Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus ... more Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus (CCMA) is a rare disease. CCMA accounts for .63% of all mitral annular calcification (MAC) cases. The pathophysiology is still unknown. The correct diagnosis and treatment of this disease is very important to prevent complications. We present a case of giant CCMA with advanced mitral stenosis and hypertrophic cardiomyopathy, presenting with symptoms of infection and therefore a preliminary diagnosis of infective endocarditis. Because of these features, we wanted to share our case as it is the 1st case in the literature.
Left ventricular outflow stenosis can develop at the supravalvular, valvular, and subvalvular lev... more Left ventricular outflow stenosis can develop at the supravalvular, valvular, and subvalvular levels. Resection of strictures at the diffuse subvalvular level is very difficult. In such pathologies, Konno‐Rastan procedure provides very successful solutions as an anterior aortoventriculoplasty method. In this article, we performed anterior aortaventriculoplasty surgical treatment for tunnel type left ventricular outflow tract stenosis, recurrent subvalvular discrete membrane, and aortic regurgitation in an adult patient with a history of partial atrioventricular septal defect repair and subvalvular discrete membrane resection operation in early childhood. The Konno‐Rastan procedure, which we applied to the redo case, which is rarely used in adult patients and rarely seen in the literature, is shared.
Introduction Failure to differentiate supraventricular from ventricular arrhythmias is the most f... more Introduction Failure to differentiate supraventricular from ventricular arrhythmias is the most frequent cause of inappropriate implantable cardioverter-defibrillator (ICD) therapies. We hypothesized that the postpacing interval (PPI) after overdrive right ventricular pacing may differentiate ventricular (VT) from supraventricular tachycardia (SVT) such as sinus tachycardia, atrial flutter and atrial tachycardia. This hypothesis is based on the entrainment maneuver. Reentrant tachycardia circuit for VTs would haveshorter distance to RV apex than SVTs have, and the conduction time between a ventricular pacing site and the tachycardia origin is expected to be shorter in VTs than in SVTs. Methods 220episodes from 38 patients with single chamber ICDs that RV overdrive pacing could not terminate or change the tachycardia cycle length (TCL) were retrospectively reviewed. Episodes were classified as VTs (n=115) and SVTs (n=105). TCLs, PPIs and PPI-TCL were compared between groups. Results ...
Objective Earlier studies have reported that a decrease in exercise capacity might indicate endot... more Objective Earlier studies have reported that a decrease in exercise capacity might indicate endothelial dysfunction. However, the effects of improvement of endothelial functions on exercise capacity have not been evaluated. The aim of the present study is to investigate the effects of nebivolol on flow-mediated dilatation (FMD), and on the exercise capacities of the patients with slow coronary flow (SCF). Methods The study population included 25 subjects with SCF (Group 1) documented by the thrombolysis in myocardial infarction (TIMI) frame count, and 25 control group (Group 2) subjects with normal coronary angiography, for a total of 50 subjects who underwent coronary angiography due to several indications and had no coronary lesion. The TIMI frame count (TFC) values of the subjects in Group I for left anterior descending artery, right coronary, and circumflex coronary artery were 61.8 ± 30.6, 37.2 ± 17.4, and 34.6 ± 17.4, respectively. All the subjects received nebivolol 5 mg/day....
Percutaneous transvenous mitral valvuloplasty has emerged as an effective nonsurgical technique f... more Percutaneous transvenous mitral valvuloplasty has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic or asymptomatic mitral stenosis. A 63 year-old woman was diagnosed as having a mitral stenosis 10 years ago, and underwent percutaneous mitral balloon valvuloplasty. The right popliteal and tibial arteries were pulseless. In transesophageal echocardiography severe mitral stenosis (8 mmHg mean gradient and 12 mmHg peak gradient), and a valvular area of approximately 1,10 cm2 and a thrombus of 2.9x2.4 cm were found in the left atrium. Using median sternotomy, aorta-bicaval cannulation, and extracorporeal circulation the right atrium was exposed. The thrombus was placed at the origin of the transseptal puncture, originating from it. This rare case is presented.
