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Amaç: Bu çalýþmada pediatrik kardiyoloji yoðun bakým ünitesi’nde tedavi amaçlý inhale nitrik oksit (iNO) kullanýlan olgular deðerlendirildi.
Yöntemler: 2011–2012 yýllarý arasýnda pediatrik kardiyoloji yoðun bakým ünitesinde iNO kullanýlan 32 olgu çalýþmaya alýndý. Hastalar üç gruba ayrýldý. Grup I (ameliyat sonrasý hastalar), Grup II (diretken pulmoner hipertansiyonlu yenidoðan hastalar), Grup III (primer hipertansiyon veya Eisenmenger Sendrom’lu hastalar). Yaþ, cinsiyet, aðýrlýk, primer taný, kan örneði, pulmoner arter basýncý (PAB), sistemik arteryel basýnç (SAB), oksijen satürasyonu deðerleri incelendi.
Bulgular: Grup I’de 25 olgu, Grup II’de 3 olgu, Grup III’te 4 olgu mevcuttu. Olgularýn ortanca yaþý 7 ay (daðýlým, 2 gün–10 yaþ) ve ortanca aðýrlýðý 8 kg (daðýlým, 3–40 kg) idi. iNO ortanca baþlama zamaný 12 saat (daðýlým, 1–48 saat) ve ortanca kullaným süresi 24 saat (daðýlým, 12–168 saat) idi. ÝNO öncesi ortalama sistolik PAB 40±15 mmHg, ortalama SAB 57±18 mmHg, PAB/SAB=0.69, oksijen satürasyonu %88’idi. Olgularýn iNO sonrasý PAB 24±9 mmHg, SAB 60±12 mmHg, PAB/SAB=0.40, oksijen satürasyonu %98’idi. Pulmoner arter basýncý ve PAB/SAB oraný anlamlý olarak düþerken, satürasyonda yükselme saptandý (p<0.05). Yedi hasta takip sýrasýnda kaybedildi (Grup I, n=5; Grup II, n=1; Grup III, n=1).
Sonuç: ÝNO etkin bir þekilde pulmoner arter basýncýný azaltmaktadýr. Pediatrik kardiyoloji yoðun bakým ünitesinde iNO’nun etkin kullanýmýnýn pulmoner hipertansif krizin yönetiminde mortalite ve morbidite üzerinde olumlu etkisi olmaktadýr.

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.

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Amaç: Miyokart köprüsü (MK), bazen adale köprüsü olarak da tanýmlanan, göreceli olarak iyi prognoza sahip, nadir doðumsal bir hastalýktýr. Literatürde, kararsýz anjina, miyokart enfarktüsü ve ani ölümle de iliþkisi olduðu gösterilmiþtir. Bu geriye dönük çalýþmada, koroner anjiyografi yapýlan hastalarda izole MK tanýsý konan hasta sýklýðýný ve prognozunu inceledik.
Yöntemler: Kardiyoloji kliniðinde 2008–2011 yýllarý arasýnda koroner anjiyografi yapýlan 18250 hastanýn kayýtlarý geriye dönük olarak incelendi. Saptanan 241 (%0.95) MK’li hastanýn, 181’inde (%0.99) izole MK gözlendi. Ýzole MK’li hastalar kalp sistolündeki lezyonun derecesine göre iki gruba ayrýldý. Lezyon derecesi <%70 Grup 1 (kritik olmayan darlýk) ve lezyon decesi >%70 Grup 2 (kritik darlýk) olarak tanýmlandý. Çalýþmaya alýnan hastalarýn demografik özellikleri, hastaneye ilk baþvuru yakýnmalarý, eþlik eden hastalýklar, koroner anjiyografi bulgularý (darlýðýn lokalizasyonu ve yüzdesi) ve prognozlarý hastane arþiv kayýtlarýndan elde edildi. Hasta bilgilerine telefon, poliklinik ve hastane kayýtlarýndan ulaþýldý.
Bulgular: Yirmi beþ (%13) hastada kritik darlýk (Grup 2) ve 146 hastada (%87) kritik olmayan darlýk (Grup 1) saptandý. Ortalama takip süresi 38±7 aydý. Grup 1’deki hastalarýn 15 (%10.2) ve Grup 2’deki hastalarýn 2’sine (%8) (p=anlamsýz) tekrar eden anjina ataklarý nedeniyle yeniden koroner anjiyografi yapýlmýþtý. Takip sürecinde hiçbir hastada miyokart enfarktüsü görülmedi.
Sonuç: Ýzole MK’li hastalar diðer çalýþmalara benzer þekilde, göreceli olarak iyi seyirli bir prognoz sergilemiþtir. Miyokart köprüsünün semptom ve prognozu darlýk derecesinden baðýmsýz olarak bulunmuþtur.

