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Çalýþmamýzda 11 normal, 36 KAH'lý olguda intravenöz (ÝV) Dipiridamol (Dp) sonrasýnda ve handgrip ile izometrik egzersiz (ÝHE) sýrasýnda uygulanan radyonüklid ventrikülografinin (RVg) koroner arter hastalýðý (KAH) tanýsýndaki deðeri araþtýrýldý. Test öncesi, IV Dp sonrasý ve ardýndan ÝHE sýrasýnda RVg yapýldý. Normal olgularda Dp sonrasýndaki ve ÝHE sýrasýndaki ortalama ejeksiyon fraksiyonu (EF) artýþlarý KAH'lý olgulara göre anlamlý olarak yüksekti (% 6.6±2.6 ya % 2.6±4.0 p<0.001 ve % 5.6±1.9 a %-0.4±4.3). EF'daki % 5 den düþük artýþ anormal cevap olarak kabul edildiðinde tek baþýna Dp'un duyarlýlýðý % 72, özgüllüðü % 73 bulundu. ÝHE, Dp ile birlikte uygulandýðýnda duyarlýlýk % 83'e yükselirken özgüllükte deðiþme olmadý. KAH'lý olgularýn 5'inde (% 14) Dp'den sonra, 12'sinde (% 33) ÝHE sýrasýnda yeni duvar hareket bozukluðu oluþtu. Sonuç olarak IV Dp ile birlikte yapýlan ÝHE sýrasýndaki RVg'nin KAH tanýsýnda deðerli bir yöntem olduðu kanýsýna varýldý.

To assess the efficacy of IV dipyridamole (DP) combined with isometric handgrip exercise (IHE) inducting ischemia detectable by radionuclide ventriculography (RV2), we used both tests to study 11 normal subjects and 36 patients with coronary artery disease (CAD). RVg was performed at rest, after IV Dp (0.56 mg/kg) and during IHE. The mean increases in ejection fraction (EF) in the normal subjects after Dp and during IHE were significantly more than than of patients with CAD (6.6±2.6 % versus 2.6±4.0 %, p<0.001; and 5.6±1.9 % versus - 0.4±4.3 %, p<0.001). Considering an increase of less than 5 % in EF an abnormal response, the sensitivity and specificity of Dp alone were found to be 72 % 73 %, respectively. Combining IHE with Dp increased sensitivity to 83 % without a loss in specificity. Five patients (14 %) with CAD showed new wall motion abnormalities after Dp and 12 patients (33 %) after IHE, while no new wall motion abnormality was demonstrated in normal subjects. It is concluded that IHE during RVg for the detection of CAD can be conveniently combined with Dp, because it increases the sensitivity of the test compared to Dp alone without any loss in specificity.

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Akut miyokard infarktüsü nedeniyle yoðun bakým ünitesinde takip edilen 17 hastada (15 erkek, 2 kadýn) atriyel natriüretik peptid (ANP) düzeyleri ölçüldü. Kan örnekleri, göðüs aðrýsý baþladýktan sonraki 12, saatte alýndý ve kontrol grubunu oluþturan 10 saðlýklý kiþinin (8 erkek, 2 kadýn) ANP düzeyleriyle karþýlaþtýrýldý. Hasta grubunun ANP düzeyleri kontrol grubuna göre anlamlý derecede yüksek bulundu (p<0.01). inferior miyokard infarktüsünde ANP düzeyleri anterior miyokard infarktüsüne göre anlamlý þekilde yüksekti (p<0.05). Trombolitik tedavi alanlarda ANP, almayanlara oranla anlamlý derecede düþük bulundu (p<0.01). Bu bulgular, ister direkt miyokard hasarýna, isterse infarktüs nedeniyle geliþen fonksiyon bozukluðuna baðlý olsun, akut miyokard infarktüsünde ANP düzeylerinin yükseldiðini göstermektedir.

