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Background and Aim: The annual risk of major bleeding due to anticoagulant use ranges from 2% to 5%, with 0.5% to 1% of these bleedings being fatal. The global usage of oral anticoagulants is 0.65%, with warfarin being the most commonly used oral anticoagulant agent. In our study, we aimed to determine the long-term bleeding risks of patients using warfarin in our clinic and to make treatment and risk factor adjustments according to this risk situation. We investigated the effectiveness of the most commonly used bleeding risk scores and their superiority over one another in this study. Materials and Methods: This study included patients taking warfarin from January 2010 to January 1, 2022. Demographic data, laboratory parameters, known, and potential bleeding risk factors were recorded for all patients. Pre-treatment CHA2DS2-VASc, ATRIA, HAS-BLED, and ORBIT scores were calculated for all patients included in the study, along with their time in therapeutic range (TTR) values during follow-up. Patients were retrospectively monitored for bleeding events. Results: In our study, we observed that anemia, chronic kidney failure, cancer, and mechanical valves were associated with an increased risk of bleeding compared with other risk factors. We found that among the risk scores assessed in patients, the HAS-BLED risk score more strongly predicted the risk of bleeding than the other risk scores. Additionally, we found that low TTR values were directly associated with bleeding. Conclusion: Modifying identified risk factors in patients during the warfarin treatment process (such as anemia, chronic kidney failure, etc.) may reduce the risk of bleeding. Similarly, close monitoring of TTR, particularly in patients with high HAS-BLED and ORBIT risk scores assessed before treatment initiation, is considered a safe treatment approach to reduce the risk of bleeding.

Background and Aim: Over the years, transvenous lead extraction (TLE) procedures (TLEP) have been increasing because of factors such as infection, loss of device function, and lead-related complications. This study aimed to evaluate the factors affecting major complications during TLEP. Materials and Methods: Between January 2011 and May 2023, patients who underwent TLE of cardiac implantable electronic devices were included in the study. The demographic and procedural features of all patients were evaluated according to major complications. Results: A total of 121 consecutive patients (192 leads) underwent TLEP. The mean age was 63 ± 17.3 years, and 76% were male. Most leads were active fixation leads (67%) and 74 procedures (61%) required an extraction device. The mean lead dwell time was 5.6 ± 5.2 years. Major complications were observed in 16 procedures (13.2%) and 5 of them (4.1%) resulted in exitus. When we compared the groups according to the major complication, the rates of chronic obstructive pulmonary disease (4 vs. 3; P = 0.020), existence of passive fixation leads (PFL) (24 vs. 9; P = 0.013), and device indication (P = 0.012) were higher in the complication group. Multivariate analysis revealed that only the presence of PFL was associated with major complications. (odds ratio 4.486, 95% confidence interval 1.365-14.748; P = 0.013) Conclusion: The present study showed that the presence of a PFL is a predictive factor for major complications.

Background and Aim: Awareness of electrocardiographic (ECG) changes is crucial in patients who receive coronavirus disease 2019 (COVID-19) treatment. In this study, we aimed to evaluate ECG parameters in patients under COVID-19 therapy and their relationship with the severity of lung involvement and the disease on the basis of thoracic computerized tomography (TCT) findings and laboratory parameters. Materials and Methods: Of 350 patients hospitalized due to COVID-19 between March 2020 and June 2020, 300 patients with available data were retrospectively analyzed. Blood analysis, electrocardiographic, and clinical findings were evaluated. Six-month follow-up data were also recorded. Results: The patients were categorized into two groups: survivor (n = 206, 68.7%, Group 1) and nonsurvivor patients (n = 94, 31.3%, Group 2). The mean total follow-up period was 125.39 ± 73.09 days. The mean age was similar in both groups. In multivariate regression analysis that aimed to predict COVID-19 disease severity, it was found that besides increased C-reactive protein and D-dimer levels, and ≥50% lung involvement in TCT, which are well known as bad prognostic factors, the corrected QT interval duration (QTc) prolongation ≥60 miliseconds (msn) during hospitalization was associated with worse prognosis in COVID-19 patients during follow-up. Conclusion: Our study is the first study that demonstrated that the presence of ≥60 msn QTc prolongation during hospital stay was found to be the most valuable ECG parameter to predict the prognosis and had a significant association with ≥50% lung involvement in TCT in patients under anti-COVID therapy. Close monitoring of this ECG parameter is important both in terms of treatment planning and interpretation of disease progression.

Introduction: Atrial fibrillation (AF) is the most common arrhythmia with a prevalence that increases by aging. AF causes morbidity and mortality due to thromboembolic events. In developing countries, the use of new generation medications can be delayed. Objective: We evaluated nonvalvular AF patients without effective oral anticoagulation (OAC) when non- vitamin K antagonists (NOACs) were mostly unavailable in Turkey before 2012–2013. The results were compared with what would happen if NOAC was available in use. Patients and Methods: Two-hundred and five patients in AF with adequate information were detected 123 of these patients were nonvalvular AF, (92 patients in these 123 ones were not taking OAC or on ineffective INR range) were included in the study. Results: Thirty-one (25.2%) of these patients were already on effective warfarin therapy. Ninety-two (74.8%) patients were not on warfarin therapy or on out of effective therapeutic range. About 52.2% of participants were female. The mean age was 70.62 ± 11.8 years. Eighteen (19.5%) patients had a recurrent stroke. Conclusion: OACs are recommended for patients with high stroke risk according to CHA2DS2-VASc score. OAC therapy significantly decreases mortality, morbidity, and also especially stroke risk. The only OAC therapy was warfarin over the decades until NOACs have been found. In our study, if NOACs could be available before 2012 in Turkey, 74.8% of our cohort would be under the effective anticoagulation and 19.5% of patients may have avoided from stroke. This is important for patients' lives and also for their costs.

