Makale Özeti | Tam Metin PDF

Makale Özeti | Tam Metin PDF

Amaç: Aterosklerozun þiddetinin ve yaygýnlýðýnýn basit ve invaziv olmayan yöntemlerle tespiti oldukça önemlidir. Ateroskleroz yükü Gensini skor sistemi (GSS) kullanýlarak belirlenebilmektedir. Karotis intima medya kalýnlýðý (KÝMK), plazma asimetrik dimetilarjinin (ADMA) seviyesi ve endotel fonksiyon bozukluðu aterosklerozun iyi bilinen belirteçleridir. Bu çalýþmanýn amacý GSS ile tespit edilen ateroskleroz yükü ile ADMA, KÝMK ve endotel fonksiyon bozukluðu arasýndaki iliþkiyi incelemektir.
Çalýþma planý: Koroner anjiyografi yapýlmýþ olan ardýþýk hastalar deðerlendirildi. Akut koroner sendromlu (AKS) 50 hasta, stabil koroner arter (SKA) hastalýðý olan 50 ve koroner arterleri normal (NKA) 50 olgu çalýþmaya alýndý. Çalýþmaya alýnan tüm olgularýn GSS, ADMA, KÝMK ve endotel fonksiyonlarý ölçüldü ve karþýlaþtýrýldý.
Bulgular: GSS deðerleri AKS grubunda SKA grubuna göre daha yüksekti (75.4 ve 54.9; p<0.001). KÝMK AKS ve SKA gruplarýnda NKA grubundan daha yüksekti (sýrasýyla, 0.98, 0.96, 0.78 mm; p<0.001). Endotel baðýmlý vasodilator yanýt (EBVY) AKS ve SKA gruplarýnda NKA grubundan daha düþüktü (sýrasýyla, %3.5±2.1, %3.3±1.8, %7.2±3.5; p<0.001). AKS ve SKA gruplarýndaki plazma ADMA konsantrasyonu NKA grubundakinden daha düþüktü (sýrasýyla, 0.928, 0.992, 0.475 μmol/l; p<0.001). GSS ile plazma ADMA konsantrasyonu arasýnda zayýf pozitif korelasyon (r=0.293; p=0.002), GSS ile KÝMK arasýnda orta derecede pozitif korelasyon (r=0.508; p<0.001), GSS ile EBVY arasýnda orta derecede negatif korelasyon saptandý (r=-0.662; p<0.001).
Sonuç: Bu çalýþmada, plazma ADMA konsantrasyonu, KÝMK ve endotel fonksiyon bozukluðu ile koroner arter hastalýðý arasýndaki iliþki gösterilmiþ olmasýna raðmen AKS ve SKA gruplarý arasýnda yalnýzca GSS açýsýndan anlamlý farklýlýk saptanmýþtýr.

Objectives: Detection of extent and severity of atherosclerosis using easy, non-invasive methods is of great importance. Atherosclerotic burden may be evaluated with the Gensini scoring system (GSS). Carotis intima media thickness (CIMT), plasma asymmetric dimethyl arginine (ADMA) level, and endothelial dysfunction are well known surrogate markers of atherosclerosis. The aim of this study was to evaluate the relationship between atherosclerotic burden determined by the GSS, and ADMA, CIMT and endothelial function.
Study design: Consecutive patients who had undergone coronary angiography were evaluated. 50 patients with acute coronary syndrome (ACS), 50 patients with stable coronary artery disease (SCA), and 50 patients with normal coronary arteries (NCA) were included. All subjects’ GSS, ADMA, CIMT and endothelial functions were evaluated and compared.
Results: GSS was higher in ACS than SCA (75.4 vs 54.9; p<0.001). CIMT was higher in ACS and SCA in compared to NCA (0.98, 0.96, 0.78 mm respectively; p<0.001). Endothelium derived vasodilatory response (EDVR) was decreased in ACS and SCA in compared to NCA (3.5±2.1%, 3.3±1.8%, 7.2±3.5% respectively; p<0.001). Plasma ADMA concentration was higher in ACS and SCA in compared to NCA (0.928, 0.992, 0.475 μmol/l respectively; p<0.001). There was a weak positive correlation between GSS and plasma ADMA levels (r=0.293; p=0.002), an intermediate positive correlation between GSS and CIMT (r=0.508; p<0.001), and an intermediate negative correlations between GSS and EDVR (r= -0.662; p<0.001).
Conclusion: This study showed that CIMT, ADMA concentration and endothelial dysfunction were significantly associated with CAD. However, only the GSS was significantly different between ACS and SCA groups.

