Vejetasyonunun direkt gerçek zamanlı intrakardiyak ekokardiyografi görüntüleme altında perkütan yaklaşımla küçültülmesi

Infection of cardiac implantable electronic devices is one of the most dangerous complications, and the main treatment approach is the removal of cardiac implantable electronic device from the body. We present a case of successful lead removal of implantable cardioverter-defibrillator infection at which right ventricular lead had giant vegetation material. We performed percutaneous debulking of giant right ventricular lead vegetation by percutaneous approach under the realtime intracardiac echocardiography visualization because of the high risk of pulmonary artery embolization of giant infectious material and poor lung and general condition of the patient.Kalp içi elektronik cihaz enfeksiyonu, en tehlikeli komplikasyonlardan biridir ve ana tedavi yaklaşımı, kalp içi elektronik cihazın vücuttan çıkarılmasıdır. Bu olguda, implante edilebilen kardiyoverter-defibrilatör enfeksiyonunun sağ ventrikül leadinde devasa bir vegetasyon materyali bulunan bir vakayı başarılı bir şekilde sunuyoruz. Hastanın pulmoner arter embolizasyonu riskinin yüksek olması, akciğer ve genel durumunun kötü olması nedeniyle, gerçek zamanlı intrakardiyak ekokardiyografi görüntülemesi altında perkütan yaklaşımla devasa sağ ventriküler lead vejetasyonunun küçültülmesi işlemi gerçekleştirildi

Egzersiz ile şiddetlenen göğüs ağrısının nadir bir nedeni olarak Dunbar sendromu

Özet Medyan arkuat ligaman T12/L1 vertebra seviyesin- de aortik hiatusu çaprazlayan sağ ve sol diyafram kruslarını birbirine bağlayan fibröz bir bağdır. Az sayıda hastada bu ligamanın düşük seviyeli yerleşimi çölyak arterin proksima- linde ciddi darlığa neden olarak çölyak arter bası sendromu olarak bilinen iskemik semptomlara yol açar. Bu durum ay- rıca medyan arkuat ligaman sendromu ya da Dunbar send- romu olarak da bilinir. Semptomlar arasında özellikle yemek sonrasında gelişen epigastrik ya da retrosternal ağrı, kilo kaybı, bulantı, kusma, ishal ve iştahsızlık sayılabilir. Ciddi olgularda egzersiz sırasında kan akımının cilde ve kaslara yönlenmesine bağlı olarak gelişen çalma fenomeni sonu- cunda egzersiz ile ilişkili karın ağrısı gözlenebilir. Bilgisayarlı tomografik anjiyografi mezenter anjiyografi ile birlikte çölyak arter bası sendromu tanısında altın standart tanı yöntemi- dir. Medyan arkuat ligamanın cerrahi tedavi ile gevşetilmesi genellikle ilk tercih edilen tedavi seçeneğidir. Burada ye- meklerden sonra olan ve özellikle egzersiz ile şiddetlenen epigastrik bölgeye de yayılan retrosternal ağrı şikayeti ile başvuran 46 yaşında erkek hastada koroner semptomları ile de karışabilecek çölyak arter bası sendromu sunuldu.Summary The median arcuate ligament is a fibrous band connecting the left and right diaphragmatic crura across the aortic hiatus at the level of the T12/L1 vertebral bodies. The low insertion point of this ligament causes significant stenosis of the proximal portion of the coeliac artery in a small group of patients, and contributes to ischemic symptoms known as coeliac artery compression syndrome (CACS). It is also re- ferred to as median arcuate ligament syndrome or Dunbar syndrome. Symptoms include especially postprandial epi- gastric or retrosternal pain, weight loss, nausea, vomiting, diarrhea and reduced appetite. In severe cases, exercise re- lated abdominal pain may be caused by steal phenomenon, whereby blood is shunted to the skin and relevant muscles during exercise. Computed tomographic angiography and mesenteric angiography are the gold standard diagnostic modalities to confirm diagnosis of CACS. Surgical therapy with release of the median arcuate ligament usually is the primary treatment of choice. Here, we present a 46-year-old male CACS patient with postprandial and especially exer- cise-induced retrosternal pain radiating to the epigastric re- gion, which may be misperceived as a coronary symptom

