Objective: Experience with administration of inhaled nitric oxide (iNO) in pediatric cardiac intensive care unit was retrospectively reviewed.
Methods: Data from 32 pediatric patients treated with iNO between 2011 and 2012 were collected. Patients were divided into 3 groups: Group I comprised postoperative patients, Group II comprised newborns with persistent pulmonary hypertension (PPH), and Group III comprised patients with primary pulmonary hypertension (PH) or Eisenmenger’s syndrome. Age, sex, weight, primary diagnosis, arterial blood sample, pulmonary artery pressure (PAP), systemic arterial pressure (SAP), and oxygen saturation levels were analyzed.
Results: Groups I, II, and III included 25, 3, and 4 patients, respectively. Median weight was 8 kg (range: 3–40 kg), and median age was 7 months (range: 2 days–10 years). On average, iNO treatment was initiated at the 12th hour after admission to the unit (range: 1–48 hours) and continued for a median duration of 24 hours (range: 12–168 hours). Systolic PAP was 40±15 mmHg, mean SAP was 57±18 mmHg, PAP/SAP ratio was 0.69, and oxygen saturation levels were 88% prior to iNO treatment. Following iNO treatment, PAP decreased to 24±9 mmHg (p<0.05), PAP/SAP ratio decreased to 0.4 (p<0.05), SAP showed no change (60±12 mmHg), and saturation levels increased to 98% (p<0.05). Seven patients died during follow-up (Group I, n=5; Group II, n=1; Group III, n=1).
Conclusion: iNO seems to effectively reduce PAP, and can be used effectively and safely to prevent pulmonary hypertensive crises in pediatric cardiac intensive care units.

Objective: Myocardial bridge (MB), also known as muscular bridge, is a rare congenital disease with relatively good prognosis. However, it has been associated with unstable angina, myocardial infarction, and sudden cardiac death. Incidence and prognosis of patients diagnosed with isolated MB after having undergone coronary angiography are evaluated in the present retrospective study.
Methods: Coronary angiograms of 18,250 patients, obtained between 2008 and 2011, were reexamined for presence of MB at the cardiology clinic. Of these patients, 241 (0.95%) had MB, and 181 (0.99%) had it as an isolated finding. Patients with isolated MB were divided into 2 groups according to severity of the lesion in the cardiac systole. Group 1 was comprised of patients with non-critical (<70%) stenosis; group 2 was comprised of patients with critical (≥70%) stenosis. Demographic characteristics, symptoms at initial diagnosis, and coronary angiographic findings regarding localization and severity of stenosis were noted. Follow-up was performed by phone, with outpatient clinic visits, and by reviewing hospital records.
Results: Twenty-five patients (13%) had critical stenosis (group 2), and 146 (87%) had non-critical stenosis (group 1). Mean follow-up duration was 38±7 months. Recurrent angina and repeated coronary angiography were reported in 15 group 1 patients (10.2%) and in 2 group 2 patients (8.0%) (p=nonsignificant). No instance of myocardial infarction was reported.
Conclusion: Isolated MB seems to be a relatively benign disease, a conclusion made in accordance with those of previous studies. Symptoms and prognosis are not determined by degree of stenosis generated by the muscular bridge.

Objective: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is more effective at estimating glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) equation, particularly in patients with mildly impaired renal function. Recent studies have demonstrated, using the Cockroft-Gault and MDRD formulas, a significant correlation between slow coronary flow (SCF) and normal to mildly impaired renal function. However, these studies had some limitations. The aim of the present study was to investigate the relationship between SCF and normal to mildly impaired renal function using the CKD-EPI equation.
Methods: A total of 370 patients were included, 172 with normal coronary flow (NCF) and 198 with SCF. All participants had normal to mildly impaired renal function. Both the CKDEPI and MDRD formulas were used to calculated estimated glomerular filtration rate (eGFR), which was compared between groups.
Results: No significant difference in mean values of eGFR was found between the NCF and SCF groups (CKD-EPI: 92.9±14.7 vs 92.7±14.2, p=0.72; MDRD: 89.5±19.5 vs 88.2±17.0, p=0.70, respectively). Among patients with eGFR(MDRD) ≥90 mL/ min/1.73 m2, mean eGFR levels were lower among patients with SCF (107.0±12.7 vs 102.7±10.0, p=0.02).
Conclusion: No correlation was found between SCF and normal to mildly impaired renal function.

Objective: Atrial fibrillation is the most common arrhythmia and is associated with a five- fold increased risk of thromboembolic events. Vitamin K antagonists (VKAs) have been the mainstay of oral anticoagulant prophylaxis and the data on stroke prevention strategies are limited to VKA era. The purpose of this study is to evaluate the use of VKA, non-Vitamin K antagonist oral anticoagulants (NOAC), and antiplatelet agents in patients with non-valvular atrial fibrillation (NVAF).
Methods: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES) is an observational, multicenter, prospective study of patients with NVAF. The study targeted enrollment of 7835 patients from 68 sites in Turkey. All the data will be collected at one point in time and current clinical practice will be evaluated. (ClinicalTrials.gov number NCT02344901).
Results: Baseline characteristics of patients, antithrombotic therapies, transition to NOACs and rate/rhythm control strategies will be evaluated.
Conclusion: The RAMSES registry will be the largest study in Turkish NVAF patients. The study will provide insights into real-world problems and anticoagulant treatment in patients with NVAF.

