Harun Kilic

Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options

OBJECTIVES We aimed to present our experience regarding the unusual vascular complications and specific treatment strategies in patients who underwent transradial coronary procedure (TRC). BACKGROUND Transradial access provides lower vascular access site complication rates compared with transfemoral access. However, there is lack of data obtained from large study populations concerning the incidence and treatment strategies of hemorrhagic and vascular complications following a TRC in the literature. METHODS 10,324 patients (2,652 patients with percutaneous coronary intervention and 7,672 patients with a diagnostic transradial coronary angiography) who underwent a TRC from February 2010 to December 2014 were reviewed to identify cases of large hematoma, perforation, arteriovenous fistula, and pseudoaneurysm. RESULTS The observed incidence was 0.44% (45 patients) for all unusual vascular and hemorrhagic complications. Of these 45 patients; 32 patients (0.31%) presented with large hematoma (≥6 cm), 8 patients (0.08%) presented with perforation, 4 patients (0.04%) presented with arteriovenous fistula (AVF), and only 1 case (0.009%) presented with radial artery pseudoaneurysm. Forty-one of forty-five patients were managed with mechanical compression. Surgery was performed in only 3 cases; a patient with a brachial artery perforation leading to compartment syndrome, a patient with AVF resulting in limb ischemia, and a patient with radial artery pseudoaneurysm. A right internal mammarian artery perforation resulting in huge breast hematoma was treated via endovascular graft stent implantation. CONCLUSIONS Hemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction.

Association between plasma asymmetrical dimethylarginine activity and severity of aortic valve stenosis

Objectives Aortic valve stenosis is the most common valvular heart disease in the Western world. The most common cause of aortic valve stenosis in adults is calcification of a normal trileaflet or congenital bicuspid valve. Calcific aortic valve stenosis is an active disease process characterized by mechanical stress, endothelial damage, lipid accumulation, inflammation, synthesis of extracellular matrix proteins, and calcification, reminiscent of atherosclerosis in many aspects. Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase which reduces the bioavailability of nitric oxide and begets endothelial dysfunction. The goal of this study was to examine the association between ADMA activity and severity of aortic valve stenosis. Methods One hundred and nine patients were included in this study. Patients were grouped as those with mild aortic stenosis (42 patients, group 1), moderate aortic stenosis (36 patients, group 2), and severe aortic stenosis (31 patients, group 3). ADMA activity was measured by ELISA kit. Results Mean ADMA activity in group 3 was significantly higher than that in groups 1 and 2 (1.94 ± 0.45 vs. 0.87 ± 0.37 μmol/l, P < 0.001 and 1.94 ± 0.45 vs. 1.34 ± 0.52 μmol/l, P < 0.001, respectively). Serum ADMA activity was positively correlated with mean aortic gradient and maximum aortic gradient and negatively correlated with aortic valve area. Conclusion Our results showed that serum ADMA activity is higher in patients with severe aortic valve stenosis. ADMA activity is positively correlated with aortic valve stenosis severity. Serum ADMA level may be used as a precious marker to evaluate and follow up the severity of aortic valve stenosis.

Spontaneous rectus sheath hematoma during rivaroxaban therapy

Rivaroxaban is an oral anticoagulant agent that directly inhibits Factor Xa and interrupts both the intrinsic and extrinsic pathway of the coagulation cascade and is currently indicated for use in patients for atrial fibrillation and prophylaxis of deep venous thrombosis. The present case reports of spontaneous rectus sheath hematoma during rivaroxaban therapy for atrial fibrillation in a 75-year-old woman.

