bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial Infarction with Normal Coronary Arteries: The Pathologic and Clinical Perspectives
Authors: Tun Aung , Khan Ijaz A.
Published: July 2008

Myocardial infarction with normal coronary arteries is a syndrome resulting from numerous conditions but the exact cause in a majority of the patients remains unknown. Cigarette smokers and cocaine users are more prone to develop this condition. The possible mechanisms causing myocardial infarction with normal coronary arteries are hypercoagulable states, coronary embolism, an imbalance between oxygen demand and supply, intense sympathetic stimulation, non-atherosclerotic coronary diseases, coronary trauma, coronary vasospasm, coronary thrombosis, and endothelial dysfunction. It primarily affects younger individuals, and the clinical presentation is similar to that of myocardial infarction with coronary atherosclerosis. Thrombolytics, aspirin, nitrates, and beta blockers should be instituted as a standard therapy for acute myocardial infarction. Once normal coronary arteries are identified on subsequent angiography, the calcium channel blockers could be added since coronary vasospasm appears to play a major role in the pathophysiology of this condition. The beta blockers should be avoided in cocaine-induced myocardial infarction because the coronary spasm may worsen. In myocardial infarction with normal coronary arteries, complications such as malignant arrhythmia, heart failure, and hypotension are generally less common, and prognosis is usually good. Recurrent infarction, postinfarction angina, heart failure, and sudden cardiac death are rare. Stress electrocardiography and imaging studies are not useful prognostic tests and long- term survival mainly depends on the residual left ventricular function, which is usually good.
Cardiac Troponin I Levels in Patients with Left Heart Failure and Cor Pulmonale
Authors: Güler Niyazi , Bilge Mehmet , Eryonucu Beyhan , Uzun Kürcat , Avci Mehmet Emin , Dülger Haluk
Published: July 2008

Cardiac troponin levels are regarded as the most specific of currently available biochemical markers of myocardial damage. Elevated levels of troponin have been previously reported in patients with left heart failure, reflecting small areas of undetected myocardial cell death. The aim of this study was to compare the levels of the cardiac troponin I (cTnl) in patients with left- and right-sided heart failure.

Cardiac troponin I levels were studied with immunochemical methods in patients with right heart failure (n = 17) resulting from chronic obstructive pulmonary disease, ischemic left heart failure (n = 23), and nonischemic left heart failure (n = 18) who were admitted to departments of cardiology and chest diseases. Also, cTnl levels were measured in 32 healthy subjects as control group. Protein markers of myocardial injury (cTnl and myoglobin) in patients with left and right heart failure were collected approximately 12 to 36 hours after onset of obvious symptoms. Serum creatine kinase MB band was determined on admission and thereafter twice a day during the first 3 days.

Elevated levels of serum cTnl were found in patients with nonischemic (0.83 ±0.6 ng/mL, p<0.01) and ischemic left heart failure (0.9 ±0.5 ng/mL, p<0.01) when compared to healthy subjects, whereas serum cTnl levels in patients with right heart failure due to chronic obstruc tive pulmonary disease were not significantly different from those of control subjects (0.22 ±0.1 vs 0.16 ±0.1 ng/mL, p> 0.05). In addition, creatine kinase MB band and myoglobin levels were not significantly different between patient and healthy groups.

The mean of cTnl levels in ischemic and even nonischemic left heart failure were increased compared to the mean of values in healthy individuals but without significant creatine kinase MB band and myoglobin elevations. But cTnl levels were not increased in patients with right heart failure due to chronic obstructive pulmonary disease. These data indicate that the cTnl levels are abnormal in left heart failure but not in cor pulmonale.
Contrast Harmonic Power Doppler Imaging of Congenital Ventricular Diverticulum
Authors: Ueda Takashi , Mizushige Katsufumi , Yukiiri Kazushi , Aoyama Tohru , Kondo Isao , Kohno Masakazu , Matsuo Hirohide
Published: July 2008

A case of an 81-year-old woman with a left ventricular diverticulum who underwent myocar dial contrast echocardiography is reported. After administration of the contrast agent, a pulsed Doppler flow measurement clearly revealed the biphasic waveform of the ejection flow in the pre-systolic and systolic phase at the ostium of the diverticular cavity. A harmonic power Doppler image showed that part of the diverticulum wall had similar acoustic proper ties to the ventricular septal wall. Intracardiac blood flow and myocardial perfusion could be clearly evaluated and a ventricular diverticulum was correctly diagnosed using contrast echocardiography.
Effects of Atrial Pacing on QT Dispersion in Patients with Coronary Artery Disease Without Angina Pectoris and ST Segment Depression
Authors: Demir Ahmet Duran , Senen Kubilay , Balbay Yücel , Soylu Mustafa , Tikiz Hakan , Korkmaz Sule
Published: July 2008

The aim of this study was to investigate QT dispersion during atrial pacing in patients with coronary artery disease (CAD) without clinical ischemia, such as angina pectoris and ST segment depression. Thirteen patients with normal coronary arteries and 42 patients with CAD (12 with single-vessel, 16 with two-vessel and 14 with three-vessel disease) having no angina pectoris or ST segment depression during atrial pacing with maximum rate of 120/minute were enrolled in the study. Twelve-lead surface ECGs were recorded at 100 mm/second paper speed before pacing, at maximum pacing rate, and during the recovery period for measurement of QT interval parameters.

