ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 11 (8)
Volume: 11  Issue: 8 - December 2011
EDITORIAL
1.Management meeting of The Anatolian Journal of Cardiology, improvements, again our losses, new gains
Bilgin Timuralp
PMID: 22137961  doi: 10.5152/akd.2011.215  Pages 659 - 660
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.A survey for the evaluation of the training period of cardiology specialists in Turkey
Bekir Serhat Yıldız, Mustafa Beyazıt Alkan, Hasan Güngör, İlker Gül, Murat Bilgin, Mustafa Akın, Sanem Öztekin, Mehdi Zoghi
PMID: 22037099  doi: 10.5152/akd.2011.185  Pages 661 - 665
Objective: To evaluate postgraduate training period, social life and problems of cardiology residents in Turkey by using a questionnaire form and to compare with the core curriculum of European Society of Cardiology for general cardiology. Methods: Overall, 529 residents of cardiology ages in range of 24-35 years (mean age: 26.5±2.0 years, 81.4% male) participated as volunteers in this cross-sectional survey study. An 86-item questionnaire form was used to evaluate the education process, capacity of knowledge and skill and social effectiveness level of participants. The questionnaire were composed both closed- and open-ended questions. The questionnaire form was filled in with the face-to-face communication method. The data of survey were compared with the core curriculum of European Society of Cardiology for general cardiology training period. All values were expressed as mean±SD or percentage values. Chi-square or Fischer exact test was used to compare categorical variables. A p value was found significant at <0.05 level. Results: The participants were working in various university hospitals (70.3%) and training-research (state) hospitals in 31 different provinces in Turkey (40.8% in Marmara region). They visited 40±10 outpatients and 10±5 hospitalized pts daily in the clinics. The 3-5 residents worked at the clinic on night shifts and mostly (89%) 8 or more night shifts per month were held in their first training years. During first three-years of training 76% of residents have performed echocardiography, 40.8%-transesophageal echocardiography and 10% - intraoperative echocardiography. The 84.3% of them evaluated exercise tests, 76.4%-Holter electrocardiography and 53.3%-tilt-table tests. The rate of residents working in coronary angiography laboratories was 54.3%. The 53.7% of residents performed coronary angiography and 64%-only in the 4th year of their training. The number of coronary angiography performance was under expected when compared with European Society of Cardiology curriculum. The 18.5% of residents were participated as assistant researcher in an international multi-center study and only 10% had an article published in national journals (4.3% published in Science Citation Index). The 30.6% considered the cardiology training period in their centers to be insufficient, whereas 37.4% found it partially sufficient and 31.9% sufficient. Only 32.9% of participants could dedicate time for social activities. Conclusion: According to the referred core curriculum of ESC for general cardiology the training of cardiology residents in non-invasive applications is adequate however coronary angiography applications are slightly insufficient in Turkey. In addition, the number of publications per capita is quiet low.

3.Diagnostic accuracy and clinical utility of echocardiographic indices for detecting left ventricular diastolic dysfunction in patients with coronary artery disease and normal ejection fraction
Necla Özer, Sercan Okutucu, Alper Kepez, Hakan Aksoy, Onur Sinan Deveci, Enver Atalar
PMID: 22037100  doi: 10.5152/akd.2011.186  Pages 666 - 673
Objective: The aim of present study was to assess the clinical utility and diagnostic accuracy of diastolic dysfunction criteria that were recommended in current American Society of Echocardiography and European Association of Echocardiography recommendations for prediction of increased LVEDP (>16 mmHg) in patients with coronary artery disease and normal EF. Methods: Forty-five consecutive patients (mean age=61.5±10.3 years) referred for cardiac catheterization were enrolled in this prospective study. All patients underwent transthoracic echocardiography and tissue Doppler imaging within 24 hours before cardiac catheterization. Patients were divided into 2 groups according to left ventricular end diastolic pressure (LVEDP) (LVEDP>16 mmHg, n=23; LVEDP≤16 mmHg, n=22). Receiver operating characteristics curve analyses were performed and sensitivity, specificity, positive predictive value and negative predictive value were calculated for indices to detect high LVEDP. Results: Among the indices, left atrial volume index (LAVI) ≥34 ml/m2 (sensitivity=60.0% and specificity=90.0%) and ratio of transmitral to septal annular velocities during early filling (septal E/e’ ratio) ≥15 (sensitivity=30.4% and specificity=95.5%) had more reasonable sensitivity and specificity. Receiver operating characteristics curve analysis revealed that best predictors of high LVEDP were septal E/e’ [area under curve (AUC)=0.694, standard error (SE)=0.66, p=0.01] and LAVI (AUC=0.669, SE=0.63, p=0.045]. There were statistically significant correlations between LVEDP and septal E/e’ (r=0.541, p=0.001) and LAVI (r=0.461, p=0.002). A proposed algorithm consisting LAVI ≥34 ml/m2 and septal E/e’ >8 could determine diastolic dysfunction with a 95.6% sensitivity and 54.5% specificity. Conclusion: Septal E/e’ (≥15) and LAVI (≥ 34 ml/m2) were the better predictors of the increased LVEDP than the other echocardiographic parameters. There were statistically significant moderate positive correlations of LVEDP with septal E/ e’ and LAVI. Combination of LAVI and septal E/e’ is useful to detect diastolic dysfunction.

4.Implications of tilt-table induced faint time in patients with reflex syncope
Ümit Hıdır Ulaş, Kevin McNeeley, Di Zhang, Gisela Chelimsky, Thomas Chelimsky
PMID: 22037101  doi: 10.5152/akd.2011.187  Pages 674 - 677
Objective: The aim of this study was to determine whether patients who faint earlier in the course of a tilt table study represent a separate population with a poorer prognosis or different pathophysiology. We analyzed differences across patients with different syncopal times on the tilt-table study to answer this question. Methods: This was a retrospective, approved, chart review. From our database of over 6000 patients, we identified 1222 patients with syncope. After excluding patients with orthostatic hypotension, postural tachycardia syndrome and diabetes, we were left with 131 patients with pure reflex syncope. We divided fainters into an early (<20 minutes) and late (>20 minutes) faint times. Along with the tilt table test all patients underwent heart rate response for deep breathing, Valsalva maneuver and quantitative sudomotor axon reflex tests. Results: By 10 minutes in the tilt study, only 18% of subjects had fainted, 65% by 20 minutes, 92% by 30 minutes and 96% by 35 minutes. Age was evenly distributed across all syncopal times. Neither the 14 abnormal cardiac responses to deep breathing nor the 20 abnormal Valsalva maneuvers, nor the 28 abnormal axon reflex responses clustered with an early or late faint time. Conclusion: A 10-minute tilt will miss 82% of syncopal episodes, while a 30- minute tilt increases the yield 10-fold, missing only 8%. Patients with early faint times did not differ from patients with late fainting times with regard to age or autonomic test abnormalities. Timing of syncope during the tilt table test does not associated with more severe dysautonomia. A prospective study is needed to confirm these observations.

5.Relationship of brain natriuretic peptide with metabolic syndrome parameters: an observational study
Sanem Öztekin, Özlem Karakurt Arıtürk, Nuray Yazıhan, İlker Ünal
PMID: 22037102  doi: 10.5152/akd.2011.188  Pages 678 - 684
Objective: Metabolic syndrome (MS) was independently associated with increased risk of incident heart failure and coronary artery disease. In this study, we sought to identify whether there is an association between metabolic syndrome components and left ventricular diastolic functions and brain natriuretic peptide (BNP) levels. Methods: This study is a cross-sectional, observational study. Two hundred consecutive patients with MS were selected to form the study population. Echocardiographic parameters and BNP were determined. Mann-Whitney U test and Kruskal-Wallis test were used to compare BNP levels in categorical variables. Spearman rank correlation analysis was used to investigate the correlation between BNP level and other numerical variables. Linear regression analysis was used to find the variables affecting the BNP level. Results: BNP level was higher in females than males [11.14 (0.12-87) vs 7.49 (0.01-99) pg/dl, p=0.04]. None of the MS parameters affects the BNP level in MS patients. MS criteria number that the patient had was not related to BNP level. Sixty seven percent of patients had left ventricular (LV) diastolic dysfunction. BNP was independent from LV diastolic function. Multiple linear regression analysis demonstrated that having diabetes mellitus increases BNP level by 7.73 unit (β=7.73, 95% CI - 2.321 - 13.149, p=0.006). Conclusion: None of the MS parameters affects the BNP level in MS patients. Diastolic dysfunction existence did not affect the BNP level of MS patients. There is an association between diabetes mellitus and BNP, independent of left ventricle diastolic functions.

