Hakan Süygün

Impact of transcatheter aortic valve implantation on the left ventricular mass.

BACKGROUND Aortic stenosis (AS) induces pressure overload of the left ventricle (LV) and results in left ventricular hypertrophy. The remodeling of the LV in patients with AS is a com-plex process including structural and functional disturbances. After aortic valve replacement, reverse remodeling of LV begins. The aim of this study was to evaluate the impact of transcatheter aortic valve ımplantation (TAVI) on LV mass (LVM) in early and mid-term follow-ups after the procedure. METHODS AND RESULTS We enrolled consecutive 75 patients who underwent successful TAVI. Transthoracic echocardiography was performed prior to TAVI and at hospital discharge, in the 1st month and 6th month of the follow-ups. The mean LV ejection fraction improved significantly after TAVI (54.2 ± 15.0% to 57.3 ± 11.7%, p < 0.001). There were no significant changes between the baseline and discharge mean LVM and LVM index values (LVMI; p = 0.1). However, LVMI decreased significantly in the 1st month of follow-up compared to baseline (123.3 ± 20.3 to 127.9 ± 21.3 g/m², respectively, p < 0.001). Also, significant regression of LVM was observed at the 1st month of follow-up compared to baseline (228.3 ± 33.5 g vs. 236.5 ± 34.2 g, respectively, p < 0.001). Furthermore, the significant regression in both of LVM and LVMI continued at 1st and 6th months of the follow-ups (p < 0.001). CONCLUSIONS A significant regression of LVM was observed after TAVI. These changes may have prognostic value in patients with severe AS.

Low-dose oral contraceptive-induced acute myocardial infarction

Abstract Objectives: Since their introduction, oral contraceptives (OCs) have been associated with risk to both the venous and the arterial systems. Studies have shown that OC use is associated with a risk of venous thromboembolism, ischaemic stroke and acute myocardial infarction (MI). MI is rarely seen in patients using OCs, particularly in the absence of clinical risk factors or smoking. Case: We report a case of acute inferior MI in a 20-year-old non-smoker who had used a low-dose OC (3 mg drospirenone and 30 μg ethinyl estradiol) for 1 month. As far as we know, this is the youngest case of acute MI associated with a low-dose OC. Conclusion: Low-dose OCs may also be responsible for acute MI even in a very young female without any cardiovascular risk factors. Therefore, the clinicians should be aware of this mortal events during follow-up of the patient using OCs.

First trans-subclavian transcatheter aortic valve replacement using Lotus valve system.

Transcatheter aortic valve implantation (TAVI), most commonly performed via retrograde femoral artery access, is a promising alternative to surgical aortic valve replacement in elderly, high-risk patients with severe aortic stenosis (AS). Approximately one-third of these patients suffer from severe iliofemoral arteriopathy, ruling out transfemoral approach. The case of a 74-year-old man with severe AS and bilateral iliofemoral arteriopathy treated with left trans-subclavian (TS) TAVI using the Lotus valve system is described in the present report.

Trans-subclavian aortic valve replacement with various bioprosthetic valves: Single-center experience

OBJECTIVE Transcatheter aortic valve replacement (TAVR) has been accepted as an alternative to surgery in high risk or inoperable patients with severe aortic stenosis (AS). Although transfemoral approach is the most often preferred means of access, in patients with severe ilio-femoral arteriopathy, other vascular access sites may be required. The aim of the present study was to report our experience with trans-subclavian approach for TAVR using different valve systems. METHODS Among 273 patients undergoing TAVR between June 2011 and May 2016, 10 patients (mean age: 68.3±7.6 years; 6 males) with high surgical risk were excluded from transfemoral TAVR because of ilio-femoral arteriopathy. Under general anesthesia, 9 of these patients underwent TAVR via left subclavian artery (SCA) and 1 patient via right SCA. Surgical cut-down and closure techniques were utilized in all patients. Eight balloon-expandable Edwards Sapien XT valves (size: one 23 mm, six 26 mm, and one 29 mm) were used, 1 patient received 26 mm balloon-expandable Sapien 3 valve, and 1 patient had 27 mm self-expandable Lotus valve implanted. RESULTS Procedural success rate was 90%. Mean aortic gradient decreased to 10.6 mmHg from 47.4 mmHg. Emergent surgery was required in 1 patient due to complication of ventricular valve embolization. Thrombus formation at right SCA was detected in 1 patient and resolved with medical therapy. In-hospital mortality was not observed in any patients. CONCLUSION Trans-subclavian approach for TAVR is safe and feasible. Proper patient and valve selection concurrent with utilization of multimodal imaging techniques are crucial for successful and uncomplicated procedure.

