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Ýleri mitral yetersizliðinin (MY) sol atriyal trombüs (T) oluþumunu önleyici etkisi bilinmektedir. Ayrýca, ileri MY'nin sistolik disfonksiyonu (SD) bulunan sol ventrikül (SV) içinde mural T oluþumunu da önleyebildiði öne sürülmüþtür. Çalýþmamýz, SV sistolik disfonksiyonu bulunan olgularda iskemik MY varlýðýnýn SVT sýklýðýna etkisini araþtýrmayý amaçlamaktadýr. Çalýþma grubu, koroner anjiyografi ve sol ventrikülografi ile iskemik sol ventrikül SD bulunan 1313 hastadan (E 1133, K 180, yaþ 56±18 yýl) oluþturulmuþtur. Olgularýn hiçbirinde kronik antikoagülan kullaným öyküsü mevcut deðildi. Epikardiyal koroner arterler 91 olguda normal olup, tek damar, 2 damar ve 3 damar hastalýðý, sýrasýyla 328, 330 ve 564 olguda mevcuttu. Anjiyografik MY ciddiyeti hafif, orta ve ileri olarak derecelendirildi. Septal (S), apikal (AP) ve/veya anterolateral (AL) segmentlerde diskinezi ve anevrizma, sýrasýyla 394 ve 470 olguda bulundu. Posterobazal (PB), posterolateral (PL) ve/veya inferiyor (I) segmentlerde diskinezi ve anevrizma, sýrasýyla 110 ve 181 olguda bulundu. Ýskemik dilate kardiyomyopati 158 olguda mevcuttu. Mural SVT 191 (%14.5), ciddi iskemik MY 125 (%9.5) olguda gözlendi. Seri genelinde, ileri MY bulunan olgularda, MY bulunmayanlara kýyasla SVT sýklýðý anlamlý olarak düþük bulundu (%4 ve %15.6, OR: 0.2, p<0.001). Ýleri MY varlýðýnda, gerek iskemik dilate kardiyomyopati (%6.8 ve %34.2, OR:0.19, p<0.001), gerekse segmenter SVSD (%2.5 ve %13.7 %, OR: 0.2, p<0.01) gruplarýnda SVT sýklýðýnda anlamlý azalma bulundu. Ýleri MY'nin bulunuþu halinde SVT sýklýðý AL,S ve A segmentlerde anevrizma bulunanlarda anlamlý (%3 ve %18, OR: 0.14, p<0.0001), diskinezi grubunda ise anlamlý olmayan bir azalma (%4.7 ve %16, OR: 0.26, p= 0.1) göstermekteydi. Buna karþýlýk, ileri MY PB, I ve/veya PL segmentlerde anevrizma veya diskinezi bulunanlarda SVT sýklýðý üzerinde etkili bulunmadý (%3.7 ve %3, OR: 1.2, p>0.05). Sonuç olarak; (1) Ýleri derecedeki MY'nin gerek iskemik dilate kardiyomyopati, gerekse anteriyor SV duvar anevrizmasý bulunan olgularda SVT oluþumunu önleyebildiði düþünülmüþtür.

Protective effect of severe mitral regurgitation (MR) against left atrial thrombus (T) formation has been documented. It was also proposed that severe MR could prevent T formation in the left ventricle (LV) in the presence of systolic LV dysfunction (LVD). The purpose of this study is to investigate whether ischemic MR prevents T formation within the LV in patients with LVD. Study population comprised 1313 pts (M 1133, F 180, age 56±18 years) with is-chemic LVD documented by coronary angiography and left ventriculography. None of the patients had history of chronic anticoagulation. Epicardial coronary arteries were normal in 91 patients, and single-vessel, two-vessel, and triple-vessel disease were documented in 328, 330, and 564 patients, respectively. Global systolic LVD was defined as EF < 0.50. Severity of the angiographic MR was graded as mild, moderate and severe. Dyskinesia and aneurysm related to septal (S), apical (A) and/or anterolateral (AL) wall segments were found in 394 and 470 pts, respectively. Dyskinesia and aneurysm associated with posterobasal (PB), posterolateral (PL) and /or inferior (I) wall segments were detected in 110 and 181 pts, respectively. Ischemic dilated cardiomyopathy was documented in 158 patients. Mural LVT and severe ischaemic MR were detected in 191 (14.5 %) and 125 (9.5%) patients, respectively. Overall incidence of LVT was found to be lower in patients with MR as compared to those without MR (4% vs 15.6%, OR: 0.2, p<0.001). In comparison to the absence of MR, severe MR was associated with a lower incidence of LVT in patients with ischemic dilated cardiomyopathy (6.8% vs 34.2%, OR: 0.19, p<0.001) and in patients with segmentary LVD (2.5% vs 13.7%, OR: 0.2, p<0.01). There was a significant difference in reference to presence of severe MR in patients with aneurysm (3% vs 18%, OR: 0.14, p<0.0001), and a nonsignificant difference in patients with dyskinesia (4.7% vs 16%, OR: 0.26, p=0.1) related to A, AL, S wall segments. However, MR had no impact on incidence of LVT in the group with aneurysm or dyskinesia related to PB, I, or PL segments (3.7% vs 3%, OR: 1.2, p>0.05). Conclusions: (1) Severe MR seems to prevent mural LVT formation both in patients with ischemic dilated cardiomyopathy and in patients with aneurysm related to anterior LV wall segments, and (2) this protective effect of severe MR against LVT formation may be associated with diastolic volume overloading which may offset stagnation and procoagulant state within the LV with systolic dysfunction.

