The value of measured partial oxygen pressure during pulmonary vein closure and the relationship with the diameter of the closed vein in patients with cryoablation.

Aim: The aim of this study was to investigate the value of partial oxygen pressure (PO2) changes measured in the left atrium (LA) during transient pulmonary vein (PV) closure in patients undergoing cryoablation and its relationship with the diameter of the closed PV.Methods: The study was carried out on a total of 25 cases. The grouping of PVs was made separately as the left supe-rior, left inferior, left common, right superior, right inferior, right common and total PVs. PV measurement was made from angiographic images obtained after the cryoablation balloon was inflated and opaque. From the LA, the difference between the PO2 values in the blood gases obtained before and during the temporary closure of each PV was evaluated as the PO2 change. The difference of the lowest temperature reached during the closing of each PV from -36 & DEG;C was termed the heat difference. The relationship of PO2 change with PV diameter and the heat difference were investigated.Results: There was no significant relationship between any of the PV diameters and PO2 changes (p > 0.05). There was a significant relationship between heat differences and PO2 changes in the left superior (p = 0.011), right superior (p = 0.049), right 'common' (p = 0.037) and total PVs (p = 0.001), but there was no significant relationship between heat differ-ences and PO2 changes in the left inferior, left 'common' and right inferior PVs (p > 0.05).Conclusion: In the light of these data, PO2 change could demonstrate the success of cryoablation, and was related with the cooling degree, but not with the PV diameter

Massive cardiac thrombosis in a patient with Sheehan's syndrome

Growth hormone deficiency (GHD) is a risk factor for increased cardiovascular disease, and it has been recently demonstrated that abnormalities in coagulation system might contribute to the increased cardiovascular morbidity and mortality. However, there is not enough data related to the major thrombotic events in GH-deficient patients. We describe the case of a 62-year-old woman with Sheehan's syndrome who developed massive cardiac thrombosis. She was hospitalized with acute pulmonary edema. ECG revealed high ventricular responsive atrial fibrillation (AF) and T-wave inversion on precordial leads. The ejection fraction of left ventricle (LVEF) was measured as 60% by transthoracic echocardiography (TTE) and there was 2nd degree mitral regurgitation with concentric hypertrophic LV walls. Transesophagial echocardiography (TEE) established thrombi both at right atrium and left atrial appendix. Before anticoagulant therapy several hemostatic and fibrinolytic markers were measured. Except increased D-dimer concentration (763.14 mu g/L (0-325)) we did not observe any pathological finding in these parameters. After 14 days of discharge, the patient was admitted to the intensive care unit with upper gastrointestinal bleeding. The warfarin and salicilate were stopped for two months. At the end of two months, the patient was again hospitalized with congestive heart failure and there was a high ventricular responsive AF on ECG. TEE was performed and three thrombi were demonstrated at right atrium (RA), left atrium (LA) and left ventricle (LV). There was no active bleeding on upper GIS endoscopy and anticoagulant therapy was restarted. In this particular case massive cardiac thrombi involving three chambers (LA, RA, LV) were more extensive than expected in AF. Moreover, there was a 2nd degree mitral regurgitation in the patient, and based on previous Studies mitral regurgitation has been associated with less prevalent LA spontaneous echo contrast and fewer thromboembolic events. Therefore we hypothesized that severe GHD in the present case might be the major contributing factor in massive cardiac thrombosis. In summary, based on previous data there is increased risk of thromboembolic events in GHD although the mechanism is unclear yet. Our case is the first case showing massive cardiac thrombosis in a severe GH-deficient patient with Sheehan's syndrome. Therefore, patients with GHD should be screened carefully for thrombus in clinical practice, and further studies need to be done to understand the relation between GHD and coagulation system

Red Blood Cell Distribution Width in 'Non-Dippers' versus 'Dippers'

