Evaluation of common carotid artery wall stiffness by shear wave elastography in smokers and non-smokers.

INTRODUCTION: Smoking is one of the most important preventable causes of cardiovascular diseases. Vascular disease caused by smoking is associated with vascular endothelial damage, platelet aggregation, and adhesion. In our study, we examined the effect of chronic smoking on vessel wall stiffness in smokers and control group by measuring carotid artery wall stiffness by shear wave ultrasonography. METHODS: Sixty-two smokers of similar ages and genders, and 67 people who never smoked in the last ten years were included as the control group in this cross-sectional study. Arterial wall stiffness over the common carotid arteries of all participants was measured by shear wave elastography (SWE). In addition, each patient's blood pressure, fasting blood glucose, body mass index (BMI), HDL and LDL cholesterol measurements were recorded. RESULTS: Arterial wall stiffness values in smokers were found to be statistically significantly higher than in non-smokers. The mean of SWE measurements of the smokers was 47.3 ± 6.2 kPa, and that of the control group was 42.9 ± 4 kPa. The mean values of HDL and LDL of the smokers were 46.9 ± 5.6 mg/dL and 147.3 ± 9.3 mg/dL, respectively, and those of the control group were 50.3 ± 5.1 mg/dL and 136.9 ± 5.9 mg/dL. The LDL cholesterol values were statistically significantly higher in smokers compared to the control group, and HDL cholesterol values were statistically significantly lower in smokers. CONCLUSIONS: In our study, the arterial wall stiffness values measured by the SWE technique were higher in smokers than non-smokers.

Predictors of the right ventricular perforation caused by active-fixation pacing and defibrillator leads: A single-centre experience.

INTRODUCTION: Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking. METHODS: We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter-defibrillator leads were included in the study. RESULTS: Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066-12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011-1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120-1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910-1.088; p = .032) were independent predictors of RV perforation. CONCLUSION: Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active-fixation leads.

Electrocardiographic Predictors of Complete Heart Block During Right Ventricular Lead Implantation in Patients Who Underwent Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) device procedures have their own complications in addition to the complications associated with standard pacemaker implantations. This study aimed to analyze the predictors of the right bundle branch injury resulting in complete heart block (CHB) during right ventricular (RV) lead implantation in patients who underwent CRT with defibrillator. We conducted an observational study of consecutive 790 patients who underwent CRT with defibrillator device implantation at our institution from 2010 to 2022. Relevant clinical information and complete data regarding the echocardiographic data, implantation procedure, and clinical follow-up were collected into a computerized database. A total of 29 patients (3.7%) had CHB during RV lead implantation. In multivariate analysis, left axis deviation (odds ratio [OR] 2.408, 95% confidence interval [CI] 1.025 to 5.658, p = 0.044), QRS width (OR 1.022, 95% CI 1.001 to 1.043, p = 0.035) and QRS alternans (OR 4.214, 95% CI 1.788 to 9.930, p = 0.001) were found independently related to right bundle branch injury resulting in CHB development during RV lead implantation. In conclusion, left axis deviation, QRS width, and QRS alternans were associated with a higher rate of CHB, and these findings provide insight into optimal and safe CRT device implantation strategies based on preprocedural characteristics.

Magnetic resonance imaging/ultrasound fusion-guided sacroiliac joint corticosteroid injection in patients with axial spondyloarthritis.

Local glucocorticoid injections are used in the treatment of isolated sacroiliitis in patients with spondyloarthritis. Sacroiliac joint injections can be performed intraarticularly or periarticularly. Since the accuracy of blind injections is low, fluoroscopy, magnetic resonance imaging, computed tomography, or ultrasonography guidance are used to increase the accuracy of sacroiliac joint injections. Currently, imaging fusion software is successfully used in sacroiliac joint interventions with three-dimensional anatomic information added to ultrasonography. Herein, we present two cases of sacroiliac joint corticosteroid injections under ultrasonography-magnetic resonance imaging fusion guidance.

