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Dursun Aras

Publications and source records attributed to Dursun Aras.

At least 19 recordsLinked to original sources
PubMed2006

Plasma level of soluble P-selectin in patients with rheumatic mitral stenosis and sinus rhythm undergoing percutaneous mitral balloon valvuloplasty.

OBJECTIVE: To determine whether plasma level of soluble P-selectin (sP-selectin) increases in rheumatic mitral stenosis (MS) patients with sinus rhythm, who have scheduled for percutaneous mitral balloon valvuloplasty (PMBV), and to examine the effect of PMBV on sP-selectin level. METHODS: Twenty-six patients with MS and sinus rhythm (study group, 20 female, mean age 33 +/- 8 years) and a well-matched control group composed of 21 healthy volunteers (15 female, mean age 35 +/- 6 years) were enrolled in the study. In each patient left atrial (LA) thrombus was excluded by transesophageal echocardiography. sP-selectin levels were compared between study patients and controls, and between peripheral and LA blood. Changes in sP-selectin level 24 h and 4 weeks after PMBV were also analyzed. RESULTS: A significantly higher basal sP-selectin level was noted in study group. After PMBV, the mitral valve area (MVA) increased and the transmitral mean gradient decreased significantly. At 24th hour after PMBV, sP-selectin level decreased from 1080.38 +/- 143.87 ng/ml to 960.00 +/- 103.26 ng/ml (p < 0.0001) and at 4th-week follow-up it was decreased from 960.00 +/- 103.26 ng/ml to 879.61 +/- 98.16 ng/ml (p < 0.0001). No significant difference was found between peripheral and LA blood regarding the sP-selectin level. Correlation analysis between the difference in MVA measured 24-hour after and before PMBV and the difference in sP-selectin level measured 24-hour after and before PMBV showed a significant direct relationship between these variables. CONCLUSION: This study suggests that in patients with MS and sinus rhythm sP-selectin level increases probably due to turbulent flow across the stenotic valve. After PMBV sP-selectin shows a progessive decline, which is directly correlated with the increase in MVA.

Adult↗
PubMed2006

Relation between sympathetic overactivity and left atrial spontaneous echo contrast in patients with mitral stenosis and sinus rhythm.

BACKGROUND: Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that platelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis. METHODS AND RESULTS: Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals <90ms separated the patients with LASEC from control subjects with a sensitivity of 77% and specificity of 90%; a low frequency >79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio >3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter >4.3 cm increased the LASEC formation by 3.0 folds, HR >78 beats/min by 6.4 folds, standard deviation of all NN intervals <90 ms by 9.2 folds, a low frequency/high frequency ratio >3.7 by 6.4 folds, sP-selectin>142 by 5.8 folds. Variables affecting sP-selectin levels were LA diameter, mitral valve area, transmitral mean gradient, left ventricular ejection fraction, the presence of mitral regurgitation, HR, standard deviation of all NN intervals, low frequency, high frequency and low frequency/high frequency ratio. CONCLUSION: Sympathetic overactivity and reduced heart rate variability are important determinants for LASEC formation and increased s-P selectin levels. Therefore, platelet activation via increased sympathetic activity may play an important role in pathogenesis of LASEC.

Adult↗
PubMed2006

Non-compaction cardiomyopathy associated with myocardial bridging: A frequently overlooked or misdiagnosed cardiomyopathy.

Isolated ventricular non-compaction (IVNC) is an unclassified cardiomyopathy which occurs due to a morphogenetic abnormality involving an arrest of compaction of the loose myocardial meshwork during fetal ontogenesis. Despite recent advances in knowledge, diagnosis remains problematic because of its similarity to other diseases of the myocardium and endocardium. In this report, we describe a case of IVNC and myocardial bridging. The patient had been misdiagnosed with apical hypertrophic cardiomyopathy 2 years earlier. The correct diagnosis was established by transthoracic echocardiography and confirmed by cardiac catheterization and angiocardiography.

Cardiomyopathies↗
PubMed2006

Exercise-induced ventricular tachycardia associated with J point ST-segment elevation in inferior leads in a patient without apparent heart disease: a variant form of Brugada syndrome?

Exercise-induced monomorphic ventricular tachycardia originating in the right ventricular outflow tract without evidence of structural heart disease can be idiopathic or can be the harbinger of structural abnormalities such as arrhythmogenic right ventricular dysplasia. Recently, the so-called variant Brugada syndrome has been reported in very few cases in the literature and is much less electrophysiologically defined in terms of its clinical significance. We present the case of a 21-year-old man with exercise-induced monomorphic ventricular tachycardia (left bundle-branch block/right axis deviation), without detectable structural heart disease, with evidence of J point and ST-segment elevation in electrocardiogram leads II, III, and aVF after intravenous administration of propafenone. This is followed by a brief discussion on the new concept of "variant Brugada syndrome," drug-induced electrocardiographic changes, normal-variant repolarization abnormality, and idiopathic right ventricular outflow tract tachycardia.