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Amaç: Bu çalýþmada akut miyokart enfarktüsü (AME) geçirmiþ ve perkütan koroner giriþimle yeniden kanlandýrma yapýlmýþ olgularda kardiyak rehabilitasyonun (KR) sol ventrikül diyastolik fonksiyonlarý üzerine olan etkisi deðerlendirildi.
Çalýþma planý: Toplam 82 hasta çalýþmaya dahil edildi. AME sonrasý KR programýný tamamlayan 42 olgu hasta grubu ve ilk seanstan sonra sürdüremeyen 40 adet hasta kontrol grubu olarak çalýþmaya alýndý. Mitral dolum akýmlarýný oluþturan erken diyastol pik akým hýzý (E) ve geç diyastolik pik akým hýzý (A), E/A oraný, erken diyastol pik akým hýzý azalma süresi (DT) ve mitral A dalgasýnýn süresi ölçüldü. Apikal pencerelerden mitral anulus doku hareket hýzlarý doku Doppler ile deðerlendiridi. Erken diyastol hareket hýzý e’ olarak tanýmlandý. E/e’ hesaplandý ve doku Doppler incelemesi ile izovolümik gevþeme zamaný (IVGZ) ölçüldü. Pulmoner ven akýmý ileri dalga formlarýnýn erken sistol pik hýzý (S) ve diyastol pik hýzý (D) tespit edilerek S/D oranlarý alýndý. Atriyum geri akým süresi (Ar) ile mitral -A dalgasý süresi arasýndaki fark hesaplandý.
Bulgular: E/A oraný ve septal e’ dalgasý hýzýnýn kardiyak rehabilitasyon ile anlamlý olarak iyileþtiði görüldü (sýrasýyla p=0.048 ve p=0.006). E/e’ ölçümlerinde istatistiksel olarak anlamlý fark bulunamadý (p=0.138). Sol ventrikül diyastolik fonksiyonu kardiyak rehabilitasyon ile kýsmen düzelmiþ olarak deðerlendi. Enfarktüsten sorumlu damar ile sol ventrikül diyastolik fonkiyonlarý arasýnda herhangibir iliþki kurulamadý. Hipertansiyon ile E/A arasýnda istatistiksel olarak anlamlý iliþki bulundu (p=0.000).
Sonuç: KR, AME geçirmiþ ve yeniden kanlandýrma yapýlmýþ olgularda sol ventrikül septal e’ ve E/A dalgasýnda anlamlý iyileþmeye neden olmakta ve bu iyileþme özellikle hipertansiyonu olan olgularda ön plana çýkmaktadýr.

Objectives: We aimed to observe the effect of cardiac rehabilitation (CR) on left ventricular diastolic function in patients with acute myocardial infarction (AMI) and revascularization by percutaneous coronary intervention (PCI).
Study design: 82 patients were enrolled the study; 42 who were participating in a CR program, and 40 who did not maintain the program as a control group. Measurements of mitral inflow included the peak early filling (E-wave) and late diastolic filling (A-wave) velocities, the E/A ratio, deceleration time (DT) of early filling velocity and mitral A-wave duration. The early diastolic annular velocity has been expressed as e’ with PW tissue Doppler imaging. The mitral inflow E velocity to tissue Doppler e’ (E/e’) was calculated and isovolumic relaxation time (IVRT) was measured. Measurements of pulmonary venous waveforms included peak systolic (S) velocity, peak anterograde diastolic (D) velocity and the time difference between the duration of the atrial reversal (Ar) and mitral Awave duration (Ar-A).
Results: E/A and septal e’ were better with the CR group than the control group. (p=0.048 vs p=0.006 respectively). The difference between E/e’ measurements were not statistically significant (p=0.138). The left ventricular diastolic function of patients were partially improved with cardiac rehabilitation. There was no association between infarct-related artery (IRA) and diastolic functional measurements of the left ventricle in the individuals. Only hypertension was found significantly associated with E/A (p=0.000).
Conclusion: CR improves septal e’ and E/A significantly in patients with AMI and revascularized successfully by PCI, especially in those with hypertension.

