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Abstract | Full Text PDF

Abstract | Full Text PDF

Amaç: Kan basýncý (KB) deðiþkenliði hipertansiyonda (HT) hedef organ hasarý ve kardiyovasküler olaylarla iliþkilidir. Bu çalýþmanýn amacý KB normal olan kiþiler ve yeni taný konmuþ hipertansiyonlu olgularda KB deðiþkenliði ile nötrofil/lenfosit oraný (N/L oraný) arasýndaki iliþkiyi araþtýrmaktýr.
Çalýþma planý: Bu kesitsel çalýþmaya yeni taný konan hipertansiyonlu ve KB normal 150 kiþi (63 erkek, ortalama yaþ 52.1±5.2 yýl) alýndý. Tüm hastalara 24 saat tansiyon Holter cihazý (24s-THC) ile KB izlemi, transtorasik ekokardiyografi tetkiki ve biyokimyasal kan testi yapýldý. 24s-THC’dan elde edilen verilere göre hastalar dört gruba ayrýldý. Grup 1= Normal tansiyonlu dipper (ND), Grup 2= Normal tansiyonlu nondipper (NN), Grup 3= Hipertansiyonlu dipper (HD), Grup 4= Hipertansiyonlu non-dipper (HN).
Bulgular: En yüksek N/L oraný deðeri HN grubunda elde edildi (p=0.005 ve ND, p=0.046 ve NN ile p<0.001 ve HD). N/L oraný ND, NN ve HD gruplarýnda benzer bulundu. N/L oraný ile gece sistolik KB (r=0.178, p= 0.031), gece diyastolik KB (r=0.176, p=0.032) ve ortalama KB deðiþimi (r=-0.246, p=0.003) arasýnda korelasyon saptandý. Çoklu doðrusal regresyon analizinde ortalama KB deðiþkenliði yüksek N/L oranýnýn baðýmsýz öngördürücüsü olarak saptandý (β=0.186, %95 GA=0.918-0.982, p=0.044). ROC eðrisi analizinde N/L oraný >2.7 seviyesi, non-dipper HT’yi %83 duyarlýlýk ve %65 özgüllükle tahmin ettirmektedir (ROC eðrisi altýndaki alan=0.653, %95 GA=0.565- 0.741, p=0.001).
Sonuç: Bu çalýþmada, N/L oraný KB deðiþkenliði ile iliþkili bulunmuþtur. N/L oraný HT’ye baðlý artmýþ kardiyovasküler olaylarý öngörmede kullanýlabilecek bir parametre olarak ön plana çýkmaktadýr.

Objectives: Blood pressure (BP) variability is associated with hypertensive (HT) target organ damage and cardiovascular events. The aim of this study was to investigate the relation between neutrophil to lymphocyte ratio (NLR) and BP variabil- ity in hypertensive and normotensive subjects.
Study design: In this cross-sectional study, 150 subjects (63 male, mean age 52.1±5.2 years) were enrolled. In all patients, blood samples and 24-hour ambulatory blood pressure (BP) monitoring were obtained. According to 24-hour ambulatory BP results, participants were divided into four investigation categories. Group 1= Normotensive dipper (ND), Group 2= Normotensive non-dipper (NN), Group 3= HT dipper (HD), Group 4= HT non-dipper (HN).
Results: Highest NLR values were determined in the HN group (p=0.005 vs. ND, p=0.046 vs. NN and p<0.01 vs. HD). NLR values were similar among the ND, NN and HD groups (p>0.05, for all). NLR was correlated with night systolic blood pressure (SBP) (r=0.178, p=0.031), night diastolic blood pressure (DBP) (r=0.176, p=0.032) and BP variation rate (r=- 0.246, p=0.003). Multiple linear regression analysis showed BP variation rate to be an independent predictor of high NLR value (β=0.186, 95% CI=0.918-0.982, p=0.044). In ROC anal- ysis, a level of NLR>2.7 predicted non-dipper HT with 83% sensitivity and 65% specificity (ROC area under curve: 0.653, 95% CI=0.565-0.741, p=0.001).
Conclusion: In the present study, we found that NLR levels were significantly correlated with BP variability. The measure- ment of NLR may be used to indicate increased risk of HT- related adverse cardiovascular events.

