The aiın of th is study was ıo deterınine the effects of plasına hoınocyste ine levels and ınethylene tetrahydrofolate reductase (MTHFR) ınutation on the presence and the extent of coronary atherosclerosis. 242 consecutive patients undergoing coronary angiography were prospectively evaluated for conventional risk factors, p lasına h oınocysteine levels, B 12, folate levels and MTHFR genotype. The mean plasma homocysteine levels were 18.5±1 1 pmol/L in 15 1 patients with coronary artery disease and 1 5.6±1 O ı.ııno i/L in 91 patients w ith normal coronary arteries (p>0.05). Plasma homocysteine levels above 15 ı.ınıol/L was a s ignificanı risk factor for coronary artery disease (p=0.03, RR 2. 1, %95 CI 1.07-4.4), and levels above 15 ı.ımol/L were also sign if icantly correlated to the extent of atherosclerosis (p=0.04, RR 3.2 %95 CI 1.3-8.2). The folate levels w ere 7 .0±3.2 ng/nıl in control s and 5.1±1.3 ng/ml in patients with coronary artery disease. When the MTHFR genotype was d e terınined, TT genotype was present in 7.4% of patients and 5.2% of controls (p>0.05). TT genotype was significantly correlated to plasma honıocyste ine levels (p=O.OO 1) and also correlated w ith ıhe extent of coronary atherosclerosis (p=0.03). Our data indicare that a plasma homocysteine level above 15 ~o l/L is a significant risk factor for the presence and extent of coronary artery disease. TT genotype was an important predictor of the homocysteine levels and the extent of coronary atherosclerosis.

This study evaluates whether patients with coronary artery disease (CAD) and severely depressed ejection fraction (L VEF) benefit from coronary artery by-pass grafting(CABG). From February 1994 to December 1995,37 patients (ınean age 57.2; 20 male, 17 fenıale) with LVEF ~30% and with viable nıyocardium as demonstrated by thallium-201 stress and redistribution inıaging (except for 6 patients undergoing emergency CABG) and suitable vessel lumen for CABG, underwent isolared CABG performed by the same staff. Total duration of hospital stay was 8.6 days. The hospital mortality rate which we estinıated as 10.2% by Parsonnet scoring preoperatively, was found Lo be 5.4%. Postoperative L VEF which was assessed by MUGA, inıproved from 25.5±2.7 to 35.6±6.8. According to KaplanMeier analysis, the survival rate was found as 92% during the follow-up period. The 2 major conıpl ications recorded postoperatively were a rrh ythnıia (25%) and low output syndrome (16.2%). As a result, CABG in patients with severely impaired LV function appears beneficia I if the vessels are operable and if there is salvageable myocardium; being performed with relative safety, CABG appears to be an alternative approach to transplanlation or cardiomyoplasty in patients w ith CAD and poor LV. Key words:

Whether the human cytomegalovirus plays a causal role in atlıerosc l e rosis etiology is controversial. We conducted a case-control study to investigate whether previous infection with cytomegalovirus is associated with coronary heart disease and markers of systemic inflammation, because systemic inflammation also may play a role in atherosclerosis. We also studied the correlation between anticytomegalovirus antibody titer and coronary artery disease. 150 cases (45 female, mean age, 58,7 ± 7,6 years) with a documented coronary heart disease anel 160 vol unteer control ca ses (50 female, m ean age 57,82 ± 8,1 years) were studied. Cytomegalovirus serology was performed to determine presence of specific IgG antibodies and titers of the anticytomegalovirus antibodies. In addition, C-reactive protein levels were determined in each case. The prevalence of specific antibodies to cytomegalovirus was 57,3% in the ptaient groups, 56% among the controls (p=0,39). But high anti -cytoınegalovirus titer (~ 1 :800) was seen in the patient group w ith a higher ineidence (26,6% versus 10%, p=O,OOO). Mean value of C-reactive protein was higher in the patient group (2,99 ± 0,92 mg/L, versus 1,79 ± 0,51 ıng/L, p=O,OOO), and there was a linear correlation with the high antibody titer and the level of Creactive protein (r=0,35, p=O,OOO). These findings support that, instead of the seropositivity of the population, the titer of anti cytomegalovirus lgG antibody and the levels of Creactive protein may predict coronary artery disease.

Earlier appearance of arterial wave reflections due to increased arterial stiffness may cause Iate systolic wave in the brachial artery Doppler study. In this study, we investigated the relationship between Iate systolic wave and cardiovascular risk factoı·s such as hypertension, diabetes, gender, age, hyperlipidemia and sınoking. Blood flow profile and velocity of the brachial artery were determined noninvasively by ultrasound pulsed Doppler technique under the guidance of a B-mode ultrasound image in 56 patients with hypertension. In 23 patients (38.6%) with hypertension, a Iate systolic wave was observed in the brachial artery Doppler study. There was no signi ficant stenosis along the brachial artery on the B-mode images. In patients with hypertension hyperlipidemia (p<0.05), cigarette s ın ek in g (p<0.05), diabetes mellitus (p<0.05) and advanced age (p<0.05) were found to be independent risk factors for Iate systolic wave. Thus stiffness of the arterial system induced by certain cardiovascular risk factors may produce alterations in regional wave reflections and changes peripheral arterial Doppler signs.

