No abstract

Hydatid cyst is a parasitic disease caused by Echinococcus granulosus. It is endemic in Asia, Africa, South America, and the Mediterranean region including Turkey. Cardiac involvement is rare. Surgery is the definitive treatment of cardiac hydatid cysts; however, to avoid recurrence after surgery, medical therapy should be also continued. Left ventricular free wall is the most common location, followed by the right ventricle and interventricular septum. Involvement of mitral valve is extremely rare. Herein, we present a case of hydatid cyst with myocardial involvement leading to severe mitral valve regurgitation which was successfully treated with surgery.

T ranscatheter aortic valve replacement (TAVR), also called transcatheter aortic valve implantation (TAVI), is often suitable for surgically high-risk or ineligible patients who have aortic stenosis. Although TAVR is less invasive than surgery, major vascular sequelae and strokes occur more often in TAVR groups than in surgical groups.1,2 Coronary artery obstruction during valve implantation is less frequent but can still be fatal. 3 We present the case of a patient whose left main coronary artery (LMCA) became obstructed by native-valve calculus 2 hours after TAVR. Case ReportIn November 2012, a 78-year-old woman, diagnosed 4 years earlier with severe degenerative aortic stenosis, presented with a one-year history of increasingly labored breathing and edema in the legs. She was being treated for hypertension, diabetes mellitus, severe chronic obstructive pulmonary disease, and heart failure (New York Heart Association functional class IV). In addition, she had a large umbilical hernia that could not be operated on because of the high surgical risk. This hernia reduced her respiratory capacity by pressing on the lungs through the diaphragm.Auscultation revealed S 3 and S 4 , a grade 4/6 systolic ejection murmur best heard in the aortic area and spreading through the carotid arteries, thin crepitant crackles extending to the middle zones of the right lung, and decreased breathing sounds in the left lung. The patient had 3+ pretibial edema. An electrocardiogram (ECG) showed atrial fibrillation and nonspecific ST-T changes. A chest radiograph showed a collapsed left lung.A transthoracic echocardiogram (TTE) revealed severe aortic stenosis (mean gradient, 59 mmHg), moderate tricuspid regurgitation, a systolic pulmonary artery pressure of 48 mmHg, and a left ventricular ejection fraction of 0.65. The patient's calculated Society of Thoracic Surgeons risk score was 5.5%; her Surgical Replacement and Transcatheter Aortic Valve Implantation score placed her at high risk. Because of her age and comorbid conditions, we decided to perform TAVR and not surgery. A transesophageal echocardiogram (TEE) showed a tricuspid aortic apparatus and bulky calculus on and between the valves (Fig. 1). The aortic annular size was 22 mm. Multislice computed tomograms showed no tortuosity or calcification of the iliofemoral arteries but revealed severe calculus on the aortic valve; the distance between the aortic annulus and LMCA was 13 mm (Fig. 2). Coronary angiograms revealed normal coronary arteries.In the catheterization laboratory, the patient was placed under general anesthesia. With use of TEE guidance and rapid temporary pacing, we performed aortic bal-

Background/aim: Transcatheter aortic valve implantation (TAVI) is an innovative approach to the treatment of aortic stenosis (AS) as an alternative to surgery in high-risk patients. Mean platelet volume (MPV) is considered an indicator of endothelial dysfunction, platelet function, and activation. In this study, we aimed to investigate MPV changes in patients undergoing TAVI. Materials and methods:This study included 100 patients diagnosed with symptomatic severe AS and treated with TAVI between July 2011 and August 2013. Hematological parameters of the patients were examined prior to the procedure and 24 h, 1 month, and 6 months after TAVI.Results: A statistically significant change in patients' MPV was detected after TAVI compared to the baseline situation (P: 0.001). While no statistically significant change was observed on the first day after TAVI, at discharge, compared to the baseline situation, a statistically significant decrease was seen 1 month and 6 months after discharge. Conclusion:We have demonstrated a decrease in MPV after surgery compared to the value before surgery. We have sought to propound the change in MPV as an indication of endothelial function after TAVI.

Diminished serum PON activity is significantly and independently associated with the presence and severity of CAC, and vice versa.