Amaç: Bu çaJýþmada, doðuþtan Kalp hastalýðý nedeniyle daha önce sternotomi ile tamir uygulandýktan sonra tekrar ameliyat edilen astalarda yeniden ameliyat nedenleri, uygulanan cerrahi teknik ve sonuçlan deðerlendirildi.
Çalýþma planý: Çalýþmaya sternotomi ile tamirden sonra yeniden ameliyat edilen 108 hasta (59 erkek. 49 kadýn; ort. yaþ 10.2±9.7: daðýlým 9 gün-58 yýl) alýndý. Üç hastada sað torakotomi, üç hastada Clamshell insizyonu tercih edilirken, 102 hastada yeniden sternotomi yapýldý. Otuz üç hastada daha önceki palyatif bir giriþimi takiben tam düzeltme, altý hastada ise tekrar palyatif bir giriþim uygulandý. Diðer ameliyatlar veya nedenleri þunlardý: Sað ventrikul çýkýþ yolu ameliyatý (n=2l), atriyoventrýküler kapak ameliyatý (n=l6), sol ventrikul çýkýþ yolu ameliyatý (n=l3), Fontan revizyonlarý (n=7), arteryel switch/doubte swtch sonrasý ameliyatlar (n-7), pufmoner venöz dönüþ restenozu (n=2), rezidüel veya tekrarlayan atriyal/ventriküler septal defekt (n-2), Senning sonrasý triküspid yetersizliði, aritmi (n=l).
Bulgular: Erken dönemde dokuz hasta (%8,3) kaybedildi. On üç hastada (%13,1) yoðun bakýmda kalýþ süresi bir hafta veya üzerinde idi. Birisi kaybedilen hasta olmak üzere, iki hastada sternum açýlýrken ciddi kanama geliþti. Ameliyat sonrasýnda þu komplikasyonlar görüldü: Kanama revizyonu (n=2), kalýcý pacemaker implantasyonu (n=3), trakeostomi (n=6), plevral efüzyon (n=7), pnomotoraks (n=1), þilotoraks (n=l), sað diyafragma paralizisi (n=3), geçici serebrovasküler olay (n=1).
Sonuç: Doðuþtan kalp anomalilerinin tedavisinde yeniden ameliyat ihtiyacý daha çok aþamalý tamir gereksinimi veya Kaçýnýlmaz olarak ortaya çýkan sorunlardan kaynaklanmaktadýr. Endikasyonlarýn ve zamanlamanýn patolojiye ve uygulanacak iþleme göre doðru belirlenmesi gerekir.

Objectives: We evaluated the causes of reoperations, surgical techniques, and results of patients who had undergone a previous repair by sternotomy for congenital heart defects.
Study design: The study included 108 patients (59 males, 49 females; mean age 10.2±9.7 years; range 9 days to 58 years) who required a reoperation following a repair by sternotomy. A right thoracotomy was performed in three patients, Clamshell incision in three patients, and resternotomy in 102 patients. Thirty-three patients under-went total repair follovving a palliative procedure, while six patients underwent a subsequent palliative procedure. Other reoperations were performed for the follovving: right ventricle outflow tract (n=21), atrioventricular valve (n=16), left ventricle outflovv tract (n=13), Fontan revisions (n=7), arterial switch/double svvitch reoperations (n=7), pulmonary venous retum restenosis (n=2), residual/recurrent atrial/ventricular septal defect (n=2), tricuspid regurgitation and arrhythmia after the Senning operation (n=1).
Results: Hospital mortality occurred in nine patients (8.3%). Thirteen patients (13.1%) experienced a prolonged intensive care unit stay (>1 week). During sternal reentry major hemorrhage occurred in two patients, one of whom died. Postoperative complications included re-exploration for bleeding (n=2), permanent pacemaker implantation (n=2), tracheostomy (n=6), pleural effusion (n=7), pneu-mothorax (n=1), chylothorax (n=1), right diaphragmatic paralysis (n=3), and transient cerebrovascular event (n=1).
Conclusion: The majority of reoperations after repair of congenital heart defects are due to staged repairs or to inevitably ensuing problems. Proper indications and tim-ing are essential dependi