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Amaç: Bu çalýþmadaki amacýmýz kronik böbrek yetersizliði (KBY) hastalarýnda önyükteki azalmanýn sað ventrikül sistolik fonksiyonlarýný belirlemede kullanýlan yeni ve eski ekokardiyografik parametreler üzerine etkisini araþtýrmaktýr.
Çalýþma planý: Yaþ ortalamasý 48±15, 19’u kadýn toplam 30 KBY’li hasta çalýþmaya alýndý. Hastalarýn hemodiyaliz öncesi ve sonrasýnda ekokardiyografi ile; sol ventrikül ejeksiyon fraksiyonu (SVEF), sol atriyum hacmi, sað atriyum alaný, sað ventrikül diyastol sonu alaný, sistolik pulmoner arter basýncý, sað ventrikül fraksiyonel alan deðiþikliði (FAD), nabýz sað ventrikül miyokard performans indeksi (Tei indeksi), sað ventrikül doku dopler S’ velositesi, izovolumetrik miyokardiyal akselerasyon (IVA), triküspit anuler plan yerdeðiþtirme (TAPSE), sað ventrikül çýkýþ yolu sistolik yerdeðiþtirme (RVOT SE) parametreleri deðerlendirildi.
Bulgular: Sað ventrikül sistolik fonksiyonlarýný belirlemeye yarayan sað ventrikül S’ velositesi ve RVOT SE parametrelerin hemodiyaliz sonrasý anlamlý bir deðiþiklik olmadýðý (sýrasý ile p=0,919 ve p=0,186); FAD, Tei indeksi, IVA ve TAPSE deðerlerinin ise belirgin bir þekilde arttýðý (tümü için p<0,001) bulundu. Ayrýca TAPSE ile çekilen sývý miktarý arasýnda pozitif korelasyon (r=0,375 ve p=0,041) saptandý.
Sonuç: Sað ventrikül sistolik fonksiyonlarýnýn deðerlendirilmesinde kullanýlan sað ventrikül S’ velositesi ve RVOT SE'nin önyükten baðýmsýz; FAD, Tei indeksi, IVA ve TAPSE'nin önyük baðýmlý olduðu belirlenmiþtir. Ayrýca sadece TAPSE’nin çekilen sývý miktarý ile korele olduðu saptanmýþtýr.

Objectives: The goal of the study was to determine the effect of decreased preload on right ventricular systolic function, as measured by new and old echocardiographic parameters in chronic renal failure (CRF) patients.
Study design: A total of 30 CRF patients (mean age 48 ± 15 years and 19 female) undergoing hemodialysis were included in the study. Echocardiography was used to determine left ventricular ejection fraction (LVEF), left atrial volume, right atrial area, right ventricular end-diastolic area, systolic pulmonary artery pressure, right ventricular fractional area change (RV FAC), right ventricular myocardial performance index (Tei index), right ventricular tissue Doppler S' (RV S') velocity, isovolumic myocardial acceleration (IVA), tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract systolic excursion (RVOT SE) before and after hemodialysis.
Results: The RV S' velocity and RVOT SE parameters which are indicators of right ventricular systolic function did not change significantly after hemodialysis (p=0.919, p=0.186). However, the RV FAC, Tei index, IVA and TAPSE values were significantly increased (p<0.001 for all). TAPSE was found to be the only parameter that had a positive correlation with the amount of fluid removed (p=0.041 and r=0.375).
Conclusions: Although RV S' velocity and RVOT SE, was found to be independent of preload, RV FAC, Tei index, IVA and TAPSE values were depend on the preload. In addition, TAPSE correlated with the amount of fluid removed.

