Outcomes of Percutaneous Balloon Mitral Valvuloplasty in Significant Mitral Stenosis with Moderate Mitral Regurgitation - Single Center Study

Objective:Rheumatic heart disease is the deposition of immune complexes which cause malfunction of the heart valves. Percutaneous mitral balloon valvuloplasty (PMBV) is an established treatment option in patients with symptomatic moderate or severe rheumatic mitral valve disease, but PMBV is not a preferred option in mitral stenosis (MS) patients with moderate mitral regurgitation (MR) due to the risk of severe MR. The aim of this study was to evaluate the safety and feasibility of PMBV in symptomatic MS patients with moderate MR by comparing the post-procedural parameters with those of MS patients with mild or no MR.Method:Among 104 patients with symptomatic MS, 10 patients with moderate MR were classified as group 2 while 94 patients who had mild or none MR were classified as group 1 in the present work. All patients underwent PMBV and pre- and post-procedural mitral valve area, MRs were recorded and cardiovascular events and complications were assessed in 30 days.Results:The only difference in both groups before and after the procedure was the severity of the MR. Cardiovascular death was not observed for both groups in 30 days. In group 1, there were 3 patients and in group 2, there was 1 patient who developed severe MR after PMBV. All patients who had post-procedural severe MR required mitral valve replacement in 30 days due to severe MR in group 1. The composite complication rate was similar between the groups.Conclusion:PMBV might be an alternative treatment option for selected patients having significant MS with moderate MR

The association of left atrial mechanics with left ventricular morphology in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study

Purpose: Hypertrophic cardiomyopathy (HCM) is related with structural and pathologic changes in the left atrium (LA) and left ventricle (LV). The aim of this study was to explore the association between LA mechanics and LV charac-teristics in patients with HCM using cardiac magnetic resonance feature tracking (CMR-FT). Material and methods: A total of 76 patients with HCM and 26 healthy controls were included in the study. The pa-rameters including the extent of LV late gadolinium enhancement (LGE-%) and the LV early diastolic longitudinal strain rate (edLSR) were assessed for LV. LA conduit, booster, and reservoir functions were assessed by LA fractional volumes and strain analyses using CMR-FT. HCM patients were classified as HCM patients without LGE, with mild LGE-% (0% = 10%), and prominent LGE-% (10% < LGE-%).Results: HCM patients had worse LA functions compared with the controls (p < 0.05). The majority of LA functional indices were more impaired in HCM patients with regard to LGE. LA volumes were higher in HCM patients with prominent LGE-% compared with HCM patients with mild LGE-% (p < 0.05). However, only a minority of LA functional parameters differed between the 2 groups. LA strain parameters showed weak to modest correlations with LV LGE-% and LV edLSR.Conclusions: LV characteristics, to some extent, influence LA mechanics, but they might not be the only factor induc-ing LA dysfunction in patients with HCM

Association Between Bifurcation Angle and Coronary No-reflow Following Primary Percutaneous Coronary Intervention in Patients

Objective:Percutaneous coronary intervention (PCI) has become the treatment method for patients presenting with ST elevation myocardial infarction (STEMI). One of the well-known complications of PCI is no-reflow. Studies demonstrated a relationship between endothelial dysfunction and disturbed vascular flow due to angulation of vascular tree. Although the relationship between hemodynamic alterations and coronary angulation is evident, there is a lack of detailed analysis in terms of hemodynamic changes between vascular geometry and coronary no-reflow. We aimed to elucidate the relationship between vascular geometry and coronary no-reflow.Method:We reviewed PCI database of our hospital and enrolled a total of 120 patients with STEMI, who developed no-reflow following PCI, and sex and age matched 80 patients with normal flow. For each group, demographic and clinical characteristics, laboratory values and two dimensional quantitative coronary angiography measurements were evaluated.Results:Patients with no-reflow had a higher prevalence of hypertension and diabetes mellitus. In addition, serum C-reactive protein levels were higher in patients with no-reflow compared to patients with normal flow (p<0.001). On the other hand, serum hemoglobin levels were significantly lower in patients with no-reflow compared to patients with normal flow (p<0.001). With respect to 3 dimensional coronary measurements, calculated bifurcation angle of left anterior descending artery (LAD) and circumflex artery (CX) was significantly wider in the no-reflow group than in the control group [110.9° (21.8°) vs. 85.9° (15.8°), p<0.001].Conclusion:Our data showed that a strong association existed between bifurcation angle of LAD-CX and no-reflow phenomenon in STEMI patients who underwent PCI