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P dalga dispersiyonu (PDD), yeni bir elektrokardiyografik parametre olup, sinüzal uyarýlarýn intra-atriyal ve inter-atriyal nonhomojen ve kesintili iletilmesi ile iliþkilidir. PDD maksimum ve minimum P dalga süreleri arasýndaki fark olarak ifade edilebilir. Yakýn zamanda yayýnlanmýþ çalýþmalarda uzamýþ P dalga süresi ve artmýþ P dalga dispersiyonunun yüksek atrial fibrilasyon riski ile iliþkili olduðu bildirilmiþtir. Bu çalýþmanýn amacý mitral darlýklý hastalarda P dalga dispersiyonunu belirlemek ve perkütan mitral balon valvüloplasti (PMBV) iþleminin P dalga dispersiyonu üzerine etkisini deðerlendirmektir. Çalýþmaya PMBV adayý 29 mitral darlýklý hasta (26 bayan, 3 erkek; yaþ 33±6 yýl) ve 27 saðlýklý gönüllü (24 bayan, 3 erkek; yaþ 32±7 yýl) kontrol grubu olarak dahil edildi. Ýþlemden bir gün önce hasta ve kontrol grubundaki tüm kiþilerin elektrokardiyogramlarý çekildi ve transtorasik ekokardiyogramlarý yapýldý. Ýþlem sonrasý birinci gün, birinci ay, ve altýncý ayda çalýþmaya dahil edilen hasta gruplarýndaki tüm kiþilerin elektrokardiyogramlarý çekildi. Hasta grubundaki kiþilerin transtorasik ekokardiyogramlarý iþlem sonrasý birinci gün, birinci ay ve altýncý ayda tekrarlandý. Çekilen elektrokardiyogramlardan maksimum ve minimum P dalga süreleri ölçüldü ve PDD hesaplandý. Mitral darlýklý hasta grubunda maksimum P dalga süresi ve PDD saðlýklý kontrol grubuna göre istatistiksel olarak anlamlý derecede daha yüksek saptandý (p<0.001). Ancak, minimum P dalga süreleri acýsýndan hasta ve kontrol grubu arasýnda istatistiksel olarak anlamlý fark yoktu. PMBV sonrasý birinci gün, birinci ay ve altýncý ayda yapýlan ölçümlerde maksimum P dalga süresi ve PDD'nun iþlem önçesi ölçülen bazal deðerlere göre ilerleyici bir þekilde istatistiksel olarak anlamlý derecede azaldýðý tespit edildi (p<0.001). Birinci gün, birinci ay ve altýncý ayda ölcülen maksimum P dalga süresi ve PDD kendi aralarýnda karþýlaþtýrýldýðýnda yine istatistiksel olarak anlamlý azalma tespit edildi (p<0.01). Ancak, minimum P dalga sürelerinde anlamlý bir deðiþiklik gözlenmedi. PDD'nda ki azalma ile ekokardiyografik parametrelerdeki düzelme arasýnda istatistiksel olarak anlamlý korelasyon saptanmadý. Sonuç olarak, yüksek atrial fibrilasyon riskini gösteren PDD mitral darlýklý hastalarda saðlýklý bireylere göre istatistiksel olarak anlamlý derecede daha yüksektir. PMBV sonrasý PDD kýsa ve uzun dönemde istatistiksel olarak anlamlý derecede düþmektedir.

