Objectives: We evaluated the long-term results of paclitaxel-eluting stents in diabetic patients with symptomatic coronary artery disease (CAD).
Study design: A total of 200 patients with symptomatic CAD, a positive treadmill test, and angiographically confirmed lesions (≥2 mm and ≥70%) underwent paclitaxel-eluting stent implantation (n=267). The patients were assessed in two groups depending on the presence (n=68; 46 men, 22 women; mean age 58.7 years) or absence (n=132; 103 men, 29 women; mean age 56.5 years) of diabetes. Coronary angiographies were repeated after a mean of 12.1±5.1 months following implantation. The mean follow-up was 15.4±6.4 months. Major cardiac events included acute myocardial infarction (AMI), death, and a subsequent intervention.
Results: The diabetic group presented with smaller pre-procedure reference vessel diameters, a greater number of bifurcations, long lesions, and long stents (p<0.05). Other quantitative measurements did not differ significantly. Mortality did not occur during the follow-up period. Major cardiac events did not differ significantly between patients with (5.9%) and without (3.8%) diabetes (p>0.05). The incidences of AMI (1.5% vs 0.8%), recurrent angina pectoris (2.9% vs 2.3%), percutaneous angioplasty (2.9% vs 2.3%), and surgical revascularization (1.5% vs 0.8%) were not different in the diabetic and nondiabetic groups, respectively (p>0.05). Major cardiac events were similar in diabetic patients receiving insulin or oral antidiabetic agents.
Conclusion: Our data favor the effective and safe use of paclitaxel-eluting stents in diabetic patients with respect to comparably low rates of restenosis and major cardiac events.

Objectives: Epidemiological studies have demonstrated that elevated triglyceride levels increase the risk for coronary artery disease (CAD). This study sought to evaluate the approach to triglyceride levels in patients with CAD in the cardiology department of a tertiary medical center.
Study design: The study consisted of 100 consecutive patients (79 males, 21 females; mean age 58±10 years) who were admitted to the cardiology department of a university hospital with angina pectoris and were found to have CAD by elective coronary angiography. Data were obtained from hospital records. Lipid profiles of the patients and management strategies were assessed.
Results: Hyperlipidemia was detected in 66%. The mean total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol levels were 203±44 mg/dl, 195±106 mg/dl, 43±11 mg/dl, and 124±38 mg/dl, respectively. On admission, none of the patients were receiving fibrates, and 31% were on statin treatment, which increased to 65% on discharge. In 10 patients, triglyceride levels were not determined at all. According to the Adult Treatment Panel III (ATP III), triglyceride levels were normal (<150 mg/dl) in 29 patients (32.2%). Twenty-five patients (27.8%) had a high-normal triglyceride level (150 to 199 mg/dl), of which statin treatment was instituted in 14 patients on discharge. Thirty-five patients (38.9%) with a high triglyceride level (200 to 499 mg/dl) had hypertriglyceridemia as the most prominent lipid profile; of these, statin treatment was instituted in 27 patients and fibrates were prescribed to three patients.
Conclusion: Our data show that triglyceride levels do not receive proper attention and that fibrates are underused in the treatment of hypertriglyceridemia in CAD. Considering high triglyceride levels, awareness of physicians for hypertriglyceridemia and its treatment should be enhanced.

Objectives: The association between elastic properties of the aorta and uric acid levels was investigated in patients with newly diagnosed hypertension.
Study design: The study included 109 patients (68 females, 41 males; mean age 51.6±6.9 years) with newly diagnosed hypertension. Echocardiographic examination was performed. Systolic and diastolic diameters were measured by M-mode echocardiography, and elastic indices (aortic strain and distensibility) were calculated. Pulse pressure was obtained by a sphygmomanometer. Blood samples were obtained to determine serum uric acid levels and other biochemical parameters. The results were compared with those of a control group consisting of 21 age- and sex-matched healthy volunteers.
Results: Compared to the control group, aortic strain and distensibility were significantly lower (p<0.001) and uric acid levels were significantly higher (p=0.044) in hypertensive patients. In multivariate regression analysis, aortic strain and distensibility showed independent relationships with uric acid levels (p=0.010 and p=0.009, respectively), age (p=0.001 and p<0.001), and left ventricular mass index (p=0.002 and p<0.001) in the patient group. Multivariate analysis according to gender showed that aortic strain and distensibility were in independent relationship with uric acid levels, age, and left ventricular mass index only in female patients.
Conclusion: These data support the view that increased uric acid levels may have a role in the pathogenesis of impaired elastic properties of the aorta especially in hypertensive women.

Objectives: Paravalvular leakage and embolic events associated with St. Jude Silzone mechanical heart valves were retrospectively assessed.
Study design: The study included 28 consecutive patients (17 males, 11 females; mean age 47±17 years; range 10 to 79 years) in whom St. Jude silzone-coated heart valves were implanted. Four patients received aortic, four patients received mitral, and 20 patients received both mitral and aortic valvular mechanical heart valves. Among those with aortic valve replacement, one patient underwent supracoronary graft implantation, one patient underwent coronary artery bypass grafting, and one patient underwent surgery due to tetralogy of Fallot and a previous Waterson shunt operation. Paravalvular leakage was assessed with transthoracic echocardiography in the third and sixth postoperative months, and major embolic events were clinically assessed in the early and late period. The mean follow-up was 70 months (range 64 to 89 months).
Results: Paravalvular leakage did not occur postoperatively, and mortality was not observed in the early postoperative period. No major embolic events were recorded in the early and late periods.
Conclusion: Our results demonstrate that valvular replacement with St. Jude Silzone-coated mechanical heart valves does not contribute to early paravalvular leakage and major embolic events.