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Amaç: Kronik obstrüktif akciðer hastalýðý (KOAH) tüm dünya ülkelerinde giderek artan önemli bir morbidite ve mortalite nedenidir. Perikart sývý birikimi (PSB) ise özellikle pulmoner arter hipertansiyonunda ölümün öngördürücüsü olduðu kanýtlanmýþ güncel bir konudur. Bizim bu çalýþmadaki amacýmýz KOAH’lýlarda PSB varlýðýnýn ölüm öngördürücüsü olup olmadýðýný saptamaktýr.
Çalýþma planý: Çalýþmamýza 488 KOAH’lý hasta ve 50 olguluk kontrol grubu alýndý. Baþlangýçta KOAH’lýlarýn 37’sinde (%7.5) PSB saptandý. Bütün hastalar ortalama 12 ay (1-16 ay aralýðýnda) takip edildi. Saðlýklý kontrol, PSB(+) (n=37) ve PSB(–) gruplarýnýn (n=451) solunum fonksiyon test sonuçlarý ve ekokardiyografi verileri karþýlaþtýrýldý.
Bulgular: PSB(+) grupta sað ventrikül fonksiyonlarýnýn daha bozuk olduðu, pulmoner arter basýncýnýn daha yüksek olduðu saptandý. Kaplan-Meier sað kalým analizinde ortalama bir yýllýk takipte PSB(+) grupta mortalite daha yüksekti. (PSB(–) grupta 139 (%30.8) PSB(+) grupta ise 21 (%56.8) log-Rank p deðeri: 0.009). Ayrýca regresyon analizinde artmýþ yaþ, oksijen kullanýmý ve PSB’nin varlýðý artmýþ mortalite riski ile iliþkili bulundu.
Sonuç: KOAH bulunan kiþilerde ortalama bir yýllýk takipte, PSB varlýðý mortalite için baðýmsýz öngördürücüdür.

Objectives: Chronic obstructive pulmonary disease (COPD) is an increasingly important cause of morbidity and mortality worldwide. Pericardial effusion (PE) is a current issue proven to be a mortality predictor, especially in pulmonary arterial hypertension. In this study, we aimed to evaluate the prognostic value of PE in COPD.
Study design: The study cohort consisted of 488 COPD patients and a control group of 50 healthy patients. At the start of the study, 37 patients (7.5%) had PE. Mean followup time was 12 months (range; 1-16 months). Clinical spirometric and echocardiographic data were compared between patients with PE(+) group (n=37), patients without PE(–) group (n=451) and the healthy control group.
Results: Right ventricular functions were more depressed and pulmonary arterial pressure was more elevated in the PE(+) group. Also, Kaplan-Meier survival curve analysis showed that at one-year follow- up, mortality was higher in the PE(+) group: PE(-) group 139 (30.8%), PE(+) group 21 (56.8%) log-Rank p value: 0.009). Age, presence of PE, and oxygen usage were independent predictors of mortality in Cox regression analysis.
Conclusion: Presence of PE predicts mortality in COPD patients at one-year follow-up.

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Amaç: Çalýþmamýzýn amacý çok kesitli bilgisayarlý tomografi (ÇKBT) ile saptanan sol ön inen arter (LAD) miyokart köprülerinin (MK) morfolojik ve fonksiyonel özelliklerini ve koroner arter hastalýðý ile iliþkisini geriye dönük olarak deðerlendirmektir.
Çalýþma planý: Çalýþmaya ÇKBT ile koroner anjiyografi yapýlan 191 ardýþýk hasta dahil edildi. Koroner lezyonlar ve MK’nin morfolojik özellikleri (derinlik, uzunluk, koroner aðzýna olan uzaklýðý) incelendi.
Bulgular: Çok kesitli bilgisayarlý tomografi ile LAD’de 41 hastada (%21.5) MK tespit edildi. MK proksimalinde aterosklerotik lezyon %49 (20/41) oranýnda saptandý. MK segmentinin derinliði ile sistolik baskýnýn derecesi arasýnda istatistiki olarak anlamlý iliþki saptandý (r=0.538, p<0.01). MB segmentinin koroner aðzýndan uzaklýðý ile sistolik baskýnýn derecesi arasýnda iliþki saptanmadý. MK segmentinin uzunluðu ile sistolik baský derecesi arasýnda iliþki saptanmadý (r=0.058, p=0.721). MK’nin morfolojik özellikleri ile proksimal bölümde saptanan koroner arter hastalýðý arasýnda iliþki bulunamadý.
Sonuç: Çok kesitli bilgisayarlý tomografi ile MK’nin fonksiyonel ve morfolojik özellikleri iyi bir þekilde belirlenebilir. MK olan koroner segmentinin derinliði, baský derecesi ile iliþkili olup MK özellikleri ile MK’nin proksimal bölümünde gözlenen koroner arter hastalýðý arasýnda iliþki saptanmamýþtýr.

