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Volume : 25 Issue : 7 Year : 2021
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The Anatolian Journal of Cardiology - Anatol J Cardiol: 25 (7)
Volume: 25  Issue: 7 - July 2021
EDITORIAL
1.Miscellaneous attractive studies
Çetin Erol
doi: 10.5152/AnatolJCardiol.2021.7  Page 461
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Comparison of non-vitamin K antagonist oral anticoagulants and well-controlled warfarin in octogenarians with non-valvular atrial fibrillation: Real-world data from a single tertiary center
Arzu Neslihan Akgün, Emir Karaçağlar, Uğur Abbas Bal, Mehmet Bülent Özin
doi: 10.5152/AnatolJCardiol.2021.25058  Pages 462 - 467
Amaç: Atriyal fibrilasyon (AF) klinik pratiğimizde en sık görülen aritmidir ve prevalansı yaşla beraber artar. Bununla birlikte, ≥80 yaş üzerindeki hastalarda oral antikoagülan (OAK) kullanımı hakkındaki veriler kısıtlıdır. Biz de çalışmamızda non valvüler AF’si olan oktogeneryan hastalarda vitamin K antagonisti olmayan oral antikoagülanların (NOAK) ve varfarinin etkinliğini ve güvenilirliğini değerlendirmeyi amaçladık.
Yöntem: Ocak 2017-Aralık 2019 tarihleri arasında hastanemizdeki ≥ 80 yaş üzerinde ve NVAF tanısı alan 387 hastanın kayıtları retrospektif olarak incelendi. NVAF hastaları 2 gruba (NOAK ve varfarin alanlar) ayrıldı. Bu gruplardaki inme/sistemik emboli ve majör kanama insidansı incelendi.
Bulgular: Toplam 322 hasta çalışmaya dahil edildi. Medyan takip süresi NOAK grubu için 10.9 ay ve varfarin grubu için 12.1 aydı. Primer etkinlik sonlanım noktası inme / sistemik emboli ve primer güvenlik sonlanım noktası ise büyük kanamalardı. 220 hasta NOAK alıyordu ve en çok tercih edilen NOAK'lar sırasıyla apiksaban (% 53.6), rivaroksaban (% 29.5), dabigatran (% 13.2) ve edoksaban (% 3.6) idi. Ortalama 302,7 hasta yılı takibinde, varfarin alan hastalarında inme veya sistemik embolik olay insidansı biraz daha yüksek olsa da aradaki fark istatistiksel olarak anlamlı değildi (p = 0.862). Majör kanama olaylarının insidansı ise iki tedavi grubu arasında benzerdi (p = 0.824).
Sonuç: Çalışmamız, NVAF olan oktogeneryan hastalarda güvenlik ve etkinlik sonlanımlarının iki tedavi grubu arasında (NOAK-Varfarin) benzer olduğunu ortaya koymaktadır.
Objective: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence increases with age. Nevertheless, data about the use of oral anticoagulants (OACs) among patients with ≥80 years remains limited. This study aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in octogenarians with non-valvular AF (NVAF).
Methods: Medical records of 387 patients who were ≥80 years and diagnosed with NVAF in our hospital between January 2017 and December 2019 were evaluated retrospectively. Patients with NVAF were divided into 2 groups (NOACs and warfarin), and the incidence of stroke/systemic embolism and major bleeding were analyzed.
Results: A total of 322 patients were included in the study. The median follow-up duration was 10.9 months for the NOACs group and 12.1 months for the warfarin group. The primary efficacy outcome was stroke/systemic embolism, and the primary safety outcome was major bleeding. A total of 220 patients were taking NOACs, and the most preferred NOACs were apixaban (53.6%), rivaroxaban (29.5%), dabigatran (13.2%), and edoxaban (3.6%) in this order. During a mean follow-up of 302.7 patient-years, the incidence of stroke or systemic embolic events was slightly higher among patients with warfarin but the difference was not statistically significant (p=0.862). The incidence rates of major bleeding events were similar between the treatment groups (p=0.824).
Conclusion: Our study revealed that the safety and efficacy outcomes are similar between the 2 treatment groups in octogenarians with NVAF.

