Objectives: We aimed to determine the effect of drug-eluting stent (DES) implantation on soluble CD40 ligand (sCD40L) levels in patients with stable coronary artery disease undergoing stent replacement.
Study design: Eighty-nine consecutive patients (33 women, 56 men; mean age 61±10 years) with stable coronary artery disease undergoing stent replacement were recruited. Preand post-procedural blood samples were collected for sCD40L analysis, and differences in plasma levels were calculated and expressed as delta sCD40L. Total size and length of implanted stents and pre- and post-dilatation procedures were recorded for each patient, for possible impact on sCD40L release. Patients were followed for one year following procedures for possible adverse cardiac events such as death, myocardial infarction and revascularization.
Results: Forty-nine patients received bare metal stent (BMS) and 40 patients received DES. There were no differences between BMS- and DES-implanted patients in terms of age, stent size and length, and delta sCD40L plasma levels. Delta sCD40L was correlated only with total implanted stent length (r=0.374, p<0.001). Delta sCD40L levels were divided into quartiles for better determination of the procedural parameters that are effective on biomarker release. Total stent length (p=0.008), stent size (p=0.038) and pre-dilatation procedure (p=0.034) were the statistically differing parameters between delta sCD40L quartiles. Although statistically non-significant, all three adverse events were observed in patients with the highest quartile (p=0.179).
Conclusion: Procedural sCD40L release did not differ between DES- and BMS-implanted stable coronary artery disease patients. Total implanted stent length, stent size and pre-dilatation procedure were the influential parameters on procedural sCD40L release.

Objectives: We report our initial experience with thrombectomy devices in patients with acute ischemic stroke.;
Study design: Demographic, clinical, and angiographic findings of 19 consecutive patients (7 females and 12 males; mean age 61.4±12.5 years) with acute ischemic stroke were evaluated retrospectively.
Results: The mean initial National Institutes of Health Stroke Scale (NIHSS) score was 19.5±5.6. Middle cerebral artery was the occluded artery in all of the patients (proximal occlusion in 11, distal in 8 and tandem occlusions in 7 patients). Successful revascularization was achieved in 16 patients (84%). The mean NIHSS score was 8.4±8.2 at 24 hours after the procedure, and 60% of patients showed a modified Rankin scale score of ≤2 at 90 days. New occlusion by migrated emboli was observed in 2 (11%) cases. None of the patients had experienced post-procedural symptomatic intracerebral hemorrhage; 3 patients died during the three-month follow-up. In all patients, thrombectomy was performed with retrievable Solitaire AB stent system.
Conclusion: This single-center experience with mechanical thrombectomy devices demonstrated that high success rates can be achieved by experienced interventional cardiologists in equipped cath labs throughout the country.

Objectives: In this study, systolic and diastolic function parameters were measured with conventional and tissue Doppler echocardiography in coronary slow flow phenomenon (CSFP) patients and compared to those of a control group.
Study design: Sixty patients (49 male; mean age 52.4±12.1) in whom CSFP was detected during coronary angiography study and 30 volunteers with normal coronary arteries (21 males; mean age 50.2±12.1) were included in this study. CSFP was determined using the TIMI frame count (TFC) method. TIMI frame count was calculated in each coronary artery using the TFC method. Left ventricular systolic and diastolic function was assessed by conventional echocardiography and tissue Doppler imaging. TFC correlation between diastolic function parameters was measured.
Results: Baseline demographic and laboratory results did not differ significantly between the groups. TIMI frame counts were greater in the CSFP group compared to controls (p<0.001). Left ventricular ejection fraction (65.93±8.06% vs 66.63±5.96%), E/A ratio (1.11±0.36 vs 1.22±0.33), and isovolumetric relaxation time (IVRT) (85±17 cm/s vs 84±13 cm/s) measured with conventional echocardiography showed no significant difference between the two groups. Em (7.0±2.1 cm/s vs 7.4±1.7 cm/s), Am (7.4±2.0 cm/s vs 7.0±1.4 cm/s) and E/Em (10±3 vs 10±1) measured with tissue Doppler echocardiography showed no significant difference between the two groups. Corrected TIMI frame count for the left descending coronary artery (cLAD) and mean TFC were not correlated with the E/A ratio, deceleration time (DT), IVRT, or E/Em ratio.
Conclusion: Left ventricular systolic and diastolic functions were preserved in CSFP.

