Objectives: We retrospectively reviewed patients with infective endocarditis (IE). Study design: Thirty-three patients (13 girls, 20 boys; mean age 8.6±4.3 years; range 9 months to 17 years) were treated for IE at Hacettepe University İhsan Doğramacı Children’s Hospital during an 11-year period. This retrospective evaluation included predisposing factors, signs and symptoms on presentation, physical examination and laboratory findings, treatment modalities, and the results. Results: Twenty-two (66.7%) and 11 (33.3%) patients had congenital and rheumatic heart diseases, respectively. Eleven patients (50%) with congenital heart disease had a history of previous surgery, six (54.6%) of whom were operated on two months before the diagnosis of IE. Antibiotics were used in 15 patients (45.5%) for various periods before a week to the diagnosis. Transthoracic echocardiography showed vegetations in 29 patients (87.9%). Blood cultures were positive in 54.6% of the patients, with gram-negative bacteria accounting for the majority of cases. Nineteen patients (57.6%) received medical therapy, while 14 patients (42.4%) were treated both medically and surgically. Echocardiographic findings were consistent with intraoperative findings. There were no deaths among surgically treated patients, whereas five patients (26.3%) died while on medical treatment, all of whom had cerebral, pulmonary, and/or renal emboli. The most frequent complications were congestive heart failure (36%), glomerulonephritis (27%), and peripheral embolism (21.2%). Conclusion: Timely diagnosis and surgical treatment are of utmost importance in IE patients, particularly in those in whom gram-negative and staphylococcal bacteria may considerably increase morbidity and mortality.

Objectives: This study was designed to compare clinical, electrocardiographic, echocardiographic, and hemodynamic features of patients with end-stage cardiac failure, who died or were alive while on the heart transplant waiting list. Study design: Sixty patients (47 men, 11 women; mean age 56±11 years) who were on the waiting list were studied in two groups. Group I included those who died (n=26; 17 men, 9 women; mean age 44±17 years) and group II included those who were alive (n=34; 30 men, 4 women; mean age 46±5 years) while waiting for a suitable donor. The two groups were compared with regard to demographic and clinical (United Network for Organ Sharing - UNOS - status) characteristics, medical therapies, risk factors for coronary artery disease, electrocardiographic (QT dispersion, QRS duration) and echocardiographic findings, and hemodynamic parameters. Results: No significant differences existed between the two groups with regard to age, risk factors for atherosclerosis, atrial fibrillation, etiologies of heart failure, and the cardiac index. However, the following parameters differed significantly in group I: the number of female patients (p=0.04); the number of patients with IB status according to the UNOS criteria (p=0.01); both the QT dispersion interval and corrected QT dispersion (p<0.001); right ventricular ejection fraction (p=0.002); pulmonary artery systolic pressure (p=0.002) and right ventricular end-diastolic diameter (p=0.01); and transpulmonary gradient (p<0.03). Conclusion: Consideration of significant determinants of mortality in patients awaiting heart transplantation may contribute to decreases in mortality due to heart failure.

Objectives: Obesity is known to increase the incidence of hypertension. We investigated the effect of hypertension on the results of cardiopulmonary exercise test in obese women. Study design: Among women who applied for routine cardiovascular examination, three groups were formed: group A consisted of 22 obese patients with body mass index (BMI) ?30 kg/m2 and stage 1 hypertension; group B consisted of 22 otherwise healthy obese women (BMI<30 kg/m2), and group C included 16 nonobese (BMI<25kg/m2) healthy individuals. Symptom-limited cardiopulmonary exercise testing was performed in all the subjects to measure walk time (WT), peak VO2 (maximal oxygen consumption), VO2 at anaerobic threshold (AT), minute ventilation (VE), peak heart rate (HR), and VE/VO2. Before and during testing, blood pressures were recorded and electrocardiographic studies were made. Results: There were no significant differences between the three groups with regard to age, the ejection fraction, and left ventricular mass index. Groups A and B did not differ with regard to BMI and left ventricular diastolic dysfunction. Significant differences were found between groups A and B with regard to WT, peak VO2, AT, VE, and systolic and diastolic blood pressures measured before and after the test (p=0.0001). Compared to group C, WT (p=0.002), peak VO2 (p=0.0001), and VE (p=0.05) were significantly different in group B, whereas AT did not reach significance (p=0.189). Between the two obese groups, WT (p=0.002), peak VO2 (p=0.042), AT (p=0.005), and VE (p=0.02) differed significantly, whereas VE/VO2 did not (p=0.978). Conclusion: Our data show that the presence of hypertension in obese women is an important additional risk factor for further restrictions in the functional capacity.

Fistulas are the most common anomaly of the coronary arteries. A 48-year-old woman presented with typical chest pain. She had no cardiovascular risk factors and no ischemic signs. Transthoracic echocardiography revealed a diastolic turbulence at the distal part of the pulmonary artery and an aberrant vascular structure on parasternal short-axis views. Coronary angiography showed a fistula from the the left anterior descending artery to the pulmonary artery, associated with an aneurysmal sac 16 mm in diameter, before reaching the pulmonary artery. The patient refused surgical treatment.

A 71-year-old man presented with shortness of breath that increased in severity within the past six hours. Medical treatment following an initial diagnosis of acute pulmonary edema improved his symptoms. Coronary angiography performed on the seventh day of admission showed total occlusion of the left main coronary artery and well-developed collateral vessels extending from the right coronary artery to the left anterior descending (LAD) and circumflex arteries. Surgical treatment included anastomosis of the left internal mammary artery to the LAD artery and an aorto-circumflex artery bypass using a saphenous graft. Postoperative period was uneventful and his complaints did not recur within a follow-up period of 10 months. The favorable prognosis was attributed to the development of collateral vessels.

Cor triatriatum is a rare congenital cardiac anomaly in which the left atrium is divided into two compartments by an abnormal fibromuscular septum, resulting in varying degrees of obstruction of the pulmonary venous return and causing pulmonary venous and pulmonary arterial hypertension. Echocardiographic examination showed cor triatriatum in a six-month-old female infant who had frequently recurring lung infections and immune deficiency. She was submitted to surgery where the diagnosis was confirmed by cardiac catheterization and angiography. Since open surgical correction, she has been under follow-up for six months without any complications.

Statins and fibrates are two diverse groups of antilipemic drugs with different mechanisms of action and metabolism. Statins are the most effective drugs in lowering low-density lipoprotein (LDL) cholesterol levels. Fibrates decrease triglyceride-rich lipoprotein and atherogenic small-dense LDL levels while increasing the level of high-density lipoprotein (HDL). However, monotherapies with statins or fibrates may not always improve the lipid profile of patients with combined hyperlipidemia, which includes diabetes and metabolic syndrome, and hereditary primary severe hypercholesterolemia. In these situations, statin-fibrate combination therapy seems attractive because of their complementary actions on lipoprotein metabolism. Combination therapy has been reported to be very effective in lowering both triglyceride and LDL cholesterol levels. However, early reports of increased incidence of myopathy and rhabdomyolysis in patients treated with statin-fibrate combination have been somewhat discouraging. More recent studies have shown that the occurrence of myopathy is less than expected. In this paper, the role of combined statin-fibrate therapy in dyslipidemia, their mechanisms of action, efficacy and safety of statin-fibrate combination therapy, and precautions needed to be taken to reduce side effects are reviewed in the light of literature.

Potassium plays an important role in cell metabolism and membrane excitability and imbalances in its concentration are important because of ensuing life-threatening conditions. Potassium balance may be disturbed by both the neurohormonal mechanisms in cardiovascular diseases and the drugs used in these diseases. In particular, complications such as malignant ventricular arrhythmias and sudden death are of great concern in potassium instability. This article reviews current knowledge on the drugs that affect potassium balance and the relationship between the potassium ion and cardiac diseases.