Plasma atrial natriuretic peptide (ANP) levels were measured in 17 patients with acute myocardial infarction and in 10 healthy subjects with the radioimmunoassay method using standard kit procedure. Plasma was sampled at about the 12th hour of infarction. Those with clinical evidence of congestive heart failure at the time of plasma sampling or those with a history of hypertension were excluded. There were significant increases in the plasma ANp levels in patients with acute myocardial infarction (22.2±187 pg/ml) as compared with the controls (48±21 pg/ml) (p<0.01). ANP levels were significantly higher in patients with inferior myocardial infarcction (303 pg/ml) than in the others. Low ANP levels were found in the 7 patients who recieved thrombolytic therapy (188 pg/ml) (91 vs 317 pg/ml, p<0.01). Increasing plasma ANP levels in acute myocardial infarction presumably either depend on myocardial necrosis of on myocardial dysfunction caused by myocardial damage or both of them.

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1988-1991 yýllarý arasýnda 69'u kadýn (% 14), 436 sý erkek (% 86) 505 olguya koroner anjiyoplasti uygulandý. Yaþ ortalamasý 51±7 idi (26-81). Olgularýn 304'ü (% 60) tek damar, 145'i (% 29) iki damar, 56'sý (% 11) 3 damar hastasý idi. Olgularýn 485'inin (% 96) ejeksiyon fraksiyonu % 50'nin üstündeydi. Giriþimde bulunulan 505 olgunun 444 (% 88) ünde klinik baþarý saðlandý. Anjiyoplasti uygulanan 604 lezyonun 530 (% 87.3) unda baþarý saðlandý. "Stepwise regression" analizi, primer hedef darlýðýn modifiye ACC/AHA klasifikasyonu ve diabet'in bulunmasýnýn iþlem baþarýsýný belirleyen baðýmsýz deðiþkenler olduðunu gösterdi (modifiye ACC/AHA skor, p<0.0001, diabet p=0.004). Tip A lezyonlarda % 90.8, tip B1 lezyonlarda % 89.6, tip B2 lezyonlarda % 70.6, tip C lezyonlarda % 55.6 baþarý oranlarý saptandý. Sonuç olarak klinik önemi olan ara risk grubunu B1 ve B2 olarak ayýrmak standart ACC/AHA þemasýndan daha bilgilendiricidir. Lezyon karakteristiklerinden ayýrým yeri lezyonlarý, sýký (% 80-99) darlýk lezyonlarý, total oklüzyonlar ve lezyon uzunluðu iþlem baþarý oranýný ters yönde etkilemektedir.

Between October 1988-January 1991, PTCA procedure was performed in 505 patients (604 stenoses). The average age was 51±7 years. There were 436 men (% 86) and 69 women (% 14). Angiographically, 304 patients (% 60) had single-vessel disease, 145 patients (% 29) two-vessel disease and 56 patients (% 11) had three-vessel disease. Ejection fraction was higher than % 50 in 485 (% 96) patients. Procedural success was achieved in 444 patients (% 88). 530 stenoses (% 83.7) were dilated successfully. Stepwise regression analysis determined that modified ACC/AHA classification of the primary target stenosis and the presence of diabetes mellitus were the only variables independently predictive of procedural outcome (target stenosis modified ACC/AHA score p<0.0001 for success, diabetes mellitus p=0.004 for success). Success rates for type A, B1 B2 and C were 90.8 %, 89.6 %, 70.6 % and 55.6 % respectively. In conclusion, subdivision into types B1 and B2 provided significantly more information in this clinically important intermediate risk group than did the standard ACC/AHA scheme. The stenosis characteristics of bifurcation lesions, high-grade (% 80-99) stenosis, total occlusion and length of the lesions were inversely correlated with procedural success.

