Objective: We evaluated the effects of stenting on blood pressure and renal functions in hypertensive patients with proximal/ostial atherosclerotic renal artery stenosis. Methods: Twenty-six hypertensive patients (9 female, 17 male, mean age 59.0±7.4 years) who had renal artery stenosis were included into this study. Their blood pressure, urea and creatinine levels were measured at 24 hours, 3 months and 9 months after procedure. Results: Stents were implanted successfully in all cases. Implanting of stent was done with predilatation in 16 (5 %) cases and without predilatation (direct stenting) in 10 (49%) cases. Mean stent diameter and stent length were 7.11±0.3 mm and 15.0±2.2mm respectively. The antihypertensive drug therapy was stopped in 6 (23%) patients, decreased in 15 patients (58 %) and did not change in 5 (19 %) patients. No significant changes were observed in urea and creatinine levels. However, creatinine levels were lower after procedure in direct stenting patients than in patients in whom predilatation was applied (0.78±0.3 mm; 1.32±0.6, p=0.003). This difference disappeared on the 3rd month of follow-up. One patient died during follow-up period. Control angiography was performed in 23 patients. Angiographic restenosis was found in 1 (4.3%) patient. Major events during follow-up period occurred in 2 (8 %) patients. Conclusion: Stenting in hypertensive patients with renal artery stenosis is reliable and effective procedure. Selection the stenting procedure with or without predilatation depends on the clinical status of patient and the choice of the interventional team.

Objective: This study is planned to display the efficiency of fast track protocol and its difference from the conventional anesthesia in patients older than 65 years. Methods: One hundred patients older than 65 years underwent coronary artery surgery between October 2000-March 2001 in cardiovascular surgery clinic were considered in this study. Fifty patients in whom fast track protocol was applied were included into the study group, group A; fifty patients underwent conventional anesthesia technique were referred to the control group, group B. In both groups demographic characteristics, early hospital mortality, operation time, total drainage, number of transfusions, stay in the intensive care unit and discharge time were recorded. Results: The mean age was 69±3 years in group A and 70.4±3.6 years in group B. Early hospital mortality was 2% in group A, 10% in group B (p>0.05). Intensive care unit stay was 22.01±10.12 hours in group A and 60.18±32.23 hours in group B (p<0.05). Discharge time was on 5.5±1.31 day in group A and on 6.9±2.3 day in group B (p<0.05). There were no statistical differences between the two groups in respect to other parameters. Conclusion: Fast track protocol in patients older than 65 years is a suitable technique by using modern cardiac surgery methods. This protocol is successfully used by selecting the suitable patients and following the patients carefully in the postoperative period

Objective: Diastolic dysfunction of the left ventricle (LV) appears to be the earliest manifestation of myocardial ischemia. Experimental and clinical studies have shown that both early and late improvements of diastolic function occur after percutaneous transluminal coronary angioplasty (PTCA). Because of the limited utility of transmitral flow profile in the evaluation of the LV diastolic function, recently, assessment of myocardial velocities by Doppler tissue imaging is gaining importance. The aim of this study was to determine the utility of pulsed wave tissue Doppler (PWTD) pattern from the mitral and tricuspid annulus motion in the evaluation of early alterations of the LV diastolic function after revascularization with PTCA in patients with coronary artery disease. Methods: Pulsed wave tissue Doppler in combination with conventional pulsed-Doppler indices were used to evaluate LV diastolic function before and 24 hours after PTCA. Examinations were performed on 31 patients with chronic ischemic heart disease underwent elective first PTCA. As conventional Doppler indices, early diastolic mitral velocity (e), and its deceleration time (Edt), isovolumic relaxation time (IVRT), late diastolic mitral velocity (a) were measured. Using 2-dimensional echocardiography four chamber apical window, mitral annulus septal and lateral site and tricuspid annulus lateral site were viewed, and PWTD velocity profile were used to calculate; early diastolic maximum velocity and time, late diastolic maximum velocitya and time, systolic maximum velocity and time, IVRT and isovolumic contraction time (IVCT) from each site. Results: After PTCA only 2 transmitral conventional pulsed-Doppler indices were changed significantly (IVRT; from 139.7± 22.2 msec to 120 ± 15.96 msec, p=0.0001; Edt; from 279±11 msec to 248±36 msec, p=0.005). However, PWTD (mitral annulus lateral site) analyses showed significant improvement in most of the diastolic parameters: e/a ratio - from 0.806±0.26 to 0.89±0.22, p=0.012; s wave - from 11.69±3.1 cm/sec to 13.2±3.6 cm/sec, p=0.03; IVRT - from 130±37 msec to 108±29 msec, p=0,0001; IVCT - from 84.1±19.2 msec to 75.6±12.2 msec, p=0.02. Similar significant changes were also observed in the PWTD diastolic parameters of both the mitral annulus septal and tricuspit annulus sites. Peak systolic velocities that reflect the LV systolic functions, of three annular sites significantly improved early after PTCA, however ejection fraction was not changed as much as tissue Doppler parameters (s maximum velocity before PTCA: 11.7±3.1 cm/sec versus 13.2±3.6 cm/sec after PTCA, p=0.03). Conclusion: Tissue Doppler indices of the mitral annulus reflecting both the diastolic and systolic functions, improve early after successful PTCA in patients with coronary artery disease.

