A quadricuspid aortic valve causing moderate aortic regurgitation

Quadricuspid aortic valve (QAV) is a rare cause of aortic regurgitation. Most cases are detected incidentally during echocardiography, angiography, autopsy or surgery. It may also be associated with other congenital anomalies of the heart. A 70 year-old man was admitted to our hospital with a five-month history of dyspnea. Echocardiographic examination showed a QAV leading to moderate aortic regurgitation, severe mitral regurgitation, left ventricular dysfunction and aortic root dilatation. Surgical treatment was considered, but the patient refused. We describe a case of QAV leading to aortic regurgitation

Comparison of the diagnostic characteristics of electrocardiographic algorithms in detecting the localization of the accessory pathway in Wolff Parkinson White Syndrome

Amaç: Wolff Parkinson White Sendromu’nda aksesuvar yol lokalizasyonunu tespit etmek için kullanılan bazı elektrokardiyografik algo‐ ritmaların (Arruda, Boersma, Fitzpatrick ve Chiang) tanısal özelliklerinin birbirleri ile karşılaştırılması. Gereç ve Yöntem: Çalışmamıza 01.10.2013‐15.10.2017 tarihleri arasında Wolff Parkinson White Sendromu sebebi ile kliniğimize baş‐ vuran ve takibinde elektrofizyolojik çalışma yapılan 50 hasta (yaş ortalaması 34,8 ±14,3 yıl, %52’si erkek) dahil edildi. Tüm hastaların elektrokardiyogramlarında işlem öncesi preeksitasyon paterni mevcuttu. Hastaların elektrofizyolojik çalışma öncesi elektrokardiyogra‐ fileri incelendi ve herbirinde Arruda, Boersma, Fitzpatrick ve Chiang algoritmaları kullanılarak aksesuvar yol lokalizasyonu tahminleri ya‐ pıldı. Daha sonrasında elde edilen veriler ile elektrofizyolojik çalışma sonrasında tespit edilen gerçek aksesuvar yol lokalizasyonları ara‐ sındaki uyum değerlendirildi. İşlem öncesi elektrokardiyografilerine ulaşılamayan hastalar çalışma dışı bırakıldı. Dört algoritma ile elek‐ t ro fizyolojik çalışma arasındaki aksesuvar yol tahminindeki uyum fleiss kappa test istatistiği ile hesaplandı. Bulgular: Elektrofizyolojik çalışma ile doğrulanan aksesuvar yol tahmin etme gücü Arruda algoritması ile %58, Chiang algoritması ile %52, Boersma algoritması ile %48 ve Fitzpatrick algoritması ile %38 olarak tespit edildi. Algoritmaların elektrofizyolojik çalışma ile olan uyumları incelendiğinde Arruda algoritması orta derecede uyum göstermekte idi (Kappa: 0,48, p <0,001). Diğer 3 algoritma ise zayıf de‐ recede uyum göstermekte idi. Sonuç: Aksesuar yol lokalizasyonunu belirlemede elektrofizyolojik çalışma altın standart yöntem olarak bilinmektedir. Söz konusu elek‐ trokardiyografi algoritmalarının aksesuvar yol lokalizasyonunu tahmin etme gücü beklenenden düşük olmasına rağmen bu algoritma‐ ların elektrofizyolojik çalışma öncesi kullanımının işlemin başarı şansını artırabileceğini düşünmekteyiz. Bu çalışmada kullanılan algorit‐ malar arasında en yüksek tahmin gücü Arruda algoritmasında saptandı (%58).Objective: To compare the diagnostic characteristics of some electrocardiographic algorithms (Arruda, Boersma, Fitzpatrick, and Chiang) used to detect accessory pathway localization in Wolff Parkinson White Syndrome. Material and Method: Our study included fifty patients (mean age 34.8±14.3 years, 52% male) who applied to our clinic from 01.10.2013 to 15.10.2017 due to Wolff Parkinson White Syndrome and underwent electrophysiological study. There was a pre‐excita‐ tion pattern in the electrocardiograms of all patients before the procedure. The electrocardiograms of the patients were examined be‐ fore the electrophysiological study, and accessory pathway localization estimations were made using the Arruda, Boersma, Fitzpatrick, and Chiang algorithms for each. The compatibility between the data obtained afterwards and the actual accessory pathway localiza‐ tions detected after electrophysiological study was evaluated. Patients whose electrocardiograms could not be accessed before the pro‐ cedure were excluded from the study. The agreement between the four algorithms and the electrophysiological study in the prediction of the accessory pathway was calculated using the Fleiss’ kappa test statistics. Results: Accessory pathway prediction power verified by electrophysiological study was determined as 58% by Arruda’s algorithm, 52% by Chiang’s algorithm, 48% by Boersma’s algorithm and 38% by Fitzpatrick’s algorithm. Upon review of the agreement of the algorithms with the electrophysiological study, the Arruda’s algorithm showed moderate agreement (Kappa: 0.48, p<0.001). The other 3 algorithms showed weak level of agreement. Conclusion: Electrophysiological study is known as the gold standard method for detecting accessory pathway localization. Although the power of these electrocardiogram algorithms to predict accessory pathway localization is lower than expected, we believe that the use of these algorithms before electrophysiological study may increase the chance of success of the procedure. Among the algorithms used in this study, the highest predictive power was found in the Arruda algorithm (58%)