3.Evaluation of acute alterations in electrocardiographic parameters after cryoballoon ablation of atrial fibrillation and possible association with recurrence
Abdulkadir Uslu, Ayhan Küp, Serdar Demir, Kamil Gülşen, Batur Gönenç Kanar, Mehmet Çelik, Gökay Taylan, Alper Kepez, Taylan Akgün
doi: 10.5152/AnatolJCardiol.2021.33726  Pages 468 - 475
Amaç: Mevcut çalışmanın amacı kriyobalon ablasyonunun atriyal ileti ve ventriküler repolarizasyondaki heterojeniteyi yansıttığı ileri sürülen elektrokardiyografik parametreler üzerine akut etkisini araştırmaktır.
Metod: Dışlanma kriteri olmayan ve 01.01.2015 ile 31.12.2018 tarihleri arasında atriyal fibrilasyon (AF) için kriyobalon ablasyon uygulanmış olan toplam 67 hasta (yaş 52.6 ± 13.2, 43 erkek) çalışma popülasyonunu oluşturdu. Ablasyon öncesi ve ablasyon sonrası aynı günde elde edilen elektrokardiyografik kayıtlar P dalga dispersiyonu, QTc dispersiyonu, Tp-Te intervali ve Tp-Te/QT oranı için retrospektif olarak incelendi. Ablasyon öncesi ve sonrası değerler arasındaki farklılığın önemi test edildi. Kriyobalon ablasyon kaynaklı muhtemel değişikliklerin derecesi ile takip süresinde gözlenen AF rekürrensi arasındaki ilişki araştırıldı.
Bulgular: Kriyobalon ablasyonu sonrası P dispersiyonu (30.1 ± 6.8 vs 35.9 ± 9.4 ms, p <0.001), QT dispersiyonu (20.7 ± 7.5
vs 24.0 ± 8.8 ms, p < 0.001), Tp-Te intervali (V5 üzerinde 83.6 ± 8.1 vs 110.2 ± 9.5 ms, p <0.001) ve Tp-Te/QT oranının (V5 üzerinde 0.22 ± 0.03 vs 0.28 ± 0.02, p<0.001) anlamlı derecede arttığı gözlendi. Herhangi bir parametredeki değişim ile AF rekürrensi arasında ilişki yoktu.
Sonuç: Kriyobalon ablasyonunun akut dönemde atriyal ileti ve ventriküler repolarizasyon ile ilişkili elektrokardiyografik parametreler üzerine önemli etkileri vardı. Bu değişikliklerin zamana bağlı değişimlerinin ve klinik gidiş üzerine etkilerinin araştırılması için gelecek prospektif çalışmaların sonuçlarına ihtiyaç vardır.
Objective: This study aimed to evaluate the acute effect of cryoballoon ablation (CB-A) on electrocardiographic parameters that have been suggested to reflect heterogeneity in atrial conduction and ventricular repolarization.
Methods: A total of 67 patients (52.6±13.2 years, 43 men) without any exclusion criteria who had undergone CB-A for atrial fibrillation (AF) between January 01, 2015, and December 31, 2018, constituted our study population. Electrographic recordings obtained before and after the ablation procedure on the same day were retrospectively evaluated for the P-wave dispersion, QTc dispersion, Tp-Te interval, and Tp-Te/QT ratio. The pre- and post-ablation values were tested for significant differences. The association of the possible CB-A-related changes in these parameters with AF recurrence during follow-up was evaluated.
Results: P dispersion (30.1±6.8 vs. 35.9±9.4 ms, p<0.001), QT dispersion (20.7±7.5 vs. 24.0±8.8 ms, p<0.001), Tp-Te duration (on V5 83.6±8.1 vs. 110.2±9.5 ms, p<0.001), and Tp-Te/QT ratio (on V5 0.22±0.03 vs. 0.28±0.02, p<0.001) were observed to increase significantly after CB-A. There was no association between the magnitudes of change in any parameter and AF recurrence.
Conclusion: CB-A had significant effects on electrocardiographic parameters related to atrial conduction and ventricular repolarization in the acute phase after CB-A. Further prospective studies are required to examine the time-related course of these alterations and their impact on clinical outcomes.

