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Cardiac 3-dimensional printing for pre-procedural planning of structural heart procedures is a promising new tool. Despite current potential drawbacks, 3-dimensional models can help cardiologists better understand and treat complex cardiac defects. We describe a successful coronary cameral fistula closure planned with the aid of a 3-dimensional model. (Level of Difficulty: Advanced.), Graphical abstract, Cardiac 3-dimensional printing for preprocedural planning of structural heart procedures is a promising new tool. Despite current potential drawbacks…

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease such as atherosclerosis or cancer. Some authors speculated that atherosclerotic coronary artery disease (CAD) could be considered a “cancer of the coronary arterial wall”. Although the percutaneous coronary intervention (PCI) has proven to be effective in decreasing mortality rates among patients with acute coronary syndromes, the previous meta-analyses of PCI versus optimal medical therapy for stable CAD have not been able to demonstrate a reduction in major adverse cardiac outcomes. However, few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. Recently, the precision medicine is defined as an evidence-based approach that uses innovative tools and biological and data science to customize disease prevention, detection, and treatment, and improve the effectiveness and quality of patient care. Providing patients with accurate and complete information appears to be an effective way to combat the reliance on the oculostenotic reflex. The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. As said by Doctor William Osler, “The good physician treats the disease; the great physician treats the patient who has the disease.”

Introduction Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited. Aim To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula. Material and methods We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012. Results There were 20 patients (14 men; mean age: 53 ±8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 ±1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel. Conclusions Percutaneous closure of coronary artery fistula is a safe and effective treatment modality.

Objectives: In this article, our aims were to analyze and assess the data related to coronary revascularization rates, particularly in recent years. Study design: For this purpose, results of important studies, statistics of the Organisation for Economic Co-operation and Development (OECD) countries and data from Turkey's Social Security Agency (SSA) were analyzed for the first time. Until recently, there has been no healthy digital database regarding revascularization rates in Turkey. In the years following the establishment of SSA, it became possible to collect and analyze data obtained from the Medulla database of the Agency. Using the data from the Agency for the period 2009-2011, revascularization rates and cost analyses were performed. Results: Between 2000 and 2010 in European countries as well as in other OECD countries, the percutaneous coronary intervention (PCI) rate was on average 75% of the total revascularization rate and neared 80%. In some countries, the rate has exceeded 85%. In our country, in 2009, 2010 and 2011, the number of coronary angiography procedures and as a result PCI has steadily increased. The rate for PCI was 66.8% in 2009, but it increased to 74% in 2011. At the same time, PCI accounted for 2/3-4/5 of all revascularization procedures. In the cost analysis, however, PCI constituted only 1/5-1/4 of the costs of all revascularization procedures. Conclusion: This report is the first analysis in this area and it gives an initial idea about the current situation of the numerical and financial aspects. This analysis has provided the opportunity to obtain more accurate information about coronary revascularization rates in Turkey and to compare the data to that of other countries.

Calcified nodules in human coronary arteries are usually focally distributed. Non-invasive imaging of coronary arteries by bedside emergency transthoracic echocardiography in adults is possible and may become a useful adjunct to other methods of coronary artery examination. Coronary artery stenosis can be identified as localized color aliasing and accelerated flow velocities. Complete visualization of individual ostial coronary segments might ease the demonstration of coronary stenosis by bedside transthoracic echocardiography. The left main coronary artery stenosis requires prompt emergency evaluation and treatment because emergency conditions have higher mortality rates. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life-threatening condition.

Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects.

Both Brugada syndrome (BrS) and arrhythmogenic right ventricle dysplasia/cardiomyopathy (ARVD/C) can cause repolarization abnormalities in right precordial leads and predispose to sudden cardiac death (SCD) due to ventricular arrhythmias. Although there is controversy over whether BrS is distinct from ARVD/C, it is believed that both are different clinical entities with respect to both the clinical presentation and the genetic predisposition. The coexistence of these two relatively rare clinical entities is also reported, but, some hypothesized that it is more possible that disease of the right ventricular muscle might accentuate the Brugada electrocardiographic pattern. In clinic practice, there may be cases where the dividing line is not so clear. We report a 33-year-old male presenting with recurrent syncope, who has a peculiar pattern of coved-type ST-segment elevation (ST-SE) with epsilon-like wave in right precordial leads.

A 33‐y‐old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow‐up period. Copyright © 2008 Wiley Periodicals, Inc.

Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4 ± 0.3 cm2, mean wilkins valve score value was 8.9 ± 1.7, left atrial diameter was 5.0 ± 0.7 cm, left atrial area was 37.2 ± 12.6 cm2, and systolic pulmonary arterial pressure (SPAP) was 44 ± 11 mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

OBJECTIVE The present study was designed to analyse and compare the major coronary risk factors of female and male patients with premature coronary artery disease (CAD) aged < or = 45 years. METHODS We evaluated 4613 consecutive patients who underwent coronary angiography at our institution; 572 symptomatic patients (489 men and 83 women) diagnosed as having premature CAD (age < or = 45 years) were included in our analysis. For each patient, the presence of major coronary risk factors such as family history of CAD, hypercholesterolaemia, diabetes mellitus, hypertension and cigarette smoking were recorded. Besides, clinical presentation and angiographic findings were also recorded. RESULTS The most common risk factor was cigarette smoking in young men (70.3%). However, the major coronary risk factor was hypercholesterolaemia in young women (67.5%). When we compared two groups with respect to major coronary risk factors, we found that the prevalence of diabetes mellitus and hypertension were significantly higher in young women than in young men (diabetes mellitus: 27.7% vs. 12.3%, respectively, P < 0.001, hypertension: 56.6% vs. 23.4%, respectively, P < 0.001). However, cigarette smoking was found to be significantly higher in men than in women (70.3% vs. 28.9% respectively, P < 0.001). CONCLUSION We have shown for the first time the impact of gender on the coronary risk factor profile in young Turkish patients with premature CAD. These findings may be useful for gender-based management and risk factor modification of young patients with premature CAD.

BACKGROUND Atrial septal defect (ASD) is a common form of congenital heart defect in adults, which affects all cardiac chambers. Atrial myocardial function in patients with ASD has not yet been clearly elucidated. The aim of this study was to investigate atrial myocardial deformation properties in patients with ASDs. METHODS The study involved 24 patients with a secundum type ASD, and 22 healthy subjects. Color Doppler myocardial imaging was used to measure left and right atrial myocardial systolic strain and strain rate values, together with peak systolic velocity, early velocity, and late diastolic velocity. RESULTS There was no significant difference between the two groups with regard to age, gender, body mass index, heart rate, blood pressure, left atrial diameter, and ventricular function. The peak systolic atrial myocardial strain and strain rate values in each of the atrial walls studied were lower in the ASD group compared to those of the control group, but the difference reached statistical significance only in the case of the right atrial wall (right atrial strain: 48.0 +/- 32.7% vs 100.2 +/- 46.6%, P = 0.006; right atrial strain rate: 2.6 +/- 1.2/sec vs 3.8 +/- 1.2/sec, P = 0.024). CONCLUSION The left to right cardiac shunt that results from ASD leads to a reduction in the right atrial myocardial longitudinal lengthening that occurs during ventricular ejection. These findings demonstrate that the reservoir function of the atrium is impaired and atrial stiffness increases in patients with ASDs.

The common coexistence with coronary artery disease has led to the suggestion that coronary artery ectasia (CAE) is a variant of coronary artery disease. The mechanisms, however, responsible for CAE formation during the atherosclerotic process and the exact clinical significance are not well known. In this study, we aimed to investigate platelet activity in patients with isolated CAE by using specific markers of platelet activation as P-selectin, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4).Thirty-two patients with isolated CAE without significant stenosis and 30 control participants with angiographically normal coronary arteries were included in this study. According to the angiographic definition used in the Coronary Artery Surgery Study, a vessel is considered to be ectasic when its diameter isor = 1.5 times that of the adjacent normal segment in segmental ectasia. Plasma P-selectin, beta-TG and PF4 levels were measured in all patients and control participants using enzyme-linked immunosorbent assay method.Patients with isolated CAE were detected to have significantly higher levels of plasma P-selectin, beta-TG and PF4 in comparison with control participants with angiographically normal coronary arteries (P-selectin: 248+/-46 vs. 154+/-32 ng/ml, respectively, P0.001; beta-TG: 51+/-19 vs. 21+/-9 ng/ml, respectively, P0.001; PF4: 58+/-23 vs. 33+/-11 ng/ml, respectively, P0.001).In conclusion, we have shown for the first time that patients with isolated CAE have raised levels of plasma P-selectin, beta-TG and PF4 compared with control participants with angiographically normal coronary arteries, suggesting increased platelet activation in patients with CAE.

Myocardial bridging is a common congenital coronary abnormality recognized primarily with systolic narrowing or 'milking effect' shown by coronary angiography. We report the case of a 58-year-old man with signs and symptoms of myocardial ischemia who underwent transthoracic echocardiography and coronary angiography. The present case suggests the clinical role of transthoracic echocardiography in demonstrating characteristic coronary flow abnormalities in patients with muscular bridge in the region of the mid LAD.

Dextrocardia is a rare cardiac anomaly in which the heart is located in the right chest along with the cardiac long axis directing to the right and inferiorly. Although, it is a rare clinical phenomenon, coronary artery disease with dextrocardia is presumed to be of similar frequency as in the general population. Percutaneous coronary intervention has some technical difficulties in these patients. We hereby report a male patient with dextrocardia who was previously treated with coronary artery bypass graft surgery.

We evaluated the short-term results of percutaneous excimer laser angioplasty in acute myocardial infarction. Of the 18 patients studied, 2 were female and 16 male with a mean age of 56.6 ± 12.1 years. Thrombolysis in myocardial infarction grades 0, 1, and 2 flow was observed in 10, 5, and 3 cases, respectively, prior to the procedure. The degree of stenosis was 97.9% ± 5.1%. The lesion was crossed with a laser catheter in all cases, using a mean number of 808 ± 384 laser pulses. Type C dissection developed in only 1 case (6%). Except for this case, distal flow was grade 3 in all the patients. Following the procedure, ST segment resolution exceeding 70% was achieved in 14 cases (78%) within the first 90 minutes. The success rate of laser ablation was 94% (17 patients). Stent implantation was performed in all the cases. In conclusion, laser angioplasty is an effective and reliable treatment for acute myocardial infarction.

OBJECTIVE The purpose of this study was to evaluate the long term effect of clopidogrel-based antiplatelet therapy on neointimal formation. METHODS This study comprised 78 patients with typical stable angina pectoris or documented myocardial ischaemia, and with only one angiographic lesion in one native coronary artery undergoing successful stent implantation without predilatation with C-reactive protein levels < or =5 mg/l at 72 h after the procedure. All patients received dual antiplatelet therapy with 75 mg/day clopidogrel and 300 mg/day aspirin for four weeks. Clopidogrel was switched to isochronous placebo in half of the patients (n=39) at the end of the fourth week. This allocation was maintained for 20 weeks, and at week 24 of the study, coronary angiography and intravascular ultrasound imaging were performed again in all cases in order to evaluate the changes that had occurred in the in-stent neointimal formation; rates of restenosis were also recorded RESULTS At the end of the follow-up period, angiographic stenosis diameter and restenosis rates were smaller in the clopidogrel group than in the placebo group (23.3% versus 35.6%, p=0.05 and 5.12% versus 10.25%; p=0.03 respectively); the intravascular ultrasonographic neointimal cross sectional area was also smaller in the clopidogrel group (3.6 +/- 2.7 mm(2) versus 5.2 +/- 2.5 mm(2), p=0.03). CONCLUSIONS Long-term clopidogrel administration significantly reduced neointimal formation at the stent site as well as reducing major clinical events in patients who did not develop high-risk systemic inflammatory response after percutaneous coronary intervention.

The aim of this study was to evaluate the effects of stenting on blood pressure and renal functions in azotemic patients with proximal/ostial atherosclerotic renal artery stenosis. Thirteen azotemic patients (5 females, 8 males, average age, 62.7 +/- 8.3 years) who had renal artery stenosis were included in the study. Their blood pressure, estimated glomerular filtration rate (EGFR), and creatinine levels were measured at baseline and during follow-up. Stents were implanted successfully in all of the cases. The average stent diameter and stent length were 7.2 +/- 0.5 mm and 17.2 +/- 3.4 mm, respectively. Antihypertensive drug was abandoned in 1 (7.6%) patient, reduced in 10 patients (76.9%), and not changed in 2 (15.3%) patients. Significant improvement was observed in the mean serum creatinine level at the 12th month when compared with baseline (2.56 +/- 0.88; 1.83 +/- 0.62, P < 0.001). EGFR was 18.38 +/- 4.64 before the procedure and 22.67 +/- 3.81 during follow-up (P < 0.0001). According to the GFR criteria, renal function was determined to be worse in 1 (7.6%) patient, stabilized in 2 (15.3%), and improved in 10 (76.9%) patients. One patient died during the follow-up period. Angiographic restenosis was observed in 2 (15.3%) patients. Follow-up major events were observed in 3 (23%) patients. Stenting azotemic patients with renal artery stenosis is a reliable and effective procedure for achieving an improvement in renal function.

Background It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. Methods To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration). Results The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. Conclusion If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.

Elevated levels of C-reactive protein (CRP) are considered to be one of the indicators of poor prognosis in coronary artery disease (CAD). The aim of this study was to evaluate anti-inflammatory effects of atorvastatin in patients with CAD by measuring serum CRP levels.After measuring the baseline levels of CRP and lipid fractions, the patients were divided into two groups. In Group A (n = 46), atorvastatin (20 mg/day) was administered in addition to classic antianginal treatment (beta-blocker, nitrate and aspirin). In Group B (n = 32), the usual antianginal treatment was continued. Following 4 weeks of treatment the same measurements were repeated.In Group A, CRP decreased from 20.3 mg/dl (95% CI, 9-31.8) to 10.8 mg/dl (95% CI, 2.7-18.9) (p0.001). In Group B, CRP decreased from 17 mg/dl (95% CI, 13.1-21) to 12.8 mg/dl (95% CI, 9.7-15.9) (p0.01). The decrease in group A was more than in group B (p = 0.003).In patients with CAD, atorvastatin exerted an anti-inflammatory effect represented by decreasing CRP levels. This effect was independent of the change in low density lipoprotein cholesterol (LDL-C) or high density lipoprotein cholesterol (HDL-C) levels.

Diffuse in-stent restenosis remains an important problem in percutaneous transluminal coronary angioplasty (PTCA). In this trial, we studied the early and mid-term outcomes of excimer laser coronary angioplasty (ELCA) on diffuse in-stent restenosis. ELCA was performed in 23 patients (19 males). The mean length of the lesions was 14.3 +/- 3 mm and the mean age was 58 +/- 7 years. The minimal lumen diameter (MLD) was measured by on-line quantitative coronary angiography. Before the procedure, MLD was 0.9 +/- 0.4. The Q/non-Q-wave myocardial infarction (MI), coronary artery bypass graft (CABG), PTCA, and mortality were recorded during the procedure and at 6 months follow up. The fluence of laser emission was 45 mj/m2 and the repetition rate was 25 pulses per second. Adjunctive balloon angioplasty was performed in all of the cases at a mean 7 +/- 2 atm pressure. The procedure was successfully performed in all of the cases. Type-B dissection developed, after ELCA in 1 patient (4%). Perforation, death, cerebrovascular accidents, emergency CABG, PTCA or Q/non-Q wave myocardial infarction were not observed. MLD was 0.9 +/- 0.4 mm before ELCA, 1.8 +/- 0.9 mm (P0.05) after ELCA, and 3.1 +/- 0.7 mm after PTCA. At 6 months follow up, there were 2 (8.7%) Q-wave myocardial infarctions and 2 (8.7%) recurrent anginal pain cases. Control angiography was obtained in 20 cases (87%). Control angiography was not accepted by 3 patients. Their maximal exercise test was negative. Angiographic restenosis was observed in 6 cases (30%). The rate of target lesion revascularization (TLR) was 5 of 23 (22%) in the patients treated with ELCA. It is concluded, ELCA is a safe and efficient debulking technology for treating diffuse in-stent restenosis.

On the 43rd day after open heart surgery, pericardial effusion developed in a patient and resulted in cardiac tamponade. Since the drainage could not be obtained by subxiphoid window technique due to location of fluid and presence of fibrinous adherence and a thrombus in pericardial space, transcatheter intrapericardial recombinant tissue plasminogen activator (tPA) was instilled in the patient. Thus, the intrapericardial fibrinous adherence and the thrombus disappeared, and the effusion was drained efficiently.

Between 1996 and 1998, surgery was carried out in 4 patients with myocardial bridging who had angina refractory to medical therapy. Two patients were treated by supraarterial myotomy and 2 underwent coronary artery bypass grafting. One patient suffered a right ventricular perforation that was successfully repaired. Surgery is recommended for a grade-III myocardial bridge.

