Objectives: We evaluated short-term results of transcatheter closure of secundum atrial septal defects (ASD) with the Amplatzer septal occluder (ASO) in adults.
Study design: The study included 12 patients (6 males, 6 females; mean age 31±9 years; range 17 to 54 years) who underwent transcatheter ASD closure with the ASO device. Prior to the procedure, the mean pulmonary to systemic flow ratio was 1.9±0.3 (range 1.5 to 2.6). The mean ASD diameter measured by transesophageal echocardiography was 13.9±2.8 mm, the mean stretched diameter of ASD measured by balloon sizing was 15.8±3.4 mm, and the mean ASO device diameter was 17.3±4.7 mm. The patients were evaluated before and six months after the procedure by echocardiography, electrocardiography, and the New York Heart Association (NYHA) functional classification.
Results: Transcatheter ASD closure was successfully performed in 11 patients (91.7%). The mean procedure time was 72 minutes. There was no residual shunt at six months after closure. No serious complications occurred during the procedure and within a mean follow-up of 11.6±2.3 months. Echocardiographic examination at six months showed significant decreases in right ventricular end-diastolic diameter (VEDD) (p=0.007), right/left VEDD ratio (0.003), systolic pulmonary artery pressure (p=0.017), and significant increases in left ventricular ejection fraction (p=0.014) and left VEDD (p=0.005). There were significant decreases in maximum (p=0.003) and minimum (p=0.006) P-wave durations, and P-wave dispersion (p=0.028). The NYHA functional capacity improved significantly from 1.8±0.8 to 1.3±0.5 (p=0.014).
Conclusion: Transcatheter closure of secundum ASD with the ASO device is a safe and effective method in adult patients, resulting in significant improvement in clinical symptoms and cardiac dimensions.

Objectives: We evaluated the efficiency of noncontact mapping, a new mapping technique, for the catheter ablation of right ventricular outflow tract tachycardias.
Study design: The study included 13 symptomatic patients (4 males, 9 females; mean age 39±15 years) with a structurally normal heart, who had sustained ventricular tachycardia (VT) or nonsustained VT with ventricular premature beats (VPB), all arising from the right ventricular outflow tract. For noncontact mapping-guided (EnSite) ablation, first right ventricular geometry was reconstructed. Then, voltage maps of the right ventricle were obtained during sinus rhythm and tachycardia (or ectopic) beats. Index arrhythmia was induced in the form of sustained VT in three patients, and nonsustained VT or VPB in 10 patients. Radiofrequency was applied to endocardial foci of tachycardia beats using a standard, 4-mm ablation catheter.
Results: The endocardial breakthrough sites of the beats were the posterior septum in seven patients, anterior septum in four patients, and posterior free wall in two patients. A mean of 25 (range 7 to 45) radiofrequency current deliveries were applied to the target sites. The mean procedure time was 190 minutes. Index arrhythmia was eliminated in 10 patients after the procedure. No serious complications occurred during or after the procedure.
Conclusion: Our experience with radiofrequency ablation of right ventricular outflow tract tachycardias under noncontact mapping guidance shows that this procedure can be performed efficiently and safely in our country.

Objectives: We investigated the frequency of metabolic syndrome (MetS) and abdominal obesity and evaluated the level of awareness about these two conditions in healthcare workers.
Study design: A total of 723 healthcare workers (372 physicians, 247 nurses, 104 other healthcare staff; mean age 32.8±8.2 years) from four centers were included. Demographic, anthropometric, and biochemical data were recorded, lifestyle features were inquired, and the levels of awareness about abdominal obesity and MetS were surveyed. The criteria recommended by the Adult Treatment Panel (ATP) III were used for the diagnosis of abdominal obesity and MetS. The presence of MetS was evaluated in 178 subjects. Univariate and multivariate analyses were performed to evaluate the association between lifestyle features and abdominal obesity.
Results: The frequency of abdominal obesity was 13.8% and it was significantly higher in males than in females (19.1% vs 10.6%; p=0.002). Metabolic syndrome was diagnosed in 14 participants (7.9%), and there was no significant difference between men and women in this respect (p>0.05). The cut-off values for abdominal obesity and at least three criteria of MetS were correctly listed by 47 participants (6.5%) and 240 participants (33.2%), respectively, with physicians showing significantly higher awareness levels (p=0.001). In multivariate analysis, age ≥40 years and male gender were significantly associated with abdominal obesity.
Conclusion: Our results demonstrate that only a minority of healthcare workers are cognizant of MetS as a clinical syndrome and the definition of abdominal obesity.

