Objective: The state of pulmonary vascular bed in congenital heart disease is the predictor of the patients’ clinical condition, prognosis and outcome of surgical intervention.This study aims to investigate the condition of pulmonary vascular bed analysing pulmonary artery stiffness by means of Doppler echocardiography. Method: Thirty-three patients (16 females, mean age 26±15 years) with various congenital heart diseases such as atrial septal defect (20 patients), ventricular septal defect (10 patients), patent ductus arteriosus (2 patients), atrioventricular septal defect ( 1 patient) were enrolled in this study. Systemic flow (Qs), pulmonary flow (Qp), systemic vascular resistance, pulmonary vascular resistance were calculated according to Fick method by using data obtained during left and right heart catheterization. Echocardiographically, pulmonary artery stiffness (PAS) was calculated by using maximal frequency shift (MFS) and accelleration time (AcT) of the pulmonary artery flow trace. PAS (kHz/sec)= MFS/AcT. Results: Invasively, the average Qp/Qs ratio, mean pulmonary artery pressure, and pulmonary vascular resistance were found as 2.58 ± 1.25, 25±20 mmHg, and 135±217 dyn.sec.cm-5, respectively. Echocardiographically, PAS was found to be 33±17 kHz/sec. Pulmonary artery stiffness was correlated with mean pulmonary artery pressure (r=0.63; p<0.001) and pulmonary vascular resistance (r=0.55, p<0.001), while no relation was found with Qp/Qs. Conclusion: Estimation of pulmonary artery stiffness by using pulmonary flow maximal frequency shift and acceleration time obtained by means of Doppler echocardiography may give us an idea about the state of pulmonary vascular bed.

Objective: Contrast media induced nephropathy (CIN) is diagnosed as the acute renal failure developed following intravenous contrast media usage when all other causes of renal failure are excluded. In this study, we investigated the effects of captopril given before coronary angiography (CA) on CIN development. Methods: A total of 80 patients, 43 males and 37 females, mean age: 58 ± 8 years (range: 18-80), with serum creatinine level below 2 mg/dl, who underwent coronary angiography in Cardiology Clinic of Izmir Atatürk Training and Research Hospital between October 2000- February 2002, were included into the study. Captopril was administered in 48 patients 8 hours and an hour before CA (Captopril group). Remaining 32 patients had no captopril treatment (Control group). There were no significant differences between the groups by means of clinical and biochemical parameters. The levels of serum creatinine and serum urea and creatinine clearance in 24 hours urine were measured before CA application and 48 hours after the procedure. Results: Five patients (8.3%) in the Captopril group and 1 patient (3%) in Control group developed CIN and this difference was statistically significant (p=0.02). Conclusion: Captopril is a risk factor for development of contrast media induced nephropathy.

Original Article Clinical and Angiographic Predictors of Creatine Kinase Enzyme Elevation After Successful Coronary Stent Implantation: Effects on Subsequent Target Vessel Revascularization Erhan Babalık 1, Kadriye Orta 1, Tevfik Gürmen 1, Murat Gülbaran 1, Servet Öztürk 1, Barış Ökçün 1 1 İstanbul Üniversitesi Kardiyoloji Enstitüsü, Kardiyoloji Anabilim Dalı, İstanbul Anatol J Cardiol 2003; 3: 107-112 This article was viewed 121 times, downloaded 0 times Key Words: Stent, koroner, kreatin kinaz, revaskülarizasyon Full Text (PDF) Related Articles Send a comment Share Abstract Objective: The aims of the present study are to evaluate clinical, angiographic, and procedural determinants of creatine kinase (CK) elevation following successful coronary stent implantation, and to assess the relationship between postprocedural CK release and subsequent target vessel revascularization. Methods: Study population was composed of 400 consecutive patients who underwent successful coronary stent implantation. Forty-six patients (11.5%) had CK enzyme levels >2 times the upper limit of normal. This group was compared to 100 patients with no CK release after stenting. Results: Baseline, angiographic and procedural characteristics did not differ between patients with and without postprocedural CK elevation. The significant predictors of CK elevation by multiple logistic regression analysis are unstable angina (p<0.001, OR=5.62 with 95% CI of 2.35-13.45), multiple stenting (p=0.04, OR=2.55 with 95% CI of1.02-6.40) and side branch occlusion (p=0.03,OR=12.20 with 95% CI of 1.22-121.71). By multivariate analysis, postprocedural CK release was found to be a significant determinant of subsequent target vessel revascularization (p=0.032,OR=3.84 with 95% CI of 1.12-13.18). Conclusion: Our results indicate that side branch occlusion, implantation of > 1 stents per lesion and coronary stenting in unstable angina pectoris are strong predictors of postprocedural CK release. There is a significant relationship between postprocedural CK elevation and subsequent target vessel revascularization.

