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Biomedical subjects

C Erol

Publications and source records attributed to C Erol.

At least 37 records · Page 2Linked to original sources

Percutaneous transluminal coronary angioplasty of anomalous coronary arteries. Case reports.

To date, technical experience reported in the literature is very limited on angioplasty in patients with anomalous coronary arteries. Balloon angioplasty may be a more favorable approach for revascularization in these vessels. A major factor is selection of the guiding catheter. The authors report 4 patients with severe atherosclerotic lesions of anomalous coronary arteries who underwent coronary angioplasty of the anomalous vessel. Three patients had an anomalous circumflex artery and 1 had an anomalous right coronary artery. Angiographic and clinical success were achieved in 3 patients.

Adult↗

Coronary artery aneurysms. Report of two cases and review of the literature.

Two patients who had angiographically proven coronary artery aneurysms are presented. The clinical pictures of these patients were similar to that of patients with atherosclerotic coronary artery disease. Both had severe angina pectoris, and the second patient (case 2) had had myocardial infarction. Their coronary artery aneurysms were single, fusiform (case 1) and saccular (case 2) in shape and not associated with extensive coronary atherosclerosis. They were treated medically and did well.

Coronary Aneurysm↗

Significance of dual left anterior descending coronary artery in interventional cardiology. A case report.

The variants of the left anterior descending (LAD) coronary artery are important in interpretation of coronary angiograms and in interventional procedures. The authors present a patient who had percutaneous transluminal coronary angioplasty and stent implantation to a presumed proximal LAD without the realization that dual LAd was present because of the total occlusion of the long LAD.

Angioplasty, Balloon, Coronary↗

Obesity and left ventricular diastolic dysfunction.

To assess the influence of obesity on left ventricular function, 20 obese women (mean body mass index (BMI) 33.8 +/- 3.1 kg/m2 and mean age 31.1 +/- 2.4 years) without evidence of heart disease were evaluated by echocardiography. Obese subjects had greater left ventricular mass index (103 +/- 22 g/m2, 76 +/- 18 g/m2; P < 0.0001) and augmented fractional shortening (39 +/- 2.6%, 36 +/- 0.1%; P < 0.0001) than normals. Isovolumic relaxation time was prolonged in the obese group (92 +/- 11 ms) as compared with the control group (76 +/- 11 ms; P < 0.0001). The ratio of peak early and atrial filling velocities was significantly lower (1.2 +/- 0.4, 1.9 +/- 0.6; P < 0.0001) and atrial contribution was higher (39 +/- 9, 25 +/- 5; P < 0.0001) in obese subjects than in normals. Shortened deceleration time was measured in obese subjects (142 +/- 30, 179 +/- 20 ms; P < 0.0001). In conclusion, obesity causes relaxation and early filling abnormalities and diastolic filling is compensated by augmented atrial contribution. Diastolic dysfunction is an early indicator of cardiac involvement in obesity.

Adult↗

Importance of notching and slurring of the resting QRS complex in the diagnosis of coronary artery disease.

Data on the correlation of coronary artery disease (CAD) and electrocardiographic findings are, except for Q waves, still controversial. The purpose of this study was to determine whether QRS complex notching and slurring (N&S) is of significant value as a diagnostic discriminator in the detection of CAD. This study comprised 500 consecutive patients aged between 24 and 81 years (mean, 53.4 years) who underwent coronary angiography because of chest pain. Patients were evaluated for CAD, angiographic evidence of myocardial infarction (MI), N&S, and abnormal Q waves. Of these 500 patients, 418 had CAD, and 370 of these had significant (> or = 70%) coronary artery obstruction. The remaining 82 patients had normal coronary arteries. The data revealed that the distribution of N&S in the patients with or without CAD was similar in both the inferior and limb leads (P > .05). But the percentage of N&S in more than two contiguous limb leads was higher in the patients with CAD than in the patients without CAD. Notching and slurring in at least one limb lead was found to be of no value in the diagnosis of MI, of wall motion abnormalities, and of significant obstruction. Notching and slurring in the anterior leads is more sensitive but less specific than abnormal Q waves in the same leads in the detection of significant obstruction, anterior MI, and anterior wall motion abnormalities. Notching and slurring in the anterior leads has as much importance as abnormal anterior Q waves in the detection of angiographic evidence of anterior infarct, of anterior wall motion abnormalities, and of significant coronary artery obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Restenosis after transluminal coronary angioplasty: a risk factor analysis.

