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Volume : 3 Issue : 4
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Anatol J Cardiol: 3 (4)
Volume: 3  Issue: 4 - December 2003
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EDITORIAL
1.Meeting of Associate Editors, AKD and PREMISE
Bilgin Timuralp
PMID: 14675874  Pages 289 - 290
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Single Clamp Technique in Elderly Patients Undergoing Coronary Artery Surgery
Melih Hulusi Us, Mutasım Süngün, Kerim Çağlı, Mert Yılmaz, Alaaddin Pekedis, Ömer Yüksel Öztürk
PMID: 14675875  Pages 291 - 295
Objective: The results of single clamp and partial clamp techniques were retrospectively compared in elderly patients (> 70 years) undergoing coronary artery bypass grafting operation (CABG). Methods: A total of 244 elderly patients undergoing CABG between January 1995 and March 2002 in our center were studied. Single-clamp technique was used in 32 cases (Group 1) and partial-clamp technique was used in 212 cases (Group 2). All patients had isolated coronary artery lesions and a primary elective coronary bypass grafting surgery was planned for every case. Preoperative, operative and postoperative variables; age, gender, pre- and post-operative neurological status (stroke, amaurosis fugax, aphasia, hemiplegia, hemiparesis), cerebrovascular diseases, diabetes mellitus, hypertension, number of distal grafts, left ventricular score, durations of aortic cross-clamping and cardiopulmonary bypass (CPB) times, perfusion pressure during CPB, and postoperative cardiac status were recorded. Patients with a history of neurological complications were excluded from the study. Results: Overall, mean age was 71.9 ± 2.18. Patients in Group 1 were significantly older as compared to patients in Group 2 (p < 0.01). Average duration of cross-clamping in Group 1 was significantly longer (p<0.001) compared to Group 2, but there were no differences with regard to the total duration of cardiopulmonary bypass (p = 0.535). No patients had neurological complications in Group 1, however 22 patients in Group 2 had neurological complications (p £ 0.05). Conclusions: Although single-clamp technique was associated with a longer cross-clamp time, the duration of CPB was not increased and the incidence of neurological complications was low.

EDITORIAL COMMENT
3.Nightmare For Cardiac Surgeons: Neurologic Injury
Mehmet Ateş
PMID: 14675876  Pages 296 - 298
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
4.Immunohistochemical and Electron-Microscopic Characteristics of Secretory Cardiomyocytes in Experimental Myocardial Infarction
V.A. Azizov, S. R. Muradova
PMID: 14675877  Pages 299 - 302
Objective: To study immunohistochemical and electron-microscopic features of secretory cardiomyocytes in experimental myocardial infarction (MI). Methods: Totally 15 hearts of dogs with experimental MI were studied. For electron-microscopic study materials were collected from left atrium, and its several parts (appendix, lateral and frontal walls). For immunohistochemical analysis of atrial natriuretic factor (ANF) incubation in monoclone immune serum was used (standard monoclonal serum and primary mice antibodies, Immunon). For statistic processing we used Chi-square test (criterion of Pearson agreement). Results: Immunohistochemical and electron-microscopic investigation after 24 hours from experimental myocardial infarction indicated increase of specific activity of secretory cardiomyocytes and after 48 hours decrease of secretion of ANF while cardiomyopathy appears. After 72 hours, blockade of ANF secretion with decompensation of secretory cardiomyocytes occurred. Conclusion: Imunohistochemical investigations and analysis of submicroscopic structures of secretory cardiomyocytes after experimental MI showed, that cells were functionally active 24 hours after myocardial infarction with further (48 hours and 72 hours of MI) decrease in amount and impairement of activity.

