Renovascular hypertension: Review

Hypertension, one of the risk factors for development of cardiovascular diseases, is classified as primary and secondary according to the mechanism of development. Secondary hypertension is the elevation of blood pressure, whose underlying cause can be defined and often be treatable. The most common cause of secondary hypertension is renovascular hypertension (RVHTN). RVHTN is defined as blood pressure elevation due to obstructive disease of one or two main renal arteries or their branches. The main reason of RVHTN is stenosis from atherosclerosis affecting main renal artery, and the most of the remaining cases are fibromuscular dysplasia. The former is mostly seen in men at an advanced age, the latter is especially seen in young women. If RVHTN is suspected after clinical evaluation, noninvasive diagnostic tests first must be done. If the non invasive test results are positive, renal arteriography must definitely be considered to confirm the diagnosis. The aim of therapy for RVHTN is to regulate blood pressure, prevent problems that are caused by ischemia due to renal artery stenosis, and reverse such problems. Severity of hypertension, etiology of RVHTN, the presence of renal function abnormalities, and the presence of comorbid conditions that affect the patient's survival are important in guiding treatment. Four treatment alternatives are under consideration for RVHTN cases: medical treatment, percutaneous transluminal renal angioplasty (PTRA), PTRA and stent placement, and surgical revascularization. Every outpatient clinic should make a treatment choice according to their experience and after careful consideration of the patient's risks and benefits from revascularization therapy. Copyright © 2012 by Türkiye Klinikleri

Circumflex coronary artery fistulae with myocardial bridging in the right coronary artery: Case report

Congenital coronary fistula is a rare heart anomaly, which is a conection between a coronary artery and a cardiac chamber. Most such fistulas drain into the right side of the heart including the pulmonary artery. Congenital left sided fistula is even more uncommon. Coronary artery bridging has been recognized for a long time and shows an almost uniform predilection for the left coronary artery distribution. Most ofthese patients are asymptomatic; however, myocardial infarction, congestive heart failure, infective endocarditis, arrhythmias or rupture of the aneurismal involved vessel may occur. Herein, we report an unusual case of circumflex coronary artery fistula in association with myocardial bridging in the right coronary artery distribution. Copyright ©2010 by Tükiye Klinikleri

Relationship of admission mean platelet volume with no-reflow in acute myocardial infarction treated with fibrinolysis

Platelets play a central role in the pathogenesis of acute coronary syndromes. Mean platelet volume (MPV) is a controversial issue in platelet reactivity, the extent of coronary artery disease, and response to reperfusion therapy. Thus, we sought to determine the relationship of admission MPV and no-reflow in patients with acute STsegment elevation myocardial infarction (STEMI) treated with fibrinolysis. 164 patients (143 male, 21 female) who had presented with STEMI treated with fibrinolysis and had undergone coronary angiography, were included in our study. Blood samples for MPV estimation were obtained on admission. All angiograms were assessed with respect to TIMI flow scale in infarct-related artery. Patients were divided in two groups: group 1 with reflow (TIMI=3, n = 42) and group 2 with no-reflow (TIMI<3, n = 122). Both univariate and multivariate analyses were performed on clinical and laboratory factors with relation to angiographic reperfusion. All characteristics were similar between the two groups. MPV was not associated with no-reflow (p=0.504). Multivariate analysis determined that RCA as an IRA was independent predictor of angiographic reperfusion. No-reflow phenomenon was observed significantly fewer when RCA was an IRA (odds ratio 2.6, 95% confidence interval 1.2 to 5.3, p=0.009). Our study showed that MPV is not related to angiographic reperfusion in patients with STEMI treated with fibrinolysis

Percutaneous closure of a tunnel shaped aneurysmatic VSD

Percutaneous closure of a congenital VSD is safe and effective method of treatment, which has increasingly been considered, after much work and progress in technology have taken place in this area. Ventricular septal defects make up the majority, 40% of all congenital cardiac defects. Cases exhibit a wide clinical spectrum ranging from asymptomatic presentation to full blown congestive heart failure, depending on the size of the defect. There might even occur a spontaneous closure depending on the size and the location of the defect. As our female patient has refused the surgical treatment for a long time, a percutaneous approach was offered to her. Upon consent to the procedure, and after further diagnostic testing, a percutaneous closure was performed for the first time in our clinic