BACKGROUND: Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is a major problem limiting the long-term efficacy of the procedure. The purpose of this study was to determine whether risk factors such as cigarette smoking, diabetes mellitus, hypertension or hypercholesterolaemia correlate with restenosis after PTCA. We also studied the relationship between a history of previous myocardial infarction and the extent of coronary artery disease (single-, two- or three-vessel) with restenosis after coronary angioplasty. METHODS: A total of 360 patients underwent successful PTCA. Follow-up coronary angiograms were performed in 181 patients after a mean +/- SD period of 6 +/- 4 months. RESULTS: The restenosis rate was 49%. We divided the patients into two groups: 89 patients with restenosis (8 women and 81 men) and 92 patients with no restenosis (14 women and 78 men). Age, sex, a history of cigarette smoking, diabetes mellitus and a history of previous myocardial infarction were not associated with restenosis. Serum levels of triglyceride were also unrelated to the restenosis rate. Restenosis was associated with hypertension, low levels of high-density-lipoprotein cholesterol, high levels of low-density-lipoprotein cholesterol and high total cholesterol levels (P < 0.001). Patients with two-vessel or multivessel disease had significantly higher restenosis rates than patients with single-vessel disease (P < 0.001). CONCLUSION: Patients with hyperlipidaemia, hypertension and multi-vessel disease appear to be higher risk of recurrent restenosis.

Adult↗

Antiarrhythmic effect of converting enzyme inhibitors in congestive heart failure.

In this study 24-h Holter electrocardiographic recordings were used to measure the effects of an angiotensin converting enzyme inhibitor, enalapril given for 4 weeks, on the frequency of cardiac arrhythmias in 24 patients (14 patients had enalapril, 30 patients had placebo) with congestive heart failure (New York Heart Association Functional Class 3) receiving maintenance therapy with digoxin and furosemide. Although the placebo group had no change in the frequence of arrhythmias, enalapril-treated patients showed significant decrease in the frequency of premature ventricular complexes couplet, bigemine VPS and ventricular tachycardia. Moreover, it was observed that six cases of atrial fibrillation returned to sinus rhythm. During enalapril treatment, some patients experienced increased serum potassium levels, but there was no change in serum digoxin levels. We also observed echocardiographic improvement in left ventricular function as well as clinical symptoms of congestive heart failure. Finally we observed that there was an antiarrhythmic effect of enalapril in congestive heart failure. We thought that the antiarrhythmic effect of enalapril in congestive heart failure was probably due to hemodynamic improvement.

Aged↗

Effects of percutaneous transluminal coronary angioplasty on late potentials and high frequency mid-QRS potentials.

The high frequency mid-QRS potentials and late potentials are important in coronary artery disease because they are related to the extent of ischemia and prognosis. In this study, the effects of successful percutaneous transluminal coronary angioplasty (PTCA) on these potentials were evaluated. Twenty-four patients with coronary artery disease (aged 34-67 years, 5 women, 19 men) were examined. Eight of these patients had a history of myocardial infarction (4 anterior, 3 inferior, 1 anterior and inferior). Signal averaged ECG was recorded at 40- to 250-Hz frequency ranges for late potentials and 150- to 250-Hz frequency ranges for mid-QRS potentials before PTCA, and they were repeated 1 month later. The QRS duration (107.7 +/- 9.8 to 105.3 +/- 9.3 ms, p < 0.0001) root-mean-square voltage (39.4 +/- 20.1 to 47.7 +/- 22.2 microV, p < 0.00001) and low amplitude signal duration (30.7 +/- 9.9 to 27.7 +/- 9.3 ms, p < 0.001) showed significant changes in 40- to 250-Hz ranges before and after PTCA. The same results were also obtained in the 150- to 250-Hz frequency ranges: the QRS duration decreased (90.9 +/- 9.8 to 86.5 +/- 9.1 ms, p < 0.005) and the root-mean-square voltage increased (5.5 +/- 1.6 to 6.1 +/- 1.8 microV, p < 0.00001). Thus, successful PTCA causes improvement in late potential parameters, so the risk of malign arrhythmia that affects the prognosis can be reduced. Additionally, the increase in high frequency mid-QRS potentials shows the decrease in the ischemia after PTCA.