A 33-year-old woman presented to emergency department with palpitations. Her initial rhythm strips were interpreted as first-degree AV block and bigeminy premature ventricular contractions. However, after careful analysis of the ECG, a diagnosis of Wolff-Parkinson- White (WPW) …

In patients with stable coronary artery disease, the effect of oxygen (O2) inhalation to regional myocardial functions and its relation to the degree of the coronary artery stenosis is still unclear. This article investigates the effect of O2 therapy on regional myocardial functions in patients with coronary atherosclerosis according to the severity of stenosis. Myocardial segments were evaluated via tissue velocities, strain, strain rate, and tissue tracking. While O2 inhalation improves late diastolic myocardial velocity and tissue tracking in normally perfused myocardial regions, a negative effect was observed on systolic and diastolic parameters of myocardial segments, which are perfused by insignificantly stenotic coronary arteries. Although nasal O2 treatment has unfavorable effects on regional myocardial functions in patients with coronary artery disease, this effect remains subclinic with short-term inhalation. However, it is reasonable to pursue the effects of longer-term O2 inhalation on myocardial function especially in patients with insignificant coronary stenosis.

Background Although ischemia induced QRS complex changes have been described previously, their relationship with impaired reperfusion, which is known to be associated with poor clinical outcomes, is not clear. Methods and Results To investigate the relationship of QRS duration changes with myocardial reperfusion, we studied 165 acute myocardial infarction (MI) patients who were administered fibrinolytic therapy for reperfusion. For each patient, 12-lead electrocardiogram (ECG) with a paper speed of 50 mm/s was recorded on admission and repeated at the 60th and 90th min following fibrinolytic therapy. Based on the myocardial blush grades obtained from a control coronary angiography, patients were divided into reperfusion (grades 2, 3) and impaired reperfusion (grades 0, 1) groups. We detected impaired reperfusion in 74 patients. The patients in the impaired reperfusion group were older, more often diabetic, and had longer pain-to-needle intervals. They also had significantly longer QRS durations at admission compared to reperfusion group patients (91±11 vs 79±11 ms, p

OBJECTIVE Mean platelet volume (MPV), a marker for platelet reactivity, and white blood cell count (WBC-C), a marker for inflammation, have been shown to be predictive of unfavourable outcomes among survivors of ST elevation myocardial infarction (STEMI). The relationship of admission MPV and WBC-C with infarct-related artery (IRA) patency is not clear. We aimed to evaluate the value of admission MPV and WBC-C for the prediction of IRA patency, in patients with acute STEMI treated with primary percutaneous coronary intervention. METHODS Blood samples were obtained on admission in 351 STEMI patients. The patients who had thrombolysis in myocardial infarction (TIMI) 3 flow in initial angiography constituted the IRA patent group and others having less than TIMI 3 flow constituted the IRA occluded group. RESULTS In 16% of the patients, IRAs were found to be patent on initial angiography. Patients in the IRA occluded group had higher admission MPVs (9.3+/-1.2 vs. 8.6+/-1.3 fl, P

Right ventricular rupture is a rare complication after myocardial infarction and a few cases were reported. We present the case of a 65-year-old Caucasian man with inferior and right ventricular myocardial infarction which was complicated by right ventricular rupture following successful percutaneous revascularization. The transthoracic echocardiography revealed right ventricular free wall rupture with pericardial effusion. The patient underwent a pericardial drainage by pericardiotomy without myocardial repair because of the self-limiting pattern of the right ventricular free wall rupture. The formation of a mural thrombus at the small rupture site limited the leakage and contributed to the outstanding favourable prognosis of the patient with early revascularization even without surgical repair.

Patients presenting with chest pain and nondiagnostic electrocardiograms (ECG) in the emergency department (ED) often pose a challenge to physicians. QT dispersion (QTD) is an electrocardiographic marker of myocardial ischemia due to nonhomogenous ventricular repolarization. We hypothesized that QTD could accurately identify patients with acute coronary syndrome (ACS) who presented with chest pain and nondiagnostic initial ECGs.All patients admitted to the ED with chest pain and nondiagnostic initial ECGs were included in the study prospectively. QTD and QTc dispersion (QTcD) were measured at the initial ECGs and compared for ACS patients vs. non-ACS patients. A receiver operating characteristic curve was drawn to evaluate the diagnostic value of QTD and QTcD for ACS.Of the 137 patients with an initially nondiagnostic ECG, 51 were finally diagnosed with ACS (37%). Mean QTD and QTcD of patients with ACS were significantly greater than those of patients without ACS (39.61 +/- 12.9 vs. 32.56 +/- 15.1, p=0.004; 46.12 +/- 16.3 vs. 38.10 +/- 18.2, p=0.009, respectively). The area under the curve was 0.624, p=0.015 for QTD, and 0.603 and p=0.049 for QTcD. When various cut-off points were evaluated, potentially useful values were determined between 30 and 50 ms for QTD (sensitivity 86% and 10%, specificity 35% and 97%, respectively). These values were 40.5 and 49.5 ms for QTcD (sensitivity was 96% and 32%, specificity was 12% and 77%, respectively).For patients with chest pain and nondiagnostic initial ECG, ACS risk is high if QTD and QTcD values are greater than 40 ms. Therefore, QTD and QTcD can help identify patients with acute coronary syndrome who present with chest pain and a nondiagnostic initial ECG. However, poor operator characteristics of QT dispersion could limit its value as a diagnostic test in the clinical setting.

