Evaluation of craniofacial anthropometry of children with ß-thalassemia major in the eastern Anatolia: a case-control study.

OBJECTIVE: The present study aims to compare ß-thalassemia major patients and healthy individuals in terms of anthropometric characteristics and changes in craniofacial profile. SUBJECTS AND METHOD: Craniofacial anthropometric measurements were performed on a total of 422 subjects (199 ß-thalassemia major patients and 223 healthy individuals) by using a millimetric caliper and tape measure on 19 anthropometric parameters (8 horizontal, 10 vertical, and 1 head circumference) in cranial, facial, nasal, orolabial, and orbital zones. RESULTS: The difference between the orbital, nasal, and orolabial zone parameters of healthy subjects and ß-thalassemia major patients was found to be statistically significant (p < 0.05). There was no statistically significant difference between the groups in terms of head circumference in the cranial zone and total facial height in facial zone (n-gn) values (p˃0.05). In intragroup comparison between females and males with ß-thalassemia, statistically significant differences were found in forehead width (ft-ft), forehead height (tr-gl), right eye width (R ex-ex), and upper lip height (sn-stm) (p < 0.05). CONCLUSION: Understanding the craniofacial profile changes in ß-thalassemia major patients and increasing our knowledge about the relationship between the course and severity of disease and the level of these changes would contribute to the advancements in diagnoses to be made in facial and jaw zones of these patients and in the treatment plans. CLINICAL RELEVANCE: We believe that the analysis and results of the craniofacial anthropometric data obtained in the study will contribute to the diagnosis and treatment processes of patients with ß-thalassemia major in areas of expertise such as craniofacial surgery, orthodontics, and hemato-oncology.

Thrombus entrapped in a patent foramen ovale, causing only vague symptoms.

Patent foramen ovale provides a passage from venous circulation to arterial circulation. This may allow passage of a thrombus formed in the venous system into the systemic circulation. We present a case in which a thrombus was entrapped in a patent foramen ovale. A 45-year-old woman presented with complaints of atypical chest pain and pretibial edema. Transthoracic echocardiography showed normal systolic function and grade I diastolic dysfunction. Pulmonary artery pressure was 43 mmHg. There was a mobile multilobular mass in the right atrium, attached to the interatrial septum via a thin pedicle. Transesophageal echocardiography showed a biatrial mass. It was 7-10 mm thick, multilobular, homogeneously echogenic, and highly mobile. It passed through the patent foramen ovale into the left atrium. The left atrial part was 6-8 mm thick, relatively shorter, and less mobile. The patient denied any symptoms related to a cerebrovascular accident. Heparin was initiated and an urgent operation was decided. Intraoperative transesophageal echocardiography showed that the mass was a thrombus which had become smaller due to anticoagulation. She had no neurologic symptoms postoperatively. Venous Doppler examination revealed deep vein thrombosis and warfarin was started.

Left atrial appendage can still cause clinical events after ligation.

We present a 71-year-old female patient with transient ischaemic attack. A thrombus located at the stump of previously ligated left atrial appendage was suspected as the cause of event.

Echocardiographic, electrocardiographic, and clinical correlates of recurrent transient ischemic attacks: a follow-up study.

BACKGROUND: Transient ischemic attack (TIA) is presumed to be of cardiovascular origin. The aim of the study was to evaluate the electrocardiographic, echocardiographic, and clinical signs for predicting TIA recurrence. METHODS: A total of 100 consecutive patients presenting with a first episode of TIA without atrial fibrillation, previous stroke, and uncontrolled diabetes or hypertension were enrolled in the study. The electrocardiographic, echocardiographic, and clinical parameters were obtained in those patients. The patients received a follow-up of bimonthly visits and were grouped according to the presence (or lack) of TIA recurrence in the follow-up period. RESULTS: Of these patients, 23 experienced recurrent TIA and 72 did not; 5 patients dropped out. Independent risk factors evaluated for TIA recurrence were aortic diameter, left atrial diameter, P-wave dispersion, hyperlipidemia, absence of lipid lowering, and warfarin treatment. CONCLUSION: Careful electrocardiographic and echocardiographic evaluation of patients with TIA may help assess the outcome of patients and guide therapeutic interventions.

