ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 2 (2)
Volume: 2  Issue: 2 - June 2002
EDITORIAL
1.On YOK and Publications, CINAHL, Gaddum Curve and Love
Bilgin Timuralp
Pages 89 - 90
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.The Effects of Coronary Collateral Circulation on Left Ventricular Functions in Patients with Coronary Artery Disease
İzzet Tandoğan, Tayfun Altınok, Halil Aslan, Alpay Turan Sezgin, İrfan Barutçu, Ertan Yetkin, Ramazan Özdemir, Mehmet İleri
PMID: 12134548  Pages 91 - 95
Objective: The role of coronary collateral circulation (CCC) on the improvement of left ventricular function in coronary artery disease is controversial. The aim of this study is to investigate the effect of CCC on left ventricular function in patients with ischaemic heart disease. Methods: Accordingly, 76 patients (39 female, 37 male, mean age - 61±17 years) who had single vessel disease with >85% narrowing in left anterior descending coronary artery were enrolled in this study. Coronary collateral circulation was determined according to the Rentrop classification (Class 0= no collateral circulation; class 1= small branches of occluded vessel fill with CCC; class 2= epicardial segment of the occluded vessel partially fills with CCC; class 3= epicardial segment of the occluded vessel totally fills with CCC). Left ventricular function was assessed with echocardiography and left ventricular regional wall motion score (0=normokinetic; 1= hypokinetic; 2= akinetic; 3= dyskinetic; 4= aneurysmatic). Rentrop classification of the patients were compared with left ventricular regional wall motion scores and ejection fractions. Results: Twenty one of 76 patients had no collateral circulation. The regional wall motion score of class 0 patients was similar with that of patients with CCC (class 1,2,3) (2.28 ± 2.1 vs 3.39 ± 2.1, p>0.05). Particularly, the regional wall motion score was positively correlated with Rentrop classes (p<0.05). Class 3 patients had the highest wall motion score (4.24 ± 2.5, p<0.05). Patients with and without CCC had similar left ventricular ejection fractions (49±11 vs 46± 17, p>0.05). Conclusion: This study showed that development of CCC has no preventive effect on left ventricular functions in patients with coronary artery disease. Interestingly as the stage of CCC increases left ventricular function worsens. It may be the result of the fact that patients with well developed CCC have more severe coronary artery disease.

EDITORIAL COMMENT
3.Left Ventricular Functions and Collateral Circulation in Coronary Artery Disease
Sinan Dağdelen
PMID: 12795243  Pages 96 - 97
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
4.Coronary Bypass Reoperations: (Evaluation of 104 Cases)
Mehmet Ünal, Ergun Demirsoy, Harun Arbatlı, Selim Tansal, Naci Yağan, Faruk Tükenmez, Deniz Şener, Bingür Sönmez
PMID: 12134549  Pages 98 - 105
Background: Repetitive procedures usually take place in the natural course of coronary heart disease. The aim of this study was to evaluate the risk factors, which affect coronary bypass reoperations, and to compare them with the postoperative results of the coronary first operations and the reoperations. Methods: Between January 1995 and January 2000, coronary reoperations were performed in 104 cases (Coronary reoperations group) by the same surgical team. Ninety-nine of them were the first, 3 were the second and 2 were the third reoperations in this group. At the same period of time, 3609 patients underwent coronary bypass procedure as the first operation (Coronary 1. operation group). Eighty-seven patients were male (83.65%), 17 were female (16.35%) and the mean age was 60.82 ± 9.49 in reoperation group; while among 2916 patients 2223 were male (80.8%), 693 were female (19.2%) and the mean age was 60.37±9.58 in the first operation group. Results: Incidence of prolonged ventilation (p-=0.0001), renal dysfunction requiring dialysis (p=0.01), need for intraaortic balloon pump (p=0.0001) and prolonged intensive care unit (p=0.01) and hospital stay (p=0.01) were significantly higher in reoperation group. The mortality rate was 9.62 % in the reoperation group while it was 2.2 % in the first operation group (p=0.0001). Conclusions: The high morbidity and mortality of coronary bypass reoperations can be reduced to acceptable levels accordingly with early therapy prior to ventricular dysfunction and clinical deterioration that will improve the outcome in these patients.

