P wave dispersion is increased in pulmonary stenosis.

AIM: The right atrium pressure load is increased in pulmonary stenosis (PS) that is a congenital anomaly and this changes the electrophysiological characteristics of the atria. However, there is not enough data on the issue of P wave dispersion (PWD) in PS. METHODS: Forty-two patients diagnosed as having valvular PS with echocardiography and 33 completely healthy individuals as the control group were included in the study. P wave duration, p wave maximum (p max) and p minimum (p min) were calculated from resting electrocardiography (ECG) obtained at the rate of 50 mm/sec. P wave dispersion was derived by subtracting p min from p max. The mean pressure gradient (MPG) at the pulmonary valve, structure of the valve and diameters of the right and left atria were measured with echocardiography. The data from two groups were compared with the Mann-Whitney U test and correlation analysis was performed with the Pearson correlation technique. RESULTS: There wasn't any statistically significance in the comparison of age, left atrial diameter and p min between two groups. While the MPG at the pulmonary valve was 43.11 +/- 18.8 mmHg in PS patients, it was 8.4 +/- 4.5 mmHg in the control group. While p max was 107.1 +/- 11.5 in PS group, it was 98.2 +/- 5.1 in control group (p=0.01), PWD was 40.4 +/- 1.2 in PS group, and 27.2 +/- 9.3 in the control group (p=0.01). Moreover, while the diameter of the right atrium in PS group was greater than that of the control group, (38.7 +/- 3.9 vs 30.2 +/- 2.5, p=0.02). We detected a correlation between PWD and pressure gradient in regression analysis. CONCLUSION: P wave dispersion and p max are increased in PS. While PWD was correlated with the pressure gradient that is the degree of narrowing, it was not correlated with the diameters of the right and left atria.

QT dispersion in non-apneic simple snoring patients and the effect of surgical therapy on QT dispersion.

AIM: Increased QT dispersion in cases of obstructive sleep apnea, which may induce serious arrhythmias, is a well-known process. However, there is little information about the QT dispersion in patients with simple snoring without apnea. We investigated QT dispersion in snoring and the effect of surgical therapy on QT dispersion. METHODS: One hundred and sixty two patients with simple snoring without apnea were included in this study. Patients had polysomnography and surface electrocardiography (ECG) on the pre-operative 1st week and post-operative 4th week. The patients underwent one of the three surgical procedures, which include uvulopalatopharyngoplasty, laser assisted uvulopalatoplasty, and cautery assisted uvulopalatoplasty. QT dispersion was calculated in each patient from pre-operative and post-operative surface ECG. Pre-operative and post-operative values were compared using the student's t test. P<0.05 was considered statistically significant. RESULTS: One hundred and fourteen of the patients were male, 48 were female, and the mean age was 35.2+/-14.1 years (range: 21-51). No improvements were observed in 9 of the patients. Surgical interventions were successful in 153 patients (94%). Post-operative QTc max and QTc dispersion values were significantly shortened, and QTc min was increased compared to the pre-operative values (449.6+/-6.2 vs. 440.9+/-20.8, and 68.2+/-8.4 vs. 43.8+/-6.2, and 381.3+/-7.8 vs. 397.0+/-5.9 respectively; P=0.001). CONCLUSION: This study shows that QT dispersion is increased in simple snoring patients without apnea and that QT dispersion decreases after surgical interventions.

Comorbidity of constrictive pericarditis and hemophilia A.

OBJECTIVE: To report a case of comorbidity of constrictive pericarditis and hemophilia A. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old male with hemophilia A was referred to our clinic and was examined with the subsequent evaluation of shortness of breath, leg edema and ascites. Clinical and laboratory examinations were performed. The results were consistent with constrictive pericarditis (CP), and the symptoms were completely relieved following institution of medical therapy. CONCLUSION: Because hemophilia A and pericarditis may be coincidentally present clinical conditions, avoidance of surgical procedures in hemophilic patients is preferable unless the resolution of the symptoms of pericarditis cannot be effected by medical therapy.

Aortic elastic properties in young pregnant women.

This study aimed to investigate the aortic elastic properties of young pregnant women by comparing them with those of age-matched healthy females. The study group consisted of 21 pregnant women at a mean age of 26 +/- 1 years; 22 healthy women at a mean age of 25 +/- 1 years constituted the control group. Doppler-color echocardiographic variables and serum estradiol (E2) levels were measured from both groups. The blood samples were obtained from the control group in the first week after menstrual bleeding. Diastolic and systolic blood pressure (DBP and SBP, respectively) were measured with a sphygmomanometer. Systolic and diastolic aortic diameters (AOS and AOD, respectively) were measured 3 cm proximal to the aortic valves. Aortic elastic properties were assessed according to the following formulas: 1, Aortic strain = (AOS - AOD)/AOD; 2, Aortic distensibility = 2 x (AOS - AOD)/(PP x AOD); 3, Aortic diameter change = AOS - AOD; 4, Aortic stiffness index = ln(SBP/DBP)/(AOS - AOD)/AOD. The results were expressed as mean +/- standard deviation and compared by t-test between groups. P < 0.05 was considered as statistically significant. All women in the study group were in their first pregnancy and second trimester. The height and weight were 160 +/- 5 vs 164 +/- 6 cm and 60 +/- 9 vs 54 +/- 3 kg in the study vs control groups, respectively (P < 0.05). The AOD was 26 +/- 3 vs 26 +/- 4 mm and AOS 29 +/- 3 vs 28 +/- 4 mm. Pulse pressure was 43 +/- 3 vs 45 +/- 8 mmHg in the study vs control groups, respectively (P > 0.05). The serum E2 level was significantly higher in pregnant women (21 300 +/- 2 300 pg/ml). Derived aortic elastic properties in pregnant women were also increased significantly (P < 0.0005). The indexes of aortic elastic properties are altered and aortic stiffness is decreased among young pregnant women. This may be due to the adaptation mechanisms including high estradiol levels detected in pregnancy.

Noncompaction of ventricular myocardium involving both ventricles.

AIM: We aimed to present a case with ventricular myocardial noncompaction involving both ventricles. METHODS AND RESULTS: Noncompaction of ventricle is a rare and unclassified congenital cardiac malformation is due to an arrest in intrauterine endomyocardial morphogenesis. We presented a ventricular myocardial noncompaction case involving both left and right ventricles. The physical examination of this case is consistent with mitral regurgitation and the echocardiographic findings are consistent with noncompaction of ventricular myocardium involving both ventricles with left ventricular systolic failure. CONCLUSION: Transthoracic echocardiography is a useful clinical tool for diagnosing noncompaction of both the right and left ventricular myocardium. The LVNC definition can also be utilized for RVNC, which this diagnosis has never been reported in a Turkish patient.

Short QT interval syndrome: a case report.

Twelve-lead electrocardiograms revealed fine atrial fibrillation and a short QT interval (SQTI) (<300 milliseconds) with an average ventricular rate of 54/min in a 20-year-old male presented with exertional dyspnea. His echocardiographic evaluation revealed interatrial septal aneurysm and slightly dilated pulmonary artery. An electrophysiologic study revealed atrial fibrillation with a very high frequency, short ventricular effective refractory period (130 milliseconds) and ventricular fibrillation inducible with 3 short coupled extrastimuli. Signs were consistent with the rare SQTI syndrome. Although SQTI syndrome is associated with increased risk for sudden cardiac death, the patient was free of arrhythmia symptoms and denied any syncope or presyncope. Family history was also negative for sudden cardiac death and for any symptom suggestive of arrhythmia. The patient refused implantable defibrillator and was treated with anticoagulation and quinidine therapy.

Partial atrial standstill: a case report.

Twelve-lead electrocardiograms revealed no atrial activity and a wide QRS escape rhythm at 38 beats/min in a 20-year-old man who presented with syncope. Doppler echocardiography documented the absence of A wave both in the tricuspid and mitral valve flow. The only mechanical activity was documented at the left atrial appendage. An electrophysiologic study demonstrated electrical inactivity in the right atrium and an atrial tachycardia in the left atrium. Atrial pacing with maximum output did not capture the atria. Our case represents an advanced stage of partial atrial standstill, with a mechanical and electrical atrial activity confined only to the left trial appendage. The patient remained asymptomatic after receiving a VVIR pacemaker and anticoagulation therapy.

[Short-term effect of nebivolol on the left ventricular diastolic function]. / Nebivololün sol ventrikül diyastolik fonksiyonlari üzerine erken dönem etkisi.

OBJECTIVE: To determine the effects of nebivolol on diastolic functions of the left ventricle in the hypertensive patients in the early treatment period. METHODS: Twenty patients with mild to moderate hypertension taking daily 5 mg of nebivolol were assessed by using Doppler echocardiography before and after 6-week drug treatment period. The results were analyzed with Wilcoxon test and p<0.05 was accepted as statistically significant value. RESULTS: The arterial blood pressure and heart rate of the patients significantly decreased after 6 weeks of treatment. Statistically significant decrease was found in the peak of A wave velocity, isovolumetric relaxation time, E wave deceleration time and increase in E/A ratio with Doppler echocardiography after 6-week treatment period. No statistically significant difference was observed in the peak velocity of E wave after treatment period. CONCLUSION: We found that nebivolol improved left ventricular diastolic function in patients with hypertension in the early term.

Aortic elasticity in patients with ankylosing spondylitis.

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease which may show cardiac involvement. The effect of AS on aortic elasticity has not been previously defined. The aim of this study was to determine whether there was any change in aortic elasticity in AS. METHODS AND RESULTS: Thirty-five AS patients without cardiovascular involvement and 30 healthy subjects were enrolled into the study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. The mean aortic strain and distensibility indexes in the AS group were lower than those in the control group. The mean aortic stiffness index in the AS group was higher than that in the control group (p < 0.05). No correlation between the means and the duration was observed in the AS group. CONCLUSION: We found that in AS patients without cardiac involvement, aortic elasticity was decreased and this decrease was not correlated with the duration of AS.