Ýstirahat elektrokardiyografisinde (EKG) saptanan ST-T deðiþikliklerinin, koroner arter hastalýðýna (KAH) baðlý ölüm riskini arttýrdýðý ve KAH'nýn aðýrlýk derecesi ile iliþkili olduðunun belirlenmesi bu olgularda iskeminin artmýþ olabileceðini akla getirmektedir. Bu amaçla ardýþýk 100 olgu egzersiz TI-201 Single Photon Kompüterize Tomografi (SPECT) ile incelendi. Olgular istirahat EKG'sinde ST-T deðiþikliði tespit edilenler (grup 1, n=38) ve edilmeyenler (grup 2, n=62) olarak iki gruba ayrýldý. Her iki grup arasýnda yaþ, cinsiyet, miyokard infarktüsü ya da koroner bypass cerrahisi geçirenlerin sayýsý açýsýndan anlamlý bir fark yoktu. Keza egzersiz testi (ET) sonrasýnda da her iki grup açýsýndan hýz-basýnç, çarpýmý (çift-çarpým=Ç.Ç7 ve egzersiz kapasitesi (MET) açýsýndan anlamlý bir fark saptanmadý. Bununla beraber 1. grupta ET sonrasý ST depresyonu anlamlý olarak daha sýk izlenirken (p<0.001), ET ile göðüs aðrýsý geliþenlerin sayýsý yönünden her iki grup arasýnda anlamlý fark görülmedi. TI-201 miyokard sintigrafisinde toplam perfüzyon defekti gösteren segment sayýsý 1. grupta 2. gruba kýyasla anlamlý olarak daha fazla bulundu (p<0.001). Redistribüsyon 1. grupta 2. gruba göre daha sýk izlenirken (p<0.001), 1. grupta revesibl defekt saptanan segment sayýsý da 2. gruptan anlamlý olarak daha fazlaydý (p<0.001). Bunun yanýnda sabit defekt izlenen olgu ve segment sayýsý açýsýndan her iki grup arasýnda anlamlý fark saptanmadý. Sonuç olarak, istirahat EKG'sine ait ST-T deðiþikliklerinin bu olgularda iskeminin artmýþ olmasýndan ötürü olduðu ve bunun neticesinde progozu olumsuz yönde etkilediði düþünüldü.

The association of ST-T wave abnormalities on the baseline resting electrocardiography (ECG) with the severity of coronary artery disease (CAD) and increased risk of death from CAD suggest increased ischemia in these patients. To investigate this, 100 consequtive patients were studied by exercise TI-201 Single Photon Computerized Tomography (SPECT). Patients were divided into 2 groups according to the presence (group 1, n=38) or absence (Group 2, n=62) of ST-T wave abnormalities on their resting ECGs. There was no difference between the two groups with respect to age, gender, previous myocardial infarction and coronary artery bypass surgery. The double product (SBPxHR) and workload (METS) achieved were also comparable between the 2 groups. Exercise-induced ST segment depression was found to be significantly more frequent (p<0.001) in group 1,whereas exercise-induced chest pain was similar between the 2 groups. The total number of segments with perfusion defects were significantly higher in group 1 compared to group 2 (p<0.001). In addition, redistribution occured more frequently (p<0.001) and the number of segments with reversible perfusion defects were significantly higher in group 1 compared to group 2 (p<0.001) There was no significant difference in terms of persistent defects between the two groups. These data suggest that incrensed ischemia may be the underlying pathology with resting ST-T wave abnormalities and account for the poor prognosis in these patients.