P wave dispersion (PWD) is a new electrocardiographic marker that has been associated with inhomogeneous and discontinuous propagation of sinus impulses. It can be defined as the difference between maximum and minimum P wave duration. Recent studies have been reported that prolonged P wave duration and increased P wave dispersion carry an increased risk for atrial fibrillation. The objectives of this study were to determine PWD in patients with mitral stenosis (MS), and to evaluate the effects of percutaneous mitral balloon valvuloplasty (PMBV) on PWD. The study population consisted of two groups: Group I consisted of 29 patients with MS (26 women, 3 men; aged 33±6 years) who were candidate for PMBV and Group II consisted of 27 healthy volunteers (24 women, 3 men; aged 32±7 years). Twelve-lead electrocardiogram (ECG) was recorded and echocardiographic evaluation was performed for each patient one day before PMBV and repeated at first day, at the end of the first month and at sixth month after successful PMBV. Baseline maximum P wave duration and PWD of group I were significantly higher than those of group II (p<0.001). However there was no statistically significant difference between group I and group II regarding minimum P wave duration (p>0.05). Maximum P wave duration and PWD decreased progressively on measurements at first day, at the end of the first month and at sixth month after PMBV (p<0.001, table-II). When the maximum P wave duration and PWD measused on first day, at the end of the first month and at sixth month were compared with each other, a significant decrease was also detected (p<0.01, table-II). There was no statistically significant difference between the values of minimum P wave duration measured before PMBV, at first day, at the end of the first month and at sixth month after PMBV. There was no statistically significant correlation between the decrease in PWD and the improvement in echocardiographic parameters. In conclusion, PWD is significantly higher in patients with mitral stenosis indicating high risk for atrial fibrillation, than in healthy control subjects and it decreases significantly after PMBV both in short and long term.

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Kronik tam týkalý (KTT) lezyonlara balon anjiyoplasti iþleminde baþarý oranýnýn düþük, restenoz oranýnýn yüksek olduðu bilinmektedir. Yakýn geçmiþte yayýnlanan randomize çalýþmalarda ise KTT lezyonlara stent implantasyonunun balon anjiyoplastiye göre restenozu ve tekrar týkanmayý azalttýðý gösterilmiþtir. Ancak, KTT lezyonlara stent yerleþtirilmesiyle elde edilen yararýn doku azaltýcý lazer anjiyoplasti uygulamasýyla nasýl etkileneceði konusunda eldeki bilgiler halen sýnýrlýdýr. Bu çalýþmada kliniðimizde, Haziran 1997-Þubat 2000 tarihleri arasýnda KTT lezyonlarýna lazer anjiyoplasti ve ardýndan stent uygulanan 35 hastanýn iþlemle ilgili ve uzun dönem klinik ve anjiyografik izleme sonuçlarýný inceledik. Bir hastada(%3) iþlem baþarýsýz oldu, diðer hastalarda majör kardiyak olay geliþmeden iþlem baþarýyla sonuçlandý. Buna göre iþlem baþarýsý %97 idi. ELCA uygulamasý sonrasýnda 34 KTT lezyona 36 stent yerleþtirildi. Hastane içi izleme döneminde 2 (%6) hastada yan dal týkanmasýna baðlý Q dalgalý olmayan miyokard infarktüsü geliþti. Tüm hastalar 6 ay izlendi. Hastalarýn 9'unda (%27) treadmill testi pozitif sonuç verdi ve bunlarýn da 7'sine (%20) tekrar PTKA yapýldý, 1'i (%3) koroner baypas operasyonuna verildi. 6 aylýk izleme boyunca hastalarýn hiçbirinde ölüm veya miyokard infarktüsü geliþmedi. Buna göre olaysýz hayatta kalým oraný %77 bulundu. Hastalarýn 28'ine (%83) 6 ay sonra koroner anjiyografi yapýldý; kantitatif analizle referans damar çapý ortalamasý 2.7mm olup vakalarýn 14'ünde (%50) restenoz saptandý. Sonuç olarak; serimizde KTT lezyonlara ELCA ve ardýndan stent uygulamasýnda primer baþarý yüksektir. Ancak restenoz oraný ve hedef damara tekrar giriþim gereði de yüksektir. Serimizdeki damarlarýn çapýnýn göreceli olarak düþük (referans damar çapý 2.7mm) olmasý ve kullanýlan stentlerin uzun (uzunluk ortalamasý 24mm) olmasý ve %14 hastada KTT lezyonun ayný zamanda ostiyal lokalizasyon göstermesi bu yüksek restenoz oranýný ve hedef lezyona tekrar giriþim oranýný açýklayabilir. Stent implantasyonu öncesinde KTT lezyonlara ELCA uygulamasýnýn olasý yararýnýn araþtýrýlmasý için büyük ölçekli randomize çalýþmalara gereksinim vardýr.

