Objective: Calcification is a frequent cause of the clinical failure of bioprosthetic heart valves fabricated from glutaraldehyde pretreated bovine pericardium. The major object of the present study is to prevent calcification of pericardial bioprosthetic heart valve materials with TPEN. Methods: Bovine pericardium was cut into 2-cm2 pieces, rinsed in phosphate-buffered saline solution, transferred into +4°C phosphate-buffered saline containing 0.625% glutaraldehyde for initial fixation for 48 h, and allocated into two groups. Control samples were treated in an identical fresh solution for five more days. Others underwent additional fixation in phosphate-buffered saline 2µM TPEN for 48 h. They were then transferred into phosphate-buffered saline + 0.625% glutaraldehyde solution at 37°C (pH 7.4) for three more days. Pericardial patches were inserted into the dorsal pouches of 18 juvenile male Wistar rats as control and study groups. Rats were divided into two groups and sacrificed consecutively by the end of 9th and 12th weeks. The biomechanical properties and calcium contents of explanted tissues were tested and were also assessed histopathologically. Results: The difference in the calcium contents of the control and study groups’ pericardial tissues at the 9th, and 12th weeks were statistically significant (p=0.0001, p=0.0001). The comparison of calcium contents between controls of 9th and 12th weeks and study groups’ of the 9th and 12th weeks pericardial tissues were also significant (p=0.0001 and p=0.0001). Histopathologic and biomechanical assessment also supported these findings. Conclusion: Calcific degeneration of glutaraldehyde-fixed bovine pericardium can be reduced by using TPEN without any effect on durability.

Objective: Evidence for a connection between obesity and cardiovascular disease is derived from epidemiological studies. The aim of this study was to evaluate the cardiovascular risk factors in obese women and their first-degree relatives. Methods: Fifty-five obese women and their 154 first-degree relatives (daughter, son, sister, brother), 60 non-obese women and their 100 first-degree relatives were enrolled in this cross-sectional controlled study. Blood pressure, heart rate, body mass index (BMI), waist-to-hip ratio (WHpR), waist circumference (WC) and lipid levels were measured in all participants. Serum concentrations of insulin were measured by chemiluminescence method, plasma levels of high sensitive C-reactive protein (hs CRP) by immunoturbimetric assay and fibrinogen by coagulation method. Measurement of insulin resistance was calculated using homeostasis model assessment (HOMA). Statistical analysis was preformed using Chi-square, Student’s t and Mann–Whitney U tests. The relationship between obesity indices and cardiovascular risk factors were studied using linear regression analysis. Results: Mean values of BMI in female and male relatives were found as 25.10±2.5 kg/m2 and 23.50±4.98 kg/m2, respectively. In relatives, the frequencies of obesity, overweight and normal weight were found to be 8.9%, 25.8% and 65.1%, respectively. Central obesity was found higher in males than in females in the first-degree relatives, using WC (28.5% vs. 14.3%, p=0.001) or WHpR (30.9% vs. 24.5%, p=0.002). Elevated blood pressure (≥ 140/90 mmHg) was recorded in 23.6% of obese women and in 8.4% of their relatives. Mean HOMA-IR levels of obese women and their relatives were found as 3.26±0.7 and 2.07±1.1, respectively. Mean hs CRP levels of obese women and their relatives were 0.98±0.08 mg/dl and 0.23±0.03 mg/dl, respectively (p=0.002). Mean fibrinogen levels of obese women and their relatives were 443.21±45.9 mg/dl and 321.10±38.23 mg/dl, respectively. Conclusion: In obese women and their relatives, body mass index and waist circumferences are related with blood pressure, total cholesterol, fibrinogen and insulin resistance. If there are obese women in family, first-degree relatives have 1.8 fold increased obesity frequency. Body mass index increases together with cardiovascular risk factors. In early term, prevention of obesity may decrease developing of cardiovascular risk.

