[Drug-eluting stents in multivessel coronary artery disease: Was one of the important fortresses of surgery conquered?]. / Cok damar koroner arter hastaliginda ilaç salinimli stentler: Cerrahinin önemli kalelerinden biri fethedildi mi?

Since the drug eluting stents have provided better results concerning restenosis and repeat revascularization comparing to bare metal stents, percutaneous coronary interventions are performing increasingly in more complex stenoses. However, drug eluting stents did not show any advantage on prevention of myocardial infarction and survival. Currently there is no any completed controlled randomized study showing the superiority or equality of drug eluting stents over coronary bypass surgery by means of efficacy and safety. While the long-term results of drug eluting stents still unclear, everyday progressively more patients with multivessel disease are undergoing percutaneous coronary intervention with drug eluting stent implantation. The aim of this review is to discuss the efficacy and safety of drug eluting stents in patients with multivessel disease.

QT dispersion in sarcoidosis.

STUDY OBJECTIVES: QT dispersion (QTd) is the maximal interlead difference in QT interval on surface 12-lead ECG. An increase in QTd is found in various cardiac diseases. Sarcoidosis augments inhomogeneity in ventricular repolarization by sarcoid granuloma, which significantly correlates with ventricular fibrillation. Changes in QTd in the course of sarcoidosis have not been investigated previously. DESIGN: The study included 35 patients with systemic sarcoidosis. The diagnosis of systemic sarcoidosis was made by biopsy. Thallium scintigraphy was performed in all patients with systemic sarcoidosis. Cardiac sarcoidosis was diagnosed in 16 patients based on abnormal thallium scintigraphy and normal coronary arteriography results. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT, and minimum corrected QT intervals were measured. Twenty-four healthy subjects represented the control group for QT interval analysis. MEASUREMENTS AND RESULTS: In the cardiac sarcoidosis group, mean QTd (+/- SD) was significantly greater than in the noncardiac sarcoidosis group and control group (49.50 +/- 10.86 ms, 28.14 +/- 11.02 ms, and 27.08 +/- 10.41 ms, respectively; p < 0.001). cQTd was significantly greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group and control group (53.17 +/- 10.44 ms, 30.61 +/- 10.94 ms, and 29.01 +/- 10.52 ms, respectively; p < 0.001). QTmax (440 +/- 15.01 ms, 409 +/- 14.86 ms, and 410 +/- 13.21 ms; p < 0.001) and cQTmax (449 +/- 16.31 ms, 417 +/- 12.51 ms, and 418 +/- 11.76, respectively; p < 0.001) were also significantly greater in patients with cardiac sarcoidosis. In a limited follow-up group (11 cardiac and 9 noncardiac sarcoidosis patients), the incidence of premature ventricular contraction (PVC) on ECG was greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group (36% and 0%, respectively; p < 0.05). A medium correlation existed between QTd and PVC (r = 0.331, p < 0.05). CONCLUSIONS: QTd, cQTd, QTmax, and cQTmax are prolonged in patients with cardiac sarcoidosis compared to the patients with noncardiac sarcoidosis and control subjects. The incidence of PVC on ECG was greater in the cardiac sarcoidosis group than in the noncardiac sarcoidosis group.

Acute alcohol intake and QT dispersion in healthy subjects.

OBJECTIVE: QT dispersion (QTd) is the maximal interlead difference in the QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in patients with various cardiac diseases and reflects cardiac autonomic imbalance. Variability of QT duration among the 12 surface ECG leads expresses electrical instability and greater susceptibility to malignant ventricular arrhythmias. Electrophysiological studies have shown that heavy episodic drinking facilitates the induction of ventricular tachyarrhythmias in some heavy drinkers. However, the association between QTd and acute alcohol intake has not been studied previously in healthy subjects. METHOD: In a randomized crossover study, 10 healthy male volunteers (average [SD] age 30 [2.1] years, range: 25-33) received either alcohol (six 12-oz cans of beer) or placebo (juice). The alcohol group consumed 0.97 [0.12] g/kg body weight ethanol, and the placebo group consumed the same amount of juice in a 1-hour period. After a 48-hour washout period, the alcohol group drank juice, and the juice group drank alcohol. QTd and corrected QTd (cQTd) were measured in a baseline ECG after the alcohol period (AP) and after the juice period (JP). RESULTS: In comparison with baseline ECG (31.7 [9.4] ms), QTd values after AP (42.1 [10.8] ms) were significantly prolonged (p = .027), but this was not so after JP (33.8 [7.1] ms; p = NS). Also in comparison with baseline ECG (35.7 [11.1] ms), cQTd values after the AP (49.8 [12.7] ms) were significantly prolonged (p = .005), but again, this was not so after the JP (36.8 [7.3] ms; p = NS). CONCLUSIONS: Heavy episodic drinking is associated with an increase in QTd and cQTd.

Tricuspid valve perforation by permanent pacemaker lead--a case report.

Tricuspid valve perforation with pacemaker lead is one of the extremely rare complications of transvenous pacemaker implantation. Approximately all reported cases have been diagnosed at autopsy. The authors present a case of tricuspid valve perforation caused by pacemaker lead that was diagnosed during cardiac surgery and treated successfully by removing the lead and suturing the tricuspid valve.

Adrenal adenoma presenting with ventricular fibrillation.

We report the case of a 58-year-old man who presented with ventricular fibrillation. The serum potassium level was 1.8 mEq/L after successful cardioversion. Coronary angiography showed a normal heart with no structural defects, but 12-lead electrocardiography showed indications of left ventricular hypertrophy, which was confirmed by echocardiography. Laboratory examinations showed a suppressed renin level and an elevated serum aldosterone level. Computed tomography then revealed a right adrenal mass. The patient was treated with surgical resection of the adenoma. This case emphasizes the importance of meticulous search for secondary causes of hypertension, before the occurrence of serious complications.

New-onset conduction defects and their relationship with in-hospital major cardiac events in unstable angina pectoris.

BACKGROUND: The aim of this prospective cohort study was to describe the incidence and the risk factors for the development of intraventricular conduction defects and the relationship of these defects with in-hospital major cardiac events (MACE) in unstable angina pectoris. METHODS: Two-hundred-and-seventy consecutive patients presenting with Braunwald class IIIB angina without a conduction defect at admission were included in the study and followed up during the in-hospital period. RESULTS: Fifty-one patients who developed non-ST-elevation myocardial infarction during the first day were excluded from the study. Of the remaining 219 patients, 40 (18%) had a new permanent conduction defect (group 1) and 179 (82%) did not have a conduction defect (group 2) during the in-hospital period. The patients in group 1 were significantly older (mean age of 63.5 +/- 11 years compared with 59 +/- 10 years, P = 0.01) and a history of previous coronary artery bypass grafting (CABG) was more frequent in this group (12.5% compared with 1.6%, P = 0.004). By logistic regression analysis, age (P = 0.01, odds ratio (OR) = 1.473, 95% confidence interval (CI) = 1.108-2.612) and previous CABG (P = 0.005, OR = 3.995, 95% CI = 1.811-7.383) were also found to be risk factors for the development of a conduction defect. In-hospital total MACE, death and heart failure were more frequently observed in group 1 (P = 0.005, P = 0.02, P = 0.001, respectively). The incidences of recurrent refractory angina, acute myocardial infarction and urgent revascularization were not different between the groups. ST-segment depression at admission (P = 0.009, OR = 1.654, 95% CI = 1.228-2.675) and a new-onset conduction defect (P = 0.02, OR = 1.625, 95% CI = 1.244-2.754) were found to be predictors of the development of in-hospital MACE. CONCLUSIONS: In unstable angina pectoris, patients with a new-onset conduction defect are relatively older and have more frequently undergone previous CABG. Because in-hospital MACE, death and heart failure are more common in patients with a new conduction defect, they should be considered as high risk and treated more aggressively.

An unusual cause of reflex cardiovascular syncope: vagal paraganglioma.

Vagal paraganglioma is one of the rare tumors of the neuroendocrine system. We are reporting a vagal paraganglioma case presented with uncommon features of the disease: asystole and syncope. Syncope episodes occurred 3 years before the major symptoms of the disease. Dual chamber pacemaker failed to prevent syncope attacks because of the vasodepressor component. The patient was treated successfully with en bloc removal of tumor and vagal nerve. Syncope episodes disappeared after operation.

Pacemaker related endocarditis: analysis of seven cases.

Vegetative electrode infection following permanent pacemaker implantation is a rare and serious complication. Among 1920 patients who underwent permanent pacemaker implantation in our institute between 1980 and 2000, 7 patients aged 65 to 78 years were diagnosed to have pacemaker related endocarditis. In this study, the clinical course and management strategies for these patients are reviewed. The most frequently encountered factors contributing to development of pacemaker infection were local complications such as postoperative hematoma and inflammation, and recurrent surgical interventions on the pacemaker system. In blood cultures S. aureus was the most common causative microorganism. Echocardiography could be performed in 5 patients. Three patients were referred to open-heart surgery for total removal of the pacemaker system, and one patient had his pacemaker system removed percutaneously. The remaining 3 patients did not agree to either surgical or percutaneous removal. These patients have been under antibiotic therapy for approximately 3 years and they still do not have any signs of a serious infection. Consequently, in patients with permanent pacemakers, infective endocarditis should be considered in the presence of fever and local symptoms. Blood cultures should be obtained and echocardiography should be performed. Complete removal of the pacemaker system with intensive antibiotic treatment is necessary for complete eradication of the infection. However, if percutaneous or surgical removal of the electrodes cannot be done because of high perioperative risk or the patient does not agree to undergo either method, medical treatment with long term antibiotic use may be considered as an alternative.