Objectives: Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status. Methods: The present study involved 123 hypertensive patients and 65 age-and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 +/- 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 +/- 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the night-time, these subjects were 'dippers', and all other subjects were 'non-dippers'. Results : Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 +/- 0.89 and 14.1 +/- 1.33 vs. 13.0 +/- 1.42%, p = 0.027 and p <0.001, respectively). Also RDW values in non-dippers were statistically higher compared to those in dippers (p = 0.008). Although there were negative correlations between RDW values and nocturnal systolic BP fall (p = 0.027, r = -0.199) and diastolic BP fall (p = 0.383, r = -0.079) in all hypertensive patients, these correlations did not reach a statistically significant level. Conclusion: Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls. Copyright (C) 2012 S. Karger AG, Base

Coronary ischemia induced Wolf Parkinson White syndrome

A 60-year-old woman was admitted to cardiology clinic because of typical chest pain. The presenting electrocardiography (ECG) revealed sinus rhythm and T wave inversion on inferolateral wall. Her chest pain relapsed at second day of admission and electrocardiogram recorded during chest pain had ECG changes consistent with Wolf Parkinson White (WPW) syndrome. She underwent cardiac catheterization and borderline lesion was detected in proximal of left anterior descending artery and direct stent implantation was performed. This is the first case report in which acute ischemia may induce typical ECG changes of WPW in a patient with concealed WPW syndrome. We concluded that acute coronary ischemia may manifest concealed WPW syndrome. (C) 2007 Elsevier Ireland Ltd. All rights reserved

The effects of octreotide in dilated cardiomyopathy - An open-label trial in 12 patients

Octreotide, a somatostatin analogue, has been found effective in the treatment of acromegalic cardiomyopathy. We investigated whether intermittent octreotide therapy had beneficial effects in patients with ischemic or idiopathic dilated cardiomyopathy, which are refractory to conventional therapy

The relationship between the level of plasma B-type natriuretic peptide and mitral stenosis

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are both secreted primarily from the ventricle myocardium in response to the increase in volume and pressure. We aimed to investigate the relationship between the severity of mitral stenosis (MS) and the level of plasma BNP. A total of 56 patients (50 female, 6 male) were included in the study. Mitral stenosis and its related parameters were evaluated by echocardiographic methods. Patients were divided into three groups as with mild, moderate and severe MS according to their planimetric valvular area. Plasma BNP levels were measured using "Triage-B-type natriuretic peptide test" method (Biosite Diagnostics, San Diego). The relationship of BNP with mitral stenosis and other echocardiographic parameters were studied. The comparison of the 3 groups with one another revealed that the BNP level in the group with moderate MS was higher than that in the group with mild MS, however it was statistically insignificant (74.9 +/- 49.7 versus 49.9 +/- 40.5 pg/ml, p > 0.05). BNP level in the group with severe MS was significantly higher than that in the mild MS (144.3 +/- 83.9 versus 49.9 +/- 40.5 pg/ml, p < 0.001) and that in the moderate MS group (144.3 +/- 83.9 versus. 74.9 +/- 49.7 pg/ml, p < 0.05). When patients were taken together, as the area of the mitral valve decreased, the level of BNP underwent a corresponding increase (r:-0.48, p < 0.001). We have ascertained that the level of plasma BNP and the degree of MS are significantly correlated, and as MS becomes more serious, the plasma BNP level rises

Conservative management of the perforation of a side branch of the left main coronary artery during coronary angiography

We report perforation of a side branch of left main coronary artery during coronary angiography. We suppose that the engaging of the catheter into a small side branch caused this complication. Furthermore, we observed that the conservative approach might be successful in the restoration of such coronary artery perforations. To the best of our knowledge this is the first reported case of left main side branch coronary artery perforation during angiography. (C) 2007 Elsevier Ireland Ltd. All rights reserved

The effect of septum and right ventricular free- Wall on right ventricular diastolic function in mild hypertension- A colour tissue doppler echocardiographic study