Bundle-Branch Block↗
PubMed2006

Comparison of presence and extent of coronary narrowing in patients with left bundle branch block without diabetes mellitus to patients with and without left bundle branch block but with diabetes mellitus.

We prospectively analyzed the clinical, echocardiographic, and coronary arteriographic data of 51 patients with type 2 diabetes mellitus with left bundle branch block (LBBB), 51 patients with type 2 diabetes mellitus without LBBB, and 51 patients with isolated LBBB matched for age and gender. Extent of coronary artery disease (CAD) was classified according to the standard method into 1-, 2-, or 3-vessel disease and was estimated by calculation of the Gensini score. The left ventricular ejection fraction was analyzed by echocardiography. Age, gender, and percentage of patients with a smoking habit or family history of CAD did not differ among the groups. The rates of hypertension and levels of serum creatinine, cholesterol, and triglycerides were statistically higher in group I compared with the other 2 groups. Patients with diabetes and LBBB (group I) had significantly higher scores for the severity (Gensini score) of CAD (p <0.001) and more 3-vessel disease (p <0.001). After adjustment for hypertension, hypertriglyceridemia, and hypercholesterolemia with covariance analysis, the presence of LBBB was also associated with a higher Gensini score in patients with diabetes compared with those with diabetes but without LBBB and those with isolated LBBB (p <0.001). The present study, for the first time, has shown that patients with type 2 diabetes mellitus and concomitant LBBB have more severe and extensive CAD and advanced left ventricular dysfunction compared with those with diabetes but without LBBB and those with isolated LBBB.

Aged↗
PubMed2006

Clinical features of isolated ventricular noncompaction in adults long-term clinical course, echocardiographic properties, and predictors of left ventricular failure.

BACKGROUND: Isolated ventricular non-compaction (IVNC) is a rare disorder characterized by prominent trabecular meshwork and deep recesses. We retrospectively assessed the clinical characteristics and natural course of IVNC in adults diagnosed at our hospital. METHODS AND RESULTS: Sixty-seven adult patients (44 male, mean age 41 +/- 18 years) with the diagnosis of IVNC were evaluated in this retrospective cohort. Its prevalence was found to be .14%. Forty-seven patients (70%) had class I/II functional capacity. Fifty-seven patients (85%) had electrocardiographic abnormalities, and the most common one was left ventricular (LV) hypertrophy (25%). LV systolic function was depressed in 44 patients (66%), with a median ejection fraction (EF) of 35% (range: 20%-48%) at diagnosis. Multiple regression analysis revealed that age at initial presentation, the total number of affected segments, and the ratio of non-compaction/compaction (NC/C) were the independent predictors of LV systolic dysfunction. Familial occurrence of IVNC was 33%. During a mean follow-up of 30 months (range: 9-50 months), major complications including ventricular tachycardia, heart failure requiring hospitalization, and cerebrovascular events were observed in 36%, 34%, and 9% of the patients, respectively. Ten patients (15%) with IVNC died in this study. LVEF at initial presentation and functional capacity at last visit were found to be independent predictors of mortality. CONCLUSION: This study suggests that IVNC is a form of cardiomyopathy with higher prevalence and relatively better prognosis than previously reported. Age at initial presentation, ratio of NC/C, and number of affected segments seem to be major determinants of LV systolic dysfunction, while initial LVEF and last functional capacity predict mortality in this cohort.

Adult↗
PubMed2006

Hemodynamic change in transmitral gradient during Valsalva maneuver and its relation with left atrial function, functional capacity, and pulmonary artery pressure in patients with mitral stenosis in sinus rhythm.