Corrected QTd (QTcd) increased from 43.4 ±8.1 to 49.3 ±9.5 ms (p<0.05) in the control group, from 46.1 ±8.1 to 74.3 ±7.7 ms (p < 0.000 1) in the single-vessel disease group, from 48.5 ±10.4 to 93.8 ±22.1 ms in the two-vessel disease group (p< 0.0001), and from 49.7 ±13.6 to 128.5 ±31 ms (p<0.0001) in the three-vessel disease group at peak atrial pacing period. A positive correlation was found between the severity of CAD and QTcd (r=0.49, p<0.0001). It was found that pacing-induced QTc dispersion identifies coronary disease extent, even when there is no ST depression or T wave inversion during pacing.
Treatment of Patients with Thromboangiitis Obliterans with Cyclophosphamide
Authors: Saha Kunal , Chabra Navdeep , Gulati Surindra Mohan
Published: July 2008

This report describes a small, nonrandomized trial of cyclophosphamide in the treatment of patients with advanced thromboangiitis obliterans (TAO) with modest results. The rationale of the treatment was based on the immunopathogenesis of the disease, ie, autoimmune vasculitis of peripheral arteries. Twelve male patient volunteers with TAO were included for the trial. Diagnosis was based on the history of chronic smoking or tobacco chewing, clinical features of ischemia of peripheral vessels, radioarteriography showing arterial block, and characteristic histopathologic changes of affected arteries. Cyclophosphamide (400 mg) was given intra venously daily to the patients for 7 days followed by daily oral administration of 100 mg cyclophosphamide for another 7 weeks. Clinical conditions of the patients started to improve during the third week of the treatment and maximum benefit was noticed at the end of the treatment. There was significant decrease of intermittent claudication and twentyfold increase of claudication distance as well as relief of rest pain. Before starting treatment 6 patients had developed ulcers on their affected limbs; these healed completely in 2, partially healed in another 2, and showed no improvement in the remaining 2, who never stopped smoking. However, immunosuppressive therapy failed to show any improvement of arterial block, as evidenced by radioarteriography and any significant increase of skin temperature over the affected limbs. Nevertheless, histopathologic studies of biopsies taken from the diseased arteries after completion of therapy showed decreased influx of lymphocytes and plasma cells in the thrombi as well as in the arterial walls in comparison to the biopsies taken before the start of treatment. During the treatment the degree of immunosuppression was monitored by blood leukocyte and lymphocyte counts, which were kept between 4,000/mm3 and above 3,000/mm3 and not less than 500/mm 3, respectively, indicating modest immunosuppression and no serious complications. All patients were followed up for 1 year. Only 2 patients, who resumed smoking, had relapse.
Relationship Between Internal Risk Factors for Development of Decubitus Ulcers and the Blood Flow Response Following Pressure Load
Authors: van Marum R.J. , Meijer J.H. , Ooms M.E. , Kostense P.J. , van Eijk J.T. , Ribbe M.W.
Published: July 2008

The objective of this study was to investigate the extent to which internal risk factors for the development of decubitus ulcers are related to the blood flow response following the relief of a pressure load. There were 122 nursing home patients (43 men, 69 women, mean age: 81 ±8 years; range: 60-97). The following potential, internal risk factors for the development of decubitus ulcers were assessed: chronic disorders (diabetes mellitus, cardiovascular disease [congestive heart failure, history of myocardial infarct or angina pectoris] and cerebrovascular accident), fever, blood pressure, nutritional status, serum hemoglobin concentration, and serum urea and serum creatinine concentrations. Skin temperature response (latency time and total response time) was measured following relief of a 100 kPa test pressure.

The presence of cardiovascular disease, cerebrovascular accident, poor nutritional condition, high serum urea and male gender showed a significant relationship with an impaired blood flow response. The delayed latency found showed a similarity to the so-called "no-reflow phenomenon." The association of cardiovascular disease and a cerebrovascular accident with a delay in the blood flow response may result from endothelial damage. A poor nutritional condition may be associated with a deficit of scavengers of oxygen-derived free radicals. The presence of free radicals may damage endothelium during reperfusion, thus influencing the blood flow response. The association of high serum urea with delayed vasodilatation may theo retically be explained by the association of serum urea and impaired kidney functioning, since the kidney is an important organ in the production of vasoactive substances. Serum urea can also be considered a measure for nutritional condition. Gender may function as a substitute for other, unmeasured factors that are related to blood flow response.
ST Elevation in the Anterior Precordial Leads During Right Ventricular Infarction: Lessons Learned During Primary Coronary Angioplasty
Authors: Cafri Carlos , Orlov Genadi , Weinstein Jean Marc , Kobal Sergio , Ilia Reuben
Published: July 2008

ST elevation in the anterior leads may be due to isolated right ventricular infarction associated with occlusion of a nondominant or codominant right coronary artery. The authors report a case of isolated right ventricular infarction from a dominant right coronary artery's proximal occlusion in the presence of collateral circulation provided by the left coronary artery. Extensive damage occurred owing to compromise of the collateral circulation during primary coronary angioplasty. This is an unusual angiographic pattern for isolated right ventricular infarction. The potential consequences of percutaneous interventions to collateral vessels is discussed.
Massive Right Atrial Thrombosis Due to Hickman Catheter Requiring Open Heart Surgery
Authors: Latif Tahir , Steiman David M. , Gagaoudakis Patricia
Published: July 2008