6.Relationship between heart-type fatty acid-binding protein levels and coronary artery disease in exercise stress testing: an observational study
Hatem Arı, Yusuf Alihanoğlu, Aysel Kıyıcı, Şükrü Karaarslan, Mehmet A. Vatankulu, Hasan Gök
PMID: 22037103  doi: 10.5152/akd.2011.189  Pages 685 - 691
Objective: Although, there has been great improvement on the diagnosis and early treatment of acute coronary syndromes, especially in terms of myocardial damage biochemical markers, we do not have a specific marker yet, for using the diagnosis of stable coronary artery disease (CAD). This study aimed to evaluate the relationship between CAD and the changes of heart-type fatty acid binding protein (H-FABP) levels before and after exercise stress testing (EST). Methods: A total of 47 patients were enrolled in this observational study. Of 47 patients, 21 had normal coronary anatomy; the remaining 26 patients had coronary lesions over 70% in at least one major coronary artery. All patients performed EST. Along with this, H-FABP levels before EST and at peak exercise, 1st hour, 3rd hour (3h), were measured in all patients. Differences among the measurements were evaluated through the Friedman test and Wilcoxon test, and the Bonferroni correction was applied to determine which measurement caused the difference. Results: Contrary to expectations, the means of the H-FABP values measured at particular intervals for each group tended to decline from the basal level to the 3h level. When the difference between the 3h measurement and the basal level was compared in each group, the decreasing was statistically significant in both groups (p<0.05). A statistically significant decrease at the 3h measurement compared to the basal level in the CAD group was more apparent than in the control group (2.790±2.569ng/ml vs. 0.837±2.070ng/ml, p=0.009). Conclusion: We found that H-FABP levels did not increase during EST and contrary to expectation, were inclined to decrease. We thought that decreasing H-FABP levels likely resulted from exercise-induced proteinuria.

7.Increased neopterin levels and its association with angiographic variables in patients with slow coronary flow: an observational study
Ercan Varol, Mehmet Gülcan, Firdevs Aylak, Mehmet Özaydın, Recep Sütçü, Doğan Erdoğan, Abdullah Doğan
PMID: 22088857  doi: 10.5152/akd.2011.190  Pages 692 - 697
Objective: Although various inflammatory markers have been studied in patients with slow coronary flow (SCF), serum neopterin levels have not been studied previously. We investigated the serum neopterin and high sensitivity C-reactive protein (hs-CRP) levels and the relationship between neopterin and hs-CRP levels and TIMI flow in patients with SCF. Methods: The study group consisted of 51 patients with SCF. An age and gender matched control group was composed of 40 subjects. Coronary flow rates of all patients and control subjects were documented by Thrombolysis in Myocardial Infarction (TIMI) frame count. We measured serum neopterin and hs-CRP levels at the same time in patients with SCF and control subjects in this cross-sectional observational study. Chi-square, Mann-Whitney U and unpaired t tests, Pearson correlation and linear regression analyses were used for statistical analysis. Results: The TIMI frame counts for all coronary arteries and the mean TIMI frame count were significantly higher in the SCF group than controls. Serum neopterin levels were significantly higher among patients with SCF when compared with control group (2.13±1.03 vs. 1.60±0.50 ng/ml; p=0.004). Serum hs-CRP levels were significantly higher among patients with SCF when compared with control group (2.06±1.32 vs. 0.74±0.40 mg/L respectively; p<0.001). There was a significant association of serum neopterin levels (β=0.60, 95% CI: 4.93-9.06, p<0.001) and serum hs-CRP levels (β=0.29, 95%CI: 0.84-4.33, p=0.004) with mean TIMI frame count independent of potential confounders such as age, gender, body mass index, smoking, glucose and cholesterol levels. Conclusion: We have shown that serum neopterin and hs-CRP levels were significantly elevated in patients with SCF when compared with control subjects. Serum neopterin and hs-CRP levels were correlated with mean TIMI frame count in patients with SCF.