Objective: The D-SPIRIT registry is designed to investigate the safety and efficacy of dabigatran etexilate in patients with nonvalvular atrial fibrillation (NVAF) and to collect data on outcomes in clinical practice.
Methods: The D-SPIRIT is a national, prospective, observational, post-marketing registry involving patients with NVAF who have been taking dabigatran etexilate therapy for stroke prevention for a minimum of 6 months prior to enrollment. The registry will collect and analyze data from routine care, enrolling up to 600 patients in 9 centers. Patients will be followed up for 2 years to evaluate effectiveness and safety. A sample size of 600 subjects is proposed based on the following assumptions; Two-sided significance level of 0.05 (1-sided significance level of 0.025), ischemic stroke incidence rate of 0.768%–1.111%, hemorrhagic stroke incidence rate of 0.109%–0.130%, transient ischemic attack incidence rate of 0.722%–0.623%, therapy discontinuation incidence rate of 40% at day 730, and duration of enrollment period of 12 months with non-uniformed enrollment rate. Ethics approval was given by Dokuz Eylül University Ethics Committee of Clinical Research (2014/54) and approved by the Turkish Ministry of Health.
Conclusion: Potential results of D-SPIRIT registry will add data from clinical practice to those from the RE-LY trial to expand knowledge of dabigatran etexilate treatment in patients with NVAF.

Objective: Prevalence of depression and anxiety increases following cardiac revascularization. The aim of this study was to examine the effects of a cardiac rehabilitation program on psychological status of patients after cardiac revascularization.
Methods: A total of 120 patients who underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) were enrolled in an 8-week rehabilitation program. A brief mood survey was administered before the program and repeated following its completion. Psychological state was assessed for depression, anxiety, panic symptoms, difficulty in adaptation, and relational satisfaction. Changes in mood scores were analyzed with paired t-tests and linear regression models to predict response.
Results: A total of 95 men and 25 women were enrolled. Average age was 60.0±8.4 years. Eighty-two patients underwent PCI, the remaining 38 underwent CABG. Following rehabilitation, depression reduced from 28.3% to 10.8% (p=0.002), anxiety decreased from 21.7% to 9.1% (p=0.012), panic symptoms reduced from 16.7% to 5.8% (p=0.014), and difficulty in adaptation decreased from 30.0% to 10.9% (p=0.0002). Changes in state of depression were not predicted by medical, social, or physical factors, while changes in anxiety were negatively affected by smoking. Psychological changes after rehabilitation were not influenced by presence of acute myocardial infarction (MI) before revascularization.
Conclusion: Enrollment in cardiac rehabilitation after coronary revascularization positively impacts psychological status of patients, as assessed by brief mood survey.

While it is known that consumption of licorice may lead to cardiac arrhythmias, there have been no reports of atrial fibrillation resulting from the consumption of licorice root syrup. A 57-year-old male with no prior history of cardiovascular disease was admitted to the emergency department with palpitation. His electrocardiogram showed atrial fibrillation with a moderate to rapid ventricular rate. In laboratory assessment, potassium was 2.0 mmol/L and plasma renin activity and aldosterone level were suppressed (<300 ng/L/hour, 42 ng/L respectively). Volumes of the heart chambers were within normal range and functions and structures of the heart valves were normal in echocardiographic assessment. The arrhythmia was resolved with propafenone infusion.

Unilateral pulmonary artery agenesis (UPA) is a rarely-observed congenital anomaly with diverse clinical signs and symptoms. It is most often diagnosed in childhood due to the high mortality rate prior to adulthood. This report describes the case of a 71-year-old woman who presented with exertional chest pain, dyspnea and palpitations and who was diagnosed as having left pulmonary artery (LPA) agenesis, hypoplastic left lung supplied by collateralization from each of the three normal major coronary arteries, and atrial fibrillation.

The closure of a secundum atrial septal defect through the jugular vein in a child with interrupted inferior vena cava with azygos continuation by steerable delivery catheter is described in the present report. The steerable catheter can be used to correct the perpendicular position of the device over the margins of the defect, and is particularly useful in cases of large defects.

Fabry disease is the second most common inherited (X-linked recessive) lysosomal storage disease associated with multiple organ involvement. Cardiac involvement of Fabry disease varies. Successful radiofrequency ablation of a Fabry disease patient with Wolff-Parkinson- White syndrome and left ventricular noncompaction is described in the present report.

Cholesterol embolization syndrome (CES) is a multi-systemic disease with immunological features which is a rare but an important cause of acute kidney injury (AKI) after invasive angiography. It frequently occurs in elderly male population with extensive atherosclerosis. CES should be considered in the differential diagnosis of AKI after angiography because its prognosis and treatment is completely different from contrast-induced nephropathy. Herein, we describe two cases of CES developed after invasive angiography. In the first case, renal biopsy was performed and CES was proved with characteristic renal lesions. The second patient had blue toe syndrome and persistent renal dysfunction.

A 5-year-old male with a double outlet right ventricle with noncommitted ventricular septal defect and pulmonary stenosis underwent a bidirectional Glenn operation at 2 years and a Fontan operation with ligation of the pulmonary trunk at 5 years. He presented with pleural effusion 3 months after the Fontan operation. Physical examination revealed a grade 3/6 systolic murmur in the pulmonary area. Echocardiographic evaluation revealed an antegrade pulmonary flow (APF) of gradient 80 mmHg across the ventriculopulmonary communication. Cardiac catheterization and angiography demonstrated the presence of residual antegrade pulmonary flow and stenosis at the pulmonary artery bifurcation. Both pathologies were treated using a single covered stent. Relief of the pulmonary artery stenosis and total occlusion of the residual APF was demonstrated on a control angiogram.

Transcatheter aortic valve implantation (TAVI) is a novel therapeutic option, recommended for the treatment of patients with severe aortic stenosis who are at high risk from conventional open surgery. Multiple registries have documented favorable outcomes, including survival and quality of life. Success of TAVI depends upon the consideration of patient selection. Echocardiography is a mandatory tool to provide important data in patient selection, evaluation, guidance of intervention, and patient follow-up.