The risk of catheter-related sepsis and clot formation in patients with an indwelling central venous line is well recognized. However the risk of developing a large thrombus in the right atrium is less well known. Right atrial thrombus can be a life-threatening complication of long- term indwelling catheters and should be considered in the workup of these patients. A case of a 71-year-old lady who developed a large atrial thrombus due to a Hickman catheter is reported that required open heart surgery. Incidence, pathophysiology, clinical presentation, diagnosis, and treatment options are also reviewed.
A Giant Left Ventricular Thrombus in a Patient with Acute Myocardial Infarction
Authors: Hirano Hajime , Takao Makiko , Nomoto Junko , Matsunaga Akira , Tsuchiya Yoshihiro , Ideishi Munehito , Saku Keijiro
Published: July 2008

The authors report a patient with acute anteroseptal myocardial infarction with a giant left ventricular thrombus at the apex. The patient also had nephrotic syndrome due to diabetic nephropathy. Coronary angiography showed 90% stenosis at segment 6 of the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty and intracoro nary stenting were performed on the 30th day, and effective coronary blood flow was obtained. Heparin was injected intravenously for the first 7 days, and warfarin was administered there after. The left ventricular thrombus disappeared after 46 days. No evidence of arterial throm boembolism was found during the disappearance of the left ventricular thrombus as deter mined by echocardiography.
Slow Coronary Flow: A Distinct Angiographic Subgroup in Syndrome X
Authors: Goel Pravin K. , Gupta Suresh K. , Agarwal Ajay , Kapoor Aditya
Published: July 2008

Patients evaluated for chest pain with angiographically normal coronary arteries are usually labelled syndrome X. A portion of these patients may not have a cardiac cause for their symptoms. The authors aimed to study a subset within this group who showed the phenom enon of slow coronary flow (SCF) as evidenced by a slow antegrade progression of the dye on the coronary arteriogram to see if this could be used as a marker of myocardial ischemia.

This observational study included 207 patients being evaluated for suspected coronary artery disease and found to have normal coronary angiograms. SCF was seen in 49 of these patients (23.7%) while the remaining 158 (76.3%) had normal coronary flow (NCF), as detected by the corrected thrombosis in myocardial infarction (TIMI) frame count method (TIMI frame count more than 2 SD of normal). Forty of the 49 patients (82%) in the SCF group had classical angina as compared with only 51 of the 158 patients (32%) in the NCF group (p<0.01). Also, a definitively positive exercise test was observed more commonly in the SCF group than in the NCF group (71% vs 42%, p<0.01).

The authors conclude that SCF patients constitute a definite subset within the wide spectrum of syndrome X and that the phenomenon of SCF could be used as a marker for myocardial ischemia.
Accelerated Atherosclerosis in Tertiary Syphilis and Successful Treatment with Saphenous Vein Grafting
Authors: Ogus N. Temucin , Cakalagaoglu Cantürk , Cakalagaoglu Fulya , Cicek Sertac
Published: July 2008

A 48-year-old male patient having none of the known risk factors for atherosclerosis underwent coronary artery bypass graft (CABG) surgery because of double-vessel coronary artery disease. During the operation, the aorta, both internal thoracic arteries (L/R-ITA), and the femoral artery were sclerotic, and CABG was performed using only saphenous vein grafts. A diagnosis of tertiary syphilis had been confirmed by either microscopic or serologic tests. There were different degrees of sclerosis in different arteries of different sizes. The presence of coronary artery disease with no known atherosclerotic risk factors should include preoperative testing for connective tissue disorders, chronic inflammatory disease, and cold hemagglutinins, because of the possible use of obligatory deep hypothermia or total circulatory arrest due to a diseased ascending aorta.
Smoking Diminishes the Beneficial Effect of Statins: Observations from the Landmark Trials
Authors: Milionis Haralampos J. , Rizos Evangelos , Mikhailidis Dimitri P.
Published: July 2008

The landmark statin trials showed a significant reduction in morbidity and mortality associated with ischemic heart disease. However, it may not be widely appreciated that smoking had a marked adverse effect on outcome in these trials. In both the primary and secondary preven tion setting, the effect of smoking was broadly similar. Smoking markedly increased the risk of events in the placebo and treatment groups. For example, in the primary prevention trials, this risk was 74-86% higher when smokers were compared with nonsmokers in the placebo groups. The corresponding figures for the secondary prevention trials were 23-61%. The risk of events in untreated nonsmokers was of a similar order to that seen in smokers taking statins. Although statin treatment was associated with a significant reduction in events in smokers, the best outcome was observed in nonsmokers treated with statins (primary preven tion : lovastatin or pravastatin; secondary prevention: pravastatin or simvastatin). The highest risk of events in any group was in the smokers on placebo. This information may increase clinician and patient awareness as to the marked harmful effect of smoking relative to effective, evidence-based treatment (ie, the use of statins).
Anomalous Coronary Artery Origin Associated with Bicuspid Aortic Valve in a Patient with Rheumatic Mitral Stenosis
Authors: Tejada Julio G. , Albarran Agustín , Hernandez Felipe , Jimenez Santiago , Tascon Juan C.
Published: July 2008

A rare case of an anomalous left coronary artery arising from the right sinus of Valsalva asso ciated with bicuspid aortic valve is presented. This case is unique because these congenital anomalies were associated with rheumatic mitral stenosis. This anomalous coronary origin was found at catheterization before balloon mitral valvuloplasty. The clinical significance of this finding is discussed.
Pathophysiology of Early Coronary Angioplasty with Stenting on Non-Q-Wave vs Q-Wave Myocardial Infarction
Authors: Tomoda Haruo , Aoki Naoto
Published: July 2008