Prognostic value of non-alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been shown to predict cardiac events in several patient populations. However, the relationship between NFS and response to CRT has not been investigated. The aim of the study was to investigate the predictive role of NFS in the assessment of response after CRT. METHODS: Three hundred thirty-six patients with heart failure undergoing CRT were prospectively studied. Liver fibrosis were assessed according to the non-alcoholic fatty liver disease fibrosis score (NFS), which includes age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase /alanine aminotransferase ratio, platelets, and albumin. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at six months at follow-up. RESULTS: Two hundred thirty-eight patients (71%) had CRT response after 6 months of follow-up. Receiver-operator characteristic curve analysis showed NFS cutoff value of < -1.12 for predicting CRT response with a sensitivity of 70.4% and a specificity of 52.9%. The patients were also divided into four groups according to the quartiles of NFS. The proportion of response to CRT was increased with lower level of NFS value. Multivariate logistic regression analysis demonstrated the NFS score < -1.12 and LVIDs were independent predictors of the CRT response. In the second model of analysis which included NFS, quartiles demonstrated that fourth NFS quartile and LVIDs were independent predictors of CRT response. CONCLUSION: Liver fibrosis assessed by NFS can provide valuable information to predict reverse remodeling in patients undergoing CRT. The present study supports monitoring of NFS to improve preoperative risk stratification of these patients.

A novel adaptive state-of-charge balancing control scheme for cascaded H-bridge multilevel converter based battery storage systems.

Variations in state-of-charges (SOCs) of batteries in a cascaded H-bridge multilevel converter (CHB-MLC) based battery storage system (BSS) could lead to undesired efficiency and performance drops, even failure of the whole system. Hence, SOC balancing is crucial for BSSs. Avoiding over-modulation region, ensuring zero common-mode voltage and reaching balanced SOC condition as quickly as possible are the key points to consider while performing SOC balancing. In this paper, a gain-scheduling based adaptive SOC balancing method is proposed for single-phase CHB-MLC based BSSs. In the proposed method, gains of the proportional controllers are updated at each sampling time based on the mathematical relationship between instantaneous SOCs and voltage reference of the CHB-MLC. Performance of the proposed method is validated through a Monte Carlo simulation based numerical analysis and experimental studies on a single-phase three-module CHB-MLC based BSS. Results reveal that the proposed method achieves SOC balancing at least two times faster than the traditional constant gain methods while avoiding over-modulation region and having zero common-mode voltage.

Radiographic predictors of failure of simple manual traction of transvenous implantable cardioverter-defibrillator leads: a single-center experience.

BACKGROUND: Extraction of the implantable cardioverter-defibrillator (ICD) leads could be a difficult procedure due to fibrous tissue around the lead and anatomical variations. In this report, we present our experience in the radiographic predictors of failure of simple manual traction (SMT) in patients with dual-coil ICD requiring lead extraction (LE). METHODS: Between January 2017 and February 2021, 103 leads were removed in 65 consecutive patients; 65 (63.1%) were dual-coil ICD leads, 22 (21.4%) were atrial, and 16 (15.5%) were coronary sinus leads. Patient-based and procedural data were collected and analyzed retrospectively. Clinical and procedural characteristics were compared and radiographic predictors of failure of SMT of ICD leads were assessed. Projected anteroposterior (AP) lead tortuosity was measured and lead slack score was estimated on chest X-ray (CXR). RESULTS: Simple manual traction failed in 27 (42%) of the ICD leads. Ottawa slack score (odds ratio [OR] 2.368, 95% CI [1.261-4.447]; P = 0.007), AP lead tortuosity > 1.10 (OR 7.477, 95% CI [1.718-35.542]; P = 0.007), and number of previous interventions (OR 6.016, 95% CI [1.184-30.557]; P < 0.030) were found to be independently related to the failure of SMT. Receiver-operator characteristic curve analysis yielded an AP lead tortuosity cutoff value of > 1.10 for predicting the failure of SMT. The area under the curve was 0.744; the 95% confidence interval (CI) was 0.617 to 0.871 (P = 0.001), with a sensitivity of 63% and a specificity of 73%. CONCLUSION: Simple manual traction success in our study varied based on radiographic lead-related parameters. Before planning the procedure, increased AP lead tortuosity in vasculature and higher lead slack score can be easily determined on CXR and may be associated with more fibrous adherences, the complexity of the LE, and failure of SMT.

