Rifat Eralp Ulusoy

Aortic elastic properties in young pregnant women

This study aimed to investigate the aortic elastic properties of young pregnant women by comparing them with those of age-matched healthy females. The study group consisted of 21 pregnant women at a mean age of 26 ± 1 years; 22 healthy women at a mean age of 25 ± 1 years constituted the control group. Doppler-color echocardiographic variables and serum estradiol (E2) levels were measured from both groups. The blood samples were obtained from the control group in the first week after menstrual bleeding. Diastolic and systolic blood pressure (DBP and SBP, respectively) were measured with a sphygmomanometer. Systolic and diastolic aortic diameters (AOS and AOD, respectively) were measured 3 cm proximal to the aortic valves. Aortic elastic properties were assessed according to the following formulas: 1, Aortic strain = (AOS − AOD)/AOD; 2, Aortic distensibility = 2 × (AOS − AOD)/(PP × AOD); 3, Aortic diameter change = AOS − AOD; 4, Aortic stiffness index = ln(SBP/DBP)/(AOS − AOD)/AOD. The results were expressed as mean ± standard deviation and compared by t-test between groups. P < 0.05 was considered as statistically significant. All women in the study group were in their first pregnancy and second trimester. The height and weight were 160 ± 5 vs 164 ± 6 cm and 60 ± 9 vs 54 ± 3 kg in the study vs control groups, respectively (P < 0.05). The AOD was 26 ± 3 vs 26 ± 4 mm and AOS 29 ± 3 vs 28 ± 4 mm. Pulse pressure was 43 ± 3 vs 45 ± 8 mmHg in the study vs control groups, respectively (P > 0.05). The serum E2 level was significantly higher in pregnant women (21 300 ± 2 300 pg/ml). Derived aortic elastic properties in pregnant women were also increased significantly (P < 0.0005). The indexes of aortic elastic properties are altered and aortic stiffness is decreased among young pregnant women. This may be due to the adaptation mechanisms including high estradiol levels detected in pregnancy.

The Effects of Lipid-Lowering Therapy on Graft Patency in Coronary Bypass Surgery Patients

BACKGROUND Our aim was to investigate the effects of lipid-lowering treatment (LLT) on graft patency in coronary artery bypass grafting (CABG) patients. METHODS A total of 209 CABG patients (95 men, 45%) with a total cholesterol level above 200 mg/dL and a low-density lipoprotein level above 100 mg/dL were included. Patients were divided into 2 groups on the basis of administration of LLT after CABG: group 1 received LLT after the operation (those patients undergoing operations after 1998, n = 102, 49% male) and group 2 did not receive LLT after the operation (those patients undergoing operations between 1992 and 1998, n = 107, 42% male). Median duration of follow-up was 5.2 years. Follow-up angiography could be obtained in 108 (52%) patients (56 in group 1, 52 in group 2). RESULTS There was a 42% reduction in ischemic events and deaths in group 1, and 60% of these patients had a symptom-free or event-free period for 6 years. The 5-year graft patency for left internal mammary artery-to-left anterior descending artery grafts in group 1 was 95%, and the corresponding figure was 90% in group 2. Right coronary artery-to-saphenous vein graft patency was 66% for group 1 and 30% for group 2. Circumflex artery-to-saphenous vein patency rate was 59% for group 1 and 53% for group 2. A higher graft patency was found in group 1 as a whole. CONCLUSION Results of this retrospective study support the fact that LLT provides a higher graft patency for CABG patients.

Papillary fibroelastoma of mitral papillary chordae in a young patient

Our case is a 38-year-old man, admitted to Cardiology Department with shortness of breath. Echocardiography yields a hyperechogenic mass localized to papillary muscle with severe mitral regurgitation. Coronary angiography demonstrated radiopacity localized to the papillary muscle. The excision of the mass was consistent with elastic tumor, which was reported as papillary fibroelastoma attached to the papillary chordae of the mitral valve. A 29 no St-Jude bileaflet mechanical valve was implanted to mitral position. Papillary fibroelastoma (PF) can be found in young age and originate from the papillary muscle, which the radiopaque angiographic appearance of the mass supports the diagnosis.

Novel intubation technique for transesophageal echocardiographic examination

Pharyngeal intubation is a challenging problem during transesophageal procedures. The rate of unsuccessful intubation varies from 1.5 to 1.9%. In this article, we described a novel technique, which we utilize in our hospital for the difficult intubations without any technical failure for the insertion of the transesophageal probe.

Nomogram for Mitral Valve Area Assessment

Dear Editor, We have read the article by Uzun et al. titled “A nomogram for measurement of mitral valve area by proximal isovelocity surface area method.”1 The use of nomogram for complex calculations is very advantageous in terms of requiring less time. It has been used in many instances such as measuring body surface area and body mass index in medical area. The measurement of mitral valve area is still a challenge for echocardiographers because each method has its own limitations. The proximal isovelocity surface area method has the potential to overcome many of these limitations.2–4 Although the deviations in measurement of radius and the need for angle correction has been proposed by many other authors, we think that the most important limitation for the use of this method seems to be the complexity of the method. It should be kept in mind that the radius is measured correctly if the echocardiographer uses this method and compares it with others (as reference methods) when there is no limitation for other methods. The need for angle correction is with a great extent alleviated by the nomogram proposed by Uzun et al. However, we have some comments about the proportion of aliasing velocity (Val) and maximum velocity (Vmax). The authors have used the proportion of 1:8 for Val:Vmax. The nomogram has been drawn according to this proportion. We think that dividing a number by eight is still complex and may necessitate calculator. The nomogram would be simpler if they had used the proportion of 1:10. The process of dividing by 10 only includes shifting the comma to the left by one digit. Everybody can make this modification without using a calculator. Another problem is the adjustment of aliasing velocity. The authors have not mentioned

Comorbidity of Constrictive Pericarditis and Hemophilia A

Objective: To report a case of comorbidity of constrictive pericarditis and hemophilia A. Clinical Presentation and Intervention: A 21-year-old male with hemophilia A was referred to our clinic and was examined with the subsequent evaluation of shortness of breath, leg edema and ascites. Clinical and laboratory examinations were performed. The results were consistent with constrictive pericarditis (CP), and the symptoms were completely relieved following institution of medical therapy. Conclusion: Because hemophilia A and pericarditis may be coincidentally present clinical conditions, avoidance of surgical procedures in hemophilic patients is preferable unless the resolution of the symptoms of pericarditis cannot be effected by medical therapy.