Yilmaz Gunes

Early ambulation after diagnostic heart catheterization.

The general recommended strategy after arterial invasive procedures is a 4- to 6-hour bed rest that is associated with patient discomfort and increased medical costs. We hypothesized that mobilization of selected patients at the second hour would not increase vascular complications. Coronary angiography was performed through the femoral route via 6-Fr catheters. Homeostasis was achieved by manual compression and maintained with a compressive bandage. A total of 1446 patients were ambulated at the second hour and 1226 of them were discharged without complication. A total of 220 patients required further follow-up due to blood oozing; 154 patients were conventionally ambulated due to difficult arterial access, longer (>15 minutes) compression time, hematoma formation within 2 hours, or hypertensive state (blood pressure >180/100 mm Hg). Twenty-five (16%) of those patients developed minor bleeding after ambulation. No major bleeding or large hematoma was observed during in-hospital observation. Ecchymosis (10% [2-hour group] vs 21% [4—5 hour group]) and small hematomas (22% vs 9%) were the most frequent complications after discharge. Early mobilization of selected patients undergoing diagnostic heart catheterization through the femoral artery via 6-Fr catheters is safe and associated with acceptable bleeding complication rates.

Increased Risk of Atrial and Ventricular Arrhythmia in Long-Lasting Psoriasis Patients

Background. Several reports have demonstrated an association between psoriasis and cardiovascular diseases. P wave dispersion (PWD) is the most important electrocardiographic (ECG) markers used to evaluate the risk of atrial arrhythmias. QT dispersion (QTD) can be used to assess homogeneity of cardiac repolarization and may be a risk for ventricular arrhythmias. Aim. To search PWD and QTD in patients with psoriasis. Methods. Ninety-four outpatient psoriasis patients and 51 healthy people were evaluated by physical examination, 12-lead ECG, and transthoracic echocardiography. Severity of the psoriasis was evaluated by psoriasis area and severity index (PASI). Results. Mean disease duration was 129.4 ± 83.9 (range, 3–360) months and PASI ranged from 0 to 34.0 (mean ± SD; 7.6 ± 6.7). Compared to control group, psoriatic patients had significantly shorter Pmax and Pmin durations, longer QTcmax, and greater PWD and QTcD. Transmitral deceleration time (DT) and isovolumetric relaxation time (IVRT) were significantly longer among psoriasis patients. QTcD and PWD were significantly correlated with disease duration (r = 0.693, P < 0.001, and r = 0.368, P = 0.003, resp.). Conclusions. In this study, we found that both PWD and QTcD are increased in psoriasis patients compared to healthy subjects. In addition, they had longer DT and IVRT.

Clinical profile and outcome of coronary artery ectasia

Coronary artery ectasia (CAE), a rare clinical condition, is defined as dilatation of the coronary artery 1.5 times greater than that of an adjacent normal segment.1 It usually accompanies coronary artery disease (CAD). The clinical significance of CAE is not well defined and conflicting results have been reported.1–3 Our objective in this study was to examine the clinical characteristics of CAE and its prognosis. We retrospectively reviewed the coronary angiograms of 8812 patients between February 2001 and September 2004 at Kosuyolu Heart and Research Centre and Medical Park Hospital, Istanbul, Turkey. CAE was detected in 122 (1.38%) patients, 72 (59%) of whom had coexisting significant CAD defined as > 70% diameter stenosis of major coronary arteries or ⩾ 40% stenosis of the left main stem (group A). Twenty nine patients (23.7%) had isolated CAE and 21 (17.2%) patients had accompanying non-significant CAD; together they were categorised as group B. Group C comprised 152 randomly chosen patients with significant CAD but without ectasia, matched for sex and age. The term ectasia was applied when most or all of the vessel was involved. The term aneurysm was applied in case of localised dilatation.3 Coronary aneurysms were detected in 53 (0.6%) patients and they were not included in the CAE groups. Patients with valve disease, cardiomyopathy, and previous coronary artery bypass grafting and percutaneous coronary intervention were excluded from the study. Hypertension was defined as blood pressure > 140/90 mm Hg on at least two consecutive measurements or …

Função endotelial vascular em pacientes com fluxo coronário lento e os efeitos do nebivolol

BACKGROUND: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.

