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TEKHARF Çalýþmasýnýn orijinal ve yeni kohortlarý, baþka amaçlarýn yanýsýra, toplam ve koroner kalp hastalýðý (KKH) mortalitesi ile yeni koroner olay prevalanslarýný deðerlendirmek amaciyle, son olarak 2000 yýlý yazýnda tarandý. Ölüm konusunda 1. derece akraba ve/veya saðlýk ocaðý personelinden bilgi alýndý; yaþayanlarda bilgi edinmekten baþka, fizik muayene ve 12-derivasyonlu EKG kaydý yapýldý.Yeni koroner olay tanýmýna, son taramadan beri geliþen fatal ve fatal olmayan miyokard infarktüsü, yeni stabil angina ve/veya miyokard iskemisi girdi. 1269'u erkek, 1294'ü kadýn olmak üzere, 2563 kiþi tam izlendi. Bunlardan 66 erkek ile 41 kadýnýn öldüðü belirlendi. On yýl boyunca geliþen tüm nedenli 290 ölümden, KKH kökenlisi yine %42 pay aldý. On yýl takip sonucu ülke geneli için yýllýk tüm-nedenli ölüm oraný erkeklerde binde 12.3, kadýnlarda binde 8 olarak hesaplandý. Bu gözlem, 1990'lý yýllarda Türk eriþkinlerinde yýlda ortalama 182 bin erkek ile 120 bin kadýnýn öldüðünü düþündürmektedir. Yýllýk koroner mortalite bin eriþkin arasýnda erkekte 5.2, kadýnda 3.2 bulundu. Her yýl koroner nedene baðlý olarak kaybedilen yurttaþlarýmýzýn sayýsýnýn (%3 oranýnda arttýðýna dair tutucu bir varsayýmla) son yýl içerisinde 92 bini erkek olmak üzere, 153 bin olduðu tahmin edilmektedir. Kýrkbeþ ila 74 yaþ kesiminde toplam mortalite prevalanslarý sýrasiyle binde 20.3 ve 12.9 oranýnda olup kadýnlarýmýzda Avrupada en yüksek düzeydedir. Ayný yaþ kesiminde KKH ölüm prevalanslarý sýrasiyle binde 8.0 ve 4.7 oranýnda olup Avrupada yine en yüksek düzeylerdedir. Ani ölümleri içeren yeni koroner olay sýklýðýnýn ülke genelinde içinde bulunduðumuz yýl 260 bin olduðu tahmin edilebilir. Koroner kalp hastalýðý için aldýðýmýz ölçütler kadýnlarda daha daraltýldý. Buna raðmen anýlan hastalýða bu yýl 170 bin kiþinin yeni olarak yakalandýðýna, bunlarýn katýlmasýyla 2 milyona ulaþan mevcut koroner hastasý havuzunun bu yýl yaklaþýk 90-100 bin hastayla geniþlediðine iliþkin ipucu elde edildi. Bu bilgiler, ülkemizde koroner hastalýk 'salgýný'nýn baþladýðýný ve bu salgýndan koruyucu önlemlerin çok daha etkin biçime getirilmesinin gerektiðini düþündürmektedir.

The Turkish Adult Risk Factor Study, initiated in 1990 on a random sample of 3687 adults (20 years of age or over) residing in 59 communities scattered to all regions of Turkey, was followed up lastly in the summer of 2000. This paper reports 10-year cumulative data on the prevalence of coronary and all-cause mortality as well as of new coronary events based on a follow-up of 28790 person-years. Cardiovascular history and physical examination were obtained, and a 12-lead ECG was recorded at rest. New coronary events were defined to include fatal and nonfatal myocardial infarction, newly developed stable angina with or without associated myocardial ischemia. 2563 participants (of whom 1294 women) were examined or were reported to have died. Of the 290 deaths cumulated over 10 years, 42% were attributed to coronary origin. Overall annual death rate was 12.3 per 1000 men and 8 per 1000 women in a relatively young cohort the mean age of which moved from 37 to 50 years over the follow-up period. Coronary heart disease (CHD) mortality was found 5.2 per 1000 men and 3.2 per 1000 women. This indicated the occurrence of a coronary mortality of approximately 153.000 in the year 2000. In the age bracket of 45-74 years, overall mortality per 1000 was high, namely 20.3 in men and 12.9 in women. CHD mortality in the same age bracket was 8.0 in men and 4.7 in women. Rates in men were among the five highest European countries while rates in women exceeded even those of Ukraine women. Prevalence of CHD was estimated to be as 90 men and 71 women per 1000 adults, an observation which permitted to infer that 2.0 million Turkish adults currently suffer from CHD. Annual incidence of new coronary events which included fatal coronary events was estimated as 260.000, a very high rate for a "young" nation and suggesting that the CHD prevalence is rising at an annual rate of 5%. In order to stem the tide of the recent coronary "epidemic", these findings necessitate far more effective implementation of cardiovascular preventive measures among Turkish adults.

