Plasma levels of tumor necrosis factor-alpha and its receptors in patients with mitral stenosis and sinus rhythm undergoing percutaneous balloon valvuloplasty.

This study aimed to determine whether plasma levels of tumor necrosis factor-alpha (TNF-alpha) and soluble TNF receptor (sTNF-R) increases in rheumatic mitral stenosis (MS) patients with sinus rhythm and to examine the effect of percutaneous mitral balloon valvuloplasty (PMBV) on these parameters. Twenty-six patients with MS and sinus rhythm (study group, 20 female, mean age 33 +/- 8 years), who were scheduled for PMBV, and a well-matched control group consisting of 21 healthy volunteers (15 female, mean age 35 +/- 6 years) were enrolled in the study. Tumor necrosis factor-alpha and sTNF-R levels were compared between study patients and controls, and between peripheral and left atrium (LA) blood. Changes in TNF alpha and sTNF-R levels 24 h and 4 weeks after PMBV were analyzed. Significantly higher baseline TNF-alpha and sTNF-R levels were noted in the study group. In the study group, TNF-alpha and its receptors were also found to be higher in LA blood than in baseline peripheral blood. After PMBV, mitral valve area (MVA) increased and transmitral pressure gradient decreased significantly. At the 24th hour after PMBV, the TNF-alpha level decreased from 29.61 +/- 12.22 pg/ml to 22.42 +/- 8.81 pg/ml (P < 0.0001) and at the 4th week, from 22.42 +/- 8.81 pg/ml to 18.92 +/- 7.37 pg/ml (P < 0.0001). Similar reductions were observed in the sTNF-R level. Regression analysis between the difference in sTNF-R level measured 24 h after and before PMBV and the difference in MVA measured 24 h after and before PMBV showed a significant direct relationship between these variables. This study suggests that isolated rheumatic MS without atrial fibrillation is accompanied by increased TNF-alpha and sTNF-R level. The successful PMBV establishes a significant reduction in TNF-alpha and its receptors, probably due to improved postprocedural hemodynamic parameters.

Recurrence of ventricular tachycardia degeneration by low-energy implantable cardioverter-defibrillator shocks: a case report.

Despite their proven efficacy at reducing mortality in selected patients, implantable cardioverter-defibrillators have some proarrhythmic effects. In this report, we present a case of a patient with recurrent ventricular tachycardia degeneration to ventricular fibrillation by appropriate low-energy implantable cardioverter-defibrillator shocks.

Coronary-coronary bypass grafting to reduce the risk of aortic atheroembolism.

Coronary-coronary bypass grafting refers to making anastomoses between two segments of the same coronary artery or between different coronary arteries, and provides less "touch" to the aorta, which is important for the patients with severely atherosclerotic ascending aorta. In this report we represent a case of a patient with extensive atherosclerotic aorta, in whom a saphenous vein graft was placed between the acute marginal and the posterior-descending branches of the right coronary artery during an off-pump coronary artery bypass grafting surgery.

Exercise-induced ventricular tachycardia associated with asymptomatic Brugada syndrome in a patient with urinary bladder stone.

It is well-known that autonomic nerve modulation has an important role in the occurrence of ventricular tachyarrhythmias in Brugada syndrome. A 59-year-old man underwent cardiac evaluation before surgery for urinary bladder stone. He had no cardiac complaints and the only coronary risk factor was heavy smoking. The electrocardiogram showed a saddleback type ST-segment elevation in leads V1-V2, and left axis deviation. During exercise stress test, ventricular tachycardia with a left bundle branch block pattern appeared, and the saddleback type ST-segment elevation in V2 changed into a coved-type ECG at the recovery phase. The ventricular tachycardia was hemodynamically stable and normalized without medication. An echocardiogram showed normal left and right ventricular functions, and subsequent coronary angiography revealed normal coronary arteries. Based on these findings, a diagnosis of asymptomatic Brugada syndrome was made. Considering this particular case, it can be speculated that bladder-cardiac reflex may stimulate the autonomic nervous system via the vagus nerve and unmask Brugada syndrome.

[The significance of admission hs-CRP in patients undergoing primary percutaneous intervention for acute myocardial infarction]. / Akut miyokard infarktüsü nedeniyle primer perkütan girisim uygulanan hastalarda basvuru anindaki hs-CRP düzeyinin önemi.