Objective: Endovascular treatment of aortic aneurysms is getting popular in our country due to its less invasive nature and shortened hospital stay. The initial experience with endovascular stent-graft implantation procedures to treat abdominal aortic aneurysms and their results were evaluated retrospectively in this study. Methods: Eight patients with abdominal aortic aneurysms were treated with endovascular stent grafts. Seven patients were male and 1 was female with the mean age of 63.13±9.23 (48-72) years. Six patients were considered not proper for conventional surgical treatment. Results: The procedure was converted to conventional surgery in one patient due to traumatic rupture of the iliac artery during the intervention. Type I “endoleak” was detected in 1 patient in the first month and was treated successfully by balloon dilatation of the proximal neck. Type II “endoleak” in two patients resolved spontaneously in the postoperative follow-up. No mortality was occurred. The mean intensive care unit stay was 24.57±10.37 (20-48) hours, mean hospital stay was 4.00±1.83 (3-8) days, and mean use of blood and blood products was 456.25±722.81 ml, excluding the patient treated by conventional surgery. The mean follow-up period was 9.36±3.75 (4-15) months. Conclusion: Endovascular treatment of abdominal aortic aneurysms is a good therapeutic alternative with low morbitity even in complicated cases. More studies are needed to enlighten the safety, effectiveness and durability of this therapeutic modality

Objective: The intraaortic balloon pump (IABP) is usually the first choice of mechanical device used for perioperative cardiac failure. The aim of this retrospective study was to determine the effectiveness of intraoperative IABP use in patients who could not be weaned from cardiopulmonary bypass (CPB) and to determine the possible perioperative and early postoperative prognostic factors for mortality. Methods: Between June 1992-December 2001 a total of 69 patients who underwent coronary artery bypass grafting and required IABP support in weaning from CPB due to cardiac pump failure were included into the study. The mean age was 61.9±7.5 years. The effectiveness of IABP and preoperative, operative and postoperative risk factors for mortality were evaluated retrospectively. Results: Following the insertion of IABP, 59 (85.5%) patients could be weaned from CPB whereas 10 patients (14.5%) could not. In the early postoperative period, 13 (22%) patients died due to cardiac pump failure. The average in-hospital mortality rate for patients who were treated with an IABP was found as 33.3% (23 patients). Univariate analysis identified left ventricular enddiastolic pressure, ventricular performance score, urgent operation and perioperative myocardial infarction as the risk factors for early death. The minor and major IABP releated -complications occurred in only 8 patients. Conclusion: Due to the contributory effects, effectiveness and low complication rate, IABP may be used in patients who cannot be weaned from CPB