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Bu prospektif çalýþmanýn amacý sol ventrikül ejeksiyon fraksiyonunu (EF) ve duvar hareketlerini Tc 99m Tetrofosmin ile yapýlan EKG ile senkronize miyokard perfüzyon sintigrafisi (GSPECT) ve radyonüklid ventrikülografi (MUGA) ile karþýlaþtýrmaktýr. Materyal Metod: Bu çalýþmayý koroner arter hastalýðý þüphesi ile veya koroner arter hastalýðý olduðu bilinen ve Nükleer Týp Anabilim Dalýna baþvuran 45 hasta (22 kadýn, 23 erkek), yaþ aralýðý 38-74(ortalama yaþ 62.3±7.8) oluþturmuþtur. Tüm hastalara bir hafta içinde MUGA ve GSPECT yapýlarak her iki metodla EF deðerleri ve duvar hareketleri deðerlendirmeye alýnmýþtýr. Hastalar perfüzyon sintigrafilerine göre üç ana gruba ayrýlmýþtýr. Birinci grupta perfüzyonu normal olan 15, iskemi olan grupta 14 ve üçüncü grupta ise enfarktüslü 16 hasta mevcuttur. GSPECT ve MUGA arasýndaki EF deðerlerindeki farklýlýk Student's t testi ile deðerlendirildi. MUGA ve GSPECT arasýndaki korelasyon Lineer regresyon analizi ile (pearson's r korelasyonu) yapýldý. Duvar hareketlerindeki uyum ise kappa analizi ile gerçekleþtirildi. Sonuçlar: Birinci grupta EF MUGA ve GSPECT ile sýrasý ile %64.4±6.4, %65.8±6.4 (p<0.17), iskemik grupta ise %58.5±10.6 ve %55.1±12.3 olarak hesaplandý (p<0.06). Enfaktüslü hastalardan oluþan grupta ise ejeksiyon fraksiyonlarý MUGA ile %44.5±13.1 ve GSPECT ile %39.5±12.1 bulunmuþtur (p<0.007). Duvar hareketlerini vizüel olarak karþýlaþtýrdýðýmýzda her iki metodda da oldukça uyumlu bulundu (kappa 0.899). Sonuç olarak, GSPECT ile egzersiz sonrasý belirlenen sol ventrikül EF ile MUGA ile belirlenen EF arasýnda, gerek normal, gerekse iskemik ya da infarktüslü hastalarda ileri derecede anlamlý korelasyon olduðu belirlenmiþtir.

The aim of this prospective study was to compare left ventricular global ejection fraction (EF) and wall motion with Tc99m Tetrofosmin Gated SPECT (GSPECT) and radionuclide ventriculography (MUGA). Material and method: The patient population comprised 45 patients (22 female, 23 male) with an age range of 38-74 years (mean age 62.3±7.8). GSPECT stress and MUGA were performed within a week to all patients. The patients were divided in 3 groups according to myocardial perfusion findings. Fifteen patients had normal myocardial perfusion (N), 14 had ischemia (I) and 16 had myocardial infarction (MI). Comparison between MUGA and GSPECT ejection fractions were performed with Student paired t test. Correlations between MUGA and GSPECT EF were evaluated using linear regression. The agreement for evaluation of regional wall motion was assessed using kappa statistics. Results: In the first group the ejection fractions were 64.5±6.4 %, 65.9±6.4 % (p<0.17). In the second group the ejection fractions were 58.6±10.6 % 55.1±12.3 % (p<0.06), in the third group 44.5±13.1 %, 39.5±12.1 % (p<0.007) for MUGA and GSPECT respectively. Comparison of evaluation of regional wall motion between the two methods demonstrated excellent agreement (the kappa value was 0.899). I concluded that GSPECT and MUGA provided good correlation of global EF measurements in normal persons, and patients with ischemic heart disease or previous myocardial infarction.