[Percutaneous closure of secundum atrial septal defects in pediatric and adult patients: short- and mid-term follow-up results].

OBJECTIVES We aimed to evaluate the short- and mid-term results of patients with atrial septal defect (ASD) who were treated with percutaneous closure. STUDY DESIGN Seventy-nine patients with secundum ASD (54 female and 25 male; mean age 26.2±17.2; range 3 to 71] years) were included in this study. Patients were evaluated by transthoracic (TTE) and/or transesophageal echocardiography (TEE). Amplatzer septal occluder (ASO) was used in all patients. In 76 patients, the procedure was performed under local anesthesia with TTE, while in the other 3 patients, it was performed with general anesthesia with TEE. Patients were followed up at the 1st, 3rd, 6th and 12th months and annually thereafter. Mean follow-up time was 13.6±6.6 months. RESULTS Mean diameter of ASDs was 18.2±7.5 mm and 20.7±8.04 mm during balloon dilatation, and mean diameter of implanted devices was 22.7±8.5 mm. Procedural time was 40.2±12.6 minutes and fluoroscopy time was 10.9±4.1 minutes. The procedure was successfully performed in all patients (100%). One patient with cardiac tamponade died seven days after cardiac surgery. In two patients, the implanted devices embolized to the pulmonary circulation. Residual flow was found in three patients immediately after the procedure, without residual shunts one month after closure. Mild pericardial effusion in one patient and significant residual shunt due to device malposition in another were discovered during the follow-up at 1 and 6 months, respectively, after the procedure. CONCLUSION Our findings showed that percutaneous closure of ASDs is successful in most patients with a low complication rate, and demonstrated that residual shunts do not develop in the majority of patients in the short- and mid-term.

Myocardial infarction associated with thrombus formation in non-culprit coronary arteries

Acute coronary syndromes may be associated with a systemic acute pro-thrombotic condition, possibly involving inflammatory mechanisms as well, which are not confined to a single spot in the coronary circulation. Multivessel coronary thrombosis appears to be an exceptionally rare clinical finding. Here we present a case of anterior MI complicated by thrombi in circumflex and right coronary arteries.

Decreased risk of ventricular arrhythmias with treatment of nebivolol in patients with coronary slow flow.

BACKGROUND Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF. AIM To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters. METHODS The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol. RESULTS Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p < 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p < 0.001) values significantly decreased after treatment with nebivolol. CONCLUSIONS Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.

PP-062: VASCULAR ENDOTHELIAL FUNCTION IN PATIENTS WITH CORONARY SLOW FLOW AND THE EFFECTS OF NEBIVOLOL

BACKGROUND Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.

Treatment of aortocoronary graft lesions with graft-stents.

Objective Previous controlled trials do not indicate a superiority of the polytetrafluoroethylene membrane-covered stent graft compared with a conventional stent with respect to acute results, restenosis, or clinical event rates. We evaluated the outcome of stenting aortocoronary bypass grafts with polytetrafluoroethylene-covered stent. Methods The study included 64 patients who had 73 saphenous graft–stent implants. Clinical follow-up was obtained for a median of 6.2 months (1–9 months) for 54 patients. Results The mean age of the grafts was 9.2±6 years (2–14 years). Procedural success was achieved in 72 of 73 lesions (98.6%). One patient having an anterior Q-wave myocardial infarction died on the second day of procedure. Four patients (6.2%) sustained distal embolization and no reflow. No reflow was overcome after intracoronary administration of nitroglycerine and verapamil in two cases. At follow-up, stable angina pectoris had developed in 10 patients (18%), unstable angina pectoris in two patients (3.7%), acute myocardial infarction in two patients (3.7%), and cardiac death in one patient (1.8%). A total of 45 patients had a coronary angiogram at 6 months of follow-up or earlier, and restenosis at the target site was detected in eight of 53 lesions (15%). Conclusions Saphenous graft lesions can be managed successfully with polytetrafluoroethylene-covered stents with acceptable long-term clinical outcome. Further and larger studies are needed to compare conventional stents, polytetrafluoroethylene-covered stents, drug eluting stents, and additional benefit of distal protection devices in these subgroups.