Impaired aortic elastic properties in young patients with prehypertension.

OBJECTIVES: Although hypertension has been shown to be one of the most important predictors of reduced arterial elasticity, there is not enough data about aortic elastic properties in patients with prehypertension. Accordingly, the current study was designated to evaluate aortic elastic features in young patients with prehypertension. MATERIAL AND METHODS: The study population consisted of 25 newly diagnosed prehypertensive individuals (18 men, mean age=34+/-6 years) and 25 healthy controls (16 men, mean age=33+/-6 years) eligible for the current study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. RESULTS: Prehypertensive patients were detected to have significantly lower aortic distensibility and strain indexes than the controls: (5.77+/-1.91 vs. 8.63+/-2.67 cm dynx10, respectively, P<0.001; strain index: 13.81+/-4.50 vs. 17.47+/-4.25%, respectively, P=0.005). Aortic stiffness index beta of the prehypertensive group, however, was significantly higher than that of the control group (3.73+/-1.41 vs. 2.97+/-0.82, P=0.02). CONCLUSION: Whatever the mechanism, young patients with prehypertension have impaired aortic elasticity compared with healthy controls. This finding has suggested that the development of overt hypertension may be prevented or delayed by using the agents that have the ability to reduce arterial stiffness by regressing and/or preventing functional and structural changes on the arterial wall.

[The value of augmentation index and myocardial performance index obtained from cardiac catheterization pressure recordings in predicting coronary artery disease]. / Kardiyak kateterizasyona ait basinç kayitlarindan elde edilen artirma indeksi ve miyokardiyal performans indeksinin koroner arter hastaligini öngörme degerleri.

OBJECTIVE: The aim of the study was to determine the relation between some parameters, which can be obtained from cardiac catheterization pressure records, and coronary artery disease. METHODS: The study included 65 patients, in whom coronary angiography was performed by the cardiologists of the study. The parameters could be obtained in 40 patients (59+/-6 years; 28 male), and statistical analysis included the data of these patients. From the pressure recordings, myocardial performance index (MPI), isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), ejection time (ET), augmentation wave amplitude (AW), augmentation wave time (AWT) and augmentation index (AI) were measured manually. Coronary artery disease was defined as the presence of any lesion, without regarding the degree of narrowing. The parameters were evaluated with respect to relation with presence of coronary artery disease (Mann-Whitney U test), relation with risk factors for atherosclerosis (Mann-Whitney U test and Chi square test) and capability of predicting coronary artery disease (area under ROC curve, AUC). Statistical significance was set at 0.05. RESULTS: The presence of coronary artery was significantly related to AI, AWT, AW, IVCT and MPI (p<0.001 for all). The most sensitive parameters for coronary artery disease were AI (sensitivity 94%, AUC -0.846, p<0.001) and AW (sensitivity 94%, AUC -0.848, p<0.001), while the most specific one was AWT (specificity 82%, AUC -0.833, p<0.001). The MPI and IVCT were weakly related with risk factors, while IVRT had stronger relation. The parameters of augmentation wave were significantly related with high density lipoprotein cholesterol, whereas the relation with low density lipoprotein cholesterol was weak. CONCLUSION: The parameters, which are obtained from cardiac catheterization pressure recordings, are related with coronary artery disease. They may be useful for predicting future coronary artery disease especially in patients with normal coronary angiogram. It is useful to add these parameters into the reports of coronary angiograms.

Left atrial functions after myocardial infarction.