EDITORIAL COMMENT
5.Coronary Bypass Reoperations
İsa Durmaz
PMID: 12795244  Pages 106 - 107
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
6.Evaluation of Success of Mitral Valvuloplasty in the Early Period with Cardiopulmonary Exercise Test
Şennur Ünal Dayi, Tamer Akbulut, Gültekin Hobikoğlu, Haldun Akgöz, Ufuk Gürkan, Ömer Dağ, Serdar Yılmazer, Şükrü Aksoy, Gülşah Tayyareci, Ahmet Narin
PMID: 12134535  Pages 108 - 112
Objective: It was shown that percutaneous balloon mitral valvuloplasty (PMBV) has provided symptomatic improvement in cases with mitral stenosis. The purpose of this study was to investigate the influences of successful PBMV on cardiopulmonary exercise test (CPET) in patients with mitral stenosis early after intervention. Methods: Twenty-nine patients with mitral stenosis were included in this study. Nineteen patients had undergone PBMV and ten patients were studied as control group. An incremental symptom limited CPET was carried out within the 24 hours before the PMVB procedure and within the five days thereafter. Breath by breath O2 uptake (VO2) and CO2 production (VCO2) were measured in these subjects. Results: The mean mitral valve area (MVA) in the PBMV group before the procedure was 1.2±0.7 cm2 and the mean pressure gradient (PG) through the mitral valve was 12.63±4.87 mmHg; after the procedure, the mean MVA was 1.9±0.3 cm2 and the mean PG was 4.9±2.3 mmHg. The mean MVA in the control group was 1.4±0.16 cm2 and the mean PG was 7.2±3.54mmHg. In the PBMV group, exercise time was 12.1±6 min before the procedure and increased to 18.75±5.5 min after the procedure (p=0.0001); peak VO2 value rised from 1035±392 ml/min to 1178±373 ml/min (p=0.0001) and VO2 at the anaerobic threshold from 667±286 ml/min to 772±268 ml/min (p=0.006). Peak VO2/HR rised from 10.97±6.10 ml/min to 12.24±7.36 ml/min (p=0.001). No significant difference was observed in the control group. Conclusions: The results of this study demonstrate that successful PBMV causes evident rise in exercise capacity, so that patients can manage the same exercise levels with lower heart rates and more economic ventilation.

7.The Relationship of the Left Atrial Spontaneous Echo Contrast Integrated Backscatter with Left Atrial Appendix Function and Tissue Doppler Characteristics
Ertuğrul Ercan
PMID: 12134536  Pages 113 - 118
Objective: Integrated backscatter (IBS) is an objective method to measure spontaneous echo contrast (SEC) quantitatively. The purpose of this study was to investigate the relationship between the quantitative values of left atrial SEC measured by using IBS with its qualitative gradation as well as the left atrial appendix (LAA) functions and LAA tissue Doppler characteristics (TD). Methods: Thirty-two patients (23 female, 9 male) with various diseases undergoing transesophageal echocardiography (TEE) were included. Mean age was 52+13 years. Left atrial SEC was graded as no SEC (n=12), mild (n=12) or severe SEC (n=8) in patients underwent TEE. LAA peak emptying and LAA apical and basal TD velocities were measured. LAA ejection fraction was assessed by standard means. Results: Between no SEC and mild SEC groups, left atrium IBS and LAA apical TD values were found statistically significant. But there were no differences between two groups regarding LAA emptying velocities, LAA ejection fraction values and LAA basal TD values. All of these parameters were found statistically different between severe and mild SEC groups. The left atrial IBS values were found to be correlated positively with the qualitative SEC grade. The left atrial IBS values correlated negatively with LAA emptying, apical TD velocities and LAA ejection fraction values. Conclusion: Integrated backscatter provides an objective quantitative measure of SEC that correlates well with LAA apical TD velocities and the other parameters of LAA.