4.Severe right ventricular hypertrophy in hypertrophic cardiomyopathy: Serious symptoms, complex surgical procedures, and poor prognosis in Fuwai Hospital
Xueqi Dong, Di Zhang, Yi Qu, Xu Meng, Lin Zhao, Xianliang Zhou, Yaxin Liu
doi: 10.5152/AnatolJCardiol.2021.98537  Pages 476 - 483
Objective: Severe right ventricular hypertrophy (SRVH) in hypertrophic cardiomyopathy (HCM) is rare. We studied the clinical characteristics and prognosis of 36 patients with HCM and SRVH in a Chinese cohort.
Methods: Patients with HCM and SRVH were enrolled between 2013 and 2017. The clinical characteristics, treatment therapies, and clinical outcomes of the 36 patients were retrospectively studied and compared with those of 128 patients without SRVH.
Results: Patients in the group with SRVH were younger than those in the group without SRVH (27.58±15.09 years vs 40.34±13.21 years, respectively; p<0.001). Patients with SRVH had more serious clinical symptoms and a higher New York Heart Association functional class than those without SRVH. Most patients in the group with SRVH exhibited diffuse RV hypertrophy, and 13 patients presented with biventricular outflow tract obstruction. Maximal left ventricular (LV) wall thickness (27.29±7.95 mm vs 24.33±5.85 mm, respectively; p=0.027) and LV outflow tract gradient (80.83±24.41 mm Hg vs 42.3±5.7 mm Hg, respectively; p=0.000) were significantly greater in patients with SRVH than in those without SRVH. A total of 30 patients in the group with SRVH underwent surgical correction. During a median follow-up period of 48 months, six patients with SRVH reached primary clinical endpoints (four sudden cardiac deaths, one heart failure–related death, and one heart transplantation), whereas only two deaths occurred in the patients without SRVH.
Conclusion: We conclude that patients with HCM and SRVH exhibit serious symptoms and have complex surgical requirements and poor clinical outcomes.

5.Left atrial expansion index is associated with recurrent stroke
Shih Hung Hsiao
doi: 10.5152/AnatolJCardiol.2021.29866  Pages 484 - 490
Objective: Although left atrial (LA) expansion index is associated with cardiovascular prognosis, whether it affects recurrent strokes is still unknown.
Methods: This study enrolled 176 patients hospitalized with first ischemic stroke. Their stroke subtypes were classified as cardioembolic stroke (CE), noncardioembolic stroke (NCE), embolic stroke of undetermined source (ESUS), or transient ischemic attack. The LA expansion index was calculated as (Volmax−Volmin) × 100%/Volmin, where Volmax was defined as maximal LA volume and Volmin as minimal LA volume. The study endpoint was recurrent ischemic stroke.
Results: Over a five-year (mean 4.9 years) follow-up period, 21 (11.9%) participants reached the study endpoint, including 10 with CE, five with NCE, and six with ESUS. The LA expansion index was lower in the event groups compared with the non-event group. For predicting recurrent stroke, LA expansion index <62.5% (76% sensitivity and 68% specificity) was superior to LA volume and E/e’. Kaplan-Meier curves revealed that the five-year cumulative recurrent stroke rate in patients with LA expansion index <62.5% was 23.9%, which was significantly higher than the five-year cumulative recurrent stroke rate of 4.6% in patients with LA expansion index >62.5% (log rank p<0.001). The LA expansion index was a significant independent predictor of recurrent stroke (hazard ratio=0.873; 95% confidence interval: 0.790–0.973 per 10% increase in LA expansion index; p=0.009).
Conclusion: The LA expansion index is useful for predicting recurrent stroke.