Objectives: The aim of this study was to retrospectively evaluate the morphologic and functional features of myocardial bridging (MB) and to investigate the impact of morphologic features on presence of atherosclerosis with multi-detector computed tomography (MDCT) coronary angiography.
Study design: The study population consisted of 191 consecutive patients. Besides coronary lesions, morphologic features of the MB (depth, length and the distance of the tunneled artery from the left coronary ostium) were analyzed.
Results: MDCT detected MB on left anterior descending artery in 41 patients (21.5%). The prevalence of atherosclerotic plaques proximal to the MB of LAD was 49% (20/41). There was a statistically significant correlation between percentage of systolic compression and depth of the tunneled segment (r=0.538, p<0.01). There was no relation between distance of the tunneled segment from the ostium and degree of systolic compression. No significant correlation was found between percentage of systolic compression and length of the tunneled segment (r=0.058, p=0.721). Morphologic features of MB were not related to the presence of CAD in proximal segments.
Conclusion: MDCT coronary angiography depicts the morphologic and functional features of the MB in detail. The depth of MB segment was correlated with systolic compression of MB. There was no relationship between distance of the tunneled segment from the ostium and systolic compression.

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Amaç: Bu çalýþmada, foramen ovale açýklýðýnýn (FOA) perkütan yolla kapatýlmasýnýn tekrarlayan inmeleri önlemesi ve yeni aritmi oluþumuna etkisi manyetik rezonans görüntüleme (MRG) ve Holter monitörizasyonu ile deðerlendirildi.
Çalýþma planý: Tüm hastalar birden fazla kez MRG ile tanýsý doðrulanmýþ inme veya geçici iskemik atak geçirmiþlerdi. Saðdan sola geçiþin olduðu FOA tanýsý, transözofajiyal ekokardiyografi (TÖE) ve transkraniyal Doppler ile gösterildi. Manyetik rezonans görüntüleme ile deðerlendirme, FOA kapatýlmadan önce ve bir yýl sonra yapýldý. Yirmi dört saatlik Holter monitörizasyonu iþlemden önceki bir ay içinde ve iþlemden sonra altýncý ayda yapýldý.
Bulgular: Daha önce MRG ile tespit edilmiþ serebral iskemik olayý olan 47 hastada (25 kadýn, ortalama yaþ: 38.7 yýl) FOA, perkütan yolla kapatýldý. Bir yýl sonra yapýlan TÖE ile hiçbir hastada kalýcý saðdan sola geçiþ izlenmedi. On dört aylýk izleme sonucunda yeni serebrovasküler olay veya MRG’de yeni lezyonlar görülmedi. Holter monitörizasyonu ile aritmi insidansý iþlem sonrasýnda anlamlý derecede artýþ göstermedi (p=0.917).
Sonuç: Klinik ve MRG ile yapýlan bir yýllýk izleme sonucunda, perkütan yolla FOA kapatýlan hastalarda tekrarlayan iskemik olay ve iþleme baðlý ciddi bir komplikasyon görülmemiþtir. Ayrýca Holter monitörizasyonu, iþleme baðlý aritmi insidansýnda iþlem öncesine göre artýþ olmadýðýný göstermiþtir.

Objectives: In this study, we aimed to evaluate the effect of percutaneous closure of patent foramen ovale (PFO) on the recurrence of stroke and new cardiac arrhythmia using magnetic resonance imaging (MRI) and Holter monitoring.
Study design: Patients with PFO had >1 previous stroke or transient ischemic attack documented with MRI in the first event. PFO with right to left shunt was detected by transesophageal echocardiography (TEE) and transcranial Doppler ultrasound. MRI examinations were performed on patients before and one year after PFO closure was applied. A twenty-four hour Holter monitoring was performed in all patients within 1 month before and 6 months after the procedure.
Results: Percutaneous PFO closure was performed on 47 patients (25 female, mean age: 38.7 years) who had cerebral ischemic events detected by MRI. A year after the procedure, TEE showed that there was no residual interatrial right-to-left shunting. After a 14 month follow-up, no new cerebrovascular event and no new lesion on MRI were recorded. The incidence of arrhythmia did not increase significantly after the procedure on Holter monitoring (p=0.917).
Conclusion: One-year clinical and MRI follow-up study of patients with cerebral ischemic events and percutaneous closure of PFO showed no recurrent event and no significant complication associated with the procedure. In addition, Holter monitorization demonstrated that the procedure did not increase the incidence of arrhythmias compared with pre-procedural monitoring.