OBJECTIVES: We evaluated the role of admission high-sensitivity C-reactive protein (hs-CRP) level in estimating myocardial perfusion and in-hospital adverse events in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). STUDY DESIGN: The study included 43 consecutive patients (34 males, 9 females; mean age 59+/-11 years) who underwent PCI for STEMI within six hours after the onset of symptoms. Coronary angiograms were evaluated with respect to TIMI flow grade, corrected TIMI frame count, and myocardial blush grade (MBG). Electrocardiograms obtained 90 min after PCI were analyzed for ST-segment resolution. In-hospital adverse events were recorded. hs-CRP level was measured by immunonephelometry in blood obtained immediately before PCI. RESULTS: The mean hs-CRP level was 1.35+/-1.17 mg/dl. Based on the median hs-CRP value (0.98 mg/dl), 22 patients with a low hs-CRP level had a lower frequency of hypertension (p=0.047), decreased TIMI frame counts of the left anterior descending (p=0.010) and circumflex (p=0.033) arteries, a higher rate of ST resolution (p=0.000), improved MBG (p=0.015), and shorter hospitalization (p=0.028). Adverse events occurred in six patients (14%), in five of whom (5/21) the hs-CRP level was above 0.98 mg/dl. hs-CRP was significantly correlated with corrected TIMI frame counts of the left anterior descending (r=0.388, p=0.01) and circumflex arteries (r=0.336, p=0.027), length of hospitalization (r=0.357, p=0.019), and inversely correlated with MBG (r=-0.415, p=0.006). In multivariate regression analysis, hs-CRP was found to be an independent predictor of ST resolution (p=0.008). ROC analysis showed that a higher level of hs-CRP than 0.88 mg/dl predicted poor MBG with 73% sensitivity and 31% specificity (95% CI 0.577-0.899, p=0.01). CONCLUSION: In STEMI patients undergoing primary PCI, high levels of admission hs-CRP are associated with poor myocardial perfusion and longer hospitalization.

Extremely rare cardiac involvement: recurrent pericardial hydatid cyst.

Echinococcus granulosus is a common infestation in sheep and cattle raising countries. Although it is typically encountered in liver and lung, rare cardiac involvement of this infestation has very important clinical complications such as heart failure, valve regurgitation, pericardial effusion-tamponade and arrhythmia. In addition, pericardial infestation is an extremely rare condition of Echinococcus granulosus. Here, we report a case of recurrent pericardial hydatid cyst presenting exertional dyspnea, palpitation and presyncope attacks in a 72-year-old man. The diagnosis of recurrent pericardial hydatid cyst was made by transthoracic echocardiography, computed tomography and surgical history.

Bronchogenic cyst of interatrial septum.

Bronchogenic cyst, also known as inclusion cyst, is a type of congenital endodermal heterotropia derived from an abnormal development of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Its interatrial localization is extremely rare and making a final diagnosis without surgery challenges the clinician. Herein, we report a 58-year-old male patient who had an interatrial bronchogenic cyst related to transient ischemic attack.

Lower fetuin-A predicts angiographic impaired reperfusion and mortality in ST-elevation myocardial infarction.

AIMS: Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. METHODS AND RESULTS: One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 µg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level. CONCLUSIONS: Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.

Evaluation of atrial vulnerability immediately after radiofrequency catheter ablation of accessory pathway in patients with Wolff-Parkinson-White syndrome.

PURPOSE: The intrinsic atrial vulnerability is proposed as one of the mechanisms of paroxysmal atrial fibrillation (PAF) in Wolff-Parkinson-White (WPW) syndrome. In this study, we examined the early changes in atrial refractoriness and intra- and inter-atrial conduction times after radiofrequency (RF) catheter ablation of accessory pathway (AP). METHODS: Twenty-four consecutive patients with WPW syndrome and documented AV reciprocating tachycardia but without history of PAF (fourteen male, mean age 39 +/- 9.5 years) and 27 control subjects (six female, mean age 51.4 +/- 10.1 years) with AV nodal reentrant tachycardia (AVNRT) who underwent ablation of the slow AV nodal pathways were enrolled into the study. Regional atrial effective refractory periods (AERPs), AERP dispersion, and intra- and inter-atrial conduction times were obtained before and 30 min after ablation and were compared between two groups. In the study group, patients with and without inducible AF were also compared regarding these parameters. RESULTS: In the study group, AERPs in higher right atrium and right posterolateral atrium were significantly increased, and AERP dispersion, intra-atrial, and inter-atrial conduction times were significantly decreased after ablation; AERP in distal coronary sinus was unchanged. In control group, no significant difference was observed in these parameters. Inducibility of AF was significantly reduced following ablation of AP in the study group (from seven to zero of 24 patients, p = 0.016). Comparison between patients with (n = 7) and without (n = 17) AF revealed that left atrium diameter was larger, AERPs in the right posterolateral atrium before and after ablation, and ERP of AP were shorter in AF group. CONCLUSION: In WPW syndrome patients, RF catheter ablation of AP results in an 'immediate' decrease in atrial vulnerability. Since inducibility of AF becomes more difficult in this less vulnerable atrium, the AP itself may play an important role in the development of AF.

Atrioventricular block induced by mad-honey intoxication: confirmation of diagnosis by pollen analysis.

An unusual type of food poisoning, mad-honey intoxication, can be observed in the Black Sea region of Turkey and various other parts of the world. It can occur after ingestion of grayanotoxin-contaminated honey produced from the nectar of Rhododendron ponticum and other plant species, chiefly of the Ericaceae and Sapindaceae families. Mad-honey intoxication can result in severe cardiac complications, such as complete atrioventricular block. The diagnosis is generally reached on the basis of the patient's history of honey intake. In this report, we describe the case of a patient who had mad-honey-related complete atrioventricular block; in this instance, the diagnosis was confirmed by a pollen analysis of the suspect honey.