8.Effect of oral contraceptive therapy on homocysteine and C-reactive protein levels in women: an observational study
Vajihe Norouzi, Morteza Seifi, Soudabeh Fallah, Mohsen Korani, Ali Samadikuchaksaraei
PMID: 22137941  doi: 10.5152/akd.2011.191  Pages 698 - 702
Objective: Increased levels of homocysteine and C-reactive protein (CRP) are considered as independent risk factors for atherosclerosis. As the level of these factors is affected by sex hormones, a population-based assessment of their changes following oral contraceptive therapy is needed to avoid the side effects that might arise of these variations. To this aim, the present study was to investigate the effect combined oral contraceptive (OCP) on CRP and homocysteine levels among young healthy women. Methods: We conducted an observational cross-sectional analysis of 90 healthy, non-obese women (mean age 25 years and body-mass index 22 kg/m2). Forty-five healthy women on OCP and 45 healthy controls were studied for CRP and homocysteine levels by enzyme-linked immunosorbent assay (ELISA). Unpaired t test and Chi-square test were used for comparison of variables between oral contraceptive users and non-oral contraceptive users. Results: The results showed that the homocysteine (13.268±3.475 vs. 7.288±2.621 μmol/L) and CRP (5863.0±1349.5 vs. 1138.3±691.12 ng/ml) levels were significantly higher in women receiving OCP in comparison with the control group (p=0.027 and p<0.001, respectively). Conclusion: The alteration in homocysteine and CRP levels could be attributed to the OCP suggesting that use of these pills should be reviewed in women with increased risk of atherosclerosis and other cardiovascular risk factors.

9.Effects of different statins, ezetimibe/simvastatin combination on hsCRP levels in unstable angina pectoris and non-ST elevation myocardial infarction patients: a randomized trial
Esat Namal, Nur Şener, Turgay Ulaş, Zafer Akçalı, Erkan Öztekin, Fatih Borlu
PMID: 22088858  doi: 10.5152/akd.2011.192  Pages 703 - 710
Objective: The aim of our study was to evaluate the effects of two different statins and a statin/ezetimibe combination on high sensitive C-reactive protein (hsCRP) values, which were given at high doses in the early period of acute coronary syndromes. Methods: A total of 150 patients with non-ST elevation myocardial infarction and unstable angina pectoris were enrolled to our prospective, randomized, single-blind study. Patients were divided into three groups by block randomization method. One group received 20mg/day atorvastatin, one group received 10 mg/day rosuvastatin and the other group received 10 mg/day ezetimibe/simvastatin combination therapy, which was initiated within the first 24 hours of admission. Follow-up duration was 2 months. Biochemical investigations and hsCRP levels (by nephelometric method) were performed with 138 patients evaluated at baseline, 10th and 60th days of therapy. Decreases of hsCRP levels were analyzed with one-way MANOVA and repeated measures of ANOVA methods. Post-hoc Tukey HSD test was performed for finding the different group, when the difference was detected between the groups. Results: Tenth day hsCRP levels in ezetimibe/simvastatin group was significantly lower than the other groups (p<0.001). Further, after 60 days of follow-up a significant reduction was seen in hsCRP levels in ezetimib/simvastatin group (in ezetimibe/simvastatin group the mean hsCRP was reduced from 38.4±15.0 mg/L to 2.4±1.3 mg/L, in atorvastatin group the mean hsCRP was reduced from 27.3±11.7 mg/L to 4.1±2.4 mg/L and in rosuvastatin group the mean hsCRP was reduced from 22.0±6.9 mg/L to 3.6±1.7 mg/L (F (1.1, 148.2) = 746.9, p<0.01 and the difference between drugs; F (2.2, 148.2) = 32.1, p<0.01). No side effects related to drugs were seen during follow-up in all three treatment groups. Conclusion: This study showed that ezetimibe/simvastatin 10 mg/day combination treatment was superior to atorvastatin 20 mg/day and rosuvastatin 10 mg/day treatment in reducing the inflammatory markers when high dose statins was started in the early period of unstable angina and non ST elevation myocardial infarction.