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Q dalgalý miyokard infarktüsü sonrasý, etkilenen miyokard bölgesinde doku Doppler velosite gradiyentinin azaldýðý bilinmektedir. Çalýþmamýzýn amacý, Q dalgasýz infarktüs (nonQ-MI) geçiren hastalarda, segmenter disfonksiyon olmaksýzýn miyokardiyal fonksiyon bozukluðunu doku Doppler ekokardiyografi ile göstermektir. Metod: Çalýþmaya, kontrol grubu (KG) olarak koroner arter hastalýðý olmayan 20 (14'ü K, yaþ ort 51±15) ve çalýþma grubu (ÇG) olarak nonQ-MI olup segmenter hareket bozukluðu olmayan 25 vaka (18'i K, yaþ ort 57±10) alýndý. Doku Doppler görüntüleme ile mitral lateral anuler bölgenin sistolik gradiyent (Sm), EKG'de Q dalgasýnýn baþlangýcýndan pik Sm'ye kadar geçen süre (Q-Sm), erken ve geç diyastolik gradiyentler (Em, Am) ölçüldü. Koroner anjiyografi sonrasý, sol ventrikülografi aracýlýðý ile ejeksiyon fraksiyonu (EF) ve -Dp/Dt hesaplandý. Bulgular: Her iki grup arasýnda EF ve -Dp/Dt bakýmýndan anlamlý farklýlýk yoktu. ÇG ile KG karþýlaþtýrýldýðýnda; ÇG'unda, Sm (6.7±1.9 ve 9.8±2.9 cm/sn, p<0.00001) ve Em/Am daha düþük (0.9±0.4 ve 1.3±0.7, p=0.013), Q-Sm daha uzun (172.9±29.8 ve 141.2±30.9 msn, p=0.0003) idi. Her iki grupta, Sm ve Q-Sm ile EF arasýnda orta derece anlamlý korelasyon tespit edildi (sýrasýyla ÇG'unda 0.59, -0.55 ve KG'unda 0.70, -0.61). ÇG ve KG'unda, Em/Am ile -Dp/Dt arasýnda orta derece anlamlý korelasyon tespit edildi (sýrasýyla 0.66 ve 0.62). Sonuç: NonQ-MI'lý hastalarda, doku Doppler kullanarak yukarýda bahsedilen sistolik ve diyastolik parametreler, invaziv ölçümlerle orta derecede korelasyona sahiptir. Bu grup hastalarda, invaziv sistolik ve diyastolik ölçümler normal olmasýna raðmen, doku Doppler ile gösterilen sistolik ve diyastolik miyokardiyal gradiyent deðiþiklikleri, miyokard disfonksiyonunun erken noninvaziv göstergeleridir.

After Q wave myocardial infarction (MI), decreased tissue Doppler velocity gradient in the effected segments was well known. The aim of this study demonstrates the myocardial dysfunction without segmental dysfuntion by using tissue Doppler echocardiograpy in patients with nonQ-wave MI. Methods: As the study group (SG) 25 pts with nonQ-wave MI and without segmental dysfunction (18 F, 7 M; mean age 57±10) and as a control group (CG) 20 pts without coronary heart disease (14 F, 6 M; mean age 51(15) were included the study. Systolic velocity gradient (Sm), the time from the electrocardiographic Q wave to the peak of the Sm (Q-Sm), early and late diastolic velocity gradients of mitral lateral anulus were measured by tissue Doppler imaging. During the catheterization, the ejection fraction (EF) and -Dp/Dt were calculated. Results: EF and -Dp/Dt were similar in both groups. When SG and CG compared, Sm (6.7±1.9 vs 9.8±2.9 cm/sec, p<0.00001) and Em/Am were lower (0.9±0.4 vs 1.3±0.7, p=0.013) and Q-Sm longer (172.9±29.8 vs 141.2±30.9 msec, p=0.0003) in the SG. When correlated for Sm and Q-Sm with EF, moderate correlations were seen in both groups (in the SG 0.59, -0.55 and in the CG 0.70 and -0.61, respectively). In the SG and CG, moderate correlations were seen between Em/Am and -Dp/Dt (0.66 and 0.62, respectively). Conclusions: Systolic and diastolic parameters which provided by using the tissue Doppler imaging mentioned above, have moderate correlations between them selves and invasive measurements in patients with nonQ-wave MI. Although invasive systolic and diastolic measurements were normal, changes in the systolic and diastolic myocardial velocity gradients, showed by tissue Doppler imaging, are early noninvasive determinants of myocardial dysfunction.