Objective: Obstructive sleep apnea syndrome (OSAS) is a syndrome defined frequently by decrease in arterial oxygen saturation and repeated upper airway obstruction episodes during sleep. The most important complications of OSAS patients belong to cardiovascular system. Systemic arterial hypertension (43-60%), pulmonary hypertension (20-30%), coronary artery disease (20-30%) and congestive heart failure (5-10%) are among OSAS associated cardiovascular disease spectrum. In this study, we investigated the frequency of hypertension (HT), which is the most common cardiovascular disease seen in patients admitted with OSAS suspicion. Methods: Overall 263 consecutive patients with possible OSAS were included in this cross-sectional study. Diagnostic polysomnography (PSG) was performed in all patients with 44-channel polysomnograph (Compumedics E series, Australia) one whole night. Sleep stages and respiratory events were manually scored. Patients with apnea hypopnea index (AHI) <5 were diagnosed as OSAS negative, patients with AHI between 5-14 were diagnosed as mild OSAS, patients with AHI between 15-29 were diagnosed as moderate OSAS, patients with AHI ≥ 30 were diagnosed as severe OSAS. Relation of OSAS and presence of HT was statistically analyzed with Chi-square test. Results: According to PSG records of the patients who were assessed with OSAS suspicion, 54 (20.5%) patients were assessed as OSAS negative, 26(9.9%) - mild OSAS, 45 (17.1%) - moderate OSAS, and 138 (52.5%) were diagnosed as severe OSAS. Hypertension was present in 4 (7.4%) of 54 OSAS negative patients and 56 (36.8%) of 209 patients with OSAS, the difference was significant (p=0.001). When we assessed mild OSAS patients and moderate-severe OSAS patients in terms of HT frequency, HT was present in a lower rate in mild OSAS patients as compared with patients with moderate-severe OSAS (3/26 versus 53/183; p=0.044). When we compared OSAS negative patients with moderate-severe OSAS patients, HT was less frequently found in OSAS negative patients (4/54 versus 53/183, p=0.001). Conclusion: It is determined that hypertension was more frequently seen in patients with OSAS than in patients without OSAS and that HT frequency increased in parallel to the severity of OSAS.

Objective: Elevated asymmetric dimethylarginine (ADMA) levels, an endogenous inhibitor of nitric oxide synthase, are an important cardiovascular risk factor. In patients with diabetes, increased ADMA levels have been reported, which may be associated with endothelial dysfunction. In this study, effect of nebivolol on serum ADMA levels in hypertensive patients with type 2 diabetes have been compared with metoprolol, an another beta-blocker. Methods: A total of 54 patients (27 female, 27 male; mean age: 53.0±8.7 years) with type 2 diabetes and hypertension were included in this randomized, open-label, prospective study. Patients were randomized to receive either nebivolol 5 mg/day (n=28) or metoprolol 100 mg/day (n=26) for 12 weeks. When the patients could not reach target blood pressure levels at the end of week 4, indapamide (2.5 mg/day) was added. Enzyme Linked Immunosorbent Assay was used for serum ADMA measurements. Results: Similar reductions in blood pressure values were observed in both groups (p>0.05). In nebivolol group, there were no significant changes in serum ADMA levels compared to baseline (0.6±0.2 µmol/l vs 0.6±0.1 µmol/l, p>0.05), whereas in metoprolol group a 35.6% increase in serum ADMA levels was observed (0.6±0.1 µmol/l vs 0.7±0.2 µmol/l, p<0.01). Conclusions: We observed a significant increase in ADMA levels, a marker of endothelial dysfunction, during metoprolol treatment, whereas nebivolol had neutral effects on ADMA levels in patients with type 2 diabetes mellitus and hypertension.

Objective: The study aimed to evaluate the effects of putting a sandbag on femoral access site after cardiac invasive procedure and changing patients’ position in bed on vascular complications rate and the severity of back pain related to the duration of bed rest after procedure. Methods: This randomized controlled study included 169 patients divided into five different groups assigned randomly. Group 1 patients were applied 4.5 kg sandbag for 30 minutes and Group 2 patients were applied 2.3 kg sandbag for 2 hours on femoral access site after procedure. Group 1 and 2 patients’ body positions were changed every hour beginning from the second hour. Group 3 patients received application of 4.5 kg sandbag for 30 minutes and Group 4 patients were applied 2.3 kg sandbag for 2 hours on femoral access site after procedure and these patients’ body positions were not changed after catheterization. Group 5 patients remained in supine position without changing position and had no application of a sandbag. Results: The incidence of vascular complications was not significantly different in the group with application of sandbag when compared with the group without application of sandbag. Back pain was reported more often in the patients whose positions were not changed and whose heads of beds were not raised (p<0.05). Conclusion: Sandbag was not effective in decreasing the incidence of the vascular complications after procedure. To increase the comfort and to decrease the back pain of the patient, the patient’s position should be changed and the head of the bed should be raised about 30 or 45 degrees.