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Ateroskleroz multifaktoriyel bir olaydýr. Aterosklerozun önlenmesi veya geriletilmesinde önemli bir yöntem risk faktörlerinin kontrol altýna alýnmasýdýr. Bu sebeple toplumdaki aterosklerotik risk faktörleri sýklýðýnýn bilinmesi önemlidir. Kayseri bölgesi kentsel populasyonda sistematik örnekleme yöntemi ile belirlenen 30 yaþ ve üzeri bireylerde aterosklerotik risk faktörleri araþtýrýldý. Belirlenen 1382 kiþiden 659'u kadýn, 471'i erkek toplam 1130 kiþi çalýþmaya katýldý. Katýlanlarýn yaþ ortalamasý 45.7±11.5, yaþ daðýlýmý 30-92 idi. Çalýþmaya katýlan kiþilerde açlýk kan þekeri tayini, oral glukoz tolerans testi, kan lipitleri tayini, kan basýncý ve antrepometrik ölçümler gerçekleþtirildi. Erkeklerde ortalama total kolesterol 192.4±35.3 mg/dl, LDL-k 117.7±33.5 mg/dl, HDL-k 43.1±8.8 mg/dl ve trigliserid 152.7±104.2 mg/dl; kadýnlarda total kolesterol 193.1±38.5 mg/dl, LDL-k 121.8 ± 34.8 mg/dl, HDL-k 45.6±8.9 mg/dl ve trigliserid 128.5±34.8 mg/dl, HDL-k 45.6±8.9 mg/dl ve trigliserid 128.5±77.6 mg/dl olarak bulundu. Ortalama total kolesterol ve LDL-k kaçýsýndan cinsler arasýnda anlamlý bir farklýlýk yokken (p>0.5), HDL-k kadýnlarda, trigliserid erkeklerde daha yüksek olarak bulundu (p<0.01). HDL-k beklenildiði gibi düþük ve obezite beklenildiðinden daha sýk olarak bulundu. Çalýþma grubumuzda düþük HDL-k, diabet, sigara içimi, hipertansiyon ve obezite gibi risk faktörlerini yüksek oranlarda tesbit ettik.

Atherosclerotic risk factors were studied in a crosssectional study with systematic sampling of resi- 68 dents 30 years of age and over in the urban population of Kayseri. Among the 1382 subject sampled, total 1130 participants, 659 women and 471men completed the study. Means of age were 45.7 ± 11.5 and age range was 30-92. Fasting blood glucose and lipid levels were measured; oral glucose tolerance test, blood pressure and anthropometric measures were performed in participants. Mean total cholesterol, LDL-c, HDL-c and triglyceride levels were, respectively 192.4 ± 35.3, 117.7 ± 33.5, 43.1 ± 8,8 152.7 ± 104.2 in men and 93.ý ± 38.5, ý21.8 ± 348.8, 4,5.6 ± 8.9, ý28.5 ± 77.6 in women. Mean total cholesterol and LDL-c levels were not significantly different in both sexes. HDL-c Jevel was significantly higher in women and triglyceride Jevel in men (p

