THE USE OF DRUG ELUTING STENTS IN SINGLE AND
MULTIVESSEL DISEASE: RESULTS FROM OUR CENTRE EXPERIENCE
Özgül S, Batıraliev T, Serçelik A, Düzkale M.A, Besnili F.
Drug eluting stents have been shown to reduce the rate of in-stent
restenosis in cases where coronary artery lesions are treated. We wanted to
evaluate the result of our experience with drug eluting stents in such
patients. Design and Patients: This study includes all consecutive patients
treated at Sanko medical centre, Gaziantep, treated with drug-eluting stents
.
Between January 2003 and May 2004,81 patients with 100
lesions were treated(67 males,14 females) with mean (SD) age of 53.1±10.2
years. Of all patients studied 77.7% had single vessel disease, 20.9% had
two vessel disease, and 1.2% had three vessel disease. Six months clincal
follow up was performed in all patients. Control coronary angiography was
performed in 61 patients. Six months mortality was 0%, and no acute MI
occured, and no target lesion revascularisation occured in the patients.
Coranary artery restenose rate was 0%. Major adverse cardiac event rate was
0%.
The use of drug eluting stents in
single and multivessel coronary disease produces good short and medium term
results. Longer term follow-up is required to confirm these obsevations.
Key Words:
Coronary artey disease, single vessel disease, multivessel disease, drug
eluting stent
TOTALLY ENDOSCOPIK ATRIAL
SEPTAL DEFECT REPAIR WITH ROBOTIC ASSISTANCE: SURGICAL TECHNIQUE
AND REVIEW OF THE LITERATURE
Kaplan S, MorganJ.A, Argenziano M, Smith C.R,
Öz M.C.
Just like other technologies, cardiac surgery also
underwent important changes during the past decade: minimally invasive
approach, endoscopic interventions, Heartport, off-pump coronary bypass,
just to name a few.
Over the last several years, improvements in robotic
technology and computer enhancement have permitted the performance of
minimally invasive procedures. More specifically, improvements in
visualization systems, retractors, and stabilizers, as well as alternative
methods of vascular cannulation and cardiopulmonary bypass (CPB) have
enabled cardiac surgeons to avoid a sternotomy or thoracotomy for certain
procedures, reducing surgical trauma to patients. Repair of an atrial septal
defect (ASD), can be performed totally endoscopically through four 1-cm
incisions. Ports are inserted, through which an endoscopic camera and
instruments are passed. Utilizing a surgical robotic system, surgeons can
manipulate small endoscopic instruments, which are inserted through ports 1
cm in size, achieving many of the technical maneuvers previously possible
only with open surgery.
To date, we have performed 21
totally endoscopic ASD repairs with robotic assistance. Here, we present the
results of these patients. Furthermore, this report provides a detailed
description of the operative technique and a brief review the current
literatures.
ASSESSMENT OF MYOCARDIAL
PERFUSION AFTER PRIMARY CORONARY ANGIOPLASTY
Tavil Y, Abacı A.
Assessment of myocardial perfusion after coronary
revascularization in patients wich acute mycardial infarction is very
important. There are many techniques to asses the myocardial perfusion after
primary coronary angioplasty. In this review, we summarized the techniques
to evaluate myocardial perfusion after primary coronary angioplasty.
THE USE
OF THE DISTAL PROTECTION SYSTEMS IN PERCUTANEOUS CORONARY INTERVENTIONS
Akgül F, Batıraliev T.
Embolization is not a remarkable problem in most native
coronary and peripheral interventions. However, the risk of distal
embolization is a significant problem in saphenous vein grafts (SVG), and in
thrombotic lesions seen in acute coronary syndrome. Distal embolization
frequently results in elevation in cardiac enzymes and extends myocardial
damage and, as a result, it worsens morbidity and mortality in these
patients. During last decade, glycoprotein IIb/IIIa antagonists have been
used to prevent distal embolization. Although glycoprotein IIb/IIIa
antagonists have been shown to be useful during primary percutaneous
coronary interventions in patients with acute myocardial infarction, because
of SVGs have large embolic burdens overwhelm effective platelet inhibition,
glycoprotein IIb/IIIa antagonists do not reduce the incidence of acute
events during SGV interventions. Recently, as alternative to pharmacological
treatment, a variety of embolic protection devices have been developed to
prevent distal embolization during SVG interventions. Basically, these
devices are classified into two types; those having a balloon system and
other having a filter system. In this article, we reviewed the use of both
types of the embolic protection devices during coronary interventions in the
light of the literature.
PERCUTANEOUS CORONARY INTERVENTION IN
CARDIOGENIC SHOCK
Yalçın R.