Comparison of selective coronary angiography through the ablation catheter versus conventional coronary angiography to guide ablation of premature ventricular contractions originating from aortic cusp.

BACKGROUND: Intraprocedural coronary angiography (CA) is recommended in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we aimed to compare selective coronary angiography (SCA) through the contact force (CF)-sensing radiofrequency catheter with conventional coronary angiography (CCA) to guide ablation of premature ventricular contractions (PVC). METHODS: This was a retrospective observational cohort study of prospectively collected data of 87 consecutive patients undergoing PVC ablation at a single institution between February 2016 and June 2021. Forty-six patients (53%) underwent SCA and forty-one patients (47%) underwent CCA. Data were consecutively collected case-by-case and entered into a computerized database. Procedural characteristics, complications, and clinical outcomes were compared between the SCA and CCA groups. RESULTS: Successful ablation was achieved in seventy-seven (89%) patients. Total procedure and fluoroscopy time and radiation dose were significantly lower in SCA group (93 ± 22 min vs 102 ± 20 min, p = 0.042; 12 ± 3 min vs 14 ± 4 min, p = 0.030; 3292 ± 1221 µGy m2 vs 3880 ± 1229 µGy m2, p = 0.028, respectively). Median ambulation time was significantly longer in CCA group (6.8 ± 1 h vs 17.8 ± 1.8 h, p = 0.006). CONCLUSIONS: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and safe. This technique precludes the requirement of an additional arterial access and decreases the total procedure and fluoroscopy time and radiation dose.

Added value of coronal-T1W sequence to the lumbar MR imaging protocol for low back pain. / Valor de la secuencia coronal-T1W agregada al protocolo de imágenes de resonancia magnética en casos de dolor lumbar

INTRODUCTION: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. OBJECTIVE: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1W SE) coronal sequence added to the lumbar MRI protocol for low back pain. MATERIALS AND METHODS: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. RESULTS: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. CONCLUSION: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

Introducción. La resonancia magnética (RM) es el método de imágenes diagnósticas más apropiado para investigar el dolor lumbar. Dado que este es muy común, son muchas las resonancias magnéticas de este tipo que se hacen. Objetivo. Analizar los hallazgos extraespinales que se pueden detectar al agregar la secuencia coronal T1W al protocolo de imágenes de RM para el dolor lumbar y evaluar su efecto clínico. Materiales y métodos. En el 2015 se agregó una secuencia coronal ponderada en T1W al protocolo de resonancia magnética lumbar de rutina de nuestro hospital. Se evaluaron retrospectivamente 969 imágenes solicitadas en casos de dolor lumbar y realizadas con este protocolo. Los hallazgos obtenidos a partir de dichas imágenes se agruparon luego como asociados con el dolor lumbar (categoría 1) y no asociados con el dolor lumbar (categoría 2). Se evaluó, asimismo, si los hallazgos extraespinales registrados podían detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63 %) de los hallazgos extraespinales se asociaron con lumbalgia (categoría 1) y 56 (37 %) correspondieron a la categoría 2. El 78 % de los hallazgos extraespinales se detectaron solo en imágenes coronales-T1W y no en las convencionales. Conclusión. La secuencia coronal-T1W agregada al protocolo de rutina de la resonancia magnética lumbar puede ayudar a detectar afectaciones extraespinales y guiar el tratamiento clínico.

Added value of coronal-T1 W sequence to the lumbar MR imaging protocol for low back pain / Valor de la secuencia coronal-TIW agregada al protocolo de imágenes de resonancia magnética en casos de dolor lumbar

Introduction: Magnetic resonance imaging (MRI) is the most appropriate imaging method to investigate low back pain. As low back pain is very common, a large number of MRI scans are performed. Objective: To evaluate the extraspinal findings and clinical effect of the T1-weighted spin echo (T1 W SE) coronal sequence added to the lumbar MRI protocol for low back pain. Materials and methods: In 2015, we added a T1-weighted (T1W) coronal sequence to our routine lumbar MRI protocol. We retrospectively evaluated 969 lumbar MRI images for low back pain performed with this protocol. The extraspinal MRI findings obtained from them were then grouped as associated with low back pain (Category 1) and not associated with low back pain (Category 2). We also evaluated whether the recorded incidental extraspinal findings could be detected on conventional sagittal and axial images. Results: Ninety-six (63%) of the extraspinal findings were associated with low back pain (Category 1) and 56 (37%), Category 2. Seventy-eight percent of the extraspinal findings were detected only on coronal-T1W images and not on conventional images. Conclusion: Adding coronal-T1W sequence to the routine protocol of lumbar MRI can help to identify extraspinal findings and guide clinical treatment.