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Kardiyovasküler sistem kesintisiz tek katlý endotel hücreleri ile döþelidir. Endotel hücreleri devamlý olarak nitrik oksit (NO) salgýlayarak hem vasküler tonusu ve kan basýncýný düzenler hem de trombosit adezyonunu ve agregasyonunu baskýlar. Ayrýca NO'in damar düz kas hücrelerinin çoðalmasýný ve göçünü de baskýladýðý saptanmýþtýr. Sigara içilmesi endotel hücrelerinde fonksiyon bozukluðuna neden olarak NO aktivitesinde azalmaya yol açmaktadýr. Bu çalýþma kronik sigara içiminin plazma NO düzeyi ve trombosit adezyonu ve agregasyonuna etkisini araþtýrmak amacý ile yapýldý. Çalýþmaya herhangi bir saðlýk problemi olmayan, son bir hafta içinde hiçbir ilaç almayan ve 24-47 yaþlarýnda 101 gönüllü erkek olgu alýndý. Olgular üç gruba ayrýldý. Grup I: Aðýr (>20 adet/gün) sigara içenler (n: 40). Grup II: Hafif (<20 adet/gün) sigara içenler (n: 38). Grup III: Sigara içmeyen ve sigara dumanýna maruz kalmayanlar (n: 23). Olgulardan 24 saatlik sigarasýz dönemi ve 12 saatlik açlýk periyodunu takiben alýnan venöz kanda NO düzeyi, trombosit agregasyonu ve trombosit adezivitesi ölçüldü. Serum NO konsantrasyonu grup I'de: 12.05 ± 2.83 µM, grup II'de: 13.98 ± 2.52 µM ve grup III'de: 18.69 ± 9.91 µM olarak saptandý. Grup I ve II'de NO konsantrasyonu grup III'e göre anlamlý derecede azalmýþtý (sýrasýyla p<0.001, p<0.01). Ayrýca grup I'deki NO konsantrasyonu grup II'dekine göre de anlamlý derecede azalmýþ olarak bulundu (p<0.05). Trombosit adezivitesi ve trombosit agregasyonu açýsýndan gruplar arasýnda hafif farklar olmasýna raðmen istatistiksel açýdan anlamlý deðildi (p>0.05). Sonuç olarak sigara içen saðlýklý bireylerde NO düzeyinin azaldýðý ve bu azalmanýn içilen günlük sigara sayýsý ile artýþ gösterdiði; fakat trombosit agregasyonu ve adezivitesinde ise in vitro þartlarda anlamlý deðiþiklik olmadýðý kanaatine varýlmýþtýr.

Endothelial cells by secreting continously nitric oxide (NO), endothelial cells regulate both vascular tone and blood pressure, and suppress thrombocyte adhesion and aggregation. In addition, it is determined that they suppress the increase and migration of vein smooth muscle cells. Smoking cigarette causes functional disruptions in endothelial cells, and leads to a reduction in NO activity. The aim of this study was to investigate the effect OF smoking cigarettes on aggregation, thrombocyte adhesion and plasma NO level. 101 volunterering cases, aged 24-47 years, not subjected to any medication during the past week and having no health problem, were included in the study. The patients were classified into 3 groups. The first group (Group I, n:40) comprised 'heavy smokers with a smoking history of >20 cigarettes per day. The second one (Group II, n:38) consisted of 'moderate smokers' with a smoking history of >10-20 cigarettes per day. 23 nonsmokers were accepted as a control group (Group III). Venous blood from the cases was injected after 15-minuter est following a 12-hour hunger period and 24-hour period without smoking. From this blood, the level of NO, thrombocyte aggregation and thrombocyte adhesivity was measured. Serum NO concentration in group I was 12.05 ± 2.83 µM, and was 13.98 ± 2.52 µM in group II, while it measured 18.69 ± 9.91 µM in group III. NO concentrations in both group I and group II were significantly lowered as compared to that of group III (respectively p<0.001, p<0.01). In addition, NO concentration in group I was significantly lowered than of that of group II (p<0.05). Although there were slight distinctions among groups in regard to thrombocyte adhesivity and aggregation, they did not differ significantly (p>0.05). Consequently, we concluded that NO level is diminished in smokers, more prominently among heavy smokers; but thrombocyte aggregation and adhesivity in ex vivo circumstances, does not appear to be affected by smoking.

