Ertan Demirtas

Single coronary artery with anomalous origin of the right coronary artery as a branch from the left anterior descending artery: a very rare coronary anomaly

Abstract Anomalous origin of the right coronary artery arising from the left anterior descending artery (LAD) is a very rare coronary anomaly. It has previously been reported in only six adult cases. In this report, we present a patient with an anomalous origin of the right coronary artery from the LAD. The patient had anginal symptoms with exercise. Myocardial perfusion imaging with thallium-201 revealed a reversible inferior perfusion defect. We suggest that this could cause myocardial ischemia.

Comparison of Electrocardiographic Repolarization Patterns between Hypogonad Males and Normal Subjects

Background: There is a significant difference in repolarization on the surface ECG between men and women. The effect of testosterone on repolarization of myocardium may provide a basis for the physiological and pathophysiological importance of these distinctions between sexes. The purpose of this study is to compare the repolarization characteristics of surface ECG in patients with secondary hypogonadotropic hypogonadism to those of healthy men and women.

Admission plasma leptin level strongly correlates with the success of thrombolytic therapy in patients with acute myocardial infarction.

Obesity-associated alterations in coagulation and fibrinolytic factors in favor of thrombosis are well known. Observations suggest that leptin, a recently discovered obesity gene product, in addition to being a satiety factor, induces platelet aggregation, accelerates formation of firm thrombi, and is associated with abnormal fibrinolysis. The authors studied the influence of plasma leptin concentrations on admission within 6 hours of acute myocardial infarction (MI) on the outcome of thrombolytic therapy (TT). Forty-one patients with acute MI who underwent TT were enrolled into the study. Levels of plasma leptin were determined with radioimmunoassay method in samples obtained just before initiation of TT. Patients were initially classified according to the admission plasma leptin concentrations, and it was observed that failure of reperfusion therapy with streptokinase was significantly higher in patients with admission plasma leptin concentrations ≥14 ng/mL (group 2) as compared to patients with admission plasma leptin concentrations <14 ng/mL (group 1). Final failure of TT, identified both by reinfarction and absence of early reperfusion as assessed noninvasively, was observed in 11 patients (39%) in group 1 and in 10 patients (77%) in group 2 (p=0.025). Left ventricular ejection fraction was slightly but significantly higher in group 1 than in group 2 (p=0.031). High plasma leptin concentrations on admission in patients within 6 hours after the onset of acute MI are associated with less TT efficacy. The authors suggest that admission leptin levels may play a role in the management of patients with acute MI.

C-Reactive protein on admission and the success of thrombolytic therapy with streptokinase: is there any relation?

BACKGROUND Recent evidence has demonstrated that inflammation plays a major role in the initiation and progression of atheroma plaques. C-reactive protein (CRP) is shown to have prognostic significance in acute coronary syndromes. We investigated the influence of CRP levels before thrombolytic therapy on infarct-related artery (IRA) patency and the degree of residual stenosis. METHODS 45 consecutive patients with a first attack of acute myocardial infarction (MI) who underwent streptokinase therapy and subsequently coronary angiography were enrolled into the study. Patients were divided into 2 groups according to the level of CRP on admission. RESULTS Serum CRP levels were > or =0.5 mg/dL in 26 patients (Group-I) and <0.5 mg/dL in 19 patients (Group-II). The patency of IRA (TIMI-2 and 3) evaluated at 90th minute after the initiation of thrombolytic therapy was similar between the two groups (62% vs. 68%, p>0.05). However, the presence of TIMI-3 flow was significantly lower and TIMI-2 flow was higher in Group-I as compared to Group-II (12% vs. 53%, p=0.003 and 50% vs. 16%, p=0.018 respectively). Additionally, among patients with patent IRA, the degree of residual stenosis was significantly higher in Group-I (80 +/- 14% vs. 68 +/- 15%, p=0.032). CONCLUSION High serum CRP levels on admission in patients within 6 hours after the start of acute ST-segment elevation MI are associated with lower TIMI flow grades and higher residual stenosis of IRA after intravenous streptokinase. Our observations imply that patients with higher CRP levels on admission require closer follow-up during and after acute MI.