6.Clinical analysis of cardiac autonomic ganglion plexus ablation for bradyarrhythmia: Research protocol for an intervention study
Mingliang Shao, YaoDong Li, Xianhui Zhou, Yanmei Lu, Ling Zhang, Baopeng Tang
doi: 10.5152/AnatolJCardiol.2021.94797  Pages 491 - 495
Objective: This study aimed to explore the safety and effectiveness of selective cardiac autonomic ganglion plexus (GP) ablation on patients with bradyarrhythmia. The heart is controlled by its own intrinsic and central autonomic nerves. Increased cardiac vagal tone leads to sinus node dysfunction and atrioventricular conduction disorders, resulting in bradyarrhythmia. Pacemaker implantation can relieve the symptoms of arrhythmia caused by bradycardia, but it is not easy for patients to accept a pacemaker implantation as a form of treatment. Therefore, more and more attention has been paid to cardiac vagus nerve ablation.
Methods: In this study, 20 patients who met the inclusion criteria of GP ablation in the First Affiliated Hospital of Xinjiang Medical University from November 2019 to June 2020 were enrolled. Biochemical and other related examinations along with electrophysiological examinations were conducted before ablation, and then cardiac GP ablation was performed. The patients were followed up 3 times at 3, 6, and 12 months after the operation.
Results: The minimum HR and mean HR were significantly increased after treatment with cardiac autonomic GP ablation (p<0.01). Moreover, the SDNN (Standard deviation of Normal-to-Normal Intervals) and RMSSD (Root mean square successive differences between successive R-R intervals) was significantly decreased after treatment with cardiac autonomic ganglion plexus ablation for 6 months and 12 months (p<0.01).
Conclusion: Cardiac GP ablation is relatively simple and easy to implement in units that have performed radiofrequency ablation for bradyarrhythmias. This procedure can be performed without any new equipment. Some patients with bradycardia may not have a permanent pacemaker implantation and may go in for additional treatment options.

7.Could arterial stiffness be early reversible target organ damage test in childhood hypertension?
Duygu Övünç Hacıhamdioğlu, Özben Ceylan, Aytül Hande Yardımcı
doi: 10.5152/AnatolJCardiol.2021.67927  Pages 496 - 504
Amaç: Çocuklarda hipertansiyon (HTN) yönetimi yakın zamanda güncellenmiştir. Bu çalışma, Avrupa Hipertansiyon Derneği 2016 Kılavuzuna göre yönetilen primer hipertansiyonlu çocuklarda tedavi sonrası hedef organ hasarı ve arteriyel sertlik parametrelerindeki değişiklikleri sunmaktır.
Yöntem: Çalışmaya dahil edilen primer HTN hastaları yeni tanı almış ve tedavi edilmemiş olup minimum 6 aylık takip süreleri vardı. HTN 24 saatlik ayaktan kan basıncı monitörizasyonu (AKBM) ile doğrulanmıştır. Tüm hastalara takip eden değerlendirmeler yapıldı; vücut kitle indeksi (VKİ), karotis intima media kalınlığı (cIMT), sol ventrikül kitle indeksi (LVMI), plazma kreatinin, üre, elektrolitler, ürik asit, açlık glukoz, kan lipitleri, idrar tetkiki, idrar kültürü, sabah ilk idrardan albumin: kreatinin oranı. AKBM cihazı, santral kan basıncı (cKB) ve nabzı dalga hızı (PWV) gibi ölçümler yapabilmektedir.
Bulgular: Yüz dört hastadan 32’si (17 erkek) çalışmaya alındı. Hastaların 17’si erkekti ve obezite sıklığı %53 idi. Tedavi öncesi ile karşılaştırıldığında kreatinin, üre, sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), sistolik yük, diyastolik yük, santral sistolik kan basıncı (sSKB), sSKB z-skoru, sDKB ve PWV z-skoru azalırken, LVMI z-skoru ve VKİ z skoru değişmedi.
Sonuç: Kan basıncı düzeldikten sonra henüz LVMI gerilememişken arteriyel sertliğin belirteçleri olan sSKB, cSKB z skoru ve PWV z skor değerleri geriledi. Bu, kısa süreli takipte bile kan basıncı kontrolünün kardiyovasküler sistem üzerindeki düzeltici etkisini desteklemektedir. Çocukluk çağında kan basıncı kontrolünün arteriyel sertliğe etkisini için daha fazla prospektif çalışmalara ihtiyaç vardır.
Objective: The recommended treatment for hypertension (HTN) in children has been revised recently. This study aimed to present the changes in target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary HTN who were managed in accordance with the 2016 European Society of Hypertension Guidelines.
Methods: Patients with primary HTN included in this study were newly diagnosed, untreated, and were followed-up for a minimum of 6 months. HTN was confirmed by 24-h ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, and first morning urine albumin tocreatinine ratio. The ABPM device performed measurements such as central blood pressure (cBP) and pulse wave velocity (PWV).
Results: Thirty-two of 104 patients were enrolled. Seventeen patients were male, and 53% were obese. Compared with pretreatment, creatinine, urea, systolic BP (SBP), diastolic BP (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z score, cDBP, and PWV z score decreased, whereas LVMI and BMI z scores were unchanged.
Conclusion: After BP improvement, while LVMI did not regress, the cSBP, cSBP z, and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of BP control on the cardiovascular system even in a short-term follow-up. Further longitudinal studies are needed for the assessment of BP control on arterial stiffness in childhood.