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Amaç: Bu çalýþmamýzda yeni diabetes mellitus tanýsý konmuþ hastalarda sol ventrikül geometrik paternleri ile koroner akým rezervi (KAR) arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
Çalýþma planý: Çalýþmamýza yeni diabetes mellitus tanýsý konmuþ 116 hasta ile saðlýklý 31 olguluk kontrol grubu dahil edildi. Tüm hastalara ekokardiyografik deðerlendirme yapýldý. Diyabetli hastalar sol ventrikül kitle indeksi ve göreceli duvar kalýnlýðýna göre dört gruba ayrýldý (NG: Normal geometri; KR: Konsantrik remodelling; EH: Ekzantrik hipertrofi; KH: Konsantrik hipertrofi). KAR koroner hiperemik diyastolik en yüksek hýzýnýn istirahatteki en yüksek hýza oraný olarak hesaplandý.
Bulgular: Kontrol grubu ile kýyaslandýðýnda diyabetli hasta grubunda KAR azalmýþ bulundu (p<0.05). En düþük KAR, kontrol grubu ve diðer gruplar kýyaslandýðýnda KH grubunda saptandý (p<0.05, hepsi için). Ayný zamanda, KAR deðeri KR ve EH grubunda NG ve kontrol grubuna göre daha düþük bulundu. Ýki deðiþkenli analizde KAR, sol ventrikül geometrisi ile (r=-0.449, p=0.001), sol ventrikül kitle indeksi (r=-0.401, p<0.001), göreceli duvar kalýnlýðý (r=-0.247, p=0.008), HbA1c (r=-0.576, p<0.001) ve mitral kapak E/A oraný ile (r=0.239, p=0.01) iliþkili bulundu. Çok deðiþkenli analizde, KAR sol ventrikül geometrisi (β=-0.449, p<0.001), sol ventrikül kitle indeksi (β=-0.192, p=0.016) ve HbA1c (β=-0.576, p<0.001) ile baðýmsýz iliþkili saptandý.
Sonuç: Yeni diabetes mellitus tanýsý konmuþ hastalarda KAR bozulmuþtur. Bu bozulmanýn derecesi normal geometriden konsantrik hipertrofiye doðru artmaktadýr. Bu durum diabete baðlý miyokardýn yapýsal yeniden þekilllenmesinin KAR üzerine etkili olabileceðini düþündürmektedir.

Objectives: The aim of this study was to investigate the association between coronary flow reserve (CFR) and left ventricle (LV) geometric patterns in patients with newly-diagnosed diabetes mellitus (DM).
Study design: We studied 116 patients with newly-diagnosed DM and 31 healthy control subjects. Echocardiographic examination was performed on all subjects. Four different geometric patterns were identified in diabetic patients, according to LV mass index (LVMI) and relative wall thickness (RWT) [NG: Normal geometry; CR: Concentric remodeling; EH: Eccentric hypertrophy; CH: Concentric hypertrophy]. CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio.
Results: Compared with controls, CFR was decreased in diabetic patients (p<0.05). The lowest CFR values were observed in the CH group compared with control and other groups (p<0.05, for all). Also, CFR values of the CR and EH groups were lower than NG and the control group (p<0.05, for all). CFR was associated with LV geometry (r=-0.449, p=0.001), LVMI (r=-0.401, p<0.001), RWT (r=-0.247, p=0.008), HbA1c (r=-0.576, p<0.001) and mitral valve E/A ratio (r=0.239, p=0.01) in bivariate analysis. CFR was independently associated with LV geometry (β=-0.449, p<0.001), LVMI (β=-0.192, p=0.016), and HbA1c (β=-0.576, p<0.001) in multivariate analysis.
Conclusion: CFR was impaired in newly-diagnosed DM. The degree of this deformation increases from normal geometry towards to concentric hypertrophy. This condition suggests that myocardial structural remodeling due to diabetes might be effective on CFR.

