Cem Nazli

To Be or Not to Be Patent: The Relationship Between Migraine and Patent Foramen Ovale

Migraine is a common neurological disorder with an uncertain pathogenesis. A pathophysiological link has been proposed between the migraine headache and patent foramen ovale (PFO). However, the data about the association of migraine with the presence of PFO are conflicting. The study aims to prospectively investigate the prevalence of PFO in patients with migraine compared with that of control subjects.

The Prognostic Impact of In-Hospital Change in Mean Platelet Volume in Patients With Non–ST-Segment Elevation Myocardial Infarction:

It is unclear whether changes in mean platelet volume (MPV) are associated with total mortality in acute coronary syndromes. We investigated whether the change in MPV predicts total mortality in patients with non–ST-segment elevation myocardial infarction (NSTEMI). We retrospectively analyzed 419 consecutive patients (19 patients were excluded). The remaining patients were categorized as survivors (n = 351) or nonsurvivors (n = 49). Measurements of MPV were performed at admission and after 24 hours. The difference between the 2 measurements was considered as the MPV change (ΔMPV). The end point of the study was total mortality at 1-year follow-up. During the follow-up, there were 49 deaths (12.2%). Admission MPV was comparable in the 2 groups. However, both MPV (9.6 ± 1.4 fL vs 9.2 ± 1.0 fL, P = .044) and ΔMPV (0.40 [0.10-0.70] fL vs 0.70 [0.40-1.20] fL, P < .001) at the first 24 hours were higher in nonsurvivors than survivors. In multivariate analysis, ΔMPV was an independent predictor of total mortality (odds ratio: 1.84, 95% confidence interval: 1.28-2.65, P = .001). An early increase in MPV after admission was independently associated with total mortality in patients with NSTEMI. Such patients may need more effective antiplatelet therapy.

Are all patients with psoriasis at increased risk for coronary artery disease

Associations have been recently recognized between psoriasis and an increased incidence of atherosclerotic diseases. However, there are scarce data on the prevalence of coronary lesions in patients with psoriasis. The aim of this study was to identify the calcified and non‐calcified atherosclerotic coronary lesions in patients with psoriasis compared to controls. Forty patients with psoriasis and 42 control subjects matched for age, sex, and cardiovascular risk profile were included in this case–control study. Coronary lesions were evaluated by a 128‐slice dual source multidetector computed tomography scanner. Coronary calcification scoring was calculated according to the Agatston score. The prevalence of atherosclerotic coronary lesions (psoriasis: 15%, controls: 16.7%; P = 0.83) and the mean coronary calcification scoring (psoriasis: 9.9 ± 35.2 Agatston unit, controls 2.8 ± 12.0 Agatston unit; P = 0.81) did not show a significant difference between the two groups. Multivariate analysis identified age ≥48 years and fasting blood glucose ≥99.0 mg/dl as independent predictors of coronary artery disease in patients with psoriasis (F = 30.9; P = 0.001; adjusted R2 = 0.49). Patients with psoriasis had the same prevalence of calcified and non‐calcified atherosclerotic coronary lesions as compared to controls. Our results demonstrated the necessity of considering the age and fasting blood glucose of patients with psoriasis in a decision for further cardiovascular evaluation.

Decline in mean platelet volume in patients with patent foramen ovale undergoing percutaneous closure : cardiovascular topic

Summary Introduction The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure. Methods Sixteen PFO patients undergoing percutaneous closure to prevent recurrent ischaemic events and 15 asymptomatic patients with PFO were enrolled in the study. Mean platelet volume was compared between patients with and without a history of stroke. We also compared pre- and postprocedural MPV levels in patients undergoing percutaneous PFO closure. Results Mean platelet volume, which is a marker for platelet activity, was similar in PFO patients with and without stroke (9.34 ± 1.64 vs 9.1 ± 1.34 fl; p = 0.526). Interestingly, MPV decreased significantly after percutaneous closure compared to pre-procedural levels (9.34 ± 1.64 vs 8.3 ± 1.12 fl; p = 0.001). Conclusion Our findings suggest interatrial communication through a PFO may be related to increased MPV and increased platelet activity.

The relation between international normalized ratio and mortality in acute pulmonary embolism: A retrospective study

Acute pulmonary embolism (PE) is a serious clinical disease characterized by a high mortality rate. The aim of this study was to assess the prognostic value of international normalized ratio (INR) in acute PE patients not on anticoagulant therapy.

