Objective: We report our clinical experience with the Amplatzer device in transcatheter closure of 80 atrial septal defects (ASD) in children. Methods: Among 99 patients (mean age: 7.2±3.8 years) with ASD selected by transthoracic echocardiography, procedures were performed in 80 patients under general anesthesia with fluoroscopic and transesophageal echocardiographic (TEE) guidance. Optimal device size was selected after stretched balloon sizing of the ASD’s. The patients were discharged at 24 hours after an evaluation with X-ray, electrocardiography and echocardiography. Results: The mean follow-up period (FUP) was 38±14 months. Mean ASD size was 11.5± 3.7 mm at TEE (stretched size: 17.6±3.9 mm). The mean size of the device was 18.6±4.0 mm. Procedure and fluoroscopy time were 52.1±17.8 minutes and 11±4.9 minutes respectively. Immediately after the procedure 35 patients (43.8%) had residual shunts. Trivial shunt remained in only 2 of them (2.5%) after FUP. None of the patients had major complications. Minor and transient rhythm abnormalities were observed in 5 patients and trivial mitral regurgitation was seen in 6 patients. Conclusion: Amplatzer is an effective and safe device for transcatheter closure of ASD especially in pediatric patients.

Objective: The purpose of this study was to determine the feasibility and significance of the proximal isovelocity surface area (PISA) method in children with rheumatic mitral regurgitation (MR). Methods: Thirty-one children (mean age 12.3±3.1 years), with chronic MR, were evaluated by semiquantitative and quantitative Doppler, quantitative two-dimensional echocardiography and the PISA methods. Also, we compared the effective regurgitant orifice area, regurgitation volume and systolic left ventricular functions in mild-moderate and severe MR. Results: There were no statistically significant differences in the regurgitant orifice area and regurgitant volume values obtained by the PISA method and the quantitative Doppler (p>0.05) but they were different from the same values obtained by two dimensional echocardiography (p<0.05). There were excellent correlations between the regurgitant orifice area, regurgitant volume and the radius of the proximal flow convergence hemisphere (r=0.882, r=0.925, r=0.880; p<0.05). We found a very good correlation between the regurgitant orifice area obtained by the PISA and left ventricular end-diastolic diameters, the ratio of the jet/left atrial area, grading with color Doppler imaging (r=0.763, r=0.745, r=0.618; p<0.05). Conclusion: It is concluded that MR can be accurately predicted in children by using the PISA method as like as the Doppler method.

Objective: Angiotensin converting enzyme (ACE) is a key enzyme in angiotensin II production which causes myocardial hypertrophy and hyperplasia. In this study we aimed to investigate the relation between ACE I/D gene polymorphism and left ventricular mass (LVM), dimensions and systolic functions calculated by mitral annular motion (MAM) in young healthy male subjects. Methods: Complete echocardiographic examination was performed in 49 male healthy subjects (mean age 22.9±2.1 years) consisting of 18 ACE DD, 18 ACE DI and 13 ACE II genotypes. We calculated LVM and mass index (LVMI) by M-Mode echocardiography. The systolic MAM was recorded at 4 sites (septal, lateral, anterior, and posterior) by M-mode echocardiography and the MAM-ejection fraction (EF) was calculated from above four sites. Ejection fraction was also calculated by Simpson’s method. Results: There was no significant difference among the three genotypes according to age, body mass index, systolic and diastolic blood pressure and heart rate. Interventricular septum (IVS) and left ventricular posterior wall (LVPW) diastolic thickness, LVM and LVMI were found significantly different among 3 ACE genotypes. Those measurements were higher in DD genotype in comparison to the DI and II genotypes. There was no significant difference among the three genotypes according to EF-MAM and EF by Simpson’s method. Conclusion: In young healthy male subjects having ACE DD genotype, even though LVM and LVMI were within normal limits, their measurements were found to be higher than in subjects with ACE DI and II genotypes respectively. There was no difference among the three genotypes according to left ventricular systolic functions.