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Yeni geliþmekte olan immünsüpresif tedavi rejimlerine raðmen kalp nakli ameliyatlarýnda özellikle ilk üç ayda görülen rejeksiyon epizodlarý önemli morbidite ve mortalite nedeni olmaya devam etmektedir. Teofilin post-transplant görülebilen bradikardinin tedavisinde yeri olan bir ilaçtýr. Bu ilacýn ayný zamanda bir takým immün düzenleyici etkilerinin olduðu bilinmektedir. Bu çalýþmada post-transplant bradikardi nedeniyle teofilin kullanýlan 27 hasta ile ayný immünsüpresif rejimle tedavi edilmiþ ve rejeksiyon risk faktörleri benzer olan 29 hastanýn endomiyokardiyal biopsi sonuçlarý, hücresel ve humoral rejeksiyon epizodlarý sýklýðý, hemodinamik bozukluða yol açan rejeksiyon epizodlarý ve ilk rejeksiyona kadar geçen süre retrospektif olarak araþtýrýldý. Teofilin kullanýmýnýn hücresel ve humoral rejeksiyon epizod-larýnýn sýklýðýný azaltmadýðý, hemodinamik bozukluða yol açan rejeksiyon epizodlarýna da etkisi olmadýðý görüldü. Ancak teofilin kullanýmý ile 3 aylýk ortalama biyopsi skorlarýnda anlamlý azalma (kontrol grubu 0.98 ± 0.51, teofilin grubu 0.73 ± 0.42) (p=0.04) ve ilk rejeksiyonun görülme süresinde uzama tespit edildi (kontrol grubu 24 ± 21 gün, teofilin grubu 51 ± 26 gün) (p=0.05). Sonuç olarak teofilinin immün süpresif tedavi rejimlerine eklenmesinin rejeksiyon epizodlarý yönünden olumlu etkisinin olabileceðini düþündük. Prospektif, randomize daha fazla hastayla yapýlacak çalýþmalarýn, ilacýn immünsupresif tedavi rejimlerine adjuvan olarak eklenme potansiyelini daha iyi ortaya koyacaðýný düþünüyoruz.

Despite new medical therapies in immunosuppressive regimen for heart transplantation patients, rejection still has an important role for morbidity and mortality especially in the first three months of transplantation. Theophylline is a drug which can be used to treat post-transplant bradycardia. This drug is also known to have some immunemodulatory effects. In the present study we investigated the clinical and laboratory indices of rejection in 27 patients treated with theophylline for post-transplant bradycardia. We examined 29 patients treated with the same immunosuppressive regimen as the control group. The study was done retrospectively. The clinical risk factors for rejection were similar for both groups. We searched for endomyocardial biopsy scores, number of cellular and humoral rejection episodes and rejection episodes with hemodynamic compromise. We observed that number of cellular and humoral rejection episodes and number of episodes with hemodynamic compromise did not change with theophylline therapy. However, average biopsy scores were influenced favorably with theophylline therapy (control group 0.98 ± 0.51, theophylline group 0.73 ± 0.42) (p=0.04), and time to first rejection was prolonged in patients using theophylline (control group 24 ± 21 days, theophylline group 51 ± 26 days) (p=0.05). We concluded that adding theophylline to the standard immunosuppressive regimen might favorably affect the rejection process. Prospective, randomized, larger studies to test the potential role of theophylline as an adjunct therapy to the standard immunosuppressive regimen is probably indicated.

