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Öğe A case of hypothyroidism mimicking acute coronary syndrome(Springer, 2006) Gündüz , Hüseyin; Arınç, Hüseyin; Yolcu, Mustafa; Akdemir, Ramazan; Kanat, Mustafa; Uyan, CihangirHypothyroid patients have increased concentrations of creatinine kinase that is mostly due to increased CK-MM. However, CK-MB has also been reported to increase above reference values in hypothyroid patients without apparent myocardial damage. This may create confusion during the evaluation of myocardial injury in a hypothyroid patient presenting with chest pain. Troponin I is considered as a superior marker for the diagnosis of myocardial infarction in hypothyroid patients. However, there are some reports showing an increase in the level of troponin I without any myocardial damage in hypothyroid patients as in our case. In this report, we present a 47 years old male hypothyroid patient who had chest pain, abnormal electrocardiographic findings and increased cardiac enzymes suggesting acute coronary syndrome although he had normal coronary arteriogram.Öğe A closed interatrial septal aneurysm mimicking a tumor in the left atrium(Texas Heart Inst, 2006) Akdemir, Ramazan; Duran, Sadık; Bulur, Serkan; Kaya, Ahmet; Sözen, Serhat Bahadır; Bilir, Cemil; Uyan, Cihangir…Öğe Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation(Blackwell Publishing, 2005) Akdemir, Ramazan; Özhan, Hakan; Bulur, Serkan; Ünlü, Hakan; Gündüz, Hüseyin; Arınç, Hüseyin; Uyan, CihangirPurpose: The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). Methods: We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients, and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA), and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these three methods was determined. Results: The mean RFPV for mild, moderate, and severe MR were 26.4 +/- 7 cm/sec, 43.3 +/- 7 cm/sec, and 60.3 +/- 7.3 respectively (P < 0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1%-64.3% for mild and 100%-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC, and RJA (P < 0.0001, r = 0.87; P < 0.0001, r = -0.84, P < 0.0001, r = 0.76, respectively). Conclusion: This results show that RFPV is a reliable and simple semiquantitative new method that can be used for determining severity of MR.Öğe Complete atrioventricular block in Becker Muscular Dystrophy: A case report(2003) Akdemir, Ramazan; Uyan, Cihangir; İmirzalıoğlu, Necat; Yazıcı, MehmetCardiac involvement in Becker Muscular Dystrophy, including dilated cardiomyopathy, mild to moderate degree mitral regurgitation, cardiac conduction system abnormalities and various arrhythymias, is one of the leading problems during the progression of the disease (1,2). But, complete atrioventricular block associated with Becker Muscular Dystrophy which necessitates permanent pacemaker implantation is a rare condition. We reported a patient with Becker Muscular Dystrophy which complicated complete atrioventricular block and dilated cardiomyopathy.Öğe Ebstein's anomaly in siblings: an original observation(Kluwer Academic Publ, 2002) Uyan, Cihangir; Yazıcı, Mehmet; Uyan, Ayten Pamukçu; Akdemir, Ramazan; İmirzalıoğlu, Nejat; Dokumacı, BarbarosSiblings, a 26-year old male and a 31-year old female, were found do have Ebstein's anomaly. Ebstein's anomaly is characterized by a downward displacement of the tricuspid valve into the right ventricle due to anomalous attachment of the tricuspid leaflets. Echocardiography is the method of choice to diagnose Ebstein's anomaly on its own or in association with other heart defects. Complications such as right ventricular failure, infective endocarditis, and paradoxical embolism can occur. Ebstein's anomaly diagnosed in adult life is a benign and stable disease, particularly if the patient is asymptomatic. These cases may represent a familial form of Ebstein's anomaly.