Acute myocardial infarction results in not only left ventricular but also left atrial dysfunction. Left atrial function is important for optimal filling of the left ventricle. In this study, we aimed at evaluating left atrial functions 6 months after acute myocardial infarction in three different patient groups (thrombolytic therapy, primary percutaneous intervention, or no reperfusion strategies). Between October 2002 and May 2003, 48 patients with ST elevation myocardial infarction who were either administered thrombolytic therapy (group T, n=16), underwent primary angioplasty (group A, n=20), or underwent no reperfusion therapy (group C, n=12) at our unit were enrolled into the study. Echocardiography was performed in these patients 6 months after acute myocardial infarction. Left atrial contractility was assessed by atrial ejection force. Left atrial contribution was assessed by atrial fractional shortening and left atrial volume was calculated. The left atrial volume was significantly higher in group C (P<0.05), but there was no significant difference between groups A and T (P>0.05). Patients in group C had significantly lower atrial ejection force values compared with the other groups (P<0.05). Atrial fractional shortening was not significantly different among the three groups (P>0.05). Atrial ejection force, which is an indicator of left atrial contractility, is better with either angioplasty or thrombolysis. Left atrial volume is higher in patients who were not treated with reperfusion strategies. Further studies are needed to explain the mechanism involved.

Utility of myocardial performance index measured by left ventricular catheterization.

BACKGROUND: Myocardial performance index (MPI) is a valuable index of global ventricular performance. It is almost always measured by Doppler echocardiography. The purposes of this study were (I) to compare MPI measured by catheterization (MPIc) and that measured by Doppler echocardiography (MPId), and (2) to compare it with the functional status. MATERIALS AND METHODS: The study included 80 patients who had undergone left heart catheterization. The MPIc was measured from the pressure recordings obtained at left ventricle and aorta. RESULTS: Mean MPId and MPIc were 0.40 +/- 0.12 and 0.42 +/- 0.12, respectively. Mean left ventricular end diastolic pressure (LVEDP) was 13 +/- 5 mm Hg. Mean heart rate was 77 +/- 11 beats/min. Mann-Whitney U test revealed that MPIc could discriminate between the functional statuses of the patients. The regression analysis revealed that there is a good correlation between MPIc and MPId, LVEDP or heart rate. There was no significant difference between MPIc and MPId (p > 0.05). CONCLUSION: The present data show that (I) the MPIc has a strong correlation with MPId; (2) it is a good discriminator of functional status. It may provide an additional information regarding the left ventricular performance in patients who underwent the cardiac catheterization.

A different method for measuring mitral valve area with special emphasis on concomitant aortic regurgitation: A new application of proximal isovelocity surface area method.

Measurement of mitral valve area is still a challenge for the echocardiographers. Each method has its own limitations. In this study we assessed a different method and compared it with the other methods. The study included 50 consecutive patients with mitral stenosis. The reference method was planimetry. The suggested method was compared with the pressure half-time method, proximal isovelocity surface area method with and without angular correction, and the continuity method. There was a good correlation between each method and planimetry. The suggested method had the best correlation both for patients with and without aortic regurgitation. The pressure half-time method and continuity method overestimated the mitral valve area for patients with aortic regurgitation, whereas proximal isovelocity surface area method without angular correction overestimated the area in all patients. In conclusion, this method has very good correlation with planimetry. It can be used both in patients with and without aortic regurgitation.

Speckle tracking based myocardial velocities: our experience with novel software.

OBJECTIVE: Speckle tracking is a new imaging modality capable of providing information about myocardial motion in all three directions: longitudinal, circumferential and radial. There are many software packages with their unique tracking algorithms and user interfaces in the market. We aimed to evaluate the feasibility of QLAB software in clinical practice and speckle based myocardial velocities in healthy subjects. METHODS: Thirty-two subjects were enrolled in the study. Images from apical four-chamber, apical two-chamber, parasternal short-axis (mitral valve-apical levels) views were acquired and analyzed offline with QLAB. We measured speed and velocity data in longitudinal, circumferential and radial directions. Time percent of these events were also calculated. In the final data analysis 825 of 832 segments (99.2%) were included. Mann Whitney U, Student's t and Kendall's tau-b coefficient tests were used for statistical analysis. RESULTS: We determined that circumferential speed was significantly higher (p<0.001) than radial velocity in both parasternal short-axis views. Likewise, longitudinal speed was higher (p<0.001) than radial velocity in apical views. Notwithstanding the speed and velocity data, time percent of radial velocity were significantly lower (p<0.001 for all) than their longitudinal or circumferential counterparts. We also notified that apex was the segment reaching its maximum speed at earliest time. QLAB measurement time was relatively long (8.1+/-1.7 min) and intraobserver agreement was lost in 3% of the segments. CONCLUSION: In addition to these findings, we consider QLAB software package for speckle tracking needs some improvements to shorten measurement time and decrease user intervention.