Objectives: We compared the incidences of left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and arrhythmia in patients with dipper (DHT) and non-dipper (NDHT) hypertension.
Study design: Seventy-eight patients with essential hypertension were evaluated in two groups according to the results of 24-hour ambulatory blood pressure monitoring. Compared to daytime values, those whose nighttime blood pressure decreased ≥10% were defined as dippers (n=44, 35 females, 9 males; mean age 59±8 years), and those whose blood pressure decreased <10% were defined as non-dippers (n=34, 28 females, 6 males; mean age 58±8 years). The two groups were compared with respect to blood pressure levels, echocardiographic findings, and rhythm disturbances on 24-hour Holter monitoring.
Results: Patients with NDHT exhibited significantly higher incidences of LVH (p=0.03) and LVDD (p=0.003). Aortic root diameter (p=0.001), end-diastolic thicknesses of the interventricular septum (p=0.002) and left ventricular posterior wall (p=0.03) were also significantly increased in this group. On 24-hour Holter monitoring, the number of patients with ventricular premature beat (VPB) (p=0.03), the total number of VPBs (p=0.03), and the number of VPBs per hour (p=0.001) were significantly greater in the NDHT group.
Conclusion: Our results suggest that, due to increased incidences of LVH, LVDD, and VPB, patients with NDHT should be further assessed with regard to increased risk for cardiovascular mortality and morbidity.

Objectives: We compared Doppler echocardiographic features before and after radiofrequency catheter ablation (RFCA) performed for Wolff-Parkinson-White (WPW) syndrome in patients with and without atrial fibrillation (AF).
Study design: Forty patients with WPW syndrome were evaluated in two groups depending on the presence of AF (6 females, 14 males; mean age 33±15 years) and atrioventricular reciprocating tachycardia (AVRT) (8 females, 12 males; mean age 32±18 years). Echocardiographic examination was performed in all the patients 24 hours before and after RFCA. Doppler parameters were recorded including E and A transmitral filling velocities and their velocity-time integrals (VTI), mitral diastolic filling time (mDFT), deceleration time, isovolumic contraction and relaxation times, aortic ejection time (ET) and aortic VTI.
Results: The most common localization of the accessory pathway was the left lateral wall (n=9) in patients with AF, compared to one patient in the AVRT group. During programmed electrical stimulation, orthodromic AVRT was induced in all the patients with AVRT; of the AF group, six patients had AF and 14 patients exhibited AVRT that degenerated into AF. The two groups did not differ significantly before and after RFCA with regard to two-dimensional and Doppler echocardiographic parameters (p>0.05). Significant changes observed in both groups after RFCA were as follows: increases in A velocity and A wave VTI (p<0.05), decrease in the E/A ratio (p<0.05), prolongation of mDFT (p<0.001), and shortening of aortic ET (p<0.01). Following the procedure, preexcitation disappeared in all the patients and none had tachyarrhythmia.
Conclusion: There were no echocardiographic parameters associated with AF in patients with WPW syndrome.

Hennekam syndrome is an autosomal recessive disease characterized by intestinal lymphangiectasia accompanied by severe lymphedema of the limbs, genitalia, and face, and learning difficulties. A 38-month-old boy was admitted with breathing difficulty. He had facial abnormalities and preputial hyperplasia consistent with Hennekam syndrome. Lymphangiography showed lymphedema in the left eye and right foot. Teleradiography showed cardiomegaly and echocardiography showed massive pericardial effusion. He first underwent pericardiocentesis for the removal of pericardial effusion, but pericardial tube drainage was required upon recurrence of effusion. On the fifth day, the drain was removed because of significant decrease in the drainage.