5.Trimetazidine Improves Recovery During Reperfusion in Isolated Rat Hearts After Prolonged Ischemia
Murat İkizler, Sadettin Dernek, Behçet Sevin, Tuğrul Kural
PMID: 14675878  Pages 303 - 308
Objective: Trimetazidine (TMZ) is a cellular anti-ischemic agent, which has been studied in clinical and experimental investigations, and was shown to have protective affects against myocardial ischemia and reperfusion injury. The major objective of this study was to investigate the cardio-protective effects of trimetazidine in prolonged global ischemia subjected Langendorff perfused rat hearts. Methods: Twenty rats (Male Sprague-Dawley) were divided into two study groups. In Group 2 (n=10) TMZ was given by intra-gastric gavage (3 mg/kg BW twice daily for 5 days) prior to operation and was added to the Krebbs-Henseleit perfusate to create a 10-6 M solution to perfuse the isolated rat hearts. Group 1 (n=10) reserved as control group and received saline at the same time period. All hearts were paced at 300 beats/min. After a 20-minute of stabilization period, hearts in both groups were arrested for 120 minutes with crystalloid cardioplegia. After ischemic period, the hearts were then reperfused for 30 minutes. Hemodynamic measurements from left ventricular latex balloon, coronary flow, and creatine kinase (CK-MB) and troponin T (cTnT) levels determined from the coronary effluent were analyzed at the end of stabilization and at every 10-min intervals during reperfusion, and results were compared between two groups. Results: No significant differences were observed in all entered hemodynamic and biochemical parameters between two groups at the end of the stabilization. However, peak systolic pressure, end diastolic pressure and +dP/dt values reflected improved mechanical myocardial recovery in Group 2 hearts after prolonged ischemia. Besides coronary flow measurements were higher in Group 2 compared with Group 1. CK-MB and cTnT levels indicated to less enzymatic damage in trimetazidine treated hearts during reperfusion. Conclusion: In conclusion, both pre-treatment and treatment protocols with TMZ reduce the myocardial damage caused by global ischemia following reperfusion. We could speculate that this beneficial effe

6.The Relationship Between Rhythm Disturbances and Incisions in Adult Sinus Venosus Atrial Septal Defects
Hakan Bingöl, Faruk Cingöz, Ufuk Demirkılıç, Ahmet Turan Yılmaz, Harun Tatar
PMID: 14675879  Pages 309 - 312
Objective: Sinus venosus type atrial septal defects (SVASD) differ from the secundum atrial septal defects by its location and high incidence of combination with other cardiac anomalies, which inherently increases the risk of postoperative complications. Right atriotomy is the most preferred approach for repairing the SVASD. Postoperative sinus node dysfunction or other rhythm disturbances can be observed. We compared the postoperative complications between lateral cavatomy and right atriotomy in patients who had SVASD. Methods: Twenty-seven patients who had SVASD (of 384 total ASD’s) associated with partial anomalous pulmonary venous connection (PAPVC) underwent surgical repair during the period of January 1992 – December 2001 in Gülhane Military Medical Academy. Sinus venosus type atrial septal defect was repaired through right atrial incision by routine bi-caval cannulation in 14 patients (Group 1) and repaired through lateral caval incision by direct caval cannulation in 13 patients (Group 2). Lateral cavatomy was closed by pericardial patch in Group 2. We analyzed the relationship between incidence of rhythm disturbances and the technique in patients who had SVASD with or without partial anomalous pulmonary venous connection prospectively. Results: All patients had a classical superior SVASD intraoperatively. Persistent left superior vena cava (PLSVC) was observed in 5 patients (Group 1=3 patients, Group 2=2 patients). Postoperative mortality was seen in one patient in Group 1 due to pulmonary venous obstruction. In Group 1, one patient underwent re-operation for upper and middle lobectomy of the right lung. Ambulatory Holter monitorizations were done in all patients per 3 months periodically. In Group 1 sinus node dysfunction was observed in 4 patients and atrial fibrillation was observed in 2 patients, while in Group 2 only one patient had atrial fibrillation during follow-up period (p=0.037). Conclusion: Repair of SVASD in adult patients is associated with low operative mortality and morbidity. The closure of the defect by pericardial patch is the most preferred technique but obstruction of caval veins can be seen. We suggest that posterior cavatomy can be preferred to atriotomy because of low incidence of sinus node dysfunction and pulmonary or caval obstruction.