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Amaç: Fragmante QRS’in koroner arter hastalýðýnda kardiyak olaylarýn öngördürücüsü olduðu daha önce gösterilmiþtir. Bu çalýþmada biz ST yükselmesiz miyokart enfarktüslü (STYzME) hastalarda baþvuru 12 derivasyonlu elektrokardiyografisindeki (EKG) fragmente QRS (fQRS) varlýðýnýn kötü sonlanýmlarý öngördürebileceðini göstermeyi amaçladýk.
Çalýþma planý: STYzME’li 149 hasta (112 erkek, 37 kadýn) geriye dönük incelendi. fQRS paterni majör koroner arter sahasýndan sorumlu birbirini takip eden 2 derivasyonda baþlangýçtaki R’, S dalgasýnýn sonunda çentikleþme olmasý, RS fragmantasyonu veya QS kompleksleri olmasý olarak tanýmlandý. Baþvuru sýrasýnda kaydedilen 12-derivasyonlu EKG’de fQRS varlýðý ile birincil (kardiyovasküler ölüm) ve ikincil (tekrarlayan enfarkt ve perkütan veya cerrahi yolla hedef damar revaskü- larizasyonu) sonlaným noktalarý arasýndaki iliþki incelendi. Ortalama takip süresi 18 (13-24) aydý.
Bulgular: fQRS olan ve olmayan gruplardaki hastalarda yaþ hariç bazal özellikler ve laboratuvar bulgularý arasýnda anlamlý fark yoktu. fQRS grubunda hastalar daha yaþlýydý [64 yýl ve 59 yýl, p=0.048]. Ortalama 18 aylýk takipte, kardiyovasküler ölüm ve tekrar enfarkt geçirme fQRS grubunda anlamlý olarak daha yüksekti (sýrasýyla, %26.1 ve %8.7, p=0.005; %23.9 ve %10.7, p=0.035). Toplam 149 hastada çoklu deðiþ- ken analizi ile; yaþýn ≥65 olmasý ve baþvurudaki 12-derivasyonlu EKG’de fQRS varlýðýnýn kardiyovasküler mortalitenin güçlü, baðýmsýz öngördürücüsü olduðu bulundu (sýrasýyla, HR: 4.91, %95 CI: 1.60-15.03, p=0.005; HR: 2.77, %95 CI: 1.02-7.50, p=0.044).
Sonuç: Baþvuru EKG’sinde fQRS olmasý STYzME’li hastalarda uzun dönem mortalitesinin artýþý ile iliþkilidir.

Objectives: Fragmented QRS (fQRS) as a predictor of cardiac events in coronary artery disease has previously been reported. In this study, we hypothesized that presence of fQRS on a 12-lead electrocardiogram (ECG) on admission would be predictive of adverse outcomes in non-ST elevated myocardial infarction (NSTEMI).
Study design: A total of 149 NSTEMI patients (112 male, 37 female) were retrospectively analyzed. The fQRS pattern was defined as the presence of an additional R’, notching in the nadir of the S wave, fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationship between presence of fQRS on admission on a 12-lead ECG, and primary end points [cardiovascular death (CVD)] and secondary end points (re-infarction, repeat target vessel revascularization [percutaneous/surgical]) were assessed. The median follow-up time was 18 (13-24) months.
Results: Other than age, there were no significant differences in baseline characteristics and laboratory findings for patients in the fQRS and non-fQRS groups. The patients in the fQRS group were older [64 years vs 59 years, p=0.048]. CVD and re-infarction were significantly higher in the fQRS group in the median 18-month follow-up (26.1% vs 8.7%, p=0.005; 23.9% vs 10.7%, p=0.035, respectively). By a multivariate regression analysis in all 149 patients, age ≥65 years and the presence of fQRS in a 12-lead ECG on admission were found to be powerful independent predictors of cardiovascular mortality (HR: 4.91, 95% CI: 1.60-15.03, p=0.005; HR: 2.77, 95% CI: 1.02-7.50, p=0.044, respectively).
Conclusion: Presence of fQRS on a 12-lead ECG on admission is associated with increased long-term mortality in patients with NSTEMI.

