Objective: Complete atrioventricular (AV) block is a rhythm disorder that can result from various causes. The aim of this study was to define etiological factors, clinical features, pacemaker needs, in-hospital mortality rates and factors affecting these parameters in the patients with complete AV block. Methods: For this aim, 191consecutive patients admitted to the hospital with complete AV block or who developed AV block during their hospital course between January 1999-September 2002 were included into the study. Results: The most common underlying cause of AV block was found to be the ischemia, which was followed by unknown etiology and iatrogenic complete AV block. The most common cause of in-hospital mortality was ischemic (especially acute) heart disease. No etiological factor for complete AV block was found in most of symptomatic patients presented with syncope. In patients with ischemic complete AV block, mortality and syncope rates were found to be high, especially in patients with multivessel disease. Permanent pacemaker was implanted in 76 of 191 patients with complete AV block and the significant portion of these patients were those without an etiological cause. Conclusion: Thus, it is revealed that factors affecting mortality in patients with complete AV block are acute myocardial infarction and age while other clinical parameters and pacemaker implantation had no effects on mortality.

Objective: To evaluate patients who were referred to our center with suspicion of fetal arrhythmia for diagnosis, results of treatment and prognosis. Methods: Thirty -three patients referred to our center for evaluation of fetal cardiac arrhythmias were examined by M-mode, two-dimensional and Doppler echocardiography for cardiac anomaly and type of dysrhythmia Results: Arrhythmias were diagnosed in 15 of 33 patients. Four cases demonstrated tachycardia, 5 - ectopic beats, 6 - bradycardia. Of 5 fetuses with tachycardia, transplacental antiarrhythmic drugs were administered in three cases; two of them with hydrops died and conversion of the arrhythmia was achieved in one. Six patients with bradycardia had poor perinatal outcome, with 3 deaths occurred (two of them had third degree atrioventricular block, one of them had sinus bradycardia). All patients with ectopic beats had a good perinatal outcome. Conclusion: The results suggest that bradycardic and/or hydropic fetuses have poor prognosis, however fetuses with ectopic beats generally have desirable prognosis.

Objective: Diagnostic and therapeutic cardiac interventions have being performed in expanding numbers during last years. Forty-two cases with peripheral vascular injuries requiring surgical therapy after 64.911 cardiac interventions in our center between 1985 and 2002 were evaluated retrospectively. Methods: Thirty-three of vascular injuries (78.6%) occurred after angiography/catheterization, and the remaining vascular injuries (21.4%) occurred after angioplasty/stent procedures. There were 12 female (28.6%) and 30 male (71.4%). The mean age was 51.3±4.1 years. The localization of the arterial injuries were femoral region in 37 cases (88.1%) and brachial region in 5 cases (11.9%). The complications were recorded as arterial thrombosis in 19 cases, pseudoaneurysm in 14 cases, hematoma in 5 cases, arteriovenous fistula in 2 cases, deformed stent stuck in 2 cases. Arterial injuries were treated by performing embolectomy in 16 cases, embolectomy and saphenous patch plasty in 3 cases, resection of pseudoaneurysm and PTFE patch plasty in 1 case, draining of hematoma and primary repair in 5 cases, primary repair of femoral arteriovenous fistula in 2 cases and removal of the deformed stent from femoral artery in 2 cases. Results: The incidence of vascular complications was significantly higher in brachial interventions when compaired with femoral interventions (p<0.0001). The postoperative morbidity was found as 14.3% in our cases. Conclusion: The early diagnosis and treatment are very important in peripheral vascular complications after cardiac interventions; otherwise, delay can cause loss of related extremity

Objective: High baseline insulin and glucose levels and presence of accompanying dyslipidemia, which are considered in the pathogenesis of metabolic syndrome X, were also observed in patients with cardiac syndrome X, which is similar to metabolic syndrome X in many aspects. In this study we aimed to compare serum insulin, glucose and lipid levels in patients with coronary slow flow which is hypothesized as a subgroup of cardiac syndrome X with those of healthy subjects and determine the relation of corrected TIMI frame count (cTFC) with these levels. Methods: Forty-six patients with normal epicardial coronary arteries but determined as coronary slow flow in coronary angiography performed because of chest pain and 16 healthy subjects having normal coronary arteries but without coronary slow flow were included in this study. Maximal exercise stress test according to Bruce protocol was performed in all patients. Baseline serum insulin, glucose and lipid levels were measured from venous blood samples of patients in both groups. TIMI ‘frame count’ method was used for diagnosis of coronary slow flow. The relationship between the degree of coronary slow flow and serum insulin, glucose and lipid levels was investigated. Results: Exercise stress test results of both groups were considered as negative regarding ischemia. There were no differences between 2 groups in serum insulin, glucose and lipid levels. (p>0.05). No relationship were determined by correlations analysis between serum insulin, glucose and lipid levels and corrected TIMI frame count. Conclusion: Normal values of insulin, glucose and lipid levels in patients with coronary slow flow and lack of their relation with cTFC support the opinion that coronary slow flow is a separate from the cardiac syndrome X clinical entity.

