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Anatol J Cardiol: 4 (1)
Volume: 4  Issue: 1 - March 2004
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EDITORIAL
1.Renewed Associate Editor's Staff and Expectations of the Year 2004
Bilgin Timuralp
Pages 1 - 2
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Effective Regurgitant Orifice Area of Rheumatic Mitral Insufficiency: Response to Angiotensin Converting Enzyme Inhibitor Treatment
Deniz Oğuz
PMID: 15033608  Pages 3 - 7
Objective: This study was designed for quantification of mitral regurgitation by echocardiographic measurements such as regurgitant volume (RV), regurgitant fraction (RF) and effective regurgitant orifice area (EROA), and to assess the effect of angiotensin converting enzyme inhibitor (ACEI) therapy on these measurements. Methods: Patients with rheumatic mitral insufficiency were divided into two groups: Study group (SG)-10 females, 2 males aged 10-18years, body surface area 1.49±0.05m2, receiving digoxin therapy for at least one year and Control group (CG)-8 females, 4 males, aged 8-17years, body surface area 1.38±0.07m2, with no treatment. Patients in the two groups had no symptoms of cardiac failure. Angiotensin converting enzyme inhibitor therapy was given to SG patients on admission. Echocardiographic examinations were applied on admission and at the 20th day of therapy with ACEI and digoxin. Results: Study group’s left ventricular end-diastolic volume (108.03±41.21 ml/m2), mitral stroke volume (510.37±321.58 ml/m2) and regurgitant volume (423.48±305.00 ml/m2) were significantly higher (p<0.05) on admission than in the CG (81.98±21.53 ml/m2, 315.34±207.38mL/m2 and 245.77±179.84mlm2, respectively). Aortic stroke volume at the 20th day of therapy was significantly higher in SG than in the CG. Therapy with ACEI decreased significantly SG’s left ventricular diastolic volume. Conclusion: Angiotensin converting enzyme inhibitors should be started at an early stage of mitral regurgitation. The effective regurgitant orifice area is a feasible and easy method for the outpatient follow-up of mitral regurgitation.

EDITORIAL COMMENT
3.An Overview of the Mitral Regurgitation
Osman Bolca
PMID: 15033609  Pages 8 - 9
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
4.Metabolic Syndrome in Patients After Coronary Bypass Surgery: Prevalence and Compliance with Treatment
Mehmet Baltalı, Hidayet Tarık Kızıltan, Mehmet E. Korkmaz, Semra Topçu, Mustafa Demirtaş, Şah Topçuoğlu, Ahmet Birand
PMID: 15033610  Pages 10 - 16
Objective: The aim of this study was to evaluate the prevalence of metabolic syndrome (MS) and its components, to determine the patients’ compliance with pharmacologic therapy and lifestyle modification, and to clarify the association of demographic and socioeconomic factors with the MS in Turkish patients with prior coronary artery bypass surgery (CABG). Methods: Two hundred and seventy-three patients (age range 35-77, 208 men) were interviewed and examined 1.0-2.2 years after CABG. Results: The prevalence of MS was 44.8% (55.4% among women and 41.3% among men). The most prevalent metabolic risk factor was visceral obesity among females, and elevated blood pressure among males. Rates for regular physical activity were lower in patients with MS, compared with those without MS (%36.9 vs. %47.7, p<0.05). Compared with patients without MS, use of aspirin was lower among patients with MS (%84.4 vs. %93.4, p<0.05). Logistic regression analysis revealed an independent association of age ≤65 years and low educational level with MS. Conclusion: We found a high prevalence of metabolic syndrome and its components among patients with prior CABG. Patients with MS had lower rate of regular physical activity and aspirin use, compared with those without MS.