This study was undertaken to evaluate the pathophysiologic and clinical effects of the early application of percutaneous transluminal coronary angioplasty (PTCA) supported by stenting on non-Q-wave myocardial infarction (MI). Ninety-four patients with non-Q-wave MI and 316 patients with Q-wave MI were studied. Early PTCA with provisional stenting (40%) was performed in all of them. A history of MI (22% vs 12%, p=0.018), preinfarction angina ≤24 hours before the onset of MI (60% vs 33%, p<0.001), and patent infarct-related vessels (83% vs 21 %, p<0.001) were significantly more common in non-Q-wave MI than in Q-wave MI. As predictors of the occurrence of non-Q-wave MI, preinfarction angina (p = 0.00 1 ) and previous MI (p=0.021) were significant variables. Clinical outcomes showed more improvement in in- hospital death (0.0% vs 5.0%, p = 0.036) and long-term event-free curves for death and/or MI (p = 0.035) in non-Q-wave MI than Q-wave MI when patients with previous MI were excluded. There was no significant difference in clinical outcome between the two groups when patients with previous MI were included. The high incidence of patent infarct-related vessels and prein farction angina as well as the improved outcome obtained by early PTCA/stenting suggest instability of coronary occlusion and culprit coronary lesions in non-Q-wave MI. In conclusion, non-Q-wave MI constitutes a characteristic feature of MI induced by unstable coronary lesions, and early interventional therapies are presumed to result in improved outcomes by stabilizing the unstable culprit lesions.
Acute Renal Infarction Secondary to Left Ventricular Thrombus, Masquerading as a Renal Calculus—A Case Report and Brief Review of Literature
Authors: Singh Gurdev , Dhawan Rajiv , Potteiger Chad E. , Bedi Ashwani , Modesto Thomas A. , Gutknecht David R.
Published: July 2008

Acute embolic renal infarction is an entity that is often misdiagnosed as a renal calculus because of similar presenting symptoms. This leads to delay in the initiation of treatment and to increased morbidity. Few case reports exist relating cardiac emboli to acute renal infarction. The authors present a patient with a renal embolism secondary to left ventricular thrombus. A brief review of the literature highlighting the importance of clinical suspicion in making an accurate diagnosis, the utility of various diagnostic studies, and comparison of various treatment options is presented.
Effects of Valsalva Maneuver on QT Dispersion in Patients with Ischemic Heart Diseases
Authors: Balbay Yucel , Cosgun Ayhan , Jean-Baptiste Rachel , Demir Ahmet D. , Tikiz Hakan , Korkmaz Sule , Kutuk Emine
Published: July 2008

Previous studies showed that increased QT dispersion (QTd) has been observed during episodes of myocardial ischemia or infarction and identify the patients at risk of arrhythmia or sudden death. The objective of this study is to investigate the relationship between coronary artery disease and QTd during the Valsalva maneuver. The study population included 85 subjects (21 with normal coronary arteries, 35 with stable angina pectoris, and 29 with unstable angina pectoris). Twelve-lead surface ECGs were recorded at 50-mm/sec paper speeds and were obtained before the Valsalva maneuver and during the strain phase. The results indicate a significant difference in mean time increase between the control group and the group with stable angina pectoris (mean difference = 16.10 milliseconds, p<0.000), and between the control group and the group with unstable angina pectoris (mean difference = 35.26 milliseconds, p<0.000). The mean difference in time between these groups was also compared (mean difference = 19.17 milliseconds), and was statistically significant (p<0.000). There are some conditions like constipation, severe coughing spells, nausea, vomiting, and carrying or lifting heavy objects that increase intrathoracic pressure and may increase QT dispersion. Therefore, all these conditions should be treated appropriately and carrying or lifting heavy objects is forbidden, especially in patients with coronary artery disease.
Nonselective Left Internal Mammary Artery Angiography During Right Transradial Coronary Angiography: A Simple, Rapid, and Safe Technique
Authors: Kwang Soo Cha  , Moo Hyun Kim  , Hung Jui-Sung , Jong Soo Woo  , Young Dae Kim  , Jong Seong Kim
Published: July 2008

Internal mammary artery angiography is increasingly required, but the technique for left internal mammary artery (LIMA) angiography during right transradial coronary angiography is not well established. The authors investigated the feasibility and safety of a new, simple, and rapid nonselective technique. Following right transradial coronary angiography, LIMA angiography was performed using a 5 French (Fr) Judkins JL-3.5 catheter in 110 patients. The catheter, placed in the ascending aorta with its natural curve, was withdrawn slowly while being rotated clockwise to engage its tip in the proximal left subclavian artery. Contrast material was injected while sphygmomanometer cuff inflation was applied to the left upper arm. In the last 50 patients, the angiography was performed twice randomly with and without the cuff inflation. In 108 patients (98%), the catheter was successfully engaged in the subclavian artery in a mean of 11 ±8 seconds (range, 3-136) from the time when it was withdrawn from the ascending aorta, and nonselective LIMA angiography was successfully performed. The image quality of the angiograms was satisfactory in 103 (95%) of the 108 patients. In the last 50 patients, the image quality of the angiograms was determined satisfactory in 48 (96%) and 45 (90%) patients, with and without the cuff inflation, respectively. The difference was statistically not significant. There were no complications, including arterial dissection and thromboembolism. In conclusion, nonselective LIMA angiography can be readily and safely performed during right transradial coronary angiography using a 5 Fr Judkins JL-3.5 catheter.
Implantable Event Loop Recorder Prevents Misdiagnosis of Underlying Arrhythmia in Patients with Unexplained Palpitations
Authors: Görenek Bülent , Kudaiberdieva Gulmira , Çavuşoğlu Yüksel , Göktekin Ömer , Ata Necmi , Ünalir Ahmet , Birdane Alparslan , Timuralp Bilgin
Published: July 2008

