Introduction: Recent studies have shown a significant association between left atrial (LA) global longitudinal strain (GLS) and the progression of atrial fibrillation (AF) with significantly decreased LA GLS in patients with paroxysmal AF. Significantly higher levels of serum galectin-3 have also been found in patients with non-valvular AF. This study aimed to examine the relationship of the early stage of atrial fibrosis and reduced atrial deformation with serum galectin-3 concentration in middle-aged patients with a first episode of nonvalvular AF. Patients and Methods:This study prospectively enrolled 34 patients who were admitted to our emergency department and required either a medical or electrical cardioversion due to the first episode of AF, without any structural or coronary heart disease and with normal LA size. Additionally, 31 control subjects were also enrolled. The diameter, volume, and mechanical function of LA, including strain (S) and strain rate (SR), and serum galectin-3 levels were measured. Results:The average age was 48.5 ± 10.4 years. Galectin-3 values were not significantly different between the AF and control groups (r= 0.42; p= 0.51) and were found to correlate inversely with peak negative SR on apical four chamber (r= −0.31, p= 0.02) and two chamber (r= −0.25, p= 0.04) views. In comparison to the control group, the AF group had significantly lower values of peak systolic S on four chamber view (p= 0.037), peak late diastolic S (p= 0.04), peak positive SR on apical four-chamber view (p= 0.04), and peak late negative SR on apical four chamber (p= 0.03) and two-chamber (p= 0.02) views. Conclusion:Middle-aged patients with the first episode of AF and normal LA sizes had reduced LA reservoir and active atrial functions. Although beginning signs of LA functional remodeling were shown on S and SR imaging, these were not completely reflected by serum galectin-3 levels.Key Words: Atrial fibrillation; strain; strain rate; galectin-3 İlk Atak Non-valvular Atrial Fibrilasyonlu Orta Yaşlı Hastalarda Galectin-3 ÖZET Giriş: Biz bu çalışmada ilk atak non-valvular atriyal fibrilasyon (AF)'lu orta yaşlı hasta grubunda serum galectin konsantrasyonu ile AF erken evresi arasındaki ilişkiyi araştırdık. Hastalar ve Yöntem:Bu çalışmaya acil servisimize ilk atak AF ile başvuran, medikal ya da elektriki kardiyoversiyon yapılmış, yapısal ya da koroner kalp hastalığı olmayan normal LA boyuta sahip 34 hasta ve 31 kontrol hastası prospektif olarak dahil edildi. Ekokardiyografik bulgular kayıt altına alındı ve serum galectin düzeyleri ekokardiyografi öncesi alınan kan örneklerinden ölçüldü. Bulgular:Hastaların ortalama yaşı 48.5 ± 10.4 yıldı. Galectin değerleri arasında AF ve kontrol grubu arasında anlamlı fark saptanmadı (r= 0.42 ; p= 0.51) ve apikal dört boşluk (r= -0.31, p= 0.02) ve iki boşluk görüntü-den (r= -0.25 , p= 0.04) pik negatif SR ile negatif korele bulundu. Kontrol grubu ile karşılaştırıldığında, AF grubunda dört boşluk görüntüden pik sistolik strain (p= 0.037), pik geç diastolik strain (p= 0.0...

ÖZGiriş ve Amaç: Bu çalışmada merkezimizde transkateter aortik kapak implantasyonu (TAVİ) uygulanan hastaların erken ve geç dönem klinik ve ekokardiyografik takip sonuçları değerlendirildi.Hastalar ve Yöntem: 2011-2013 yılları arasında kliniğimizde ciddi aort darlığı (AD) nedeni ile TAVİ uygulanan 48 hastanın erken ve geç dönem sonuçları değerlendirildi. Tüm hastalara transfemoral yaklaşım ile CoreValve biyoprotez kapak yerleştirildi ve hastalar 17,4±15,3 ay takip edildi. Bulgular:Hastaların (24'ü kadın, ortalama yaş 77,4±8,1) işlem öncesi ortalama aortic kapak alanı (AVA) 0,7±0,2 cm 2 , ortalama aortik kapak gradiyenti (MnG) 55,4±19,8 mmHg, fonksiyonel sınıfı New York Kalp Cemiyeti (NYHA)'ne göre 2,5±0,4 iken, TAVİ işlemini takiben AVA, MnG ve fonksiyonel sınıflamalarında anlamlı düzelme görüldü. İşlem başarısı %87,5 olup, hastalara ortalama 1,5±0,5 kapak implante edildi. 1 hastada kapak implantasyonu sonrası hemodinamiyi bozan ileri paravalvüler AY geliştiği için cerrahi aort kapak replasmanı yapıldı. İşlemde 3 hastada AV tam blok, 2 hastada koroner obstrüksiyona bağlı ventriküler taşikardi; işlem sonrası erken dönemde ise 3 hastada geçici iskemik atak, 2 hastada minör kanama gelişti. 3 hasta işlemde gelişen kalp tamponadı nedeniyle, 1 hasta işlem sonrası 28. gün enfeksiyon ve sepsis nedeniyle, 2 hasta kompleks ventriküler artimiye bağlı kardiyak arrestten, 2 hasta da 1. ve 4. aylarda kalp dışı nedenlerden hayatını kaybetti. İşlemin 3 yıllık yaşam süresi %75 bulundu.Sonuç: Cerrahi riski yüksek veya opere edilemeyecek olan semptomatik AD hastalarında, cerrahiye alternatif bir tedavi yöntemi olarak klinik pratiğe girmiş olan TAVİ işlemi, erken ve geç dönem sonuçları itibariyle başarılı ve güvenilir bir yöntemdir.Anahtar kelimeler: aort darlığı, ekokardiyografi, transkateter Acar ve ark. / Aort darlığında TAVİ ABSTRACT Background: The early and late term results of who underwent transcatheter aortic valve implantation (TAVI) in our center were evaluated in this study. Patients and Methods:The early and late term results of 48 patients with severe aortic stenosis who underwent the TAVI procedure in our clinic between 2011 and 2013 years were evaluated. All of our patients were implanted with CoreValve bioprosthetic valves through the transfemoral approach and followed-up for 17.4±15.3 months.Results: Before the procedure, the mean aortic valve area (AVA) was 0.7±0.2cm 2 , the mean valvular gradients (MnG) were 55.4±19.8 mmHg and the mean functional class was 2.5±0.4. Following the TAVI procedure the AVA, MnG and functional class were improved, significantly. The technical success rate was %87.5, and mean 1.5±0.5 valves was implanted in all patients. Surgical AVR was required for 1 patient because of severe paravalvular leakage. At the procedure, in 3 patients third degree atrioventricular (AV) block and in 2 patient coronary occlusion were developed. The patients with third degree AV block was required permanent pacemaker. In the early term after TAVI in 3 patients transient ischemic attack and in 2 patients minors...

Post-myocardial infarction (MI) ventricular septal defect (VSD) one of the fatal complications of acute coronary syndrome-is a rare clinical situation (incidence, 1-2%) (1) . Post-MI VSD is often presented with total left anterior descending artery (LAD) occlusion; it mostly occurs at anterolateral localization and less often at posterior localization after inferior MI (2) . A 55 year old male patient came to the emergency room with chest pain. He was diagnosed with inferior MI and was taken to the angiography laboratory for primary percutaneous coronary intervention (PCI). There was ST elevation at the inferior leads on electrocardiogram. On angiography, LAD and circumfl ex artery (Cx) were normal-without critical stenotic lesions and distal RCA was totally occluded ( Figure 1A,1B,2A). The stenotic lesion was opened with successful PCI and stent implantation ( Figure 2B,C). The patient was discharged with cure. The same patient came with the complaints of fatigue and exertional dyspnea 1 month later. On echocardiography, a ventricular septal defect was seen at the anterior portion of the septum near the baseline segment of the heart. On arrival, his blood pressure was 90/60 mmHg and pulse was 100 bpm. He was immediately admitted to the ICU. After stabilization with inotropic support and intraaortic balloon pump, he was urgently taken to the operating room. The operation was performed under general anesthesia and cardiopulmonary bypass. An incision was made on the diaphragmatic surface of the heart through the left ventricle next to the interventricular septum. The interior of the left ventricle was exposed with this incision, and the septal defect on the anterior surface near the baseline of the heart was repaired with a Dacron patch. Being reinforced with Tefl on felt, the ventriculotomy incision was closed primarily ( Figure 3A,B,C). Post-MI VSD is often seen as a complication of anterior MI. It is primarily involved with total LAD occlusion and less often with additional Cx and/or right coronary artery (RCA) lesion(s). In this case, the interesting point is that LAD and Cx were completely normal without critical stenotic lesions while the isolated total RCA occlusion was seen. Post-MI VSD can be seen

Cancer-associated thrombosis worsens the lives of patients substantially. Venous manifestations of cancer-associated thrombosis include deep vein thrombosis and pulmonary embolism. Arterial events include stroke and myocardial infarction. In this patient, myocardial infarction and cardiogenic shock are associated with diffuse coronary thrombosis together with peripheral thrombosis. He had surgery because of bladder carcinoma. Severe hypercoagulable condition probably facilitated by cancer itself and surgery caused multivessel coronary and peripheral intense thrombus burden. Intracoronary 10 mcg/kg tirofiban bolus and 15 mg tissue plasminogen activator (tPA) were administered respectively before revascularization and thrombectomy operation was performed. Complete revascularization was achieved.

CorrespondenceA 69-year-old male patient presented with postprandial abdominal pain, food fear and signifi cant weight loss (25-30 kg) that gradually worsened over the past 4 years, suggesting a diagnosis of chronic mesenteric ischemia. Eight months ago, he had had a myocardial infarction (MI) followed by coronary artery bypass grafting (left internal mammarian artery to left anterior descending artery (LIMA-LAD) and aorta-circumfl ex artery (Ao-CX)), as well as a long-standing history of hypertension and smoking for years. Laboratory examination was normal with the exception of elevated fasting hyperglycemia (124 mg/dL). The electrocardiography showed sinus rhythm with right bundle branch block. He reports having undergone gastroenterology examination several times in the past. No pathology could be detected in endoscopy and colonoscopy. Celiac and mesenteric angiography were performed that demonstrated 90% stenosis of celiac artery. Considering the symptoms, intervention to the lesion was planned. The patient was taken to the angiography laboratory. Selective catheterization of the celiac trunk was performed by a 7F right Judkins catheter guide sheath through the femoral artery from anteroposterior and left lateral projections. Endovenously, 10.000 U of heparin was administered. The stenosis was passed by a 0.014 hi-torque extra support guidewire. The lesion was predilated with a 4.5 x 12 mm balloon. A 6.0 x 18 mm balloon expandable stent was implanted after ballooning. The lesion was fully opened. No complications occurred. After the procedure, the patient was completely symptom-free during and after meals, which also provided signifi cant psychological relief due to recuperation of the ability to eat without fear.