Cardiogenic shock (CS) is the most serious complication
of acute coronary syndromes (ACS). It is associated with an extremely high
in hospital and long-term mortality rate in all types of ACS. The CS
mortality rate of 8% in patients treated conservatively has been decreased
with early revascularization (percutaneous coronary intervention (PCI) or
coronary artery bypass graft).
Primarily based on the results of the SHOCK trial,
European and American guidelines for the management of STEMI recommend
coronary angiograpy and revascularization with PCI as class I
indications for patients who are
within 36 hours of an STEMI who
develop CS, are <75 years of age, and revascularization can be performed
within 18 hours of onset CS. In addition, the guidelines firmly recommended
the use of intra-aortic balloon pump counterpulsation (IABP) among
hemodynamically unstable ACS patients, espectially those with CS. IABP is
also effective in patients with persistent ST elevetion after PCI.
Clinical and procedural factors may
be important roles in hospital mortality rates in CS. Advancing age,
decreasing left ventricular function, history of renal failure, histroy of
peripheral vascular disease, type C lesion, stenosis in the left main
coronary artery, severe multivesvel disease, total occlusion in the left
anterior descending coronary artery, use of nonstent devices and no
glycoprotein IIb/IIIa inhibitor therapy during the procedure, and failed
labora-tory procedure (post-PCI TIMI flow grade lower than TIMI 3) were
significantly associated with increased in hospital mortality. It must be
remembered that selection bias (on patient or therapy) may play a Major role
in affecting outcomes.
High rate multivessel disease and
left main disease argues for more complete revascularization. Stenting may
reduce the risk associated with multivessel procedures and increase the
completeness of reperfusion.
The mortality rate associated with
CS in patients aged >75 years remains high, but early revascularization in
appropriately selected patients may be successful similar to that in younger
patients. The decision for interventional therapy in the elderly (>75 years)
patients should be carefully weigheted on the biological age the
co-morbidity of the individual patient.
Despite early PCI, the mortality in
these patients remains high. Therefore all efforts should be undertaken to
prevent the occurence CS such as pre-hospital thrombolysis, primary PCI,
rescue PCI, early IABP, avoide from iatrogenic negatif inotropy and
hypotension.
TRANSIENT CORTICAL BLINDNESS FOLLOWING CARDIAC CATHETERIZATION
WITH MODERN CONTRAST MEDIA: A CASE REPORT AND A REVIEW OF THE
LITERATURE
Yazıcı M, Kınay O, Nazlı C, Kılıçaslan B,
Gece H, Biçeroğlu S, Ergene O.
Transiet cortical blindness after contrast media exposure
has been reported to be as high as 1-4% after cerebral or vertebral
angiography with modern non-ionic, low osmolality radiocontrast agents. In
this study we present a case of abrupt cortical blidness after exposure to
contrast media during diagnostic coronary angiography; to our knowledge, the
literature with iobitridol use.
CONGENITAL CORRECTED
TRANSPOSITION OF THE GREAT ARTERIES ASSOCIATED WITH MYOCARDIAL
BRIDGING OF OBTUSE MARGINAL BRANCH OF THE LEFT CIRCUMFLEX ARTERY
Akdemir R, Gündüz H, Yazıcı M, Özhan H,
Erbilen E, Albayrak S, Uyan C.
A 54-year-old
male was admitted to the emergency department with complaints of
progressive dyspnea and chest paint on exertion. The electrocardiography
revealed sinusal tachicardia and QS patterns in all precordial leads.
Chest x-ray showed an enlarged cardiac silhouette. No cardiac murmur was
heard on auscultation. The patient underwent transthoracic echocardiography
and coronary angiography. 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.
A VERY RARE FORM OF ANOMALOUS CORONARY
ARTERY ORIGIN: LEFT MAIN CORONARY ARTERY ARISING FROM THE RIGHT
SINUS OF VALSALVA ( A CASE REPORT AND REVIEW OF THE LITERATURE)
Doğan S.M, Birdane A, Göktekin Ö, Görenek B.
Coronary artery anomalies are rare. Prognosis of the
patient whose left main coronary artery originates from the right sinus of
Valsalva depends on the course of the left main artery. We reported a
62-year old woman with a family history of sudden cardiac death in who left
main coronary artery arising from the right sinus of Valsalva and courses
between the aorta and pulmonary trunk. Although this anomaly is relatively
uncommon in angiographic series, it is significantly over-represented in
pathology series. The patients whose the course is interarterial should be
underwent prophylactic coronary bypass operation.
Key Words: Coronary artery anomaly, Left main artery, Coronary
angiography