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1988-1991 yýllarý arasýnda 69'u kadýn (% 14), 436'sý erkek (% 86) 505 olguya koroner anjiyoplasti uygulandý. Yaþ ortalamasý 51±7 idi (26-81). Olgularýn 304'ü (% 60) tek damar, 145'i (% 29) iki damar, 56'sý (% 11) 3 damar hastasý idi. Olgularýn 485'inin (% 96) ejeksiyon fraksiyonu % 50'nin üstündeydi. Major komplikasyon 505 olgunun 31 (% 6.1) inde görüldü. Ölüm oraný % 1.2 idi. "Stepwise regression" analizi, primer hedef darlýðýn modifiye ACC/AHA klasifikasyonu ve diabetin bulunmasýnýn iþlem komplikasyonunu belirleyen baðýmsýz deðiþkenler olduðunu gösterdi (Modifiye ACC/AHA skor p=0.0002, diabet p=0.0001). Tip A lezyonlarda % 3, tip B1 lezyonlarda % 7.5, tip B2 lezyonlarda % 13.8, tip C lezyonlarda % 22 komplikasyon oranlarý saptandý. Sonuç olarak, klinik olarak önemli olan ara risk grubunu B1 ve B2 olarak ayýrmak, standart ACC/AHA þemasýndan daha bilgilendiricidir. Ayrým yeri lezyonlarý ve yüksek dereceli darlýk (% 80-99) lezyonlarý komplikasyon açýsýndan önemlidir.

Between October 1988-January 1991, PTCA procedure was performed in 505 patients (604 stenoses). Average age was 51±7 years. There were 436 men (86 %) and 69 women (14 %). Angiographically, 304 patients (60 %) had single-vessel disease, 145 patients (29 %) two-vessel disease and 56 patients (11 %) had theree-vessel disease. Ejection fraction was higher than 50 % in 485 (96 %) patients. Minor complication rate was 15.4 %. Major ischemic complications occurred in 31 cases (6.1 %), of which nonfatal myocardial infarction and emergency bypass surgery consituted each 1.6 %. Death rate was 1.2 %. Stepwise regression analysis determined that modified AC/AHA classification of the primary target stenosis and the presence of diabetes mellitus were the only variables independently predictive of complications (target stenosis modified ACC/AHA score p=0.0002, diabetes mellitus p=0.0001). Complication rates for type A, B1, B2 and C were 3 %, 7.5 %, 13.8 % and 22 %, respectively. In conclusion, subdivision into types B1 and B2 provided significantly more information in this clinically important intermediate risk grup than did the standard ACC/AHA schema. The stenosis characteristics of bifurcation lesions and high-grade (80-99 %) stenosis were significantly correlated with procedural complications.

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Colchcine akut gut artritinin tedavisinde kullanýlan antienflamatuar bir ilaçtýr. Kollajen sentezi ve sekresyonunu inhibe ettiði, kollajenaz aktivitesini artýrdýðý için enflamasyon ve fibroziste seyreden hastalýklarýn tedavisinde tavsiye edilmektedir. Biz de akut idiyopatik perikarditlerde tedavi deðerini saptamak amacýyla nonsteroidal antienflamatuar tedaviye yanýt vermeyen 15 hastada (9 erkek, 6 kadýn, yaþ aralýðý 23-60 yýl, ortalama yaþ 44) colchicine kullandýk. Perikardit 10 hastada postperikardiyotomi sendromu, 2 hastada Dressler, 2 hastad idiyopatik, bir hastada Tbc perikarditi idi. Birinci gün yükleme dozu þeklinde 3 mg/gün, 2 gün 2 mg/gün ve 3. günden itibaren 1 mg/gün idame dozunda 8 hafta süreyle verildi. Tbc perikarditi dýþýnda tüm olgularda olumlu sonuç alýndý. Güçlü antienflamatuar etkisi nedeniyle akut idiyopatik veya immunolojik mekanizmanýn rol oynadýðý perikarditlerin tedavisinde ilk seçilecek ilaç olduðu yargýsýna varýlmakla birlikte, nonsteroidal antienflamatuar ajanlarla yapýlacak kontrollü çalýþmalarla doðrulanmasý gerektiði düþünüldü.