Objective: We evaluated the association of plasma total homocysteine (tHcy), cardiac risk factors and total nitrite in coronary artery disease (CAD) patients, cardiac syndrome X patients and in healthy subjects. Methods: Forty two CAD, 22 cardiac syndrome X patients and 30 healthy subjects, aged 30 to 75 years were included into the study. Blood samples of tHcy, serum total nitrite and cardiac risk factors were studied appropriately. The results were compared between the groups. The independent contributions of tHcy and total nitrite to CAD and cardiac syndrome X and their interactions with cardiac risk factors were evaluated. Results: After adjusting for age, median values of tHcy and total nitrite were evaluated for their skewness. Coronary artery disease patients had higher median plasma tHcy levels than cardiac syndrome X patients (p<0.001) and healthy subjects (p<0.001) and lower serum total nitrite levels than patients in the two other groups (p<0.05), respectively. Using a univariate linear regression analysis tHcy had a moderately significant positive correlation with age (b=0.34, p=0.002) and a weakly significant inverse correlation with female gender (b=-0.24, p=0.032). Using a partial correlation analysis by controlling for age, gender and clinical situations tHcy had a positive but moderately significant correlation with LDL cholesterol (r=0.23, p=0.01) and triglycerides (r=0.27, p=0.016). Total nitrite had a positive but weakly significant correlation with HDL cholesterol (r=0.23, p=0.04) and fibrinogen (r=0.24, p=0.03) and an inverse but moderately significant correlation with LDL cholesterol (r=-0.37,p=0.001). Using a multivariate stepwise regression analysis total nitrite was inversely and significantly associated with tHcy (b=-0.45) in the control group.The contribution of HDL cholesterol to the association was b=-0.45, p=0.044, R2=36.2%, HDL cholesterol with fibrinogen - b=-0.45, p=0.05, R2=36.6% and HDL cholesterol with LDL cholesterol - b=-0.45, p=0.05, R2=36.3%. In a forward stepwise logistic regression analysis the age adjusted odds ratio (OR) for coronary artery disease per standard deviation change in log- transformed tHcy concentration was- 0.82, p=0.013 and in total nitrite concentration was- 1.08, p=0.02. Using the same model neither tHcy nor total nitrite was associated with cardiac syndrome X (p=0.221 and p=0.112), respectively. Conclusion: The low nitrite levels can be a marker of endothelial dysfunction in the presence of hyperhomocysteinemia and other cardiac risk factors. Our results might support endothelial dysfunction in CAD but not in cardiac syndrome X patients.