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Diabetes mellitus (DM)'a baðlý olarak geliþen kardiyomiyopati iyi bilinen bir klinik antite olmasýna raðmen, kadiyak tutulumun hastalýðýn hangi aþamasýnda baþladýðý yeterince araþtýrýlmamýþtýr. Çalýþmanýn amacý, yeni baþlayan tip II DM'lu hastalarda iskemik kalp hastalýðý ve/veya hipertansiyondan baðýmsýz olarak sol ventrikül diyastolik fonksiyonlarýnda herhangi bir deðiþiklik olup olmadýðýnýn ekokardiyografik inceleme ile araþtýrýlmasý ve bu hastalardaki sol ventrikül diyastolik fonksiyonlarýnýn kan glukoz kontrolü ile olan iliþkisinin belirlenmesidir. Çalýþmaya tip II DM'lü 23 hasta (10 kadýn, 13 erkek; yaþ ortalamasý: 49.3±8.8 yýl) alýndý. Hastalarýn ortalama DM süresi 1.37±0.68 yýl (maksimum 3 yýl) idi. Kontrol grubunu 24 saðlýklý birey (10 kdýn, 14 erkek; yaþ ortalamasý: 45.7±7.6 yýl) oluþturdu. Diabetek hastalarýn normotensif olmalarý ve iskemik kalp hastalýðýnýn bulunmamasý öngörüldü. Hasta ve kontrol gruplarý arasýnda yaþ, vücut kitle indeksi, kalp hýzý ve diyastolik arter basýncý bakýmýndan anlamlý fark yoktu. Hasta ve kontrol gruplarýnýn ortalama diyastolik atrial doluþ akýmýnýn maksimal hýz (amax)'larý ve hýz zaman integral (A-VTI)'leri arasýnda anlamlý fark yoktu. Buna karþýlýk hasta grubunun erken diyastolik akýmýnýn maksimal hýzý (Emax) (57.2±10 cm/sn) ve hýz-zaman integrali (E-VTI) 586.1±20 cm) kontrol grubununkilere (Emax; 7.5±12, E-VTI 109.4±26 cm) göre anlamlý olarak daha düþüktü (p<0.0001 ve p<0.01). Emax/Amax ve E-VTI/A-VTI oranlarý da hasta grubunda, kontrol grubuna göre anlamlý derecede düþük bulundu (Emax/Amax için sýrasýyla 09.01 ve 1.22±0.2, p<0.0001; E-VTI/A-VTI için sýrasýyla 1.24±0.27 ve 1.63±0.37, p<0.0001). Ayrýca hasta grubunun izovolümetrik relaksasyon zamaný kontrol grubuna göre uzamýþtý (sýrasýyla 102±9.7 msan ve 85±8.3 msan, p<0.0001). Sol ventrikül ejeksiyon fraksiyonu, kardiyak indeks ve sol ventrikül kitle indeksi hasta ve kontrol gruplarý arasýnda anlamlý farklýlýk göstermemekte idi. Hasta grubunun HbAI deðerleri ile E-VTI/A-VTI oraný arasýnda anlamlý negatif korelasyon (r:-0.6, p<0.05) mevcuttu. Sonuç olarak, yeni taný konulmuþ tip II DM'lu hastalarda sol ventrikül diyastolik fonksiyonlarýnýn erken dönemde hipertansiyon ve iskemik kalp hastalýðýndan baðýmsýz olarak bozulduðu ve diyastolik fonksiyonlardaki bu bozulmanýn muhtemelen kan glukoz düzeyinin kontrolü ile yakýn iliþkisi bulunduðu kanýsýna varýldý.

Although cardiomyopathy due to diabetes mellitus (DM) is well known, it has not been adequately investigated in which stage of DM starts affection of the heart. The aims of this study were to investigate any change of left ventircular diastolic functions determined by echocardiography in patients with new diagnosed type II DM, and to determine the relation between diastolic functions and blood glucose control. Twenty-three patients (1O women and 13 men; mean age 49.3±8.8 years) with DM were included to the study. Mean duration of DM was 1.37±0.68 (maximum 3) years. A control group consisted of 24 healthy persons (1O women and 14 men; mean age 45.7±7.6 years). The patients had neither hypertension nor coronary heart disease. Mean values of age, body mass index, heart rate and diastolic arterial pressure were not significantly different in both groups. There was no significant difference in the mean values of maximal velocity (Amax) and velocity time integral (A-VTI) of diastolic atrial filling flow between the two groups. Mean maximal velocity (Emax: 57.2±10 cm/sec and 70.5±ý2, respectively, p<0.0001) and velocity time integral (E-VTI: 86.1±20 cm and 109.4±26 cm, respectively, p<0.01) of early diastolic filling flow of the patient group were less than those of the control group. The ratios of Emax/Amax (0.9±0.1 and 1.22±0.1, respectively, p