Colchicine is an antiinflammatory agent used in the treatment of gout arthritis. It has been advocated in disorders associated with inflammation and subsequent fibrosis since it inhibitis collagen synthesis and secretion, and enhances collagenase activity. We used colchicine to evaluate the efficacy in 15 patients (9 men and 6 women between the ages of 23 and 60, with a mean age of 44) unresponsive to nonsteroidal antiinflammatory therapy. Pericarditis was due to postpericardiotomy syndrome in 10 patients. Dressler syndrome in 2, tuberculosis in 1. The remaining two were termed idiopathic. The drug was given 3 mg/d in the first day. 2 mg/d in the second day as a loading dose and 1 mg/d subsequently for 8 weeks as maintenance. Favorable results were obtained in all cases except in one patient with tuberculous pericarditis. Because of its potent antiinflammatory effect, colchicine may be used in the treatment of idiopathic or immunologicallymediated pericarditis as a drug of choice. However, this should be confirmed by comparative studies done with colchicine vs nonsteroidal antiinflammatory drugs.

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Bu çalýþmada, ekokardiyografik olarak sol ventrikül hipertrofisi (SVH) geliþmiþ hafif ve orta dereceli hipertansiyonlu hastalarda cilazapril'in uzun süreli kullanýmýnýn kan basýncý, SVH, sol ventrikül sistolik ve diyastolik fonksiyonlarý üzerine olan etkileri araþtýrýldý. Bu amaçla, yaþlarý 42-64 (ortalama 56±4) arasýnda deðiþen 10 erkek, 16 kadýn hasta çalýþmaya alýndý. Hastalara günde tek doz 2.5-5 mg cilazapril baþlandý. Tedaviden önce ve tedavinin 1,2,3,4,5 ve 6. aylarýnda hastalarýn kan basýnçlarý ölçüldü, nabýz vurularý sayýldý, tedaviden önce ve tedavinin 1,2,3 ve 6. aylarýnda EKG, telegrafi ve kan biyokimyalarý incelendi. M-mode, 2D ve renkli Doppler ekokardiyografik deðerlendirmeleri yapýldý. Hastalarýn 17'sinde (% 64) kan basýncý kontrolü için günde 5 mg cilazapril gerekti. Tedavi sonunda sistolik ve diyastolik kan basýnçlarýnda önemli düþme gözlendi (p<0.05). Kalp hýzýnda önemli deðiþiklik olmadý. Tedavi ile sol ventrikül kitle indeksinde önemli azalma meydana geldi (önce: 173±24, sonra: 136±18 gr/m2, p<0.01). Cilazapril, diyastolik fonksiyon parametrelerini olumlu yönde etkiledi; izovolumetrik relaksasyon zamaný (IRZ) ile E dalgasý deselerasyon zamaný (DZ) deðerlerinde istatistiksel olarak önemli azalma ve E:A oranýnda önemli artýþ saptandý (p<0.05). EKG'de ve laboratuvar deðerlerinde deðiþiklik olmadý. Yedi (% 27) hastada öksürük (3), çarpýntý (2) ve yüzde ödem (2) gibi yan etkiler görüldü, bunlardan 2 (% 7) hastada ilaç kesilmesi gerekti. Sonuç olarak, SVH geliþmiþ hafif ve orta dereceli hipertansiyonda cilazapril ile etkin kan basýncý kontrolü yanýnda SVH'nde gerileme ve sol ventrikül diyastolik fonksiyonlarýnda önemli düzelme saðlandýðý, sol ventrikül sistolik fonksiyonlarýnýn deðiþmediði kanýsýna varýldý.

The aim of the present study was to investigate the effects of cilazapril on blood pressure (BP), left ventricular hypertrophy (LVH) and LV systolic and diastolic functions in patients with mild to moderate hypertension and echocardiographically confirmed LVH. Previously untreated 10 male and 16 female patients, aged between 42-64 years (mean 56±4) were given cilazapril 2.5-5 mg once daily for 6 months. BP and heart rate were evaluated monthly, while ECG, chest x-ray, blood chemistry and M-mode, 2D, color-coded Doppler echocardiograms were evaluated before treatment and on the 1,2,3 rd and 6th months of therapy. Seventeen patients (64 %) needed 5 mg/day cilazapril for BP control. Cilazapril treatment reduced resting systolic and diastolic BP (p<0.05). LV mass index also decreased significantly (173±24 vs 136±18, p<0.01). The deceleration time of mitral peak early velocity, isovolumic relaxation time and E: A ratio reduced significantly after cilazapril treatment (p<0.05). Side effecs such as palpitation (2), cough (3) and facial edema (2) were observed in 7 (27 %) patients and cessation of therapy was necessary in 2 (7 %). In conclusion, long-term antihypertensive therapy with cilazapril controls blood pressure, concamitantly brings about LVH regression and improvement in diastolic function in patients with mild to moderate hypertension.