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Amaç: Perkütan mitral balon valvüloplastinin (PMBV) global sol ventrikül sistolik ve diyastolik fonksiyonlarý üzerine etkisi total ejeksiyon isovolümetik (TEÝ) indeks ile deðerlendirildi.
Çalýþma planý: Ýzole romatizmal sýký mitral darlýk nedeniyle PMBV uygulanan ardýþýk 76 hasta (16 erkek, 60 kadýn; ortanca yaþ 36; daðýlým 19-68) incelendi. Mitral lateral annulustan yapýlan pulse-dalga doku Doppler ekokardiyografi ile sistolik ve diyastolik fonksiyon parametreleri ve bu verilerden hesaplanan TEÝ indeksi, PMBV öncesinde, iþlemden 48 saat ve üç ay sonra deðerlendirildi.
Bulgular: Ýþlem sonrasý erken dönemde, diyastolik fonksiyon parametrelerinden maksimum erken diyastolik hýz (p=0.001) ve erken-geç diyastolik hýz oranýnda (p=0.02) artýþ, isovolümetrik relaksasyon zamanýnda düþme (p=0.02); sistolik fonksiyon göstergesi olarak da maksimum sistolik hýzda (p=0.01) anlamlý artýþ görüldü. Global fonksiyonlarý yansýtan TEÝ indeksinde ise, iþlem öncesine göre (TEÝ indeksi 0.7±0.3), iþlemden 48 saat (TEÝ indeksi 0.5±0.2, p=0.06) ve üç ay sonra (0.6±0.2, p=0.97) gözlenen azalma istatistiksel olarak anlamlý deðildi.
Sonuç: Mitral annuler sistolik ve diyastolik fonksiyon göstergelerinde PMBV sonrasýnda iyileþme olmasýna raðmen, TEÝ indeksinde anlamlý deðiþiklik oluþmamaktadýr. Mitral annuler longitudinal hareketteki deðiþiklikler, subvalvuler aparatusun kýsmen serbestleþmesi sonucu fonksiyonel sýnýrlamanýn ortadan kalkmasýna baðlý olabilir.

Objectives: We evaluated the effect of percutaneous mitral balloon valvuloplasty (PMBV) on global systolic and diastolic functions of the left ventricle with the use of the total ejection isovolume (TEI) index.
Study design: The study included 76 consecutive patients (16 males, 60 females; median age 36 years; range 19 to 68 years) who underwent PMBV for isolated rheumatic mitral stenosis. Systolic and diastolic indexes were measured by pulsed Doppler tissue imaging echocardiography from the mitral lateral annulus and the TEI index was calculated before, and 48 hours and three months after PMBV.
Results: Concerning diastolic function parameters, there was an improvement in the maximum early diastolic velocity (p=0.001), early and late diastolic velocity ratio (p=0.02), and a decrease in the isovolumetric relaxation time (p=0.02) immediately after PMBV. Maximum systolic velocity (p=0.01) improved as a systolic function parameter. Left ventricular global function did not improve significantly 48 hours (TEI indices 0.7±0.3 vs 0.5±0.2, p=0.06) and three months (0.7±0.3 vs. 0.6±0.2, p=0.97) after PMBV.
Conclusion: Parameters of mitral annular systolic and diastolic functions seem to be improved after PMBV, accompanied by an insignificant change in the TEI index. These changes in myocardial longitudinal functions may be due to the relief of functional restriction by the mobilization of the subvalvular apparatus.