Chronic coronary occlusions (CCO) are considered unfavorable for percutaneous balloon angioplasty because of low rate of success and high rate of restenosis. Stent implantation after recanalization of CCO has been shown to reduce restenosis and reocclusion rates compared with balloon angioplasty in recently published randomized trials. However, it is not well known whether laser debulking before stent implantation would further improve stenting benefit in CCO. Thus, we prospectively analyzed the procedural and long-term clinical and quantitative angiographic follow-up results of 35 patients who underwent laser angioplasty followed by stent implantation for CCO between June 1997 and February 2000. The procedure was completed successfully without any major cardiac event in 34 patients in whom the lesion was successfully crossed with a guidewire, but in one patient (3%) the procedure was unsuccessful. Thus, the rate of success was 97%. Thirty-six stents were implanted in 34 CCO lesions following laser debulking. Non-Q wave myocardial infarction developed in 2 (6%) patients during the in hospital follow-up period. Treadmill test was positive in 9 (27%) patients after six months follow-up. Seven (20%) of them had repeat angioplasty for restenosis and one (3%) underwent coronary bypass surgery. Death or Q wave myocardial infarction did not occur during follow-up period, and event-free survival rate was 77%. Twenty-eight (83%) patients had angiographic follow-up six months after the procedure; the mean reference vessel diameter was 2.7 mm in quantitative analysis and restenosis was found in 14 (50%) patients.In conclusion; the procedural success rate is high, but the restenosis and target vessel revascularization rates were also high in our patients who underwent laser debulking followed by stent implantation for CCO lesions. Relatively small vessel size (2.7 mm in diameter) and and the mean 24 mm-stent length may explain these high rates of restenosis and of repeat procedure in our patient population. In addition, 5 (14%) of CCO lesions had ostial location, might further contribute these disappointing results. We need large scale randomized trials detecting effect of laser debulking before stent implantation in CCO lesions.

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Kardiyak debinin saðlanmasýnda sol atriyum (LA) mekanik fonksiyonlarýnýn önemli katkýsý mevcuttur. Bu çalýþma ileri dönem konjestif kalp yetersizliðinde (KKY) sol atriyal mekanik fonksiyonlarý araþtýrmak amacý ile yapýldý. Çalýþmaya NYHA grup III veya grup IV KKY bulunan 68 hasta ve yaþça uygun 15 saðlýklý gönüllü alýndý. KKY etyolojisi 44 hastada iskemi (grup I), 16 hastada idiyopatik dilate kardiyomiyopati (grup II), 8 hastada romatizmal mitral yetersizliði (grup III) idi. Sol atriyal volümler biplan "area-length metodu" kullanýlarak; mitral kapaðýn tam açýldýðý anda (LAVmax), tam kapandýðý anda (LAVmin) ve atriyal sistolün baþýnda (EKG de p dalgasý) (LAVp) ölçüldü, tüm volümler vücut yüzey alanýna indekslendi ve aþaðýdaki sol atriyal fonksiyon parametreleri hesaplandý. Sol atriyal pasif boþalma volümü (LAPEV)=LAVmax-LAVp, LA pasif boþalma fraksiyonu (LAPEF)=LAPEV/LAmax, Konduit volüm (CV)= sol ventriküler atým volümü-(LAVp- LAVmin), LA aktif boþalma volümü (LAAEV)= LAVp-LAVmin, LA aktif boþalma fraksiyonu (LAAEF)=LAAEV/LAVp, LA total boþalma volümü (LATEV)=LAVmax-LAVmin, LA total boþalma fraksiyonu (LATEF)=LATEV/LAmax. LAVmax, LAVmin ve LAVp tüm kalp yetersizliði gruplarýnda kontrollere göre anlamlý derecede artmýþ bulundu (p<0.001). LAPEV grup I ve grup II'de kontrol grubundan anlamlý derecede farklý bulunmaz iken, grup III'te anlamlý derecede daha yüksek bulundu (p<0.05). Buna karþýn LAPEF her üç grupta da anlamlý derecede düþüktü (p<0.001). "Konduit" volüm her üç grupta da kontrol grubuna benzerdi (p>0.05). LAAEV grup I (p<0.005) ve grup III'de (p<0.001) anlamlý derecede yüksek iken, grup II de anlamlý fark saptanmadý. LAAEF tüm kalp yetersizliði alt gruplarýnda da anlamlý derecede azalmýþtý (sýrasý ile p<0.05, p<0.005, p<0.005). LATEV sadece grup III'de anlamlý derecede yüksekti (p<0.001), buna karþýn LATEF her üç grupta da anlamlý derecede düþüktü (p<0.001). Bu çalýþmanýn sonuçlarý iskemi, dilate kardiyomiyopati ve mitral yetersizliðine baðlý ileri dönem kalp yetersizliklerinin hepsinde sol atriyumun hem aktif, hem pasif hem de total boþalma fraksiyonlarýnýn azaldýðýný, kompansatuar mekanizmalarýn iþlemediðini göstermektedir.