The implantable event loop recorder is informative in the establishment of underlying arrhythmia and may aid in treatment of patients with infrequent unexplained palpitations.
Cryptogenic Ischemic Stroke and Paradoxical Embolism: Should A Patent Foramen Ovale Be Closed?
Authors: Rachko Maurice , Safi Arshad M. , Yeshou Dima , Pillai Nisha , Salciccioli Louis , Stein Richard A.
Published: July 2008

Paradoxical embolism is a well-recognized cause of stroke. While the diagnosis in the majority of the cases with a patent foramen ovale is presumptive, numerous treatment strategies have been described. However, there is no single approach that has been overwhelmingly recom mended for these patients. A patient is described who presented with ischemic stroke. Transesophageal echocardiography revealed a thrombus that straddled a patent foramen ovale. Anticoagulation with intravenous heparin resulted in resolution of thrombus and neuro logic deficit. The literature regarding diagnosis and treatment of paradoxical embolism in the presence of patent foramen ovale is reviewed.
Effects of Cardiac Rehabilitation on Atrial Wave in Patients After Myocardial Infarction
Authors: Di Maio Fernando , Rizzo Vito , Campbell Stefano Villatico , Petretto Federica , Corbellini Antonella , Bianchi Americo , Bianco Gianluca , Meloni Fortunato , Bernardo Vincenzo , Tallarico Demetrio
Published: July 2008

Cardiac rehabilitation (CR) can improve cardiac hemodynamic performance in patients after myocardial infarction (MI). Little evidence is provided concerning the consequences of CR on atrial wave duration, and less is known about the link between pre-arrhythmogenic patterns and the cardiovascular performance improvement in these subjects. Twenty-six patients, post- MI 0 to 7 days, underwent a complete CR cycle and a signal-averaged electrocardiogram (SAECG) for the evaluation of atrial activation parameters (group 1) to appreciate if physical training can promote parallel improvement in cardiovascular and intra-atrial conduction para meters. A control group of 24 well-matched nonischemic subjects (group 2) was chosen for data comparison. Resting heart rate (p<0.01) and resting double product (p<0.01) decreased after CR in groups 1 and 2, while diastolic blood pressure at maximal stress was decreased in group 1 (p<0.01) with a parallel increase in the time of physical training (p < 0.05). SAECG parameters of atrial activation were unchanged in group 1 after the comparison and only total atrial duration activation (dA) reached statistical significance (113.3 ± 17.2 msec vs 120.8 ± 14.2 msec, subjects after CR vs before CR, p<0.01). CR could improve intra-atrial activation in subjects after MI, but the consequences of hemodynamic adjustment of the trained heart must undergo a more accurate evaluation to verify if CR can prevent adverse arrhythmogenic complications of Ml through cardiovascular performance improvement.
Comparison of Clinical Echocardiographic and Hemodynamic Characteristics of Male and Female Patients who Underwent Mitral Balloon Valvuloplasty
Authors: Yetkin Ertan , Çehreli Sengül , ileri Mehmet , Şenen Kubilay , Atak Ramazan , Yanik Ahmet , Yetkin Özkan , Şaşmaz Hatice
Published: July 2008

The clinical echocardiographic and hemodynamic characteristics and outcome of male and female patients before and after valvuloplasty were evaluated. The study population consisted of 34 male and 122 female consecutive patients who successfully underwent percutaneous balloon mitral valvuloplasty (PBMV). Clinical, echocardiographic, and hemodynamic variables were compared between male and female patients. Male patients were significantly older than female patients at the time of PBMV (39 years vs 34 years p < 0.05). Mitral valve score was significantly higher in male patients (p<0.01). The mitral valve area before PBMV in male patients was significantly less than that in female patients (0.97 ±0.22 cm2 vs 1.09 ±0.25 cm2, respectively, p<0.05). The pulmonary artery pressures of female patients before PBMV were higher than those of males (48 mm Hg vs 40 mm Hg, respectively, p<0.05). The restenosis rates in male and female patients at the end of the follow-up period (38 months) were 20% and 9%, respectively (p < 0.05). In conclusion, male patients are older than female patients at the time of the PBMV procedure, and male patients have worse echocardiographic parameters and restenosis rates than female patients with the exception of pre-procedural pulmonary artery pressure.
Transcutaneous PO2 Response to Transient Arterial Occlusion In Peripheral Vascular Disease Detected by Heating Power Oximeter
Authors: Frau Giuseppe
Published: July 2008

Transcutaneous PO 2 (TcpO2) was measured in 30 patients with peripheral arterial obstructive disease (PAOD) and in 30 age-matched controls in the hand and foot using a heating power electrode oximeter (HP-E). The HP-E was connected with a software modified monitor to simul taneously record changes in arterial stasis in the skin (TcpO 2 mm Hg) and in the underlying tissue 3.5 to 4 mm from the HP-E (TcpO 2 mW). In the hands of patients with PAOD, the following was found, lower mean values of the rest flow (R-F) and of the recovery area (Rc-Ar); delayed appearance of both a PO2 decrease after the start of stasis (ODT) and the increased value after the cuff deflation (ORT); and little relevance of flow changes in the tissues under the HP-E. In the foot homolateral to the obstructive lesion, the hemodynamic effects of the stasis were not consistently a result of circulatory insufficiency. In light-medium PAOD the correlation was more significant with the walking-free distance (WFD). However in severe PAOD, the perfusion was usually depressed and the variable values tended to flatten. This study confirmed the diagnostic reliability of this test in PAOD patients. Furthermore simulta neous exploration of two microvessel levels increased its diagnostic possibilities.
Plaque Rupture on the Carotid Artery Observed by Doppler Ultrasonography
Authors: Ohyama Hideo , Mizushige Katsufumi , Takahashi Tsutomu , Hosomi Naohisa , Kohno Masakazu
Published: July 2008