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Yaþ ortalamasý 41±13 yýlý (15-71) olan, 68'i (% 39.8) kadýn, 103'ü (% 60.2) erkek toplam 171 normal olgu çalýþmaya alýndý. 15-29 yaþ grubunda 45, 30-39 yaþ grubunda 42, 40-49 yaþ grubunda 36, 50-59 yaþ grubunda 24, 60 ve yukarý yaþ grubunda 24 olgu vardý. Fizyolojik mitral yetersizliði, pulsed Doppler ile % 40.9, renkli akým ile % 43.3 (p>0.05); triküspid yetersizliði pulsed Doppler ile % 53.2, renkli akým ile % 54.9 (p>0.05); aort yetersizliði her iki yöntemle de % 4.7 (p>0.05) olarak bulundu. Olgularýn % 35.1 inde tek kapak, % 29.3 ünde çift kapak, % 7'sinde üç kapak % 0.5 inde dört kapakta fizyolojik yetersizlik vardý. Yetersizlikli kapak sayýsý yaþlý olgularda daha fazlaydý. Türk toplumundan bir kesit olarak, normal olgularda fizyolojik yetersizlik prevalansýnýn diðer toplumlardan anlamlý farklýlýk göstermediði, renkli Doppler uygulamanýn daha kapsamlý ve daha az zaman alýcý olduðu sonucuna varýldý.

Our study group included 171 normal subjects with a mean age 41±13 years (range: 15-71) in 68 women and 103 men. There were 45 subjects in age group 15-29 years, 42 in age group 30-39 years, 36 and 24 in the subsequent age groups, 24 subjects 60 years of age or over. Physiological mitral regurgitation was detected in 40.9 % of patients with pulsed Doppler, compared to 43.3 % patients with color-flow imaging (p>0.05). Tricuspid regurgitation was detected in 53.2 % subjects with pulsed Doppler and in 54.9 % of subjects with color-flow (p>0.05). Pulmonary regurgitation was detected in 12.3 % of subjects with pulsed Doppler and in 14 % of subjects with color-flow (p>0.05). Aortic regurgitation was detected in 4.7 % patients both with pulsed Doppler and color-flow imaging. Physiologic valve regurgitation was observed in 35.1 %, 29.3 %, 7 % AND 0.5 % of subjects with respect to 1, 2, 3 and 4 valves, respectively. The number of affected valves increased with age. In was concluded that the prevalence of physiologic valve regurgitation in normal subjects in a selected Turkish population was not significantly different from other populations and that the use of colorflow Doppler echocardiography was more detailed and less time-consuming.

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Lipid ve lipoprotein seviyeleri ve diðer bazý risk faktörleri, anjiografik ve operatif muayene ile obliteratif aterosklerotik arteriopati saptanan 35 hastada incelendi. 72 asemptomatik normal kiþi kontrol grubu olarak seçildi. Serum kolesterol ve trigliserid ortalama düzeyleri kontrol grubunda sýrasýyla 168±31 mg/dl ve 144±81 mg/dl iken hasta grubunda 191±44 mg/dl ve 183±76 mg/dl olarak bulundu ve iki gruptan elde edilen bu ortalama deðerler arasýndaki farkýn istatistik olarak anlamlý olduðu görüldü. Kontrol ve hasta grubunda ortalama serum HDL-kolesterol, LDL-Kolesterol, Apo-AI, Apo-B düzeyleri arasýnda istatistik olarak anlamlý fark bulundu. Arterioskleroz obliterans saptanan hastalarýn % 77'si sigara içiyordu, % 37'si hipertansif, % 14'ü obes ve % 5.7'si diabetikti. Serum HDL-kolesterol seviyeleri kontrol grubundaki sigara içenlerde içmeyenlere göre anlamlý þekilde daha düþüktü; bu, çoðu sigara içen arterioskleroz obliterans olan hastalarda azalmýþ HDL oranýný açýklayabilir.