10.Novel method to evaluate the conduction velocity and conducting area during isthmus-dependent atrial flutter
Hitoshi Ishida, Kazuo Matsumoto, Masahiro Uenishi, Motoki Hara, Nobuyuki Komiyama, Ritsushi Kato, Shigeyuki Nishimura, Takeshi Tobiume, Yurika Ishizuka, Zekeriya Küçükdurmaz, Alim Erdem, Ebru Gölcük
PMID: 22088859  doi: 10.5152/akd.2011.193  Pages 711 - 716
Objective: The difference of the conduction velocity (CV) around the tricuspid valve annulus between the counter-clockwise (CCW) atrial flutter and the clockwise (CW) atrial flutter has not been well clarified. This study was undertaken to evaluate the CV and the conducting area (CA) per millisecond around the tricuspid valve annulus using the electroanatomical mapping. Methods: The electroanatomical mapping was performed during the tachycardia for 30 consecutive patients (mean age: 61±16 years) with isthmus-dependent atrial flutter (CCW, 25; CW, 5). We measured the CV and the CA of five divided areas of the right atrium, that is, upper septum (US), lower septum (LS), isthmus (I), upper lateral wall (UL) and lower lateral wall (LL) using the novel measurement method in the isochronal map. Statistical differences of these data between the two groups were assessed by the Student’s t-test and one-way analysis of variance methods. Results: In total, the CV of the LS was significantly slower than other areas (m/sec: US, 0.57±0.18; LS, 0.43±0.18; UL, 0.60±0.26; LL, 0.53±0.20; I, 0.50±0.17; p<0.05) and the CA of the US and UL were significantly larger than other areas (mm2/sec: US, 34.5±16.2; LS, 16.2±9.5; UL, 40.0±14.1; LL, 27.0±17.0; I, 16.8±8.5; p<0.0001). There was no significant difference between the CCW and the CW atrial flutters in terms of the CV and the CA of equally divided five areas. Conclusion: In both of the CCW and the CW atrial flutters, the CV of the LS was significantly slower than other areas and the CA of the lower atrium was significantly smaller than the upper atrium.

EDITORIAL COMMENT
11.Typical atrial flutter. What’s new?
Gürbüz Murat
PMID: 22137960  doi: 10.5152/akd.2011.214  Pages 717 - 718
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
12.Comparison of left and right ventricular pulsed and tissue Doppler myocardial performance index values using Z-score in newborns with hypoxic-ischemic encephalopathy
Hayrullah Alp, Sevim Karaaslan, Tamer Baysal, Bülent Oran, Rahmi Örs
PMID: 22088860  doi: 10.5152/akd.2011.194  Pages 719 - 725
Objective: The aim of the study is determination of myocardial performance index (MPI/Tei index) using pulsed (PD) and tissue Doppler (TD) techniques to show cardiac response in newborns with hypoxic-ischemic encephalopathy (HIE) and healthy newborns and eventually evaluation of the differences between these two techniques. Methods: The study is a prospective observational study. Twenty term newborns diagnosed as perinatal asphyxia during postnatal 24 hours due to the defined criteria and fifty healthy term neonates as control group were included the study. Hypoxic group was divided into two groups with Sarnat stages, Sarnat Stage 1 and 2-3. MPIs (Tei indexes) were calculated with PD and TD echocardiographic techniques in all groups after the 24 hours of birth and one year later. The statistical differences between same techniques were calculated with Kruskal-Wallis test and Z score was used to compare the superiority of two techniques. Results: The MPI values calculated by PD (0.41±0.04, 0.51±0.02) and TD (0.59±0.04, 0.51±0.02) during the first day of life in Sarnat Stage 2-3 in both ventricles were significantly higher than the control group (p<0.01, p<0.02, p<0.03). While the Z score, calculated for MPI measured by PD and TD methods, were found similar in both ventricles in Sarnat Stage 1 and control groups, it was significantly different in other groups of Sarnat stages. Conclusion: The degree of cardiac response in neonates with HIE is associated with the severity of hypoxia. MPI values are not different from the controls in newborns received mild hypoxia while they are higher in the patients who were received moderate or severe hypoxia. Any advantage could not be found between two techniques according to the measurement values, but higher variability in the value of MPI, measured by TD method, calculated from moderate and severe hypoxia group was detected.