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Amaç: Akut miyokard infarktüsü geçiren hastalarda, koroner anjiyografiyle kanýtlanmýþ koroner arter darlýðýnýn belirlenmesinde multidedektör bilgisayarlý tomografinin (MDBT) baþarýsý araþtýrýldý.
Çalýþma planý: Akut miyokard infarktüsü tanýsýyla hastaneye yatýrýlan 18 hastaya (6 kadýn, 12 erkek; ort. yaþ 51.3) klinik açýdan stabilizasyon saðlandýktan sonra koroner anjiyografi yapýldý. Daha sonra, iki gün içinde MDBT uygulandý. Koroner anjiyografiyle koroner arter lümeninde %50'den fazla darlýk görülen segmentler belirlendi ve bu segmentler MDBT ile deðerlendirmeye alýndý.
Bulgular: Koroner anjiyografi ile deðerlendirilen 288 seg-mentin 48'inde %50 üzerinde darlýk saptandý. Bu lezyon-larýn 24'ü (%50) MDBT ile görüntülenebildi (duyarlýlýk %50, özgüllük %97.5). Multidedektör bilgisayarlý tomografi, proksimal segmentlerde koroner anjiyografiyle belirlenen 10 lezyonun dokuzunda (duyarlýlýk %90, özgüllük %98.4, pozitif öngördürücü deðer %90, negatif öngördürücü deðer %98.4); orta segmentlerde 12 lezyonun yedisinde (duyarlýlýk %58.3, özgüllük %95.8, pozitif öngördürücü deðer %87.5, negatif öngördürücü deðer %82.1); distal segmentlerde 14 lezyonun üçünde (duyarlýlýk %21.4, özgüllük %92.5, pozitif öngördürücü deðer %50, negatif öngördürücü deðer %77.1) baþarýlý bulundu.
Sonuç: Ýnvaziv olmayan bir görüntüleme yöntemi olan MDBT, proksimal koroner arter segmentlerinin ve göreceli olarak orta segmentlerin deðerlendirilmesinde güvenle kullanýlabilir.

Objectives: The success of multidetector computed tomography (MDCT) was assessed in detecting coronary artery stenoses in patients with angiographically proven coronary artery disease following acute myocardial infarction.
Study design: Eighteen patients (6 women, 12 men; mean age 51.3 years) who were hospitalized with the diagnosis of acute myocardial infarction undervvent coronary angiography after clinical stabilization was restored. Within two days of coronary angiography MDCT was performed. Segments that were angiographically shown to have stenosis exceeding 50% of the coronary artery lumen were evaluated by MDCT.
Results: Of 288 segments studied, coronary angiography showed more than 50% stenosis in 48 segments, of which 24 segments (50%) were also demonstrated by MDCT (sensitivity 50%, specificity 97.5%). The success of MDCT according to the localization was as follovvs: nine in 10 proximal segments (sensitivity 90%, specificity 98.4%, positive predictive value 90%, negative predictive value 98.4%); seven in 12 middle segments (sensitivity 58.3, specificity 95.8%, positive predictive value 87.5%, negative predictive value 82.1%); and three in 14 distal segments (sensitivity 21.4, specificity 92.5%, positive predictive value 50%, negative predictive value 77.1%).
Conclusion: Multidetector computed tomography can be safely used as a noninvasive imaging method in the assessment of proximal and, in part, middle coronary artery segments.

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Amaç: Akut miyokard infarktüslü (AMÝ) hastalarda erken dönem kollateral dolaþým (KD) varlýðý araþtýrýldý ve bunun klinik, elektrokardiyografik ve anjiyografik parametrelerle iliþkisi deðerlendirildi.
Çalýþma planý: Çalýþmaya, ilk altý saat içinde baþvuran AMÝ'li 79 hasta (63 erkek, 16 kadýn; ort. yaþ 57) alýndý. Primer anjiyoplasti öncesinde koroner anjiyografi ile infarktla iliþkili damar, anlamlý darlýk (>%50 darlýk) saptanan damar sayýsý, sorumlu damarda lezyonun yeri (proksimal, orta ve distal) ve KD varlýðý kaydedildi. Ýnfarktla iliþkili damara KD'nin derecesi Rentrop sýnýflamasýna göre deðerlendirildi. Ýlk altý saat içinde çekilen EKG'lerde Q dalgasý varlýðý ve resiprokal ST segment deðiþiklikleri belirlendi.
Bulgular: Otuz bir hastada (%39.2) infarktla iliþkili damara KD görüldü. Sorumlu lezyon 43 hastada (%54.4) sol ön inen (LAD) koroner arter, 11'inde (%13.9) sirkumfleks (Cx) arter, 25'inde (%31.7) sað koroner arterde (RCA) idi. Ýlk altý saat içindeki EKG'de, 34 hastada (%43) Q dalgasý görülmedi; resiprokal ST segment çökmesine ise 53 hastada (%67.1) rastlandý. Kollateral dolaþým RCA týkanmalarýnda, LAD ve Cx týkanmalarýna göre daha fazla görüldü (sýrasýyla %60, %32.6 ve %18.2, p=0.012). Kollateral dolaþým varlýðý ile hipertansiyon (r=0.226, p=0.045) ve RCA týkanmasý (r=0.309, p=0.006) arasýnda anlamlý iliþki bulundu. Çokde-ðiþkenli regresyon analizinde, sadece RCA týkanmasýnýn KD varlýðýný öngörmede baðýmsýz belirleyici olduðu görüldü (r=0.377, p<0.001).
Sonuç: Kollateral dolaþým, AMÝ'nin erken döneminde, hipertansiyon öyküsü ve RCA týkanmasý olan hastalarýn önemli bir kýsmýnda iþlevsel hale gelmektedir. Bu bulgular AMÝ'de tedavi seçiminde (invaziv/konservatif) yardýmcý olabilir.

Objectives: We investigated the presence of collateral circulation (CC) during early period of acute myocardial infarction (AMI) and evaluated its relationship with clinical, electrocardiographic, and angiographic parameters.
Study design: Ýn 79 patients (63 men, 16 vvomen; mean age 57 years) who presented within the first six hours of AMÝ, coro-nary angiography was performed before primary angioplasty to determine the infarct-related artery (IRA), the number of arteries with significant stenosis (≥50%), localization of stenosis (proxi-mal, middle, or distal), and the presence of CC. The presence of Q waves and reciprocal ST-segment changes were evaluated on initial electrocardiograms. Collateral circulation to the IRA was graded according to the Rentrop scoring system.
Results: Collateral circulation to the IRA was detected in 31 patients (39.2%). Ýnfarct-related artery was the left anterior descending (LAD) coronary artery in 43 patients (54.4%), circumflex (Cx) artery in 11 patients (13.9%), and the right coronary artery (RCA) in 25 patients (31.7%). On initial electrocardiograms, Q wave was absent in 34 patients (43%) and reciprocal ST-segment depression was present in 53 patients (67.1%). Collateral circulation was more common in RCA occlusions than those involving the LAD and Cx arteries (60%, 32.6%, and 18.2%, respectively; p=0.012). The presence of CC was significantly correlated with hypertension (r=0.226, p=0.045) and RCA occlusion (r=0.309, p=0.006). In multiple regression analysis, only RCA occlusion was found to be an independent predictor for CC (r=0.377, p<0.001).
Conclusion: In the early period of AMÝ, collateral circulation becomes functional in a considerable number of patients who have hypertension and RCA occlusion. This may be helpful in choosing between conservative and invasive treatments.

