Zeki Dogan

Impact of serum alkaline phosphatase level on coronary collateral circulation

BACKGROUND Serum alkaline phosphatase (ALP) level has been shown to be a prognostic factor for myocardial infarction and stroke via its promotion of vascular calcification. AIM To investigate for the first time the correlation between serum ALP level and coronary collateral circulation (CCC) development. METHODS A total of 356 patients with stable angina pectoris were evaluated retrospectively. Patients were classified according to ALP level and CCC grade. Rentrop 0-1 flow was defined as impaired CCC. Serum ALP > 129 mg/dL in men and > 104 mg/dL in women was defined as elevated ALP. All groups were compared statistically according to clinical, laboratory and demographic features. RESULTS Impaired CCC was observed in 53.7% of the patients. The mean ALP level was 102.8 ± 57.9 mg/dL, and elevated ALP levels were obtained in 19.4% of cases. There was a significant correlation between ALP and CCC grade, and impaired CCC was associated with relatively higher ALP values (65.2% vs. 50.9%, p = 0.03). Multivariate regression analysis also showed a significant correlation between elevated ALP level and impaired CCC (OR 1.85, with a 95% CI 1.056-3.264; p = 0.03). CONCLUSIONS Serum ALP is a widely avaliable unfavourable prognostic parameter in coronary heart disease. Elevated ALP levels were associated with inadequate CCC, which supports the previously reported literature concerning the negative prognostic value of ALP levels in cardiovascular settings.

Coronary-carotid artery collateral formation in Takayasu's arteritis: First reported case in the literature

We present the first case report of coronary-carotid artery collateral formation in Takayasus arteritis. There was a vasculitic involvement of both subclavian and carotid arteries with critical stenosis; cerebral perfusion was supported with collaterals arising from the mesenteric arteries and coronary artery. <Learning objective: A case of coronary-carotid artery collateral formation in Takayasus arteritis is presented. Such an angiographic finding has not been reported previously, and this case could be the first description of coronary-carotid artery collaterals development. The learning objective of the article is to evaluate collateral circulation in Takayasus arteritis from different vasculature including the coronary system.>.

A case with a huge left ventricular thrombus growing over the posterior papillary muscle and chordae tendinae

We present a case with a giant left ventricular thrombus grown over papillary muscle and chordae tendinae. The patient had declined both surgical and fibrinolytic therapy. After long-term anticoagulation therapy, regression was observed without embolic complication. Anticoagulation with warfarin may be preferred in such cases presenting with huge left ventricular thrombus encircling papillary muscle and chordae tendinae. <Learning Objective: There are no clear-cut guidelines about the treatment strategies for huge ventricular thrombus. Herein, we present a case of giant left ventricular thrombus grown over papillary muscle and chordae tendinae. We showed that long-term anticoagulation may be effective for patients with huge ventricular thrombus grown over papillary muscle and chordae tendinae.>.

Percutaneous Intervention of Sequential Coronary Venous Graft

We present a case with coronary bypass grafts in which venous graft was anastomosed to obtuse marginal (OM) 1 and OM2 branches sequentially. We performed percutaneous intervention to the proximal circumflex (CX), OM1, and bridging segment of the venous graft. Finally, bridging segment of the venous graft began to function as a CX body extending between the OM1 and OM2.

Non-ST Elevation Myocardial Infarction Triggered by Subclavian Steal Syndrome

Coronary-subclavian artery (SCA) steal syndrome is an uncommon phenomenon in which coronary flow is diverted into the SCA through the patent left internal mammary artery (LIMA) conduit due to critical subclavian stenosis. The prevalence of significant left SCA (LSCA) stenosis in patients, referred for coronary bypass surgery, has been reported to be 0.2 to 6.8%. Most patients usually present with angina pectoris, and secondary myocardial infarction is rarely reported. Herein, we present a case of coronary bypass graft in which a left anterior descending artery-LIMA graft was applied to supply the left arm due to complete LSCA occlusion. The patient was hospitalized with a diagnosis of non-ST elevation myocardial infarction.

Observation of Left Ventriculography with a Single Left Coronary Injection via Unique Coronary-Cameral Fistulas

Observation of Left Ventriculography with a Single Left Coronary Injection via Unique Coronary-Cameral Fistulas Coronary cameral fistulas are rare clinical findings in the routine angiographic examination. They usually drain into cardiac chambers with a small paths which lead to restricted opacification of the chambers. Herein, we presented a case of coronary cameral fistulas with unique multiple paths throughout rich microvascular mesh leading to complete opacification of left ventricle similar to standard ventriculographic study.