Spontaneous rupture of a giant Coronary Artery Aneurysm after acute Myocardial Infarction

Coronary artery aneurysm is commonly defined as a localized dilatation exceeding the diameter of adjacent normal coronary segments by 50% [1]. Coronary artery aneurysms may be fusiform, involving the full circumference of the coronary artery, or saccular, involving only a portion of the circumference [2]. Causes of coronary artery aneurysms include atherosclerosis (accounting for 50% of cases), Kawasaki disease, polyarteritis nodosa, infection, trauma, coronary dissection, percutaneous coronary angioplasty, and congenital malformations [3]. The abnormal blood flow within the coronary artery aneurysm may lead to thrombus formation, embolization, rupture, myocardial ischemia or myocardial infarction [4]. Here we present a case of a giant fusiform coronary artery aneurysm who passed away due to coronary rupture after acute myocardial infarction

A rare Congenital Coronary Artery Anomaly: Woven Right Coronary Artery associated with Myocardial Infarction

Woven coronary artery (WCA) is an extremely rare and still not a clearly defined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1]. Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very difficult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2]

Importance Of Reciprocal St Segment Depression In The Extensive Coronary Artery Disease

Aim : We investigated the relationship between the severity of reciprocal ST depression and the extent of coronary artery disease in patients with inferior myocardial infarction. Method : Ninety-five consecutive patients (52 women 43 men, with a mean age of 54±5 years) who had acute inferior myocardial infarction were included in the study. Reciprocal changes in the ST segment were defined as ST depression of> 1 mm in at least two out of four of the precordial leads V1-V4. All the patients had undergone coronary angiography within seven days of admission. The extension of coronary artery disease which was measured by Gensini and Reardon scores, was compared with the reciprocal changes on ECG recorded at the time of admission. Result : There was a significant correlation between reciprocal ST depression and disease extension (r=0.68 for Gensini score, r= 0.88 for Reardon score, p< 0.05 for both). Conclusion: The presence of ST segment depression in the precordial leads during the acute inferior myocardial infarction was associated with greater myocardial necrosis and more frequent left coronary artery disease

Relation of Serum ADMA, Apelin-13 and LOX-1 Levels with Inflammatory and Echocardiographic Parameters in Hemodialysis Patients

Cardiovascular diseases are the leading causes of mortality in patients with chronic kidney disease. Nitric oxide has a critical role in both endothelial dysfunction and the atherosclerosis process. We aimed to investigate the relationships between serum asymmetric dimethyl arginine (ADMA), LOX-1, and Apelin-13 levels, which are known to act over nitric oxide with endothelial dysfunction and cardiac morphology as well as with each other in hemodialysis patients. The study comprised a total of 120 patients (53females and 67males) receiving hemodialysis three times a week for at least 6months and an age-gender matched control group (55 females and 58 males). Serum ADMA, LOX-1, and Apelin-13 levels were measured using the ELISA technique. Echocardiography, 24-h blood pressure monitoring by the Holter and carotid artery intima-media thickness (CIMT) measurement was performed on all of the included subjects. The associations between serum ADMA, LOX-1, and Apelin-13 levels with CIMT, echocardiographic parameters [left ventricular mass (LVM) and left ventricular mass index (LVMI)], and inflammatory markers [high sensitive C-reactive protein (hsCRP) and neutrophil lymphocyte ratio (NLR)] were evaluated by correlation analysis. Serum ADMA, Apelin-13, and LOX-1 levels were significantly higher in the hemodialysis group than the controls (P<0.001, P<0.001, and P<0.001, respectively). CIMT, hsCRP, and NLR levels were also significantly higher in the hemodialysis group (P<0.05, P<0.001, P<0.001, respectively). Significant correlations were observed among the serum ADMA, Apelin-13, and LOX-1 levels. Moreover, notably positive correlations were found between these three biochemical markers and LVM, LVMI, hsCRP, and CIMT. Serum ADMA, Apelin-13, and LOX-1 levels can be indicators not only for the inflammatory process but also for the pathogenesis of cardiovascular diseases in hemodialysis patients