Mixed-dentition analysis in a Turkish population.

OBJECTIVE: To study the reliability of the Tanaka-Johnston mixed-dentition analysis in Turkish individuals and develop a new population-adjusted regression equation for predicting the size of unerupted canines and premolars. The new regression equations were tested to establish their validity in Turkish children. METHODS: The mesiodistal dimensions of teeth on study casts of 12- to 14-year-old Turkish children were measured. The actual tooth measurements were then compared with predicted values using the Tanaka-Johnston equation. Subsequently, the new regression equations were tested in a group of 50 individuals to determine their validity. RESULTS: The Tanaka-Johnston regression equations overestimated the actual mesiodistal widths of permanent canines and premolars. With the new regression equations, no statistically significant differences were observed between actual and predicted widths. CONCLUSION: The Tanaka-Johnston prediction method is not accurate when applied to a Turkish population. The new equations are reliable for predicting the width of unerupted canines and premolars in Turkish individuals.

Comparison of facial proportions and anthropometric norms among Turkish young adults with different face types.

BACKGROUND: This study aimed to determine the prevalence of three different face types among Turkish young adults based on facial indices, to assess and compare the vertical and horizontal dimensions for each type, and to establish anthropometric norms for Turkish adults. METHODS: A total of 173 healthy young adults (83 females and 90 males) 17 to 25 years of age were examined. Using anthropometric landmarks, 8 horizontal and 10 vertical direct measurements were made with a millimetric compass. RESULTS: Using facial indices, 59 of the 173 subjects were classified as euryprosopic, 49 as mesoprosopic, and 65 as leptoproposic. In the total evaluation of both groups, all the parameters were higher in the males except forehead heights 1 and 2. A comparison of face types in females and males separately showed no significant differences between the parameters. CONCLUSIONS: The data presented in this study may help plastic surgeons and orthodontists objectively determine the relationships between facial structures for different face types. Additionally, the facial anthropometric norms derived from this study may be useful in the treatment of Turkish patients.

A nomogram for measurement of mitral valve area by proximal isovelocity surface area method.

INTRODUCTION: Although its accuracy has been documented in many studies, the proximal isovelocity surface area (PISA) method is not used widely for mitral valve area (MVA) measurement. In this study, we prepared a new nomogram and tested its use in MVA assessment. MATERIAL AND METHODS: The study included 23 patients (age: 27 +/- 5 years) with mitral stenosis, of whom 7 were in atrial fibrillation. The MVA was measured by four methods: planimetry (PL) (reference method), pressure-half time (PHT), conventional PISA (CP), and nomogram (Nomo) methods. The nomogram included two unknowns: (1) r; the radius of the first PISA section; (2) a; the length of the border opposite to the PISA angle in the triangle with both adjacent borders of 1 cm. The nomogram was also tested for its popularity potential by eight echocardiographers, none of whom were included in the author list. RESULTS: Mean MVA(PL) was 1.85 +/- 0.53 cm(2) (range: 0.72-2.99), mean MVA(PHT) was 1.72 +/- 0.56 cm(2) (range: 0.91-3.30), mean MVA(CP) was 1.69 +/- 0.45 cm(2) (range: 0.97-2.54), and MVA(Nomo) was 1.70 +/- 0.44 cm(2) (0.96-2.49). The nomogram correlated with planimetry (r = 0.87; P < 0.001), pressure half-time (r = 0.71; P < 0.001) and conventional PISA (r = 0.99; P = 0.000) methods. The nomogram method also correlated with planimetry in patients with atrial fibrillation (r = 0.81; P = 0.026). The echocardiographers found that the nomogram is superior to the planimetry and conventional PISA methods but inferior to the pressure half-time method in terms of simplicity. CONCLUSION: The new nomogram is potentially helpful in measurement of MVA. It may be used as an additional method in assessing severity of mitral stenosis.