Öğe The effect of decreasing preload on valvular regurgitation in patients undergoing dialysis [Diyalize giren hastalarda önyük azalmasinin kapak yetersizliklerine etkisi](Turkiye Klinikleri, 2005) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Akdemir, Ramazan; Oğuzhan, Abdurrahman; Uyan, CihangirObjective: In chronic renal patients undergoing dialysis, calculations of left ventricular diameter and mass may be inordinately large and valve regurgitation may be develop to a high degree as a result of volume overload. In our study, we investigated the effect of ultrafiltration on left ventricular and atrial diameters, as well as on the collapsibility of the inferior vena cava and severity of valvular regurgitation present before dialysis. Material and Methods: A total of 30 patients, 16 male and 14 female, with a diagnosis of end-stage renal disease with hypervolemia and scheduled to undergo ultrafiltration in addition to hemodialysis were included in our study. Before and after ultrafiltration, left ventricular diastolic and systolic diameters, interventricular septum and posterior wall diastolic and systolic thicknesses, left atrial and aortic root diameters, and the severity of pericardial effusion, if present, were noted. Mitral, tricuspid, aortic and pulmonary valve functions were measured and, if regurgitation was present, its severity was staged in 4 categories. Inferior vena cava expiratory and inspiratory diameters were measured and a collapsibility index was calculated. Results: There was a significant decrease in left atrial and ventricular diastolic and systolic diameters after hemodialysis. Although the severity of mitral and tricuspid regurgitation decreased significantly, aortic and pulmonary regurgitation was not affected. A significant decrease in IVC expiratory and inspiratory diameters and an increase in collapsibility were noted. Conclusion: Dialysis causes significant changes in hemodynamic and echocardiographic parameters due to a decrease in intravascular fluid. In particular, a decrease in the presence and severity of valvular regurgitation occurs as a result of this procedure. Copyright © 2005 by Türkiye Klinikleri.Öğe Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocardial infarction: Primary angioplasty versus thrombolytic therapy(2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Tamer, Ali; Yazıcı, Mehmet; Erbilen, Enver; Uyan, CihangirAtrial fibrillation is a common arrhythmia occurring in about 10-20% of patients with acute myocardial infarction. P-wave dispersion and P-wave duration have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P wave duration and dispersion in patients with acute anterior wall myocardial infarction. We have retrospectively evaluated 72 consecutive patients (24 women, 48 men; aged 58 ±12 years) experiencing a first acute anterior wall myocardial infarction (AMI). Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and on pach day of hospitalization. Maximum (P max) and minimum (P min) P wave durations and P wave dispersions (PWd) were calculated before and after treatment. There were no significant differences between the groups regarding age, gender, left ventricular ejection fraction (LVEF), left atrial diameter and volume, cardiovascular risk factors and duration from symptom onset to treatment. PWd and P wave durations were significantly reduced after PTCA (mean P max was 113±11 ms before and 95±17ms after the treatment [p=0.007]. Mean PWd was 46±12 ms before and 29±10 ms after the treatment (p=0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97±22 ms versus 114±16 ms and for PWd 31±13 ms versus 55±5 ms, respectively). Primary angioplasty reduces P max and P wave dispersion.Öğe Elastic properties of the ascending aorta and left ventricular function in patients with hypothyroidism(Blackwell Publishing, 2005) Özhan, Hakan; Yazıcı, Mehmet; Albayrak, Sinan; Erbilen, Enver; Bulur, Serkan; Akdemir, Ramazan; Uyan, CihangirBackground: We sought to clarify the possible role of elastic properties of the ascending aorta in the development of cardiac disease associated with hypothyroidism (HT). Methods: A total of 37 patients with HT (age: 39.3 +/- 8.9years) and 29 control subjects were studied. AscendingAortic (Ao) diameter, Ao elastic indexes, strain (AoST), distensibility (AoD), stiffness index (AoSI), and pressure strain modulus were calculated from the echocardiographically derived Ao diameters. Myocardial performance index (MPI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) were measured by Doppler echocardiography to assess diastolic LV function. Patients were treated with levothyroxine and followed-up for 6 months. Thyroid function tests and echocardiographic measurement's were repeated at the end of the study. Results: AoD (cm(2) dyn(-1) 10(-3)) and AoST (%) were significantly lower (3.8 vs. 6.1; P < 0.001, 7.4 vs. 12.6, P < 0.001; respectively), whereas AoSI was higher in HT patients (6.2 vs. 3.3; P < 0.001). After treatment, AoD and AoST were increased (5.7; P < 0.001 and 11.8; P < 0. 001; respectively), whereas AoSI was decreased significantly (3.7; P < 0. 001). Also, early / late mitral peak velocity ratio (Emax/Amax) was significantly lower in HT patients (1.19 vs 1.34; P < 0.001), whereas MPI was higher (0.52 vs. 0.42; P < 0.001). MPI showed a strong correlation with aortic root indexes [AoST (r = -0.61/P < 0.001); AoD, (r = -0.57/P < 0.002); AoSI, (r = 0.531P < 0.005)] in the HT group. After 6 months of therapy, MPI significantly decreased P < 0.001) and EIA ratios were normalized (P < 0.001). Conclusions: Ao root functions have an important role on diastolic LV function. Levothyroxine replacement therapy can reverse all of these adverse effects of HT.Öğe Embolised stent into the circumflex coronary artery during percutaneous coronary intervention(International Heart Journal Association, 2006) Uyan, Cihangir; Gündüz, Hüseyin; Arınç, Hüseyin; Akdemir, RamazanDislodgement and embolisation of the new generation of coronary stents before deployment are rare. If it is impossible to withdraw the embolised stent from the coronary artery, the stent may be crushed into the side wall of the coronary artery with a balloon over a wire passed alongside the embolised stent.Öğe Evaluation of right ventricular function in patients with thyroid dysfunction(Karger, 2006) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Seyfeli, Ergün; Kanat, Mustafa; Özhan, Hakan; Uyan, CihangirBackground: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. Patients and Methods: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. Results: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. Conclusions: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals. Copyright (c) 2006 S. Karger AG, Basel.Öğe Heart rate turbulence and heart rate variability in patients with mitral valve prolapse(Oxford Univ Press, 2006) Gündüz , Hüseyin; Arınç, Hüseyin; Kayardı, Mahmut; Akdemir, Ramazan; Özyıldırım, Serhan; Uyan, CihangirAims Heart rate turbulence (HRT) and heart rate variability (HRV) have been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. However, the predictive valsue of HRV alone is modest and information on HRV in patients with mitral valve protapse (MVP) has so far been conflicting. In addition, no studies have previously evaluated HRT in patients with MVP. To define better the effects of MVP on cardiac autonomic function, we assessed HRT and time-domain parameters of HRV in patients with MVP. Methods and results Fifty patients with MVP and 70 controls without MVP were investigated. The diagnosis of MVP was confirmed by cross-sectional echocardiography in the parasternal long-axis view and apicat 4-chamber view. The HRV and turbulence analysis were assessed from a 24-hour Hotter recording. When HRT parameters were compared, the values of the HRT onset and slope were significantly lower in MVP patients than in the controls group (-0.109 +/- 0.207 vs. -0.289 +/- 0.170%, P = 0.001 and 8.6 +/- 7.2 vs. 11.5 +/- 7.4 ms/RRI, P = 0.043, respectively) and the number of patients who had abnormal HRT onset was significantly higher in the MVP group than in controls (15 vs. 8, P = 0.011). In addition, HRV parameters were not statistically different between the two groups. Conclusion Although we found that the decrease in HRV parameters was not significantly different between MVP patients and controls, HRT variables (especially HRT onset) were significantly lower in MVP patients. Therefore, in our opinion, HRT is an attractive, easily applicable, and better way of non-invasive risk prediction compared with another non-invasive risk predictor, HRV.Öğe HLA-DR B1 and DQ B1 polymorphisms in patients with coronary artery ectasia(Acta Cardiologica, 2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Erbilen, Enver; Yazıcı, Mehmet; Duran, Sadık; Uyan, CihangirObjectives - The purpose of our study was to evaluate the significance of polymorphisms in HLA class II genes in coronary artery ectasia (CAE) patients. Methods and results - Twenty-six patients with CAE without associated cardiac defects were enrolled in the study. CAE was defined as luminal dilation of 1.5- to 2.0-fold of normal limits. Ninety-five healthy subjects who were donors for different organ transplantations, were chosen as control group. Physical examination, electrocardiography and chest X-ray were completely normal in these cases. Both the patients and the control group were screened and compared for their HLA class II genotypes. HLA-DR BI * 13, DR 16, DQ2 and DQ5 genotypes were significantly more frequent in the patient group. When the known risk factors of coronary heart disease were compared in the patients carrying these genotypes with the non-carrying group, no significant differences were encountered. Conclusions - HLA-DR BI * 13, DR 16, DQ2 and DQ5 may be associated with the pathogenesis and increase the risk of CAE.Öğe Images in Emergency Medicine: Acute severe coronary spasm associated with 5-fluorouracil chemotherapy(Bmj Publishing Group, 2006) Duran, Sadık; Bulur, Serkan; Sözen, Serhat Bahadır; Bilir, Cemil; Uyan, Cihangir; Akdemir, Ramazan…Öğe Immediate and six months clinical and angiographic results of intracoronary Ephesos stent implantation: the "Ephesos-1" study(Taylor & Francis Ltd, 2005) Uyan, Cihangir; Akdemir, Ramazan; Gündüz , Hüseyin; Özhan, Hakan; Arınç, HüseyinBackground - This study was conducted to evaluate the clinical and angiographic results of the Ephesos stent implantation in patients with symptomatic coronary artery disease. The Ephesos stent is a new balloon-expandable, stainless steel, tubular stent with multicellular design. Methods - One hundred ten patients with native coronary artery disease were included in the study. The Ephesos stents were implanted in 163 de novo lesions detected in these patients. Immediate and long-term clinical and angiographic follow-up results were evaluated. Results - Most of the patients had unstable angina 63.6%, and 36.7 % of the lesions were type B and C. Mean lesion length was 12.7 +/- 4.7. In 62% of the patients the reference lumen diameter was < 3 mm. One Q-wave and one non-Q-wave myocardial infarction (MI) occurred due to acute thrombotic occlusion during hospital stay. The 6-month event-free survival rate was 77.3%. No patients died in the six-month follow-up period, but 2 patients had non-Q wave MI and I patient experienced Q-wave MI within this period. Control angiographic data was collected from I 10 patients (100% of patients and a total of 163 lesions). Angiographic restenosis rate was 18.1 %. Twenty-two patients with restenosis had repeated target lesion balloon dilatation. Conclusion -The results of the present study showed that the Ephesos stent is a safe and effective choice with a low incidence of major adverse cardiac events and restenosis rate within six months of follow-up.Öğe KOAH'lı istirahat koşullarında ekspiratuar akım hızları ve arter kan gazı değerlerinin egzersiz performansına etkisi(2002) Yazıcı, Mehmet; Arbak, Peri Meram; Balbay, Öner Abidin; Maden, Emin; Erbaş, Mete; Erbilen, Enver; Uyan, CihangirBu çalışmada KOAH'lılarda istirahat koşullarında ekspiratuar akım hızları ve kan gazı değerlerinin yürüme bandında efor testi parametreleri (treadmill exercise testing parametres: TETP) ile ilişkisi ve bunun hastalığın şiddetini öngörmedeki değeri araştırılmıştır. Bu çalışmaya 45 KOAH'lı hasta (kadın/erkek: 9/36, yaş ortalaması: 6111yıl) ve 21 sağlıklı birey (kadın/erkek: 4/17, yaş ortalaması: 6010 yıl) alındı. Tüm KOAH'lı hastalar (I. grup, FEV1 %51.37.2) FEV1 değerlerine göre 3 altgruba (II. grup/hafif KOAH, FEV1 %60-79, III. grup/orta düzeyde KOAH, FEV1 %40-59, IV. grup/ileri derecede KOAH, FEV1 %40 ) ayrıldı. Kontrol grubunda FEV1 %80 idi. Tüm gruplara istirahat koşullarında spirometri ile SFT ve sonrasında semptomla sınırlı maksimum efor testi uygulandı. Toplam koşu süresi (TKS), toplam metabolik eşdeğerleri (TMET), maksimum VO2 ( mVO2) düzeyleri ve maksimum kalp hızı (mKH), III. grup (mV02: 17.64.9; p0.0001, TKS: 3.81.1; p0.0001, TMET: 4.81.3, p0.001, mKH: 127.917.3 p0.01) ve IV. grupta (mVO2: 15.25.3, p0.0001, TKS: 3.31.2, p0.0001, TMET: 3.91.5, p0.0001, mKH: 114.915.6, p0.001) kontrollere (mVO2: 27.35.9, TKS: 7.11.3, TMET: 8.32.2, mKH: 137.313.4) göre anlamlı farklılık göstermekteydi. Ek olarak IV. grupta ventriküler erken atım sayısı (VEAS) kontrol grubuna göre anlamlı olarak artmıştı (2.91.4'e 1.71.1, p0.01). Hafif KOAH grubunun tüm değerleri kontrol grubuna benzerdi. FEV1 ile TETP arasında III. grupta (mVO2: r0.35/p0.005, TKS: r0.31/p0.01, TMET: r0.29/p0.01) ve IV. grupta (mVO2: r0.49/p0.001, TKS: r0.45/p0.005, TMET: r0.31/p0.01, mKH: r0.29/p0.01, VEAS: r0.27/p0.05) anlamlı korelasyonlar saptandı. Ayrıca IV. grupta PaO22 değerleri ile TETP arasında da benzer bir ilişki (mVO2: r0.43/p0.005, TKS: r0.35/p0.01, TMET: r0.32/p0.02, mKH: r0.31/p0.03, VEAS: r-0.29/p0.05) bulundu. Bu çalışmada orta-ileri derecede KOAH'lılarda istirahat ekspiratuar akım hızları ve PaO2 değerleri ile efor testi parametreleri arasında yakın bir ilişki olduğu ve bu ilişkinin hastalığın ciddiyetini öngörmede önemli bir rolü olabileceği sonucuna vardık.Öğe Koroner anjiyografi yapılan hastalarda iohexolün solunum fonksiyon testi parametrelerine etkisi(2004) Akdemir, Ramazan; Özhan, Hakan; Balbay, Öner Abidin; Erbaş, Mete; Gündüz, Hüseyin; Arbak, Peri Meram; Uyan, CihangirAmaç: Damar içine uygulanan anjiyografik kontrast ajanlara bağlı olumsuz yan ekilerin varlığı daha önceki çalışmalarda bildirilmiştir. Bu çalışmanın amacı günlük uygulamada “iohexolün”ün koroner anjiyografi sırasında kullanımına bağlı solunumsal etkilerini incelemektir. Materyal ve Metod: Koroner arter hastalığı ön tanısıyla koroner anjiyografi yapılan 30 hasta çalışmaya alındı. Kronik obstruktif akciğer, bronşiyal astım, miyokard infarktüsü ve ekokardiyografik olarak saptanmış sol ventrikül sistolik disfonksiyonu olan hastalar çalışmaya alınmadı. Koroner anjiyografiden hemen önce ve sonra solunum fonksiyon testi yapıldı ve kan gazı bakıldı. Hastalar anjiyografide koroner arter hastalığı olanlar (Grup1) ve olmayanlar (Grup2) şeklinde ikiye ayrıldı. Koroner anjiyografi işlemi tek deneyimli bir operatör tarafından yapıldı. Protokol gereği hastaların hiç birine sol ventrikülografi yapılmadı. Bulgular:Koroner anjiyografi öncesi ve sonrası sonuçlar karşılaştırıldı. İşlem sonrası bakılan birinci saniye sonu forse orta ekspiryum volüm (FEV1), maksimum mid-ekspiryum akım hızı (MMFR) 25-75, arteriyel oksijen basıncı (PaO2),bikarbonat (HCO3) değerleri tüm hastalarda anlamlı derecede düşük bulundu ( p 0.01). İşlem sonrası bakılan FEV1 ve PaO2 Grup1’de diğer gruplara göre anlamlı derecede daha düşük bulundu ( p 0.01) Sonuç: Bilinen bir akciğer hastalığı olmayan hastalarda iohexol kullanılarak yapılan tanısal koroner anjiyografi, solunum fonksiyon testi parametrelerinde küçük, ama önemli bir bozulmaya yol açmaktadır. Bundan dolayı bilinen akciğer hastalığı olanlarda opak madde kullanımında dikkatli olunması gerekli olduğu sonucuna varıldı.Öğe Myocardial bridging of obtuse marginal branch of the left circumflex artery associated with congenital corrected transposition of the great arteries(Elsevier Ireland Ltd, 2005) Gündüz , Hüseyin; Akdemir, Ramazan; Tataroğlu, Cenk; Albayrak, Sinan; Erbilen, Enver; Akdemir, Nermin; Uyan, CihangirA 54-year-old male was admitted to the emergency department with progressive dyspnea and chest paint during exercise. Congenital corrected transposition of the great arteries was detected on echocardiography. Coronary angiography revealed myocardial bridging on the obtuse marginal branch of the left circumflex coronary artery. Being a rare complex cardiac anomaly we discussed the congenitally corrected transposition of the great arteries (CCTGA) in association with myocardial bridging. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe A new effect of acetylsalicylic acid ? Significantly lower prevalence of nasal carriage of Staphylococcus aureus among patients receiving orally administered acetylsalicylic acid(Univ Chicago Press, 2006) Karabay, Oğuz; Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Uyan, CihangirWe aimed to evaluate effect of acetylsalicylic acid on the prevalence of nasal carriage of Staphylococcus aureus. Patients were orally administered a prophylactic dose of acetylsalicylic acid and then were compared with control subjects. The prevalence of nasal carriage of S. aureus was significantly lower among patients who received acetylsalicylic acid than among the control subjects (P < .001).Öğe Paradoxical embolism in Ebstein's anomaly(2001) Uyan, Cihangir; Yazıcı, Mehmet; Uyan, Ayten Pamukçu; Dokumacı, BarbarosA 26-year-old man with Ebstein's anomaly had cerebellar infarction due to paradoxical embolism. Ebstein's anomaly is characterized by a downward displacement of the tricuspid valve into the right ventricle due to anomalous attachment of the tricuspid leaflets. Echocardiography is the method of choice to diagnose Ebstein's anomaly on its own or in association with other heart defects. Paradoxical embolism is a potential complication whenever a right to left shunt exists (for example, atrial septal defect). Ebstein's anomaly diagnosed in adult life is a benign and stable disease, particularly if the patient is asymptomatic; surgical correction must be performed if the patient becomes symptomatic because of either paradoxical embolism or worsening of the tricuspid regurgitation.Öğe The relation between homocysteine and calcific aortic valve stenosis(Karger, 2005) Gündüz , Hüseyin; Arınç, Hüseyin; Tamer, Ali; Akdemir, Ramazan; Özhan, Hakan; Binak, Emrah; Uyan, CihangirBackground: In patients diagnosed with calcific aortic valve stenosis, cardiac risk factors are similar to those of coronary artery disease; homocysteine concentration is an independent risk factor for coronary artery disease. The aim of this study was to investigate the correlation between plasma homocysteine levels and aortic valve stenosis and the influence of homocysteine levels on the coexistence of coronary artery disease in patients with moderate to severe aortic valve stenosis. Methods: Fifty-eight patients who had been diagnosed with moderate to severe aortic stenosis formed the test group of this study, and 47 healthy subjects without coronary artery disease or aortic valve stenosis formed the control group. The patients with aortic stenosis were divided into two groups according to the presence or absence of coronary artery disease in their coronary angiograms. After 12 h fasting venous blood samples were collected and total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and homocysteine levels were measured and compared between the two groups. Measurements and Results: The mean blood homocysteine level was 10.8 +/- 3.3 mu mol/l in patients with aortic valve stenosis and 8.1 +/- 4.7 mu mol/l in the control group; the difference between these levels was statistically insignificant. The patients with aortic valve stenosis had significantly higher levels of total cholesterol and hypertension and were more likely to have a positive family history for coronary artery disease. When the two subgroups of patients with aortic valve stenosis were compared, mean blood homocysteine levels were 13.2 +/- 3.1 and 8.3 +/- 2.2 mu mol/l, respectively, showing significantly higher levels in the group with coronary artery disease. In this comparison patients with coronary artery disease were also found to have significantly higher levels of total cholesterol and LDL and they were more likely to be smokers. Conclusions: Although there was no relation between blood homocysteine levels and the existence of aortic valve stenosis, in cases with both coronary heart disease and aortic stenosis homocysteine levels were significantly higher than in the patients with pure aortic valve stenosis. Copyright (c) 2005 S. Karger AG, Basel.