Contraction and relaxation of the heart causes decrease and increase in myocardial video intensity (MVI) recorded from echocardiographic iınages, respectively. Some studies suggest that this physiological cyclic variation of MVI diıninishes in ischemic conditions. The present study was planned to compare the cyclic variations of MVI recorded from patients with coronary artery disease (CAD) and healthy subjects and to define its contribution to the diagnostic accuracy of dipyridamole stress echocardiography (DSE). DSE was performed to 34 patients with CAD (56±7 years) and 20 age matched controls (52±12- years). In all patients, the end-diastolic and endsystolic 20 echocardiographic images of 3 consecutive beats recorded on video tapes during peak stress and rest were digitized. The mean MVI values of end-systolic and end-diastolic frames of both ischeınic and non- ischemic segments during rest and peak exercise were obtained using a special software for analyzing medical images (Image Tool 2.0). The MVI index was defined as (end-diastolic MVI) - (end-systolic MVI)/ end-diastolic MVI x 100. In our study, the sens itivity, specific ity and diagnostic accuracy of DSE were 70%, 85% and 77.5% by us ing conventional wall motion seering method, respectively. During DSE, the mean and end- systolic MVI values of ischeınic segments were significantly increased when compared with non-is- chemic segments (mean: 48±8 - 40±6 ; p

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Right ventricular abnormalities in patients with pure restrictive ventilatory impairment (PRVI) has not been extensively studied up to date. The purpose of this study was to evaluate the left ventricular diastol i c function and the right ventric ula r involvement in patients with PRVI by Do ppler echocardiography. Methods: Two-dimens ional, M-mode, and Doppler echocardiography were performed on 24 patients, 21 men and 3 women, with PRVI due to several etiologies, and 23 healthy subjects as the control group. Patients with any disease that affect the Ieft ventricular functions were not included in the study. All subjects underwent respiratory tests and arterial blood gas assessment. Patients were grouped according to the severity of restrictive ventilatory impairme nt. An echo-Doppler examination was made to measure left ventricular ejection fraction and diastolic filling parameters and right ventricular end-diastolic wall thickness, end-diastolic area, and diastolic fi lling parameters, and pulmonary acceleration time and mean arterial pulmonary pressure ([mPAP = 78 - (0.52 x pulmonary acceleration time]). Results: Right ventricular area index was higher in patients with PR VI than that in healthy subjects (9.4±2. 1 cm2/m2, 7.9± 1.6 cm2/m2, respectively, p<0.05). Right ventricular wall th ickness was higher in patients with mild-moderate and severe PRVI than that in the control group (3,8±0.6 mm, 4. 1±1.1 mm, 2.8::!:0.4 mm, respectively, p

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Currently, revascularization procedures !ike PTCA or coronary ste nting have been used in nuın ero u s cardiology centers. Although these methods are very successful in early term, their initial success are surpassed by the Iate term restenosis. Not maintaning early term success of these methods have led the researchers to study the prevention of the restenesis problem. Pharmacological interventions used to prevent have not reached very successful results. But, studies pertinent to th is issue are continuning. Therefore, it is pointed out that new elinical research and endovascu lar brachytherapy and the effects of ionizing radiation over restenosis area have been investigated. Different issues in the area of endovascular brachytherapy which is a relativetey new technique are stil! debateful or not clear enough. In this article, general principles of brachytherapy, the systems existing at present, and the l iteratuı·e related to this topic are reviewed.

"Vasovagal syncope" is both the most prevalent form of neuro-card iogenic syncope and the most common cause of syncope. Many elinical situations may predispose to vasovagal syncope. Identification of various c ircumstances as "trigger" of syncopal attack is important not only for the diagnosis but also for the treatment and prevention of recurrent episodes. In many cases, prodromal symptoms occuıTing several seconds before the syncope are often observed, and these may be considered as the signals of danger. Prognosis of vasovagal syncope is generally benign. However, physical injury may result from syncopal episodes in patients without prodromal symptoms or in particular situations that individuals are working in a risky environment. Recurrence rate of vasovagal syncope is quite variable, corre lated with the number of syncopal ep isodes reported. Pathophys iologic basis of vasovagal syncope has not been precisely understood. It can be summarized that in patients susceptible to vasovagal syncope, continuity of the adaptive mechanisms maintaining the normal systemic pressure and the cerebral perfusion are impaired, and this impairment leads to an unexpected vasodilation and/or bradycardia which cause a decrease in cerebral perfusion and syncope. In the last decade, head-up tilt table testing has been the preferred diagnost ic test for the differential diagnos is of vasovagal syncope. Therapeutic options for th is elinical situation may be classified as acute interventions during the syncopal episodes, treatment strategies for the recurrences and fina lly the preventive approaches.

The ineidence of coronary artery anomalies from angiographic series ranges from 0.6 % to 1.6 %. Single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium. It occurs in approximately 0.024% to 0.044 % of the population. The angiographic features of a case of isolated single coronary artery without narrowing are presented. Key words:

In this paper, a two-year-old child and a twenty-year old adult with isolated double aortic arch have been described. Radiological findings of both cases are discussed.