Introducción. La resonancia magnética (RM) es el método de imágenes diagnósticas más apropiado para investigar el dolor lumbar. Dado que este es muy común, son muchas las resonancias magnéticas de este tipo que se hacen. Objetivo. Analizar los hallazgos extra espinales que se pueden detectar al agregar la secuencia coronal T1 W al protocolo de imágenes de RM para el dolor lumbar y evaluar su efecto clínico. Materiales y métodos. En el 2015 se agregó una secuencia coronal ponderada en T1W al protocolo de resonancia magnética lumbar de rutina de nuestro hospital. Se evaluaron retrospectivamente 969 imágenes solicitadas en casos de dolor lumbar y realizadas con este protocolo. Los hallazgos obtenidos a partir de dichas imágenes se agruparon luego como asociados con el dolor lumbar (categoría 1) y no asociados con el dolor lumbar (categoría 2). Se evaluó, asimismo, si los hallazgos extra espinales registrados podían detectarse en imágenes axiales y sagitales convencionales. Resultados. Noventa y seis (63 %) de los hallazgos extra espinales se asociaron con lumbalgia (categoría 1) y 56 (37 %) correspondieron a la categoría 2. El 78 % de los hallazgos extra espinales se detectaron solo en imágenes coronales-T1W y no en las convencionales. Conclusión. La secuencia coronal-T1 W agregada al protocolo de rutina de la resonancia magnética lumbar puede ayudar a detectar afectaciones extra espinales y guiar el tratamiento clínico.

Selective angiography through radiofrequency catheter during ablation of premature ventricular contractions originating from aortic cusp: A single-centre experience.

INTRODUCTION: Intraprocedural coronary angiography is recommeded in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we present our experience in selective coronary angiography through the radiofrequency catheter during premature ventricular contraction (PVC) ablation. METHODS AND RESULTS: We prospectively recruited 43 consecutive patients who underwent PVC ablation in the aortic cusps between March 2018 and April 2021. We performed coronary angiography through the contact force (CF)-sensing ablation catheter at the ablation site. Successful ablation was achieved in 38 (88%) of patients. No technical problems occurred after the contrast injection and ablation parameters were within the normal values, without any change of impedance and CF-sensing values and neither electrogram signal quality after contrast injection. No complications occurred during the procedure, hospital stay, and during one-year follow-up (15.3 ± 3.1 months). CONCLUSION: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and no minor or major complications occurred in our experience.

Pulmonary fibrotic-like changes on follow-up chest CT exam in patients recovering from COVID-19 pneumonia.

INTRODUCTION: To date, there is limited data on the long-term changes in the lungs of patients recovering from coronavirus (COVID-19) pneumonia. In order to evaluate pulmonary sequelae, it was planned to investigate fibrotic changes observed as sequelae in lung tissue in 3-6-month control thorax computerized tomography (CT) scans of moderate-to-severe COVID-19 pneumonia survivors. MATERIALS AND METHODS: A total of 84 patients (mean age: 67.3 years ±15) with moderate-to-severe pneumonia on chest tomography at the time of diagnosis were included in the study, of which 51 (61%) were males and 33 (39%) were females. Initial and follow-up CT scans averaged 8.3 days ± 2.2 and 112.1 days ± 14.6 after symptom onset, respectively. Participants were recorded in two groups as those with and without fibrotic-like changes such as traction bronchiectasis, fibrotic - parenchymal bands, honeycomb appearance according to 3-6 months follow-up CT scans. Differences between the groups were evaluated with a two-sampled t-test. Logistic regression analyzes were performed to determine independent predictive factors of fibrotic-like sequelae changes. RESULT: On follow-up CTs, fibrotic-like changes were observed in 29 (35%) of the 84 participants (Group 1), while the remaining 55 (65%) showed complete radiological recovery (Group 2). With logistic regression analysis, hospital stay of 22 days or longer (OR: 4.9; 95% CI: 20, 32; p< 0.05) and a CT score of 15 or more at diagnosis (OR: 2.2; 95% CI: 13.5, 18; p< 0.05) were found to be an independent predictor for sequelae fibrotic changes in lung tissue. CONCLUSIONS: More than one-third of patients who survived COVID-19 pneumonia had fibrotic-like sequelae changes in the lung parenchyma. These changes were found to be associated with the presence of severe pneumonia at the time of diagnosis and longer hospital stay.