EDITORIAL COMMENT
5.Metabolic Syndrome and Coronary Heart Disease
Çavlan Türkoğlu
PMID: 15033611  Pages 17 - 18
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
6.Reexploration for Bleeding and Tamponade in Intensive Care Unit Following Open Heart Surgery
Mehmet Ali Özatik, Kamil Göl, Baran Budak, Şeref Küçüker, Ahmet Sarıtaş, Binali Mavitaş, Erol Şener, Oğuz Taşdemir
PMID: 15033612  Pages 19 - 22
Objective: Following open heart surgery some patients can need reexploration in the intensive care unit due to bleeding or pericardial tamponade. This study evaluates the impact of reexploration in the intensive care unit (ICU) on morbidity and mortality rates. Methods: Between January 1990 and January 2002 overall 18578 open heart surgery procedures were performed in our clinic and among them 570 (3%) patients required reexploration due to bleeding or pericardial tamponade. Reexplorations were done in the operating room (OR) in 385 (67.5%) patients and in the ICU in 185 (32.5%) patients. Results: Among patients 383(67.2%) were male and 187(32.8%) were female. Mean age for reexploration in the OR group was 46.9±16.3 years, and in the ICU group was 48.2±15.7 years. The use of fresh frozen plasma and bank blood was significantly higher in the ICU group (p<0.0001). Fifty patients (27%) who were reexplored in ICU had intraaortic balloon pump (IABP) support (p<0.0001). Sixty six patients (%17.1) died in OR group and 70 patients (37.8%) died in the ICU group (p<0.001). Following reexploration, 24 (6.2%) patients in the OR group and 17 (9.1%) patients in the ICU group had major infection (p>0.05). There was no statistically significant difference among groups in hospital stay time. Conclusion: Following open heart surgery, especially among hemodynamically unstable patients, to avoid possible problems of transfer to the OR and time lost, reexplorations can be done in ICU. This practice does not increase morbidity and hospital stay.

EDITORIAL COMMENT
7.Reexploration in the Intensive Care Unit and Open Heart Surgery
İsa Durmaz
PMID: 15033613  Pages 23 - 24
Abstract | Full Text PDF

8.Middle and Late-Term Results of Coronary Artery Bypass Surgery in Very Young (20-29 Years) Patients
Ufuk Demirkılıç, Bilgehan Savaş Öz, Cengiz Bolcal, Nezihi Küçükarslan, Hakan Bingöl, Erkan Kuralay, Harun Tatar
PMID: 15033614  Pages 25 - 29
Objective: The purpose of this study is to evaluate the etiologic factors of coronary artery disease (CAD) in very young patients. We want to indicate the importance of selection of the bypass graft materials and to investigate mid and long-term results of coronary artery bypass surgery (CABG) in young patients. Methods: Coronary artery bypass surgery was performed in 7734 patients in Gülhane Military Medical Faculty between April 1991-June 2001. The study group included 21 patients (0.027%). Mean age was 23.9±2.4 years. All risk factors were treated and control angiography was performed in 17 patients. Results: Hyperlipidemia was found in 15 patients, smoking in 11, diabetes mellitus in 7, alcohol use in 6, obesity in 5 and, hypertension in 4 patients. We recognized Behçet’s disease in two patients including complete form in one case and incomplete form in the other one. Left internal mammarian artery (IMA) was used in 21, left and right IMA in 4 and left and right IMA and radial artery grafts in 2 patients. Mean cross clamp time was 16.5±3.4 minutes and extubation time was 4.6±1.5 hours. Patients were discharged in 5.9±1.7 days. Conclusion: We determined a high graft patency rate in our patients during mid and long-term follow-up period due to the use of arterial grafts. To increase graft patency rate the importance of risk factors treatment should be taken into consideration.