Plaque rupture may play an important role in acute cerebral events. Recent technological advances in ultrasonographic systems provide a feasible diagnostic modality of atheroscle rotic lesion by clearly visualizing flow conditions and vessel morphology. A 58-year-old man with chronic renal failure underwent duplex Doppler ultrasound in which ruptured plaque on carotid arterial wall was imaged. Color Doppler imaging showed that the plaque shoulder at the proximal site was hit by forward flow to the brain and ruptured. Curling flow in the inner space of the plaque was observed. Carotid arteriography at the corresponding site of ruptured plaque revealed the space within the plaque similarly contrasted. A magnetic resonance imaging of brain performed after identifying plaque rupture revealed small cerebral infarcts at the cerebral cortex. Plaque rupture could be demonstrated by color Doppler imaging at the proximal edge of plaque and curling flow in the intraplaque space may have released small thrombi to vessel lumen. Plaque rupture of the carotid artery may play an important role in the development of small cerebral infarction.
Venous Thrombosis from Air Travel: The LONFLIT3 Study
Authors: Cesarone Maria Rosaria , Belcaro Gianni , Nicolaides Andrew N. , Incandela Lucrezia , De Sanctis Maria Teresa , Geroulakos George , Lennox Andrew , Myers Kenneth A. , Moia M. , Ippolito Edmondo , Winford Michelle
Published: July 2008

The LONFLIT1 and 2 studies established that in high-risk subjects after long (> 10 hours) flights, the incidence of deep venous thrombosis (DVT) may be between 4% and 6%. The LONFLIT3 study aimed to evaluate methods of prevention in high-risk subjects. Of 467 subjects contacted for the study, 300 were included. These 300 subjects at high risk for DVT were randomized, after informed consent, into three groups: 1) a control group that had no prophylaxis; 2) an aspirin treatment group, in which patients were treated with 400 mg , (tablets of oral, soluble aspirin; one dose daily for 3 days, starting 12 hours before the beginning of the flight); and 3) a low-molecular-weight heparin (LMWH) group, in which one dose of enoxaparine was injected between 2 and 4 hours before the flight. The dose was weight-adjusted (1000 IU [equivalent to 0.1 mL] per 10 kg of body weight). Subjects with potential problems due to prophylaxis with aspirin or LMWH or at risk of drug interactions were excluded. Of the 100 included subjects in each group, a total of 249 subjects completed the study (dropouts due to low compliance or traveling/connections problems were 17%). Age and sex distribution were comparable in the three groups as well as risk distributions. Mean age was 47 (range, 28-75; SD, 11; 65% males). Of the 82 subjects in the control group, there were 4.82% of subjects with DVT with two superficial thromboses. In total 4.8% of limbs suffered a thrombotic event. Of 84 subjects in the aspirin treatment group, there were 3.6% of patients with DVT and three superficial thrombosis. In total 3.6% of limbs had a throm botic event. In the LMWH group (82 subjects), there were no cases of DVT. One superficial thrombosis was documented. In total only 0.6% of limbs had a thrombotic event (p < 0.002 in comparison with the other two groups). DVT was asymptomatic in 60% of subjects; 85% of DVTs were observed in passengers in non-aisle seats. Mild gastrointestinal symptoms were reported in 13% of patients taking aspirin. One dose of LMWH is an important option to consider in high-risk subjects during long-haul flights.
Validity of the Leg-O-Meter, an Instrument to Measure Leg Circumference
Authors: Bérard Anick , Kurz Xavier , Zuccarelli François , Abenhaim Lucien
Published: July 2008

The objective of this study was to validate the Leg-O-Meter measure against the clinical assessment of edema made by physicians using data from a 1-year follow-up study of unse lected patients with chronic venous disease of the leg (CVDL). The Leg-O-Meter consists of a tape measure fixed to a stand attached to a small board on which the patient is in standing position. Its reliability has been shown to be above 97%. Data from the Venous Insufficiency Epidemiologic and Economic Study (VEINES) were used: 1,521 patients from France, Belgium, Italy, and Quebec (Canada) who spontaneously consulted a physician between 1994 and 1995 with a complaint resulting from venous problems of the legs were included. Baseline variables included leg circumference measurements using the Leg-O-Meter; physicians were also asked to diagnose edema and report it as present or absent on each leg. Clinical edema and leg circumferences were assessed again 3 to 6 months after the baseline visit and 12 months after baseline. The tape measure of the Leg-O-Meter was fixed at 13 cm from the floor. The first and last assessments were used to evaluate the variation in edema during the follow-up period. Clinical variation in edema status was assessed as follows: improved, if edema was diagnosed at baseline but not at the final visit; unchanged, if edema was diagnosed at both visits; and worsened, if there was no diagnosis of edema at baseline but a diagnosis of edema was made at the final visit. Variation in measured edema was classified as improved if there was a decrease in leg circumference of more than 1 cm between baseline and final evaluation; unchanged, if the difference in leg circumference was between plus or minus 1 cm between the 2 assessments; and worsened, if there was an increase in leg circumference greater than 1 cm between the 2 assessments. Data-driven cut-off points were also used: 1.3 cm and 1.5 cm. Sensitivity and specificity of the Leg-0-Meter using physician diagnosis as "gold standard" were calculated. In addition, receiver operating characteristics (ROC) curves were calculated by using the 3 different leg circumference cut-off points in order to determine the accuracy of the Leg-O-Meter to detect changes in edema. The overall accuracy of the Leg-O-Meter was 0.84 (standard error (se) = 0.06). Accuracy was greater when 1.5 cm was used as a cut-point. The Leg-O-Meter is an objective, reliable, and standardized instrument to assess patients over time. A change of 1.5 cm between 2 measurements gives a valid estimate of improvement or worsening of edema, when compared to physicians' diagnosis. The Leg-O-Meter is also sensitive to any changes in leg circumferences, which is an advantage over the clinical evalu ation of edema.
Evaluation of Plasma Endothelin-1 Levels in Patients with Cerebral Infarction
Authors: Alioglu Zekeriya , Örem Asim , Bülbül Ismail , Boz Cavit , Özmenoğlu Mehmet , Vanizor Birgül
Published: July 2008

Endothelin-1 (ET-1) is a vasoconstrictor peptide derived from endothelium. Many authors have shown that ischemic stroke is associated with elevated plasma ET-1 levels. Also, the present findings related to plasma ET-1 levels with clinical status, size of the infarction, location of the infarction, and prognosis of the cerebral infarction were contradictory. In this study, plasma ET-1 levels in 30 patients with cerebral infarction within 72 hours after the onset of focal neurologic deficit and at their seventh day postinfarction were measured by a microplate enzyme immunoassay. Thirty sex- and age-matched healthy subjects were accepted as a control group. The mean plasma ET-1 concentrations in patients on admission, in patients at day 7, and in control subjects were 1.93 ± 1.79, 1.03 ± 1.02, and 0.65 ±0.32 fmol/mL, respec tively. The mean plasma ET-1 level of patients on admission was found to be significantly higher than in patients at day 7 and in control subjects (p < 0.05). No significant difference in ET-1 levels was observed between the patients at day 7 and control subjects. Furthermore, there was no correlation between plasma ET-1 concentration and size of infarction, location of infarction, degree of clinical neurologic deficit, or prognosis of cerebral infarction. It was concluded that plasma ET-1 levels shortly after ischemic stroke were increased, which may be associated with the acute-phase reaction of cerebral infarction and may have deleterious effects on development of neuronal injury.
Emergency Coronary Stenting for Complete Thrombotic Occlusion of an Unprotected Left Main Coronary Artery in Acute Myocardial Infarction Complicated by Cardiogenic Shock in an Octogenarian Patient
Authors: Tariq M. , Carroll R. , Zabih I. , Stenberg R.G. , Hussain K.M.A.
Published: July 2008

This report concerns an 82-year-old white man, who was admitted with cardiogenic shock secondary to an acute anterior myocardial infarction with right bundle branch block requiring an intra-aortic balloon pump for hemodynamic support and mechanical ventilatory support for respiratory distress. An immediate cardiac catheterization with coronary angiography revealed a complete thrombotic occlusion of the left main coronary artery. Prompt stent-supported percutaneous transluminal coronary angioplasty to the occluded left main coronary artery, a critical stenosis of the ostial left anterior descending artery, and the left circumflex coronary artery, allowed for recovery from this life-threatening condition and subsequent discharge from the hospital of this octogenarian patient. It is suggested that in a critical clinical condition with particularly challenging coronary anatomical findings, stent-supported coronary angio plasty can be lifesaving treatment in selected patients with octogenarian status with acute myocardial infarction.
Clinical, Bacteriologic and Echocardiographic Evaluation of Infective Endocarditis in Ankara, Turkey
Authors: Heper Gulumser , Yorukoglu Yavuz
Published: July 2008

This study consists of a retrospective evaluation of microbiologic, echocardiographic, and clinical characteristics of patients with infective endocarditis seen at Türkiye Yüksek Ihtisas and SSK Ihtisas Hospitals during the previous 5 years to provide a basis for comparison with other series. The study was performed retrospectively. The mean age of the patient population, which consisted of 74 cases, was considerably low (24.6 ± 12.3 yr). The majority of the patients were male (male/female = 1.96). Rheumatic valvular disease was the underlying cardiac pathosis in 66% of the cases. Congestive heart failure, embolic episodes, and mortality were more frequent among those with echocardiographically demonstrable cardiac vegetations. The microbiologic profile was considerably different from that of other series. In addition, this popu lation showed a higher rate of congestive heart failure compared to other series. The patients with infective endocarditis in this series in the previous 5 years were found to be different from series reported from western countries.
Spontaneous Coronary Artery Dissection A Case Report and Review of the Literature
Authors: Mohamed Hassan A. , Eshawesh Abdulhamid , Habib Naiyer
Published: July 2008