Objective: A plant powder called “Maraş Powder” has been used widely instead of cigarette in the South-Eastern region of Turkey. It was confirmed that this powder has been made of tobacco N. rustica L. Our aim was to investigate whether the use of Maraş Powder is as harmful as cigarette smoking or not. Methods: Forty-five Maraş Powder users (Group I), 32 persons who smoked cigarette (control-Group II) and 30 healthy persons neither smoking nor using Maraş Powder (Group III) were included into the study. Laboratory investigations, electrocardiography and echocardiography were performed in all participants of the study. For evaluation of the ventricular repolarization parameters, 50 mm/sec ECG recordings were used. Echocardiographic investigation was performed for assessment systolic and diastolic function. Results: No differences were found by means of ventricular repolarization parameters among the three groups (p>0.05). Echocardiographic investigation revealed similar systolic function results in all of the three groups. There was reduced early filling velocity of the left ventricle (p=0.03, p=0.02) and increased filling velocity of the atrial component (p=0.02, p=0.02) in group I and group II. When they were compared to group III, deceleration time was also increased (p<0.01, p<0.01). Isovolumetric relaxation time was higher in group I and group II than that of group III (p=0.02, p=0.03). In group I and group II, total cholesterol (p=0.03, p=0.02), LDL-cholesterol (p<0.01, p<0.01) and triglyceride levels (p<0.01, p<0.01) were found to be higher than those of group III, whereas HDL levels were lower (p=0.02, p<0.01). Conclusion: As a result, we thought that Maraş Powder is as harmful as cigarette smoking and it has similar negative effects on cardiovascular system. In our opinion, “Maraş Powder” is a smokeless tobacco use.

Objective: The purpose of this study was to describe the clinical/pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit and other hospitals of Anatolia over a fifteen-years period. Methods: Between 1984 and 2001, fifty cases of surgically treated cardiac hydatid disease were identified by systematic literature search from Anatolia. Twelve patients were operated at the Department of Cardiovascular Surgery, Ankara University within the same period. Overall thirty-nine patients were female (mean age 29.8 ±14 years). Sixty-three percent of patients were complaining of dyspnea at the time of referral to the hospital and 22% presented with signs of acute coronary syndrome. Results: The most common cardiac location was the left ventricle (46.7%) followed by the interventricular septum, the right ventricle and atria. The most common procedure was controlled puncture and aspiration of the cyst content, its excision and closure of the resulting cavity, which were performed under cardiopulmonary bypass. Overall Anatolian operative mortality was 4.8% (3 patients). No late deaths but recurrence in one patient have occurred. Conclusion: In view of the lack of efficient alternative treatment options, we recommend surgical intervention even in asymptomatic patients in order to prevent the occurrence of lethal complications.

Acute rejection is a major complication after heart transplantation. Prognosis depends on early detection and effective treatment. Currently, the most reliable technique for the detection of acute cardiac rejection is endomyocardial biopsy (EMB). Because of invasive procedure, it is not suitable for daily monitoring. If the pattern of rejection shows a focal distribution, false-negative results can be expected. So far, many studies were performed to evaluate diagnostic value of noninvasive procedures in acute rejection, but none of them was found to be superior to EMB. Value of different noninvasive procedures in the diagnosis of acute rejection after heart transplantation is discussed in this review.

Cardiac transplantation has emerged as the therapeutic procedure of choice for patients with end-stage heart disease but the availability of donor organs remains major limiting factor allowing only 1% of the candidates actually become transplant recipients. New therapeutic strategies are under intensive research for patients who do not meet patient selection criteria for transplantation or who suffer from donor organ shortage. Even though there are significant developments in the medical treatment of cardiac failure, the prognosis of this condition continues to be poor. The 20-40% of the candidates for cardiac transplantation die while they are included in the waiting list. Twenty percent mortality has been reported within the first year of transplantation with additional yearly mortality of 5% following the first year. Financial constraints, complications of immunosuppression and functional failure of the transplanted hearts are other limiting factors. This has brought up the necessity to search for alternative surgical treatment methods besides increasing the waiting periods of transplant candidates. The aim of this report is to summarize other currently available therapeutic alternatives for patients with end-stage cardiac disease.