Woven coronary artery is a rare coronary anomaly generally considered to be benign. The true inci... more Woven coronary artery is a rare coronary anomaly generally considered to be benign. The true incidence of woven coronay anomaly is not known. It is characterized by the twisting course of multiple thin channels along the vessel in any coronary artery with a normal blood flow. A few cases have been reported until now and the cases of woven anomaly are generally adult patients. This anomaly has been shown in both right and left coronary arteries and may be associated with acute coronary syndromes. In this case report, we present a 60-year-old female patient with a woven anomaly in the left anterior descending coronary artery.
The American Journal of the Medical Sciences, 2016
The role of contrast-enhanced (ce) cardiac magnetic resonance in risk stratification of patients ... more The role of contrast-enhanced (ce) cardiac magnetic resonance in risk stratification of patients with depressed left ventricle (LV) function is widely studied. In this study, we investigated the myocardial infarct size and characteristics by ce-magnetic resonance imaging (MRI) and its relationship with spontaneous ventricular arrhythmia occurrence during follow-up of in patients with mild LV systolic dysfunction and nonsustained ventricular tachycardia (VT). This study enrolled 32 patients with postmyocardial infarction with an LV ejection fraction between 40% and 50% and nonsustained VT. Cardiac MRI performed to identify cardiac scar size and characteristics. Dense scar, peri-infarction zone and total infarct masses were calculated, these values to LV mass ratios were obtained. All patients were followed up 48 ± 6 months. Cardiac magnetic resonance data compared among patients with (n = 6) and without spontaneous sustained VT (n = 26). During follow-up, 6 patients experienced sustained VT (VT+ group), whereas 26 patients had no sustained ventricular arrhythmia (VT- group). The groups had similar baseline clinical characteristics. The LV masses, volumes and ejection fractions did not differ significantly between 2 groups. For the VT+ group versus VT- group dense scar to LV mass were similar (3.1 ± 0.3% versus 3.3 ± 0.9%, P = not significant). Ratio of peri-infarction zone to LV mass (30.9 ± 6.1% versus 21.3 ± 7.5%, P = 0.007) and total infarct to LV mass (34.1 ± 6.1% versus 24.6 ± 7.9%, P = 0.011) were larger in patients with sustained VT. This small study supports the potential utility of ce-MRI to identify patients with postmyocardial infarction prone to develop serious ventricular arrhythmias.
Background: The aim of this study was to assess left ventricular (LV) myocardial regional functio... more Background: The aim of this study was to assess left ventricular (LV) myocardial regional function in overt hypothyroidism by use of tissue Doppler imaging and to compare the results to the hormonal profile and standard Doppler echocardiographic examination. Methods: Hypothyroidic (Group 1, n = 25) and euthyroidic patients (Group 2, n = 25) underwent transthorasic echocardiography, strain and strain rate imaging. Results: Standard echocardiography showed that patients with overt hypothyroidism had significantly longer isovolumic contraction time (IVCT) (P < 0.05), deceleration time (DT) (P = 0.014) and isovolumic relaxation time (IVRT) (P = 0.022). Tissue Doppler imaging showed that the mean peak systolic strain (SI) (16.47 ± 1.45 vs. 20.63 ± 1.51, P < 0.001), the mean peak systolic strain rate (SSR) (1.05 ± 0.13 vs. 1.47 ± 0.11, P < 0.001), the mean peak early diastolic strain rate (ESr) (1.72 ± 0.38 vs. 2.03 ± 0.25, P < 0.05) and the mean peak late diastolic strain rat...
Amaç: İki farklı operasyon tekniği ile 12 yıllık anevrizma onarımı uygulamalarımızı ve geç dönem ... more Amaç: İki farklı operasyon tekniği ile 12 yıllık anevrizma onarımı uygulamalarımızı ve geç dönem ekokardiyografik değerlerini karşılaştırdık. Gereç ve Yöntemler: Kliniğimizde 1994-2006 yılları arasında toplam 68 olguya sol ventrikül anevrizma onarımı uygulandı. 54 (%79.4)'ü erkek, ...
Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus ... more Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus (CCMA) is a rare disease. CCMA accounts for .63% of all mitral annular calcification (MAC) cases. The pathophysiology is still unknown. The correct diagnosis and treatment of this disease is very important to prevent complications. We present a case of giant CCMA with advanced mitral stenosis and hypertrophic cardiomyopathy, presenting with symptoms of infection and therefore a preliminary diagnosis of infective endocarditis. Because of these features, we wanted to share our case as it is the 1st case in the literature.
Left ventricular outflow stenosis can develop at the supravalvular, valvular, and subvalvular lev... more Left ventricular outflow stenosis can develop at the supravalvular, valvular, and subvalvular levels. Resection of strictures at the diffuse subvalvular level is very difficult. In such pathologies, Konno‐Rastan procedure provides very successful solutions as an anterior aortoventriculoplasty method. In this article, we performed anterior aortaventriculoplasty surgical treatment for tunnel type left ventricular outflow tract stenosis, recurrent subvalvular discrete membrane, and aortic regurgitation in an adult patient with a history of partial atrioventricular septal defect repair and subvalvular discrete membrane resection operation in early childhood. The Konno‐Rastan procedure, which we applied to the redo case, which is rarely used in adult patients and rarely seen in the literature, is shared.
Introduction Failure to differentiate supraventricular from ventricular arrhythmias is the most f... more Introduction Failure to differentiate supraventricular from ventricular arrhythmias is the most frequent cause of inappropriate implantable cardioverter-defibrillator (ICD) therapies. We hypothesized that the postpacing interval (PPI) after overdrive right ventricular pacing may differentiate ventricular (VT) from supraventricular tachycardia (SVT) such as sinus tachycardia, atrial flutter and atrial tachycardia. This hypothesis is based on the entrainment maneuver. Reentrant tachycardia circuit for VTs would haveshorter distance to RV apex than SVTs have, and the conduction time between a ventricular pacing site and the tachycardia origin is expected to be shorter in VTs than in SVTs. Methods 220episodes from 38 patients with single chamber ICDs that RV overdrive pacing could not terminate or change the tachycardia cycle length (TCL) were retrospectively reviewed. Episodes were classified as VTs (n=115) and SVTs (n=105). TCLs, PPIs and PPI-TCL were compared between groups. Results ...
Objective Earlier studies have reported that a decrease in exercise capacity might indicate endot... more Objective Earlier studies have reported that a decrease in exercise capacity might indicate endothelial dysfunction. However, the effects of improvement of endothelial functions on exercise capacity have not been evaluated. The aim of the present study is to investigate the effects of nebivolol on flow-mediated dilatation (FMD), and on the exercise capacities of the patients with slow coronary flow (SCF). Methods The study population included 25 subjects with SCF (Group 1) documented by the thrombolysis in myocardial infarction (TIMI) frame count, and 25 control group (Group 2) subjects with normal coronary angiography, for a total of 50 subjects who underwent coronary angiography due to several indications and had no coronary lesion. The TIMI frame count (TFC) values of the subjects in Group I for left anterior descending artery, right coronary, and circumflex coronary artery were 61.8 ± 30.6, 37.2 ± 17.4, and 34.6 ± 17.4, respectively. All the subjects received nebivolol 5 mg/day....
Percutaneous transvenous mitral valvuloplasty has emerged as an effective nonsurgical technique f... more Percutaneous transvenous mitral valvuloplasty has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic or asymptomatic mitral stenosis. A 63 year-old woman was diagnosed as having a mitral stenosis 10 years ago, and underwent percutaneous mitral balloon valvuloplasty. The right popliteal and tibial arteries were pulseless. In transesophageal echocardiography severe mitral stenosis (8 mmHg mean gradient and 12 mmHg peak gradient), and a valvular area of approximately 1,10 cm2 and a thrombus of 2.9x2.4 cm were found in the left atrium. Using median sternotomy, aorta-bicaval cannulation, and extracorporeal circulation the right atrium was exposed. The thrombus was placed at the origin of the transseptal puncture, originating from it. This rare case is presented.