Spontaneous coronary artery dissection remains an extremely rare cause of myocardial ischemia and infarction. The clinical picture of spontaneous coronary dissection is often sudden cardiac death or fatal myocardial infarction. This report describes a previously healthy woman who developed spontaneous coronary artery dissection. She presented with sudden onset of chest pain and was found to have evidence of acute inferior wall myocardial infarction. She received streptokinase immediately after admission to the coronary care unit. Coronary angio graphic studies revealed a linear dissection involving the proximal and mid segments of the right coronary artery.
Successful Surgical Resection of a Muscular Bridge in a Patient with Nonobstructive Hypertrophic Cardiomyopathy
Authors: Atmaca Yusuf , Özdöl Çağdaş , Pamir Gülgün , Kilickap Mustafa , Oral Derviş
Published: July 2008

The authors report a case of myocardial bridging associated with nonobstructive hypertrophic cardiomyopathy and severe intractable chest pain that was relieved by surgical resection of the muscular bridge. Surgical resection of a myocardial bridge may be considered in patients with refractory symptoms that can clearly be attributed to muscular bridge.
Primary Cardiac Lymphoma
Authors: Saotome Masao , Yoshitomi Yuji , Kojima Shunichi , Kuramochi Morio
Published: July 2008

Primary cardiac lymphoma, which is very rare, is generally regarded to have a poor prognosis. A case of a 69-year-old man with primary cardiac lymphoma diagnosed by antemortem exam ination is reported. A computed tomography scan of the chest demonstrated a huge right atrial mass with invasion into the other chambers. No mediastinal lymphadenopathy was detected. Cytologic analysis of pericardial effusion revealed diffuse large B-cell type non- Hodgkin malignant lymphoma. The patient died on the 18th day of chemotherapy (cyclophos phamide, hydroxydaunomycin, oncovin, and prednisone) due to low-output syndrome and multiple organ failure. At autopsy, massive gray-white tumor almost occupied the right atrium and invaded the right inferior lobe of the lung. Although prognosis of primary cardiac lymphoma remains poor, early diagnosis may improve the prognosis.
Clinical and Angiographic Outcomes of Diabetic Patients After Coronary Stenting: A Comparison of Native Vessel Stent Restenosis Rates in Different Diabetic Subgroups
Authors: Heper Gülümser , Durmaz Tahir , Namik Murat S. , Örnek Ender
Published: July 2008

The main objectives of this study were to analyze the relationship between stent restenosis and microalbuminuria, which may express not only the glomerular vessels damage but also widespread microvascular dysfunction including coronary arterial disease, and to determine the angiographic and clinical outcomes of different diabetic subgroups after coronary stenting. Identification of the factors that may predict the outcome after coronary stent placement in diabetic patients could assist in deciding different stenting strategies in different diabetic subgroups. Control coronary angiographies were performed in 136 diabetic patients 6 months after coronary stent implantation. Patients were divided into 3 subgroups according to their microalbuminuria status. Clinical and angiographic outcomes and distribu tion of various risk factors were determined for these subgroups. Blood pressure and serum cholesterol concentrations were higher in the overt diabetic nephropathy group. The mean diseased vessel segment rate was lower in patients without microalbuminuria. Although the mean stent length and size were similar, patients without microalbuminuria had lower restenosis rates (23.9% vs 53.2% [microalbuminuria] and 46.2% [overt diabetic nephropathy] p < 0.01). Insulin therapy or gender caused no difference in restenosis rate. Although stent lengths and diameters were not different, patients with microalbuminuria had higher restenosis rates. The authors suggest that microalbuminuria may be an independent risk factor for restenosis in patients with diabetes.
Pulmonary Venous Flows Reflect Changes in Left Atrial Hemodynamics During Mitral Balloon Valvotomy
Authors: Yalçin Fatih , El-Amrousy Mahmoud , Müderrisoğlu Haldun , Korkmaz Mehmet , Flachskampf Frank , Tuzcu Murat , Garcia Mario G. , Thomas James D.
Published: July 2008

Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 ± 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 ±0.2 cm2 and 14.6 ±5.4 mmHg to 1.9 ±0.3 cm2 and 6.3 ± 1.7 mmHg, respectively (p<0.001). AR peak reverse flow velocity and AR duration decreased from 29 ±13 cm/s and 110 ±30 msec to 19 ±6 cm/s and 80 ±29 msec respectively (p<0.001). Transmitral Doppler E wave deceleration time decreased from 327 ±85 to 209 ±61 s and cardiac output increased from 4.2 ± 1.0 to 5.2 ± 1.1 L/minute (p<0.001). The changes in LA pressure were correlated with changes in S/D (r=0.57, p<0.05). The changes in endsystolic LA pressure-volume relationship were also correlated with changes in S/D (r=0.52, p<0.05). Endsystolic LA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.
Long-Term Survival in Truncus Arteriosus Communis Type A1 Associated with Ehlers-Danlos Syndrome
Authors: Carvalho Gustavo , Silva Alexander A. , Bestetti Reinaldo B. , Leme-Neto Antonio C.
Published: July 2008

Long-term survival is rare in patients with truncus arteriosus communis type A1 due to the early appearance of pulmonary artery obstructive changes. A 48-year-old woman with truncus arteriosus communis type A1 diagnosed with chest radiography, two-dimensional echocardio graphy, and cardiac catheterization is presented. The right ventricular pressure was 108 mm Hg , whereas the systolic pulmonary artery pressure was 98 mm Hg. A concomitant diagnosis of the Ehlers-Danlos syndrome was made with clinical findings. The association of Ehlers- Danlos syndrome, in which a collagen synthesis defect is observed in arterial vessels, might have interfered with pulmonary artery intimal proliferation, thus precluding the appearance of advanced pulmonary artery luminal obstructive changes and allowing long-term survival.