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Amaç: Atriyum fibrilasyonlu (AF) hastalar AF kontrolü ve kardiyovasküler (KV) risk profili açýsýndan deðerlendirildi.
Çalýþma planý: Türkiye genelinde 40 merkezden toplam 510 hasta (ort. (SS) yaþ: 67.1 (12.3) yýl, %55.1’i kadýn) ile tek vizit temelinde gerçekleþtirilen bu çalýþmada; hastalarýn demografik özellikleri, AF’nin özellikleri, Avrupa Kalp Ritmi Birliði (EHRA) AF kardiyak semptom sýnýflamasýna göre semptom sýklýðý ve skoru, AF kontrolü, kardiyovasküler (KV) risk profili, AF tedavisi ve uygulanmakta olan tedavi yaklaþýmlarýnýn kanýta dayalý kýlavuzlarla uyumu deðerlendirildi.
Bulgular: Vizit gününde sinüs ritmi (%10.2) veya kalp hýzýnýn (KH) ≤80 vuru/dakika (%29.2) olduðu AF þeklinde olmak üzere AF kontrolü hastalarýn %39.4’ünde mevcuttu. Kalýcý AF (%56.0) en sýk gözlenen AF tipi olup, semptomlar V0 öncesi (%78.8) veya V0 esnasýnda (%56.5) olmak üzere hastalarýn %89.2’sinde tespit edildi. Yaþ (%72.4) ve hipertansyion (%70.0) en önemli KV risk faktörleri olarak saptandý. Hýz ve ritm kontrol stratejilerinin kayýt vizitinde hastalarýn sýrasýyla %76.5 ve %19.2’sinde seçildiði belirlendi. Ort. (SS) EQ-5D skorlarý VAS için 63.1 (19.8) iken yararlaným endeksi için 0.62 (0.4) olarak bulundu.
Sonuç: Uluslararasý, gözlemsel, kesitsel ve öncü çalýþma niteliðindeki REALISE AF çalýþmasýna Türkiye’den katýlan AF’li hastalarýn gerçek yaþamdaki tedavi uygulamalarýný yansýtan bu çalýþmada, AF kontrolünün optimal düzeyde saðlanamadýðý ve bu durumun hastalarda semptom sýklýðý, fonksiyonel bozukluk ve yaþam kalitesi deðiþimlerinin yaný sýra KV olaylar nedeni ile hastanaye baþvuru ve müdahale gereksiniminde artýþa yol açtýðý tespit edilmiþtir.

Objectives: To assess control of atrial fibrillation (AF) and cardiovascular (CV) risk profile of AF patients with previously established AF therapies.
Study design: A total of 510 patients (mean (SD) age, 67.1 (12.3) years, 55.1% females) enrolled from 40 centers across Turkey were evaluated on a single-visit basis in terms of patient demographics, characteristics of underlying AF, the frequency and scoring of symptoms according to European Heart Rhythm Association AF cardiac symptoms classification, control of AF, cardiovascular (CV) risk profile, AF treatment and the consistency of current therapeutic practice with evidence-based guidelines.
Results: AF was controlled in 39.4% of patients based on sinus rhythm on the day of visit (10.2%) and AF with HR ≤80 bpm (29.2%). Permanent AF was the most commonly identified type of AF (56.0%). Symptoms were evident in 89.2% of patients either before V0 (78.8%) or at V0 (56.5%). Age (72.4%) and hypertension (70.0%) were the leading CV risk factors. Rate-control and rhythm-control strategies were chosen in 76.5 and 19.2% of patients at the enrollment visit. Mean (SD) of EQ-5D scores for VAS and for single index utility were 63.1 (19.8) and 0.62 (0.4), respectively.
Conclusion: In this real life survey of AF patients from Turkey participating in the global contemporary, international, observational, cross-sectional REALISE AF survey, AF was determined to be not optimally controlled, leading patients to experience frequent symptoms, functional impairment and altered QoL,as well as frequent hospital admissions for cardiovascular events and a high requirement for procedures.