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Amaç: Hipertansiyon, tip 2 diyabeti olan hastalarda sýk olarak eþlik eden bir hastalýktýr. Hipertansiyonun tedavisi, diyabetin makro ve mikrovasküler komplikasyonlarýnýn azaltýlmasýnda oldukça önemli bir yere sahiptir. Bu çalýþmanýn amacý hipertansiyonu olan diyabetli hastalarda kan basýncý kontrol (<140/85 mmHg) düzeyini saptamak ve antihipertansif ilaçlarýn reçetelenme biçimini deðerlendirmektir.
Çalýþma planý: Bu çalýþma, Türkiye’de üçüncü basamak bir merkezde yürütülen ileriye dönük, kesitsel, gözlemsel bir çalýþmadýr. Yediyüz yedi diyabetli hasta içinden hipertansiyonlu 500 hasta hipertansiyon kontrolü ve tedavi yaklaþýmlarýnýn belirlenmesi için deðerlendirildi. Lojistik regresyon analizi kullanýlarak her bir antihipertansif ilaç sýnýfýnýn makro ve mikrovasküler hastalýklarýn varlýðý açýsýndan reçetelenme olasýlýðý araþtýrýldý.
Bulgular: Hastalarýn çoðu (%95) antihipertansif ilaç kullanmakla birlikte sadece %41’i hedef kan basýncý deðerlerine (<140/85 mmHg) ulaþmýþtý. Renin anjiyotensin sistemi (RAS) blokerleri en sýk (%82.4) reçete edilen antihipertansif ajanlardý ve RAS blokerleri ile diüretik kombinasyonu en sýk tercih edilen kombinasyon tedavisi idi. Hastalarýn çoðu bir veya iki antihipertansif ilaç kullanmaktaydý (sýrasýyla, %39.5; %44.7). Koroner arter hastalýðý olan hastalarda beta bloker kullanýmý daha olasý idi (Odds oraný=3.6; %95 güvenlik aralýðý=2.3-5.6; p<0.001).
Sonuç: Diyabetli hipertansif hastalarýn çoðu hipertansiyon tedavisi almalarýna raðmen, yarýdan fazlasýnda kan basýncý kontrol altýnda deðildir

Objectives: Hypertension is a common comorbidity in patients with type 2 diabetes. Management of hypertension is of paramount importance in reducing macro and microvascular complications of diabetes. The aim of this study is to determine the rate of blood pressure control (<140/85 mmHg) in diabetic patients with hypertension, and to evaluate the prescribing pattern of antihypertensive medications.
Study design: This was a prospective, cross-sectional, observational study conducted in a tertiary centre in Turkey. Of 707 patients with diabetes, 500 hypertensive patients were evaluated to determine control of hypertension and treatment attitudes. Logistic regression analysis was used to evaluate the likelihood of prescription of each class of antihypertensive medications for the presence of macro and microvascular complications.
Results: Most of the patients (95%) were on antihypertensive therapy. Only 41% achieved target blood pressure values (<140/85 mmHg). Renin angiotensin system (RAS) blockers were the most frequently (82.4%) prescribed antihypertensive agents, and a combination of RAS blockers and diuretics were the most commonly preferred combination therapy. Most of the patients were on 1 antihypertensive drug or a combination of 2 drugs (39.5% and 44.7%, respectively). Patients with coronary artery disease were more likely to receive beta blockers (Odds ratio=3.6, 95% confidence interval=2.3-5.6; p<0.001).
Conclusion: Although most of the diabetic hypertensive patients were on hypertensive therapy, more than half had uncontrolled blood pressure.