Lipid and lipoprotein levels as well as certain other risk factors were studied in 35 patients with arteriosclerosis obliterans (confirmed by angiographic and operative examination). Seventy-two asymptomatic normal subjects sevred as controls. The mean serum total cholesterol and triglyceride levels in control subjects were 168±31 mg/dl and 144±81 mg/dl respectively. In patients with arteriosclerosis obliterans, these values were 191±44 mg/dl, and 183±76 mg/dl. Significant differences existed in the mean serum total cholesterol and triglyceride levels between two groups. The mean LDL-cholesterol, Apo-B levels were significantly higher in patients than in controls. HDL-cholesterol and Apo-A1 levels were signifiantly lower in patients than in controls. Patients with arteriosclerosis obliterans were characterized as follows: 77 % were smokers, 37 % were hypertensive, 14 % were obese, and 5.7 % had diabetes. The HDL-C levels were significantly lower in controls who smoked than in non-smoking control subjects; this may indirectly explain the reduced HDL ratio in patients with obstructive peripheral vascular disease, most of whom were smokers.

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Ýlk muayenelerinde sistolik kan basýncý 140-160 mmHg, diyastolik kan basýncý 90-105 mmHg olan 300 hastada ambulatuvar kan basýncý ölçümleri yapýlarak beyaz gömlek hipertansiyonu ensidansý araþtýrýldý. 300 vakanýn 54'ünde (% 18) beyaz gömlek hipertansiyonu tanýsý kondu. Ayrýca kadýnlarda beyaz gömlek hipertansiyonu ensidansýnýn ayný yaþ erkeklere göre daha fazla olduðu saptandý. Erkeklerde bu ensidans yaþa baðýmlý olduðu saptandý. Erkeklerde bu ensidans yaþa baðýmlý olmaksýzýn % 12 civarýnda iken, 40 yaþýn altýndaki kadýnlard % 26.4, kýrk yaþýn üstündeki kadýnlarda ise % 20.9 bulundu (p<0.05). Hastalarýn ilk muayenelerinde hipertansiyon saptayan hekimin, beyaz gömlek hipertansiyonu tanýsýný her zaman için hatýrlamasý üzerinde duruldu.

The incidence of "white-coat hypertension" was investigated by ambulatory blood pressure monitoring in 300 hypertensive patients whose systolic blood pressure were between 140-160 mmHg and diastolic blood pressure were between 90-105 mmHg during the first office examination. The average incidence was 18 per cent, significantly higher in women (23.4 %) than men (12.5 %) in the same age groups. Though the incidence was similar in men of all ages, it was 26.4 % in women below 40 years of age and 20.9 % in women older than 40 years (p<0.05). Physicians should keep in mind the diagnosis of white-coat hypertension when hypertension is diagnosed during the first office examination.