An evaluation of quality of life, physical activity level and symptoms in patients with early stages of chronic venous disease.

BACKGROUND: Chronic venous disease (CVD) is a common, long-term disease that has a variety of symptoms, signs and decreases the patients' quality of life (QoL) of the patients. The aim of this study was to evaluate QoL, symptoms, and physical activity level of CVD patients with early stages (C1 and C2 classes). METHODS: The sample of this study composed of 40 patients diagnosed with CVD. The data were collected by face-to-face interview method in the cardiovascular surgery outpatient clinic. Participants were diagnosed with duplex ultrasound (DUS). A personal information form, venous insufficiency epidemiological and economic study-quality of life/symptoms (VEINS-QOL/Sym), and international physical activity questionnaire were used to assess the participants. RESULTS: According to DUS results, 23 participants had unilateral CVD, 17 participants had bilateral CVD. Thirty-six of these limbs were stage C2 according to CEAP, twenty one were stage C3. The patients with CVD had low QoL and physical activity level, also moderate pain intensity. Pain, swelling, restless leg, heavy legs, night cramps, and itching were more common symptoms. There was no statistical difference between unilateral/bilateral CVD patients in QoL scores, physical activity level, and pain intensity (p˃0.05). CONCLUSION: There was no difference between the extent and severity of the disease and QoL, physical activity level, variety of symptoms. To increase the physical activity level and to evaluate the quality of life may be important for the management of the disease from the early stages of the disease (C1 and C2 classes).

Fast three-dimensional time-of-flight magnetic resonance angiography: Should it be used in routine neuroimaging for headaches?

OBJECTIVES: We aimed to evaluate the diagnostic efficacy of fast three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) in the detection of cerebral aneurysms. METHODS: We screened 1589 patients over a 3-year period, who underwent a magnetic resonance imaging for headache. Fast 3D TOF MRA images taken in addition to routine neuroimaging sequences, which were examined by two independent observers to assess cerebral aneurysms. RESULTS: Sixty-nine aneurysms were detected in 63 patients. The locations of the aneurysms were as follows: Middle cerebral artery, 27.5% (n = 19); internal carotid artery, 53.6% (n = 37); anterior cerebral artery, 5.8% (n = 4); posterior cerebral artery, 5.8% (n = 4); anterior communicating artery, 5.8% (n = 4); and ophthalmic artery, 1.4% (n = 1). Thirty-five (50.7%) were 7 mm or less, 23 (33.3%) were 8-10 mm, and 11 (15.9%) were 11 mm or larger. About 88% of pathological cases (n = 61) were saccular and 12 (n = 8) were fusiform type aneurysms. The interobserver compliance was high (K = 0.83) for detecting the aneurysms. CONCLUSION: Considering the mortality and morbidity of subarachnoid hemorrhages, 3D TOF MRA is a successful, non-invasive method for detecting cerebral aneurysms. Results of the present study have shown that adding 3D TOF MRA to the routine brain imaging protocol is a beneficial tool for diagnosis.

Vascular pectoralis minor syndrome as an overlooked condition: A case report.

Thoracic outlet syndrome is characterized by pain, paresthesia, muscle weakness, and arterial/venous symptoms caused by compression of the neurovascular structures. Compression mainly occurs at three distinct areas in the thoracic outlet: the retropectoralis minor space, the costoclavicular space, and the interscalene triangle. As the symptoms of these three compression sites are very similar, it is difficult to pinpoint the location of the compression and the treatment methods are quite different. Ultrasound-guided diagnostic injections play an important role in the differential diagnosis. Herein, we report a 49-year-old female patient who was previously diagnosed with thoracic outlet syndrome and scheduled for decompression of cervical ribs, but cured by conservative methods after being diagnosed with pectoralis minor syndrome.

