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Results
of thrombolytIc treatment In patIents wIth ST elevatIon
myocardIal InfarctIon
Bostan M, Büyükkaya E, Kahveci G,
Bozkurt E.
Restoration of full
antegrade flow in the ST elevation myocardial infarction by percutaneus
coronary intervention (PCI) is the principal treatment of choice. However an
experienced team is mandatory which is available 24 hour a day. Therefore
reperfusion with thrombolytic treatment is the most common reperfusion of
choice worldwide. Limited number of data about usage of thrombolytic
treatment in STEMI is available in our country. The objective of current
study is to evaluate the results of trombolytic treatment retrospectively
and to report it.
Three hundred twenty-one
patients diagnosed as STEMI and treated with fibrinolytic therapy at Rize
State hospital between 1999-2007 years were enrolled in the current study.
World Health Organization's criterias was used in diagnosis of STEMI.
Demographic characteristics of patients, type of the STEMI, effects and side
effects of the therapy were evaluated retrospectively.
The mean age of 321 patients
with STEMI (291 male and 30 female) was 57,35 years. Average age of male and
female patients was 56,45±9,09, 66,10±11,20 respectively. The localization
STEMI was anterior in 169 patients, inferior in 139 patients and other
localizations in 17 patients. Streptokinase was administered in 199 patients
and tissue plasminogen activator (tPA) in 122. 258 patients (80%) had
successful outcome and remaining 63 patients (20%) had poor outcome.
Although primary PCI is
superior to fibrinolytic therapy in patients with STEMI, there are lots of
limitations in clinical practice. Therefore fibrinolytic therapy is an
effective treatment of choice in STEMI which is easy to perform in anywhere
and anytime
SurgIcal treatment of post MI VSD In
patIents who were hemodynamIcally stabIlIzed wIth preoperatIve
(+) Inotrops and IABP
Erdoğan B.M, Uygur F,
Yamak B, Batryaliev T, Kısacıkoğlu B.
Post MI VSD has been
mostly encountered in patients over 65 years of age, have
single vessel disease and male patients developing the first
miyocardial infarction. Surgical approach is the treatment
of post MI VSD. Early diagnosis and surgery followed by
hemodynamic stabilization may improve the surgical success.
Between
01.01.2000 and 31.12.2005 seventeen patients were operated
on with the diagnosis of Post MI VSD. Six of 17 patients
were female (35.3%) and 11 ( 64,7%) male. Mean age was
found as 67.2±7.7 (55 - 78) years. All patients had coronary
angiographic examination. Left ventriculography were done in
hemodynamically stable patients. Otherwise VSD was located
with echocardiography. Preoperative EF scores were between
22% to 76% (mean 45,3% ± 13, 2). Eight patients admitted to
the hospital in cardiogenic shock. (+) inotrops were
urgently started and IABP introduced to these patients. The
mean interval between the onset of Post MI VSD and surgical
procedure was 19,3±12,4 days (1 day - 45 days). The mean
period between VSD occurence and angiography was 5,2±10,6
days (1 day - 43 day).
Eight
patients were in cardiogenic shock. Ten patients received
IABP assistance preoperatively. Patients were extubated at
avarage of 25.5±16.5 hours postoperatively. Two patients
died after the operation in the early postope-rative period.
The hospital mortality was 11.8 %. Both of the these
patients had VSD located on the inferior septum. Patients
were transferred to the ward at 4.3±2.2 days (2-7 days) and
discharged at 9.2±3.2 days (6-14 days). Postoperative
echocardiography control did not show any residual VSD.
IABP
assistance for patients have low cardiac out-put due to wide
spread myocardial infarction and post MI VSD is important.
Patients who were hemodynamically stabilized with (+)
inotrops + IABP assistance may improve the surgical results
for these high risk patients.
Key Words: Post MI Ventricular septal defect, Surgery
Inferior wall acute
myocardial infarction (MI) is often complicated by
atrioventricular (AV) block and this relatively frequent
complication bears great clinical significance because of
the high mortality. This study assessed whether there are
baseline clinical factors and electrocardiographic patterns
of acute inferior MI that are associated with greater risk
of developing complete atrioventricular block (CAVB).
Seventy-nine
patients with CAVB and 119 randomized patients with acute
inferior MI but without AV block were compared. The
patients with CAVB had lower mean blood pressure on
admission and ejection fraction but hig-her hypertension,
syncope, peak creatine kinase- myocardial band levels, 3-vessel
disease, ventricular arrhythmias, in-hospital mortality. The
patients with acute inferior MI and greater than 65 years
old had a 2.2 times higher risk of CAVB. Moreover, ST
elevation in RV4 greater than 1 mm increased the development
of CAVB by 3.7 folds, ST elevation greater than 2.75 mm in
lead III by 12.3 folds, ratio of elevation in lead III:II
greater than 1.5 by 3.7 folds but the thrombolytic therapy
decreased the development of CAVB by 3.2 times.