9.Coronary Bypass Surgery in Very Young Patients
Sinan Dağdelen
PMID: 15033615  Pages 30 - 31
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
10.Epidemiological and Pharmacological Profile of Congestive Heart Failure at Turkish Academic Hospitals
Ali Ergin, Namık Kemal Eryol, Şükrü Ünal, Abdullah Deliceo, Ramazan Topsakal, Ergun Seyfeli
PMID: 15033616  Pages 32 - 38
Objective: We aimed to investigate the status of the treatment of congestive heart failure (CHF) in academic hospitals in Turkey. Methods: Overall 661 successive patients from 16 academic hospitals were included in this retrospective study. In addition to treatments given to the patients before admission to hospital, during their hospital stay, and at hospital discharge, data regarding their functional classifications, causes of CHF, and laboratory findings were also recorded. Results: In our study the mean age of patients was 61±12 years and the mean hospital stay 10±6 days. Ischemic CHF was observed more frequently in men (72%, 46%, p<0.001), while hypertension and rheumatic CHF were more frequent in women (27% vs 19%, p<0.001 and 24% vs 9%, p<0.001 respectively). While 90% patients’ were in NYHA III-IV class at admission to hospital, only 2% of patients were in class IV at hospital discharge. The proportion of smokers was greater in men than in women (68% vs. 12% ). Atrial fibrillation was present in 35% of patients. During hospitalization, angiotensin converting enzyme (ACE) inhibitors were used by 77%, diuretics by 95%, digitalis by 76%, nitrate by 85%, beta-blockers by 3 %, aspirin by 86%, anticoagulants by 44%, Ca antagonist by 10%, positive inotropic agents by 42%; and antiarrhythmic agents by 15% of patients. Conclusion: The use of ACE inhibitors, the major milestone of CHF treatment, is not on an adequate level yet. The use of beta blockers should also be encouraged.

11.Femoral Vascular Complications After Percutaneous Coronary Interventions
Tuna Katırcıbaşı, Ahmet Çamsarı, Oben Döven, Hasan Pekdemir, Necdet Akkuş, Dilek Çiçek, V.Gökhan Cin, Türkay Özcan
PMID: 15033617  Pages 39 - 44
Objective: We aimed to investigate peripheral vascular complications and their relation with treatment and clinical parameters in percutaneous transluminal coronary angioplasty (PTCA) patients. Methods: We included 321 patients (aged 57±11 years) underwent PTCA between November 2001-August 2002. The age, gender, glycoprotein 2b/3a use, thrombolytic use, intraaortic balloon treatment, transient pacemaker treatment, reintervention history, hypertension, diabetes mellitus, smoking status, family history and the correlations of these parameters with local vascular complications were assessed in all patients. Results: Pseudoaneurysm incidence was significantly correlated with; age [(n=13 68.0%) p=0.0001, OR 8.38], female gender [(n=12 63.1%) p<0.015, OR 0.32], reintervention [(n=10 52.1%) p<0.004, OR 3.6], venous sheath usage [(n=12 63%) p<0.0001, OR 9.07], thrombolytic treatment [(n=5 26.3%) p<0.0001, OR 7.9], and intraaortic balloon adjustment [(n=6 31.5%) p<0.0001, OR 7.2]. No correlation was found between pseudoaneurysm incidence and glycoprotein 2b/3a treatment, smoking, diabetes mellitus, hypertension and family history. Conclusion: The present study showed that patients of female gender, with reintervention, thrombolytic treatment, venous sheath use and intraaortic balloon adjustment are at high risk for serious femoral vascular complications, especially when they are aged. Additionally, glycoprotein 2b/3a agents can be used without increased risk of peripheral vascular complications.

12.Association Between Angiotensin Converting Enzyme Gene Polymorphism and Coronary Artery Disease in Individuals of the South-Eastern Anatolian Population
Muradiye Nacak, Vedat Davutoğlu, Serdar Soydinç, Hakan Dinçkal, Serdar Türkmen, Binnur Erbağcı, Murat Akçay, Şükrü Aynacıoğlu
PMID: 15033618  Pages 45 - 51
Objective: The deletion (D) allele of the angiotensin-converting enzyme (ACE) gene has been proposed as a genetic marker of the risk of coronary artery disease (CAD). In this study we aimed to determine the relevance of ACE gene polymorphism for coronary artery disease in the South-Eastern Anatolian population. Methods: Angiotensin converting enzyme genotypes were determined in 133 CAD patients who underwent coronary angiography. Severity of CAD was subgrouped according to the number of stenotic vessels on coronary angiography. The control group was selected from 154 healthy volunteers. Angiotensin converting enzyme genotypes were determined by agarose gel sizing after polymerase chain reaction (PCR) amplification. Results: Frequency of ACE DD genotype did not differ between patients with CAD and control subjects. However the ACE II genotype in CAD group was significantly less frequent than in control group (p=0.02). The relative risks were 0.9 (95% CI=0.56-1.43) for the DD genotypes, and 2.2 (95% CI=1.09 – 4.11) for the II genotype. In the 2-vessel CAD subgroups, the II genotypes were significantly different from control group. Conclusion: Our study did not confirm the possibility that the ACE DD genotypes may be associated with predisposition to CAD in this certain population but there is a relationship between the least frequencies of the II genotype and CAD. The II genotype seems to be an independent protective factor for CAD in the South-Eastern Anatolian population.