Early diagnosis of brucella endocarditis is of paramount importance because of its fatal consequences. The most commonly affected localization is the aortic valve, while mitral valve involvement is rare. A 44-year-old male patient with a history of rheumatic heart disease presented with fever, fatigue, and back pain. Three consecutive blood cultures revealed growth of Brucella melitensis. On transthoracic echocardiography, mitral valve area was 1.5 cm2 and there was mild mitral regurgitation. Transesophageal echocardiography showed multiple vegetations on the anterior and posterior mitral valve leaflets. Combination of medical and surgical treatment was planned for the patient with the diagnosis of brucella endocarditis.

Congenital coronary-to-pulmonary artery fistulas are rare anomalies and they generally have an asymptomatic course. We presented three symptomatic patients (2 men, 1 woman; age range 46 to 53 years) who underwent surgical repair via the epicardial approach for coronary-to-pulmonary artery fistulas. Treatment was successful in two patients. Reoperation in extracorporeal circulation was required in one patient having a plexus-like fistula. The distal orifice of the fistula was closed under direct vision from within the pulmonary artery. No complications or symptoms were seen during the follow-up of patients ranging from six months to four years. During repair of coronary-to-pulmonary artery fistulas, the presence of a plexus-like variant must be kept in mind and the treatment should be planned accordingly.

Simultaneous anterior, inferior, and right ventricular ST-segment elevation myocardial infarction is an unusual condition. A 50-year-old male patient presented with severe, squeezing chest pain of an hour onset. ST-segment elevations were detected in all precordial derivations, DII, DIII, aVF and V3R, V4R. Coronary angiography showed a significant lesion in the left anterior descending (LAD) coronary artery, just below the second diagonal branch. Balloon predilatation was performed after 40 minutes of admission, followed by bare metal stent implantation, which resulted in ST-segment resolution in all leads and relief of chest pain. Echocardiography showed dyskinesia of the left ventricular apical wall, and hypokinesia of the interventricular septum and inferior wall. Left ventricular ejection fraction was 40%. Coronary angiography and cardiac CT angiography demonstrated a wrapped LAD. The patient was discharged five days after percutaneous coronary intervention (PCI) with stabilization of his clinical status. Ten days after PCI, he presented with chest pain associated with left ventricular anterior and inferior reinfarction. Successful balloon dilatation was performed for thrombotic in-stent restenosis. His clinical condition improved and he was asymptomatic for a month, during which no signs of deterioration were observed in electrocardiographic and echocardiographic findings.

Although pericardiocentesis is a more practical and comfortable alternative to surgical drainage in patients with pericardial tamponade, it may sometimes be associated with transient ventricular dysfunction due to rapid drainage of the fluid. We presented a 42-year-old female patient who developed left ventricular systolic dysfunction and thrombus concomitant with segmental wall motion disorder in the left ventricle during pericardiocentesis for the treatment of massive pericardial effusion and cardiac tamponade. The patient developed acute dyspnea and tachycardia on the second day of pericardiocentesis with a drainage of 500 ml per day. Left ventricular ejection fraction decreased to 20%, and there was akinesis in the left ventricular apex, and severe hypokinesis in the septum. The amount of daily drainage was decreased to 250 ml. Echocardiography performed on the fifth day showed an image, 1x1 cm in size, compatible with an apically located thrombus and unfractionated heparin infusion was initiated. Coronary angiography showed normal coronary arteries. At the end of the first week, the drainage decreased below 50 ml/day. Ejection fraction returned to normal at the end of 10 days and the thrombus diminished and disappeared. Analysis of the pericardial fluid showed tuberculous pericarditis and antituberculous treatment was instituted.

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality markedly in patients with heart failure and prolonged QRS duration. Although QRS duration seems to be the main inclusion criterion for CRT in major randomized studies, nonresponders account for nearly 30% to 40% of the patients. We reviewed information on and measurement of electrical and mechanical dyssynchrony, difficulties and weaknesses of electrocardiographic and echocardiographic indices of dyssynchrony, new and alternative diagnostic modalities, and controversial issues on predicting response to treatment. Although echocardiographic assessment together with new modalities seems to be reliable and applicable in clinical practice, appropriate patient selection remains challenging for large prospective randomized trials.