Relationship Between Noninvasive Reperfusion Criteria and Pulsed‐Wave Tissue Doppler Parameters in Patients With Acute Myocardial Infarction Receiving Thrombolytic Therapy

Several studies have proven that noninvasive reperfusion criteria (NRC) have prognostic significance in patients receiving thrombolytic therapy (TT) after acute myocardial infarction (acute MI). In this study, we investigated the relationship between NRC and pulsed tissue Doppler (PTD) parameters in patients receiving TT after acute MI, and the role of PTD in the management and follow‐up of patients with acute MI. The study group (n= 41) was divided into four subgroups defined as: anterior and posterior MI, with or without NRC. In the first PTD measurements (2–3 days after acute MI), all acute MI patients had significantly smaller peak systolic (S‐wave) velocity in all evaluated segments and longer Q‐Speak durations (time elapsed from the inscription of the Q‐wave on the surface ECG to the peak of the S‐wave in PTD) as compared with control patients (n= 22; P < 0.001 for both). Among the diastolic parameters, the E/A ratio was significantly smaller in the study group compared with the control group (P < 0.001) . Among the patients who had received TT in the first 2 hours, those patients who had NRC displayed significantly higher peak S‐wave values in all evaluated segments than those without NRC (P < 0.05) . The second PTD study (4–5 weeks after acute MI), revealed that the difference between the systolic PTD parameters of the noninfarcted regions of the study and control groups disappeared. Infarct‐related segments, however, displayed significant improvement only in patients having NRC. There was a significant positive correlation between the mean mitral annular S‐wave velocity and left ventricular ejection fraction (r = 0.59, P < 0.001) . In conclusion, a significant relationship was observed between the PTD parameters and the NRC, which are known to have prognostic significance. (ECHOCARDIOGRAPHY, Volume 20, April 2003)

Radiofrequency catheter ablation of a left lateral accessory pathway in a patient with persistent left superior vena cava.

Persistent left superior vena cava is an unusual congenital anomaly that can coexist with accessory atrioventricular pathways. This anomaly can cause difficulty in mapping because of the dilated coronary sinus. This study describes a successful catheter ablation in a young male with persistent left superior vena cava and Wolff-Parkinson-White Syndrome as a result of a left lateral accessory pathway.

Seasonal Variability of QT Dispersion in Healthy Young Males

Background: There are few data related to the seasonal influences on the QT dispersion.

Effects of chronic alcohol consumption on myocardial ischemia in rats

The effects of chronic alcohol consumption on myocardial ischemia and gas perfusion with 95% O(2)-5% CO(2) were investigated in isolated rat heart. Eighteen adult male Wistar rats were used. Rats were assigned into six groups for each group to contain three rats: normal, alcoholic, normal ischemic, alcoholic ischemic, normal ischemic and 95% O(2)-5% CO(2) perfused, alcoholic ischemic and 95% O(2)-5% CO(2) perfused, respectively. Alcohol (7.2%, v/v) was given to rats by a modified liquid diet for 21 days. Rats were anaesthetized with ketamine (1-2mg kg(-1)). Hearts were quickly isolated. Normal and alcoholic rat hearts were directly sent to the electron microscopic preparation. The other hearts were cut into small pieces and put into Krebs solution. The solution was continuously bubbled using 95% N(2)-5% CO(2) 20 min for ischemia. After removal of normal ischemic and alcoholic ischemic heart specimens for electron microscopic examination, the remaining hearts of the last two groups were bubbled with 95% O(2)-5% CO(2) for another 20 min for the purpose of reperfusion and then were also prepared for electron microscopic examination. The hearts were investigated with a transmission electron microscope (Jeol 100 CXII TEM). Twenty-one days of chronic alcohol consumption was found to have no significant effect on myocardial ischemia determined by transmission electron microscopic examination. Our results suggest that there is no significant relationship between 21 days of alcohol consumption by a liquid diet and myocardial protection.