Adult↗

Cardioinhibitory response to carotid sinus massage in patients with coronary artery disease.

The relationship between cardioinhibitory response to the carotid sinus massage and the severity of coronary artery lesions and left ventricular impairment was investigated in 86 patients who underwent coronary angiography. The study group (Group 1) comprised 63 patients who had coronary lesions and the control group (Group 2) comprised 23 patients who had normal coronary arteries. There was no significant relationship between the severity of coronary artery lesions and the cardioinhibitory response to the carotid sinus massage in the study group. However, there was a positive correlation (r = 0.478, P < 0.01) between total left ventricular segment scores and the maximal change in RR interval (%) during the right carotid sinus massage in the study group. During the right carotid sinus massage, maximal change of RR interval (%) was significantly higher in patients who had segmental wall motion abnormalities than in patients who did not (83.0 +/- 72.4% vs. 32.9 +/- 42.5%, P < 0.01, respectively). In the patients who could have echocardiographic measurements there was negative correlation between fractional shortening value and maximal change of RR interval (%) (right massage; r = -0.482, P < 0.01, left massage; r = -0.334, P < 0.05). In conclusion, we found a significant relationship between the cardioinhibitory response to carotid sinus massage and the presence and severity of the segmental wall motion abnormalities and left ventricular impairment in patients with coronary artery disease.

Adult↗

Analysis of high frequency QRS potentials observed during acute myocardial infarction.

The value of high frequency QRS potentials (HFQRS) during acute myocardial infarction (AMI) was assessed to define infarct size and prognosis. HFQRS were recorded by signal-averaged ECG with 150-250 Hz frequency ranges, using X, Y, Z orthogonal leads. Recordings were obtained in surviving AMI patients (n = 33, 12 inferior, 11 anterior, 10 anterior-inferior) on the first and tenth days, but in non-survived patients (n = 5, 2 inferior, 1 anterior, 2 anterior-inferior) only on the first day. Additionally, the frequency of ventricular tachycardia (VT) was evaluated by 24-h Holter monitoring in all patients at the same days. The control group consisted of 11 healthy people. In surviving AMI patients, RMS voltage of vector magnitude reduced in anterior and anterior-inferior MI but filtered QRS duration was longer in inferior MI than normals (P < 0.05, < 0.05, < 0.01, respectively). In nonsurvived patients, RMS voltages of leads X, Y, Z and vector magnitude were lower than normals (P < 0.01, < 0.05, < 0.01, < 0.01, respectively) and surviving AMI patients (P < 0.01, < 0.05, < 0.05, < 0.05, respectively), the filtered QRS duration was found to be longer than normals and survived patients (P < 0.01, < 0.01). In patients who had VT on Holter monitoring, filtered QRS duration was significantly longer than in patients without VT (P < 0.05). As a result, HFQRS was important for defining infarct size but not malignant ventricular arrhythmias. VT was related to filtered QRS duration. HFQRS may offer significant prognostic information and contribute to early risk stratification of AMI patients.

Electrocardiography↗

The role of arrhythmia and left ventricular dysfunction in patients with acute myocardial infarction and bundle branch block.

To determine the immediate and remote prognostic significance of bundle branch block (BBB) associated with acute myocardial infarction (AMI), 40 patients with AMI and BBB were studied. One hundred forty-four patients with AMI but without BBB were evaluated during the in-hospital phase and 45 of them were taken as a control group. These patients were followed for an average of 15 months (3-28 months). Arrhythmias and left ventricular function were investigated with 24-hr Holter monitoring and echocardiography, respectively. The hospital mortality was significantly greater in patients with BBB than in the control group (32.5% vs 10.4%, p < 0.001). The main cause of mortality was pump failure in the group with BBB (76.9%) and ventricular fibrillation in the control group (53.3%). The peak creatine kinase level was significantly higher in the group with BBB than in the control group (2094.8 +/- 288.4 IU/L vs 416.7 +/- 30.5 IU/L, p < 0.001). In patients with BBB prophylactic temporary pacemaker insertion was not found to improve the hospital mortality rate. In the hospital phase, although 32% of the patients with BBB had complicated arrhythmias (multiform, paired VPB, runs, R-on-T) the cause of death in 10 of the 13 patients who died was pump failure but not arrhythmia. In patients with BBB the wall motion index and the number of patients who had a left ventricular aneurysm were greater than in patients without BBB (9.5 +/- 0.9 vs 6.3 +/- 0.6, p < 0.01 and 52.0% vs 14.3%, p < 0.01, respectively). In patients with BBB follow-up mortality (12.0%) was lower than hospital mortality (32.5%). During the follow-up period there was no significant difference between patients with BBB and those without with regard to complicated arrhythmias (14.8% vs 15.6%). These results indicate that the main cause of poor prognosis during the hospital period in patients with AMI and BBB was not arrhythmia or conduction disturbance but severe pump failure due to extensive myocardial necrosis. Prophylactic temporary pacemaker insertion did not improve the hospital mortality rate of these patients, and patients with AMI and BBB who survive the in-hospital phase after infarction have a good prognosis during the following 15 months.