Impaired Blood Rheology in Pulmonary Arterial Hypertension

Background: Understanding of the pathophysiologic manifestations of pulmonary arterial hypertension (PAH) is still evolving. The aims of the present study were to determine the alterations in blood rheology, and to investigate the relationship between those alterations and laboratory parameters in PAH. Methods: The study included 21 consecutive treatment-naive patients with PAH and 32 age and sex-matched healthy controls. Patients were categorised in class II (n = 6), class III (n = 13), and class IV (n = 2). All subjects underwent right-heart catheterisation. Erythrocyte deformability and aggregation were measured by an ektacytometer. Results: Haemodynamic variables were as follows: the mean right atrial pressure: 9.94 ± 5.76 mmHg; the average pulmonary vascular resistance: 5.66 ± 3 WU; Fick cardiac index: 4.15 ± 2.75 l/min/m2; and mixed venous O2 saturation: 64.59 ± 12.53%. The average 6-minute walk distance was 351.09 ± 133.08 m. Erythrocyte deformability measured at 0.95, 3.00, and 5.33 Pa was significantly lower, erythrocyte aggregation index (AI) was higher, and aggregation half-time (t1/2) was lower in PAH. AI and fibrinogen were positively correlated with NT pro-BNP (AI-NT pro-BNP: r = 0.579; fibrinogen-NT pro-BNP: r = 0.591). t1/2 was negatively correlated with NT pro-BNP (t1/2-NT pro-BNP: r = −0.648). Conclusions: The increase in erythrocyte aggregation and the decrease in deformability may theoretically increase the flow resistance and may be of haemodynamic significance. The association between erythrocyte aggregation and NT pro-BNP may indicate that erythrocyte aggregation increases with disease progression. These alterations contribute to the understanding of the pathophysiology and could serve as markers of disease presence. © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ

The relationship of the degree of coronary stenosis and percutaneous coronary revascularization with heart rate recovery index

OBJECTIVES: Heart rate recovery (HRR) is influenced by autonomic function. We aimed to investigate the effect of percutaneous coronary intervention (PCI) on HRR with respect to the degree of coronary stenosis (DCS) in severe coronary artery disease (CAD). METHODS: The treatment group (TG) consisted of 70 severe stable CAD patients treated with PCI and the control group (CG), 62 non-critical CAD patients, who were not treated with PCI. All participants underwent exercise test both at baseline and 3 months after coronary angiography (CAG)/PCI. HRR was defined as a change in heart rate from peak exercise to 1 minute after exercise. HRR index was described as the percentage change in HRR from 3 months after CAG/PCI to baseline. RESULTS: The TG had lower HRR than the CG (p<0.001). In the TG, HRR was inversely correlated with the number of diseased vessels at baseline (r=-0.418, p<0.001). HRR index was higher in TG than CG (p<0.001). No associations were found between HRR (p=0.136), HRR index (p=0.703) and the DCS. Patients who had multiple vessels treated, had the highest HRR index. CONCLUSION: HRR is not associated with the DCS of 70% to 99%, and PCI improves HRR in proportion to the number of coronary vessels treated in severe stable CAD

The value of gamma glutamyl transpeptidase in atrial fibrillation following coronary artery bypass grafting

Atrial fibrillation (AF) seen following open heart surgery is one of the complications with important conseqences in the short and long term. The exact cause is unknown, however oxidative stress has been postulated. In this study, the significance of serum gamma glutamyl transferase (GGT) as a predictor of oxidative stress was evaluated in cases who developed AF after coronary artery bypass grafting (CABG).One hundred patients undergoing CABG in the department of cardiovascular surgery at our hospital, were included in the study. Patients with chronic liver disease, atrial fibrillation prior to surgery, large left atrium (greater than 45 mm), the need for emergency surgery, thyroid dysfunction, were excluded from the study. Before operation all patients had echocardiographic examination, electrocardiograms taken, and blood samples drawn for routine biochemistry including GGT. Group 1 consisted of 36 patients, who developed AF; group 2 consisted of 64 patients who did not develop AF. Patients were seen at one month after surgery. Medical treatment was given to the group with AF. Beta blocker therapy was contiunued the same as prior to surgery. The groups were similar with respect to sex, cardiovascular risk factors, the extent of coronary artery disease (p>0.05). Age differed significantly between the groups (Table 1). Patients who developed AF within 48 hours after surgery had a tendency to have a higher level of GGT. The group with AF had a significantly higher level of AST (p=0.027) (Table 2). In this study, we found that patients undergoing coronary bypass surgery, who developed AF after surgery, had a tendency to have a higher level of GGT. Our finding suggests a need for larger prospective studies looking at the relationship of plasma GGT level as a predictor of oxidative stres and the development of AF after CABG