A 39-year-old male patient presented with complaints of cough and hemoptysis. He had a history of aortic coarctation repair with the use of Dacron patch aortoplasty 19 years before.Thoracic aortography showed significant narrowing of the aortic lumen and some extravasation of contrast material in the patch area. Computed tomography angiography of the chest revealed obvious narrowing at the repair site and a double lumen appearance. There was no evidence for a true aneurysm or pseudoaneurysm. Following a left thoracotomy and on partial cardiopulmonary bypass, the Dacron patch and coarctation segment were completely removed. A new Dacron graft of 20 mm was used to restore aortic continuity. A pleural flap was placed on the new Dacron graft to separate it from the lung tissue. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day. Hemoptysis disappeared following the procedure. Magnetic resonance angiography performed three months after the repair showed a patent graft and no coarctation.

Aortic dissection is a very rare clinical entity in patients with dilated cardiomyopathy. A 30-year-old man with known dilated cardiomyopathy presented with complaints of dyspnea and fatigue. Physical examination showed increased central venous pressure and a continuous murmur on the right sternal border. Echocardiography revealed severe systolic dysfunction in both ventricles (left EF 20%, right EF 25%), dissection in the ascending aorta, and moderate aortic regurgitation. Thoracoabdominal computed tomography showed that the dissection flap extended from the sinotubular junction to the iliac bifurcation. A diagnosis of De Bakey type I aortic dissection was made. Following Bentall operation, the patient was discharged on the 15th postoperative day.

The presence of a coronary sinus diverticulum along with a posteroseptal accessory pathway in its neck makes electrophysiologic studies and a successful ablation difficult. It is accompanied by increased ventricular conduction through the accessory pathway. A 21-year-old male patient presented with a complaint of paroxysmal tachycardia of a 10-year history, which lasted about 30 minutes following a sudden onset. It was unresponsive to treatment with a beta-blocker and propafenone. An electrocardiogram obtained in normal sinus rhythm showed positive delta wave activity in lead V1 while inferior leads were negative. An electrophysiologic study showed a posteroseptal accessory pathway in the neck of the diverticulum and a very rapid ventricular response during atrial fibrillation, suggesting Wolff-Parkinson-White syndrome. Ablation through the diverticulum was successful.

Lowering low-density lipoprotein (LDL) cholesterol levels is among the most important issues in combatting with atherosclerotic diseases. Introduction of statins has launched a new era in this field. Trials conducted in the past 20 years have shown the effect of statins on improved survival, with accumulating evidence justifying the need for lowering the limits set for LDL cholesterol levels. In this review, target LDL cholesterol levels pertaining to statin use are discussed in different risk groups in view of relevant randomized controlled trials.

Thanks to continuing progress in pediatric cardiac surgery and medical care, most women with congenital heart disease (CHD) reach childbearing age and consider pregnancy. Significant hemodynamic changes occur during normal pregnancy. Cardiac output increases by 50% while peripheral vascular resistance and blood pressure decrease. In the presence of maternal CHD, these hemodynamic changes can cause deterioration in cardiac functions, exacerbation of cardiac symptoms, and may result in maternal death and fetal loss. In spite of these complications, pregnancy is well tolerated in minimally symptomatic women with good ventricular function and normal oxygen saturation except in those with Eisenmenger syndrome, left heart obstruction, and Marfan syndrome. A planned pregnancy is preferable in women with CHD. Before pregnancy, maternal and fetal risks should be assessed, advisability of pregnancy must be determined, and if possible, cardiac abnormalities must be corrected or palliated. A careful and close follow-up is necessary during pregnancy. Women with high or intermediate risks should be referred for specialty care.

no summary-letter to the editor

An 62 year-old woman was admitted to our hospital because of palpitation and dyspnea. Physical examination was unremarkable except for tachycardia. A 12-lead electrocardiogram showed atrial fibrillation. Transesophageal echocardiography (TEE) revealed a large suspicious mass (4x2 cm) between superior pulmonary vens, which could have been a cardiac metastatic mass protruding into the left atrium. There were no idendefiable masses in the left atrial appendage. Fractional heparin was started to prevent any tromboembolic occurrences during follow up. Two weeks later TEE revealed that the mass became smaller (3x1cm) and became mobile and fragile. The patient had cardiac surgery performed for the removal of the intracardiac mass. On pathologic examination the mass was diagnosed as an organized thrombus.
TTE has been shown to be a superior method in defining the characteristics of a mass in the left atrium. We think to metastatic cardiac mass that between superior pulmonary vens of mass and absence of any additional masses in the left atrial appendage in our case. However, we think to organized thrombus that smaller in mass with heparin theraphy.