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Kalp yetersizliði olanlarda ve normal þahýslarda sol ventrikülün (SV) sistolik ve diyastolik fonksiyonlarý üzerine sol dal blokunun (LBBB) etkisini araþtýrmak için bu çalýþmayý planladýk. Metot: Kalp yetersizliði ve LBBB olan 36 (grup I), kalp yetersizliði olan ve LBBB olmayan 36 (grup II) ve izole LBBB olan 41 (grup III) hasta grubunun karþýlaþtýrmasý yapýldý. Grup I ve grup II'deki tüm hastalara, grup III'deki 20 hastaya koroner anjiyografi uygulandý ve SV diyastol sonu basýnçlarý ölçüldü. Tüm hastalara ekokardiyografi yapýldý. Sol ventikül ejeksiyon fraksiyonu ve ortalama dairesel lif kýsalma hýzý ölçüldü. Aþaðýdaki Doppler ekokardiyografi parametreleri deðerlendirildi; mitral kan akýmý üzerinden zirve hýzlý doluþ hýzý (E dalgasý), zirve atriyal doluþ hýzý (A dalgasý), E ve A dalga integralleri, E dalgasý akselerasyon zamaný ve deselerasyon zamaný (EDZ) ile hýzlarý (EAH ve EDH), E/A ve integralleri oraný, diyastolik akým zamaný (DZ); ayrýca aort ve mitral akým hýzlarý eþ zamanlý kaydedilerek ejeksiyon zamaný, izovolümetrik relaksasyon zamaný (ÝRZ) ve preejeksiyon periyodu ölçüldü. Bulgular: SV diyastol sonu basýnçlarý grup I, II ve III'de sýrasýyla 28±4, 22±5, 15±3 mmHg olarak ölçüldü. Grup III hastalarýnda sistolik fonksiyon parametreleri farklý olmasýna raðmen grup II ve III hastalarýnda diyastolik fonksiyon parametreleri oldukça benzer bulundu. Grup I ve II'nin karþýlaþtýrýlmasý, SV sistolik fonksiyon parametreleri benzer olmasýna karþýn diyastolik fonksiyon parametrelerinin istatistiksel olarak farklý olduðunu gösterdi. (E/A, p=0.004; EAH, p<0.001; EDH, p<0.001; EDZ, p<0.001; ÝRZ, p=0.024; DZ, p=0.03). Sonuç: LBBB olan ve olmayan kalp yetersizliði ve izole LBBB bulunan olgularda LBBB'nun etkilerini deðerlendiren bu çalýþma göstermiþtir ki, LBBB normal þahýslarda kalp yetersizliði hastalarýndakine benzer diyastolik fonksiyon bozukluðuna sebep olurken, kalp yetersizliði bulunan hastalarda diyastolik fonksiyon bozukluðunu arttýrmaktadýr.

We designed this study to examine the effect of left bundle-branch block (LBBB) on systolic and diastolic functions of the left ventricle (LV) in patients with heart failure and in subjects with isolated LBBB. Methods: A comparison between 36 patients with heart failure and LBBB (group I), 36 patients with heart failure without LBBB (group II) and 41 subjects with isolated LBBB (group III) was made. Coronary angiography was performed in all patients with group I and group II, and in 20 patients of group III. LV end-diastolic pressure was calculated. Echocardiography was performed in all patients. LV ejection fraction and mean rate of circumferential shortening were calculated. The following Doppler parameters were also evaluated: peak rapid filling velocity (E wave), peak atrial filling velocity (A wave), E and A wave integrals, E wave acceleration time, deceleration time (EDT) and rates (EAR and EDR), the E/A ratio and its integral, and diastolic flow time (DT). The ejection time (ET), isovolumetric relaxation time (IRT) and preejection period were measured using the aortic and mitral flow velocities. Results: LV end-diastolic pressure was calculated as 28±4 mmHg in group I, 22±5 mmHg in group II, and: 15±3 mmHg in group III. Although the systolic function parameters in group-III patients were different, the diastolic function parameters were found to be quite similar in both patients with group II and III. Comparison with group I and group II patients showed that there was a similarity between LV systolic function parameters while the diastolic function parameters were statistically different (E/A, p=0.004; EAR, p<0.001; EDR, p<0.001; EDT, p<0.001; IRT, p=0.024; DT, p=0.03). Conclusion: We confirmed that LBBB causes diastolic function impairment in subjects with isolated LBBB similar to those of patients with heart failure, and it also augments the impairment of diastolic function in patients with heart failure.