Long-term effects of octreotide therapy on in-stent restenosis

The purpose of this study was to assess the long-term effects of octreotide therapy on in-stent restenosis at 6-month follow-up coronary angiography and the clinical events after stenting. A randomized, double-blind, placebo-controlled trial was conducted to assess the effects of octreotide on restenosis after stenting. The patients (n = 148) received either subcutaneous octreotide or placebo 1 h before the stenting procedure and then every 8 h for 3 weeks. Percent diameter stenosis was interpreted before and after stenting, and on a 6-month follow-up coronary angiogram by quantitative coronary angiography. The mean percent diameter stenosis of the octreotide group was significantly lower than that of the placebo group on the 6-month follow-up coronary angiograms (18.8% ± 14.2% vs 35.0% ± 19.2%, respectively; P = 0.001). The restenosis rate of the octreotide group was statistically lower than that of the placebo group (11.8% vs 26.4%, respectively; P ≪ 0.05). With regard to major cardiovascular events, there was no significant difference between the octreotide and placebo groups. The administration of octreotide for treatment of in-stent restenosis results in a relatively low long-term angiographic restenosis rate and no significant acute effects on cardiovascular clinical events.

A Diffusely Aneurysmal, Giant Right Coronary Artery

A 55-year-old woman was admitted to our clinic with the complaint of atypical chest pain. Physical examination was normal except for a low-pitched systolic murmur at the apical region. The history revealed no cardiovascular risk factors. The whole blood, routine biochemical analysis, and erythrocyte sedimentation analysis were within normal limits. Transthoracic echocardiography (TTE) was performed to rule out mitral valve prolapse. It revealed that mitral valve was normal; however there was a round structure adjacent to the aorta which was 0.5 cm in diameter and showed a biphasic e ow. The right ventricle was slightly large. Although we could not e nd any e ow turbulence in the right ventricle, the patient had transesophageal echocardiography (TEE) with the suspicion of coronary artery e stula. On TEE, the origin of the right coronary artery was wide (Fig. 1) and a 32 mmHg gradient was measured with the continuous-wave Doppler. We thought there should be a stenosis at the origin of the artery because of the color Doppler e ndings (Fig. 2). As in TTE, there was no e ow turbulence in the right ventricle. Coronary arteriogram was performed to cone rm the diagnosis. It revealed that the left main, left anterior descending, and left circume ex arteries were normal. Right coronary artery was diffusely aneurysmal (Fig. 3). Its width was 20.4 mm at the proximal region. The patient was given acetyl salicylate 100 mg/day and warfarin (dose to be adjusted so as to keep the international normalized ratio between 2.5 and 3.5). Aneurysm formation of the coronary arteries may result from congenital or acquired conditions. Congenital coronary artery aneurysms are found most often in the right coronary artery. 1 Abnormal e ow patterns within the aneurysm may lead to thrombus formation, with subsequent vessel occlusion, distal thromboembolization, and myocardial infarction. 2 Coronary artery aneurysms are found in about 1.5% of patients studied at necropsy or by coronary arteriography. 3 Acquired coronary artery aneurysms, which may be multiple, can be the result of atherosclerosis, trauma, angioplasty, atherectomy, laser procedures, arteritis (including syphilis), mycotic emboli, mucocutaneous lymph node syndrome (Kawasaki disease), systemic lupus erythematosus, 4 or dissection (spontaneous or secondary). Atherosclerosis-induced aneurysms are thought to result from primary thinning and/or destruction of the media, and may represent up to 50% of the cases. Angioplasty, atherectomy, and arteritis may also damage the arterial wall (media) and lead to coronary aneurysms. This aneurysm is probably congenital because: