Turgay Celik

P wave dispersion predicts recurrence of paroxysmal atrial fibrillation in patients with atrioventricular nodal reentrant tachycardia treated with radiofrequency catheter ablation.

Background: Paroxysmal atrial fibrillation (AF) recurs in up to one‐third of patients with atrioventricular nodal reentrant tachycardia (AVNRT) treated with slow pathway ablation. Therefore, identification of patients at risk for recurrence of AF after slow pathway ablation is important because of the necessity for additional therapies. The purpose of this study was to determine whether successful slow pathway ablation influences P wave parameters and whether these parameters predict the recurrence of paroxysmal AF in patients with both AVNRT and paroxysmal AF after ablation.

The Impact of Mitral Stenosis on Left Atrial Function Assessed by Two-Dimensional Speckle Tracking Echocardiography

Aims: The aim of this study is to investigate the effect of mitral stenosis (MS) on left atrial (LA) function using two‐dimensional speckle tracking echocardiography (2DSTE). Methods and Results: The study subjects consisted of 52 patients with asymptomatic MS and 52 control subjects. LA function was assessed using prototype speckle tracking software and manual tracking method. Maximal LA volume (LAVmax) and minimal LA volume (LAVmin) and LA volume before atrial contraction (LAVpre‐a) were measured. Using these volumes, LA reservoir, conduit and booster pump fuction parameters were calculated. Indexed LAVmax, LAVmin, and LAVpre‐a measurements via speckle tracking were highly correlated with manual tracing methods in both groups. Expansion index (67.8 ± 36.4 vs. 148.3 ± 44.2), diastolic emptying index (37.7 ± 12.9 vs. 58.0 ± 8.5), passive emptying (37.3 ± 14.1 vs. 70.4 ± 10.4) and passive emptying index (13.3 ± 6.3 vs. 41.3 ± 10.6) were decreased significantly in MS patients (P < 0.001). In contrast active emptying index (62.6 ± 4.1 vs. 29.5 ± 10.1) increased in MS group (P < 0.001) while active emptying (28.1 ± 13.0 vs. 28.3 ± 6.9) remained same among both groups. Conclusions: This is the first study relating LA volumes and function assessed by 2DSTE to MS. 2D speckle tracking analysis of LA volume is relatively easy and provides more detailed information regarding the changes in LA volumes during the cardiac cycle.

Effects of Primary Percutaneous Coronary Intervention on P Wave Dispersion

Background: Several studies demonstrated that P wave dispersion (PWD) increased after coronary occlusion. The effect of primary percutaneous coronary intervention (PCI) on PWD needs to be elucidated.

Woven Right Coronary Artery: A Case Report and Review of the Literature

Woven coronary artery is an extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. A few cases have been reported till now. In this case report, we present a 58‐year‐old male with a woven right coronary artery. Copyright

Prognostic significance of electrocardiographic abnormalities in diphtheritic myocarditis after hospital discharge: a long-term follow-up study.

Objective: We aimed to investigate the long‐term cardiac mortality and the relationship between cardiac mortality and electrocardiographic abnormalities in patients with diphtheritic myocarditis who survived after hospital discharge.

The Impact of Preinfarction Angina on Electrocardiographic Ischemia Grades in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Objective: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS (emergence of the J point >50% of the R wave in leads with qR configuration, or disappearance of the S wave in leads with an Rs configuration). Patients with G3I on the presenting electrocardiogram (ECG) had worse prognosis than the patients with lesser (grade 2‐G2I) ischemia. The aim of this study is to examine the effects of preinfarct angina (PIA) on electrocardiographic ischemia grades.

Papillary Fibroelastoma of the Mitral Valve with Systemic Embolization

Primary tumors of the heart are rare disorders. In autopsy studies, their incidence was reported to be 0.01–0.5%. We present the case of a papillary fibroelastoma of the mitral valve with systemic embolization in a young man.

A Case of Pneumopericardium Following Endomyocardial Biopsy

Abstractu2003 Pneuomopericardium is a very rare condition, less common than isolated pneumothorax or pneumomediastinum. Since it can occasionally cause pericardial tamponade, prompt recognition and treatment of this condition is lifesaving. Up to now only one case of isolated pneumopericardium after endomyocardial biopsy has been reported in a two‐month boy with a dilated cardiomyopathy of unknown origin. In the current case, we report a 25‐year‐old man who underwent orthotopic heart transplantation three years ago in whom isolated pneumopericardium occurred following endomyocardial biopsy performed via right internal jugular vein.