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Amaç: Günümüzde ekokardiyografi gibi giriþimsel olmayan yöntemler kullanýlarak aort esnekliði göstergeleri olan beta sertlik indeksi (BSÝ), aortik strain (AS) ve distensibilitenin (AD) hesaplanmasý mümkündür. Bu çalýþmada Maraþ otu ve sigaranýn aort esnekliði üzerine etkisini genç eriþkinlerle incelemeyi amaçladýk.
Çalýþma planý: Çalýþmaya yaþlarý 18-40 yaþ arasý 90 erkek birey alýndý. Bunlardan 30 kiþi kontrol grubu (yaþ ortalamasý 29±2), 30 kiþi sigara kullananlar (yaþ ortalamasý 28±2) ve 30 kiþi de Maraþ otu kullananlar (yaþ ortalamasý 32±2) olarak ayrýldý. Hastalarýn sistolik ve diyastolik kan basýnçlarý ölçüldü. Ekokardiyografi ile parasternal uzun eksen görüntüsünden çýkan aortanýn M-mod kayýtlarý alýnarak aortun sistolik ve diyastolik çaplarý ölçüldü. Yapýlan ölçümlerden; AS, AD ve BSÝ standart formüllerle ile hesaplandý. Her üç grubun ölçülen ve hesaplanan parametreleri karþýlaþtýrýldý.
Bulgular: Guruplar arasýnda demografik ve klinik özellikler, kan basýnçlarý, lipit profili ve serum kreatinin deðerleri açýsýndan anlamlý bir fark yoktu (p>0.05). Kontrol grubu ile karþýlaþtýrýldýðýnda Maraþ otu ve sigara kullananlarda AS ve AD daha düþük ve BSÝ daha yüksek olmasýna raðmen bu farklýlýk istatistiksel olarak önemli deðildi (AS için sýrasýyla: 17.61±2.22, 17.75±1.93, 18.48±2.02, AD için sýrasýyla: 9.03±1.12, 9.14±0.96, 9.9±1.12, BSÝ için sýrasýyla 2.72±1.07, 2.59±0.88, 2.37±0.71 hepsi için p>0.05).
Sonuç: Kýrk yaþýn altýndaki bireylerde sigara ve Maraþ otu aort esnekliði üzerinde belirgin bir deðiþikliðe yol açmamaktadýr.

Objectives: Stiffness index beta (SIB), aortic strain (AS) and distensibility (AD) are the parameters used to assess elasticity of the aorta, and can be measured by non-invasive method such as echocardiography. In this study, we aimed to analyse the effects of Maraþ powder and smoking on aortic stiffness by comparing young individuals.
Study design: The study included 90 male subjects aged 18-40 years. 30 subjects were Maras powder users (mean age; 32±2), 30 were smokers (mean age: 28±2) and 30 were healthy volunteers (mean age: 29±2). After detailed physical examination, all subjects underwent transthoracic echocardiography. Systolic and diastolic diameters of the aorta were measured from the ascending aorta at modified parasternal long axis views by M-mode echocardiography. AS, AD, and SIB were calculated using standard formulae. Group parameters were then compared to each other.
Results: There was no significant difference between the groups in terms of demographic and clinical features, including blood pressures, lipid profile and serum creatinine (p>0.05). Although AS and AD were lower, and SIB was higher in the Maraþ powder and smoking groups compared to the control group, the difference between groups was not statistically significant (for AS: 17.61±2.22, 17.75±1.93, 18.48±2.02 respectively, for AD: 9.03±1.12, 9.14±0.96, 9.9±1.12, respectively, for SIB: 2.72±1.07, 2.59±0.88, 2.37±0.71 respectively, for all p>0.05).
Conclusion: Our study revealed that smoking and Maraþ powder did not lead to a significant change in elasticity of the aorta in individuals under the age of 40.

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Perkütan mitral balon valvüloplasti (PMBV) kontrendikasyonu olmayan ve uygun kapak anatomisine sahip mitral darlýklý hastalarda birincil tedavi yöntemidir. Perikart sývý birikimi, kalp tamponadý ve trombüs oluþumu bu iþlemin nadir görülen ancak ciddi komplikasyonlarýdýr. Literatürde PMBV iþlemi ile iliþkili mortalite oraný %1 olarak bildirilmiþtir. Kalp içi trombüs varlýðý PMBV için kontrendikasyon olup iþlem esnasýnda trombüs oluþumu oldukça nadir bir durumdur. Bu yazýda, romatizmal mitral darlýðý olan ve valvüloplasti iþlemi sýrasýnda sol atriyum tavanýnda yýrtýlma ile perikart sývý birikimi ve ayný zamanda kalp içi trombüs geliþen bir olgu sunuldu.