ECG Changes Due to Hypothermia Developed After Drowning: Case Report

SUMMARY Drowning is one of the fatal accidents frequently encountered during the summer and is the most common cause of accidental death in the world. Anoxia, hypothermia, and metabolic acidosis are mainly responsible for morbidty. Cardiovascular effects may occur secondary to hypoxia and hypothermia. Atrial fibrillation, sinus dysrhythmias (rarely requiring treatment), and, in serious cases, ventricular fibrillation or asystole may develop, showing as rhythm problems on electrocardiogram and Osborn wave can be seen, especially during hypothermia. A 16-year-old male patient who was admitted to our hospitals emergency service with drowning is presented in this article. In our case, ventricular fibrillation and giant J wave (Osborn wave) associated with hypothermia developed after drowning was seen. We present this case as a reminder of ECG changes due to hypothermia that develop after drowning. Response to cardiopulmonary resuscitation after drowning and hypothermia is not very good. Mortality is very high, so early resuscitation and aggressive treatment of cardiovascular and respiratory problems are important for life.

Association between plasma asymmetrical dimethylarginine activity and saphenous vein graft disease in patients with coronary bypass.

BackgroundCoronary vein graft disease is an important contributor to the morbidity after coronary artery bypass graft surgery. Graft occlusion is a serious complication, which limits the use of the saphenous vein as a coronary bypass conduit. Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and it reduces the bioavailability of nitric oxide and begets endothelial dysfunction. The goal of this study was to examine the association between plasma ADMA activity and saphenous vein graft disease. MethodsOne hundred and three patients were enrolled in this study. Group 1 consisted of 42 patients (13 female, 29 male) who had diseased saphenous vein grafts and group 2 consisted of 61 patients (10 female, 51 male) with nondiseased saphenous vein grafts. ADMA activity was measured by the enzyme-linked immunosorbent assay kit. ResultsMean ADMA activity in group 1 was significantly higher than in group 2 (2.0±0.6 vs. 1.1±0.5 μmol/l, P<0.001, respectively). Mean platelet volume was also significantly higher in group 1 than in group 2 (8.7±1.5 vs. 8.2±0.6 fl, P=0.03, respectively).In a multivariate linear regression analysis, ADMA activity (&bgr;=2.902, P<0.001) and mean platelet volume (&bgr;=0.595, P=0.03) were found to be independent predictors of saphenous vein graft disease. ConclusionOur results showed that ADMA activity was higher in patients with saphenous vein graft disease. Increased ADMA activity might lead to the acceleration of saphenous vein graft disease. ADMA may be a precious marker for detecting late saphenous vein graft patency.

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience

BACKGROUND Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. PATIENTS AND METHODS A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. RESULTS Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). CONCLUSIONS Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Diabetic Patients Have Increased Perioperative Cardiac Risk in Heart-Type Fatty Acid-Binding Protein-Based Assessment

Objective: To test the potential role of heart-type fatty acid-binding protein (H-FABP) in detecting increased perioperative cardiac risk in comparison with cardiac troponin I (cTnI) in the early postoperative period. Subjects and Methods: Sixty-seven patients who had clinical risk factors and underwent elective intermediate - or high-risk noncardiac surgery were included in this study. Serum specimens were analyzed for H-FABP and cTnI levels before and at 8 h after surgery. None of the patients had chest pain; 27 had a history of ischemic heart disease, 3 of heart failure, 5 of cerebrovascular diseases, 40 of diabetes and 46 of hypertension. Results: The mean duration of the operations was 2.33 ± 1.27 h (range 1-6). In the postoperative period, 27 (40.3%) patients had increased H-FABP levels (≥7.5 ng/ml); the median preoperative serum H-FABP level was 0.13 ng/ml (<0.1-5.9) and the median postoperative H-FABP level was 6.86 ng/ml (<0.1-13.7). Only 1 (1.5%) patient had cTnI >0.1 µg/l during the postoperative period. Correlation analysis revealed that the presence of diabetes was associated with an increased H-FABP level (r = 0.30, p = 0.01). Of the 27 patients with H-FABP ≥7.5 ng/ml, 21 (87%) had diabetes. There was no significant correlation with other clinical risk factors, type or duration of surgery. Conclusion: The H-FABP levels significantly increased in the postoperative period. Most patients with increased postoperative H-FABP levels were diabetic. High H-FABP levels could alert clinicians to increased perioperative cardiovascular risk and could prevent underdiagnosis, especially in diabetic patients.