Objective: To assess the effect of cilazapril treatment on several hemodynamic parameters during handgrip maneuvers in patients with congestive heart failure. Cilazapril, an ACE inhibitor with high affinity, has been shown to be highly effective against a variety of vascular disorders. The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamic parameters before and after cilazapril treatment in patients with congestive heart failure is unknown. Methods: The study population included 30 patients (16 male, 14 female) with mean age of 65±18 years. The effects of handgrip maneuver on hemodynamic parameters were studied by right heart catheterization and Doppler echocardiography. Results: Heart rate (HR) and mean arterial pressures (MAP) increased significantly after handgrip maneuver (from 95±6 beats/min to 101±12 beats/min; from 109±15 mm Hg to 118±19 mm Hg, p<0.05 respectively). Pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic (s) and diastolic (d) pressures (PAP), cardiac index (CI), right ventricular systolic and diastolic pressures (RVPs and RVPd), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) did not change after handgrip maneuvers (p>0.05). On the other hand, PAPs and PAPd, RVPs and RVPd, MAP and HR (p<0.05) decreased significantly during handgrip maneuvers after cilazapril treatment. However PCWP and CI, LVEF, RVEF did not change after treatment (p>0.05). Conclusion: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Cilazapril treatment was associated with significant improvement in hemodynamic parameters during handgrip stress test, the mechanisms of which are increased sympathetic and renin-angiotensin system activation, and altered vascular tonus.

Objective: The aim of this study was to investigate the effects of anti-anginal agents on plasma norepinephrine (NE) levels and the autonomic nerve functions evaluated by advanced noninvasive electrocardiographic (ECG) tests in post-myocardial infarction (PMI) patients. Methods: The subjects were 89 PMI patients who had suffered myocardial infarction (MI) at least 2 months before they participated in this study, and who had been taking anti-anginal agent mono-therapy (typical Japanese doses) for at least 6 months. Subjects were classified into the following 3 groups, based on type of anti-anginal agent: calcium antagonists (n=31, 60 ± 12 years), nitrates (n=29, 56 ± 11 years) and b-blockers (n=29, 63 ± 14 years). Left ventricular late potentials (LP), heart rate variability (HRV), T wave alternans (TWA), QT dispersion (QTd), and plasma NE levels of all subjects were assessed. There were no significant differences in age, gender, MI location or coronary risk factors between the 3 groups. Results: There were no significant differences in the number of subjects who satisfied criteria for LP, TWA, and QTd between the 3 groups. Mean high frequency power of HRV of the calcium antagonist group was significantly (p<0.05) lower than those of the nitrate and b-blocker groups. All 3 groups had similar LF/HF, TWA microvoltage and QTd values, but mean plasma NE level of the calcium antagonist group was significantly (p<0.01) higher than those of the nitrate and b-blocker groups. Conclusions: These results indicate that calcium antagonist therapy in PMI patients lowers parasympathetic tone and elevates plasma NE levels. However, in the present study, these values remained within normal ranges.

Myocardial “noncompaction” (MN) is a rare form of cardiomyopathy due to an arrest in endomyocardial embryogenesis. It is characterized by multiple prominent trabeculations with deep intertrabecular recesses in ventricular walls. The disease usually affects the left ventricle and may cause cardiac failure, arrhythmias, and systemic embolism. We would like to present two rare cases of MN with a poor long-term prognosis. The first case is an unique case in the literature having bioprosthetic valve implantation and associated with a recovery of heart failure after the operation, the second case is another interesting case because of the association of A-V complete block, and multiple structural cardiac abnormalities.

Tissue Doppler imaging is a recently developed technique that allows direct measurement of regional or global systolic and diastolic myocardial motion velocities. Myocardial velocities may be recorded in the pulsed wave tissue Doppler (PWTD) or color tissue Doppler. Pulsed wave tissue Doppler appears to be relatively independent of preload and provides important information in various heart diseases. Technical basis, normal pattern and clinical utility of PWTD were reviewed in this article.

Although several investigations on mitral valve prolapse syndrome (MVPS) have been performed, clinical symptoms of this syndrome are not yet clarified. Atypical chest pain, palpitations, fatigue, dyspnea and anxiety are the most frequent symptoms associated with this syndrome. However, dizziness and syncope may be serious symptoms in MVPS. Dizziness and syncope are related to cardiac arrhythmias and are proposed to distinguish types, frequency of arrhythmias and relation to the symptomes. Orthostathic hypotension and tachycardia rarely occur in MVPS. The physiopathological mechanisms of these symptoms are not known clearly, but multifactorial causes are thought to be responsible including autonomic dysfunction, hyperadrenergic state, abnormalities in regulation of baroreceptors, parasympathetic derangements, decrease of intravascular volume, abnormal renin-aldosterone response to depletion of intravascular volume and abnormal release of atrial natriuretic factor.