Percutaneous mitral balloon valvuloplasty (PMBV) is the primary treatment in mitral stenosis patients with appropriate valve anatomy with no contraindications present. Pericardial effusion, cardiac tamponade and thrombus formation are rare but serious complications of this procedure. In the literature, the mortality rate associated with PMBV has been reported as 1%. The presence of intracardiac thrombus is a contraindication for PMBV. However, thrombus formation during the process is a very rare condition. In this case, we present a patient with rheumatic mitral stenosis, with both pericardial effusion and intracardiac thrombus, after laseration at the base of the left atrium during the valvuloplasty procedure.

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2007 yýlýnda koroner arter baypas operasyonu öyküsü olan ve akut ön yüz kalp krizi geçiren 57 yaþýnda bir hasta sunuyoruz. Hastanýn ayný zamanda eþlik eden ciddi sol kol aðrýsý ve siyanozu da bulunmaktaydý. Bir ay önce pankreastan kaynaklanan adenokarsinom tanýsý konan hastaya, bir hafta önce gemsitabin ve 5-florourasil içeren kemoterapinin ilk kürü uygulanmýþtý. Anjiyografide sol subklavya atardamarý baþlangýcýnda yer alan ve sol iç meme atar damarý sol ön inen koroner arter baypas greftinin ve sol kol atardamarýnýn akýmýný engelleyen dev bir pýhtý parçasý görüntülendi. Sol subklavya arterinin baþlangýç kýsmýna stent yerleþtirilerek iyi bir akým saðlandý. Sol iç meme atardamarý aracýlýðýyla, ötesi olasý pýhtý göçü ile týkanmýþ sol ön inen koroner atardamara ulaþýldý ve perkütan anjiyoplasti yapýldý, ne var ki “no reflow” fenomeni izlendi. Sol koldaki pýhtý parçasý Fogarty kateteri ile baþarýlý bir þekilde uzaklaþtýrýldý. Ýþlemden yaklaþýk yarým saat sonra, sürekli fraksiyone olmayan heparin ve nitrogliserin infüzyonu altýnda hastanýn hem göðüs aðrýsý, hem de EKG’deki ST segment yükselmeleri geriledi. Ancak hasta, yatýþýnýn yedinci gününde sepsis nedeniyle hayatýný kaybetti. Bu klinik olay ile ilgili literatürde ancak birkaç sunu mevcuttur. Bu sunuda, bu klinik olayýn etiyolojisi, baþvuru þekli ve olasý yönetim stratejileri sunulmaktadýr.

We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

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Aortokaval fistül çoðunlukla abdominal aort anevrizmasýnýn bir komplikasyonu olarak karþýmýza çýkmakla beraber nadiren lomber disk hernisi ameliyatý sonrasý komplikasyon olarak da görülebilir. Özellikle büyük arteriyovenöz fistüller zamanla yüksek debili kalp yetersizliðine neden olmaktadýr. Bu yazýda, lomber disk hernisi ameliyatýna baðlý olarak geliþen aortokaval fistülün neden olduðu yüksek debili kalp yetersizliði tanýsý konan bir olgu sunuldu.

Although aortocaval fistula is mostly encountered as a complication of abdominal aortic aneurysms, it may also arise as a complication of lumbar disc surgery. Great arteriovenous shunts especially may lead to high-output heart failure in due time. In this paper, we aim to present a case of high-output heart failure secondary to aortocaval fistule caused by lumbar disc surgery.

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Biz bu yazýda sinüs valsalva yýrtýlmasý olan 37 yaþýnda erkek hastayý sunduk. Hasta yýrtýðýn geriye doðru yaklaþýmla kapatýlmasý ile tedavi edildi. Ýþlem 26 dakika içinde baþarýyla sonuçlandýrýldý. Biz gelecekte geriye doðru yaklaþýmýn öne doðru yaklaþým yerine kullanýlabileceðini düþünmekteyiz.

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.