Koroner yavaş akım fenomeni (KYAF), normal veya normale yakın anjiyografik coroner arter varlığı ile beraber, distal koroner vasküler yatağın gecikmiş anjiyografik opasifikasyonu olarak tanımlanmıştır.

Objectives: We aimed to investigate the efficacy and safety of a belt mechanism (anjiobelt), which we developed recently and patented, which allows mobility after coronary operations and the application of adjustable pressure to the femoral artery.
Study design: Between October 2012 and April 2013, 189 consecutive patients undergoing percutaneous coronary intervention electively or due to acute coronary syndrome were enrolled. There were 96 patients in the sandbag group and 93 patients in anjiobelt group. Manual compression was applied to the femoral artery until reaching primary homeostasis. Then, a 4-5 kilogram sandbag or anjiobelt was placed. Mobilization was allowed in case of need in the anjiobelt group. Twenty-four hours after the procedure, superficial bruising in the femoral region, hematoma, pseudo-aneurysm, and arteriovenous fistula, as femoral artery complications, were noted using Doppler ultrasound.
Results: Hematoma occurred more frequently in the sandbag group. Hematoma of <1 cm developed in 52 patients with sandbag and in 25 patients with anjiobelt (p<0.0001), while hematoma of 1-5 cm developed in 5 patients with sandbag and in 3 patients with anjiobelt (p<0.0001). Femoral artery pseudoaneurysm was seen in 4 patients (2 with anjiobelt, 2 with sandbag; p=0.975).
Conclusion: Anjiobelt significantly reduces the incidence of hematoma in comparison to conventional sandbag in patients undergoing percutaneous coronary intervention. Other complications of the femoral region in terms of efficiency and safety appear to be similar to those observed with sandbag. The main problems occurring in these patients due to absolute immobilization have been eliminated with the anjiobelt.

Objectives: We aimed to evaluate the short- and mid-term results of patients with atrial septal defect (ASD) who were treated with percutaneous closure.
Study design: Seventy-nine patients with secundum ASD (54 female and 25 male; mean age 26.2±17.2; range 3 to 71] years) were included in this study. Patients were evaluated by transthoracic (TTE) and/or transesophageal echocardiography (TEE). Amplatzer septal occluder (ASO) was used in all patients. In 76 patients, the procedure was performed under local anesthesia with TTE, while in the other 3 patients, it was performed with general anesthesia with TEE. Patients were followed up at the 1st, 3rd, 6th and 12th months and annually thereafter. Mean follow-up time was 13.6±6.6 months.
Results: Mean diameter of ASDs was 18.2±7.5 mm and 20.7±8.04 mm during balloon dilatation, and mean diameter of implanted devices was 22.7±8.5 mm. Procedural time was 40.2±12.6 minutes and fluoroscopy time was 10.9±4.1 minutes. The procedure was successfully performed in all patients (100%). One patient with cardiac tamponade died seven days after cardiac surgery. In two patients, the implanted devices embolized to the pulmonary circulation. Residual flow was found in three patients immediately after the procedure, without residual shunts one month after closure. Mild pericardial effusion in one patient and significant residual shunt due to device malposition in another were discovered during the follow-up at 1 and 6 months, respectively, after the procedure.
Conclusion: Our findings showed that percutaneous closure of ASDs is successful in most patients with a low complication rate, and demonstrated that residual shunts do not develop in the majority of patients in the short- and mid-term.