Objective: In this study, we aimed to investigate effects of metoprolol treatment on transmitral, pulmonary venous flows and spontaneous echo contrast in patients with heart failure. Methods: Twenty-four patients (mean age: 55±8 years) with heart failure were enrolled to the study. All were given metoprolol succinate with titrated target dose of 50 mg/d controlled release tablets for 1 month. Transmitral flow and pulmonary venous flow, systolic, diastolic and atrial reversal flow velocities were measured, and compared with the pretreatment values. Results: Heart rate significantly decreased. No significant change was observed in ejection fraction. When the post treatment values were compared with the pretreatment values, it was detected that isovolumetric relaxation time significantly decreased (p<0.05), mitral E wave and E/A ratio were significantly increased (p<0.05 and p<0.05, respectively) after the treatment. A significant increase was observed in pulmonary vein systolic velocity after metoprolol treatment (p<0.05). Conclusion: Metoprolol treatment can cause an improvement in transmitral and pulmonary venous flows.

Objective: The glycoprotein Ia/IIa complex is a major platelet collagen receptor. Its surface expression is influenced by two linked single nucleotide polymorphisms (C807T and G873A) in the glycoprotein Ia (GPIa) gene. In this study we aimed to determine the frequency of GPIa C807T/G873A genotype in patients with myocardial infarction (MI) and healthy controls in Turkish population and association between these dimorphisms and risk factors of MI.
Methods: We examined GPIa (C807T/G873A) genotypes in 158 patients with MI and 145 healthy controls. Distributions of the C807T and G873A dimorphisms were investigated by genotyping DNA using multiplexed allele-specific PCR.
Results: There was no association between GPIa genotypes and MI. We further analysed each group for all known risk factors such as plasma lipid levels, cigarette smoking, diabetes, hypertension, gender, age, MI history and body mass index. When compared with other two genotypes for glycoprotein Ia (GT/GA and CC/GG), TT/AA showed an association with higher high-density lipoprotein (HDL) -cholesterol levels in the healthy control group, but none in the group with MI.
Conclusion: The 807TT/873AA genotype of the GPIa gene alone or in combination with risk factors had no major effect on MI, however, it appears to be associated with higher HDL-cholesterol levels in healthy subjects. (Anadolu Kardiyol Derg 2005; 5: 182-6)

Objective: Poisoning with carbon monoxide (CO) due to flash gas heater or stove being an important health problem in our region, causes significant pathologies in the body as well as death by decreasing oxygen-carrying capacity of blood. This study was planned to assess whether or not myocardial damage occurs in patients with CO poisoning. Methods: Forty consecutive adult patients with CO poisoning (30 females and 10 males) were included in this study. The mean age of the patients was 28.5±9.9 years (range: 15-56). The demographic characteristics, vital signs, the origin of CO gas, risk factors for coronary artery disease (CAD) and smoking habit of the patients were recorded. The evaluation of Glasgow Coma Scale score, electrocardiogram (ECG), peripheral arterial blood gases, complete blood count, creatine kinase (CK), creatine kinase-myocardial band (CKMB), troponin-T measurements were performed in all cases. Additionally, myocardial perfusion SPECT was performed in three cases with carboxyhemoglobin (COHb) levels over 50%. Results: Sinus tachycardia, was observed in 9 cases. Ventricular bigeminy was seen in a case with troponin-T positive test. Six of 40 cases (15%) had significantly increased CK and CK-MB levels with normal troponin-T measurements. High troponin-T levels (0.13 ng/ml) were detected only in 1 case with COHb level of 61.3%. Myocardial SPECT was performed in 3 cases with COHb levels higher than 50% and no images compatible with defects could be identified. Conclusion: The results suggested that significant myocardial damage and life-threatening cardiac hemodynamic changes do not develop in CO-poisoned patients with COHb level below 60 % and without any known underlying CAD. It is not necessary to routinely measure CK, CK-MB and troponin-T, and perform myocardial perfusion SPECT in acute CO poisoning cases without any ECG abnormality, ischemic cardiac symptoms or known CAD.