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Ýskemika kalp hastalýklarýnda koroner bypass operasyonlarý geleneksel olarak kardiyopulmoner bypass, ekstrakorporal sirkülasyon (ECC) yöntemleri kullanýlarak yapýlmaktadýr. 1995 yýlýndan itibaren pompa kullanýlmadan ve minimal torakotomi yoluyla bypass operasyonlarý gündeme gelmiþtir. Kliniðimizde 3'ü angioplasti sonrasý kritik sol ön inen koroner arter (LAD) restenozu ve 2'si angioplastiye uygun olmayan önemli LAD stenozu bulunan 5 olgu sternotomi yapýlmadan minimal torakotomi yoluyla aorto-koroner bypass operasyonuna alýnmýþtýr. Operasyonda genel anestezi altýnda minimal submamaryan insizyonla torakotomi yapýlarak, torakoskop görüntüleme yöntemi kullanýlarak sol internal mamaryan arter (LÝMA) hazýrlanmýþ ve kalp-akciðer pompasý kullanýlmadan yine torakotomi yoluyla atan kalpte LÝMA-LAD anastomozu gerçekleþtirilmiþtir. Olgularýn hiçbirinde periop ve postoperatif bir komplikasyon gözlenmemiþtir.

Traditionally coronary bypass operations are performed by extracorporeal circulation methods and by sternotomy. An alternative way to revascularize coronary vessels is described, using arterial conduits without extracorporeal circulation and via small thoracotomy. A thoracoscope is introduced into the thorax to assist in the harvesting of the left internal mammary artery. In our clinic, this technique was used to revascularize 5 patients from February 1996 to May 1996. All of them received the LIMA on the LAD coronary artery. Four patients were operated on because of unstable angina, three patients underwent previous PTC procedure on the LAD. There was neither perioperative mortality nor morbidity of myocardial infarction.

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Pulmoner kapak yokluðu sendromu (PKYS) pulmoner kapak dokusunun rudimanter veya displastik oluþu, ana pulmoner arter ve proksimal dallarýndan biri veya her ikisinin anevrizmatik dilatasyonu ile karakterize nadir bir konjenital kardiyak malformasyondur. Bu çalýþmada 1988-1995 yýllarý arasýnda bölümümüzde pulmoner kapak yokluðu sendromu tanýsý alan, yaþlarý 2 gün-17 yaþ (ort. 2.5±5.0 yýl, ortanca 6 gün) olan 4'ü kýz, 11'i erkek 15 hastanýn bulgularý retrospektif olarak deðerlendirilerek taný yaklaþýmý, izlem, týbbi ve cerrahi tedavi sonuçlarýmýz sunulmaktadýr. Taný klinik bulgular, EKG, telekardiyografinin yanýsýra hastalarýn tümünde iki-boyutlu renkli Doppler ekokardiyografi ile konmuþ, üç hastaya preoperatif kalp kateterizasyonu ve anjiografi yapýlmýþtýr. PKYS 2 hastada izole, 13 hastada Fallot tetralojisi ile birlikte (TOF-PKYS) görülmüþ, hastalarýn 14'ü 2 ay-7.5 yýl (ort. 2.1±2.1 yýl) süreyle izlenmiþtir. TOF-PKYS'li 12 hastada erken süt çocukluðu döneminde siyanoz, dilate pulmoner arterlerin bronþlara basýsýna baðlý dispne ve/veya tekrarlayan akciðer enfeksiyonlarý görülmüþ, 2'si izole PKYS olan 3 hasta geç çocukluk dönemine dek asemptomatik kalmýþ, 2 hastanýn ise semptomlarýnda 18. aydan sonra spontan düzelme olmuþtur. TOF-PKYS grubundan yaþlarý 2 ay-17 yýl olan 5 hastaya tam düzeltme ameliyatý yapýlmýþtýr. Transannüler patch ile sað ventrikül çýkýþ yolu rekonstrüksiyonu yapýlan 2 hasta ve perikard grefti ile oluþturulan monokusp pulmoner kapak takýlan bir hasta postoperatif 1-4.5 yýldýr iyi durumda izlenmektedir. Koroner anomali nedeniyle sað ventrikül ve pulmoner arter arasýna ekstrakardiyak valvsiz conduit konan 12 hasta erken postoperatif dönemde kaybedilmiþtir. PKYS'da tedavi yaklaþýmýmýz, ilk 18 ayda spontan düzelme olasýlýðý gözönüne alýnarak hastalarýn yoðun týbbi tedavi ile izlenmeleri, bu dönemi atlatanlara elektif koþullarda tercihan valvli tam düzeltme yapýlmasýdýr. Süt çocukluðu döneminde aðýr solunum güçlüðü olan hastalarda erken cerrahi giriþim planlanmalýdýr.

Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac malformation characterized by a rudimentary or dysplastic pulmonary valve, ancurysmal dilatation of the main and proximal branch pulmonary arteries. This study reports our experience with 15 patients with absent pulmonary valve syndrome seen in our department between 1988 and 1995. 4 girls and 11 boys aged 2 days-17 years (mean 2.5±5.0 years, median 6 days) were retrospectively analyzed regarding their symptoms, physical findings, ECG, chest x-ray, echocardiographic features, clinical course and management. 2 patients had isolared APVS and 13 patients had Fallot's tetralogy with absent pulmonary valve (TOF-APVS). Diagnosis was made by two-dimensional and colour flow Doppler echocardiography in each case; preoperative cardiac catheterisation and angiography was performed in 3 patients. The follow-up period in 14 patients ranged from 2 months to 7.5 years (mean 2.1±2.1 years), one patient was lost to follow-up. In 12 patients with TOF-ARVS, cyanosis and respiratory symptoms due to infection and bronchial compression by the massively dilated pulmonary arteries developed in early infancy. In 2 of these patients, spontaneous relief of symptoms was noted after 18 months of age. 3 patients, two of whom had isolated APVS, remained free of respiratory symptoms until Iate childhood. 5 patients with TOF-APVS underwent a total correction operation at the age of 2 months- 17 years. Right ventricular outflow tract reconstruction using a transannular patch was performed in 2 patients, and a hand-made monocusp perkardial pulmonary valve was inserted in one; these 3 patients are clinically well 1-4.5 years after the operation. In 2 patients with anomalous origin of the left anterior descending coronary artery from the right coronary artery, an extracardiac valveless conduit was placed between the right ventricle and the pulonary artery; both died in the early postoperative period. Our current approach to the management of APVS is to give intensive medical therapy to symptomatic infants, and to delay surgical correction for at least until 18 months, since spontaneous relief of symptoms may occur during this period. Those who survive infancy should undergo elective repair preferably with the in sertion of a pulmonary valve. Early surgical intervention should be considered in infants who fail to respond to medical management.

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Fonksiyonel tek ventriküllü (FTV) hastalarda fizyolojik tam düzeltme ameliyatý olan Fontan'da pasif bir dolaþým halini alan akciðer dolaþýmýnýn sürdürülebilmesinde ventrikülün diastolik fonksiyonlarý önem taþýmaktadýr. Geçirilmiþ olan palyatif operasyonlarýn ve Fontan operasyonunun bu fonksiyonlarda yarattýðý deðiþikliði ekokardiyografi (eko) ile inceledik. Ventrikül hipertrofisi ve sistolik fonksiyonlarý ile diastolik fonksiyon parametrelerinin iliþkisini belirlemeye çalýþtýk. Yaþlarý 2.8 - 11.7 arasýnda deðiþen ve kardiyak patolojisi bulunmayan 21 çocuk kontrol grubu olarak alýndý (Grup 1). FTV'lü 43 hasta çalýþma grubumuzu teþkil etti. Yaþlarý 4.8±3.5 (Median = 3.4) olan ve hiçbir palyatif operasyon geçirmemiþ 10 hasta grup II, 12.3 ± 11.2 (8.6) yaþýnda sistemik - pulmoner þantlý 12 çocuk grup III ve Fontan ameliyatý yapýlmýþ 11.3 ± 6.8 (9.4) yaþýnda 21 grup IV olarak alýndý. Eko ile hepatik venöz, atriyoventriküler (AV) kapak ve pulmoner venöz akým paternleri deðerlendirildi. Sistemik ve pulmoner venöz ileri akýmlarýn hýz ve hýz-zaman integrallerine (VTI) bakýldý. AV kapak akýmýnýn diastolik erken doluþ (E), atriyal sistole baðlý geç doluþ (A) akým hýzlarý ve VTI ile bunlarýn birbirlerine oraný karþýlaþtýrýldý. Ayrýca E hýzýnýn stroke volüme oranýna bakýldý. Sistemik venöz ileri akým hýz ve VTI'nin grup IV hastalarda diðerlerine göre anlamlý olarakdüþük olduðu belirlendi. Saðlýklý çocuklar ile diðer gruplar arasýnda fark tespit edilmedi. E hýzýnýn ve E/A oranýnýn tüm hasta gruplarýnda saðlýklý çocuklardan düþük olduðu görüldü. Stroke volüme göre E hýzý yalnýz Fontan yapýlmýþ olan hastalarda düþüktü, diðer hasta gruplarýnda saðlýklý çocuklardakinden farklý deðildi. Ventrikül hipertrofisinin bulunup bulunmamasýna göre gruplar kendi içinde ikiye ayrýlýp veriler yetirmediði görüldü. Yaþlarý daha büyük ve kalp hýzlarý daha düþük bulunmasýna ve sistolik ventrikül fonksiyonlarý en iyi grup olmalarýna raðmen Fontan grubunda saptanan bu farklarýn ventrikülün relaksasyon bozukluðu þeklindeki diastolik disfonksiyonu ile iliþkili olduðu düþünüldü. Sonuç olarak; Fontan yapýlmýþ veya sistemik - pulmoner þantlý FTV'lü hastalarda ventrikülün diastolik fonksiyonlarýnýn relaksasyon bozukluðuna delalet eder yönde bozulduðu belirlenmiþtir. Relaksasyon bozukluðu þeklindeki diastolik disfonksiyonun ventrikül hipertrofisinin yanýsýra, hipoksik miyokard baþarý ile de ilgili olabileceði düþünülmüþtür. Yine Fontan yapýlmýþ hastalarda sistemik venöz akýmýn yavaþladýðý gözlenmiþtir. D iastolik fonksiyonlarý deðerlendirmede, sistemik AV kapak akým hýzlarý ve oranlarýnýn karþýlaþtýrýlmasý, hem iyi bir fikir vermesi hem de ölçümlerin kolaylýðý açýsýndan yeterli görülmüþtür.

In patients with single ventricle, Fontan's operation is a total physiologic corrective surgery. In this operation, because of the passive properties of the pulmonary circulation, diastolic functions of the ventricle have great importance. For this reason, we evaluated diastolic functions of the ventricle w ith echocardiography and investigated the relations between this parameters and ventricular geometry and systolic functions. Three groups, 10 patients (group Il) aged 4.77 ± 3.48 years having no operation, 12 patients (group III) 12.34 ± 11.18 years of age with systemic - pulmonary artery shunt and 21 patients performed Fontan operation aged 11.32 ± 6. 79 years constituted our study population. At a mean age of 6.56 ± 2.78 years, 21 children having no cardiac disease were accepted as control group. Hepatic venous, atrioventricular (AV) valves and pulmonary venous flow patterns were evaluated. For the hepatic and pulmonary venous flow, maximal velocity and velocity- time integral (VTI) were measured. Maximal velocity and VTI of early (E) and late (A) diastolic wave of the AV flow and the ratio of these components and the ratio of E velocity to stroke volume were calculated. In the Fontan's operation group, maximal velocity and VTI of hepatic venous flow were the lowest. There was no difference in these parameters for other patient groups and normal children. E velocity and E/A ratio were lower than normal for the patienis with single ventricle. There was no difference in the findings in terms of the presence of ventricular hypertrophy. In spite of older age and lowest heart rate, these findings showed that in the Fontan's operation group there was a diastolic dysfunction indicating relaxation abnormalities of the ventricle. In conclusion, in the single ventricle cases with Fontan's operation or systemic- pulmonary shunt, there was diastolic dysfunction of the ventricle. We thought that this dysfunction was related to ventricular hypertrophy and ischemic myocardial injury. In Fontan operation group the velocity of systemic venous flow was lower than normal, indicaling a passive pulmonary flow. For evaluation of the diastolic functions, the measurements from the systemic AV valve were sufficient and easy.

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Doðumsal aort darlýklarýnýn tedavisinde perkütan balon valvüloplastinin akut olarak etkili oluduðu ispatlanmýþtýr. Doðumsal aort darlýklý yaþlarý 4 gün ile 20 yaþ arasýnda (median: 5.7 yaþ) deðiþen 35 hastada 37 valvüloplasti iþlemi yapýldý. Balon dilatasyon 34 olguda "retrograd" olarak femoral arter, 1 olguda "antegrad" olarak femoral venden yapýldý. Balon/anulus oraný 0.96±0.06 idi. Ýki hastada eþlik eden hafif aort koarktasyonu ve pulmoner valvüler darlýk ayný seansta balon ile açýldý. Valvüloplasti öncesi 93.2±33.3 mmHg olan aortik pik gradient iþlem sonrasý 33.0±19.6 mmHg'ya (p<0.001), sol ventrikül pik sistolik basýncý 174.4±41.2 mmHg'dan 126.5±24.6 mmHg'ya düþtü (p<.001). Ýþlemlerin 19'unda iþlem öncesi aort yetmezliði yoktu, 18'inde 1+ aort yetmezliði vardý. Olgularýn 11'inde (%29.7) aort yetmezliði arttý. Bunlarýn 4'ünde (%11.1) 3+ aort yetmezliði vardý. Yeterli teknik uygulanmasýna karþýn 2 iþlemde gradient yeterli azalmadý ve birinde kapak deðiþimi gerekti. Ortalama 22±16.3 (median 16) ay izlem sonucunda Doppler ekokardiyografi veya kalp kateterizasyonu ile deðerlendiren 22 olguda sistolik gradient 31.5±16.8 (12-90) mmHg bulundu, akut dönemdeki gradientle fark yoktu (p<0.05). Olgularýn 7'sinde 3, 8'inde 2, 8'inde 1+ aort yetmezliði vardý. Ýzleme aort yetmezliðinin derecesinde 10 olguda 1, 1 olguda 2+ artýþ olurken, 15 olguda aort yetmezliðinin derecesinde deðiþiklik olmadý. Ýkisi 12 ay altýnda olmak üzere 3 hastada femoral arter ile ilgili komplikasyon görüldü. Doðumsal aort darlýklý bebek, çocuk ve adolesanlarda aortik balon valvüloplastinin cerrahi valvatomi sonuçlarýna göre güvenli ve etkili bir yöntem olduðu, erken ve orta dönem izlemleri sonucunda bu etkinliðin devam ettiði sonucuna varýlmýþtýr.

Percutaneous balloon valvuloplasty (BAV) has proven to be acutely effective in the treatment of congenital valvar aortic stenosis. Thirty-seven BAV procedure was performed in 35 patients aged 4 days to 20 years old (median 5.7 years). Balloon dilatation was performed retrogradly though the femoral artery in 34 patients and antegradly through the femoral vein in one patient. Maximum inflated balloon size was selected as equal to or slightly less than the diameter of the aortic annulus measured angiographically. Average balloon/annulus ratio was 0.96±0.06 Balloon dilatation of coexistent aortic coarctation and pulmonary valvar stenosis was performed at the same procedure in 2 patients. Transamtic gradient decreased from 93.2±33.3 mmHg to 33.0±19.6 mmHg after BAV (p<.OOI). and left ventricular peak systolic pressure decreased from 174.4±41.2 to 126.5±24.6 mmHg (p<.001). Patients had no aortic regurgitation (AR) in 19 procedure and mild aortic regurgitation in 18 procedure before BAV. There were increased in degree of AR in 11 procedure (29.7%). Four of these 11 patients ( 1 1. 1%) had 3+ regurgitation. Despite technically adequate valvuloplasty procedure, two patients had inadequate relief of obstruction and one required aortic valve replacement. Residual peak systolic aortic gradient was 3 1.5± 16.8 (12-90) mmHg at mean 22±16.3 (median 16) months followup in 22 patients. Aortic insufficiency was 3+ in 7,2 + in 8,1+ in 8 patients. Increasement of aortic regurtation during follow-up one degree in 10 patients, two degree in 1 patients, and did not change in 15 patients. Femoral artery complication occured in 3 patients in whom two were under 12 months of age. In conclusion; our results in aortic valvuloplasty provides safe and effective acute and intermediate-term results in infants, children and adolescent with congenital aortic stenosis comparing surgical valvotomy, and this effectiviness continues early and intermediate-term follow-up.