Relation of multicenter automatic defibrillator implantation trial implantable cardioverter-defibrillator score with long-term cardiovascular events in patients with implantable cardioverter-defibrillator

OBJECTIVE: To test the hypothesis that multicenter automatic defibrillator implantation trial (MADIT) - implantable cardioverter-defibrillator (ICD) scores predict replacement requirement and appropriate shock in a mixed population including both primary and secondary prevention and long-term adverse cardiovascular events. METHODS: The study has a retrospective design. Patients who were implanted with ICD in the cardiology clinic of Atatürk University Faculty of Medicine between 2000 and 2013 were included in the study. For this purpose, 1394 patients who were implanted with a device in our clinic were reviewed. Then, those who were implanted with permanent pacemaker (n=1005), cardiac resynchronization treatment (CRT) (n=45) and CRT-ICD (n=198) were excluded. RESULTS: A total of 146 patients (98 males, 67.1%) with a mean age of 61.1 (±14.8) years were recruited. The median follow-up time was 21.5 months (mean 30.6±25.9 months; minimum 4 months, and maximum 120 months). The median MADIT-ICD scores in the patients were 2. MADIT-ICD scores were categorized as low in 15.1%, intermediate in 57.5%, and high score in 27.4% of patients. Accordingly, MADIT-ICD scores (1.29 [1.00–1.68], p=0.050), hemoglobin (0.86 [0.75–0.99], p=0.047), and left ventricular ejection fraction (EF) (0.97 [0.94–0.99], p=0.023) were determined as independent predictors of major adverse cardiovascular events in the long-term follow-up of ICD-implanted population. CONCLUSION: In this study, we showed that there was an independent association of long-term adverse cardiovascular events with MADIT-ICD score, hemoglobin, and EF in patients implanted with ICD

SAKARYA NEHRİ HAVZASI AYLIK AKIM VERİLERİNİN PARAMETRİK OLMAYAN YÖNTEMLERLE TREND ANALİZİ

In this study, monthly streamflow data of eleven stations operated by EIE (ElectricalPower Resources Survey and Development Administration) located at Sakarya river basin wereinvestigated. Three different non-parametric trend tests (Sens T, the Spearmans Rho and the SeasonalKendall tests) were selected to determine linear trends of monthly flow data. The linear slopes of trendswere calculated by using a non-parametric estimator developed by Sen. The beginning of trends wasdetermined by using the Mann-Kendall rank correlation test. In addition, homogeneities in monthlytrends were tested by using a method developed by Van Belle and Hughes. According to the analysescarried out; meaningfull trends are determined (at the 0.05 significance level) in 64% of total 132 monthof 11 stations. Generally, the determined changes are in decreasing trend. The decreasing trend ismaximum in the stations 1221 and 1243 and they are located in northwest of the basin. Maximumnegative slopes are determined in March for all stations except for stations 1216 and 1226. March is theone in which maximum number of trend is determined (10 station) and all of trends are downward. AlsoMarch is the month in which maximum slope is observed. April is the month in which least trend isdetermined (5 station). The beginning of trends was observed in the early 1980s. According to the VanBelle and Hughes Homogeneity test, there is no global trend in the basin.Bu çalõşmada Sakarya havzasõnda bulunan ve EİE tarafõndan işletilen 11 adet akõm gözlemistasyonunun aylõk ortalama akõm verileri kullanõlmõştõr. Aylõk akõm verilerinin lineer trendlerini tespitetmek için, parametrik olmayan üç farklõ metot (Spearmanõn Rho, Senin T ve Mevsimsel Mann-Kendalltestleri) kullanõlmõştõr. Trendlerin lineer eğimleri, Sen tarafõndan geliştirilen ve parametrik olmayan birmetot olan Senin trend eğim metodu kullanõlarak hesaplanmõştõr. Trend başlangõç yõllarõ parametrikolmayan Mann-Kendall Mertebe Korelasyon testi ile belirlenmiştir. Ayrõca, Van Belle ve Hughestarafõndan geliştirilen bir metot kullanõlarak, aylõk trendlerdeki homojenlikler kontrol edilmiştir. Yapõlananalizler sonucunda incelenen 11 istasyona ait toplam 132 ayõn %64ünde 0.05 önem seviyesinde anlamlõtrendler tespit edilmiştir. Trend tespit edilen aylardaki değişim genellikle azalan yönde olmuştur. 1221ve 1243 numaralõ istasyonlar azalan yönde değişimin en fazla olduğu istasyonlardõr ve bu istasyonlarhavzanõn kuzey batõ kõsmõnda yer almaktadõr. 1216 ve 1226 numaralõ istasyonlar dõşõndaki diğer bütünistasyonlarõn maksimum negatif eğimleri Mart ayõnda tespit edilmiştir. Mart ayõ 10 istasyonla en fazlatrend tespit edilen ay olmuştur ve trendlerin hepsi azalan yöndedir. Aynõ zamanda Mart ayõ maksimumeğimin de en fazla gözlendiği ay olmuştur. 5 istasyonla Nisan ayõ en az trend tespit edilen aydõr. 1980liyõllar trend başlangõç yõlõ olarak en fazla gözlenen yõllar olmuştur. Van Belle ve Hughes Homojenlik testisonuçlarõna göre ise havzada global bir trende rastlanamamõştõr

Is routine echocardiography necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia?

