İnatçı koroner perforasyon olgusunda iç içe kaplı stent kullanımı

A sixty-four year old man with a previous history of CABG was referred for coronary angiography that revealed a critical stenosis of the right posterior descending artery at the anastomosis point of the saphenous vein graft (Figure A). Percutaneous intervention was initiated by engagement of the saphenous graft ostium with a 6F JR guiding catheter, followed by crossing the lesion with a hydrophilic guidewire. A drug-eluting stent, 2.25 x 23 mm in size, (Xience, Abbott Vascular, USA) was implanted at 14 atm pressure. Control angiography revealed a marked Ellis type IV coronary perforation with leakage of blood into the pericardial cavity (Figure B). Subsequently, the patient deteriorated hemodynamically with severe chest pain and hypotension. Echocardiography showed a marked pericardial effusion along with right ventricular collapse. Protamine sulfate was used to reverse anticoagulation followed by administration of IV fl uids and emergency pericardiocentesis. A 2.5 x 15 mm balloon (Sprinter Legend, Medtronic, USA) was advanced for 10 minutes of prolonged infl ation, which failed to heal the perforation (Figure C). A 2.80 x 19 mm covered stent (Graftmaster, Abbott Vascular, USA) was implanted at the level of the perforation

A case of cortriatriatum who became symptomatic after 40 years old

Coıtriatriatum sol atriyumıın membranöz bir yapı ile iki odacığa ayrılması ile karakterizedir. Proksimal odacık pulmoner venlerle bağlantılı iken distal odacık mitral kapak yoluyla sol ventrikül ile bağlantılıdır. İzole cortriatriatumda obstrüksiyonun derecesi pulmoner venöz ve arteriyel hipertansiyonun gelişmesi ve buna bağlı semptomların ortaya çıkmasında en önemli etkendir. Odacıklar arasındaki açıklığın genişliği fizyolojik bozuklukların ve klinik semptomların ortaya çıkmasında temel belirleyicidir. Olgumuz kırk yaş üzerinde sağ kalp yetersizliği semptomlarının ortaya çıktığı, tanısının ekokardiyografi ile konulduğu nonobstrüktif cortriatriatumdur. Membranöz yapının pulmoner venlerin açıldığı sol atriyum bölümü ile sol ventrikül giriş yolu arasında kan akımına büyük ölçüde izin veren bir yapıda olması, bizim olgumuzda da semptomların ileri yaşta ortaya çıkmasına neden olmuştur.Cortriatriarum is characterized by a left atrium with two chambers divided by a discrete membrane. While proximal chamber is connected with pulmonary veins, distal chamber is connected to the left ventricle through mitral valve. In isolated cortriatriatum, degree of obstruction is the most important factors for development of pulmonary venous and arterial hypertension, as well as the related symptoms. The wideness of opening between the chambers is the main determinant of physiologic disorder and clinic symptoms. Here, we describe a case of nonobstructive cortriatriatum presented with symptom of right heart failure in the fifth decade, in whom the diagnose was made by échocardiographie examination. Since the structure of the membrane allowed adequate passage of pulmonary venous blood flow from the left atrium into the left ventricular inflow, our case had remained asymptomatic until the advanced age

Chest pain and normal coronary arteries

Normal epikardiyal koroner arterler ve göğüs ağrısı yada benzeri semptomlar koroner anjiyografik değerlendirme sırasında sıklıkla karşılaşılan bir bulgudur. Bu hastaların bazılarında gerçek miyokardiyal iskemi bulgulan gösterilmiş olmasına rağmen mekanizması net olarak bilinmemektedir. Bu makalede, bu farklı hasta grubunun klinik ve fizyolopatolojik özelliklerini güncel bilgiler ışığında gözden geçirmeyi amaçladık.Normal coronary arteries and angina pectoris or angina-like symptoms is a finding commonly encountered during coronary angiographic evaluation. Althoughl the findings of true myocardial ischemia has been shown in some of these patients, its mechanism is clearly unknown. In this article we aimed to review the clinic and phyisiopathologic properties of these distinct patients’ group in the light of current knowledges

Chest pain and normal coronary arteries

Normal epikardiyal koroner arterler ve göğüs ağrısı yada benzeri semptomlar koroner anjiyografik değerlendirme sırasında sıklıkla karşılaşılan bir bulgudur. Bu hastaların bazılarında gerçek miyokardiyal iskemi bulgulan gösterilmiş olmasına rağmen mekanizması net olarak bilinmemektedir. Bu makalede, bu farklı hasta grubunun klinik ve fizyolopatolojik özelliklerini güncel bilgiler ışığında gözden geçirmeyi amaçladık.Normal coronary arteries and angina pectoris or angina-like symptoms is a finding commonly encountered during coronary angiographic evaluation. Althoughl the findings of true myocardial ischemia has been shown in some of these patients, its mechanism is clearly unknown. In this article we aimed to review the clinic and phyisiopathologic properties of these distinct patients’ group in the light of current knowledges

QRS prolongation after cardiac resynchronization therapy is a predictor of persistent mechanical dyssynchrony

