Mehmet Celik

Effects of maternal obesity on antenatal, perinatal and neonatal outcomes

Abstract Objective: Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy. Methods: A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI) < 18.5 kg/m2 was underweight, 18.5–24.9 kg/m2 was normal weight, 25–29.9 kg/m2 was overweight and ≥30 kg/m2 was obese. The effects of obesity on fetal and maternal outcomes were investigated. Results: Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p < 0.01). Conclusion: We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.

Mechanical dispersion and global longitudinal strain by speckle tracking echocardiography: Predictors of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy

In this study, we investigated whether mechanical dispersion which reflects electrical abnormality and other echocardiographic and clinic parameters predict appropriate ICD shock in patients undergone ICD implantation for hypertrophic cardiomyopathy.

Atrial electromechanical delay in patients undergoing heart transplantation

We aimed to assess atrial electromechanical delay (AEMD) in patients who had undergone heart transplantation.

Right Pulmonary Artery Compression by Giant Aortic Aneurysm.

A 52-year-old man was admitted to our emergency department due to shortness of breath, bilateral pretibial edema, and abdominal ascites. His medical history revealed successful surgical repair of coarctation 28 years prior. Upon physical examination, his blood pressure was measured at 95/65 mmHg, heart rate 132 bpm, and oxygen saturation 80%. He had bibasilar minimal rales, jugular venous distension, massive abdominal ascites, and bilateral pitting pretibial edema. Electrocardiography showed nonspecific T-wave changes. The chest x-ray film showed an increased cardiothoracic ratio and calcified aortic walls (Fig. 1A). The laboratory test was unremarkable. Transthoracic echocardiography showed slightly decreased left ventricular systolic function with an ejection fraction of 45%, mild mitral regurgitation, a bicuspid aortic valve with mild-to-moderate aortic regurgitation, an approximately 16-cm ascending aortic aneurysm (Fig. 1B), compression of right pulmonary artery (Fig. 1C), severe tricuspid regurgitation (Fig. 1D), D-shape interventricular septum (Fig. 1E) and the descending aorta was normal and no coarctation was seen. A contrastenhanced chest computed tomography scan indicated a 16-cm ascending aortic aneurysmwith calcified ulcerated plaque (Fig. 1F and G) and the right pulmonary artery to be obstructed by the aortic aneurysm (Fig. 1H). On the basis of these findings, right-side heart failure was diagnosed due to right pulmonary artery obstruction caused by a giant aortic aneurysm. We referred the patient to the cardiovascular surgery department, and it was decided to operate on the aortic aneurysm using the Bentall procedure. The patient successfully underwent composite graft replacement of the ascending aorta and aortic valve and reimplantation of the coronary arteries into the graft. After the operation, follow-up contrast-enhanced chest computed tomography showed that right pulmonary artery obstruction had disappeared (Fig. 1I) and that the patient was recovering well. Aortic coarctation is a common congenital heart disease. It accounts for 6–8% of all congenital heart disease. After coarctation repair, there are many associated early morbidities and longterm complications that can occur even decades later. Major long-term complications after repair include recoarctation, aortic aneurysms, and systemic hypertension. Patients with bicuspid aortic valve, advanced age at the time of treatment, and high preoperative systolic peak pressure gradients may be predisposed to ascending aortic aneurysm formation. In the present case, the patient exhibited signs of right-side heart failure caused by a giant postsurgical aneurysm of the ascending aorta which appeared decades after the original intervention and was successfully operated on using the Bentall procedure. Physicians should be aware of this symptom after the surgical treatment of coarctation of the aorta and keep this long-term complication in mind.

A successful catheter ablation of a ventricular fibrillation

Malignant ventricular arrhythmias are challenging to manage, requiring a multidisciplinary approach. The mechanism, which triggers ventricular fibrillation (VF) associated with ventricular extrasystoles has not been clarified yet, however, abolishing ventricular extrasystoles may stop ventricular fibrillation in these patients. By this case presentation, we aimed to present a successful treatment of an electrical storm (ES), which developed after an acute myocardial infarction, by catheter ablation.