Objectives: It is known that obesity is related to heart failure. Asymptomatic left ventricular diastolic dysfunction (LVDD) is associated with the development of heart failure. The relationship between subclinical LVDD and overweight in children is not clear. The purpose of this study was to evaluate the effect of body mass index (BMI) and waist circumference on left ventricular mass index (LVMI) and LVDD in overweight children.
Study design: A total of 153 children were enrolled in the study. Of these, 91 were normal weight (age-adjusted BMI: 15-85 percentile), and 62 were overweight (age-adjusted BMI: 85-95 percentile). After measuring two-dimensional and M-mode echocardiographic variables, left and right ventricle diastolic functions were assessed by conventional and tissue Doppler imaging.
Results: Compared to controls, overweight children had increased left atrium, aortic and left ventricular diameters, left ventricular wall thickness, LVM and LVMI, and septal mitral annulus e’, septal e’/a’, lateral e’, lateral e’/a’, lateral tricuspid annulus e’, and e’/a’ values. There were negative correlations between tissue Doppler diastolic parameters (septal mitral annulus e’, lateral mitral annulus e’, lateral tricuspid annulus e’, septal mitral annulus e’/a’, lateral mitral annulus e’/a’, and lateral tricuspid annulus e’/a’) and BMI, waist circumference, insulin, HOMA index, as well as systolic and diastolic blood pressure. Positive correlations were found between LVMI and BMI and between LVMI and waist circumference. BMI was found to be the predictor of decreased mitral anulus septal e’, septal e’/a’, lateral e’, lateral e’/a’.
Conclusion: Compared with normal-weight children, overweight children have decreased LV diastolic function. BMI is associated with a reduction in LV diastolic function in overweight children.

We report herein an 83-year-old gentleman with lung cancer who presented with nausea, complete atrioventricular (AV) block and presyncope. Despite a present temporary pacemaker, which had been inserted through the femoral vein 5 days previously, the patient had asystole attacks that resolved with atropine administration. Coronary angiography demonstrated no critical stenosis. Sick sinus syndrome was diagnosed, and permanent pacemaker implantation was decided. However, the guidewire could not be advanced into the superior vena cava (SVC). Right jugular venogram showed complete obstruction of the SVC. Subsequent computerized tomography also revealed its obstruction by a large lung tumor. Special attention should be given to patients with benign or malignant SVC syndrome before permanent pacemaker implantation.

We report the case of a 61-year-old female who was admitted to our department with progressive dyspnea and palpitation. Transthoracic echocardiography and transesophageal echocardiography showed a small atrial septal defect (ASD, 8x7 mm). Paroxysmal atrial fibrillation (AF) was detected in Holter monitoring. As repair of ASD does not significantly reduce the risk of arrhythmias, cryoablation of AF was performed prior to ASD closure. On cardiac examination at one year, this combined intervention improved right ventricular function and prevented AF episodes.

Quadruple valve infective endocarditis of apparently normal native valves is a relatively uncommon condition, reported particularly in the setting of intravenous drug use, structural heart disease and immunocompromised state, but its occurrence outside these settings is rare. Multiple valve endocarditis is caused by Staphylococcus aureus in the majority of cases. Although Enterococcus faecalis is a common cause of bacterial infective endocarditis overall, it is rarely reported to cause multiple valve involvement. The present case is one such rare report of a patient who had quadruple valve endocarditis of normal native valves, caused by E. faecalis. Compared to single valve endocarditis, multiple valve disease is associated more frequently with heart failure, perivalvular complications and need for heart surgery; hence, early recognition of the extent of disease and number of valves involved is crucial, as this in turn influences the management, risk of complications and outcomes. Transthoracic echocardiography is a widely used first-line tool in the imaging of infective endocarditis, but transesophageal echocardiography, which is more sensitive, should be used more frequently to assess the extent of involvement. Extensive valvular involvement alone does not preclude medical management, and surgical management should be considered only in those who do not respond to antimicrobials or in the case of hemodynamic compromise or mechanical complications.

Woven coronary artery is a rare congenital anomaly with an unknown etiology. A 53-year-old male presented with exertional chest pain and dyspnea for six months. Electrocardiogram and transthoracic echocardiography were in normal range. Dobutamine stress echocardiography revealed reversible ischemia in the inferior wall. Right coronary angiography showed an 80% stenosis before the sinoatrial branch and a twisting course of the right coronary artery lumen after it divided into multiple thin channels. Left coronary angiogram revealed noncritical lesions. A diagnosis of woven right coronary artery was considered, and he was discharged with medical therapy.