Prognostic impact of pleural effusion in acute pulmonary embolism

Background Pulmonary embolism (PE) is a common and life-threatening condition associated with considerable morbidity and mortality. Pleural effusion occurs in about one in three cases; however, data on its prognostic value are scarce. Purpose To investigate the association between pleural effusion and both 30-day and long-term mortality in patients with acute PE. Material and Methods We retrospectively evaluated 463 patients diagnosed with acute PE using computed tomography pulmonary angiography (CTPA). Echocardiographic, demographic, and laboratory data were collected. The study population was divided into two groups: patients with and without pleural effusions. Pleural effusion detected on CT was graded as small, moderate, and large according to the amount of effusion. The predictors of 30-day and long-term total mortality were analyzed. Results Pleural effusions were found in 120 patients (25.9%). After the 30-day follow-up, all-cause mortality was higher in acute PE patients with pleural effusions than in those without (23% versus 9%, P < 0.001). Also, patients with pleural effusions had significantly higher incidence of long-term total mortality than those without pleural effusions (55% versus 23%, P < 0.001). In a multivariate analysis, pleural effusion was an independent predictor of 30-day and long-term mortality (odds ratio [OR], 2.154; 95% confidence interval [CI], 1.186–3.913; P = 0.012 and OR, 1.591; 95% CI, 1.129–2.243; P = 0.008, respectively). Conclusion Pleural effusion can be independently associated with both 30-day and long-term mortality in patients with acute PE.

A new method of tracheoesophageal fistula treatment: Using an atrial septal defect occluder device for closure—The first Turkish experience

ObjectiveOne of the techniques used in the treatment of tracheoesophageal fistula is applying the umbrella catheter, designed for closure of atrial septal defects, in this region. In the literature, we have encountered only 9 case reports in this regard. We shared a successfully closed tracheoesophageal fistula case with this technique.CaseA tracheoesophageal fistula in a 47-year-old male patient was successfully closed with an atrial septal defect occluder device. The patient died on the 42nd day after the procedure with no atrial septal defect occluder device-related problems.ConclusionUsing of atrial septal defect occluder device may be an appropriate option for tracheoesophageal fistula treatment. It can be said that the procedure is successful when the device is completely covered. Even so, there is a need for multi-centered, randomized, controlled studies of large series about the subject.

Transjugular closure of secundum atrial septal defect in a patient with interrupted inferior vena cava

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.

Massive transient pulmonary air embolism during permanent cardiac pacemaker implantation

Pulmonary air embolism is a rare complication with a high probability of death. We present an air embolism case during permanent cardiac pacemaker implantation procedure. When the patient worsened hemodynamically, we saw a large air embolism in the main pulmonary trunk. Air embolism can be fatal, it is always iatrogenic, but is an avoidable complication.

Are Right to Left Shunts Underdiagnosed in the Etiology of Migraine Headache? – A Response

We would like to thank Dr. Aparci and colleagues for their interest in our original research entitled “To be or not to be patent: The relationship between migraine and patent foramen ovale.” The authors indicate, left to right shunt may occur through a intrapulmonary shunt as well as through a patent foramen ovale (PFO). For that reason, they suggested that at least 8–10 cardiac cycles should be observed after the full opacification of the right atrium at contrast transthoracic echocardiography. However, the aim of our study was to investigate the prevalence of PFO in patients with migraine compared to that of control subjects. It is proposed that the timing of the appearance of microbubbles in the left atrium after full opacification of the right atrium differentiates intracardiac shunt from an intrapulmonary shunt. Microbubbles entering the left atrium within 3–5 cardiac cycles of their appearance in the right atrium has been proposed as criteria to diagnose PFO by saline contrast transthoracic echocardiography. Conversely, microbubbles entering the left atrium beyond 5 cardiac cycles are deemed to be an intrapulmonary shunt. However, there are reports suggesting that a “sizeable pulmonary shunt” may result in early appearing left atrial microbubbles (within the 3–5 cardiac cycles) and may create a false positive diagnosis of PFO. Furthermore, microbubbles may cross through a PFO after 3–5 cardiac cycles in case of a hypodynamic circulation; dilated, fibrillating atrium, or a delay in atrial shunting. In our study, we found 42 and 44% prevalence of PFO in patients with migraine and the control subjects by saline contrast transthoracic echocardiography. As we have mentioned in our article, the relatively higher proportion of PFO in both the patients and the control subjects in this study might be related to overrepresentation of the intrapulmonary shunts. PFO is an oblique slit-like defect that functions as a valve that closes on the left atrial side. The right to left shunt across the PFO depends on the pressure gradient between the two atria. Normally, the left atrial pressure is slightly higher than the right atrial pressure, and thus a right to left shunt is usually not present even in the presence of PFO. Right to left shunt through PFO occurs if the right atrial pressure exceeds the left atrial pressure. With the release phase of Valsalva maneuver, the right atrial pressure transiently increases which causes septum primum on the left side of the atrial septum to lift up and open the septae. Therefore, we agree with Aparci et al that performance of Valsalva maneuver is of great consideration in evaluating the presence of PFO. In our study, the echocardiographer asked the study population to practice Valsalva maneuver before performing the examination to get a satisfactory Valsalva maneuver, and the study population was asked to maintain Valsalva maneuver at least 5– 10 seconds during the examination. Additionally, the timing of performance of the Valsalva maneuver and the injection of microbubbles requires coordination. The ideal time for maximum right atrial opacification is at the end of the Valsalva maneuver. The subjects included in this study were asked to perform Valsalva maneuver at the time of the contrast injection,