WOS: 000384843600005PubMed ID: 26621183Purpose Prolonged QRS duration is the main selection criterion for cardiac resynchronization therapy (CRT) which ameliorates left ventricular mechanical dyssynchrony (MD). However, consequences of post-CRT QRS prolongation and residual MD have been poorly evaluated. We aimed to define the predictors of persistent MD and hypothesized that CRT-induced QRS change (Delta QRS) might have an impact on residual MD after CRT. Methods A total of 80 patients receiving CRT were included in the study. Delta QRS was calculated as the difference between the baseline and paced QRS intervals. Residual MD was assessed early after device implantation with a longitudinal dyssynchrony index (Yu index). Significant MD was defined as a Yu index >= 33 msec. Two groups were created based on residual MD and compared according to clinical, electrocardiographic and echocardiographic features. Results Patients with persistent MD had longer paced QRS durations (182.5 +/- 16.2 vs. 165.4 +/- 22.5 msec, p= 0.03) and were less likely to have left ventricular (LV) leads located in the posterolateral vein (53 % vs. 85 %, p= 0.002). The linear correlation between the Delta QRS and the Yu index values was modest (Spearman's rho=-0.341, p= 0.002); additionally, a prolonged QRS was strongly associated with MD after CRT (p= 0.00008). Both LV lead localization and CRT-induced QRS prolongation emerged as the significant predictors of persistent MD. A biventricularly paced QRS more than 10 msec longer than the pre-paced QRS width was predictive of persistent MD after CRT (sensitivity= 80 %, specificity= 62 %). Conclusions Delta QRS was found to be associated with residual MDafter CRT. Ten milliseconds of QRS prolongation predicted persistent MD after CRT

IgG4-related aortitis mimicking intramural hematoma

Introduction: Acute aortic syndromes (AAS) are life-threatening conditions,and despite advances in imaging techniques, their diagnosisand treatment remain challenging. While intramural hematomais much less common than acute aortic dissection (AD),which is the most common form of AAS, they have similar mortalityrates (1). On the other hand, aortitis may mimic intramuralhematoma (IMH) due to radiologic similarity and, thus, may leadto misdiagnosis and treatment.Here, we describe an IgG4-related aortitis case mimickingintramural hematoma (IMH) due to radiologic image and presentingwith chest pain and severe aortic regurgitation

Assessment of 25-OH vitamin D levels and abnormal blood pressure response in female patients with cardiac syndrome X

Objective: Vitamin D deficiency is associated with coronary artery disease, hypertension, heart failure, endothelial dysfunction, and metabolic syndrome. The pathophysiology of cardiac syndrome X (CSX) involves many pathways that are influenced by vitamin D levels. This study aimed to investigate the relationship between vitamin D deficiency and abnormal blood pressure response to exercise in patients with CSX. Methods: This was a cross-sectional and observational study. Fifty females with normal epicardial coronary arteries who presented with typical symptoms of rest or effort angina and 41 healthy age-matched female controls, were included. Patients with cardiomyopathy, severe valvular disease, congenital heart disease, and left ventricular hypertrophy were excluded. All patients underwent stress electrocardiography examination and 25-hydroxy (OH) vitamin D level measurements. Results: Levels of 25-OH vitamin D were significantly lower in CSX patients (9.8±7.3 ng/mL vs. 18.1±7.9 ng/mL; p<0.001). Systolic blood pressure (SBP) (188±15 mm Hg vs. 179±17 mm Hg; p=0.013) and diastolic blood pressure (DBP) (98±9 mm Hg vs. 88±9 mm Hg; p<0.001) during peak exercise were higher in CSX patients. Levels of 25-OH vitamin D were negatively correlated with peak SBP (r=–0.310, p=0.004) and peak DBP (r=–0.535, p<0.001) during exercise. To discard the multicollinearity problem, two different models were used for multivariate analyses. In the first model, metabolic equivalents (METs) (p=0.003) and 25-OH vitamin D levels (p=0.001) were independent predictors. METs (p=0.007), 25-OH vitamin D levels (p=0.008), and peak DBP were determined as independent predictors in the second multivariate model. Conclusion: In patients with CSX, 25-OH vitamin D levels were lower than those in controls; moreover, 25-OH vitamin D deficiency was also associated with higher levels of peak DBP during exercise

Serum uric acid and carotid artery intima media thickness in patients with masked hypertension

Background: Serum uric acid is related to hypertension and cardiovascular diseases. Masked hypertension is associated with an increase in cardiovascular risk. The aim of our study was to evaluate the serum uric acid level and its relationship with carotid intima-media thickness (IMT) in patients with masked hypertension. Subjects and methods: A total of 114 untreated masked hypertension patients (62 men, 52 women; mean age 44.6 ± 7.9 years) and 38 controls (20 men, 18 women; mean age 44.8 ± 7 years) were included in the study. All patients underwent 24-hour ambulatory blood pressure. Serum uric acid and carotid IMT were measured. Results: Serum uric acid was significantly higher in masked hypertension patients when compared to the control group (5.14 ± 1.42 mg/dl, 4.84 ± 1.45 mg/dl, P = 0.01). Masked hypertension patients had significantly higher carotid IMT than control subjects (0.58 ± 0.09, 0.52 ± 0.09, P < 0.001). The masked hypertension group was also divided into two groups according to the median value of the serum uric acid levels (median value: 5 mg/dl). Carotid IMT was significantly higher in patients with a higher uric acid when compared to those with a lower uric acid (P < 0.001). We also found that the serum uric acid level was a good predictor of increased carotid IMT at the receiver-operating characteristic curve. The area under the curve was 66% (95% confidence interval, 0.56-0.77), and the serum uric acid level was significantly predictive of a high carotid IMT (P = 0.001). Conclusions: Our data suggest that the uric acid levels were significantly higher in the masked hypertension group and elevated uric acid levels were associated with increased carotid IMT, indicating that elevated serum uric acid levels might contribute to the increase in cardiovascular risk in masked hypertension