Left atrial (LA) mechanical functions have an important role to maintain cardiac output. The aim of the present study was to evaluate LA mechanical functions in patients with severe congestive heart failure (CHF). Sixty-eight patients with NYHA group III or IV CHF, and 15 healthy volunteers as a control group were studied. The etiology of CHF was ischemia in 44 patients (group I), idiopathic dilated cardiomyopathy in 16 patients (group II) and mitral regurgitation in 8 patients (group III). Left atrial volume measurements were done at the time of mitral valve opening (LAVmax), at the onset of atrial systole (p wave at the electrocardiography = LAVp) and closure (LAVmin) according to the biplane area-length method. All volumes were corrected for body surface area and LA emptying functions were calculated. LA passive emptying volume (LAPEV)= LAVmax - LAVp, LA passive emptying fraction (LAPEF)= LAPEV/ LAVmax, Conduit volume (CV)=Left ventricular stroke volume- (LAVmax- LAVmin), LA active emptying volume (LAAEV)= LAVp- LAVmin, LA active emptying fraction (LAAEF)= LAAEV/LAVp, LA total emptying volume (LATEV)= (LAVmax -LAVmin), LA total emptying fraction (LATEF)= LATEV/LAVmax. LAVmax, LAVmin and LAVp were found significantly higher in patients with CHF than in controls (p<0.001). LAPEV was significantly greater in group III than in controls. LAPEF was lower in three groups than in controls (p<0.001). Conduit volume was similar in three groups compared to controls. Although LAAEV was significantly greater in group I p<0.005) and in-group III (p<0.001) than in controls, LAAEV was similar in-group II. LAAEF was significantly lower in patients with CHF than in controls (p<0.05, p<0.005, p<0.005, respectively). LATEV was greater only in-group III than in controls (p<0.001), by contrast LATEV was significantly lower in three groups than in controls (p<0.001). The results of this study suggested that left atrial active and passive emptying fractions are reduced and compensatory contribution does not work in advanced CHF due to mitral regurgitation, ischemic or dilated cardiomyopathy.

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Son yýllarda, dilate kardiyomiyopatili hastalarda biventriküler stimülasyon bir tedavi þekli olarak ileri sürülmektedir. Venöz yoldan sol ventrikül stimülasyonu saðlanabilmekle beraber bu yeni yöntemin erken ve uzun dönem takip verileri sýnýrlýdýr. Bu çalýþmanýn amacý venöz yoldan biventriküler stimülasyonun uygulanabilirliði ve uzun dönem güvenilirliðini deðerlendirmektir. Ýleri derecede konjestif kalp yetersizliði (NYHA III-IV) ve ventrikül içi ileti gecikmesi (QRS > 120 msn) olan dilate kardiyomiyopatili hastalara (sol ventrikül EF < %40, diyastol sonu çapý > 55 mm) venöz yoldan biventriküler kalp pili yerleþtirildi. Toplam 29 hastanýn 26' sýnda (%89) kalp pili baþarýyla yerleþtirildi. Yerleþtirme iþlemi sýrasýnda ortalama biventriküler uyarý eþiði, algýlama ve elektrot impedansý sýrasýyla 1,8±0,7 V, 15±7 mV, 626±194 Ohm olarak ölçüldü. Ortalama sol ventrikül elektrotu yerleþtirme süresi 54± 24 dak (24-110 dak), skopi zamaný 28±14 dak (12-67 dak) olarak tespit edildi. Hastalarýn dördünde sol ventrikül elektrodu yerinden ayrýldý. Ýki hastada aralýklý stimülasyon veya diafragma stimülasyonu gözlendi. Bu hastalarýn beþinde ikinci bir giriþim yapýldý ve üçünde sol ventrikül elektrodunun yeniden yerleþtirilmesi baþarýldý. Takip süresince (ortalama 12±7; 3 ile 27 ay arasý) biventriküler uyarý eþiði, algýlama ve elektrot impedansý sürekli biventriküler stimülasyon için uygundu. Böylece 29 hastanýn 23'ünde (%79) sürekli biventriküler stimülasyon saðlandý. Dilate kardiyomiyopatili hastalarda venöz yoldan sürekli biventriküler stimülasyon uygulanabilir ve güvenilir bir yöntem olarak kabul edilebilir sonucuna varýldý.

Biventricular pacing has recently been suggested as a treatment modality in patients with dilated cardiomyopathy. Left ventricular stimulation can be achieved by transvenous route, but acute and long-term follow-up data of this new method is limited. The aim of the study was to evaluate the feasibility and long-term safety of biventricular pacing by the transvenous route. Biventricular pacemaker implanted via transvenous route in patients with dilated cardiomyopathy (left ventricular EF < 40%, end-diastolic diameter > 55 mm) presented with advanced congestive heart failure (NYHA III-IV) and intraventricular conduction delay (QRS > 120 msec). Biventricular pacemaker was successfully implanted in 26 of 29 patients (89%). The mean biventricular pacing threshold, sensing and electrode impedance during the implantation were measured 1.8±0.7 V, 15±7 mV and 626±194 Ohm, respectively. The average procedural time of left ventricular lead implantation was 54±24 min (24-110 min) and fluoroscopy time 28±14 min (12-67 min). Left ventricular electrode dislocation occurred in four patients. Intermittent or diaphragmatic stimulation were observed in two patients. A second operation was performed in four of these patients and reposition of left ventricular leads was successfully accomplished in three of them. Biventricular pacing threshold, sensing and electrode impedance were suitable for permanent biventricular stimulation over follow-up (mean 12±7, range 3 to 27 months). So permanent biventricular stimulation were obtained in 23 of 29 patients (79%). It has been concluded that permanent biventricular pacing by the transvenous route in patients with dilated cardiomyopathy can be accepted as a feasible and safe method.

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Amaç: Son dönem kalp yetersizliðindeki olgularýn tedavisinde son 20 yýlda birçok geliþme gözlenmiþtir. Kardiyak transplantasyon bu olgularda uzun dönem sað kalým oranýna sahip en uygun tedavi yöntemidir. Materyal ve Metod: Son 3 yýllýk periyotta kliniðimizde 18 olguya kardiyak transplantasyon uygulanmýþtýr. Hastalarýn 5'i kadýn 13'ü erkek idi. Yaþ ortalamasý 44.7±14.1 idi (21-63 yaþ). Etiyoloji 10 hastada idiopatik dilate kardiyomiyopati, 7 hastada ise iskemik kardiyomiyopati idi. Tüm olgularda biatrial teknikle ortotopik KT uygulandý. Ortalama kardiyak iskemi süresi 171,4±78.5 dakikadýr (101-335 dakika). Hastalarýn tümüne üçlü immunosüpresif tedavi protokolü (siklosporin A, prednisone, azathioprine) uygulanmýþtýr. Rejeksiyon izleminde rutin olarak endomiyokardiyal biyopsi kullanýlmýþtýr. Tüm olgular yýlda bir kez koroner anjiyografi uygulanmaktadýr. Bulgular: Perioperatif mortalite 2 olgu ile %11.1'dir. Bir olguda uzamýþ entübasyon, 2 olguda da erken dönemde akut böbrek yetersizliði geliþmiþtir. Bir olgu sepsis, 1 olgu hemofagositik sendrom, 2 olgu aspergillus pnömonisi, 1 olgu da stafilokok pnömonisi nedeniyle kaybedilmiþtir. Mortalitelerin hepsi postoperatif ilk 6 ay içinde gözlenmiþtir. Yedi olguda tedavi gerektiren Grade IIIA veya üstü rejeksiyon saptanmýþtýr. Tartýþma: Kardiyak transplantasyondaki ilk deneyimlerimizin sonuçlarý ümit vericidir. Kardiyak transplantasyon uygulanan olgular rejeksiyon ve enfeksiyon yönünden yakýn takip edilmelidir.