Finally,
these ordinary electrocardiographic measurements at
admission can be used as a screening test for CAVB
development and also can be used to define the patients at
high risk. These patients must be observed more cautiously
for a potentially unstable condition or considered for a
prophylactic pacemaker implantation.
Results of long-term observation of
patients with Wolf-Parkinson-White (WPW) syndrome after radiofrequent
ablation (RFA) of accessory pathway (AP) are presented in this report.
The group of 48 patients
with paroxysms of atrio-ventricular (AV) tachycardia due to accessory
pathway presence (Wolf-Parkinson-White syndrome) was included in
investigation. WPW-syndrome was diagnosed by transesophageal
electrophysiologic investigation under of out-patient observation. All
patients were undergone by intracardiac electrophisiologic investigation
with subsequent radiofrequent ablation of accessory pathway.
Electrocardiography (ECG) and echocardiography were carried out repeatedly
for all patients before intervention and during of 3-5 years period of
observation.
Methods of pair and unpaired
criteria of Student were used for statistical analysis.
Results of catheter
radiofrequent destruction were positive in 45 cases (93,7%) from 48 ones,
i.e. paroxysms of tachycardia have been lost after complete ablation of AP.
During of long period of observation (from 3 to 5 years) none of the
patients had any complications, tachycardia recurrence, complaints on
palpitation; they had interrupted to take antiarrhythmic drugs. Parameters
of size, volume and contractility of heart measured by echocardiographically
were not changed significantly.
Results indicate on high
efficacy of the catheter radiofrequent ablation in paroxysmal av-tachycardia
under of WPW-syndrome. Positive results has been achieved in 93,7% of
patients: paroxysms of arrhythmia has been disappeared, patients interrupted
to take antiarrhythmic drug, that caused their life quality improve
significantly.
In oncology,
significant success in treatment and survival is achieved by
chemotherapy in several neoplastic diseases. Anthracyclines
are one of the most commonly used agents in the oncology
because of their considerable antineoplastic activities but
their use is significantly limited by cardiotoxic effects.
In this paper, cardiotoxicity mechanisms of these drugs,
risk factors, the management and follow-up of the patients,
the protection methods are presented.
An unusual IatrogenIc
complIcatIon: Needle In the perIcardIal space In postcardIotomy patIent
Grbolar A, Qaradaghi L, Taşoğlu İ,
Avcı T.
A 72 years-old male
patient presented to our clinic with the possibility of a
needle forgotten in the pericardial space. Patient had a
history of coronary bypass graft and benthall operation. One
year ago at the postoperative follow up there was no
evidence of early postoperative complications. One year
later in emergency room while the patient investigated for
an abdominal pain, his lateral chest x-ray revealed a
needle near the apex of the heart. The patient had no active
complain related to the needle and on physical examination
there was no significant findings. He refered to our clinic
for followup and management. The presence of the needle near
the apex of the heart confirmed by echocardiography and
thorax CT.Surgical operation for removing of the needle was
advised but the patient refused it. Forgetting tools or
sponges are rare complication of open cardiac surgery and
diagnosed perioperatively or at early postoperative period.
We repot a patient with needle forgotten near the apex of
the heart with late presentation and without active
complain.
NoncompactIon of
the ventrIcular myocardIum assocIated wIth aortIc coarctatIon and
hypertrophIc cardIomyopathyh
Yıldız A, Sezen Y, Andaç
H.M.
Non-compaction of ventricular
myocardium has been recognized as a distinct form of
cardiomyopathy with its own clinical presentation and
natural history. It is more frequently associated with
complications of congestive heart failure, thromboembolism
and malignant ventricular arrhythmias. Concomitance of non-compaction
cardiomyopathy and several congenital heart defects has been
reported. Since diagnostic work-up requires careful
evaluation, non-compaction of ventricular myocardium may not
be diagnosed despite the diagnosis and treatment of
concomitant di-sorders. We describe herein a case of
incidentally diagnosed noncompaction of the ventricular
myocardium that was operated initially in childhood for
aortic coarctation and for symptomatic hypertrophic
cardiomyopathy in young adulthood.
Significant left main
coronary artery disease is defined as > 50% narrowing of
left main coronary artery. Although, coronary artery bypass
grafting using internal mammarian artery grafting is the
gold standard for treatment of unprotected left main
disease percutaneous coronary intervention is also possible.
Balloon angioplasty of the unprotected left main coronary
artery stenosis has been associated with elevated
procedural mortality and with a poor long-term prognosis.
However,
angioplasty with stent implantation is a safe procedure in
selected patients. Compared to bare metal stents,
interventions with drug eluting stents had more favorable
outcomes in regard to restenosis and mortality.
Key Words: Left main coronary artery disease,
Coronary artery bypass grafting , Angioplasty