Background: The aim of this study was to investigate whether pericardial effusion (PE) detected by transthoracic echocardiography (TTE) was clinically significant and whether routine echocardiography was necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). Methods: A total of 202 patients with AVNRT were included in the study from three centers. The patients received basic electrophysiology-guided therapy, followed by radiofrequency ablation (RFA). All patients underwent TTE before and after RFA therapy. Results: The mean age of the study population was 46.2 &#177; 17.9 and 30.7% of the patients were male. Of these patients, six (3%) had postoperative PE, as detected by TTE. However, none of them had cardiac tamponade (CT). Four patients had minimal PE, while two had mild PE. Repeated TTE at one to three months showed resolved PE. No significant difference was seen among the patients with and/or without PE in terms of age, gender, the number of RFA applications, or RFA duration; however, significantly prolonged duration of fluoroscopy exposure was observed in the patients with PE. Conclusions: PE was detected in 3% of the patients by TTE and associated with prolonged duration of fluoroscopy exposure. However, no patients with moderate or large PE or cardiac tamponade were found in the study. In conclusion, we suggest that TTE should only be performed in the presence of clinical indications following ablation of AVNRT

Increased mean platelet volume associated with extent of slow coronary flow

Background: Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices. Methods: In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF. Results: Among the 147 patients (mean age 52.7 &#177; 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 &#177; 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15&#8211;10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99&#8211;12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43&#8211;8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22&#8211;2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43&#8211;4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05&#8211;4.33, p = 0.03) was identified as an independent correlate of extent of SCF. Conclusions: Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF

Quantitative evaluation of ischemic myocardial scar tissue by unenhanced T1 mapping using 3.0 Tesla MR scanner

PURPOSEWe aimed to use a noninvasive method for quantifying T1 values of chronic myocardial infarction scar by cardiac magnetic resonance imaging (MRI), and determine its diagnostic performance.MATERIALS AND METHODSWe performed cardiac MRI on 29 consecutive patients with known coronary artery disease (CAD) on 3.0 Tesla MRI scanner. An unenhanced T1 mapping technique was used to calculate T1 relaxation time of myocardial scar tissue, and its diagnostic performance was evaluated. Chronic scar tissue was identified by delayed contrast-enhancement (DE) MRI and T2-weighted images. Sensitivity, specificity, and accuracy values were calculated for T1 mapping using DE images as the gold standard.RESULTSFour hundred and forty-two segments were analyzed in 26 patients. While myocardial chronic scar was demonstrated in 45 segments on DE images, T1 mapping MRI showed a chronic scar area in 54 segments. T1 relaxation time was higher in chronic scar tissue, compared with remote areas (1314±98 ms vs. 1099±90 ms, P < 0.001). Therefore, increased T1 values were shown in areas of myocardium colocalized with areas of DE and normal signal on T2-weighted images. There was a significant correlation between T1 mapping and DE images in evaluation of myocardial wall injury extent (P < 0.05). We calculated sensitivity, specificity, and accuracy as 95.5%, 97%, and 96%, respectively.CONCLUSIONThe results of the present study reveal that T1 mapping MRI combined with T2-weighted images might be a feasible imaging modality for detecting chronic myocardial infarction scar tissue

Clinical results of endoprosthetic reconstructions in metastatic and primary bone tumors

In this study, we aimed to compare the functional outcomes and survival of 38 patients with primary bone and metastatic bone tumors who were reconstructed with endoprosthesis. Thirty-eight patients who underwent endoprosthesis for malign bone tumors 2012- 2015 were included in the study. We retrospectively reviewed 38 patients, eight of whom underwent limb salvage with tumor resection prosthesis of tibia, 21 femur, and 9 humerus. When comparing functional outcomes, the revised Musculoskeletal Tumor Society (MSTS) scoring system was used for all surviving patients. The patients were evaluated in two groups as primary bone tumor and metastatic bone tumor. The mean follow-up period of 32 healthy and alive patients was 38 (12 to 98) months. While 12 patients were primary malign bone tumors, the other 26 patients had bone metastasis. All six patients who died during follow-up had a diagnosis of metastatic bone tumor. Periprosthetic infection was observed in two patients, recurrence tumor in one and prosthetic dislocation in one. It was found that the MSTS score in patients with primary bone tumors (22, 6) was statistically significantly higher than in patients with metastases (17, 6) (p [Med-Science 2022; 11(1.000): 199-203