, one had AVR + MVR + Tricuspid annuloplasty, one had AVR + MVR and one had MVR + Tricuspid annuloplasty. Preoperative mean left ventricular ejection fraction (LVEF) was 45.9±9.7%. Mitral anterior leaflet was transported to the posterior annulus. Posterior leaflet was also preserved. Mean cross-clamping time was108±30 minutes. No perioperative death was recorded. Postoperative transthoracic echocardiography was performed for all patients at the postoperative 3. or 4. day for prosthetic valve function, left ventricular ejection fraction and pericardial effusion. Results: All patients had normal prosthetic valve function and no significant pericardial effusion was observed. Postoperative mean left ventricular ejection fraction was 45±8.6%. Conclusions: Bileaflet preserving mitral valve replacement prevents decrease of left ventricular ejection fraction and improves postoperative survival.
Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult populatio... more Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery-pulmonary artery fistulas detected by coronary angiography.
To obtain further insight into the role of erythrocyte antioxidant systems in the development of ... more To obtain further insight into the role of erythrocyte antioxidant systems in the development of atherosclerosis, intraerythrocyte enzyme activities and selenium levels in erythrocytes were determined in 37 patients with angiographically proved coronary artery stenosis and 15 subjects with normal coronary angiograms as controls. In a preliminary study, the enzymatic activities of glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GR) and selenium-dependent glutathione peroxidase (Se-GPx) were measured in both venous and arterial blood samples obtained from patients before angiography. The data of the preliminary study, which showed that only the Se-GPx decreased in the patients, led us to concentrate on the Se-GPx and Se levels to determine the changes in these variables. Our results showed that there was a decrease in both the activity of Se-GPx and Se levels in erythrocytes parallel to the increase in the severity of coronary artery disease. It was concluded that these parameters might be used as determinants in the assessment of the severity of the disease.
The implantation of heparin-coated stents was reported to be well tolerated, but there are confli... more The implantation of heparin-coated stents was reported to be well tolerated, but there are conflicting results about acute in-hospital complications, (sub)acute thrombosis rates, and long-term follow-up compared to uncoated stents. We compared the angiographic and clinical results after coronary placement of two stent models: the heparin-coated premounted Jostent and the uncoated premounted NIR stent. Of 710 patients revascularized, a total of 426 patients received Jostent (n = 230) or NIR stent (n = 196) implantation. The primary end points were acute or subacute thrombosis, urgent CABG, AMI or death, while the secondary end points were the comparison of the restenosis rates of the stents at the 6 th month and of the functional angina classification of the stent groups at the 1 st , 6 th and 12 th months. There were no significant differences between the Jostent and NIR stent groups regarding angiographic and procedural success. Acute thrombosis rates in the Jostent and NIR stent groups were similar while no subacute thrombosis was observed in either group. The major adverse cardiac event rates of the groups also did not differ. Angiographic restenosis occurred in 17% of the Jostent group and 16% of the NIR stent group (NS). The combined clinical and angiographic restenosis rate was also similar between the Jo and NIR groups (19% and 18%, respectively). Comparison of functional angina classes at the 1 st , 6 th and 12 th months revealed no significant difference between the study groups. In conclusion, when compared with implantation of an uncoated premounted NIR stent, implantation of a heparin-coated premounted Jostent does not provide any more benefit with respect to initial efficacy, sub(acute) thrombosis and 6-month restenosis rates and 12-month clinical outcomes.
Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very rare condition which is usually r... more Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very rare condition which is usually refractory to conventional treatment for cardiac failure but which responds favorably to restoration of normocalcemia. A 55-year-old man and a 46-year-old woman with a history of postoperative hypoparathyroidism presented with symptoms of cardiac failure and hypocalcemia. A presumptive diagnosis of dilated cardiomyopathy was considered by echocardiography and endomyocardial biopsies were consistent with cardiomyopathy. The coronary angiograms were normal and there was no apparent cause for dilated cardiomyopathy in these patients. The history of the patients and partial recovery of cardiac function after restoration of normocalcemia suggest that hypocalcemia was the cause of dilated cardiomyopathy.
A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions... more A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions, cerebral cortical dysgenetic changes, bronchiectasis and chronic sinusitis is presented. She had features of both yellow nail syndrome and Hennekam syndrome. We think that our case might be a new congenital lymphoedema syndrome or an intermediate form between these syndromes.
Background Obstructive sleep apnea (OSA) syndrome has a critical association with cardiovascular ... more Background Obstructive sleep apnea (OSA) syndrome has a critical association with cardiovascular mortality and morbidity. Aortic elastic parameters are important markers for left ventricular (LV) function and are deteriorated in cardiovascular disease. Methods and Results Aortic elastic parameters and LV functions and mass were investigated in 40 patients with OSA (apnea-hypopnea index (AHI) ≥5) (mean age 51.3±9 years, 32 males) and 24 controls (AHI <5) (mean age 51.9±5.2 years, 19 males). All subjects underwent polysomnographic examination and recordings were obtained during sleep. They also underwent a complete echocardiographic examination and systolic and diastolic aortic measurements were noted from M-mode traces of the aortic root. There were no significant differences in the demographic data of the patients with OSA and the controls. Subjects with OSA demonstrated higher values of aortic stiffness (7.1±1.88 vs 6.42±1.56, p=0.0001), but lower distensibility (9.47±1.33 vs 11.8±3.36, p=0.0001) than the controls. LV ejection fraction was significantly lower in patients with OSA when compared with the control group (61.3±5.2% vs 65.9±8.4%, p=0.0001). LV diastolic parameters were also compared and were worse in the subjects with OSA than in the control subjects (mitral E/A: 0.91±0.42 vs 1.35±0.66, p=0.001; Em/Am: 0.86±0.54 vs 1.23±0.59, p=0.021). Respiratory disturbance index had a positive correlation with aortic stiffness (r=0.63, p=0.0001 and negative correlation with distensibility (r=-0.41, p=0.001). Conclusion Aortic elastic parameters are deteriorated in OSA, which has an extremely high association with cardiovascular disease. Increased aortic stiffness might be responsible for the LV systolic and diastolic deterioration in OSA syndrome.
C ongenital coronary artery anomalies are infrequently seen during coronary angiographic study, r... more C ongenital coronary artery anomalies are infrequently seen during coronary angiographic study, reported to occur in 0.64% to 1.3% of patients (1). Most patients with a congenital coronary artery anomaly are asymptomatic; in rare cases, they may present with chest pain and have myocardial ischemia or other life-threatening conditions. We present a patient in whom the right coronary artery (RCA) coursed as the terminal branch of the left circumflex (LCx) artery. This anomaly is a very rare type of single coronary artery anomaly form.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2003
It has been shown that repeated brief coronary occlusions increase myocardial resistance towards ... more It has been shown that repeated brief coronary occlusions increase myocardial resistance towards prolonged episodes of ischemia. This phenomenon, which renders the heart more tolerant to ischemia with subsequent limitation of infarct size, has been termed ischemic preconditioning. Ischemic preconditioning also protects the heart against postinfarction left ventricular dysfunction and ventricular arrhythmias. Ischemia induced activation of adenosine receptors, and opening of ATP-sensitive potassium channels and stress protein synthesis are thought to be the potential mechanisms of this phenomenon. The exploration of the exact mechanisms of ischemic preconditioning might improve the treatment strategies for acute myocardial infarction in the future.
Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult populatio... more Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery–pulmonary artery fistulas detected by coronary angiography. D 2005 Elsevier Ireland Ltd. All rights reserved.
This article presents a patient with an arteriovenous fistula between the brachiocephalic trunk a... more This article presents a patient with an arteriovenous fistula between the brachiocephalic trunk and superior vena cava, a site not otherwise reported in the literature so far. The fistula was presumably the result of an accidental gunshot wound 8 years previously. Following the diagnosis, the fistula was repaired without any complication and the patient&#39;s symptoms disappeared.
Introduction: The percutaneous catheterization of various arteries is used in visualization of co... more Introduction: The percutaneous catheterization of various arteries is used in visualization of coronary arteries. Aim: We aimed to determine whether arterial blood samples withdrawn from femoral arteries during standard Judkin's technique in patients evaluated with coronary angiography can also be used to determine some biochemical parameters. Material and methods: In 50 controls (25 males and 25 females) and 73 coronary artery disease (CAD) patients (10 females and 63 males) paraoxonase-1 (PON1) activity, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were measured using colorimetric methods. Lipid peroxidation marker levels (conjugated dienes (CD) and thiobarbituric acid-reactive substances (TBARS)) were measured manually.