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Bu yazýda, normal ventrikül fonksiyonuna sahip Takayasu arteritinde sol ventrikül içerisindeki dev trombüsün trombolitik tedavi ile baþarýlý þekilde tedavisi sunuldu. Takayasu arteriti öyküsü olan hasta her iki bacaðýnda güçsüzlük ve aðrý ile baþvurdu. Doppler ultrason incelemesi her iki popliteal arterde subtotal trombotik týkanma ile uyumlu bulundu. Transtorasik ekokardiyografi incelemesinde normal sol ventrikül fonksiyonu ve boyutlarýna raðmen sol ventrikül içerisinde dev trombüs tespit edildi. Daha kötü sonuç doðurabilecek embolilerden kaçýnmak için hastaya cerrahi tedavi önerildi fakat hasta cerrahi tedaviyi kabul etmedi. Trombolitik tedavi uygulama kararý verildi. Üçüncü günde sol ventrikül içerisindeki trombüsün tamamen kaybolduðu ve her iki ayak dolaþýmýnýn da normale döndüðü gözlendi.

We report a case of thrombus treated with thrombolytic therapy in a patient with normal cardiac functions and Takayasu arteritis. A 27-year-old man with a history of Takayasu arteritis was admitted to our out-patient clinic with a complaint of both right and left foot pain and weakness. In a Doppler ultrasound examination, a subtotal thrombotic occlusion was found in the bilateral popliteal arteries. A transthoracic echocardiography revealed a left ventricular apical thrombus, although both cardiac functions and heart dimensions were normal. Surgical excision was recommended to avoid further embolization, but this was refused by the patient. We decided to perform thrombolytic treatment. The thrombus in the left ventricle was fully resolved by the third day. Perfusion in both feet also returned to normal.

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Costello sendromu büyüme geliþme geriliði, mental motor gerilik, tipik yüz görünümü, makrosefali, kýsa boyun, el ve ayak çizgilerinde belirginleþme, yumuþak ve gevþek deri ile birlikte kýllanma artýþý gibi bulgularla karþýmýza çýkan, nadir görülen bir sendromdur. Hastalarýn yaklaþýk üçte ikisinde kalp tutulumu olduðu ve bunun prognozu belirlediði bildirilmektedir. En sýk görülen kalp bozukluklarý pulmoner kapak darlýðý, hipertrofik kardiyomiyopati, atriyal ve ventriküler septal defekt ile aritmilerdir. Bu olgu sunumunda, hipertrofik kardiyomiyopatisi olan, klinik ve genetik olarak Costello sendromu olduðu gösterilen 14 aylýk kýz hasta, son literatür bilgileriyle birlikte sunuldu.

Costello syndrome is a rare syndrome characterized by failure to thrive, short stature, mental motor retardation, characteristic facial features, macrocephaly, a short neck, loose soft skin with deep palmar and plantar creases, and hypertrichosis. Cardiac involvement is seen in almost two thirds of patients, and is a determinant for the prognosis of Costello syndrome. The most common cardiac anomalies are pulmonary stenosis, hypertrophic cardiomyopathy, atrial septal defect, ventricular septal defect and arrhytmia. In this report, we present a 14-month-old female pediatric patient with hypertrophic cardiomyopathy, clinically and genetically diagnosed with Costello syndrome. The report also contains a review of recent related literature.

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Kalp veriminin düþmesine baðlý olarak, kalbin doku ve organlara yeterli kan gönderememesi sonucu ortaya çýkan klinik tablo kalp yetersizliði olarak adlandýrýlmaktadýr. Son dönem kalp yetersizliði yaþam süresini ve kalitesini olumsuz olarak etkilemektedir. Kalp transplantasyonu kýlavuzlara uygun týbbi tedaviye raðmen semptomlu olan hastalarýn çoðunda hala en iyi tedavi yöntemidir. Bu derlemede Türkiye’de kalp transplantasyonunun güncel durumu tartýþýlmaktadýr.

Heart failure is a clinical picture that occurs when the heart is unable to provide sufficient blood to the tissues and organs due to low performance. In end-stage heart failure, quality of life and survival rates are affected adversely. Heart transplantation is still the best method of treatment in many end-stage heart failure patients who remain symptomatic despite guideline-directed medical therapy. The current situation of heart transplantation in Turkey is discussed in this review.

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