7.Assessment of the Efficacy of Bisoprolol Administration by Cardiopulmonary Exercise Testing in Patients with Heart Failure
Sait Terzi, Şennur Ünal Dayi, Tamer Akbulut, Ömer Dağ, Hacer Köse, Ömer Şatıroğlu, Nurten Sayar, Tuba Bilsel, Şükrü Aksoy, Kemal Yeşilçimen
PMID: 14675880  Pages 313 - 318
Objective: It is well known that long-term therapy with beta-blockers reduces morbidity and mortality, improves left ventricular function in patients with heart failure. However the effect of beta-blockade on exercise tolerance in patients with heart failure remains unclear. In the present study we evaluated effects of the addition of bisoprolol to standart therapy with a diuretic and an angiotensin converting enzyme (ACE) inhibitor on exercise capacity in patients with chronic heart failure. Methods: We enrolled 52 patients (mean age 59±11 years) with stable, mild to moderate chronic heart failure and left ventricular ejection fraction of %40 or less receiving standart therapy with diuretic and ACE inhibitor. We randomly assigned patients to bisoprolol 1.25 mg (n=28) or control (n=24) groups. The drug progressively increased to a maximum dose of 5 mg per day. Cardiopulmonary exercise testing (CPET) was performed in all patients of the bisoprolol and control groups before and after 3 months from the beginning of the study. Results: We found a significant increase in exercise duration, maximal O2 uptake (pik VO2 ), the O2 uptake at the anaerobic threshold (VO2-AT) and O2-pulse (pik VO2/ HR), and improved functional capacity (p<0.001). Bisoprolol produced significant reduction in heart rate at rest (p=0.01) and during maximal exercise (p=0.041). In the control group no significant changes were observed. Conclusion: The addition of bisoprolol to the standart therapy in patients with mild to moderate heart failure is well tolerated and improves functional capacity.

EDITORIAL COMMENT
8.Factors Regulating Exercise Capacity in Heart Failure and Effects of Beta-Receptor Blockers on Exercise Tolerance
Ahmet Birand
PMID: 14675881  Pages 319 - 322
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
9.Echocardiographic Evaluation of Associated Valve Lesions in Mitral Stenosis
Şenol Demircan, Mesut Demir
PMID: 14675882  Pages 323 - 328
Objective: When mitral stenosis is associated with other valve lesions, diagnosis, prognosis and the treatment strategies are affected. Mitral valve prolapse may occur in some patological settings that affect mitral apparatus. We investigated the incidence of valve lesions including mitral valve prolapse that accompany mitral stenosis and assessed the relation between echocardiographic measures. Methods: Two hundred and one patients (31 male, 170 female) between 16 and 72 years of age (mean age 40.9±11.4 years) with mitral stenosis were included in the study. Patients were divided into three groups according to the mitral valve area obtained by echocardiography using planimetric method as Group I (MVA<1.1 cm2), Group II (MVA 1.1-1.5 cm2) and Group III (MVA > 1.5 cm2). Results: Mitral stenosis with mitral regurgitation, aortic regurgitation, aortic stenosis, combined aortic valve disease, tricuspid regurgitaion and tricuspid stenosis were found in 117 (58.2%), 84 (41.8%), 18 (9%), 9 (4.5%), 62 (30.8%) and 6 (3%) patients, respectively. Twenty- three patients (11.4%) had mitral valve prolapse in only anterior leaflet. Nobody of patients had mitral valve prolapse of posterior mitral valve leaflet. Age, gender, rhythm, degree of stenosis, degree of mitral and aortic regurgitations, mean pressure gradient, left atrial diameter, ejection fraction and valve score did not differ in patients with and without mitral valve prolapse. Conclusion: Our study has shown that valve lesions including mitral valve prolapse frequently accompany mitral stenosis and the incidence of mitral valve prolapse in patients with mitral stenosis is high.