A rare cause of retinal artery embolism: Accessory mitral valve tissue

A 42‐year‐old female patient was referred our clinic for investigation of a history of acute retinal artery occlusion. Transthoracic echocardiography showed a cyst‐like, mobile formation on posterior mitral valve leaflet. 2D and real time 3D transesophageal echocardiography showed a flexible circular mobile structure which was attached to posterior mitral valve leaflet. Echocardiographic appearance and morphological characteristics were suggestive of accessory mitral valve tissue.

Role of the oxidative stress index, myeloperoxidase, catalase activity for cardiac allograft vasculopathy in heart transplant recipients

The aim of this study was to explore the role of oxidative stress index (OSI), myeloperoxidase (MPO), and catalase (CAT) activity in cardiac allograft vasculopathy (CAV) in heart transplant recipients (HTRs).

A rare complication: diffuse alveolar haemorrhage following acute coronary syndrome

A 48-year-old male patient with past medical history of essential hypertension and smoking was admitted to our hospital with anterior ST segment elevation myocardial infarction. After treatment with 300 mg acetyl-salicylic acid, 180 mg ticagrelor, and 7500 IU unfractioned heparin IV bolus, the patient underwent coronary angiography showing total occlusion of the left anterior coronary artery. Angioplasty was performed, but slow flow phenomenon occurred after drug eluting stent implantation. Accordingly, tirofiban bolus was administered over 3 min, followed by a 0.15-μg/kg/min tirofiban infusion. The patient was transferred to a coronary intensive care unit and his pain disappeared. Transthoracic echocardiogram revealed anterior septal wall hypokinesis with slightly decreased systolic dysfunction (ejection fraction of 50%) and mild mitral regurgitation. Then, the patient developed severe dyspnoea, tachypnoea, and haemoptysis of bright red blood. On physical examination, he had diffuse rales over both lung fields. Pulse oximetry revealed a severe oxygen desaturation of 80% despite 100% O2 support. Chest X-ray film showed bilateral diffuse opacities (Fig. 1). Chest computed tomography scan demonstrated widespread alveolar filling (Figs. 2, 3). Laboratory tests showed that the haemoglobin level declined from 15 g/dL to 12.3 g/dL, and the platelet count, prothrombin time, and partial thromboplastin time were normal. On the basis of these findings, new onset shortness of breath, and haemoptysis after administration of antiplatelet agents, diffuse alveolar haemorrhage was diagnosed. Diffuse alveolar haemorrhage is a syndrome characterised by bleeding into the alveolar spaces. It is an uncommon, serious, and life threatening event. It is under-diagnosed, so physicians should be aware that antiplatelet therapy is able to induce diffuse alveolar haemorrhage and should be used with caution in patients presenting with acute coronary syndrome, who have had severe dyspnea and haemoptysis.

Multiple aneurysmatic involvement of sinus of Valsalva

Forty‐five‐year‐old male patient presented with chest pain and dyspnea lasting for three weeks. Transthoracic echocardiography demonstrated a huge right sinus of Valsalva aneurysm. Contrast‐enhanced cardiac computed tomography was performed and revealed three large unruptured sinus of Valsalva aneurysms.

Is right atrioventricular valve always tricuspid

A 71‐year‐old male with a medical history of hypertension was admitted to emergency department with hypertensive pulmonary edema. The patient appeared anxious and diaphoretic, and physical examination revealed tachypnea, crepitant rales in the both lungs and a systolic ejection murmur at the right sternal border, radiating to the both carotid arteries. The electrocardiography showed sinus tachycardia with indications of left ventricle hypertrophy Before the aortic valve surgery, transesophageal echocardiography (TEE) was performed for detailed evaluation of the aortic valve. Two‐dimensional TEE showed mild tricuspid valve regurgitation and only two of three leaflets of the tricuspid valve at a time.