To evaluate the clinical significance of body fat distribution in childhood obesity, we investiga... more To evaluate the clinical significance of body fat distribution in childhood obesity, we investigated the associations of subcutaneous and intraabdominal (preperitoneal and visceral) fat, estimated by ultrasonography, with metabolic risk factors. Fifty-one obese (age 11.5+/- 2.6 years) and 33 non-obese (age 12.2+/- 2.7 years) children. Case control study. Ultrasonographic measurements of fat thickness [maximum and minimum preperitoneal fat thicknesses (Pmax, Pmin), maximum and minimum subcutaneous fat thicknesses (Smax, Smin), visceral fat thickness (V), triceps (Tr) and subscapular (Ss) skin fold thicknesses] were documented. Blood pressures, lipid profiles, fasting insulin levels, glucose/insulin ratio and HOMA IR (homeostasis model assessment for insulin resistance) were evaluated in both groups and these parameters were correlated with body fat distribution. In the obese group, fasting insulin level was correlated to Smin, Smax, and Pmin. HOMA, accordingly, was also correlated to...
Background: Acute alcohol consumption can cause atrial fibrillation in patients with, and without... more Background: Acute alcohol consumption can cause atrial fibrillation in patients with, and without, heart disease. Increased atrial electromechanical delay (EMD) has been associated with atrial fibrillation. We evaluated the atrial conduction properties by tissue Doppler imaging (TDI) echocardiography in healthy men following acute alcohol intake. Methods: Thirty healthy male volunteers were included in this study. Baseline ECG, heart rate, blood pressure, and TDI echocardiographic findings were compared to readings taken one hour after drinking six 12-oz cans of beer (76.8 g of ethanol).
Background: Altered cardiovascular autonomic nerve function with impaired sympathovagal balance i... more Background: Altered cardiovascular autonomic nerve function with impaired sympathovagal balance is found in rheumatoid arthritis (RA). Heart Rate Variability (HRV) analysis is an important tool for assessment of autonomic nerve activity. Objective: To assess cardiac autonomic nerve function status in patients with Rheumatoid arthritis (RA) by time domain measures of HRV. Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January to December 2010. Sixty female RA patients, age range 18-50 years were constituted study group enrolled from the Outpatient Rheumatology Wing, Department of Medicine, BSMMU. Age matched thirty apparently healthy females were studied as control. Time domain measures of Heart Rate Variability (HRV) such as Mean RR intervals, Mean HR, SDNN, RMSSD, NN50% and PNN 50% were recorded for 5 minutes by a Polygraph machine to observe cardiac autonomic nerve function activity. Data were analyzed by independent sample t test. Results: Mean R-R interval, SDNN, RMSSD, PNN50%, NN50% were significantly lower (p<0.001) but heart rate was significantly (P<0.001) higher in rheumatoid arthritis patients. Conclusion: Cardiac autonomic nerve function is impaired and characterized by reduced resting parasympathetic activity in female Rheumatoid Arthritis patients.
This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(29... more This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(298)Asp gene polymorphism and hemorheological parameters. Red blood cell (RBC) deformability, aggregation were measured using an ectacytometry, whole blood, plasma viscosities were determined by a viscometer. Restriction fragment length polymorphism was used to detect polymorphism. Plasma nitrite, nitrate concentrations were determined by Griess method. The genotype distribution of the control group was as follows: 50 (67.5%) GG, 21 (28.4%) GT, 3 (4.1%) TT. A 48 (57.8%) of the patients with CAD had GG, 28 (33.7%) GT, 7 (8.5%) of them TT genotype. RBC aggregation index of CAD patients with G allele was higher and t lower compared to controls carrying the same allele. The amplitude of RBC aggregation of healthy subjects with T allele, who are under increased cardiovascular risk was lower compared to control subjects with G allele. The results of this study indicate that, alterations in RBC aggregation seem to be a consequence of CAD, more than being a preexisting cause. Additionally, some compensatory mechanisms by causing decrements in RBC aggregation, may help regulation of circulation in healthy individuals with high cardiovascular risk.
Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias,... more Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias, ventricular tachycardia may be resistant to treatment. A case of cardiac hemochromatosis complicated with ventricular tachycardia that did not respond to intravenous lidocaine, procainamide or propafenone, nor to DC cardioversion, was successtully treated with amiodarone. Amiodarone, a class III antiarrhythmic drug, may be highly effective in similar cases.
Background: Atrial electromechanical delay (EMD) parameters predict the development of atrial fib... more Background: Atrial electromechanical delay (EMD) parameters predict the development of atrial fibrillation. We investigated the effect of telmisartan treatment on atrial EMD parameters in patients with newly diagnosed essential hypertension. Methods: Thirty-six patients with essential hypertension were treated with telmisartan (80 mg/day) for 6 months. Baseline electrocardiographic P-wave measurements and echocardiographic atrial EMD parameters were compared with the 6-month follow-up.
Objective: Decrease of left ventricular ejection fraction after mitral valve replacement is a com... more Objective: Decrease of left ventricular ejection fraction after mitral valve replacement is a common problem in cardiac surgery. The aim of this study was to retrospectively evaluate mitral valve replacement with preservation of both mitral valves according to the early postoperative clinical results and left ventricular performance. Methods: Sixteen patients who underwent mitral valve replacement with bileaflet preservation between October 2009 and January 2010 were analysed. There were ten males and six females and the mean age was 64.1±6.5. The majority of patients were in NYHA functional class III preoperatively. Eleven patients had CABG + MVR, two had CABG + MVR + Tricuspid annuloplasty, one had AVR + MVR + Tricuspid annuloplasty, one had AVR + MVR and one had MVR + Tricuspid annuloplasty. Preoperative mean left ventricular ejection fraction (LVEF) was 45.9±9.7%. Mitral anterior leaflet was transported to the posterior annulus. Posterior leaflet was also preserved. Mean cross-clamping time was108±30 minutes. No perioperative death was recorded. Postoperative transthoracic echocardiography was performed for all patients at the postoperative 3. or 4. day for prosthetic valve function, left ventricular ejection fraction and pericardial effusion. Results: All patients had normal prosthetic valve function and no significant pericardial effusion was observed. Postoperative mean left ventricular ejection fraction was 45±8.6%. Conclusions: Bileaflet preserving mitral valve replacement prevents decrease of left ventricular ejection fraction and improves postoperative survival.
Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult populatio... more Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery-pulmonary artery fistulas detected by coronary angiography.
To obtain further insight into the role of erythrocyte antioxidant systems in the development of ... more To obtain further insight into the role of erythrocyte antioxidant systems in the development of atherosclerosis, intraerythrocyte enzyme activities and selenium levels in erythrocytes were determined in 37 patients with angiographically proved coronary artery stenosis and 15 subjects with normal coronary angiograms as controls. In a preliminary study, the enzymatic activities of glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GR) and selenium-dependent glutathione peroxidase (Se-GPx) were measured in both venous and arterial blood samples obtained from patients before angiography. The data of the preliminary study, which showed that only the Se-GPx decreased in the patients, led us to concentrate on the Se-GPx and Se levels to determine the changes in these variables. Our results showed that there was a decrease in both the activity of Se-GPx and Se levels in erythrocytes parallel to the increase in the severity of coronary artery disease. It was concluded that these parameters might be used as determinants in the assessment of the severity of the disease.
The implantation of heparin-coated stents was reported to be well tolerated, but there are confli... more The implantation of heparin-coated stents was reported to be well tolerated, but there are conflicting results about acute in-hospital complications, (sub)acute thrombosis rates, and long-term follow-up compared to uncoated stents. We compared the angiographic and clinical results after coronary placement of two stent models: the heparin-coated premounted Jostent and the uncoated premounted NIR stent. Of 710 patients revascularized, a total of 426 patients received Jostent (n = 230) or NIR stent (n = 196) implantation. The primary end points were acute or subacute thrombosis, urgent CABG, AMI or death, while the secondary end points were the comparison of the restenosis rates of the stents at the 6 th month and of the functional angina classification of the stent groups at the 1 st , 6 th and 12 th months. There were no significant differences between the Jostent and NIR stent groups regarding angiographic and procedural success. Acute thrombosis rates in the Jostent and NIR stent groups were similar while no subacute thrombosis was observed in either group. The major adverse cardiac event rates of the groups also did not differ. Angiographic restenosis occurred in 17% of the Jostent group and 16% of the NIR stent group (NS). The combined clinical and angiographic restenosis rate was also similar between the Jo and NIR groups (19% and 18%, respectively). Comparison of functional angina classes at the 1 st , 6 th and 12 th months revealed no significant difference between the study groups. In conclusion, when compared with implantation of an uncoated premounted NIR stent, implantation of a heparin-coated premounted Jostent does not provide any more benefit with respect to initial efficacy, sub(acute) thrombosis and 6-month restenosis rates and 12-month clinical outcomes.
Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very rare condition which is usually r... more Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very rare condition which is usually refractory to conventional treatment for cardiac failure but which responds favorably to restoration of normocalcemia. A 55-year-old man and a 46-year-old woman with a history of postoperative hypoparathyroidism presented with symptoms of cardiac failure and hypocalcemia. A presumptive diagnosis of dilated cardiomyopathy was considered by echocardiography and endomyocardial biopsies were consistent with cardiomyopathy. The coronary angiograms were normal and there was no apparent cause for dilated cardiomyopathy in these patients. The history of the patients and partial recovery of cardiac function after restoration of normocalcemia suggest that hypocalcemia was the cause of dilated cardiomyopathy.
A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions... more A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions, cerebral cortical dysgenetic changes, bronchiectasis and chronic sinusitis is presented. She had features of both yellow nail syndrome and Hennekam syndrome. We think that our case might be a new congenital lymphoedema syndrome or an intermediate form between these syndromes.
Background Obstructive sleep apnea (OSA) syndrome has a critical association with cardiovascular ... more Background Obstructive sleep apnea (OSA) syndrome has a critical association with cardiovascular mortality and morbidity. Aortic elastic parameters are important markers for left ventricular (LV) function and are deteriorated in cardiovascular disease. Methods and Results Aortic elastic parameters and LV functions and mass were investigated in 40 patients with OSA (apnea-hypopnea index (AHI) ≥5) (mean age 51.3±9 years, 32 males) and 24 controls (AHI <5) (mean age 51.9±5.2 years, 19 males). All subjects underwent polysomnographic examination and recordings were obtained during sleep. They also underwent a complete echocardiographic examination and systolic and diastolic aortic measurements were noted from M-mode traces of the aortic root. There were no significant differences in the demographic data of the patients with OSA and the controls. Subjects with OSA demonstrated higher values of aortic stiffness (7.1±1.88 vs 6.42±1.56, p=0.0001), but lower distensibility (9.47±1.33 vs 11.8±3.36, p=0.0001) than the controls. LV ejection fraction was significantly lower in patients with OSA when compared with the control group (61.3±5.2% vs 65.9±8.4%, p=0.0001). LV diastolic parameters were also compared and were worse in the subjects with OSA than in the control subjects (mitral E/A: 0.91±0.42 vs 1.35±0.66, p=0.001; Em/Am: 0.86±0.54 vs 1.23±0.59, p=0.021). Respiratory disturbance index had a positive correlation with aortic stiffness (r=0.63, p=0.0001 and negative correlation with distensibility (r=-0.41, p=0.001). Conclusion Aortic elastic parameters are deteriorated in OSA, which has an extremely high association with cardiovascular disease. Increased aortic stiffness might be responsible for the LV systolic and diastolic deterioration in OSA syndrome.
C ongenital coronary artery anomalies are infrequently seen during coronary angiographic study, r... more C ongenital coronary artery anomalies are infrequently seen during coronary angiographic study, reported to occur in 0.64% to 1.3% of patients (1). Most patients with a congenital coronary artery anomaly are asymptomatic; in rare cases, they may present with chest pain and have myocardial ischemia or other life-threatening conditions. We present a patient in whom the right coronary artery (RCA) coursed as the terminal branch of the left circumflex (LCx) artery. This anomaly is a very rare type of single coronary artery anomaly form.
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