Objective: Rheumatic valvular heart disease (RVHD) is an important health problem in Turkey, as in all developing countries. There is no exact prevalence data for RVHD in Turkey. But according to the Jones criteria, Turkey has a moderate risk for acute rheumatic fever (ARF). Patients with recurrent bouts of ARF resulting in carditis can progress to RVHD. The aim of this study was to evaluate percutaneous mitral balloon valvuloplasty (PMBV) procedures and compared the findings with the literature. Materials and Methods: PMBV procedure indication was determined according to the guidelines and heart team consensus. Echocardiography was evaluated prior to PBMV in all patients. The study included a total of 131 patients who underwent PMBV in the cardiology clinic of our hospital in the period 2007–2017. All PBMV procedures were performed under intraprocedural transesophageal echocardiography (TEE) guidance in addition to fluoroscopy with general anesthesia. Results: The patients comprised 83% female and 17% male with a mean age of 41.2 ± 10.1 years. Mean ejection fraction was 60.3% ± 3.1%, mean left atrium diameter was 46.7 ± 5.3 mm, and mean Wilkins score was 8.7 ± 1. After procedure with there was no mortality. There was statistically significant increase on mitral valve area and statistically significant decrease on pulmonary arterial pressure and statistically significant decrease on transmitral gradient. Conclusion: This is one of the few studies worldwide to have detected the safety and efficacy of PBMV with TEE and scopy coguidance. It is the first such study in Turkey. In accordance with the literature, the procedures performed with TEE and fluoroscopy co-guidance in our clinic have increased the safety of the procedure and decreased complication rates.

Introduction: We compared transcatheter and surgical closure of secundum atrial septal defects (ASDs) in terms of cost in this study. Materials and Methods: Between 2006 and 2015, 291 consecutive patients having secundum ASD, in whom percutaneous or surgical closure was performed, were included in this study. We compared the in-hospital cost of transcatheter versus surgical ASD closure in these patients. Results: We collected totaly 291 patients, 214 transcatheter and 77 surgical closure procedures, retrospectively. Patients with a surgical closure had a longer length of stay (11.8 ± 3.8 days vs. 2.8 ± 1.6 days, P < 0.001). There was no in-hospital mortality in two groups. Costs denominated in Turkish lira (TL) and United States Dollar (USD) of transcatheter closure were higher than that of surgical closure (TL 10955.6 ± 183.4 vs. TL 6016.7 ± 371.9 P < 0.001; USD 6531.2 ± 149.62 vs. USD 3896.2 ± 234.7 P < 0.001). The cost of percutaneous ASD closure increase does not correlate with the dollar rate on the annual basis. This with the supplier firms has excessive profits in the first year of the study. Conclusion: Compared with other countries with regard to cost, transcatheter ASD closure is a more expensive treatment than surgical closure in our country.

In this case, we report a successful closure of secundum atrial septal defect in a 32-year-old female patient with an interrupted inferior vena cava (IVC). Interrupted IVC was detected coincidentally during right heart catheterization. The defect was successfully closed through transjugular vein approach as an alternative to surgery.

Background: Monitoring the longevity of immunoglobulin G (IgG) responses following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections is vital to understanding the role of antibodies in preventing infection. Aims: To determine the quantitative IgG responses specific to the Spike-S1 (S1) receptor-binding domain (S1/RBD) region of the virus in serum samples taken between 4 weeks and 7 months after polymerase chain reaction (PCR) positivity in patients who are diagnosed with coronavirus disease-2019 (COVID-19). Study Design: A longitudinal study. Methods: This study included 113 patients with a clinical and molecular diagnosis of COVID-19. The first and second serum samples were taken 1 and 7 months, respectively, after the PCR positivity. S1/RBD-specific IgG antibody response was assayed using anti-SARS-CoV-2 QuantiVac ELISA (IgG) kit (Euroimmun, Lübeck, Germany). The neutralizing antibodies were investigated in 57 patients whose IgG test results were above the cut-off value. Results: In 57 patients with SARS-CoV-2 IgG, the anti-SARS-CoV-2 IgG quantitative antibody levels significantly decreased after 7 months (Z = −2.197, p = 0.028). A correlation was detected between the anti-SARS-CoV-2 IgG and nAb percent inhibition (IH%) levels detected in 1 month (rs = 0.496, p < 0.001), but without significant correlation in serum samples taken on 7 months. The nAb IH% levels of the first and second were compared for COVID-19 severity and revealed no statistical difference (p = 0.256). In the second serum sample, the nAb IH%s of patients with moderate COVID-19 showed a statistically significant difference from patients with mild COVID-19 (p = 0.018), but without significant differences between severe and moderate or mild COVID-19. Conclusion: SARS-CoV-2 quantitative IgG antibody titers are significantly reduced at long-term follow-up (> 6 months). Due to the limited information on seroconversion, comprehensive studies should be conducted for long-term follow-up of the immune response against SARS-CoV-2.