13.Follow-up of our patients with transposition of the great arteries and arterial switch operation; comparison of simple and complex transposition cases
Osman Akdeniz, Canan Ayabakan, Uygar Yörüker, Kürşad Tokel, Özlem Sarısoy, Rıza Türköz, Can Vuran, Bülent Sarıtaş, Çağrı Günaydın, Emre Özker
PMID: 22088861  doi: 10.5152/akd.2011.195  Pages 726 - 731
Objective: 1. Follow-up data of patients with simple transposition of great arteries (TGA) and TGA with ventricular septal defect (VSD), who had arterial switch operation (ASO) are compared. 2. Factors affecting mortality and morbidity after ASO are described. Methods: Seventy-six patients, who had an ASO between April 2007 and August 2010 were studied retrospectively. The patients with intact ventricular septum (IVS) (n=36) were in Group1, and those with VSD (n=40) in Group 2. The pre and postoperative clinical and echocardiographic variables and intensive care unit (ICU) outcomes were compared among groups using Mann-Whitney U, Pearson correlation and logistic regression tests. Results: The mean age at operation was 44.1 days, weight was 3.6±0.98 kg. Patients were followed for 15.5±11.21 months. The aortic cross-clamp (AoCC) and cardiopulmonary bypass (CPB) times were higher in patients with VSD (p=0.001, p=0.004). Patients in Group 1 had longer inotropic agent infusion (p=0.001). Length of stay in ICU was similar in two groups (p>0.05). There was no correlation between the length of stay in ICU and age, weight, CPB time, AoCC time. Aortic regurgitation was more frequent in Group 2 (p=0.02). During follow-up, 12 patients died (15.7%), and 8 patients had a revision operation (10.5%) (diaphragmatic plication in 4, pulmonary artery reconstruction in 1, recoarctation operation in 3 patients). Mortality was similar in groups (p>0.05). Conclusion: Arterial switch operation provides anatomical correction in TGA. Appropriate timing and good perioperative planning facilitates low morbidity and mortality in patients with VSD as in patients with simple TGA.

REVIEW
14.Diabetic cardiomyopathy
Eser Acar, Dilek Ural, Ulaş Bildirici, Tayfun Şahin, İrem Yılmaz
PMID: 22137942  doi: 10.5152/akd.2011.196  Pages 732 - 737
Diabetic individuals are at significantly greater risk of developing heart failure (HF) independent from other risk factors such as coronary artery disease (CAD) and hypertension. Diabetic cardiomyopathy (DCP) is defined as ventricular dysfunction in the absence of hypertension, coronary artery and valvular heart disease, which increases the risk of HF. Due to better understanding of its pathophysiology and clinical importance, DCP is more frequently recognized in daily practice. The most important mechanisms of DCP are hyperglycemia, insulin resistance/hyperinsulinemia, abnormal fatty acid metabolism, increased apoptosis, cardiac autonomic neuropathy and local renin-angiotensin-aldosterone system (RAAS) overactivation. Echocardiography is the most frequently used diagnostic method for the detection of this pathology. Currently, although there is no specific treatment for DCP, strict glycemic and concomitant risk factor controls seems to be the most important target strategy for prevention of the progression and treatment of DCP. In this article, we aim to provide an extensive review on the pathophysiology, diagnosis, management of DCP.

SCIENTIFIC LETTER
15.Angiography findings after late bidirectional cavopulmonary shunt operation at mid-term follow-up
Bülent Koca, Ayşe Güler Eroğlu, Selman Gökalp, Levent Saltık, Funda Öztunç
PMID: 22137943  doi: 10.5152/akd.2011.197  Pages 738 - 739
Abstract |Full Text PDF

CASE REPORT
16.Successful VT ablation in a patient with ventricular assist device and implantable cardiac defibrillator
Yahya İslamoğlu, M.Kemal Aktaş, Habib Çil, Zuhal Arıtürk, Ebru Tekbaş, Mehmet Ali Elbey
PMID: 22137944  doi: 10.5152/akd.2011.198  Pages 740 - 741
Abstract |Full Text PDF