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.

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Amaç: Hafif bozulmuþ böbrek fonksiyonlarý olan hastalarda glomerül filtrasyon hýzýný (GFR) tahmin etmede CKD-EPI (The Chronic Kidney Disease Epidemiology Collaboration) formülü MDRD (Modification of Diet in Renal Disease) formülünden daha etkindir. Yeni yayýnlar, MDRD ve Cockroft-Gault formüllerini kullanarak yavaþ koroner akýmla (YKA) normalhafif bozulmuþ böbrek fonksiyonlarý arasýnda iliþki olduðunu göstermiþtir; ancak bu çalýþmalarýn bazý kýsýtlýlýklarý mevcuttur. Biz, CKD-EPI denklemini kullanarak, YKA ile normal-hafif bozulmuþ böbrek fonksiyonlarý arasýndaki iliþkiyi araþtýrmayý amaçladýk.
Yöntemler: Çalýþmaya 370 hasta alýndý (172 hasta normal koroner akým [NKA], 198 hasta YKA). Böbrek fonksiyonlarý normal-hafif bozulmuþ hastalar seçildi. Ýki gruptaki tüm hastalarýn tahmini glomerül filtrasyon hýzý (eGFR) CKD-EPI ve MDRD formülleri ile hesaplandý ve sonuçlarý karþýlaþtýrýldý.
Bulgular: Ortalama deðerler bazýnda NKA ve YKA arasýnda eGFR açýsýndan yapýlan ölçümlerde anlamlý bir fark yoktu (sýrasýyla, CKD-EPI: 92.9±14.7 ve 92.7±14.2, p=0.72; MDRD: 89.5±19.5 ve 88.2±17.0, p=0.70). Ölçülen eGFR(MDRD) ≥90 mL/dk/1.73 m2 alt grup hastalarda ortalama eGFR deðerleri açýsýndan YKA olan hastalarda daha az bulundu (107.0±12.7 ve 102.7±10.0, p=0.02).
Sonuç: Yavaþ koroner akýmla normal-hafif bozulmuþ böbrek fonksiyonlarý arasýnda bir iliþki bulunmadý.

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.

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Amaç: Atriyum fibrilasyonu (AF) en sýk saptanan aritmi olup tromboembolik olay oranýnda 5 kat artýþla iliþkilidir. Nonvalvüler atriyum fibrilasyonunda (NVAF) inme önleme stratejileri ile ilgili olan bilgilerimiz daha çok vitamin K antagonisti (VKA) olan ilaçlar hakkýndadýr. Bu çalýþma NVAF olan hastalarda VKA, non-vitamin K antagonisti oral antikoagülan (NOAK) ve antiagregan tedavilerin kullanýmýný deðerlendirmek için tasarlanmýþtýr.
Yöntemler: RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey) çalýþmasý NVAF’li hastalarda gözlemsel, çok merkezli ve ileriye dönük bir çalýþma olarak tasarlandý. Çalýþmaya Türkiye’de 68 merkezden 7835 hasta alýnmasý planlandý. Hastalarla ilgili tüm verilerin tek bir ziyarette alýnmasý ve klinik yaklaþýmlarýn deðerlendirilmesi planlandý. (ClinicalTrials.gov numarasý NCT02344901).
Bulgular: Hastalarýn bazal demografik verileri, kullanmakta olduklarý antitrombotik tedavileri, NOAK’lara geçiþ ve hýz/ritm kontrol stratejilerinin deðerlendirilmesi planlandý.
Sonuç: RAMSES kayýt çalýþmasý NVAF’li hastalar hakkýnda Türkiye’de yapýlmýþ en büyük çalýþma olacaktýr. Bu çalýþmanýn NVAF’li hastalarda antikoagülan tedavileri ve sorunlarla ilgili gerçek hayattan veriler saðlamasý beklenmektedir.

