Ahmet Karakurt

[Percutaneous closure of secundum atrial septal defects in pediatric and adult patients: short- and mid-term follow-up results].

OBJECTIVES We aimed to evaluate the short- and mid-term results of patients with atrial septal defect (ASD) who were treated with percutaneous closure. STUDY DESIGN Seventy-nine patients with secundum ASD (54 female and 25 male; mean age 26.2±17.2; range 3 to 71] years) were included in this study. Patients were evaluated by transthoracic (TTE) and/or transesophageal echocardiography (TEE). Amplatzer septal occluder (ASO) was used in all patients. In 76 patients, the procedure was performed under local anesthesia with TTE, while in the other 3 patients, it was performed with general anesthesia with TEE. Patients were followed up at the 1st, 3rd, 6th and 12th months and annually thereafter. Mean follow-up time was 13.6±6.6 months. RESULTS Mean diameter of ASDs was 18.2±7.5 mm and 20.7±8.04 mm during balloon dilatation, and mean diameter of implanted devices was 22.7±8.5 mm. Procedural time was 40.2±12.6 minutes and fluoroscopy time was 10.9±4.1 minutes. The procedure was successfully performed in all patients (100%). One patient with cardiac tamponade died seven days after cardiac surgery. In two patients, the implanted devices embolized to the pulmonary circulation. Residual flow was found in three patients immediately after the procedure, without residual shunts one month after closure. Mild pericardial effusion in one patient and significant residual shunt due to device malposition in another were discovered during the follow-up at 1 and 6 months, respectively, after the procedure. CONCLUSION Our findings showed that percutaneous closure of ASDs is successful in most patients with a low complication rate, and demonstrated that residual shunts do not develop in the majority of patients in the short- and mid-term.

Assessment of cardiac autonomic functions by heart rate variability in patients with restless leg syndrome

OBJECTIVE The aim of the present study was to investigate cardiac autonomic effects in restless leg syndrome (RLS) using heart rate variability (HRV). METHODS A total of 35 patients with RLS and 35 healthy individuals were enrolled in the study. The severity of RLS symptoms was assessed using the International Restless Legs Syndrome Study Group rating scale (IRLS). The correlation between the severity of RLS symptoms and HRV parameters measured on an electrocardiogram was analyzed. RESULTS There were no statistically significant differences between the 2 groups with respect to age, gender, or body mass index. The mean heart rate was 85±7.1 bpm in the RLS group compared with 79.6±5.5 bpm in the control group (p=0.001). The standard deviation (SD) of all normal to normal (NN) intervals (SDNN), the mean of the deviation of 5-minute NN intervals over the entire recording (SDNN index), and the SD of the average NN intervals calculated over a 5-minute period of the entire recording (SDANN) were significantly lower in the RLS group compared with the control group (p<0.05 for all). There were no statistically significant differences between the 2 groups in the square root of the mean squared differences of successive NN intervals (RMSSD) and the proportion of adjacent RR intervals differing by >50 milliseconds in the 24-hour recording (pNN50) values (p=0.119 and p=0.07, respectively). In patients with RLS, the low frequency (LF) power and LF/high frequency (HF) ratio were significantly higher than those in the control group (2248.6±245.6 vs 712.1±346.3, 10.7±3.7 vs 2.9±1.8; p<0.0001 and p<0.0001, respectively). Compared with the control group, the RLS group had lower values for HF power, but the difference was not statistically significant (p=0.07). The severity of RLS symptoms was negatively correlated with the SDNN, SDANN index, and pNN50 (r=-0.453 and p=0.009, r=-0.340 and p=0.046, r=-0.446 and p=0.007, respectively), and positively correlated with LF power (r=0.681 and p<0.0001). CONCLUSION The study data demonstrated that cardiac autonomic impairment is associated with RLS.

Association of the Zwolle Score with Fragmented QRS Complex: A Combined Prognostic Tool for Primary Angioplasty in ST Elevation Myocardial Infarctions -

Introduction: We aimed to introduce the prognostic value of simultaneously calculated fragmented QRS and Zwolle scores as a new scoring system in primary PCI of the STEMI patients. Method: Two hundred fifty-nine STEMI patients were classified as fragmented QRS complex group (fQRS) and non-fragmented QRS complex group (non-fQRS) according to the fragmentation of QRS complex in electrocardiography. These two groups according to whether Zwolle score ≥3 were also classified as high Zwolle score with fQRS complex, high Zwolle score with the non-fQRS complex, the low Zwolle score with fQRS complex, and low Zwolle score with the non-fQRS complex group. The hospitalization data of the patients were analyzed. Results: In the fQRS group compared with the non-fQRS group, wider QRS (105.2±9.7 vs. 88±7.1, p