Several advances have occurred during the past two decades in the management of patients with end-stage heart disease. Cardiac transplantation is the best therapeutic modality to achieve long-term survival for these patients. Cardiac transplantation was performed in 18 patients (13 male and 5 female) during a three-year period. The mean age was 44.7±14.1 years (21-63 years). The etiology was idiopathic dilated cardiomyopathy in 10 patients, and ischemic cardiomyopathy in seven. Orthotopic cardiac transplantation was performed using the biatrial technique. The mean cardiac ischemia time was 170.7±61.7 minutes (101-335 min.). Triple-drug immunosuppression (cyclosporin A, prednisone, azathioprine) was given in all patients. Rejection was monitored by routine endomyocardial biopsy. All patients underwent annual coronary angiography. Results: Perioperative mortality was 11.1% with 2 deaths. Prolonged intubation was needed in 1 patient. Acute renal failure requiring dialysis was seen in 2 patients. One patient died from sepsis, 1 from hemophagocytic syndrome, 2 from aspergillus pneumonia, and 1 from staphylococcus pneumonia. All deaths were doserved within postoperative 6 months. Grade IIIA or greater rejection necessitating treatment was encountered in 7 patients. Conclusion: Our preliminary results encourage us to continue transplantation practice. Close monitoring of rejection and infection is necessary in cardiac transplant patients.

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Çalýþmamýzýn amacý anjiyografik olarak koroner arter hastalýðý (KAH) tanýsý kesinleþmiþ olgularda risk faktörlerinin prevalansýný belirlemek, bunlarýn erkek ve kadýnlarda ve çeþitli yaþ gruplarýnda daðýlýmýný araþtýrmak ve çalýþma verilerimizi Avrupa ülkelerinde KAH olgularýnda risk faktörü daðýlýmýnýn incelendiði EUROASPIRE I verileriyle karþýlaþtýrmaktýr. Hasta grubumuzu, KAH ön tanýsýyla kliniðimizde Ocak 2000 ile Mayýs 2000 tarihleri arasýnda ilk kez anjiyografi uygulanan ve anlamlý koroner lezyon saptanan 617 ardýþýk olgu (516 Erkek, yaþ ort 57.2 ± 10.8) oluþturmaktadýr. Olgularda anjiyografi öncesi, yaþ, cins, ailede prematüre koroner arter hastalýðý öyküsü, diyabetes mellitus (DM), hipertansiyon (HT), lipid profili, sigara kullanýmý, beden kitle indeksi, bel çevresi, kalça çevresi, fiziksel aktivite durumlarýna ait veriler kaydedildi. Kýrk yaþ ile 70 yaþ arasýndaki olgular 10 yýllýk yaþ gruplarýna ayrýldý ve her yaþ grubunda risk faktörlerinin daðýlýmý belirlendi. Verilerimiz dokuz Avrupa ülkesinde KAH olgularýnda risk faktörü sýklýðýnýn incelendiði EUROASPIRE I çalýþmasý verileriyle karþýlaþtýrýldý. Çalýþmamýzda, erkek olgularda KAH'nýn en sýk 50-59 yaþlar arasýnda kadýnlarda ise 60-69 yaþlar arasýnda ortaya çýktýðý saptandý. Hiperlipidemi, aile öyküsü, DM, HT, sigara içiciliði, obezite ve santral obezite sýrasýyla %58, %26, %20, %41, %65, %18, %29 oranýnda gözlendi. Risk faktörlerinin karþýlaþtýrmada obezite ve DM prevalansý bizim olgularýmýzda dokuz Avrupa ülkesi ortalamasýyla benzer, sigara kullanýmý bizim olgularýmýzda oldukça yüksek, hipertensiyon, hiperlipidemi ve ailede prematüre KAH öyküsü bizim olgularýmýzda Avrupa ortalamasýna göre daha düþük bulundu.

The aim of our study is to determine the prevalence of risk factors among subjects who have an angiographically proven CAD, look into the age-and sex- specific distribution of these factors and to compare it with those of the EUROASPIRE I study. Our patients comprises 617 consecutive subjects (516 male, mean age 57.2±10.8) who underwent an angiography between January and May, 2000, for the first time and in whom significant coronary lesions were detected. Age, gender, family history of premature CAD (FH), diabetes mellitus (DM), hypertension (HT), lipid profile, smoking, body mass index, waist circumference, hip circumference and physical activity data were recorded prior to angiography. Subjects between 40 and 70 years of age were divided into 10-year age groups and distribution of risk factors was evaluated for each age group. Data thus obtained were compared with the results of EUROASPIRE I trial, which studied the frequency of existing risk factors among CAD patients at presentation in nine European countries. Coronary artery disease was found to occur most frequently in male patients between the ages of 50-59, and in female patients, between 60-69 years of age. Hyperlipidemia, FH, DM, HT, smoking, obesity, and central obesity were found in 58%, 26%, 20%, 41%, 65%, 18%, 29% of patients, respectively. Upon comparison of the risk factors, prevalence of obesity and DM was found to be similar to the average of nine European countries among our subjects; on the other hand, smoking was found to be considerably higher, whereas HT, hyperlipidemia and family history of premature CAD were lower than the European average within our subjects.