8.Evaluation of percutaneous annuloplasty for treatment of functional mitral regurgitation: A retrospective study
Suat Görmel, Salim Yaşar, Serkan Asil, Erkan Yıldırım, Serdar Fırtına, Hatice Taşkan, Mustafa Köklü, Yalçın Gökoğlan, Barış Buğan, Ayse Saatçi Yaşar, Hasan Kutsi Kabul, Murat Çelik, Uygar Çağdaş Yüksel, Cem Barçın
doi: 10.5152/AnatolJCardiol.2021.54599  Pages 505 - 511
Amaç: Düşük ejeksiyon fraksiyonlu kalp yetmezliği ve fonksiyonel mitral yetersizliği (FMY) olan hastaların tedavisi tartışmalıdır ancak perkütan transkateter prosedürler umut vericidir. Bu retrospektif analizde, Carillon Mitral Contour Sistemi'nin “inoperabl” ciddi FMY hastalarında etkinliğini değerlendirmeyi amaçladık.
Yöntemler: Carillon cihaz implantasyonu yapılan konjestif kalp yetmezliği (KKY), ciddi FMY ve düşük ejeksiyon fraksiyonu (<% 35) olan toplam 73 hasta (ortalama yaş 66.89, dağılım 31-90) incelendi. Çalışma grubu, cihazları başarılı bir şekilde implante edilmiş hastalardan, kontrol grubu ise cihazın yerleştirilemediği hastalardan oluşturuldu. Primer sonlanım noktası, tüm nedenlere bağlı ölüm ve/veya kalp yetmezliği için ilk hastaneye yatıştan (hangisi önce gelirse) oluşmaktaydı.
Bulgular: Medyan (Q1, Q3) takip süresi 31 (11-49) aydı. Cihaz 50 hastada (implant grubu) başarıyla implante edildi ve 23 hastada (implant olmayan grup) implante edilemedi. “İmplant” grubunda hem primer sonlanım noktası hem de tüm nedenlere bağlı ölüm oranları daha düşüktü ancak farklar anlamlı değildi. Birincil sonlanım noktasın medyanı, “implant” grubu ve “implant olmayan” grup için sırasıyla 21 (% 95 CI, 8.8-33.2) ay ve 6 (% 95 CI, 0.1-11.9) aydı (p = 0.078). Nüfusun aşırı kırılgan yapısına rağmen, prosedürle ilgili komplikasyon nedeniyle sadece bir hasta vefat etti.
Sonuç: Carillon Mitral Contour Sistem implantasyonu güvenli bir işlemdir ve ciddi FMY ve düşük ejeksiyon fraksiyonu olan inoperabl hastalarda tüm nedenlere bağlı mortaliteyi ve birlerşik son nokta olarak mortaliteyi ve hastaneye yatışları azaltma eğilimindedir, ancak fark anlamlılık düzeyini karşılamamaktadır. Bu çalışma küçük ve retrospektiftir ve randomize, tercihen sham kontrollü çalışmalara ihtiyaç vardır.
Objective: The management of severe functional mitral regurgitation (FMR) in patients with heart failure (HF) and low ejection fraction is controversial, but percutaneous transcatheter procedures are promising. In this retrospective analysis, we aimed to assess the efficacy of the Carillon Mitral Contour System in patients with “inoperable” severe FMR.
Methods: Seventy three patients (mean age 66.89, range 31–90 years) with congestive heart failure (CHF), severe FMR, and reduced ejection fraction (<35%) who underwent Carillon device implantation were examined. The study group consisted of patients with successfully implanted devices whereas the control group comprised patients in whom the device could not be deployed. The primary endpoint was combined all-cause mortality and first hospitalization for HF (whichever came first).
Results: The median (Q1, Q3) follow-up was 31 (11–49) months. The device was deployed successfully in 50 patients (implant group) and not in 23 patients (non-implant group). Both the primary endpoint and all-cause mortality were lower in the “implant” group, but the differences were not significant. The median to primary endpoint was 21 [95% confidence interval (CI) 8.8–33.2] and six (95% CI 0.1–11.9) months for the implant group and the non-implant group, respectively (p=0.078).
Conclusion: Carillon Mitral Contour System implantation is a safe procedure and results in the reduction of all-cause mortality and combined endpoint of mortality and hospitalizations for HF in inoperable patients with severe FMR and low ejection fraction, although the difference did not meet the significance level.