EDITORIAL COMMENT
13.The Future of Medicine: Molecular Medicine in a Changing World
F.Sırrı Çam
PMID: 15033619  Pages 52 - 53
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
14.Reduced Coronary Collateral Vessel Recruitment Capacity in Diabetes Mellitus: An Evidence for Defective Ischaemic Tolerance
Murat Sezer, Yılmaz Nişancı, Berrin Umman, Sabahattin Umman, Ercüment Yılmaz, Faruk Erzengin, Ayhan Olcay, Önal Özsaruhan
PMID: 15033620  Pages 54 - 58
Objective: Collateral channel opening is one of the components of the ischemic tolerance developing during subsequent coronary balloon occlusions. The effect of diabetes mellitus (DM) on coronary collateral recruitment (CR) is still not known. We therefore sought the effect of DM on CR in patients with stable angina pectoris (SAP) by using intracoronary pressure measurement technique. Methods: Study material consisted of 44 patients (21 diabetic) with SAP. All of the patients had single vessel disease with more than 70% vessel narrowing and all of them underwent stent implantation to this vessel. After angiography, fiber-optic pressure monitoring guide-wire was advanced distal to the stenosis to be dilated. Myocardial fractional flow reserve (FFRmyo) was determined under adenosine hyperemia by the ratio of simultaneously measured mean distal pressure to mean aortic pressure. During subsequent two 1 minute balloon occlusions, distal pressures were recorded as coronary wedge pressure (CWP). Collateral flow index was determined by the ratio of simultaneously measured CWP to mean aortic pressure. Percentage of the improvement in the coronary flow index (CFI) (first to second occlusion) between two occlusions was determined for each patient. Results: There was no difference between two groups in terms of pre-intervention FFRmyo (0.54 ± 0.12 in DM group and 0.50 ± 0.11 in non-DM group). The baseline CFI was significantly higher in non-DM group (0.26 ± 0.09 versus 0.17 ± 0.08, p<0.03). Beyond this finding, mean CFI increased by 17% (from 0.17 ± 0.08 to 0.20 ± 0.09) in DM group and by 30 % (from 0.26 ± 0.09 to 0.34 ± 0.10) in non- DM group. There was statistically significant difference between these two groups in terms of improvement in CFI during subsequent balloon occlusions (p<0.01). Conclusion: In addition to poor collateral vessels seen in patients with DM, CR is also impaired. This finding suggests that DM abolishes ischemic tolerance in terms of CR as well.

REVIEW
15.Aspirin Resistance
Mehmet Birhan Yılmaz, Yücel Balbay, Şule Korkmaz
PMID: 15033621  Pages 59 - 62
Aspirin is an effective antithrombotic agent for many patients. However, patients taking aspirin might exhibit variable responses to in vitro tests for platelet aggregation and might experience breakthrough thromboembolic events. Although this phenomenon has been called aspirin resistance, the lack of an uniform definition or agreement on diagnostic criteria precludes definitive recommendations at this time. Aspirin resistance has been defined in patients with cardiovascular, cerebrovascular, and peripheral vascular disease. In this article, mechanisms related with aspirin resistance and clinical background in which resistance is defined, are reviewed.