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Bu yazýda, klinik uygulamaya aðýrlýk verilerek nükleer kardiyolojideki son geliþmelerden kýsaca söz edilecektir. Son beþ yýlda miyokard perfüzyon ve fonksiyonunun deðerlendirilmesinde önemli geliþmeler olmuþtur. Geliþtirilen "single photon emission tomography" yöntemi ile koroner arter hastalýðýnýn tanýsý ve lokalizasyonunun belirlenmesinde duyarlýlýk artmýþtýr. Gama kamera görüntülemesi için ideal olan, hem perfüzyonu hem fonksiyonu gösteren Tc-99m ile iþaretlenen yeni ajanlar görüntü kalitesi ve taný deðerinin arttýrýlmasýnda umut vadetmektedirler. Yaygýn olarak benimsenen T1-201 ile görüntüleme canlýlýðý belirlemedeki deðerini son çalýþmalarda daha da arttýrmýþtýr. Dipiridamole ek olarak adenozin ve dobutamin de stres amacýyla kullanýlmaya baþlanmýþ, taný deðerleri ve güvenilirlikleri ispatlanmýþtýr. Pozitron emisyon tomografi, hassas kantitatif olanaklarýyla perfüzyon ve metabolizma görüntülemesinde yeni bir teknik olarak geliþmektedir. Nükleer kardiyolojik yöntemler, elektrokardiyografi, ekokardiyografi ve kalp kateterizasyonunun yanýnda kardiyoloðun temel taný araçlarý arasýndaki yerini almýþtýr. Ülkemizde ise, nükleer kardiyoolji laboratuarlarýnýn sayýsýnýn kýsýtlý oluþu, bazýlarýnýn yeterli kalite kontrolu veya deneyime ulaþamamalarý nedeniyle perfüzyon sintigrafilerinde görülen sýk yalancý pozitif sonuçlar, ne yazýk ki kardiyologlarýn bir bölümünü bu yöntemlerden soðutan nedenler olmuþtur.

Some of the recent advances in the field of nuclear cardiology is reviewed, with particular emphasis placed on clinical applicability for patient management in current practice. Major advances in perfusion and function imaging of the heart have occurred during the past five years. Developments in technology, particularly in single photon emission computed tomography have permited improved detection and localization of coronary artery disease. New Tc-99-m-labeled perfusion agents with ideal energy for gamma camera imaging and simultaneous function and perfusion imaging capabilities show promise for enhancing the quality and diagnostic accuracy of myocardial perfusion imaging. Tl-201 continues to have widespread use, and recent studies have extended its value in the assessment of viability. In addition to dipyridamole, the new pharmacologic agents adenosine and dobutamine have also been shown to be safe and efficacious. Positron emission tomography, with the ability to perform precise quantitation, has emerged as a new facility for myocardial perfusion and metabolism imaging. Myocardial nuclear imaging has established along with electrocardiography, echocardiography and cardiac catheterization, as a basic tool for the cardiologist. Unfortunately, in Turkey, the number of nuclear cardiology facilities is limited, some of them have not adequately achieved satisfactory quality control or experience. Poor specificity of the myocardial perfusion imaging is a major problem.

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52 yaþýnda erkek hasta acil polikliniðe kardiyojenik þok tablosunda getirildi. Ýki boyutlu ekokardiyografi ile posterolateral duvarda sol ventrikül anevrizma rüptürü ve hemoperikardiyum saptandý. Hasta derhal ameliyata alýnarak defekt kapatýldý. Hasta 10 gün sonra saðlýklý bir þekilde taburcu edildi. Dört ay sonra hastaya sol ventrikülografi ve koroner anjiyografi yapýldý. Koroner damarlar genel olarak ince bulundu. Sol ön inen arterin proksimal 1/3'ünde % 50 darlýk saptandý. Sol ventrikülografide anterolateral ve posterolateral hipokinezi mevcuttu. Hasta halen semptomsuz olup aktif yaþamýna devam etmektedir. Bu vaka, ülkemizde yayýnlanmýþ, baþarýlý bir þekilde cerrahi yolla tedavi edilen ilk anevrizma rüptürü vakasýdýr.

A 52-year-old man was admitted to the hospital emergency room with cardiogenic shock. The electrocardiogram showed ST elevation and T inversion in leads I and AVL, but no Q waves. Left ventricular aneurysm rupture at the posterolateral wall and hemopericardium was diagnosed with two-dimensional and color Doppler echocardiography. The patient was directly sent to the operating room and the defect was closed. He made a good recovery. Four months later coronary angiography and left ventriculography were performed. The coronary vessels were patent and there was 50 % stenosis at the proximal 1/3 portion of left anterior descending artery. Left ventriculography showed anterolateral and posterolateral hypokinesis. The patient was symptomfree and leading an active life 4 months later. This patient is the first published case of left ventircular aneurysm rupture salvaged surgically in Turkey.

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