CASE REPORT
9.Giant pulmonary artery aneurysm caused by sibutramine-associated pulmonary arterial hypertension: First case in the literature
Barkın Kültürsay, Berhan Keskin, Ali Karagöz, Özgür Yaşar Akbal, Cihangir Kaymaz
doi: 10.5152/AnatolJCardiol.2021.64166  Pages 512 - 514
Abstract | Full Text PDF | Video

10.Unexpected cause of involuntary muscle movements: Reel syndrome
Görkem Kuş, Göksel Cağırcı, Çağın Mustafa Üreyen, Nermin Bayar, Şakir Arslan
doi: 10.5152/AnatolJCardiol.2021.38445  Pages 515 - 516
Abstract | Full Text PDF | Video

11.Transcatheter aortic valve implantation via the left axillary artery route in a patient with a permanent pacemaker: The first transaxillary artery route experience with a Meril’s MyvalTM transaortic valve in Turkey
Telat Keleş, Özlem Özcan Çelebi, Emrah Uğuz, Kevser Balcı, Engin Bozkurt
doi: 10.5152/AnatolJCardiol.2021.54857  Pages 517 - 519
Abstract | Full Text PDF

12.Is the increase in eltrombopag dose cause of myocardial infarction?
Edip Can Özgünoğlu, Nermin Bayar, Şakir Arslan, Muhammed Rıdvan Ersoysal, Rauf Avcı
doi: 10.5152/AnatolJCardiol.2021.45605  Pages 520 - 521
Abstract | Full Text PDF | Video

13.Acute myocarditis after the second dose of SARS-CoV-2 vaccine: Serendipity or atypical causal relationship?
Alberto Cereda, Cristina Conca, Lucia Barbieri, Giulia Ferrante, Gabriele Tumminello, Stefano Lucreziotti, Marco Guazzi, Antonio Mafrici
doi: 10.5152/AnatolJCardiol.2021.99  Pages 522 - 523
Abstract | Full Text PDF

LETTER TO THE EDITOR
14.Left atrial compression by extracardiac structures: A comprehensive multimodality approach
Riccardo Scagliola, Gian Marco Rosa, Italo Porto
doi: 10.5152/AnatolJCardiol.2021.162  Page 524
Abstract | Full Text PDF

15.Cerebrovascular ischemic event - what about the coronaries
Joseph C. Lee, Alaa Alghamry
doi: 10.5152/AnatolJCardiol.2021.245  Pages 525 - 526
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
16.Progressive pulmonary stenosis due to huge mediastinal thymoma
Murat Çap, Emrah Erdoğan, Abdurrahman Akyüz, Neşe Kanbal Çap, Erkan Erdur
doi: 10.5152/AnatolJCardiol.2021.11069  Pages E28 - E29
Abstract | Full Text PDF

17.Rare ruptured pulmonary arteriovenous malformation mimicking lung tumor in a girl
Suxuan Liu, Xudong Xu, Yongwen Qin, Xianxian Zhao
doi: 10.5152/AnatolJCardiol.2021.74790  Page E30
Abstract | Full Text PDF | Video