EDITORIAL COMMENT
16.The Use of Clopidogrel in Patients with Coronary Artery Disease
Erdal Çavuşoğlu
PMID: 15033622  Pages 63 - 72
Coronary thrombosis plays a central role in the development, progression, and complications of atherosclerotic heart disease. As a result, pharmacologic manipulation of the hemostatic system has been the mainstay of treatment for coronary artery disease. Since platelets are the most important cellular element in the development of arterial thrombosis, many of the most effective therapies have involved the use of various antiplatelet agents. This article focuses on clopidogrel, an antiplatelet agent belonging to the class of drugs known as the thienopyridines, in the treatment of patients with coronary artery disease.

MISCELLANEOUS
17.Primary Deep Vein Thrombosis of the Upper Extremity
Özcan Özdemir, Göksel Çağırcı, Mustafa Soylu, Hatice Şaşmaz, Emine Kütük
PMID: 15033623  Pages 73 - 78
Abstract | Full Text PDF

CASE REPORT
18.The Right Ventricular Outflow Tract Reconstruction with
Hafize Yalınız, Orhan Kemal Salih, Acar Tokcan, Hakan Poyrazoğlu, Nazan Özbarlas
PMID: 15033624  Pages 79 - 81
Abstract | Full Text PDF

19.Multiple Hydatid Cysts of Pericardium and Epicardium
Işık Şenkaya, Özlem M. Bostan, Solmaz Çelebi, Ergün Çil
PMID: 15033625  Pages 82 - 84
Abstract | Full Text PDF

20.Staged subtotal Replacement of Aorta in Progressive Aneurysms in Marfan Syndrome
Esat Akıncı, Vedat Erentuğ, Hasan Basri Erdoğan, Nilgün U. Bozbuğa, Atakan Erkılınç
PMID: 15033626  Pages 85 - 88
Abstract | Full Text PDF

21.Extensive Venous Obstruction Caused by a Permanent Pacemaker Lead
Gülten Taçoy, Murat Özdemir, Atiye Çengel
PMID: 15033627  Pages 89 - 91
Abstract | Full Text PDF

22.Ablation and Implantation of Implantable Cardioverter Defibrillator in a Case of Hypertrophic Cardiomyopathy with Atrioventricular Nodal Reentrant Tachycardia
Ahmet Vural, Ayşen Ağaçdiken, Dilek Ural, Teoman Kılıç, Güliz Kozdağ, Göksel Kahraman, Ertan Ural, Baki Komsuoğlu
PMID: 15033628  Pages 92 - 95
Abstract | Full Text PDF

23.Surgery Approach to a Young Patient with Chronic Pulmonary Embolism, Pulmonary Thromboendarterectomy: A Case Report
Süha Küçükaksu, Mahmut Mustafa Ulaş, Onurcan Tarcan, Kerim Çağlı, Haşmet Bardakçı, Omaç Tüfekçioğlu, Erol Şener, Oğuz Taşdemir
PMID: 15033629  Pages 96 - 98
Abstract | Full Text PDF

LETTER TO THE EDITOR
24.The Use of Endomyocardial Biopsy in Paediatric Heart Transplant Patients: An Institutional Approach -Letter to the Editor
Ergin Koçyıldırım, Michael Burch, Martin J. Elliott
PMID: 15033630  Page 99
Abstract | Full Text PDF

25.Statin Added to the Therapy with ACE Inhibitors in Hypertensive Patients - Letter to the Editor
Hakan Sekitmen
PMID: 15033631  Page 100
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
26.Isolated Double Orifice Mitral Valve
Serdar Küçükoğlu, Yılmaz Güneş, Barış Ökçün
PMID: 15033632  Pages 101 - 102
Abstract | Full Text PDF

27.Papillary Fibroelastoma of the Aortic Valve in a Patient with Syncope
Bülent Mutlu, Elif Eroğlu, Fatih Bayrak, Yelda Başaran
PMID: 15033633  Pages 103 - 104
Abstract | Full Text PDF

28.Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy with Apical Aneurysm
İstemihan Tengiz
PMID: 15033634  Page 105
Abstract | Full Text PDF

29.A Rare Coronary Artery Anomaly: Origin from the Single Ostium
Bilnur Yaşar, Bülent Görenek
PMID: 15033635  Page 106
Abstract | Full Text PDF



 
 
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