BACKGROUND: The hemodynamic factors contributing to the clinical symptomatology in patients with mitral stenosis (MS) have been under investigation. The objective of this study was to evaluate the use of the Valsalva maneuver in patients with MS and whether there is an association between the degree of the hemodynamic changes in transmitral gradient (TG) in response to Valsalva maneuver and functional status, systolic pulmonary artery pressure, and left atrial function in patients with MS in sinus rhythm. METHODS: The study prospectively evaluated 42 patients (37 female, mean age 40 +/- 10 years) with a diagnosis of pure MS in sinus rhythm. Patients were divided into 3 groups according to their New York Heart Association (NYHA) functional class. In all, 12 patients were in NYHA functional class I, 17 patients in class II, and 13 patients in class III. TG, including the mitral peak, mean, and late filling gradients, were calculated by the modified Bernoulli equation at rest and during the strain phase of Valsalva maneuver. The percentage changes in all TG in response to Valsalva were calculated. Traditional echocardiographic parameters for atrial function were also measured. RESULTS: We found that, in patients who were more symptomatic according to NYHA classification, a reduction in TG in response to Valsalva maneuver was blunted and associated with higher systolic pulmonary artery pressure compared with those who were asymptomatic or had mild symptoms. Patients in NYHA class III decreased mitral mean pressure gradient by only 13.5%, significantly less (P < .001) than those in classes I (53.9%) and II (41.7%). However, despite the fact that left atrial ejection fraction was low in all patients, it was not associated with functional status in patients with MS. CONCLUSION: This study, for the first time, suggests that echocardiographically determined changes in TG in response to the Valsalva maneuver may provide an objective, noninvasive means of evaluating patients with MS.

Adaptation, Physiological↗
PubMed2006

Comparison of regional systolic myocardial velocities in patients with isolated left ventricular noncompaction and patients with idiopathic dilated cardiomyopathy.

BACKGROUND: Patients with isolated left ventricular (LV) noncompaction (IVNC) exhibit a unique form of spheric LV remodeling in which the ventricular walls remain thick and the chamber does not dilate in proportion to the remodeling. This study assessed the systolic myocardial shortening properties of the long axis (LA) and short axis (SA) of the LV as determined from pulsed Doppler tissue imaging in two groups of patients with similar degrees of LV dysfunction and similar LV sphericity: patients with IVNC and patients with idiopathic dilated cardiomyopathy (DCMP). METHODS: Pulsed Doppler tissue imaging was used to record systolic myocardial velocities along the LA and SA of the LV in a group with IVNC (n = 13) and a group with DCMP (n = 13). The groups were matched for mean extent of LV dysfunction and mean sphericity index. In all 26 patients, the systolic myocardial velocity pattern for each axis featured two distinct peaks (SW1 and SW2). These peak velocities and the intervals from the electrocardiographic Q wave to each peak (Q-SW1, Q-SW2) were recorded for each axis, and group means were calculated and statistically compared. RESULTS: There were no significant differences between the IVNC and DCMP groups with respect to any of the pulsed Doppler tissue imaging variables. Concerning the data for SW1 and SW2, intragroup comparisons revealed no significant differences in either group. In each of the two groups, LA-Q-SW1 was significantly shorter than LA-Q-SW2, SA-Q-SW1, and SA-Q-SW2. Each group's LA-Q-SW2 and SA-Q-SW2 values were also statistically similar. CONCLUSION: The results indicate that, given comparable degrees of spheric remodeling and comparable LV dysfunction, patients with IVNC and patients with DCMP show similar contraction properties along the LA and SA of the LV.

Adult↗
PubMed2006

Preserved systolic function with isolated left ventricular noncompaction in an elderly patient.

Isolated left ventricular noncompaction (IVNC) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. Clinical presentations of IVNC include systolic and diastolic dysfunction, systemic embolism and ventricular arrhythmias. In recent years there has been an increasing awareness of this anomaly; however, especially in elderly, clinical characterization and natural course of IVNC are still in question. In this case, we report a case of a 78-year-old patient with the diagnosis of IVNC with preserved left ventricular (LV) systolic function. To the best of our knowledge, this is the oldest IVNC case with preserved LV systolic function in the literature.

Aged↗
PubMed2006

Serum level of lipoprotein (a) is inversely associated with the development of coronary collateral circulation.

BACKGROUND: This study sought to determine the relationship between serum lipoprotein (a) levels and angiographically visible coronary collateral circulation and to evaluate whether lipoprotein (a) exerts any effect on vascular endothelial cell growth factor. METHODS: The study population included 60 patients (39 men, mean age 59+/-13 years) with angiographically documented total occlusion in one of the major coronary arteries. Development of collaterals was classified by Rentrop's method. Patients were defined as having poorly developed collaterals for grades 0 and 1 (group 1), or well-developed collaterals for grades 2 and 3 (group 2). Serum lipoprotein (a) and vascular endothelial cell growth factor levels were determined by enzyme-linked immunosorbent assay. RESULTS: In group 1, lipoprotein (a) levels were significantly higher and vascular endothelial cell growth factor levels were significantly lower than in group 2 (34+/-19 vs. 20+/-12 mg/dl, P<0.001, and 2.5+/-0.7 vs. 3.4+/-0.8 ng/dl, P<0.001, respectively). Poorly developed collaterals were significantly more frequent in patients with lipoprotein (a) levels >or=30 mg/dl than in patients with levels <30 mg/dl (72 vs. 37%, P=0.008). A strong negative correlation was observed between lipoprotein (a) and vascular endothelial cell growth, factor (r=-0.708, P<0.0001). Multivariate analysis revealed that a high level of lipoprotein (a) negatively affected the development of collaterals, whereas the duration of angina had a positive effect. CONCLUSION: This study demonstrated for the first time that the high level of lipoprotein (a) negatively affects the formation of coronary collateral vessels in human beings. Reduced production or bioactivity of vascular endothelial cell growth factor caused by high levels of lipoprotein (a) may be the possible responsible mechanisms of hyperlipoprotein (a)-related poor collateral formation.