Transcatheter aortic valve implantation with the Edwards Sapien 3 valve: First experiences in Turkey.

OBJECTIVE Transcatheter aortic valve implantation (TAVI) has shown promising results in patients with severe aortic stenosis (AS) at high risk for open heart surgery. We aimed to evaluate outcomes of patients who underwent TAVI with Edwards SAPIEN 3 Transcatheter Heart Valve (S3), a second-generation TAVI device. METHODS Between November 2014 and June 2016, 31 high-risk patients received balloon-expandable S3 valve at Atatürk Training and Research Hospital that has the largest case series in Turkey. RESULTS Mean age of the patients was 76.1±12.6 years. Mean Society of Thoracic Surgeons and logistic European System for Cardiac Operative Risk Evaluation scores were 7.8%±3.1 and 31.4%±17.6, respectively. S3 valve was implanted in 27 patients via transfemoral approach and via trans-subclavian approach in 4 patients under local (n=29) or general (n=2) anesthesia. Procedural success rate was 100% (23 mm, n=7; 26 mm, n=16; 29 mm, n=8). Paravalvular aortic regurgitation (PAR) was absent or trivial in 29 (93.6%) patients and mild in 2 (6.4%) patients. Permanent pacemaker implantation (PPI) was required in 2 (6.4%) patients during the procedure, and in-hospital mortality occurred in 1 (3.2%) of those 2 patients. CONCLUSION S3 valve is associated with higher rate of device success and lower incidence of PAR, peripheral vascular complications, and need for new PPI.

A misdiagnosed acute myocardial infarction case in a single-ventricle patient

A 42-year-old female patient was admitted to our hospital with the complaint of squeezing chest pain and cold sweating. Physical examination was unremarkable. Cyanosis was absent. She reported experiencing weakness for 2 years; however, effort capacity was normal. Electrocardiogram revealed normal sinus rhythm with 69 bpm, ST segment elevation at inferior derivations and reciprocal ST depression at D1 and aVL leads in accordance with acute inferior myocardial infarction (Figure A). Patient was taken to catheterization laboratory. Coronary angiography revealed normal coronary arteries (Figure B, C). Cardiac biomarkers were also normal (troponin T 13.26 pg/mL, creatinine kinase MB 0.912 ng/mL). Her medical and family history revealed no cardiovascular risk factors. Apical 4-chamber view transthoracic echocardiography indicated type A (dominant ventricle is left ventricle) single ventricle with rudimentary right atrium and near-normal ejection fraction (50%) (Figure D, Video*). There was no family history of intermarriage or congenital heart disease. Causes of ST segment elevation was wide and include secondary ischemia of the myocardium, pre-existing elevation of the ST segment without acute ischemia etc. Single ventricle is an uncommon congenital heart disease, constituting approximately 1.5% of all congenital heart defects. Without surgical intervention, number of patients who reach adulthood is limited due to poor prognosis. Due to relatively asymptomatic nature of the disease, our patient was discharged under medical treatment with close follow-up. 715

A case of Gerbode-type ventricular septal defect and mitral anterior valve cleft with severe regurgitation

A 41-year-old man was admitted to our polyclinic with the complaint of New York Heart Association (NYHA) Class III dyspnea and lightheadedness. On physical examination, a 4/6 pansystolic murmur was heard maximally in all areas of the heart. There was tachycardia, but normal pulmonary signs. Electrocardiography revealed sinus rhythm with a rate of 132 beats per minute. Transthoracic echocardiography showed severe mitral valve insufficiency due to a probable mitral anterior valve cleft and a shunt from left ventricle to right atrium, leading to the diagnosis of Gerbode-type ventricular septal defect (Figure A, B, Video*). Transesophageal echocardiography showed the presence of severe mitral regurgitation and a cleft of the anterior mitral valve leaflet, thus confirming the presence of the defect (Figure C-F, Video*). The degree of regurgitation was quantified as severe, with systolic inversion of the pulmonary venous flow and regurgitant volume (72 mL). Following consultation with cardiovascular surgeons on these findings, surgery was proposed. 576

Bonsai induced acute myocardial infarction

Incidences of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. There is no any literature about a synthetic cannabinoid, being recently most popular Bonsai, to cause myocardial infarction. In this case report we presented a 33-year-old male patient who developed acute myocardial infarction after taking high doses of Bonsai.