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Bu yazýda, yakýn zamanlarda yayýnlanmýþ olan ve koroner arter hastalýðýnýn tedavisinde anjiyoplasti ile bypass cerrahisini karþýlaþtýran randomize çalýþmalar gözden geçirilmiþtir. Hastane dönemi ve uzun süreli takipte mortalite ve miyokard infarktüsü her iki revaskülarizasyon yönteminde benzer bulunmuþtur. Bu sonuçlar koroner anjiyoplastinin emniyetli bir revaskülarizasyon yöntemi olarak yerini pekiþtirmiþtir. Bypass cerrahisi, anjiyoplastiden farklý olarak daha az mükerrer revaskülarizasyona gerek göstermiþ ve hafif-orta derecede anginanýn kontrolünde biraz daha baþarýlý olmuþ, fakat mükerrer revaskülarizasyonlarýn bedeli de göz önüne alýnsa, cerrahi daha pahalý bir yöntem olmaya devam etmiþtir. Bu klinik farklarýn azaltýlmasýnda yeni anjiyoplasti yöntemlerinin rolü tartýþýlmýþtýr. Diyabetik hastalardaki anjiyoplasti sonuçlarýnýn farklýlýðý tartýþýlmýþ ve diðer klinik subgruplardaki sonuçlara deðinilmiþtir. Randomize çalýþma sonuçlarýnýn günlük uygulamaya geçirilmesindeki güçlükler üzerinde durulmuþ ve hastalarýn uzun süreli takibine dayanan müþahede tipi çalýþma sonuçlarýnýn revaskülarizasyon endikasyonlarýnýn verilmesindeki yardýmýna deðinilmiþtir.

Recent randomized trials comparing angioplasty with bypass surgery for the treatment of coronary disease were reviewed. In selected patients with suitable anatomy for both procedures, immediate and long-term follow-up mortality and myocardial infarction rates were similar between angioplasty and bypass surgery, underlining the safety of coronary angioplasty as an initial revascularization strategy. Patients undergoing angioplasty required more repeat revascularization procedures, a situation that may be improved significantly by the use of stents and other means to decrease restenosis. Bypass surgery was somewhat better in controlling mild to moderate angina pectoris, however, it continued to be more expensive than angioplasty strategy even after the repeat revascularization costs were factored in. The results in clinical subgroups, and the potential causes of worse prognosis in diabetic patients after multivessel angioplasty in some of the studies were also discussed. Finally, the pitfalls in translating these randomized study results to daily clinical practice were discussed, and the impact of large, longitudinal follow-up study results in clinical decision making process was emphasized.

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Koroner arter giriþimi esnasýnda veya sonrasýnda uzak bir damarda total oklüzyon geliþmesi seyrek rastlanan bir durumdur. Kliniðimizde LAD lezyonuna baþarýlý direksiyonel aterektomi yapýlan bir olgumuzda iþlemden altý saat sonra önceden normal olan sirkumfleks arterinde total oklüzyon geliþti. Ülkemiz de ilk defa rastlanan, literatürde çok seyrek olarak bildirilen ve daha sonra baþarý ile açýlan bu olgumuzu sunuyoruz.

Acute total occlusion occurrence in a non-instrumented coronary artery during or after coronary intervention is a rare situation. Total occlusion of circumflex obtuse marginal branch, which is previously normal, has occured 6 hours after the intervention in a patient for whom we have performed a succesful directional coronary atherectomy. The occlusion has been opened by PTCA right away. We are presenting this case which is very rare in the Iiterature and the first in our country.

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