Objective: The aim of this study was to determine the prevalence of metabolic syndrome and its components among the young adult ages in İzmir, Turkey. Methods: A population-based cross-sectional study was held including 885 subjects aged between 20 to 39 years from 45 primary health care centres in Konak, which is the biggest urban area in İzmir. A stratified sampling method was used to select the participants of 318 males and 567 females. In the study, metabolic syndrome was classified according to NCEP ATP III criterion on the basis of metabolic risk factors evaluated between December 2001 and April 2002. Results: The crude prevalence of metabolic syndrome (having three or more of the metabolic risk factors) was 3.6% among 20 and 29 years old men and 19.6% among 30 and 39 years old men and the increase by age was significant (p<0.001). The results were similar in women and the crude prevalence of metabolic syndrome increased significantly from 7.5 % in 20 and 29 years old women to 24 % in 30 and 39 years old women (p<0.001). With regard to the highest prevalences of the first three metabolic risk factors, hypertriglyceridemia, low HDL-cholesterol and high blood pressure, the age-adjusted prevalence of the metabolic syndrome was significantly higher in women than in men and all subjects (15% vs 10.2% vs 13.6%, p<0.01) respectively. Conclusion: This study revealed that the prevalence of metabolic syndrome was extremely high between young adults in urban areas and the most prevalent components of the metabolic syndrome were found to be high triglycerides, low HDL cholesterol, high blood pressure, abdominal obesity and high fasting glucose, respectively

The surgical repair of congenital heart disease often involves significant modifications to the circulatory tree. Resections, reconstructions, graft insertions and the deployment of implants and biomedical devices have an impact on local and systemic haemodynamics, which may be difficult to foresee or to assess quantitatively by clinical investigation alone. Mathematical models can be employed to visualise, estimate or predict events and physical quantities that are difficult to observe or measure, and can be successfully applied to the study of the pre- and post-operative physiology of cardiovascular malformations. This paper analyses the potentialities of computation fluid dynamics in this respect, outlining the method, its requirements and its limitations. Examples are given of lumped parameter models, axi-symmetric models, three-dimensional models, fluid-structure interaction simulations and multiscale computing applied to total cavo-pulmonary connection, aortic coarctation and aortic arch reconstruction

Minimally invasive endoscopic procedures in cardiac surgery have only become possible since the introduction of telemanipulator systems. In this study we review robotic assisted telemanipulation systems and procedures on beating and arrested heart for total endoscopic revascularization. Robotic surgery is still under development. The most important factors limiting this new technique are high costs and the fact that only selected patients are able to be operated on. But studies on technology especially to improve anastomotic techniques are going on to produce an alternative for coronary revascularisation. We didn’t yet hit all goals but the future seems promising..

Vascular smooth muscle cells accumulate excessively in the formation of neointima and have a key role in the pathogenesis of vasculoproliferative disorders such as atherosclerosis, allograft vasculopathy, bypass graft occlusion, in-stent restenosis and restenosis after percutaneous balloon angioplasty. To date there is no clinically established treatment to prevent the accumulation of smooth muscle cells in the neointima. However, much attention has been devoted to experimentally targeting the inhibition of migration and proliferation of medial smooth muscle cells. The recent identification of circulating bone marrow-derived smooth muscle progenitor has challenged the classical concept of infiltration of solely medial smooth muscle cells in the neointima. In addition, other potential sources such as circulating smooth muscle cell precursors that may not be of direct bone marrow origin, adventitial stem cells or smooth muscle cell progenitors that are released from other organs into the circulation have been demonstrated to have the potential to differentiate into smooth muscle cells. These discoveries have motivated us to reconsider how neointima forms in pathological conditions in the adult human. This update discusses recent insights on smooth muscle progenitors both from a biological and therapeutic perspective.