Persistent left superior vena cava accompanying repaired tetralogy of Fallot: Does it pose a challenge for device implantation?

Persistent left superior vena cava is a thoracic venous return anomaly. Tetralogy of Fallot is one of the most common congenital anomalies seen with persistent left superior vena cava. We are presenting a successful cardiac resynchronisation therapy device implantation in a patient with repaired tetralogy of Fallot and persistent left superior vena cava combination which has not been previously reported in the literature.

Pulmonary Embolism and Giant Cavitary Lesion Developing After COVID-19 Pneumonia.

Introduction: The clinical manifestations of the worldwide pandemic, which began in mainland China in December 2019, were very similar to viral pneumonia and defined as Coronavirus disease 2019 (COVID-19). Complications such as acute respiratory distress syndrome (ARDS), acute cardiac tissue damage, secondary infections, isolated coagulopathy and pulmonary embolism have been reported with COVID-19 disease. Clinical Findings: A 79-year-old woman admitted to the emergency room (ER) had complaints of fever and cough. The patient was admitted to the ER with the suspicion of COVID-19. Samples were collected with a nasopharyngeal swab and confirmed as COVID-19. In addition, a chest CT examination was performed. In the first evaluation after admittance, the D-dimer value was measured as 450 µg/L. In the follow-up of the patient, on the 18th day, increased respiratory distress and high D-dimer level (7893 µg/L) were detected in the laboratory findings. Outcomes: A chest CT scan had ground-glass opacities compatible with COVID-19 pneumonia. A giant cavitary lesion was detected following the development of pulmonary embolism after COVID-19 disease. Conclusions: In rare cases of COVID-19 cavitation development may occur after pulmonary infarction. In addition, it should be remembered that emphysema, giant bulla and pneumothorax may develop in COVID-19 pneumonia cases undergoing HFNC oxygen therapy. We present a case of a giant cavitary lesion that developed following a COVID-19-related pulmonary embolism.

Is the asymmetry between the vertebral arteries related to cerebral dominance?

Background/aim: The two vertebral arteries (VAs) are usually unequal in size; the left one is generally larger than the right one. It was hypothesized that the asymmetry results from the need of the dominant cerebral hemisphere for more glucose and oxygen, i.e. more blood supply. In this study, we aimed to test this hypothesis in patients by evaluating their arterial diameter and hand preference, as it is the most common criterion to determine the dominance of the hemisphere. Materials and methods: The study was performed with 844 participants who consented to participate in the study. We identified the dominant cerebral hemisphere by asking participants about their hand preference. Then we measured both the VA diameter and VA flow volume by Doppler ultrasonography. After demonstrating the asymmetry, correlation was tested. Results: Among 844 participants included in the study, the mean diameter of the right VA was 3.14 ± 0.35 mm and that of the left VA was 3.41 ± 0.54 mm, while the mean flow volume of the right VA was 119.21 ± 44.98 mL/min and that of the left VA was 151.45 ± 57.26 mL/min. It was recorded that 771 (86.43%) participants were right-handed and 73 (8.18%) were left-handed. Conclusion: No significant relationship was found between the increased blood demand of the dominant cerebral hemisphere and the vertebral artery dominance.

Systolic aortic root motion predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. Systolic aortic root motion (SARM) has been investigated in dilated cardiomyopathy patients and found that heart failure patients had reduced SARM. We aimed to investigate the relationship between SARM and response to CRT. METHODS: Fifty-six patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Transthoracic echocardiography was performed before, and repeated at 6 months in follow-up. Systolic aortic root motion was measured in each patient before the device implantation. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Forty patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT was evaluated adjusting for functional capacity, etiology of cardiomyopathy, QRS duration, baseline left ventricular dimensions/volumes and SARM. SARM was the only predictor of response to CRT (OR 1.818, 95% CI, 1.101-3.003, P = .019). CONCLUSIONS: SARM predicts non-response to CRT and may help in the selection of CRT candidates.