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Obezite, ani kardiyak ölüm için bir risk faktörüdür ve baþlýca nedenini aritmiler oluþturmaktadýr. Kardiyak repolarizasyonun gecikmesi aritmilere duyarlýlýðý artýrýr ve elektrokardiyografiye (EKG) QT intervalinin uzamasý olarak yansýr. QTD ve QTcD repolarizasyonun homojen olmadýðý durumlarda yükselir ve her ikisi de ventriküler aritmi için iyi birer belirleyicidir. Bu çalýþmanýn amacý obez çocuklarda QT, QTc, QTD ve QTcD deðerlerinin araþtýrýlmasý ve obezitede repolarizasyon bozukluklarýnýn çocukluk çaðýnda baþlayýp baþlamadýðýnýn gösterilmesidir. Çalýþmaya yaþlarý 6-16 yýl arasýnda deðiþen (ort. 10,7±2,5) 34 obez çocuk alýndý. Çocuklarda obezite tanýsý vücut kitle indeksine (BMI) göre konuldu. Kontrol grubunu obez çocuklara yaþ ve cinsiyet olarak eþ 60 çocuk oluþturuyordu (7-15,5 yýl, ort 10,6±2,4 yýl). Tüm çocuklara 12 derivasyonlu EKG çekilerek QT, QTc, QTD ve QTcD deðerleri hesaplandý. Hasta ve kontrol grubundan kan örnekleri alýnarak hemoglobin ve elektrolit düzeyleri bakýldý. Hemoglobin ve elektrolit düzeyleri açýsýndan iki grup arasýnda fark bulunamadý. QT ve QTc intervallerinin iki grup arasýnda farklýlýk göstermediði görüldü (p>0,05). QTD ve QTcD deðerleri ise obez grupta kontrol grubuna göre anlamlý derecede yüksekti (p<0,001) (Obez; QTD=51±18 ms, QTcD=72±24 ms, kontrol; QTD=40±10 ms, QTcD=48±10 ms). BMI deðerleri ile QT süresine iliþkin parametrelerin arasýnda korelasyon olmadýðý görüldü. Sonuç olarak, QTD ve QTcD deðerlerinin artmýþ olmasý obez çocuklarda ventriküler repolarizasyonun bozulduðunu, ve bu deðiþikliklerin çocukluk döneminde baþladýðýný göstermektedir.

Obesity is known to be a risk factor of cardiac death, associated above all with cardiac arrhythmias. Delayed cardiac repolarization leading to the prolongation of the QT interval is a well recognized precursor of arrhythmias. The QT interval dispersion (QTD) and corrected QT interval dispersion (QTcD) reflect inhomogeneity of repolarization, and are measurable indices of ventricular arrhythmia risk. The aim of this study was to asses QT, QTc, QTD, and QTcD values in obese children, and find out whether repolarization abnormalities begin in childhood. Thirty-four obese children (6-16 years, mean 10,7±2,5 years) were included in the study. Obesity was defined according to the body mass index (BMI). Sixty control patients (7-15,5 years, mean 10,6±2,4 years) were matched in age and gender with the obese patients. A 12-lead conventional electrocardiogram was performed in all children. A blood sample was obtained for measuring hemoglobin and of concentrations plasma electrolytes. Hemoglobin and electrolyte levels showed no statistically significant difference between patients and controls. QT and QTc intervals were similar in both groups (p>0,05), but QTD and QTcD values were significantly higher in obese children than in controls (p<0,001) (patients QTD=51±18 ms, QTcD=72±24 ms; controls; QTD=40±10 ms, QTcD=48±10 ms). There was no correlation between BMI values and the QT intervals. Our findings suggest that, increased QTD and QTcD in obese children indicate ventricular repolarization abnormalities, and that these changes start in the childhood period of obesity.

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Ýnfarkt alanýnda canlý dokunun varlýðý ve bunun tespiti hastalýðýn tedavi þeklinin belirlenmesi ve prognozu yönünden önemlidir. Bu çalýþmada;Q dalgalý miyokard infarktüsü (MÝ) geçirmiþ vakalarda, egzersizle oluþan T dalgasý normalizasyonun infarkt alanýndaki canlý dokuyu göstermedeki deðeri araþtýrýldý. Çalýþma grubu iþlemden 2-7 ay önce Q dalgalý MÝ geçirmiþ,ilgili derivasyonlarýn en az ikisinde T dalgasý negatifliði olan ve Talyum-201 tekrar enjeksiyon miyokard perfüzyon sintigrafisi uygulanan 75 hastayý (71E, ort.yaþ 55±10) içermekteydi. Vakalar, patolojik Q dalgalý derivasyonlarýn en az ikisinde eforla pozitifleþen T dalgasý varlýðýna göre iki gruba ayrýlarak (Grup-1: Eforla T dalgasý pozitifleþen 45 hasta; Grup-2:Eforla T dalgasý pozitifleþmesi olmayan 30 hasta) incelendi. Gruplar arasýnda yaþ, cins, egzersiz kapasitesi, çift-ürün yönünden istatistiksel olarak anlamlý bir fark saptanmadý. Buna karþýn canlý doku varlýðý Grup-1'de 45 hastanýn 29(%64)'unda görülürken, Grup-2'de 30 hastanýn 9(%30)'unda görüldü. Canlý doku varlýðý yönünden her iki grup arasýnda istatistiksel olarak anlamlý fark saptandý (Sýrasýyla %66'ya karþýlýk, %30; p<0,001). T dalga normalizasyonun infarkt alanýndaki canlý dokuyu göstermedeki sensitivitesi %76, spesifisitesi %56 ve test doðruluðu %66 olarak hesaplandý. Sonuç olarak; yakýn dönemde Q dalgalý MÝ geçirmiþ hastalarda eforla negatif T dalgasýnýn pozitifleþmesi infarkt alanýnda canlý doku varlýðý ile ilgili olabilir. Böylece egzersiz testi diðer tanýsal amaçlarýndan ve bulgularýndan baðýmsýz olarak Q dalgalý MÝ geçirmiþ hastalarda, infarkt alanýnda canlý doku varlýðýný belirlemede yardýmcý güvenilir bir yöntem olarak kullanýlabilir.