Does Coronary Artery Size Really Matter

Objective: To evaluate ischemia in right ventricle (RV) in patients with small caliber of right coronary artery (RCA). Patients and Methods: The study population consisted of 60 consecutive patients undergoing coronary angiography within 3 months. The patients were divided into three different groups according to lumen diameter of RCA and coronary dominance. Group 1, 2, and 3 consisted of patients with small diameter of RCA, dominant RCA, and dominant circumflex artery, respectively. RV ischemia was assessed by using pulse‐wave tissue Doppler sampling obtained from RV free wall close to the lateral tricuspid annulus at the apical four‐chamber view during dobutamine stress echocardiography (DSE). Results: When the mean systolic velocity percentages of increase from low to peak dose dobutamine in patients with small RCA were compared to those of other groups, statistically significant difference was found between group 1 and the other groups (P = 0.007 for group 1 vs group 2; P = 0.01 for group 1 vs group 3). The mean systolic velocity at peak dobutamine dose of patients with small caliber of right coronary artery was statistically lower than the other groups (P = 0.001 for group 1 vs group 2, P < 0.001 group 1 vs group 3). Conclusions: There are a group of patients with small diameter of RCA causing probable ischemia in RV and small caliber of RCA can really matter in these patients.

Mitral anterolateral papillary muscle rupture in an asymptomatic patient with mitral stenosis after percutaneous mitral balloon valvuloplasty.

Percutaneous mitral valvuloplasty is the procedure of choice for the treatment of patients with mitral stenosis and suitable valve anatomy. Papillary muscle rupture is the most worrisome complication of this procedure. A 55-year-old woman with mitral stenosis was seen in follow-up following a mitral balloon valvuloplasty performed 2 weeks earlier. She had hypertension and chronic obstructive pulmonary disease. In the presurgical evaluation of her mitral valve, Wilkins echocardiographic score was 9 (2 points for leaflet thickening, 2 points for leaflet mobility, 3 points for calcification, and 2 points for subvalvular involvement). Coronary arterial tree undertaken before mitral valvuloplasty was angiographically normal. On cardiac catheterization, the transvalvular mean gradient was 12 mmHg, and no significant mitral regurgitation was detected on ventriculography. Mitral valvotomy was performed with a 25 mm Inoue balloon with the stepwise dilation technique. However, proximal balloon was mistakenly inflated in subvalvular area. Physical examination revealed bilateral lower lung field fine crackles, a grade 2/4 diastolic murmur at the apex of the heart and dysrhythmic heart sounds. The 12-lead electrocardiogram demonstrated atrial fibrillation without any significant ST-T changes. There was no radiologic sign of congestion apart from bluntness in right cardiophrenic angle. Two-dimensional transthoracic echocardiographic (2D TTE) apical four-chamber, parasternal short-axis view and three-dimensional transthoracic echocardiographic (3D TTE) apical four-chamber view displayed a total rupture of the proximal portion of the mitral anterolateral papillary muscle (Fig. 1A–C, arrows). Left ventricular ejection faction, end-diastolic volume, end-systolic volume, and internal diameter enddystolic and end-systolic were 66%, 122 mL, 41 mL, 48 mm, and 29 mm, respectively. For better definition of the rupture, we performed 2D and 3D transesophageal echocardiography (2D and 3D TEE). The mitral valve area by pressure half time method was 1.42 cm (Fig. 2A). Two-dimensional TEE showed that the anterior mitral valve was prolapsing back into the left atrium (Fig. 2B). Real time 3D-TEE Zoom modality confirmed the prolapsing mitral anterior mitral valve (Fig. 2C). Two-dimensional TEE and real time 3D-TEE Zoom modality revealed the ruptured anterolateral papillary muscle at the anterior mitral leaflet (Fig. 3A and B, arrows). Papillary muscle rupture is a rare complication of balloon mitral valvuloplasty and is usually accompanied by severe mitral regurgitation due to mitral valve prolapse. However, the true incidence of papillary muscle rupture after percutaneous mitral valvuloplasty is not known in literature. Surprisingly, there was only mild mitral regurgitation in our case. Commissural fusion of the mitral leaflets may have prevented the formation of severe mitral regurgitation. We did not perform any surgical procedure because the patient was asymptomatic, and had mild mitral regurgitation and comorbid conditions. We herein present a case of anterolateral papillary rupture demonstrated by 3D TEE. Transesophageal echocardiography is the basic diagnostic technique in these circumstances, Address for correspondence and reprint requests: Sait Demirkol, M.D., Assistant Professor of Cardiology, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey. Fax: +90-312-3044250; E-mail: saitdemirkol@yahoo.com