Amaç: Çalışmamızın amacı hafif hipertansif hastalarda sağ ventrikül diyastolik fonksiyonlarına septum ve sağ ventrikül serbest duvarının etkisini standard ve renkli doku Doppler ekokardiyografi yöntemi ile araştırmaktır. Gereç ve Yöntem: Çalışmaya 31 hafif hipertansif hasta, (sistolik kan basıncı= 144±11 mmHg, diyastolik kan basıncı= 91±9 mmHg, yaş ortalaması 52±12 yıl, 10 erkek, 21 kadın) ile yaş-eşleştirmeli 30 sağlıklı (sistolik kan basıncı= 113±9 mmHg, diyastolik kan basıncı= 62±6 mmHg, yaş ortalaması 47±7 yıl, 14 erkek, 16 kadın) birey alındı. Tüm parametreler standart ve renkli doku Doppler ekokardiyografi ile ölçüldü. Bulgular: 31 hastanın 17'sinde (%54) sol ventrikül diyastolik fonksiyon bozukluğu, 16'sında (%52) ise sağ ventrikül diyastolik fonksiyon bozukluğu tespit edildi. Septum duvar kalınlığı (p<0.05), sol ventrikül arka duvar kalınlığı (p<0.05), sol ventrikül kitlesi (p<0.05), sol ventrikül kitle indeksi (p<0.05) ve sağ ventrikül serbest duvar kalınlığı (p<0.001) hipertansif grupta kontrol grubuna göre artmıştı. Sağ ve sol ventrikül diyastolik doluş parametreleri arasında birebir ilişki bulundu (Mitral E- Triküspid E r= 311 p0.015, Mitral A- Triküspid A r= 371 p0.003, Mitral E/A- Triküspid E/A r= 537 p0.001). Sağ ventrikül diyastolik doluş parametreleri ile sağ ventrikül serbest duvar renkli doku Doppler ekokardiyografik diyastolik parametreleri arasında anlamlı ilişki bulunmamasına rağmen, septumun renkli doku Doppler diyastolik parametreleri ile triküspid Et/At oranı arasında anlamlı ilişki bulundu. Sonuç: Hafif hipertansif hastalarda sağ ventrikül diyastolik fonksiyonları bozulmaktadır. Sağ ventrikül diyastolik fonksiyonu üzerine septum, sağ ventrikül serbest duvarına göre daha etkilidir.Aim: In this study, we aimed to investigate effect of septum and right ventricular free-wall on right ventricular diastolic function in patients with mild hypertension by standard and color tissue Doppler echocardiographic methods. Material and Methods: The study group was consisted of 31 mild hypertensive patients (systolic blood pressure/diastolic blood pressure= 144&plusmn;11/91&plusmn;9 mmHg, mean age 52&plusmn;2 years, 10 men, 21 women) and 30 age- matched normotensive control subjects (systolic blood pressure/diastolic blood pressure= 113&plusmn;9/62&plusmn;6 mmHg, mean age 47&plusmn;7 years, 14 men, 16 women). All the parameters were measured with standard and colour tissue Doppler echocardiography. Results: Left ventricular diastolic dysfunction in 17 of 31 patients (54%) and right ventricular diastolic dysfunction in 16 of 31 patients (52%) were found. Septum (p&lt;0.05), left ventricular posterior wall (p&lt;0.05), left ventricular mass (p&lt;0.05), left ventricular mass index (p&lt;0.05) and right ventricular free-wall thickness (p&lt;0.001) statistically increased in hypertensive groups than control groups. Significant correlations were observed between parameters of right and left ventricular filling in hypertensive patients (Mitral E- Tricuspid E r= 311 p0.015, Mitral A- Tricuspid A r= 371 p0.003, Mitral E/A- Tricuspid E/A r= 537 p0.001). Although no correlation was found between parameters of the diastolic filling of right ventricular and diastolic parameters of right ventricular free-wall by tissue Doppler echocardiography, significant correlation was found between tricuspid E/A ratio and diastolic parameters of septum by colour tissue Doppler echocardiography Conclusion: Right ventricular diastolic function is impaired in mild systemic hypertension. Septum is more effective than right ventricular free-wall on right ventricular diastolic function