Spontaneous coronary artery dissection (SCAD) is a rare and uncommon case of sudden cardiac death and acute coronary syndrome. Herein, we present a 13-year-old boy with chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with SCAD, possibly caused by the consumption of an energy drink, which has not been reported previously in the pediatric age group. On coronary angiography, the left anterior descending artery showed extensive dissection from the distal part of the vessel. Based on the morphology of the vessel with a dissection and TIMI flow grade III, it was decided to manage this patient conservatively with close follow-up. The aim of this report is to highlight the risks associated with the consumption of caffeinated energy drinks in children.

Percutaneous mitral balloon valvuloplasty (PMBV) is the preferred treatment in mitral stenosis patients with appropriate valve anatomy, but it may cause arrhythmic complications rarely. In the literature, the mortality rate associated with PMBV has been reported as 1%, and a small number of patients developed atrioventricular block during the process. In this report, we describe a 53-year-old female patient with severe rheumatic mitral stenosis who developed Mobitz type 2 atrioventricular block and asystole after a successful PMBV operation. Sinus rhythm was achieved with atropine in this patient. It was thought that the arrhythmia resulted from calcified plaques on the mitral valve or from conduction system damage due to high balloon pressure during the process. For the recognition and treatment of possible arrhythmic complications, it is important to monitor patients in the intensive care unit for at least 24 hours after PMBV.

In ventricular tachycardia (VT) arising in the myocardial tissue, the site of origin may be the endocardium, mid-myocardium or epicardium. The incidence of epicardial origin varies with the underlying heart disease, and is probably not more than 20% in ischemic heart disease and higher in non-ischemic cardiomyopathies. Percutaneous subxiphoid access to the pericardial space has enabled a non-surgical approach to catheter mapping and ablation of epicardial VT. Several algorithms are available for electrocardiographic recognition of epicardial origin. Idiopathic epicardial VTs are rare but may be curable by catheter ablation. The electrophysiologic principles guiding the mapping and ablation of epicardial VTs are similar to those used for endocardial VTs, but the biophysics of energy delivery may be different. Complications of the epicardial approach are also different from those of endocardial ablation, and specific precautions have to be taken to protect the coronary arteries and phrenic nerves and to avoid pericardial tamponade.

Unstable coronary artery plaque is the most common underlying cause of acute coronary syndromes (ACS) and can manifest as unstable angina, non-ST segment elevation infarction (NSTE-ACS), and ST elevation myocardial infarction (STEMI), but can also manifest as sudden cardiac arrest due to ischaemia induced tachyarrhythmias. ACS mortality has decreased significantly over the last few years, especially from the more extreme manifestations of ACS, STEMI, and cardiac arrest. This trend is likely to continue based on recent therapeutic progress which includes novel antiplatelet agents such as prasugrel, ticagrelor, and cangrelor.

Avrupa Ulusal Kardiyoloji Derneklerinin yayın organı olan dergilerin editörlerinin aldığı karar uyarınca Heart dergisinde yayımlanan yıllık Almanac serisi yazılarının tıpkıbasımı dergimizde de yayınlanmaktadır.

Important advances have been made in the past few years in the fields of clinical cardiac electrophysiology and pacing. Researchers and clinicians have a greater understanding of the pathophysiological mechanisms underlying atrial fibrillation (AF), which has transpired into improved methods of detection, risk stratification, and treatments. The introduction of novel oral anticoagulants has provided clinicians with alternative options in managing patients with AF at moderate to high thromboembolic risk and further data has been emerging on the use of catheter ablation for the treatment of symptomatic AF. Another area of intense research in the field of cardiac arrhythmias and pacing is in the use of cardiac resynchronisation therapy (CRT) for the treatment of patients with heart failure. Following the publication of major landmark randomised controlled trials reporting that CRT confers a survival advantage in patients with severe heart failure and improves symptoms, many subsequent studies have been performed to further refine the selection of patients for CRT and determine the clinical characteristics associated with a favourable response. The field of sudden cardiac death and implantable cardioverter defibrillators also continues to be actively researched, with important new epidemiological and clinical data emerging on improved methods for patient selection, risk stratification, and management. This review covers the major recent advances in these areas related to cardiac arrhythmias and pacing.