EDITORIAL COMMENT
8.Integrated Backscatter of the Left Atrial Spontaneous Echo Contrast, Left Atrial Appendix Function and Tissue Doppler
Osman Akdemir
PMID: 12795245  Pages 119 - 120
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
9.Arrhythmia Risk and Noninvasive Markers in Hypertensive Left Ventricular Hypertrophy
Bahri Akdeniz, Sema Güneri, Özer Badak, Özgür Aslan, Batuhan Tamcı
PMID: 12134537  Pages 121 - 129
Objective: Several studies have evidenced that hypertensive patients with severe left ventricular hypertophy have an increased incidence of malignant ventricular arrhtyhmia and sudden death. However arrhtyhmia risk in mild to moderate hypertrophy is uncertain. This study aims to investigate the risk of ventricular arrhythmias in hypertensive patients with mild to moderate hypertrophy and evaluate the role of noninvasive arrhtyhmia markers and ambulatory blood pressures. Methods: Ninety-nine hypertensive patients (35 male, mean age 57.3±9.6) without coronary heart disease were included the study. All subjects underwent an echocardiography for measurement of LV mass index (LVMI) and were classified in two groups; hypertrophic (LVH(+) n: 43) and nonhypertophic (LVH (-) n: 56). Ambulatory blood pressure monitoring, 24 hour ECG, signal averaged ECG, and 12 lead ECG were performed in each group seeking to identify the arrythmogenic risk. Results: Holter ECG showed that 20.1% patients had Lown class II and 12.1% patients had Lown class IVa-IVb arrhtyhmia (potentialy malignant ventricular arrhtyhmia; PMVA). PMVA incidence was significantly higher in hypertrophic groups (20.9%) compared to nonhypertrophic groups (6.5%) (p<0.05). Ambulatory systolic and diastolic blood pressures were similar in PMVA (+) and PMVA (-) patients. At least two parameters of ventricular late potentials were significantly higher in LVH (+) group (25.7%) compared to LVH (-) group (4.9%) (p<0,01). HRV parameters were not different between two groups. QTcd was significantly increased in LVH (+) than in LVH (-) patients (54.1±16.7 vs. 47.5±17.7 ms) (p<0.05) The frequency of PMVA was significantly higher in increased QTcd compared to normal QTcd (24.3%-3.4%; p<0.01) and LP(+) patients (16.2%) compared to LP (-) patients (8.7%; p<0.05). Conclusion: Our data suggest that hypertension may be associated with high risk of PMVA in patients with mild to moderate LVH particularly in presence of LP and QTcd>50 ms. QTcd and at least 2 factors of LP were increased in mild to moderate LVH. Arrythmogenecity does not seem to be related with autonomic dysregulation and ambulatory blood pressure level in hypertensive patients.

EDITORIAL COMMENT
10.Ventricular Arrhythmias in Hypertensive Patients
İstemi Nalbantgil
PMID: 12795246  Pages 130 - 131
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
11.Should Troponin-T Be Assessed During Exercise Stress Testing in Patients with Stable Angina Pectoris?
Namık Kemal Eryol, Emrullah Başar, İbrahim Özdoğru, Yüksel Çiçek, Adnan Abacı, Abdurrahman Oğuzhan, Ramazan Topsakal, Servet Çetiner
PMID: 12134538  Pages 132 - 137
Objective: This study was planned to investigate whether or not troponin-T positivity has occurred during exercise stress testing in patients with stable angina pectoris and if yes, its relationship with the severity of the disease. Methods: One hundred patients with stable angina pectoris who presented with typical chest pain were included in this study. They were subjected to the exercise stress testing according to Bruce protocol. Troponin-T was studied 3 times: immediately before, 6 and 24 hours after the exercise testing. Coronary angiography was performed two hours after the last blood sampling. Results: Exercise stress test was found positive in 67 (67%) and negative in 33 (33%) patients. Coronary artery disease was present in 47 (70.1%) of those with positive and in 17 (51.5%) with negative test results. Troponin-T was negative in all the patients before the stress test. Troponin-T was found positive in readings taken 6 and 24 hours after the test in 4 patients (6.2%) with coronary artery disease. Of these patients, 2 had positive and the remaining 2 had negative stress test results. Troponin-T was found negative in readings after the stress test in all the patients without coronary artery disease. The duration of the exercise stress test was found to be significantly shorter in patients with troponin positivity than their counterparts with negativity (277.5±81 sec vs. 428.8±195 sec, p=0.024). Troponin-T positivity after the stress test was found considerably higher in patients with three-vessel disease (p=0.021). Conclusions: Heavy exercises like stress test may severely lead to myocardial damage. The study of post-stress test troponin T readings, in patients with stable angina pectoris and with negative stress test result, may be of great help in detecting especially the patients with multiple vessel disease.