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Kardiyovasküler týp alanýnda 2001 yýlýnda Türkiye kökenli uluslararasý yayýnlarý deðerlendirmek amaciyle, Science Citation Index'in CD edisyonuna kaynak dergilerdeki Türkiye adresli yayýnlar Web of Science'ten incelendi. Kardiyovasküler týbbý ilgilendiren yayýnlardan, yalnýz SCI Expanded kapsamýnda yer alan makaleler ve editöre mektup ile toplantý özetleri dýþlanarak, geri kalan tam metinli makaleler dikkate alýndý. Birden fazla kurumdan ya da bilim dalýndan çýkan ortak yayýnlar için bir kredi sistemi uygulandý. Anýlan yýlda bilim ve teknoloji sahalarýnda çýkan Türkiye kaynaklý 6229 tam metinli makaleden, CD edisyonundaki 99'u (%2,6'sý) kardiyovasküler týbba aitti. Kardiyoloji yayýnlarýnda, önceki iki yýlda kaydedilen duraklamayý telafi edercesine, 2001 yýlýnda bir öncesine kýyasla %47'lik bir artýþ saðlandý; dünyadaki payýmýz binde 6.9'a yükseldi. Kardiyolojide 81, kalp cerrahisinde 16, çocuk kardiyolojisinde 2 makale yayýnlanmýþtý. Yayýnlanan dergilerin ortanca impakt faktörü 1.0 idi. T. Yüksek Ýhtisas Hast. yayýnlarda Hacettepe Ü.'nin önüne geçti. Ayrýca Yüzüncü Yýl, Dicle ve Karadeniz ÜTF'leri bu yýl hamle yapan merkezlerin baþýnda geldi.

Publications in cardiovascular medicine originating from Turkey's institutions were identified from the data of the Web of Science in order to assess the progress of the output. After deletion of meeting abstracts and letters to the editor, articles in full-text appearing in source publications of Science Citation Index CD Edition alone were included. A weighted credit system was utilized for items published jointly with a foreign or a noncardiological Turkish institution. A total of 99 articles and reviews were identified which represented an increase by 47% over the previous year, raising Turkey's share of world publication output in cardiovascular medicine to 6.9 per mille. Cardiology with 81 articles resumed an overwhelming position, ahead of cardiovascular surgery with 16, and pediatric cardiology with 2 articles. Median impact factor of source publications was 1.0. Turkey's Advanced Specialty Hospital led this year in publications putting Hacettepe U. into second place. Furthermore, universities of Yüzüncü Yýl, Dicle and Karadeniz ranked among centers exhibiting a great leap forward.

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Primer pulmoner hipertansiyon, kötü prognozlu, ilerleyici bir hastalýktýr. Tedavide kullanýlan pulmoner vasodilatörelerin etkinlikleri sýnýrlýdýr. Fakat son yýllarda bu konuda bazý ilerlemeler elde edilmiþtir. Bu muhtemel ajanlardan biri de sildenafildir. Burada primer pulmoner hipertansiyonlu 27 yaþýnda genç bir hasta sunulmuþtur. Hastanýn tedavisine almakta olduðu iloprosta ilave olarak günde 200 mg sildenafil eklenmiþtir. Sildenafil tedavisine baþlandýktan hemen sonra egzersiz kapasitesi düzelmiþ, yaþam kalitesi artmýþtýr. Bir gün sonra yapýlan pulmoner basýnç kontrolünde basýncýn 112 mmHg'den 73 mmHg'ye düþtüðü tespit edilmiþtir. Sildenafilin pulmoner hipertansiyon tedavisindeki rolünün prospektif çalýþmalarda derinlemesine araþtýrýlmaya ihtiyacý vardýr.

Primary pulmonary hypertension is a progressive disease, which carries a poor prognosis. To date, the efficacy of pulmonary vasodilator therapy has been limited. Despite the limitations of pulmonary vasodilator therapy, it has seen significant advances in recent years. One of these drugs, sildenafil, appears to be promising. Here, a 27-year-old young man with the diagnosis of primary pulmonary hypertension is presented. We added sildenafil 200 mg/day (qid) to the ongoing therapy of iloprost. At follow up one day and one month later, his exercise capacity was greatly improved and he enjoys a good quality of life without obvious side effects. Pulmonary artery pressure decreased from 112 mmHg to 73 mmHg one day later. Sildenafil needs to be evaluated in depth prospectively in the treatment of pulmonary hypertension.

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