Volume depletion provided by blood donation alters twist mechanics of the heart: Preload dependency of left ventricular torsion

Abstract Objectives: The crucial role of twisting motion on both left ventricular (LV) contraction and relaxation has been clearly identified. However, the reports studying the association between LV torsion and loading conditions have revealed conflicting outcomes. Previously normal saline infusion was shown to increase LV rotation. Our aim was to test this phenomenon after volume depletion in healthy volunteer blood donors. Design: A total of 26 healthy male volunteers were included in the study. LV end-diastolic and end-systolic diameter, LV ejection fraction, LV diastolic parameters, LV apical and basal rotation and peak systolic LV torsion were measured by speckle-tracking echocardiography before and after 450 mL blood donation. Results: Blood donation led to a significant decrease in end-diastolic LV internal diameter (48.7 ± 0.4 versus 46.4 ± 0.4 mm; p < 0.001) and cardiac output (6.2 ± 1.0 versus 5.1 ± 0.7 L/min; p < 0.001). There was a significant decrease in the magnitude of peak systolic apical rotation (4.4 ± 1.9° versus 2.9 ± 1.5°; p < 0.001) but no change in basal rotation (2.6 ± 1.4° versus 2.7 ± 1.6°; p = 0.81). Peak systolic LV Torsion decreased after blood donation (6.9 ± 1.9° versus 5.7 ± 2.1°; p = 0.028). Conclusions: LV apical rotation and peak systolic LV torsion seem to be preload dependent. Preload reduction provided by 450-mL blood donation decreased LV torsion in healthy male volunteers. Volume dynamics should be taken into account in the evaluation of LV torsion.

Renal subcapsular hematoma caused by hydrophilic guide wire during patent ductus arteriosus closure

Hydrophilic guide wire-associated renal subcapsular hematoma (RSH) during patent ductus arteriosus (PDA) closure is an extremely rare clinical condition. Herein, we present the case of a 16-year-old adolescent who suffered accidental hydrophilic 0.035-inch guide wire-related RSH during PDA closure. This RSH was diagnosed by computerized tomography and selective renal angiography. It was successfully treated by conservative treatment.

High-density lipoprotein subfractions and influence of endothelial lipase in a healthy Turkish population: a study in a land of low high-density lipoprotein cholesterol.

Abstract Purpose. Low concentration of high-density lipoprotein (HDL) is prevalent in Turkey. Endothelial lipase (EL) regulates lipoprotein metabolism. Small, lipid-poor HDL particles represent more-efficient cholesterol acceptors than their large, lipid-rich counterparts. The aim of this study was to investigate HDL subfractions and the effect of EL on HDL concentrations in healthy Turkish population. Methods. 102 healthy subjects were included in the study (mean age 33.6 ± 10.3 years, 42 female). HDL subfractions were assayed by single precipitation method and EL concentrations were measured by competitive enzyme immunoassay. Results. Mean HDL concentrations were 1.45 ± 0.37 mmol/L in women, 1.10 ± 0.30 mmol/L in men. Small HDL subfraction levels did not differ statistically between < 1 mmol/L and ≥ 1.6 mmol/L total HDL groups. Small HDL was not correlated with EL, low density lipoprotein cholesterol (LDL), triglyceride (TG) and age but positively correlated with total cholesterol and HDL (r = 0.2, p = 0.017; r = 0.2, p = 0.028, respectively). Large HDL was not correlated with age, EL and total cholesterol, and negatively correlated with HDL, LDL, TG (r = − 0.7, p < 0.001; r = − 0.2, p = 0.045; r = − 0.3, p < 0.001, respectively). If subjects were divided into two groups as HDL< 1 mmol/L and HDL > 1.6 mmol/L, mean EL concentrations were 475.83 ± 521.77 nmol/L and 529.71 ± 276.92 nmol/L, respectively (p = 0.086). Conclusion. There were no differences between small HDL concentrations in the HDL low and high groups. Our data did not support EL to be the reason for low HDL in a healthy Turkish population. Our results in a healthy population may serve as a reference for clinical studies on HDL subfractions.