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

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.

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.

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: İn 79 patients (63 men, 16 vvomen; mean age 57 years) who presented within the first six hours of AMİ, 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%). İnfarct-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 AMİ, 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.

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 İzmir, the performances of medical faculties in Anatolia were, in general, satisfactory this year, vvith special reference to Türkiye Yüksek İhtisas Hospital, GATA, and S. Ersek Surgical Center. The time is ripe for modifying the regulation for academic promotions.

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.

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- tatıon. 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.

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.

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.

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.