Erdogan Yasar

Intracoronary guidewire emboli: a unique complication and retrieval of the wire.

The breakdown of the guidewire during percutaneous coronary intervention (PCI) and the retention of the broken part inside the coronary or systemic vascular system is a rare complication. With the use of a flexible guidewire, the incidence of these complications has markedly decreased. In this case report, we report the withdrawal of a broken guidewire from the distal coronary during PCI.

Late pacemaker twiddler syndrome

Dr. Ihsan Dursun, MD ()) · Prof. Osman Yesildag, FESC Korhan Soylu, MD · Prof. Ozcan Yilmaz · Erdogan Yasar, Tech Murat Meric, MD Ondokuz Mayis Universitesi Tip Fakultesi, Kardiyoloji Bolumu 55139 Kurupelit Samsun/Turkey Tel.: 90-5 32 / 4 30 87 62 Fax: 90-3 62 / 4 57 60 41 E-Mail: ihsandursun@mynet.com Sirs: Twiddler syndrome, known as the rolling up of the pacemaker battery within the pacemaker pocket, was first described in 1968 by Bayliss et al. [1]. Frequently, twisting of the pacemaker battery within the pacemaker pocket ends with the dislocation of the electrode, diaphragmatic stimulation and the loss of capture [2]. This situation is not limited to only cardiac pacemaker batteries. It has also been observed in implantable cardioverter defibrillators [3]. Symptoms begin with the twisting of the pacemaker battery within the pacemaker pocket in which it is implanted. The capture problem is a result of the dislocation of the electrode. Hypoperfusion symptoms such as fatigue, tiredness, confusion, presyncope and syncope can be observed if the patient is completely dependent on the cardiac pacemaker [4]. Except the symptoms related with the failure of the cardiac pacemaker, other symptoms are also observed frequently as well due to the damage of the neigbouring organs. Ipsilateral phrenic nerve stimulation concludes the sensation of the diaphragmatic and abdominal pulsations. Additionally, if the electrodes become more twisted around the battery, rhythmic arm movements can occur due to the stimulation of the brachial plexus [5]. However not all cases display clinical symptoms [3]. Capture or pace problems can also be observed in the electrocardiography (ECG). The ECG is also abnormal if the electrode dislocates intermittently. On a chest X-ray, the electrodes can be seen as bent, twisted or dislocated and fractured [4].

The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention

PURPOSE It has been known that inflammatory mechanisms play an important role in the coronary artery disease. Our aim in this study was to investigate the relationship between the neutrophil/lymphocyte (N/L) ratio and coronary flow velocity after primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS Two hundred and ten patients who had undergone primary PCI were included. The coronary flow velocities were evaluated using the recorded PCI procedures by Thrombolysis in Myocardial Infarction (TIMI) flow grades and corrected TIMI frame counts (cTFC) values. A value of >40 for the final cTFC was accepted as an index of insufficient coronary blood flow. The white blood cell subtypes and counts were determined in the blood samples obtained at the clinics. RESULTS In 165 (78%) of the investigated patients, reperfusion was found to be sufficient (Group I) while in 45 (22%) of them (Group II) insufficient reperfusion was observed (Group II). In-hospital mortality was 7.2% (n=12) in Group I, whereas it was 17.7% (n=8) in Group II (P=0.033). Similarly, one-year mortality was higher in Group II (26.6%, n=12) than in Group I (13.3%, n=22) (P=0.031). N/L ratio was determined to be higher in Group I than in Group II (8.3±6.1 vs. 6.2±5.0; P=0.034). Also, N/L ratio was found as an independent predictor of severe no-reflow development (TIMI 0-1) and of one-year mortality (P=0.01 and P=0.047, respectively). CONCLUSIONS N/L ratio has been found to be an independent indicator for no-reflow development in patients who have undergone PCI for acute STEMI. This simple and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.

Prevalence and Characteristics of Coronary-Cameral Communications in Adult Patients: Coronary Angiographic Analysis of 16,573 Patients

Objective: To analyze the coronary angiograms of patients with symptomatic heart disease in order to determine the frequency and characteristics of coronary-cameral communications (CCCs) in a single center. Subjects and Methods: The coronary angiograms of 16,573 patients with symptomatic heart disease performed from November 2001 to January 2011 were analyzed. The diagnosis of coronary fistula and coronary-cameral microcommunications (CCMCs) was made according to previously defined criteria. Results: Of the 16,573 patients, 15 (0.09%; 8 males and 7 females, mean age 63 ± 12 years) had CCCs, while coronary fistulas were identified in 2 (0.01%). In the first patient, the coronary fistula arose from the branches of the left anterior descending (LAD) artery and the right coronary artery (RCA) and drained into the right ventricle. In the second patient, the fistula originated from branches of the LAD artery, the circumflex (Cx) artery and the RCA and drained into the left ventricle. In 7 patients, the CCMCs originated from the LAD artery. In 3 patients, the Cx artery was the origin. The CCMCs originated from the RCA in 2 patients. In 1 patient the CCMC took its origin from the RCA and the Cx artery, while in 2 patients the CCMCs were associated with intracardiac masses in the left atrium and the right atrium, respectively. Conclusion: The prevalence of CCCs in adult patients was low and that of large coronary fistulas was even lower; coronary fistulas are probably very rare in adult patients because the majority of them are detected and treated during childhood.

Evaluation of Electrocardiographic T-peak to T-end Interval in Subjects with Increased Epicardial Fat Tissue Thickness

Background The association between periatrial adiposity and atrial arrhythmias has been shown in previous studies. However, there are not enough available data on the association between epicardial fat tissue (EFT) thickness and parameters of ventricular repolarization. Thus, we aimed to evaluate the association of EFT thickness with indices of ventricular repolarization by using T-peak to T-end (Tp-e) interval and Tp-e/QT ratio. Methods The present study included 50 patients whose EFT thickness ≥ 9 mm (group 1) and 40 control subjects with EFT thickness < 9 mm (group 2). Transthoracic echocardiographic examination was performed in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. Results QTd (41.1 ± 2.5 vs 38.6 ± 3.2, p < 0.001) and corrected QTd (46.7 ± 4.7 vs 43.7 ± 4, p = 0.002) were significantly higher in group 1 when compared to group 2. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, p < 0.001), cTp-e interval (83.1 ± 4.3 vs. 76±4.9, p < 0.001), Tp-e/QT (0.20 ± 0.02 vs. 0.2 ± 0.02, p < 0.001) and Tp-e/QTc ratios (0.2 ± 0.01 vs. 0.18 ± 0.01, p < 0.001) were increased in group 1 in comparison to group 2. Significant positive correlations were found between EFT thickness and Tp-e interval (r = 0.548, p < 0.001), cTp-e interval (r = 0.259, p = 0.01), and Tp-e/QT (r = 0.662, p < 0.001) and Tp-e/QTc ratios (r = 0.560, p < 0.001). Conclusion The present study shows that Tp-e and cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in subjects with increased EFT, which may suggest an increased risk of ventricular arrhythmia.