In clinical practice, determination of viable myocardium in infarcted area is important for subsequent management and prognosis. The aim of the study was to evaluate the relationship between T-wave normalisation during exercise testing and detection of viable tissue in infarcted area by Thallium-201 re-injection study. Study group included 75 patients (71 M,4 F, mean age 55+/-10) with myocardial infarction that was diagnosed 2-7 months before exercise testing. Thallium-201 stress re-injection myocardial perfusion scintigraphy (SPECT) was performed in all patients. The study group was divided into two subgroups according to the presence or absence of transient T-wave normalisation associated with Q-wave leads corresponding to the infarcted area. During exercise testing, T-wave normalisation was observed in 45 patients in at least two contiguous leads (group 1). T-wave normalisation was not observed in the remaining 30 patients (group 2). The prevalence of viable tissue in infarcted area was higher in group 1 than group 2 (66% vs. 30%; p<0.001). The sensitivity, specificity, and accuracy of T-wave normalisation for detection of viable tissue were 76%, 56%, and 64%, respectively. In conclusion, T-wave normalisation during exercise testing is associated with higher prevalence of viable tissue in infarcted area compared to patients with persistent wave inversion.

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Büyük þantlý duktus arteriozus açýklýðý nedeni ile kilo alamayan ve sýk alt solunum yolu enfeksiyonu geçiren 8.5 aylýk bir sütçocuðunda Jackson "coil" ile oklüzyon uygulandý. Ýþlemden sonra yapýlan Doppler ekokardiografik incelemede inen-aorta sarkan "coil" helezonlarý nedeni ile jukstaduktal bölgede Doppler ekokardiyografide koarktasyon eðrisi elde edildi. Ýzlem sýrasýnda inen aorttaki turbulan akýmýn ve Doppler basýnç farkýnýn kendiliðinden azaldýðý görüldü.

Coil occlusion of patent ductus arteriosus was performed in an 8.5-month-old infant who had frequent lower respiratory tract infections and growth retardation due to big left-to-right shunt through a wide arterial duct. Post-occlusion echocardiographic examination revealed iatrogenic coarctation of the aorta with typical Doppler echocardiographic findings because of the protrusion of the loops of the coil into the descending aorta. The problem was resolved spontaneously during follow-up.

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11 aylýk, 6 kg. erkek çocuk, mitral kapak hastalýðý, sol ventrikül çýkýmýnda darlýk ve pulmoner hipertansiyon tanýlarý ile yatýrýldý. Bebeðe 6 aylýk iken supravalvüler aorta darlýðý nedeniyle açýk kalp ameliyatý ve perikard yama ile supravalvüler geniþletme yapýlmýþtý. Reoperasyonda mitral kapaðýn granülomatöz bir yapýda olduðu ve sol ventrikülün hem giriþi hemde çýkýþýnda obstrüksiyon yarattýðý görüldü. 21 no. aortik St. Jude protez kapak, ters çevrilip mitral annulusun 4-5 mm üzerine dikilerek mitral kapak replasmaný yapýldý. Postoperatif 10.günde taburcu edilen bebek, 1.yýlda iyi durumda yaþantýsýný sürdürmektedir.

An 11-month-old, 6 kg. male child was operated on due to mitral valve pathology, left ventricular outflow tract obstruction and moderate degree of pulmonary hypertension. He had had an open heart surgery and pericardial patch reconstruction of supravalvular aortic stenosis 5 months ago. During reoperation, mitral valve was looking like a granulomatous mass and it was causing significant left ventricular inlet and outlet obstruction. After mitral resection the valve was replaced with St. Jude (no.21) aortic prosthesis. Aortic prosthesis was reversed and implanted on 4-5 mm above the mitral annulus. He was discharged on the 10th day. One year later he became quite active and is growing up without any restriction.

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