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Kardiyovasküler týp alanýnda 2005 yýlýnda ülkemizden kaynaklanan uluslararasý yayýnlarý deðerlendirmek amacýyla, Science Citation lndex'in CD edisyonuna kaynak dergilerdeki Türkiye adresli yayýnlar Web of Scien-ce'ten incelendi ve yalnýzca tam metinli makaleler dikkate alýndý. Birden fazla kurumdan ya da bilimdalýndan çýkan ortak yayýnlar için bir kredi sistemi uygulandý. Geçen yýl CD edisyonunda taranan dergilerde kardiyovasküler týp sahasýnda, Türkiye'den çýkan tam metinli makale sayýsý 161'e, dünyadaki payýmýz binde 8.6 düzeyine yükseldi. Ancak, makalelerin yer aldýðý dergilerin ortanca impakt faktörü 1.22'yi koruduysa da, impakt faktörü 2 veya üzerinde olan dergilerdeki yayýnlar üç yýl üstüste 22 civarýnda kalýrken, yükselme etki deðeri daha düþük dergilerdeki yayýnlarý ilgilendirdi. 2005 yýlýnda eriþkin kardiyolojisinde üretilen 126 makaleye karþýlýk, kardiyovasküler cerrahi yayýnlarý 24, çocuk kardiyolojisi 11 makalede kaldý. Anadolu'daki kurumlarýn performansý iyi sayýlabildiði halde; Türkiye Yüksek Ýhtisas Hastanesi, Gülhane Askeri Týp Akademisi ve Dr. Siyami Ersek Göðüs Kalp ve Damar Cerrahisi Merkezi dýþýnda, Ankara ve Ýzmir'deki birçok merkez düþüþte etken oldu. Akademik terfilerde yeni koþullar aranmasý zamanýnýn geldiði kanýsýndayýz.

The progress of the output of publications in cardiovascular medicine originating from Turkey's institutions in 2005 were evaluated based on data of the Web of Science. After exclusion of meeting abstracts and letters to the editor, articles in full-text appearing in source publications of Science Citation lndex CD Edition were included. A weighted credit system was used for items published jointly with a foreign or noncardiological Turkish institution. Turkey's publications rose to 161 articles and her share of world publications to 8.6 per mille. Though the median impact factor of periodicals publishing these articles remained 1.22 in three consecutive years, the number of papers published in joumals with an impact factor of 2 or over was unchanged around 22, and the observed rise involved those with an impact factor below 2. Of these, 126 articles were concerned with adult cardiology, 24 papers with cardiovascular surgery, and 11 vvith pediatric cardiology in 2005. In contradis-tinction to certain centers in Ankara and Ýzmir, the performances of medical faculties in Anatolia were, in general, satisfactory this year, vvith special reference to Türkiye Yüksek Ýhtisas Hospital, GATA, and S. Ersek Surgical Center. The time is ripe for modifying the regulation for academic promotions.

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Sol ve sað kalp yetersizliði tanýlarýyla yatýrýlan 84 yaþýnda bir kadýn hastada, mitral ve aort kapak yetersizliðiyle birlikte kor triatriatum sinister saptandý. Transtorasik ve transözofajiyal ekokardiyografiyle belirlenen bu doðumsal anomalinin tanýsý, manyetik rezonans ve kateter anjiyografi incelemeleriyle de desteklendi. Önce týbbi tedaviyle rahatlatýlan hastaya daha sonra kor triatriatum için düzeltici cerrahi iþlem uygulandý. Hasta iyileþmiþ halde taburcu edildi.

An 84-year-old woman was hospitalized for symptoms of left and right heart failure. Transthoracic and trans-esophageal echocardiography revealed cor triatriatum sinister vvhich was accompanied by mitral and aortic regurgitation. The diagnosis of this congenital anomaly was confirmed by magnetic resonance imaging and catheter angiography. After stabilization with medical therapy, surgical correction of cor triatriatum sinister was performed. The patient was discharged with recovery.