Objective: The aim of this study was to investigate the response of heart to stress according to the size of the prosthetic valve in patients who had undergone mitral valve replacement by using dobutamine stress echocardiography (DSE) and to evaluate the relationship between the size of the prosthetic valve and cardiac recovery-remodeling process. Methods: Thirty-nine patients, who had undergone mitral valve replacement were compared in terms of left ventricular diameters, systolic functions and cardiac mass indexes in order to investigate the effect of the mechanical valve size on postoperative cardiac remodeling in this longitudinal study. They were divided into three groups according to their valve size: Group 1 (valve size<29 mm, n=11), Group 2 (valve size=29 mm, n=11) and Group 3 (valve size>29 mm, n=17). Statistical analysis was performed using Chi-square and one-way ANOVA tests to determine the statistical differences between the groups. The repeated measurements of two-way ANOVA test was used to analyze effects during long-term follow-up. Results: Only Group 1 patients achieved a significant decrease in terms of left ventricular mass index and end-diastolic diameter (138.3±29.7 g/m2 vs 86.6±15.6 g/m2 and 5.1±0.5 cm vs. 4.4±0.4 cm, p<0.05). Group 3 patients’ left ventricular ejection fraction become worse after the operation (64.0±5.6% vs. 55.9±6.5%, p<0.05). Maximum and mean pressure gradients across the mitral prosthesis as well as pulmonary artery pressure were significantly increased in all groups during DSE. Maximum gradients increased from 14.2±4.6 to 20.7±7.5 mmHg in Group 1 (p<0.05), 11.6±4.7 to 16.2±6.8 mmHg in Group 2 (p<0.05), and 10.6±3.1 to 20.8±12.7 mmHg in Group 3 (p<0.05). Isovolumic relaxation time decreased in all groups following the dobutamine infusion, as expected, but this decline was not significant in Group 3. Conclusion: A worsening in left ventricular systolic function was observed in large- sized valve prosthesis group. Only the patients who had undergone MVR with small-sized valve prosthesis achieved a decrease in cardiac mass index and preservation of the systolic function. The echocardiographically determined differences and mass index that appeared after the operation may point out that, the effect of the operation on cardiac remodeling can be related with the ventricular size.

Objective: Quercetin is an important member of dietary flavonoid family and widely present in red wine and Mediterranean diet. The major objective of the this study is to evaluate the beneficial effects of quercetin in protecting the myocardium from the deleterious effects of ischemia reperfusion (I/R) injury in chronic quercetin treatment with or without an acute quercetin infusion protocols. Methods: Forty male Sprague-Dawley rats were included in this experimental randomized study/ Langendorff perfused isolated rat hearts were subjected to 60-min of global ischemia period following 60-min of reperfusion. All animals were randomly divided into 4 groups. Group 1 animals were kept as controls. Group 3 and 4 animals received 50 mg/kg quercetin via an intragastric tube for 7 days for chronic treatment. Group 2 and 4 animals received an acute 15 mmol/L infusion for 30 minutes before the onset of ischemia. The myocardial postischemic recovery was compared using hemodynamic data (peak systolic pressure, end-diastolic pressure and +dP/dtmax), coronary flow, biochemical parameters (lactate dehydrogenase, creatine kinase –MB fraction, cardiac troponin I) from coronary effluent, and oxidative stress markers (malondialdehyde, glutathione, glutathione reductase and nitrite) from heart tissue homogenates in each group. Results: Quercetin has provided increased preservation in myocardial recovery in both chronic and acute treatment protocols compared to non-treated group. According to all estimated hemodynamic parameters, while the statistical difference between acute treated hearts and control hearts was significant (p<0.05); this significance was more clear in chronic treated groups (group III and IV) when compared to control (p<0.01). Likewise, biochemical and oxidative stress markers displayed significant differences in acute treated and chronic treated hearts when compared to control (p<0.05 and p<0.01, respectively). Conclusion: As a major dietary flavonoid, due to its antioxidant and cytoprotective actions, quercetin has the capacity to protect the myocardial tissue against global ischemia and reperfusion injury. In instances where the molecule is administered for the purpose of acute therapy, this cardioprotective effect of a significant degree can be observed to; however, this potency is further accentuated upon administration as a chronic treatment protocol for seven days.

Objective: The effects of cardiopulmonary bypass (CPB) on serum neuron-specific enolase (NSE) levels in patients without cognitive dysfunction and neurological deficit are not yet clarified. This study was designed to see the sole effect of extracorporeal circulation on serum NSE levels in patients without any clinically observed neurological deficit. Methods: Thirty-two consecutive patients undergoing first elective open-heart surgery were included in this prospective study. Neurological status was assessed by clinical examination before surgery, and on the postoperative first and second days. Blood samples were obtained after anesthesia induction before the administration of heparin, within the first hour post CPB, 24 and 48 hours after the end of operation. Each blood sample was assayed for hemoglobin (Hb), hematocrit and NSE levels. The Friedman's Test to compare the serial measurements of NSE and hemoglobin samples and the post-hoc Tukey test for paired comparisons between pre and postoperative values were applied Pearson correlation test was used to examine the correlation between NSE concentration and aortic cross-clamping time and CPB time, age, postoperative hematocrit and hemoglobin levels and the amount of blood products transfusion. Results: There were no significant differences between NSE values at any sampling time: 11.6±8.0 mg/dL, 8.7±4.7 mg/dL, 9.3±5.4 mg/dL and 8.9±5.8 mg/dL, measured preoperatively, at the end of operation, on the first and second post-operative days, respectively. There was no significant correlation between NSE values with any of the compared variables including CPB time. Conclusion: This study demonstrated that the possible damage of CPB on central nervous system and on blood cells did not reach to the extent of causing any significant increase in serum NSE levels in non-complicated patients undergoing open-heart surgery.