Arrhythmias, Cardiac↗

Clinical evaluation of the Omniscience cardiac valve prosthesis. Follow-up of up to 6 years.

From January 1984 to June 1989, 259 Omniscience valve prostheses were implanted in 225 patients. Of the 225 patients; 143 (63.6%) received mitral, 48 (21.3%) aortic, and 34 (15.1%) double valve replacements. The early mortality rate was 8.9%; 97.6% of the patients were included in this study. These patients represent a cumulative follow-up of 407.9 patient-years, with a mean follow-up of 2.03 +/- 0.1 (standard error) years. The late mortality rate was 4.03% overall, which corresponds to 2.0% +/- 0.7%/pt-yr (SE). The annual rate of valve endocarditis was 1.0% +/- 0.5%/pt-yr (SE). The linearized rate of thromboembolism was 1.2% +/- 0.5%/pt-yr (SE). Anticoagulant-related hemorrhage occurred in 15 patients with an annual rate of 3.7% +/- 0.9%/pt-yr (SE). The linearized rate of valve thrombosis was 0.2% +/- 0.2%/pt-yr (SE). By echocardiography the mean mitral valve opening was 75.9 +/- 3.1 degrees (standard deviation) for 27 patients. During follow-up study, 136 (70.8%) patients were in New York Heart Association class I, 44 (22.9%) were in class II, and 12 (6.3%) were in class III; there were 25 (11.1%) patients in class II, 166 (73.8%) in class III, and 34 (15.1%) in class IV preoperatively. Actuarial freedom from thromboembolism was 94.5% +/- 3.6% (SE); freedom from endocarditis, 97.8% +/- 1.0% (SE); freedom from anticoagulant-related hemorrhage, 91.5% +/- 2.0% (SE); freedom from valve thrombosis 99.1% +/- 0.8% (SE); and freedom from hemolysis 98.5% +/- 1.2% (SE). Actuarial survival at 6 years is 94.0% + 2.3% (SE) overall. In conclusion, the overall rate of valve-related complications with this valve is low.

Actuarial Analysis↗

Pheochromocytoma with asymmetric septal hypertrophy and Wolff-Parkinson-White syndrome.

A 24-year-old woman with pheochromocytoma associated with asymmetric septal hypertrophy, Wolff-Parkinson-White syndrome and pigmentation was operated on and the tumor was excised. The asymmetric hypertrophy and the pre-excitation disappeared after the operation, but the pigmentation increased. We discuss the relation between excessive catecholamines and these findings.

Adrenal Gland Neoplasms↗

Hepatoma with right atrial extension.

The case is described of a 14-year-old boy who had a hepatoma with a right atrial extension. He presented with edema, abdominal pain, and ascites. Two-dimensional echocardiography showed a right atrial tumor that had invaded from the inferior vena cava as an extension into the right atrium of the hepatoma.

Adolescent↗

Pericardial involvement in familial Mediterranean fever.

Two patients with familial Mediterranean fever showed the classic features of pericardial involvement and one of them (Case 2) had pericardial effusion detected by echocardiography. These and previously published cases show that familial Mediterranean fever should be considered as a cause of pericarditis and/or pericardial effusion.

Adult↗

Acute myocardial infarction and normal coronary arteries in a pregnant woman.

As it is a rare case, we report a 37-year-old woman who had transmural myocardial infarction in her last trimester. Coronary arteriography done 15 days after her normal delivery showed normal coronary arteries and left ventriculography showed an apical aneurysm. The proposed cause appears to be coronary spasm.

Adult↗