Objective: The aim of this study was to assess the frequency and the predictive factors for atrial fibrillation (AF) in patients with severe mitral regurgitation (MR). Methods: This study is a retrospective evaluation involving of 199 patients (100 females, 99 males, mean age 53.8±18.5) with severe MR who had been admitted to our clinic between 1997 and 2001. Etiologies of MR were; rheumatic heart disease (n=132), ischemic heart disease (n=44), mitral valve prolapsus (n=14), mitral annular calcification (n=9). Patients who had AF (n=95), sinus rhythm (n=98) or recurrent AF (n=6) were determined according to ECG. Age, gender, smoking, hypertension, diabetes mellitus, electrocardiographic left ventricular hypertrophy (LVH), echocardiographic left atrial (LA) diameter, left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), ejection fraction (EF), right atrial size, pulmonary artery pressure and presence or absence of mitral stenosis were recorded. Results: Atrial fibrillation was observed in 50.8% of the patients. Female gender (60% vs. 40%, p=0.009), LA diameter (5.6+1.0 cm vs. 4.8+0.6 cm, p<0.001) and right atrium size (30.7% vs. 11.2%, p=0.001) were found as the predictive factors of AF in univariate analysis. Multiple logistic regression analysis showed that advanced age (p<0.014), female gender (p=0.02), LA size (p<0.001) and coexistence of MR with mitral stenosis (p<0.013) were independent risk factors for AF in patients with rheumatic MR. None of variables could be predictive for AF in patients with ischemic MR. Atrial fibrillation was found more frequently in patients with rheumatic MR than that of ischemic MR (p<0.001). In rheumatic MR, left atrium cut-off value for AF was found to be 5.5 cm (sensitivity: 52.1%, specificity: 90.7%). Conclusion: Atrial fibrillation is a common arrhythmia in severe MR (50.8 %). Left atrial size is a powerful independent predictor for AF.

Objective: Cardiac echinococcosis is a rare pathology and in about half of cases it is not accompanied by other organs involvement. We report on our experience of surgical treatment of isolated cardiac echinococcosis (ICE). Methods: Among 5 patients with ICE operated in our clinic 1 had pericardial and epicardial involvement, 1 patient had the single cyst in the apicolateral wall of the left ventricle and 3 patients had singular cysts of the interventricular septum. All patients underwent chest X-Ray, transthoracic echocardiography, ultrasound examinations of the internal organs, hemagglutination tests and microbiologic evaluation of operative specimens. Results: Two operations were performed on a beating heart and three - using cardiopulmonary bypass. In cases of intramyocardial localizations the cyst enucleation and closure of residual cavities by plication were performed and in a case of peri- and epicardial involvement the extirpation of cysts and partial pericardiectomy were carried out. All patients postoperatively received therapy with albendazole. No intra- and postoperative complications were observed. Control echocardiography did not reveal any disturbances of myocardial performance. Two years follow-up showed absence of cyst recurrence. Conclusion: The prevailed localization of echinococci cysts in ICE is the myocardium of the LV and IVST, places with the highest myocardial mass and good perfusion. Ideal echinococcectomy is an effective surgical treatment of isolated cardiac echinococciasis

Summary: 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.

Summary: Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive episodes of apnea or hypopnea during sleep. Apnea and hypopnea cause temporary elevations in blood pressure associated with blood oxygen desaturation, arousal, and sympathetic activation and may cause elevated blood pressure during the daytime. Numerous studies have shown that OSAS was associated with an increased cardiovascular morbidity and mortality. In this review, we describe the normal hemodynamic changes that occur during sleep, the acute hemodynamic events associated with OSAS and finally we summarize the evidence for causal connection between sleep apnea and cardiovascular disease.

Summary: With the medical advances and rising expectations among cardiac surgeons and patients, older and sicker patients now undergo ever more complex operations. However, fortunately, postoperative care of cardiac surgical patients also have shown important changes parallel to the surgical improvements. Although, the events within the operating room are accepted as the main determinants for the faith of the patient, some patients, who are very ill upon arrival in the intensive care unit, may have a good long-term prognosis when postoperative care is meticulously provided. Conversely, patients who are doing well as they leave the operating room may be put at significant risk for complications by poor postoperative management. In this paper, we draw an outline of systematical approach of intensive care of cardiac surgical patients and summarize a practical manual for physicians. By applying this approach effectively, it should be expected that, the clinician is able to recognize an impending disaster earlier, initiate the proper treatment timely, and increase patient’s chances of survival.