Husnu Degirmenci

Cardiac manifestations in Behcet's disease

Behcets disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD.

The Impact of Trimetazidine Treatment on Left Ventricular Functions and Plasma Brain Natriuretic Peptide Levels in Patients with Non-ST Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Background and Objectives The aim of this study was to investigate the impact of treatment with oral trimetazidine (TMZ) applied before and after percutaneous coronary interventions (PCI) on short-term left ventricular functions and plasma brain natriuretic peptide (BNP) levels in patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing PCI. Subjects and Methods The study included 45 patients who were undergoing PCI with the diagnosis of NSTEMI. The patients were randomized into two groups. The first group (n=22) of the patients hospitalized with the diagnosis of NSTEMI was given conventional therapy plus 60 mg TMZ just prior to PCI. Treatment with TMZ was continued for one month after the procedure. TMZ treatment was not given to the second group (n=23). Echocardiography images were recorded and plasma BNP levels were measured just prior to the PCI and on the 1st and 30th days after PCI. Results The myocardial performance index (MPI) was greater in the second group (p=0.02). In the comparison of BNP levels, they significantly decreased in both of the groups during the 30-day follow-up period (29.0±8 and 50.6±33, p<0.01 respectively). However, decreasing of BNP levels was higher in the group administered with TMZ. The decrease of left ventriclular end-diastolic volume was observed in all groups at 30 days after intervention, but was higher in the group administered with TMZ (p=0.01). Conclusion Trimetazidine treatment commencing prior to PCI and continued after PCI in patients with NSTEMI provides improvements in MPI, left ventricular end diastolic volume and a decrease in BNP levels.

New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension: Serum YKL-40/Chitinase 3-like protein 1 levels and echocardiographic epicardial adipose tissue thickness

Abstract The aim of the present study was to investigate whether YKL-40 levels and epicardial adipose tissue (EAT) thickness were associated with non-dipping pattern in essential hypertension (HT). Age- and sex-matched 40 dipper hypertensive patients and 40 non-dipper hypertensive patients were included in the study. Non-dippers had significantly increased EAT thickness and higher YKL-40 and high-sensitivity C-reactive protein levels than dippers. Multivariate logistic regression analysis showed that the EAT thickness and serum levels of YKL-40 and high-sensitivity C-reactive protein were independent predictors of non-dipping pattern in essential HT. In essential HT, presence of non-dipping pattern is associated with increased inflammatory response.

A quadricuspid aortic valve causing moderate aortic regurgitation

Quadricuspid aortic valve (QAV) is a rare cause of aortic regurgitation. Most cases are detected incidentally during echocardiography, angiography, autopsy or surgery. It may also be associated with other congenital anomalies of the heart. A 70 year-old man was admitted to our hospital with a five-month history of dyspnea. Echocardiographic examination showed a QAV leading to moderate aortic regurgitation, severe mitral regurgitation, left ventricular dysfunction and aortic root dilatation. Surgical treatment was considered, but the patient refused. We describe a case of QAV leading to aortic regurgitation.

Serum YKL-40/chitinase 3-like protein 1 level is an independent predictor of atherosclerosis development in patients with obstructive sleep apnea syndrome.

OBJECTIVE The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3-like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL-40/chitinase 3-like protein 1 levels in patients with normotensive and nondiabetic OSAS. METHODS The study included 40 OSAS patients and 40 age- sex- and body mass index-matched healthy controls. Serum YKL-40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound. RESULTS The patients with OSAS had significantly increased CIMT and higher YKL-40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL-40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation<90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO2<90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL-40 and hsCRP were found to be independent predictors of CIMT. CONCLUSION In patients with OSAS, CIMT was increased. This increase was associated with serum YKL-40 level. Increased serum level of YKL-40 may be an early predictor of atherosclerosis development in patients with OSAS.

Symptomatic isolated giant hydatid cyst in the posterolateral region of the left ventricle.

A 16-year-old female presented with a three-week history of progressive dyspnea, abdominal distention, and fatigue. Her past medical history was unremarkable. On physical examination, her respiratory rate was 20/ min, pulse rate was 102/min (regular), and blood pressure was 120/80 mmHg. Electrocardiography showed sinus tachycardia. Transthoracic echocardiography showed a unilocular giant cystic mass, 5x6 cm in size, with welldefined margins attached to the posterolateral region of the left ventricle. The cystic mass had an oval shape and manifested as an encapsulated hyperechogenic image (Fig. A, B). No abnormalities were detected in other cardiac structures. Left ventricular dimensions and systolic functions (ejection fraction 60%) and the mitral and aortic valves were normal. The interventricular septum was free and the left ventricular outflow tract was not obstructed. These findings were also demonstrated by real-time three-dimensional transthoracic echocardiography (Fig. C, D). She had increased eosinophilia (6.2%) and normal levels of liver and cardiac enzymes. An indirect hemagglutination test yielded a positive result. A detailed scan with ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging did not show any hydatid cyst in other organs. Emergency cardiac surgery recommended due to the potential risk for rupture of the cystic lesion was refused by the patient. Albendazole (800 mg/day) treatment was initiated. One month later, the patient underwent surgical treatment at another center. Pathologic examination showed a hydatid cyst. At the three-month visit, the patient was asymptomatic with improved functional capacity. (Presented at the 26th National Congress of Cardiology, October 21-24, 2010, Istanbul)

Comparison of the effects of metoprolol or carvedilol on serum gamma-glutamyltransferase and uric acid levels among patients with acute coronary syndrome without ST segment elevation

Objective: Serum gamma-glutamyltransferase (GGT) and uric acid levels measured in patients with acute coronary syndrome without ST segment elevation (NSTEMI) are important in diagnosis and in predicting the prognosis of the disease. There is a limited number of clinical studies investigating the effects of beta-blockers on GGT and uric acid levels in these patients. In our study, we aimed to investigate the effects of beta-blocker therapy on GGT and uric acid levels. Methods: We conducted a randomized, prospective clinical study. Hundred patients with NSTEMI were included in this study, and they were divided into two groups. Fifty patients were administered metoprolol succinate treatment (1 × 50 mg), whereas the remaining 50 patients were administered carvedilol treatment (2 × 12.5 mg). Thereafter, all of the patients underwent coronary angiography. Blood samples were taken at the time of admission, at the 1st month, and 3rd month to detect GGT and uric acid levels. Results: There was no statistically significant difference among the metoprolol or carvedilol groups in terms of the GGT levels measured at the baseline, 1st month, and 3rd month (p=0.904 and p=0.573, respectively). In addition, there was no statistically significant difference among the metoprolol or carvedilol groups in terms of uric acid levels measured at the baseline, 1st month, and 3rd month (p=0.601 and p=0.601, respectively). Conclusion: We found that GGT and uric acid levels did not show any change compared to the baseline values, with metoprolol and carvedilol treatment initiated in the early period in patients with NSTEMI.

Giant pseudoaneurysm of the ascending aorta after left ventricular aneurysm surgery

A 45-year-old male was admitted to our hospital with a history of progressive dyspnea and chest pain for a few days. He had undergone left ventricle aneurysmorrhaphy two months before. The physical examination revealed blood pressure of 70/50 mmHg, pulse rate of 116/min, and respiratory rate of 30/min. On cardiac auscultation, heart sounds were soft and a 1/6 diastolic murmur was heard at the left sternal border. An electrocardiogram showed sinus tachycardia. Chest X-ray showed enlargement of the mediastinum (Figure A). The transthoracic echocardiogram (TTE) revealed a flow pattern into a pseudoaneurysm from the ascending aorta, which arose from the cannulation site of the previous surgery (Figure B, Video 1*) and an intraventricular flow pattern into a left ventricular aneurysm (Figure C, Video 2*). The pseudoaneurysm was 9.5x8.2 cm at its greatest anteroposterior and transverse diameters. After developing cardiogenic shock, the patient was transferred to the operating room. He collapsed after median sternotomy, and cardiopulmonary resuscitation (CPR) was started immediately. The patient did not respond to 45 minutes of CPR, and passed away. The present case is intended to emphasize that the postoperative period should be managed carefully in terms of aortic pseudoaneurysm development after cardiac surgery in patients with the propensity to aneurysm formation. 222

Effects of radiofrequency ablation on levels of cardiac biochemical markers in patients with atrioventricular nodal re-entry tachycardia.

Address for Correspondence/Yaz›şma Adresi: Dr. Ziya Şimşek, Osmangazi Mah. Tuna Sok. Gökdemir Sitesi A Blok K:6 D:29 25100, Erzurum-Türkiye Phone: +90 442 231 84 82 E-mail: ziyamposta@hotmail.com Accepted Date/Kabul Tarihi: 25.04.2013 Available Online Date/Çevrimiçi Yayın Tarihi: 26.09.2013 ©Telif Hakk› 2013 AVES Yay›nc›l›k Ltd. Şti. Makale metnine www.anakarder.com web sayfas›ndan ulaş›labilir. ©Copyright 2013 by AVES Yay›nc›l›k Ltd. Available on-line at www.anakarder.com doi:10.5152/akd.2013.229 Hakan Duman, Ziya Şimşek, M. Hakan Taş, Fuat Gündoğdu, Hüsnü Değirmenci, Eftal M. Bakırcı, Selami Demirelli, Hikmet Hamur, Orhan Demir

A Rare Congenital Anomaly: Interrupted Aortic Arch and Giant Ascending Aortic Aneurysm in a Young Male

Interrupted aortic arch (IAA) is a rare congenital cardiac defect defined as complete loss of luminal and anatomical continuity between the ascending and descending segments of the aorta. Very few patients can reach adult age without surgical correction. These cases showed diagnosis of the nearly asymptomatic Type A IAA with aortography and multislice computed tomography (MSCT). A 27-year-old male patient was applied to the internal medicine department with complaint of fatigue. They heard a diastolic murmur on the aortic focus and referred the patient to our cardiology polyclinic. Physical examination showed reguler heart beat with blood pressures of 150/90 mm Hg in the right arm, 140/90 mm Hg in the left arm, 100/60 mm Hg in the right limb and 100/60 mm Hg in the left limb, and there was a diastolic murmur prominently on the aortic fo-cus. Electrocardiogram was in sinus rhytm and normal. His chest ro-entgenogram (anteroposterior) showed a dilated aortic root. When we made echocardiography, we saw bicuspit aortic valve with moderate aortic regurgitation and dilatation of the ascending aorta (70 mm). Then an attemp to perform aortography via femoral artery fa-iled because the aortic arch was not able to go through. When we gave contrast, we saw that the aortic arch was interrupted. Aortography via the right brachial artery showed a giant ascending aortic aneurysm (70 mm), severe aortic regurgitation, interruption of the aortic arch distal to the left subclavian artery (Fig. 1, arrow) and prominent collateral circulation (Fig. 2, arrows). After aortography, the patient underwent a MSCT. MSCT confirmed the diagnosis of the IAA distal to the orgin of the left subclavian artery and measured the ascending aorta as 75 mm (Fig. 3, arrow). The patient was referred to an experienced surgeon on adult congenital heart diseases, but was denied surgery due to lack of symptoms. In this case, a rare congenital anomaly was detected with transcatheter aortography and MSCT diagnostic techniques, which complement each other. Fig. 1 Fig. 2 Fig. 3