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Koroner arter fistülü az sayýda hastada küçük çaplý ve yaþam boyu asemptomatik olsa da, geliþen semptom¬lar nedeniyle birçok hastada transkateter veya cerrahi yolla kapatma gerektirir. Bu yazýda, konjestif kalp yeter¬sizliðine baðlý semptomlarý bulunan 70 yaþýndaki kadýn hastada saptanan koroner arter fistülünün coil emboli¬zasyon yöntemiyle baþarýlý þekilde kapatýlmasý sunul¬du. Baþvuru sýrasýnda hastada, nefes darlýðý, çarpýntý, göðüs aðrýsý, NYHA sýnýf 3 fonksiyonel kapasite, sað parasternal alanda duyulan 3/6 derecesinde pansistolik üfürüm ve ikinci sol interkostal boþluk ve kalp tabanýn¬da iþitilen 2-3/6 derecesinde sürekli bir üfürüm vardý. Selektif koroner anjiyografide, proksimal sol ön inen ko¬roner arterden köken alan ve ana pulmoner artere bo¬þalan koroner arter fistülü saptandý. Distal kýsmýna bir, proksimal kýsmýna iki coil yerleþtirilmesiyle fistül baþa¬rýlý þekilde kapatýldý. Ýþlemden sonra sürekli üfürüm kayboldu. Ýkinci aydaki kontrolü sýrasýnda hasta asemptomatikti ve fonksiyonel kapasitesi belirgin dere¬cede artmýþtý.

Although a minority of coronary artery fistulae are small in caliper and may be asymptomatic throughout life, most cases will require intervention by either transcatheter tech- mques or surgery because of evolving symptoms. We report a 70-year-old female patient who underwent suc¬cessful coil embolization of a coronary artery fistula that was associated with congestive heart failure. On presen- tatýon. she had dyspnea, palpitation, chest pain, function- al capacity of NYHA class III, a pansystolic murmur of grade 3/6 in the right parasternal region, and a continuous murmur of grade 2-3/6 in the second left intercostal space and at the base of the heart. Selective coronary angiogra- phy showed a large coronary artery fistula, originating from the proximal left anterior descending coronary artery and draining into the main pulmonary artery. Embolization was performed with placement of one coil in the distal part and two coils in the proximal part of the fistula. The con¬tinuous murmur disappeared after the procedure. She was asymptomatic with significantly improved functional capacity at the second-month follow-up.

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Aterosklerotik renovasküler hipertansiyonda renal anjiyoplastinin güvenli ve etkili bir yöntem olduðu bilinmektedir. Ateroskleroz nedenli olmayanlarda ise renal tutulum ve tedavi yaklaþýmý hakkýnda veriler azdýr. Takayasu arteriti büyük damarlarý etkileyen sistemik bir vaskülittir. Renal arter tutulumu ciddi renovasküler hipertansiyon ile ortaya çýkabilir. Yirmi yaþýnda kadýn hasta, baþ aðrýsý ve hareketle artan sol kol aðrýsý nedeniyle baþvurdu. Fizik muayenede arteryel kan basýncý sol kolda 100/70 mmHg, sað kolda 220/100 mmHg ölçüldü. Sol kolda brakiyal ve radiyal nabýzlar alýnamadý. Hastanýn bütün laboratuvar bulgularý normal idi. Anjiyografide sol subklavyen arter çýkýþýnýn týkalý olduðu, supraklaviküler arter-subskapular arter kolaterallerinin iyi geliþmiþ oldu¬ðu görüldü. Selektif renal arteriyografide iki taraflý renal arter stenozu saptandý. Her iki renal artere çýplak stent yerleþtirildi. Sað renal arterde darlýk kalmadý, sol renal arterde ise %20 darlýk bulundu. Ýþlem sonrasý renal fonksiyonlarda bozulma olmadý ve üçüncü aydaki kont¬rolde sað koldaki arteryel kan basýncý 110/70 mmHg öl¬çüldü

Although renal angioplasty proved to be a safe and effec- tive treatment in atherosclerotic renovascular disease, there is limited data on nonatherosclerotic renal involve- ment and treatment strategies. Takayasu's arteritis is a systemic vasculitis primarily affecting large vessels. Involvement of renal arteries may be associated with severe renovascular hypertension. A 20-year-old female patient presented with complaints of headache and exer- cise-induced pain in the left arm. On physical examination, blood pressures were 100/70 mmHg and 220/100 mmHg in the left and right arms, respectively. Brachial and radial pulses were not palpable in the left arm. Ali laboratory find- ings were normal. Angiographic examination revealed nar- rowing of the left subclavian artery, with well-developed collaterals from the supraclavicular and subscapular arter-ies. Selective renal arteriography showed bilateral stenosis of the renal arteries. Renal artery stenting was performed, resulting in no stenosis in the right, and 20% residual stenosis in the left renal arteries. There was no deteriora- tion in renal functions. Blood pressure was 110/70 mmHg in the right arm three months after the procedure.

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Son yýllarda, kalp dokusunun yenilenmesi amacýyla uygulanan hücre nakli kalp yetersizliði tedavisinde umut vermektedir. Bu teknikte, iskelet kasý kökenli miyoblastlar veya kemik iliði kökenli kök hücreleri kalbe epikardiyal, endokardiyal veya transkoroner yolla nakledilmektedir. Bu yeni tedavi yöntemiyle, özellikle sol ventrikül fonksiyonlarýnda saðlanan düzelme dikkat çekicidir. Bununla birlikte, bazý çalýþmalarda bu yöntemin önemli bir sýnýrlamasý ortaya çýkmýþtýr. Hücre nakli sonrasýnda malign ventrikül aritmilerinin görülmesi bu konudaki en önemli çekincelerden biridir. Cerrahi olarak epikardiyal veya kateterle endokardiyal olarak otolog iskelet kökenli miyoblastlarýn verilmesi sonrasýnda aritmi sorunu ortaya çýkarken, kateterle transkoroner olarak kök hücre naklinde bu sorunla karþýlaþýlmamaktadýr. Nakledilen kök hücrelerin aritmojenik olup olmadýðý sorusu hala net olarak yanýtlanmamýþtýr.

Cardiac cell transplantation for cardiac regeneration has yielded promising results in recent years. This method consists of epicardial, endocardial, or transcoronary transplantation of mainly skeletal myoblasts or bone marrowderived stem cells into the heart. Promising results have been reported with this novel treatment, especially concerning improvement in left ventricular function. However, serious limitations have been encountered following this therapy, the most important of which is the emergence of malignant ventricular arrhythmias. Interestingly, surgerybased epicardial or catheter-based endocardial transplantations of autologous skeletal myoblasts have been associated with the development of arrhythmias while catheterbased transcoronary transplantation of stem cells has not been found to increase arrhythmia risk. After ali, the ques- tion of arrhythmogenic potential of celi transplantation has yet to be resolved.

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Anemi, kronik kalp yetersizliðinde sýk görülen bir durumdur ve semptomlarýn kötüleþmesine neden olur. Kalp yetersizliðinde anemi görülmesinin nedeni tam olarak bilinmemekle birlikte, hemodilüsyon, inflamatuvar aktivasyon, böbrek fonksiyonlarýnda bozukluk, sað kalp yetersizliðine baðlý kötü beslenme ve ilaç tedavisi gibi faktörler üzerinde durulmaktadýr. Kalp yetersizliðinde aneminin düzeltilmesinin kalp fonksiyonlarý ve morbidite üzerinde olumlu etkileri vardýr. Bu semptomatik iyileþmelere karþýn, anemiye yönelik agresif tedaviyle hiper¬tansiyon, tromboz ve endotelyal aktivasyon gibi olumsuz etkiler de görülebilir.

Anemia is commonly observed in patients with heart failure and is associated with aggravating symptoms. The cause of anemia in heart failure is not completely understood, but it is likely to be the result of a combination of factors including hemodilution, inflammatory activation, renal dysfunction, malnutrition due to right-sided heart failure, and drug therapy. Correcting anemia results in beneficial effects on cardiac function and morbidity in patients with heart failure. However, it should be recalled that aggressive treatment of anemia may also lead to adverse effects such as hypertension, thrombosis, and endothelial activation.

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