Woven coronary artery is a rare coronary anomaly generally considered to be benign. The true inci... more Woven coronary artery is a rare coronary anomaly generally considered to be benign. The true incidence of woven coronay anomaly is not known. It is characterized by the twisting course of multiple thin channels along the vessel in any coronary artery with a normal blood flow. A few cases have been reported until now and the cases of woven anomaly are generally adult patients. This anomaly has been shown in both right and left coronary arteries and may be associated with acute coronary syndromes. In this case report, we present a 60-year-old female patient with a woven anomaly in the left anterior descending coronary artery.
The American Journal of the Medical Sciences, 2016
The role of contrast-enhanced (ce) cardiac magnetic resonance in risk stratification of patients ... more The role of contrast-enhanced (ce) cardiac magnetic resonance in risk stratification of patients with depressed left ventricle (LV) function is widely studied. In this study, we investigated the myocardial infarct size and characteristics by ce-magnetic resonance imaging (MRI) and its relationship with spontaneous ventricular arrhythmia occurrence during follow-up of in patients with mild LV systolic dysfunction and nonsustained ventricular tachycardia (VT). This study enrolled 32 patients with postmyocardial infarction with an LV ejection fraction between 40% and 50% and nonsustained VT. Cardiac MRI performed to identify cardiac scar size and characteristics. Dense scar, peri-infarction zone and total infarct masses were calculated, these values to LV mass ratios were obtained. All patients were followed up 48 ± 6 months. Cardiac magnetic resonance data compared among patients with (n = 6) and without spontaneous sustained VT (n = 26). During follow-up, 6 patients experienced sustained VT (VT+ group), whereas 26 patients had no sustained ventricular arrhythmia (VT- group). The groups had similar baseline clinical characteristics. The LV masses, volumes and ejection fractions did not differ significantly between 2 groups. For the VT+ group versus VT- group dense scar to LV mass were similar (3.1 ± 0.3% versus 3.3 ± 0.9%, P = not significant). Ratio of peri-infarction zone to LV mass (30.9 ± 6.1% versus 21.3 ± 7.5%, P = 0.007) and total infarct to LV mass (34.1 ± 6.1% versus 24.6 ± 7.9%, P = 0.011) were larger in patients with sustained VT. This small study supports the potential utility of ce-MRI to identify patients with postmyocardial infarction prone to develop serious ventricular arrhythmias.
Background: The aim of this study was to assess left ventricular (LV) myocardial regional functio... more Background: The aim of this study was to assess left ventricular (LV) myocardial regional function in overt hypothyroidism by use of tissue Doppler imaging and to compare the results to the hormonal profile and standard Doppler echocardiographic examination. Methods: Hypothyroidic (Group 1, n = 25) and euthyroidic patients (Group 2, n = 25) underwent transthorasic echocardiography, strain and strain rate imaging. Results: Standard echocardiography showed that patients with overt hypothyroidism had significantly longer isovolumic contraction time (IVCT) (P < 0.05), deceleration time (DT) (P = 0.014) and isovolumic relaxation time (IVRT) (P = 0.022). Tissue Doppler imaging showed that the mean peak systolic strain (SI) (16.47 ± 1.45 vs. 20.63 ± 1.51, P < 0.001), the mean peak systolic strain rate (SSR) (1.05 ± 0.13 vs. 1.47 ± 0.11, P < 0.001), the mean peak early diastolic strain rate (ESr) (1.72 ± 0.38 vs. 2.03 ± 0.25, P < 0.05) and the mean peak late diastolic strain rat...
Amaç: İki farklı operasyon tekniği ile 12 yıllık anevrizma onarımı uygulamalarımızı ve geç dönem ... more Amaç: İki farklı operasyon tekniği ile 12 yıllık anevrizma onarımı uygulamalarımızı ve geç dönem ekokardiyografik değerlerini karşılaştırdık. Gereç ve Yöntemler: Kliniğimizde 1994-2006 yılları arasında toplam 68 olguya sol ventrikül anevrizma onarımı uygulandı. 54 (%79.4)'ü erkek, ...
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