A new echocardiographic index for assessing left ventricular function and mechanism of mitral regurgitation and its relation to other echocardiographic indices.

OBJECTIVE: Mitral regurgitation (MR) is a progressive disease of the mitral valve, which can be primary or functional. The assessment of left ventricular function in MR is still troublesome. In this study, we evaluated the validity of a new parameter, total dt, in patients with MR. METHODS: Forty patients with severe MR constituted the study group. According to the transesophageal echocardiographic evaluation, the patients were dichotomized into two groups: (1) Primary MR; n = 21, (2) Functional MR; n = 19. The total dt was defined as the sum of time intervals from 1 msto 3 ms (positive dt) and from 3 ms to 1 ms (negative dt) on the CW Doppler recording of MR jet. It was compared to other indices of left ventricular function and left ventricular geometry, including ejection fraction, fractional shortening, myocardial performance index, coaptation distance, left ventricular volume and diameter, sphericity index, and parameters of diastolic function. RESULT: The total dt correlated with myocardial performance index, coaptation distance, and sphericity index. It could differentiate between primary and functional MR with an area under curve of 0.878, followed by myocardial performance index with 0.860. The total dt > 104 ms was 79% sensitive and 81% specific for discrimination. CONCLUSION: The total dt is useful for assessing left ventricular function and also for differentiating primary MR from functional MR.

Left ventricular function in male patients with secondary hypogonadism.

BACKGROUND: In addition to the effects on ventricular repolarization, testosterone could also affect left ventricular performance. The enhancement of left ventricular contractility in testosterone-deficient rats following testosterone replacement implies to the possible testosterone effect. OBJECTIVES: The aim of the current study is to reveal the alterations of left ventricular functions, if any, in secondary hypogonadal male patients. METHODS: Thirty-four males with secondary hypogonadism comprised the study group. The control group consisted of 30 healthy subjects. Echocardiographic measurements including left ventricular dimensions, ejection fraction, mitral inflow, and left ventricular outflow parameters were obtained from all subjects. Tissue Doppler parameters were also measured from left ventricular lateral wall and interventricular septum. RESULTS: Left ventricular diameters, wall thicknesses, and performance parameters were similar in both groups. Mitral inflow parameters showed a statistically insignificant difference. Pulse-wave tissue Doppler interpretation of hypogonadal and healthy subjects were similar in terms of lateral and septal basal segment Sm, Em, and Am wave velocities. CONCLUSIONS: Regarding the findings of previous studies that showed impaired myocardial contractility and lusitropy in testosterone deficient rats and our study results, further studies are needed for better understanding of testosterone's effects on human myocardium.

Coexistence of a huge subaortic left ventricular aneurysm and a saccular descending aortic aneurysm.

A huge subaortic left ventricular aneursym was diagnosed in an asymptomatic 22-year-old male patient. The walls of aneurysm were calcific and compressed the left atrium. Also, a saccular descending aortic aneursym and moderate mitral insufficiency associated with subaortic left ventricular aneurysm were found in the current case. Up to now, the coexistence of congenital left ventricular aneurysm and saccular aortic aneursym has not been reported in the literature. We present the first case of congenital left ventricular aneurysm combined with saccular aortic aneurysm in descending thoracic aorta in this case report.

A contractile left ventricular diverticulum.

We present the first case report of left ventricle muscular diverticulum which stands in front of the right ventricle in an asymptomatic 20-year-old male. The diverticulum has a connection with the left ventricular outflow truct, and contracts simultaneously with the left ventricle. The patient has been included in our congenital anomaly follow-up program.

A giant dissecting aneurysm of ascending aorta.

Aortic aneurysm is a serious clinical challenge for the cardiologist. Aneurysm expansion frequently associated with significant dissection and rupture risk. Currently available diagnostic modalities make earlier diagnosis and therapy possible hence giant aneurysm with dissection is relatively rare. In this case report, we present a patient with giant aortic aneurysm with dissection.