Makale Arama

Diagnostic and therapeutic cardiac catheterization attempts have recently been increasing. Numerous complications may develop after cardiac catheterization, including local complications, such as thrombosis, pseudoaneurysm, arteriovenous fistula, bleeding, infection, and distal embolization at the catheter insertion site, as well as complications associated with the anesthetic agents, such as respiratory depression, tachycardia and bradycardia. A total of 120 patients, who underwent cardiac catheterization between June 2010 and June 2012 were retrospectively evaluated. The patients were aged from 9 days to 15 years (mean 3.5±4.2 years) and 58 (48%) were female and 62 (52%) were male. Of the 120 patients, 102 (85%) underwent a diagnostic cardiac catheterization procedure, whereas in 18 (15%) patients an interventional procedure was performed. Complications were encountered in 7 (5.8%) patients, aged from 9 days to 15 years (3.5±4.2 years). There were femoral hematoma in two patients, femoral bleeding in one patient, femoral thrombosis in two patients, bradycardia in one patient, and a patient developed respiratory arrest during sedation (with midazolam). Femoral venous thrombosis, which was seen in two patients, was treated with low molecular weight heparin in one case and with low molecular weight heparin and pentoxifylline in the other. Two patients who developed femoral hematoma underwent local treatment. One patient developed resistant bradycardia, for which a temporary pacemaker was inserted. A patient with femoral hemorrhage was treated with protamine sulfate. One patient, who developed respiratory arrest due to midazolam, was treated with respiratory support. All patients were discharged in a good condition after the treatment. The complications in patients who underwent cardiac catheterization in our clinic, and the risk factors for these complications were analyzed retrospectively. Patients undergoing cardiac catheterization should be closely monitored in terms of possible local and general complications. The incidence of the complications can be reduced by taking appropriate measures. The morbidity and the mortality can be reduced by early diagnosis and treatment of the complications.

In this study, we aimed to investigate the pre-valence of ST-segment elevation during exercise stress test (EST) in patients who underwent co-ronary angiography because of EST positivity, and to compare the clinical, EST, angiographic and prognostic data of patients with ST-segment ele-vation in EST with and without prior myocardial in-farction (PM1). Eighteen patients with exercise-induced ST-segment elevation were studied (male: 16 (88.8 %), female: 2 (11 %), mean age 54.1±9.9 years). Of these patients 12 had evidence of PM1. The pre-valence of ST elevation was (% 8.5) in 210 patients who underwent coronary angiography because of EST positivity. Thirteen patients (72 %) showed ST elevation in anterior, 2 (11 %) in inferior and 3 (16.6 %) in inferior+anterior leads. Three of PMI (+) patients showed ST elevation remote from pathological-Q wave, when 9 had ST elevation in the PM! localization. On the other hand, angina occured during EST in all patients with PM1 but in only 5 (41.6 %) of PM] (-) group.

İn this retropective study, patients with atherosclerotic risk factors and the related clinical diagnosis, angiographic scoring and regional distribution were investigated. A total of 630 patients (450 male, 180 female, mean age 56,2 ± 9.3) t hat underwent coronary angiography were enrolled. Patients were classified according to the clinical characteristic and Reardon’s modified severity scoring which is the indicator of the extend of coronary artery disease, was calculated. A parallel increase in coronary disease along with higher triglicehdes was observed, which was significantly different betvveen single and double vessel disease(p<0,05). The same correlation was apparent between HDL levels and the extent of the disease vvhich was remarkable in single and triple vessel disease group (p<0,05). Triglyceride levels varied as higher in males younger than 60 year of age vvhile smoking was lower in the same group (p<0,05). On the other hand hypertension was observed more frequently in elder patients (<60 year of age) (p<0,05). As a conclusion, ali risk factors other than smoking appeared to be higher than TEKHARF cohort, which were given for Central Anatolia region.

The liver is the most frequently wounded organ in the abdominal traumas and the rate of mortality is still very high. We aimed to present a case that was treated with non-operative methods which led to hepatitis because of increase in intraparenchymal hematoma in the late period. Seventeen-year-old male patient who had liver laceration after blunt abdominal traumas was treated with embolectomy due to liver hematoma. In late period, liver parenchymal hematoma can be increased and patients can develop hepatitis because of increased hematoma pressure on intraparenchymal biliary tract and this situation can be effectively treated with non-surgical methods.

Imaging Findings and Coil Embolization of A Coronary Artery Fistula

Pulmonary embolism(PE) is a serious disease which is one of the most important reason of cardiovascular mortality. In spite of the fact that electrocardography(ECG) has a limited effect on the diagnosis and determination of the prognosis of PE, it is an essential method for clinically differentiating PE from other diseases that might be confused with PE, such as myocardial infarction(MI) .The aim of this case report presentation is to discuss whether this stuation might be a marker on determination of the prognosis.and the fact that PE could mimic the ECG findings of ST elevation myocardial infarction even though it is rare. Fifty six years old patient with acute renal failure and disorder of liver dysfunction, who had been treating in intensive care unit of internal medicine department, complained about chest pain and shortness of breath occuring on second day of his admission to the hospital. The patient was taken from cardiology department with anteroseptal MI prediagnosis after evaulation of the ECG demonstrating about 4 mm ST elevation in V1-V4 precordial derivations. Coronary angiography was performed to the patient being thought to whom primary percutaneous coronary intervention might be neccessary and there was not any lesion determined in epicardial coronary arteries. The parameters obtained from transthoracic echocardiographic evaulation of the patient was corcordant with the diagnosis of PE. It was understood from the imaging reports performed previously that trombus in vena cava inferior had been detected. The patient had cardiac arrest and died while he was being prepared for the pulmonary embolectomy operation after diagnosing of PE. The aspect which made our case report more attractive is that there were only various case reports published about PE in literature, which indicateST elevationmimicing anterior myocardial infartion. It is thought that this situation might be observed in PE and might guide for determination of the prognosis as well when this case report is evaulated together with the other ones.

In this study, a modified embolic cerebral ischemia model using homologous blood clot as embolizing agent in rabbits is presented. In the study in which 16 rabbits were used, homologous blood clot was injected into the right carotid cournirdsarteri. In all rabbits, the fundus of the eye was examined intermittently before and after embolization, and carotid angiography was performed in four of them to monitor the progression of the embolism. The brains of rabbits killed by giving intracardiac formaldehyde 24 hours after embolization were removed and the localizations and volumes of the infarct sites were determined in serial sections.

In addition to the many research about organophosphate poisoning, the fact of acute myocardial infarction and respiratory failure that happen after organophosphate exposure is firstly reported. A 46 years old patient was taken into emergency with the plaint of dispne, chest pain and somnolence. By taking anamnesis, it is understood that these plaints are occured after eating cherry of which trees are disinfected with a pesticide (Dipterex SP 80 (%80 trichlorphon 0,0 dimethyl phosphonate). General situation was miserable, tachypnea and his consciosness was somnolence. The patient was immediately intubated and connected to the mechanical ventilator. There was sinus tachycardia in his electrocardiography and the elevation of pathologic Q and ST elevation in V1-4. Troponin was high in his blood test. With these indications, it was supposed that there was heart attack and respiratory failure depending on organophosphate poisoning on the patient. After the treatment of piralidoxime, acute myocardial infarction and respiratory failure, the patient was discharged from hospital for being angiography. Finally, acute myocardial infarction and respiratory failure which evolve out of organophosphate poisoning shouldn’t be ignored.

Single coronary artery is observed in approximately 2-4% of all coronary artery anomalies. In our case, 48 years old female patient had exercise-induced angina pectoris and fatigue. After her exercise electrocardiogram revealed ST depression during 9 mets, we demonstrated a single coronary artery as an extremely rare anomaly of coronary artery in which there was no original left main artery as well as right coronary artery, left anterior descending and circumflex arteries were originated from right sinus Valsalva. On medical treatment with beta blocker, her symptoms had recovered. This type of coronary anomalies is very infrequent and may be a reason of sudden death.

Multi-Slice Computed Tomography (MSCT) is a recently introduced non-invasive technique used for the diagnosis of coronary artery disease (CAD). Both MSCT and conventional coronary angiography (CAG) may provide direct visualization of the coronary arteries. To determine the diagnostic accuracy of 128-slice MSCT compared with the results of conventional CAG for the diagnosis of significant coronary artery stenosis. Forty-two eligible patients who underwent 128-slice MSCT with the suspicion of CAD and had any coronary lesion within the whole coronary tree were enrolled prospectively. Subsequently, CAG was performed to confirm the severity of coronary lesions. The records acquired by MSCT coronary angiography and conventional CAG were evaluated by 16-segment model of American Heart Association (AHA). Mean age of the patients was 56±12 years, and mean heart rate prior to the examination was 69±4 bpm (min-max: 54-78). Of 672 coronary segments, 669 were interpretable and evaluated in 42 patients. For all the interpretable segments, overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of 128-slice MSCT to detect significant stenosis were 91%, 98.5%, 93.8%, 97.8% and 97%, respectively. These values for evaluation of proximal segments were 97.8%, 96.4%, 95.7%, 98.1% and 97.1% and, for distal segments were 87.4%, 98.8%, 92.7%, 97.7% and 97%, respectively. Our results show that, the diagnostic performance of MSCT appear almost equivalent to CAG, current gold standard, with excellent, sensitivity, specificity, positive and negative predictive values. We think that, 128 slice-MSCT will be increasingly utilized in future, decreasing unnecessary coronary angiography procedures.

 Postpartum haemorrhage (PPH) which is the first cause of maternal mortality in our country is responsible for about 25% of maternal deaths in the world . While PPH is defined as loss of 500 ml or more of blood from the genital tract within 24 hours of thebirth of a baby, severe PPH is blood loss exceeding 1,000 mL. The most common causes are uterine atony, genital tract injuries and placental retention. Many methods are used such as effective implementation of the uterine fundus massage, the use of agents which myometrium contact, hypogastric and/or uterine artery ligation or embolization in its treatment. Despite this, PPH is the primer cause of maternal death in our country. To reduce maternal mortality rates caused by dependence of PPH,  evidence-based approaches are important in treatment and care. Pharmacological, surgical approaches and various applications for the third stage of labour in the prevention and treatment of PPH are used. But there are no evidence-based studies at adequate levels for all treatment. The clinical data in a large part of the PPH/therapeutic approach are limited. Therefore, it is intended in this article to determine the current approaches related to the prevention of postpartum haemorrhage and to inform health professionals about the adequacy of the initiatives implemented.

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\r\n Atrial septal defect (ASD) is also responsible for 30-33% of adult defects. . Transcatheter treatment is the first-line treatment for secuncum ASD treatment. A 36-year-old ASD patient that had a successful transcatheter closure. The occluder  embolization became, within the first 24 hours after procedure, to the aortic arcus. It is known that the devices with embolism are taken by snare and biopsy catheter, but differently, a case involving surgical removal after retraction of femoral artery by another ASD occluder device. Hybrid approach should always be mindful when removing embolized device with high success rate using different methods.

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Myocardial bridge(MB) is common congenital anomaly of coronary arteries. Altough MB is generally asymptomatic, it can manifest as angina pectoris, acute myocard infarction, very rarely fatal cardiac arrhythmias and even sudden death. 44 years old man admitted to our cardiology clinic with typical chest pain and signs of anterior ischemia at electrocardiography, coronary angiography was performed and a myocardial bridge which cause total occlusion at mid-segment of left anterior descending artery detected. In this case report we aimed to discuss mechanism of symptoms, medical and invasive theraphy options and long term follow outcomes in MB.

Patients with isolated single coronary anomaly were retrospectively evaluated for clinical features, angiographic findings and treatment options. Medical records of 27714 patients, who had undergone diagnostic coronary angiography in Türkiye Yüksek İhtisas Hospital between October 2005 and October 2008, were researched and 10 patients with the diagnosis of isolated single coronary artery were recruited into the study. The mean age of patients were 60±13 years (ranging from 33 to 77), 4 of them were men (40%) and 6 were women (60%); mean ages 49±14,5 years (ranging from 33 to 68) and 67±8 years (ranging from 60 to 77), respectively. The patient’s clinical and demographic features on admission, the treatment method used were recorded and the records of coronary angiography were examined again and were classified according to modified Lipton’s classification. Isolated single coronary artery anomaly was diagnosed in 10 patients in the group of a 27714 patients who had undergone coronary angiography. Single coronary artery was originating from right sinus valsalva in 9 patients (90%), and from left sinus valsalva in a patient (10%). Four patients (40%) had severe atherosclerosis and 2 of them had undergone coronary by-pass surgery. The rest of the patients were followed-up under medical treatment. Although isolated single coronary artery anomaly is a rare entity, in hospitals in which coronary angiographic procedures are frequent, its incidence is incidentally more common. In most of the cases clinical outcomes are well and medical treatment and follow-up is enough. In cases which we plan coronary intervention, clinical features, presence of the atherosclerotic disease and the type of coronary anomaly should be watched out.

Aim: Spinal arteriovenous malformation is a rare pathology located in the dura along the spinal canal. Multi-detector computed tomographic (MDCT) angiography is a recently developed imaging technique. We present findings of magnetic resonance (MR) imaging and multi-detector computed tomographic angiography in 16-year-old patient with spinal arteriovenous malformations. Case report: MR images showed signal voids dilated vessels at the surface of the spinal cord at C1-2 level. Also, multi-detector computed tomographic angiography demontrated dilated varix-like vessels. The patient was diagnosed as having a spinal arteriovenous malformation. Result: Multi-detector computed tomographic angiography can be a non-invasive usefulness technique in detect the spinal arteriovenous malformatios.