Investigating the Frequency of Stent Fracture and its Impact on in-Stent Restenosis in Patients Undergoing Carotid Artery Stenting

Objective: This single-center study aimed to assess the incidence and predictors of carotid artery Xact stent fractures (SF) and their impact on in-stent restenosis (ISR) during long-term follow-up. Methods: A cohort of 108 patients (97 males, median age 69.4±8 months) who underwent Xact stent placement for internal carotid artery stenosis between 2013 and 2021 and were diagnosed with SFs through fluoroscopy in 2022 were included. SFs were categorized as types I-V based on fracture characteristics. Follow-up included duplex ultrasound examinations to assess stent patency. Results: The average follow-up duration was 49.2±24.3 months, with ISR observed in 10 patients. Twenty-three SFs (21.3%) were identified: type I (5 patients), type II (7 patients), type III (3 patients), type IV (6 patients), and type V (2 patients). Calcification and stent length significantly predicted SFs (p<0.001; p<0.028). Conclusion: Calcification and stent length are associated with Xact SFs, but SFs do not impact ISR during long-term follow-up

TERSİYER BİR MERKEZİN 5 YILLIK VERİLERİNİN RETROSPEKTİF ANALİZİ: PLASENTAL İNVAZYON DERECESİ OPERATİF TEKNİKLERİ ETKİLİYOR MU?

Amaç: Çalışmanın amacı plasenta invazyon derecesi ile tedavide kullanılan cerrahi yöntemlerin ilişkisinin incelenmesiydi. Yöntem: Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde 2017-2022 yılları arasında sezaryen yapılan ve histopatolojik inceleme sonrası plasenta akreata spektrumu (PAS) tanısı alan olgular çalışmaya dahil edildi. Olguların yaşı, gebelik sayısı, daha önce geçirdikleri sezaryen sayısı, uygulanan cerrahi yöntem, eritrosit transfüzyon ihtiyaçları ve histopatolojik inceleme sonuçları elektronik ve basılı hasta dosyalarından elde edilerek olgu formuna kaydedildi. Vakaların yönetiminde kullanılan operatif teknikler, sezaryen+bilateral uterin arter ligasyonu, sezaryen+segmental rezeksiyon, sezaryen+bilateral uterin arter ligasyonu+segmental rezeksiyon+bilateral internal iliak arter ön dal ligasyonu ve son olarak sezaryen+histerektomi şeklinde belirlendi. Bulgular: Dahil edilme kriterlerini karşılayan 109 olgu retrospektif çalışmaya alındı. Olguların medyan yaşı 33 (IQR:7), geçirilmiş sezaryen sayısı ise 2 (IQR:1) olarak bulundu. Yapılan analizlerde sezaryen sayısı ile invazyon derecesi arasında pozitif korelasyon saptandı. (p.001). 52 (%48.6) olguda organ koruyucu cerrahi, 55 (%51.4) olguda ise sezaryen histerektomi operasyonu uygulandı. Histopatolojik incelemeler sonucunda 45 (%42.2) olguda PAS grade 1, 40 (%37.3) olguda PAS grade 2 ve 22 (%20.5) olguda PAS grade 3 saptandı. Uygulanan operatif yöntemler ile histopatolojik sonuçlar arasında bir korelasyon gösterilemedi (p=.394). Yine aynı şekilde cerrahi yöntemler ile daha önceden geçirilmiş sezaryen sayısı arasında bir korelasyon saptanmadı (p=.652). Olgular için gerekli olan eritrosit transfüzyon sayıları ile plasental invazyon derecesi arasında bir korelasyon gösterilmedi (p=.151). Sonuç: Plasental invazyon derecesi daha önce geçirilmiş sezaryen sayısı ile orantılı şekilde artmaktadır. Operasyon tipi ve eritrosit transfüzyon sayıları ile invazyon derecesi arasında ilişki yoktur

The role of three dimensional transesophageal echocardiography novel-score in the success of redo percutaneous balloon mitral valvuloplasty

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7–9) and novel 3D TEE score was found 4 (IQR 3–4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS