Tayfun Gürol

Comparison of Coronary Flow Velocities Between Patients with Obstructive and Nonobstructive Type Hypertrophic Cardiomyopathy: Noninvasive Assessment by Transthoracic Doppler Echocardiography

Background: We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). Methods and Results: In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 ± 14 cm/sec and 54 ± 20 cm/sec vs 41 ± 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic‐reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (−11 ± 30 cm/sec and −13 ± 38 cm/sec, vs 24 ± 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =−0.43, P < 0.005). Conclusion: We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy.

Early ambulatory discharge is safe and feasible after transradial coronary interventions

Background At present, there are no definite criteria for selecting patients eligible for same-day discharge after percutaneous coronary interventions (PCI). With rapid ambulation and reduced vascular complication rates, transradial PCI have many features that favorably reduce costs and hospital stay. This study aimed to demonstrate the possibility of early ambulatory discharge following transradial percutaneous coronary interventions. Methods 254 consecutive patients undergoing transradial PCI (elective, urgent, and emergent) at our center was observed during hospital stay. Patient demographics, angiographic characteristics, post-procedural complications, and timing of these post-procedural events were recorded. Results A total of 336 lesions were treated among 299 vessels with 277 stents. One hundred fifty-two (45.2%) lesions were Type C. There were 26 chronic total occlusions (CTO). One hundred fifty-five (61%) patients were discharged on the same day after the procedure. 24 complications (12.6%) occurred and were divided into three groups according to occurrence time. 13 (54.2%) occurred within the first 2 h and 11 (45.8%) occurred after the 24-hour period. No complications were observed between the 2nd and 24th hours. Conclusions Same-day discharge with a 2-hour observation period is safe and feasible after successful transradial PCI in appropriate patients. Although a minor number of complications occurred, these did not occur between the 2nd and 24th hours. Same-day discharge after successful transradial PCI could be an alternative for better utilization of resources.

The morphologic and functional features of LAD myocardial bridging at multi-detector computed tomography coronary angiography: correlation with coronary artery disease.

OBJECTIVES The aim of this study was to retrospectively evaluate the morphologic and functional features of myocardial bridging (MB) and to investigate the impact of morphologic features on presence of atherosclerosis with multi-detector computed tomography (MDCT) coronary angiography. STUDY DESIGN The study population consisted of 191 consecutive patients. Besides coronary lesions, morphologic features of the MB (depth, length and the distance of the tunneled artery from the left coronary ostium) were analyzed. RESULTS MDCT detected MB on left anterior descending artery in 41 patients (21.5%). The prevalence of atherosclerotic plaques proximal to the MB of LAD was 49% (20/41). There was a statistically significant correlation between percentage of systolic compression and depth of the tunneled segment (r=0.538, p<0.01). There was no relation between distance of the tunneled segment from the ostium and degree of systolic compression. No significant correlation was found between percentage of systolic compression and length of the tunneled segment (r=0.058, p=0.721). Morphologic features of MB were not related to the presence of CAD in proximal segments. CONCLUSION MDCT coronary angiography depicts the morphologic and functional features of the MB in detail. The depth of MB segment was correlated with systolic compression of MB. There was no relationship between distance of the tunneled segment from the ostium and systolic compression.

Usefulness of live/real time three/four-dimensional transesophageal echocardiography in the percutaneous closure of an iatrogenic aorto-right ventricular fistula

The development of an aorto‐right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four‐dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto‐right ventricular (AO‐RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO‐RV fistula.

Are biventricular systolic functions impaired in patient with coronoray slow flow? A prospective study with three dimensional speckle tracking

The newly developed three dimensional speckle-tracking echocardiography (3D-STE) technology provides quick and comprehensive quantitative assessment of biventricular myocardial dynamics. The impact of coronary slow flow phenomenon (CSFP) on biventricular functions has not been comprehensively evaluated using this new technology. Therefore, the aim of this study was to evaluate the effects of CSFP on biventricular systolic functions using 3D-STE. Forty patients with CSFP and otherwise normal coronary arteries (NCAs) and 40 age- and sex-matched controls with normal coronary angiograms (CAGs) were prospectively enrolled. Biventricular systolic function was evaluated by 3D-STE. Left ventricular (LV) global longitudinal, circumferential and radial strains, ejection fraction (EF) were significantly lower and LV end-systolic volume (ESV) was significantly higher in the CSFP group compared to the control group. There were no significant differences in LV mass, LV end-diastolic volume (EDV) or LV stroke volume (SV). Additionally, Right ventricular (RV) free wall, septal wall and global longitudinal strains, and RV EF were significantly lower in the CSFP group, but there were no significant differences in RV EDV, ESV and RV SV. The present study demonstrated that CSFP has a notable negative effect on not only 3D strain parameters but also biventricular EF. There was a strong correlation between the strain parameters of the affected vessel’s myocardial area and the TIMI frame count of same vessel.

A Misclassification of Pulmonary Stenosis Using Conventional Echocardiographic Methods

Background: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pressure gradient, which is affected by flow rate. Case Report: We report the first case of a pregnant patient with atrial septal defect (ASD) and pulmonary stenosis that was misclassified by conventional echocardiographic methods. Most importantly, three-dimensional transoesophageal echocardiographic assessment of pulmonary stenosis changed the entire treatment strategy. Conclusion: The planimetric calculation of the pulmonary valve (PV) opening area using three-dimensional transoesophageal echocardiographic may be helpful, especially in encounters with specialized conditions such as ASD and/or pregnancy, which can cause inaccurate recordings of the transvalvular peak gradient.

Progressive osseous heteroplasia and scoliosis

A 19-year-old man presented with back pain and limitation of motion confined to thoracolumbar area for several years of duration. There was no family history of congenital anomaly. Laboratory studies revealed no abnormality. Physical examination revealed palpable hard subcutaneous lesions over his scapula, dorsal, and lumbar spine and gluteal regions. He was referred for contrastenhanced thorax and abdomen computed tomography (CT) examination to detect potential aortic lesion because he had a Marfanoid physical appearance. The physical examination of the cardiovascular system including echocardiography and the results of CT examination for aorta was normal. However, the CT examination revealed heterotopic asymmetric ossifications of back and pelvic subcutaneous adipose tissues that extend into muscles associated with dorsolumbar scoliosis (Figs. 1–4). No additional congenital anomaly was found elsewhere in the body. On the basis of clinicoradiologic findings with normal laboratory values,

Intermittent symptomatic functional mitral regurgitation illustrated by two cases.

Abstract Functional mitral regurgitation may have different haemodynamic consequences, clinical implications and treatment options, such as surgical or percutaneous interventions or implanting a pacemaker. Here we present two cases with haemodynamically significant intermittent functional mitral regurgitation as the underlying mechanism of heart failure. The cases underline the importance of a high index of suspicion in patients with intermittent heart failure, and a careful analysis of echocardiographic images with simultaneous ECG, in order to delineate systolic and diastolic mitral regurgitation.

Coronary aneurysm mimicking a five chamber heart

A 47-year-old soccer trainer was referred for a precordial murmur incidentally noted on routine physical examination. Cardiac auscultation revealed a grade 4/6 continuous murmur heard best on the left sternal border. No other sign was detected on physical examination. Chest X-ray and ECG showed no abnormalities. Transthoracic echocardiography …