EDITORIAL COMMENT
10.Is Frequency of Mitral Valve Prolapse Increased in Mitral Stenosis Cases?
Cevat Kırma
PMID: 14675883  Pages 329 - 330
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
11.Effect of Statin Therapy Added to ACE-Inhibitors on Blood Pressure Control and Endothelial Functions in Normolipidemic Hypertensive Patients
Zülfikar Danaoğlu, Hakan Kültürsay, Meral Kayıkçıoğlu, Levent Can, Serdar Payzin
PMID: 14675884  Pages 331 - 337
Objective: Endothelium-dependent vasodilatation is impaired in hypertension. Statins have been shown to improve endothelial functions in hyperlipidemic subjects. We aimed to investigate the effect of statins on endothelium-dependent flow mediated dilatation (FMD) and blood pressure (BP) in normocholesterolemic hypertensive patients. Methods: This randomized prospective study consisted of 56 patients with newly diagnosed essential hypertension. All patients received angiotensin converting enzyme (ACE) inhibitor lisinopril (5 mg/day) as antihypertensive therapy, and half of them were randomized to simvastatin(20mg/day) irrespective of serum lipid levels. All subjects underwent brachial artery ultrasonographic examination for the measurement of FMD before randomization and at the end of 12 weeks treatment. Results: A total of 39 patients completed the study (21 patients in the statin + ACE inhibitor group, and 18 patients in the ACE-inhibitor alone group). Blood pressure levels were substantially reduced in both groups after treatment. In statin+ ACE-inhibitor group systolic pressure reduced by 23% (p=0.0001) and diastolic BP reduced by 23% (p=0.0001). In ACE-inhibitor alone group these ratios were 20% (p=0.001) and 21% (p=0.001), respectively. Meanwhile, pulse pressure (PP) decreased by 25% in statin+ ACE-inhibitor group (P=0.0001) and by 16% in ACE inhibitor-alone group (p=0.0051). Baseline FMD was significantly impaired in overall patients with hypertension as compared with healthy controls (13 ± 8 vs. 24±8 %, P = 0.001). After treatment FMD decreased by 23% in lisinopril alone group (p=0.054). There were no correlations between FMD improvement, LDL reduction, BP or PP changes in both groups. Conclusion: Addition of simvastatin to ACE-inhibitor treatment in newly diagnosed hypertensive patients with normal cholesterol levels, significantly reduced PP and facilitated BP control, but did not affect endothelium-dependent dilatation. Further long-term large scale studies are needed to clarify the effect of various statins on endothelial functions of either hypercholesterolemic or normocholesterolemic hypertensive patients.

EDITORIAL COMMENT
12.Comparing Two Different Therapies
Osman Akdemir
PMID: 14675885  Pages 338 - 339
Abstract | Full Text PDF

REVIEW
13.New Horizons in Cardiovascular Treatment: Cellular Cardiomyoplasty and Stem Cell Transplantation
Yonca Aktaş, Sinan Aydoğdu
PMID: 14675886  Pages 340 - 347
Today, congestive heart failure and acute myocardial infarction, which is accepted as the main factor that contributes to the development of heart failure, are major causes of deaths despite advances in surgical procedures, mechanical assistance devices, drug therapy and organ transplantation. However, these procedures only prevent further myocardial deterioration and do not act on the underlying pathophysiology which are fibrosis and cardiac remodeling. As further advances in genetics provide the possibility of preventing fibrosis and cardiomyocyte regeneration in damaged myocardium, studies are being made in this way. For this reason, a variety of cell types including stem cells were used and successful results were obtained. After studies on animal models; pilot studies to explore the effect of cellular cardiomyoplasty and stem cell implantation on humans have been started. Data that have been gained from human studies till now are encouraging for further studies in this era. But there is a need for larger-scale randomized trials to determine the post-transplantation risk, as well as long-term safety and efficacy.