Adult↗
PubMed2006

Atrial dissection-like appearance caused by ileus due to metastatic renal cell carcinoma.

Atrial dissection is an uncommon entity, defined as a gap from the mitral or tricuspid annular area to the interatrial septum or atrial wall, creating a new chamber with or without communication into the true left or right atrium. We present the interesting images of an atrial dissection-like appearance in the right atrium, which was actually caused by an ileus due to metastatic renal cell carcinoma in a 82-year-old man. The causes of true atrial dissection were also briefly discussed.

Aged, 80 and over↗
PubMed2006

Brugada-like early repolarization pattern misdiagnosed as acute anterior myocardial infarction in a patient with myocardial bridging of the left anterior descending artery.

The diagnosis of acute coronary syndrome in patients presenting to the emergency department with chest pain is still challenging. Since the symptoms and electrocardiographic abnormalities of patients with acute myocardial infarction can be indistinguishable from those of patients with other conditions that lead to ST-segment elevation, a high clinical index of suspicion is needed to avoid an incorrect diagnosis and subjecting the patient to unwarranted thrombolytic therapy. Our report concerns a 53-year-old male with myocardial bridging of the left anterior descending artery. He presented with the combined electrocardiographic abnormality of the Brugada-like or early repolarization pattern, which was misdiagnosed as acute anterior myocardial infarction.

Acute Disease↗
PubMed2006

Penetrating trauma to the mitral valve and ventricular septum.

Penetrating cardiac trauma is typically life-threatening and often requires urgent surgical intervention. Penetrating injury can cause damage in more than 1 cardiac structure that may be difficult to identify at the initial urgent operation. We describe the case of a young man in whom a perimembranous ventricular septal defect and perforation of the anterior leaflet of the mitral valve were caused by a screwdriver wound.

Adult↗
PubMed2005

Multi-chamber intracardiac thrombi associated with activated protein C resistance in a patient with dilated cardiomyopathy.

Combined activated protein C resistance and dilated cardiomyopathy result in a multiplicative effect on thrombosis risk. However, it is not known that whether there is an association with activated protein C resistance and dilated cardiomyopathy. We present a 18-year-old patient with dilated cardiomyopathy, who exhibited multi-chamber intracardiac thrombi on transthoracic echocardiography associated with activated protein C resistance. Our cases emphasizes that patients with cardiac thrombosis before adulthood should be screened for an underlying coagulation abnormality besides underlying cardiac disorders.

Activated Protein C Resistance↗
PubMed2005

Systemic lupus erythematosus: an unusual cause of cardiac tamponade in a young man.

Although pericarditis and pericardial effusion are common cardiac complications of systemic lupus erythematosus (SLE), cardiac tamponade is a very rare initial manifestation of this disease. We describe a case of a young male patient in whom cardiac tamponade secondary to a loculated pericardial effusion was the presenting symptom of SLE.

Adult↗
PubMed2005

Porcelain heart: a case of massive myocardial calcification.

Reports of massive myocardial calcification are limited mainly to case reports and this type intracardiac calcifications have been usually identified postmortem. We present a very interesting case of massive calcification of the left ventricular myocardium, interventricular and interatrial septae causing restrictive physiology and coronary artery obstruction in a 46-year-old Turkish woman. The diagnosis of myocardial calcification was suspected from chest X-ray and confirmed with computerized tomography and cardiac catheterization. The findings of the chest computed tomography were very similar to those previously reported cases of endomyocardial fibrosis (EMF) with massive calcification of the left ventricle.

Calcinosis↗
PubMed2005

Brugada-type electrocardiographic pattern induced by fever.

ST-segment elevation in Brugada syndrome is caused by a shift in the ionic current balance and the creation of a voltage gradient between the epicardium and the endocardium. This ionic mechanism have been shown to be temperature dependent. We describe a 33-year-old man who presented with fever with the dynamic electrocardiographic changes similar to the Brugada syndrome. These electrocardiographic anomalies disappeared when the temperature returned to normal.

Journal Article↗