Cardiac Autonomic Impairment and Chronotropic Incompetence in Dipper and Nondipper Hypertension

ABS TRACT Objective: The aim of the present study was to compare the autonomic nervous system activity indexes obtained from treadmill exercise stress testing in dipper and non-dipper hypertensive patients. Material and Methods: This study included 214 hypertensive patients, under antihypertensive medication. All study participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) and maximal exercise testing. Thereafter patients were divided into two groups: 94 dipper hypertensives and 120 non-dipper hypertensives. Heart-rate (HR) response during exercise was evaluated by the chronotropic index (CI). HR recovery (HRR) was defined as the difference between HR at peak exercise and first minute after the exercise test. Results: Daytime systolic and diastolic BP measurements were similar, however night-time measurements were significantly lower among dippers than nondippers (night-time systolic BP: 114.1±11.4 vs 126.3±15.0 mmHg, p<0.001; night-time diastolic BP: 72.3±7.3 vs 79.9±9.8 mmHg, p<0.001). Chronotropic index was lower than normal in both groups (0.79±0.1 vs 0.78±0.7 p=NS). Dippers had higher HRR values than non-dippers (31.8±4.6 vs 29.1±4.6 p<0,001). HRR was positively correlated with the percentage decline of systolic and diastolic BP from day to night (r=0.255 p<0.001 and r=0.228 p=0.001, respectively). There were no correlation between CI and percentage of systolic and diastolic BP reduction from day to night (r=0.067 p>0.05 and r=0.16 p>0.05, respectively). Conclusion: Hypertensive patients have abnormal HR response to exercise,. Nondippers had lower HRR values than dippers. This may due to a relative general decrease of parasympathetic reactivation after exercise that is linked to the failure of nighttime fall of BP.

Assessment of ischemia by using dobutamine stress echocardiography test in patients with isolated ST depression in inferior leads demonstrated during channel treadmill exercise electrocardiography test

Ahmet Karakurt, Kafkas Üniversitesi Tıp Fakültesi Paşa Çayırı, 36100 Kars, Türkiye Tel. 0474 2251150 4479 Email. karakurt38@hotmail.com Geliş Tarihi: 23.05.2012 • Kabul Tarihi: 19.03.2013 ABSTRACT AIM: We aimed to evaluate the diagnostic sensitivity, specifi city, positive and negative predictive value of dobutamine stress echocardiography test (DSET) in the diagnosis of cardiac ischemia in patients with isolated inferior ST segment depressions in treadmill exercise stress test (TMET).

A single center experience with the newly designed R Stent in small coronary vessels.

BACKGROUND: Over the past 10 years stents have been used more frequently for the treatment of de novo coronary artery stenosis. Initally these devices were used primarily in coronary arteries with diameters ranging from 3.0 to 4.0 mm. Traditionally, coronary arteries less than 3.0 mm in diameter were treated with only balloon angioplasty, due to the unavailablity of flexible, low profile, small diameter stents. In the past three years, many stents have been designed to be implanted in small coronary arteries. OBJECTIVE: The objective of this study was to evaluate the safety and feasiblity of the R Stent in patients with coronary lesions located in coronary arteries with a reference diameter 2.5-3.0 mm. METHODS AND RESULTS: Between November 1998 and September 1999, 32 patients with stable (37%) and unstable (63%) angina treated with the R Stent were included in this study. The treated lesions were in the right coronary artery (RCA) ( n = 13), left cirumflex coronary artery (LCX) ( n = 10), and left anterior descending coronary artery (LAD) ( n = 9). Of these lesions thirteen were anatomically complex. Stent deployment was successful in 97% with one crossing failure in a patient with a vessel tortuosity of greater than 75 degrees of the circumflex artery. No post-procedual major adverse cardiac and cerebrovascular event (MACCE) occurred within 30 days of stent implantation. After the procedure, patients were scheduled for a two-week telephone follow-up and a one-month clinical evaluation. At 30 days, only one patient (3%) experienced the recurrence of angina Canadian cardiovascular society classification ((CCS) Class 2). All other patients were event and angina free. CONCLUSION: This first clinical experience in patients with small vessel disease shows that the use of the R stent is safe and feasible with low rates of acute stent thrombosis.