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  • Author or Editor: Yusuf Karavelioğlu x
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This case illustrates an unusual coronary pseudo-obstruction due to competitive coronary flows from critical proximal left anterior descending (LAD) coronary artery stenosis and collateral vessels from distal right coronary artery. The flow dynamics of both antegrade and retrograde flows counterbalanced each other at the second diagonal branch level of LAD causing a total pseudo-obstruction image.

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Purpose

Heart is affected structurally and functionally in end-stage renal disease (ESRD). However, the data available about adverse effects of ESRD on right ventricle (RV) is scarce. We aimed to evaluate echocardiographic parameters of RV in nondiabetic, normotensive patients with ESRD undergoing hemodialysis (HD).

Methods

A total of 45 (24 women; mean age 52.4 ± 12.4 years) consecutive nondiabetic, normotensive patients with ESRD undergoing HD and 39 healthy age and sex-matched control subjects (22 women; mean age 50.3 ± 6.6 years) were enrolled in the study. M-mode and two dimensional images, color, pulsed and continuous wave Doppler, and tissue Doppler measurements were acquired from all subjects. Echocardiographic evaluation was performed in the days between HD dates of the patients.

Results

RV fractional area change, tricuspid annular plane systolic excursion, tricuspid E velocity, E/A ratio, tricuspid annular E′ velocity, and E′/A′ ratio were lower in patients than controls (p > 0.001, p = 0.003, p = 0.007, p = 0.005, p > 0.001, and p = 0.034, respectively). However, RV diastolic area, RV myocardial performance index, E/E′ ratio, and mean and systolic pulmonary artery pressure were higher in patients than controls (p > 0.001, p = 0.007, p = 0.005, p > 0.001, p = 0.006, respectively).

Conclusions

RV systolic and diastolic functions of nondiabetic, normotensive HD patients are deteriorated as compared to healthy controls.

Open access

ST-elevation myocardial infarction (STEMI) due to septic coronary embolism is a rare complication of infective endocarditis (IE) and is associated with high mortality rates. When common signs of IE are often overlooked on admission, the diagnosis may be established through complications, which may cause prominent symptoms. Here, we report a case of native mitral valve endocarditis with an unusual presentation with STEMI and concomitant ischemic stroke, which was due to multiple coronary and cerebral septic embolisms.

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Interventional Medicine and Applied Science
Authors: Oğuzhan Çelik, Lütfü Bekar, Mucahit Yetim, Tolga Doğan, Çağlar Alp, Macit Kalçık and Yusuf Karavelioğlu

Coronary pseudoaneurysms (CPAs) are rare complications developed after percutaneous coronary interventions. They may cause stent thrombosis, distal embolization, and coronary rupture leading to cardiac tamponade. Therefore, high-risk CPA should be promptly treated after diagnosis. They can be managed with percutaneous or surgical intervention. Herein, we aimed to present a patient who developed CPA 3 weeks after percutaneous coronary intervention and successfully treated with percutaneous intervention using a covered stent.

Open access
Interventional Medicine and Applied Science
Authors: Macit Kalçık, Mucahit Yetim, Tolga Doğan, İbrahim Doğan, Barış Eser, Lütfü Bekar, Oğuzhan Çelik and Yusuf Karavelioğlu

Background

Current evidence indicates that vascular calcification plays an essential role in the development of cardiovascular diseases in end-stage renal disease (ESRD) patients. Arterial stiffness is a marker of increased cardiovascular risk in various populations. The aim of this study is to evaluate the elastic properties of ascending aorta in patients with ESRD.

Methods

This single-center study enrolled 96 patients (45 females, age: 57.2 ± 12.8 years) with ESRD and 96 healthy controls (52 females, age: 55.3 ± 10.1 years). Aortic pressures and aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index, and aortic compliance were calculated using accepted formulae.

Results

The hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure, and aortic pulsatility index were significantly higher in patients with ESRD. Systolic and diastolic aortic diameters were similar between the groups. However, pulsatile aortic diameter change, aortic strain, aortic distensibility, and aortic compliance were significantly lower, whereas aortic stiffness index was significantly higher in ESRD group.

Conclusions

The results demonstrated that a significant difference was present in terms of aortic blood pressures between patients with ESRD and controls. In addition, the elastic properties of ascending aorta were decreased in patients with ESRD.

Open access
Interventional Medicine and Applied Science
Authors: Macit Kalçık, Mahmut Yesin, Ahmet Güner, Emrah Bayam, Mucahit Yetim, Tolga Doğan, Lütfü Bekar, Oğuzhan Çelik and Yusuf Karavelioğlu

Introduction

Impaired coronary microcirculation, inflammation, and endothelial dysfunction were reported etiological factors for microvascular angina (MVA). Recently, increased epicardial adipose tissue (EAT) thickness has been associated with hypertension, metabolic syndrome, and coronary artery disease in general population. In this study, we aimed to evaluate the EAT thickness in patients with MVA.

Methods

This study enrolled 200 patients (83 males; mean age: 55.4 ± 8.2 years) who have been diagnosed with MVA and 200 controls (89 males; mean age: 54.4 ± 8.5 years). All patients underwent transthoracic echocardiography, and EAT thickness was measured from a parasternal long-axis view as the hypoechoic space on the right ventricular free wall.

Results

The mean EAT thickness was significantly higher in MVA patients than the controls (5.5 ± 1.1 vs. 4.9 ± 0.7 mm; p < 0.001). Multiple logistic regression analysis showed that increased EAT thickness was an independent predictor of MVA (OR = 1.183, 95% CI = 1.063–1.489; p = 0.023). In receiver operating characteristic curve analyses, EAT thickness above 5.3 mm predicted MVA with a sentivity of 68% and a specificity of 63% (AUC = 0.711, 95% CI = 0.659–0.762; p < 0.001).

Conclusions

The EAT thickness was observed significantly higher in MVA patients as compared to controls. Increased EAT thickness may be associated with mechanisms that play a major role in the pathogenesis of MVA.

Open access