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.

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Amaç: D-SPIRIT kayýt çalýþmasý, günlük pratikte, dabigatran tedavisi altýndaki nonvalvular atriyum fibrilasyonu (NVAF) bulunan olgularda ilacýn etkinlik ve güvenilirliðinin deðerlendirilmesi amacý ile tasarlandý.
Yöntemler: D-SPIRIT, dabigatran tedavisi altýnda olan NVAF’li hastalarýn deðerlendirildiði ulusal, çok merkezli, ileriye dönük, gözlemsel bir veri tabaný kayýt çalýþmasýdýr. NVAF nedenli inmeden korunma amacý ile en az 6 aydýr düzenli dabigatran tedavisi altýndaki olgular hedef popülasyonu oluþturmaktadýr. Dokuz farklý merkezden 600 NVAF’li olgunun araþtýrmaya alýnmasý planlanmaktadýr. Olgular etkinlik ve güvenilirliðinin deðerlendirmesi amacý ile 2 yýl süre ile izlenecektir. Örnek büyüklüðü olan 600 katýlýmcýda þu özellikler dikkate alýnmýþtýr: Ýki taraflý anlamlýlýk düzeyi 0.005 (tek taraflý anlamlýlýk 0.025); iskemik inme (%0.768–%1.111), hemorajik inme (%0.109–%0.130) ve geçici iskemik atak olaylarýnýn (%0.722–%0.623) bir yýllýk sürede meydana gelme oranlarý; tedaviden ayrýlma oraný 730. günde %40 olmasý; tarama periyodunun 12 ay süre ile devam etmesi. Yerel etik kurul onayý Dokuz Eylül Üniversitesi Klinik Araþtýrmalar Etik Kurulu’ndan alýnmýþ, (2014/54) proje Türkiye Ýlaç ve Cihaz Kurum Baþkanlýðý tarafýndan onaylanmýþtýr.
Sonuç: D-SPIRIT kayýt çalýþmasýnýn sonuçlarý RE-LY çalýþmasýnýn sonuçlarýna ek NVAF olan hastalarda dabigatran eteksilat tedavisi ile ilgili klinik pratiði etkileyecek bilgiler katacaktýr.

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.

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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.

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Meyan kalp ritim bozukluklarýna neden olabilir. Ancak, meyan kökü þerbetinin içiminden kaynaklanan atriyum fibrilasyonu, þu ana kadar bildirilmemiþtir. Daha önce kalp ve damar hastalýðý bulunmayan 57 yaþýnda erkek hasta acil servise çarpýntý þikayetiyle baþvurdu. Laboratuvar incelemesinde potasyum 2.0 mmol/L olup plazma renin aktivitesi ve aldesteron düzeyi ise baskýlanmýþtý (<300 ng/L/saat, 42 ng/L, sýrayla). Elektrokardiyogramda yüksek ventrikül hýzlý atriyum fibrilasyonu görüldü. Yapýlan ekokardiyografik incelemede, kalp boþluklarý normal sýnýrlarda olup kalp kapaklarýnýn yapýsý ve fonksiyonlarý da normal olarak deðerlendirildi. Hastada bulunan atriyum fibrilasyonu, propafenon infüzyonu ile sinüs ritmine çevrildi.

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.

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Tek taraflý pulmoner arter agenezisi nadiren görülen bir konjenital anomalidir ve çeþitli klinik bulgular ve semptomlara sahiptir. Yüksek ölüm oranlarý nedeniyle hastalarýn çoðu eriþkin yaþa ulaþamadýðýndan çoðunlukla çocukluk çaðýnda taný alýr. Bu vakada, kliniðimize egzersizle artan göðüs aðrýsý, nefes darlýðý ve çarpýntý þikayeti ile baþvuran ve 3 normal majör koroner arterden kollateral dolaþýmla beslenen hipoplastik bir akciðer sol pulmoner arter agenezisi ve atrial fibrilasyon tanýsý konan 71 yaþýnda bir erkek hasta sunduk.

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.

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Azigos ven devamlýlýlýðý olan kesintili vena kava inferiyorda yönlendirilebilir taþýyýcý kateter yardýmýyla internal jugular ven yoluyla kapattýðýmýz sekundum tip atriyal septal defektli bir çocuðu sunduk. Bu yönlendirilebilir kateter büyük defektlerde cihazýn defektin sýnýrlarý üzerinde dikey pozisyonunu düzelterek kapatmaya yardýmcý olur.

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.

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Fabry hastalýðý en sýk ikinci kalýtsal (X’e baðlý resesif) lizozomal depo hastalýðý olup birçok organ tutulumu ile iliþkilidir. Fabry hastalýðýnýn kalp tutulumu deðiþkenlik göstermektedir. Bu yazýda, baþarýlý radyofrekans ablasyon yapýlan Wolf-Parkinson-White sendromu ve sol ventrikül nonkompaksiyonu olan bir Fabry hastalýklý olgu sunuldu.

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.

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Kolesterol embolizasyon sendromu (KES), immünolojik manifestasyonlarý olan çoklu-sistemi ilgilendiren bir hastalýktýr. Ýnvazif anjiyografi sonrasý akut böbrek hasarýna (ABH) neden olabilir. Ýleri derecede aterosklerozu olan erkek hastalarda daha sýk görülür. Kolesterol embolizasyon sendromu, anjiyografi sonrasý geliþen ABH’nýn ayýrýcý tanýsýnda mutlaka düþünülmelidir; çünkü prognozu ve tedavisi kontrast nefropatisinden çok farklýdýr. Burada anjiyografi sonrasý geliþen iki KES’li olguyu sunmayý amaçladýk. Ýlk olguda KES, böbrek biyopsisindeki karakteristik bulgularla ispatlandý. Ýkinci olguda “mavi ayak sendromu” ve kalýcý böbrek yetersizliði geliþen bir hasta sunuldu.

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.

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Ýki yaþýnda iki yönlü Glenn ameliyatý geçirmiþ ve beþ yaþýnda pulmoner trunkus baðlanmasý ve kalp dýþý Fontan ameliyatý geçirmiþ çift çýkýmlý sað ventrikül, ventriküler septal defekt ve pulmoner stenozlu bir hasta sunduk. Hasta Fontan ameliyatýndan üç ay sonra plevra sývýsýyla baþvurdu. Fizik muayenesinde pulmoner odakta 3/6 sistolik üfürüm duyuldu. Ekokardiyografik deðerlendirimede pulmoner öne doðru akým ve burada 80 mmHg basýnç farký tespit edildi. Kalp kateterizasyonu ve anjiyografi çatallanma düzeyinde darlýk ve pulmoner öne doðru akýmý gösterdi. Her iki patolojiyi de transkateter yolla kaplý stent yerleþtirerek giderdik. Kontrol anjiyogramýnda çatallanma düzeyinde darlýðýn giderildiði ve öne doðru akýmýn kaybolduðu izlendi.

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.

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Transkateter aort kapak implantasyonu (TAVÝ), ciddi aort darlýðý olan fakat ameliyat açýsýndan yüksek risk taþýyan hastalar için önerilen yeni bir tedavi yöntemidir. Birçok çalýþmada, bu yeni yöntemin yaþam kalitesinde belirgin yükselme ve saðkalýmda anlamlý derecede artýþ saðladýðý gösterilmiþtir. TAVÝ’nin baþarýsý uygun hasta seçiminin doðru bir þekilde yapýlmasýna baðlýdýr. Ekokardiyografik görüntüleme, TAVÝ tekniði ile tedavi edilmesi planlanan hastalarýn seçiminde, iþleme kýlavuzluk etmede ve sonrasýndaki takiplerinde en önemli görüntüleme yöntemidir.

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.

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