REVIEW
12.Proximal Anastomotic Marker Use in Coronary Artery Bypass Operations
Mustafa Çıkırıkçıoğlu, Gültaç Özbay, Enver Duran
PMID: 12134539  Pages 138 - 141
Detection and evaluation of aorto-to-saphenous vein anastomosis sites (proximal anastomoses) in patients who had undergone coronary artery bypass surgery are comparatively harder than native coronary orifices during follow-up re-angiography procedures. Placement of a radioopaque proximal anastomotic graft marker during coronary artery bypass procedure poses medical and economical advantages in case of postoperative re-angiography during follow-up of these patients. Indication of whether or not to use a proximal anastomotic marker is in general decide on by the operating surgeon. However, coronary angiography is a task of interventional cardiologist. Difference of the teams performing cathaterization and the surgical procedure may rise some inconsistencies in terms of requirements for these markers. In order for these dilemmas to be prevented, surgical team should be informed of the complication re-angiography procedure. Proper strategy for the implantation of this technique, which is convenient not only for cardiologist and surgeon but also in economic terms, should be decided on with collaboration of cardiology and cardiovascular surgery teams. In this article, advantages of the proximal anastomotic markers during the postoperative follow-up and re-angiography have been presented with the related literature review

13.Hypertension and Endothelial Dysfunction
İstemi Nalbantgil
PMID: 12134540  Pages 142 - 147
Endothelium; effective in vascular tonus, blood tension, blood flow and coagulation system is the biggest endocrine organ with 1800 gr. weight in human body. The endothelium releases nitric oxide, which maintains vascular integrity. In endothelial dysfunction the balance between releasing vasodilatatory and vasoconstrictory factors is changed. In the presence of essential hypertension defection in endothelium-dependent vasodilatation and increasing sensitivity to vasoconstrictors could increase vascular resistance. Although some beneficial results with angiotensin converting enzyme inhibitors, carvedilol, angiotensin-II and endothelin receptor antagonists were reported in patients with endothelial dysfunction the effectiveness of these drugs is still debate. Also the decreasing of arterial pressure was not always shown to be parallel to the restoration of endothelial dysfunction. In the future according to genetic studies, the increased use of nitric oxide releasing genes therapy will have a more effective role in regression of endothelial dysfunction.

MISCELLANEOUS
14.Differential-Diagnostic Algorithm As a Teaching and Diagnostic Method in Cardiological Practice
Leonid B. Naumov
PMID: 12134541  Pages 148 - 159
Abstract |Full Text PDF

15.Radiofrequency Catheter Ablation of the Atrioventricular Nodal Reentrant Tachycardia
M. Bülent Özin
PMID: 12134542  Pages 160 - 164
Abstract |Full Text PDF

CASE REPORT
16.Primary Coronary Angioplasty and Stent Implantation for an Acute Anterior Myocardial Infarction in the Early Postoperative Period of Laparoscopic Cholecystectomy: a Case Report
Oğuz Yavuzgil, Filiz Özerkan
PMID: 12134543  Pages 165 - 168
Abstract |Full Text PDF

17.Two Stage Surgery Approach to a Patient with Ascending Aorta Aneurysm and Coarctation of Aorta: a Case Report
Kerim Çağlı, Hasan Uncu, Kumral Ergün Çağlı, Garip Altıntaş, Mustafa Emir, Erol Şener, Oğuz Taşdemir
PMID: 12134544  Pages 169 - 171
Abstract |Full Text PDF

LETTER TO THE EDITOR
18.The Effects of Preoperative Use of ACE-Inhibitors on Renal Function After Open Heart Surgery
Suat Canbaz, Turan Ege, Mustafa Edis, Enver Duran
PMID: 12134545  Pages 172 - 173
Abstract |Full Text PDF

19.A Case of Single Ventricle Attained Adulthood Without Operation
Funda Öztunç
Pages 174 - 176
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
20.A Female Patient with Anemia and Cardiac Myxoma
Alparslan Birdane, Yavuz Beşoğul
PMID: 12134547  Page 177
Abstract |Full Text PDF

MISCELLANEOUS
21.Selection from ACC 2002 Meeting
Yılmaz Nişancı
Pages 178 - 180
Abstract |Full Text PDF



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