OBJECTIVE Recent studies demonstrate that the serum inflammatory markers increase in patients with atherosclerosis. We aimed to assess whether a difference exists between patients with acute coronary syndrome and patients with stable angina pectoris in respect to serum neopterin, procalcitonin (PCT) and C-reactive protein (CRP) levels. METHODS AND RESULTS A total of 52 patients (42 male, 10 female) who had atherosclerosis confirmed by angiography and were being followed up for an acute coronary syndrome were recruited and for control group, 45 patients with stable angina pectoris (SA) (35 male and 10 female) who underwent coronary angiography, were examined. Serum concentrations of neopterin, CRP and PCT in the study group (acute coronary syndrome) were compared to control group (stable angina pectoris). The mean neopterin level of the study group was 22.47 +/- 2.93 nmol/l, the mean CRP level was 30.40 +/- 8.05 mg/l and the mean PCT level was 0.40 +/- 0.04 ng/ml. In control group these levels were 12.26 +/- 0.61 nmol/l (p < 0.05), 5.26 +/- 0.64 mg/l (p < 0.001) and 0.19 +/- 0.02 ng/ml (p < 0.001), respectively. CONCLUSION In the presented study our results showed that these markers can be useful for the assessment of inflammation related to atherosclerosis.

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48-72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.

The treatment methods for acute myocardial infarction (MI) have started to change in the new millennium. Myocardial perfusion (ST-segment resolution) is the target rather than achieving TIMI-III flow in the infarct-related artery. In this study the authors compared the effect of percutaneous transluminal coronary angioplasty (PTCA) and excimer laser angioplasty (ELCA), which was accepted as one of the thrombolysis methods, on ST-segment resolution. A stent was applied after ELCA to 36 patients (4 women, 32 men; mean age 50.44 ±9.8 years) in group I and a stent was applied after balloon angioplasty to 44 patients (5 women, 39 men; mean age 50.77 ±12.2 years) in group II. Fisher’s exact test was used in the analysis of data, and p

The presence of thrombus in the lesion before balloon angioplasty increases the complications arising from mechanical intervention. It is known that the use of Gp llb/llla receptor blockers before the intervention enhances the reliability of the procedure. Laser thrombolysis was applied to a patient who underwent coronary angiography due to recurrent chest pain after thirty six hour administration of tirofiban and who was found to have a thrombus so large as to block the distal vessel bed of the right coronary artery. Following the procedure, the entire thrombus was broken down and Grade III distal myocardial perfusion was achieved. This case is important in demonstrating that laser application is a viable alternative in such instances, especially considering that intervention in acute coronary syndromes is on the increase and cardiologists will frequently encounter such cases.

Background. Nephrogenic ascites refers to the condition of refractory ascites of unknown aetiology and occurs mainly in patients with end-stage renal disease who are undergoing haemodialysis. Despite many treatment modalities, nephrogenic ascites remains difficult to control and has a poor prognosis. Methods. We investigated six such patients who had developed severe, apparently refractory ascites during haemodialysis. They all had seriously disturbed cardiac dimensions and function. They were treated with repeated isolated ultrafiltration and severe salt restriction, while their cardiac functions were monitored with echocardiography. Results. After a mean of 18"4 l of fluid per patient was removed in 27"8 days, ascites disappeared in all patients. Blood pressure and cardiothoracic indices were decreased from 130"20u83"10 to 95"11u 60"6 mmHg (P-0.02) and from 0.61"7 to 0.47"5 (P-0.02), respectively. At the end of treatment, heart rates had decreased from 102"10 to 85"6 beatsumin. Previously increased left atrial diameters, end-systolic and end-diastolic dimensions of the left ventricles, and right ventricular diameters reached normal values. Ejection fractions initially decreased in all patients, and then increased slightly to markedly after treatment. Conclusion. Nephrogenic ascites is a component of right-sided cardiac congestion mediated by volume overload, and it should be treated with severe salt restriction and frequent ultrafiltration with haemodialysis and, if that fails, with daily isolated ultrafiltration.