MISCELLANEOUS
14.Nonatherosclerotic Causes of Coronary Artery Disease
Turhan Kürüm, Haluk Doğutan
PMID: 14675887  Pages 348 - 352
Abstract | Full Text PDF

CASE REPORT
15.Atrioventricular Complete Heart Block Developed Due to Verapamil Use Together with Honey Consumption
Ersel Onrat, Dayimi Kaya, İrfan Barutçu
PMID: 14675888  Pages 353 - 354
Abstract | Full Text PDF

16.Endovascular Treatment of Acute Type B Aortic Dissection
Harun Arbatlı, Naci Yağan, Ergun Demirsoy, Bingür Sönmez
PMID: 14675889  Pages 355 - 357
Abstract | Full Text PDF

17.Endovascular Treatment of Acute Type B Aortic Dissection: A Case Report
Suat Büket
PMID: 14675890  Pages 358 - 359
Abstract | Full Text PDF

18.Bilateral Coronary Artery Fistulas
Taha Okan, Özer Badak, Bahri Akdeniz, Sema Güneri
PMID: 14675891  Pages 360 - 362
Abstract | Full Text PDF

19.A Case of Myocardial İnfarction Developed After Paint Thinner Exposure
Mutlu Vural, Şennur Ünal Dayi, Zeynep Tartan, Hülya Kaşıkçıoğlu, Ertan Ökmen, Neşe Çam
PMID: 14675892  Pages 363 - 365
Abstract | Full Text PDF

LETTER TO THE EDITOR
20.Workshop on Secondary Prevention of Myocardial Infarction and Stroke and Management of Cardiovascular Risk
Shanti Mendis
PMID: 14675893  Pages 366 - 367
Abstract | Full Text PDF

21.The VII World Congress of Echocardiography and Vascular Ultrasound, Buenos Aires, Argentina, October 10th-12th, 2003
Kul Aggarwal
PMID: 14675894  Pages 368 - 369
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
22.Pulmonary Vascular Sling with Aberrant Right Upper Lobe Pulmonary Artery in A Child
Osman Başpınar, Sevim Karaaslan, Bülent Oran, İsmail Reisli, Sevgi Keleş, Tamer Baysal
PMID: 14675895  Page 370
Abstract | Full Text PDF

23.Isolated Ventricular Noncompaction (Spongy Myocardium): Angiographic Diagnosis
Hürkan Kurşaklıoğlu, Atila İyisoy, Ertan Demirtaş
PMID: 14675896  Page 371
Abstract | Full Text PDF

24.A Chronic Pseudoaneurysm with Organized Thrombus at the Basal and Mid Segments of Posterolateral Wall of the Left Ventricle
B. Sıtkı Cebeci, Ejder Kardeşoğlu, Turgay Çelik, Yılmaz Cingözbay, Mehmet Dinçtürk, Ergün Demiralp
PMID: 14675897  Page 372
Abstract | Full Text PDF

25.Rare Complication of Aortic Valve Replacement: Aorto-Right Atrial Fistula
Özer Badak, Bahri Akdeniz, Özgür Aslan, Önder Kırımlı, Özhan Göldeli, Sema Güneri
PMID: 14675898  Page 373
Abstract | Full Text PDF

26.Tricuspid Valve Endocarditis Mimicking Cardiac Tumor
Suat Nail Ömeroğlu, Murat Bülent Rabuş, Nihan Kayalar
PMID: 14675899  Pages 374 - 375
Abstract | Full Text PDF

27.Mitral Complication of Mitral Stenosis: Floating Thrombus in the Left Atrium
Ömer Göktekin, Mehmet Melek, Sait Mesut Doğan, Necmi Ata
PMID: 14675900  Pages 376 - 377
Abstract | Full Text PDF



 
 
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