17.A mobile structure at the entrance of the left atrial appendage in a patient with malignant fibrous histiocytoma
Elif Elmas, Thorsten Kälsch, Martin Borggrefe, Dariush Haghi
PMID: 22137945  doi: 10.5152/akd.2011.199  Pages 741 - 742
Abstract |Full Text PDF

18.Catecholamine-induced cardiomyopathy and paraganglioneuroma in a pediatric patient
Nazmi Narin, Ali Baykan, Sadettin Sezer, Sertaç Hanedan Onan, Kazım Üzüm, Mustafa Küçükaydın
PMID: 22137946  doi: 10.5152/akd.2011.200  Pages 743 - 744
Abstract |Full Text PDF

LETTER TO THE EDITOR
19.Mitral valve surgery; from median sternotomy to closed chest procedures, from replacement to repair techniques/ Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients
Aşkın Ali Korkmaz, Burak Onan
PMID: 22137947  doi: 10.5152/akd.2011.201  Pages 745 - 746
Abstract |Full Text PDF

20.E. coli outbreak and myocarditis: a story in cardiology
Viroj Wiwanitkit
PMID: 22137948  doi: 10.5152/akd.2011.202  Page 746
Abstract |Full Text PDF

21.Electrocardiographic diagnostic dilemma: gradual QRS widening recorded by rhythm Holter monitoring
Okan Erdoğan, Burak Hünük
PMID: 22137949  doi: 10.5152/akd.2011.203  Pages 746 - 747
Abstract |Full Text PDF

22.Acute left main coronary artery occlusion following TAVI and emergency solution
Sinan Dağdelen, Hasan Gök, Cem Alhan
PMID: 22137950  doi: 10.5152/akd.2011.204  Pages 747 - 748
Abstract |Full Text PDF

23.Emergency double-valve repair during acute aortic dissection type A operation
Altuğ Tuncer, Taylan Adademir
PMID: 22137951  doi: 10.5152/akd.2011.205  Pages 748 - 749
Abstract |Full Text PDF

24.Diagnostic importance of aVR derivation in exercise stress testing for interpreting of multivessel and proximal LAD disease
Hatem Arı, Yusuf Alihanoğlu
PMID: 22137952  doi: 10.5152/akd.2011.206  Pages 749 - 750
Abstract

MISCELLANEOUS
25.Abbas Vesim Efendi (date of death-1760)
Esin Kahya
PMID: 22137958  doi: 10.5152/akd.2011.212  Page 751
Abstract |Full Text PDF

26.Türkiye Yüksek İhtisas Hospital has lost the major contributor and foundation-stone
Siber Göksel
doi: 10.5152/akd.2011.213  Page 752
Abstract |Full Text PDF

AUTHOR INDEX
27.AUTHOR INDEX

Pages 753 - 758
Abstract |Full Text PDF

SUBJECT INDEX
28.SUBJECT INDEX

Pages 759 - 769
Abstract |Full Text PDF

REFEREE INDEX
29.REFEREE INDEX

Pages 770 - 772
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
30.“Broken heart” syndrome complicated by acute severe mitral regurgitation
Selami Demirelli, Şakir Arslan, Mustafa Kurtl, Orhan Demir
PMID: 22137953  doi: 10.5152/akd.2011.207  Page E31
Abstract |Full Text PDF

31.Cerebral and coronary artery aneurysms in a patient with Behçet’s disease
Sercan Okutucu, Uğur Nadir Karakulak, Umut Kalyoncu, Kudret Aytemir
PMID: 22137954  doi: 10.5152/akd.2011.208  Page E32
Abstract |Full Text PDF

32.Congenital aortic and pulmonary stenoses demonstrated by multislice computed tomography
Ahmet Güler, Can Yücel Karabay, Soe Moe Aung, Tülay Bayram
doi: 10.5152/akd.2011.210  Pages E33 - E34
Abstract |Full Text PDF

33.Congenital aortic and pulmonary stenoses demonstrated by multislice computed tomography
Ahmet Güler, Can Yücel Karabay, Soe Moe Aung, Tülay Bayram
PMID: 22137956  doi: 10.5152/akd.2011.211  Pages E33 - E34
Abstract |Full Text PDF

34.Congenital giant aneurysm of the right atrium
Mahmoud Zaqout, Daniel De Wolf
PMID: 22137957  Page E34
Abstract |Full Text PDF



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