Objective: Early detection of dyslipidemia and long-term prevention of atherosclerosis by controlling risk factors should begin in childhood. The purpose of this study was to evaluate the prevalence of dyslipidemia according to non-high density lipoprotein cholesterol (non-HDL-C) levels in children and also evaluate serum non-HDL-C levels according to age groups, gender difference and living areas. Methods: Overall, 2896 children (1467 girls, 1429 boys) aged between 7-18 years, residing in urban and rural parts of Eskişehir, Turkey, were enrolled in this randomized cross-sectional study. Serum non-HDL-C, total cholesterol (TC) and triglyceride (TG) levels were assessed in all participants of the study. Statistical analysis was performed Student's independent-samples T test for comparison of lipid parameters and relations between lipid parameters and age, anthropometric measurements, body fat percentage were evaluated by Pearson correlation test. Results: Serum non-HDL-C levels were significantly higher in girls (115.5±31.5mg/dl) than boys (106.7±30.2 mg/Dl) (p<0.001). For girls, serum non-HDL-C levels were higher in 7-10 year age group than in 11-14-year and 15-18-year age groups (p<0.01 and p<0.05, respectively). For boys serum non-HDL-C levels of 7-10 year age group were significantly higher than in 11-14-year and 15-18-year age groups (p<0.001 for both). Serum non-HDL-C, total cholesterol and triglyceride levels were higher in girls than in boys especially in the 7-10-year-old age group. Serum TC, LDL-C, and HDL-C levels were higher in urban area residents, while serum TG levels were higher in rural area residents (p<0.001). Serum non-HDL-C levels were similar in residents of different living areas (p>0.05). In both sexes, non-HDL-C levels positively correlated with age and lipid parameters except HDL-C levels and also negatively correlated with HDL-C levels. In boys, non-HDL-C levels also correlated with total body fat percentage, weight, height. The prevalence of dyslipidemia according to non-HDL-C levels was higher (13.2%) in girls than boys (8.9%) (p<0.001). The prevalence of elevated non-HDL-C levels was higher in urban area residents than in rural area residents (p<0.05). The dyslipidemia prevalence according to non-HDL-C levels was similar with dyslipidemia prevalence according to serum LDL-C levels. Conclusion: Our results are indicative of the prevalence of dyslipidemia in children is considerably common in our population. Serum non-HDL-C levels could be used as an appropriate tool for detecting dyslipidemia in childhood.

Assessment and treatment of sexual dysfunction gain more importance in countries like Turkey where cardiovascular events are frequently seen in young adults. The mortality of cardiovascular events is reduced by primary percutaneous coronary angioplasty (PTCA), use of new thrombolytics in acute myocardial infarction (MI), and new drugs used in the treatment of heart failure. Because of the longer life expectancy, assessment of sexual functions and rehabilitation are getting more important in these patients. Since phosphodiesterase type 5 inhibitors (PDE 5) have been frequently utilized in the treatment of impotence, patients’ and the doctors’ attention have been directed towards cardiovascular risks of sexual activity. In recent years, this topic has become more important because several reports have stated the possible relationship between the use of PDE5 inhibitors and myocardial infarction. It is known, that in patients with cardiovascular diseases, sexual activity poses a low sudden death risk independent of PDE5 inhibitor use. In this review, the points that doctors should take into account while considering and treating the sexual dysfunction in patients with cardiovascular diseases are discussed.

Heart tumors can be primary in origin, can develop from direct extension of a neighboring tumor or they can be the manifestation of metastasis of a distant tumor. Myxomas are the most frequently encountered primary benign cardiac tumors. Primary malignant tumors of the heart are rare, and they are mostly sarcomatous in structure. Secondary heart tumors constitute a wide spectrum, nevertheless they most frequently originate from lung cancer, breast cancer and hematological malignancies. Heart tumors may involve myocardium, endocardium, epicardium, pericardium, or any combination of the aforementioned layers. On the other hand, the usual site for metastasis to the heart is the pericardium. These tumors do not have a well- established classification. Clinical findings are usually non-specific and transient in nature and frequently present late in the disease process. Transthoracic and transesophageal echocardiography are the most widely used diagnostic modalities. Magnetic resonance imaging and computerized tomography may be helpful for selected cases. Surgery is the principal therapeutic option in benign tumors and when recurrences are not taken into account, they have favorable prognoses. Since surgical resection is usually incomplete in malignant tumors, therapy must be individualized for each patient; even with adjuvant chemotherapy, postoperative survival is usually short. Metastases to the heart are usually approached symptomatically except for exceptional cases.