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Mitral kapak ve aort kökü replasmanýndan sonra mitral-aortik intervalvüler psödoanevrizma nadir görülen bir komplikasyondur. Mitral kapak replasmanýndan sonra sol ventrikül psödoanevrizmasý da seyrek görülen bir komplikasyondur. Burada, baþvurusundan altý yýl önce Bentall operasyonu ve mitral kapak replasmaný geçirmiþ, transözofageal ekokardiyografide sol ventrikülde iki adet psödoanevrizma ve mitral-aortik intervalvüler fibroz saptanan 48 yaþýndaki bir kadýn hastayý tanýmlýyoruz.

A mitral-aortic intervalvular fibrosa pseudoaneurysm is a rare complication after aortic and mitral valve replacement and aortic root replacement. A left ventricular pseudoaneurysm after mitral valve replacement is also a rare complication. Here, we describe a 48-year-old woman with a history of a Bentall operation and mitral valve replacement 6 years before, presenting with double pseudoaneurysms in the left ventricle and mitral-aortic intervalvular fibrosa, detected via transesophageal echocardiography.

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Pulmoner hipertansiyon (HT) ortalama pulmoner arter basýncýnýn 25 mmHg’nin üzerine çýktýðý patolojik durumdur. Pulmoner arteriyel hipertansiyon ise prekapiller pulmoner HT tipi olup, farklý etiyolojik nedenlere baðlý ortaya çýkan, benzer patolojik ve klinik bulgulara neden olan hayatý tehdit eden, pulmoner vasküler direncin yükselmesi ile karakterize bir durumdur. Dasatinib ikili Src/Abl kinaz inhibitörüdür ve imatinibe göre BCR/ABL kinaz afinitesi daha yüksektir ve kronik myelositik lösemide ve Filadelfiya kromozomu pozitif olan akut lenfoblastik lösemide (ALL) kullanýlmaktadýr. Biz ALL tedavisinde dasatinib kullanýmýna baðlý olarak pulmoner HT geliþen ve bosentan kullanýmý ile düzelen olguyu tartýþmayý amaçladýk.

Pulmonary hypertension (PHT) is a pathological condition determined as an increase in mean pulmonary arterial pressure ≥25 mmHg. Pulmonary arterial hypertension (PAH) is precapillary PHT and a life-threatening disease group which consists of different etiologies with the same pathological and clinical findings, and which is characterized by elevated pulmonary vascular resistance. Dasatinib is a dual Src/Abl kinase inhibitor associated with higher affinity for BCR/ABL kinase than imatinib, and is used in the treatment of chronic myelocytic leukemia and Philadelphia chromosome positive acute lymphoblastic leukemia (ALL). We describe a case with ALL, in whom dasatinib treatment induced PAH, and who recovered with bosentan treatment.

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Lead çýkarma iþlemleri ile ilgili yeni teknikler geliþmesine raðmen, çocuk hastalarla ilgili bilgiler sýnýrlý olup iþlem baþarýsýzlýðý ve ciddi komplikasyon riski hala çok yüksektir. Bu yazýda, beþ aylýkken ameliyat sonrasý AV tam blok nedeniyle baþka bir merkezde transvenöz tek odacýklý ventriküler pacemaker yerleþtirilmiþ olan yedi yaþýndaki çocukta büyümeyle iliþkili lead gerilmesi, mekanik basýyla iliþkili önemli triküspit yetersizliði geliþmesi ve ayný zamanda bataryanýn bitmesi nedeniyle pacemaker ve lead çýkarýlýp eþ zamanlý “SelectSecure lead” içeren çift odacýklý pacemaker yerleþtirilen hasta sunuldu. Doðumsal kalp hastalýðý olan çocuk hastalarda lead çýkarma iþlemi düþük kiloda bile Evolution Sistemi kullanýlarak yapýlabilir. Led çýkarýldýktan sonra yeni lead olarak SelectSecure lümensiz ince lead kullanýmý ile venöz obstrüksiyon riski azaltýlabilir gibi görünmektedir.

Despite technological advancements in the field of pacemaker lead extraction, available data on pediatric patients is limited, and risk of failure and severe complications remains high. In this report, we present the case of a male patient who, at five months old, had been transvenously implanted with a single-chamber ventricular pacemaker due to complete atrioventricular block. At 7-year of age, the patient was referred to us with growth-related lead tension, severe tricuspid insufficiency, and weak battery. We extracted the lead using the Evolution System and replaced the unit with a dual-chamber pacemaker with a SelectSecure lead. This new system can be used for lead extraction even in lowweight pediatric patients with congenital heart disease. Using a thin, lumenless SelectSecure lead appears to reduce the risk of venous obstruction.

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Kist hidatiðin kalp tutulumu nadir görülmektedir ve uzun yýllar semptomsuz kalmaktadýr. Bulunduðu bölgeye baðlý olarak þikayete neden olur. Bu yazýda, yoðun perikart sývýsý ile birlikte sað ventriküle basý yaparak tamponada neden olan dev kist hidatikli bir olguyu sunduk. Taný transtorasik- transözofajiyal ekokardiyografi ve bilgisayarlý tomografi ile konuldu.

Cardiac involvement in hydatid cyst disease is a rare manifestation and may remain asymptomatic for years. The location of the cyst determines the presentation. In this report, we present a case of hydatid cyst presenting with massive pericardial effusion, right ventricle compression leading to cardiac tamponade. The diagnosis was established with transthoracic, transesophageal echocardiagraphy and computed tomography.

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Biventriküler ICD (kalp içi defibrillator) yerleþtirilmesi, kardiyomiyopatisi olan seçilmiþ olgularda ani kalp ölümü riskini ve kalp yetersizliði semptomlarýný azaltmak amacýyla sýklýkla kullanýlan bir tedavi yöntemidir. Doðumsal kalp defektleri içinde dekstrokardiye 0.4/10000 oranýnda rastlanmaktadýr. Dektrokardili olgularda daha sonra kardiyomiyopati geliþme riski de oldukça düþüktür. Bu yazýda, biventriküler ICD yerleþtirilen kardiyomiyopatisi olan dekstrokardili bir hasta sunuldu.

In order to reduce sudden cardiac death and heart failure symptoms, biventricular implantable cardioverter defibrillator (ICD) implantation is a treatment method commonly used in selected patients with cardiomyopathy. The frequency of dextrocardia in congenital heart defects is approximately 0.4/10000. In this group, the frequency of cardiomyopathy development is rare. In this case report we present a patient with dextrocardia undergoing implantation of biventricular ICD.

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Stentin yerinden oynamasý, açýlmamasý, kýrýlmasý ve kaybolmasý gibi nadir komplikasyonlar koroner giriþimler sýrasýnda meydana gelebilir. Burada primer koroner giriþim sýrasýnda stent içindeki balonunun yýrtýlmasý nedeniyle yarým açýlan ve yerinden oynayan stenti sunduk. Giriþimsel bir kardiyolog bizim olgumuza benzer nadir komplikasyonlar için uyanýk olmalý ve onlarla baþedebilecek tecrübeye ve bilgiye sahip olmalýdýr.

Rare stent complications, including dislodgement of stent, unexpanded stent, stent fracture and stent loss etc. can occur during percutaneous coronary interventions (PCI). We present a semi-expanded and dislodged stent due to rupture of stent balloon during primary PCI in this case report. An interventional cardiologist should be aware of the possibility of rare complications, such as in this case, and have enough experience and knowledge to handle them.

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Kalp transplantasyonu son dönem kalp yetersizliði bulunan hastalarýn tedavisinde altýn seçenek olmuþtur. Uygun verici organý sayýsýndaki kýsýtlýlýða baðlý olarak transplantasyon listesinde uzun süre bekleyen hasta sayýsýnda artýþ olmuþtur. Alýcý ve verici seçimi, ameliyat sürecindeki bakým ve immunsüpresif tedavi ile fýrsatçý enfeksiyonlarýn önlenmesi gibi konulardaki büyük ilerlemeler kalp transplantasyonu sonuçlarýnda anlamlý iyileþmeler saðlamýþtýr. Derlememizde bu karmaþýk hastalarýn bakýmlarýna ve iyi sonuçlar elde etmek için önerilen deðiþikliklere dikkat çekilecektir.

Heart transplantation has, over the years, become the best treatment choice for patients with end-stage heart failure. The increase in longer waiting times among patients awaiting transplantation is due to scarcity of suitable donor organs. Major improvements in recipient and donor selection, perioperative management and postoperative follow- up such as immunosuppressive treatment and prevention of opportunistic infections have considerably enhanced the outcome of heart transplantation. This review will focus on the managements of these complex patients, as well as

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