Aorta-Right Atrial Tunnel: An Interesting Type of a Congenital Coronary Artery Anomaly

An 18-year-old girl with an aortico-right atrial tunnel originating from the left sinus of Valsalva, in which the left anterior descending and circumflex coronary arteries arose independently from the different parts of the tunnel, was reported. In the differential diagnosis of continuous murmur, this type of tunnel should be taken into consideration. Surgical approach should be offered.

QT dispersion increases with low glomerular filtration rate in patients with coronary artery disease

We aimed to evaluate the relationship between estimated glomerular filtration rate [eGFR] and QT dispersion [QTd] in patients with coronary artery disease [CAD]. Sixty patients [mean age 62.72 +/- 12.48 years] included 46 male, [mean age 60.89 +/- 12.70 years] and 14 female [mean age 68.71 +/- 9.86 years] were enrolled in this study. Patients were divided into 2 groups according to their eGFR using the 6 variable MDRD equation. Group 1 consisted of patients with estimated eGFR < 60 ml/min/1.73m[2] and Group 2 consisted of patients with eGFR >/= 60 ml/min/1.73m[2]. Baseline patient characteristics were homogeneous in both groups except for age, gender and smoking. Also, the extent of CAD was similar in both groups [p > 0.05] QTd values were found higher in group 1 than those of group 2 [57.23 +/- 40.65 ms vs. 31.23 +/- 14.47 ms, p = 0.002]. After adjustment for age, gender and smoking using one-way ANCOVA test, statistically significant difference in QTd still existed between the groups [p=0.038]. QTd tends to be higher in patients with poor renal function independent of severity of angiographical CAD. QTd may be a potentially useful non-invasive test in the management of patients with poor renal function, especially those with CAD

Coronary-Subclavian Steal Syndrome Presenting with Ventricular Tachycardia

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.

Urinary methylmalonic acid in patients with acute myocardial infarction

To investigate urinary methylmalonic acid [uMMA] levels and their relationship with markers of myocyte necrosis and inflammation in patients with acute myocardial infarction [AMI]. The study participants consisted of 80 consecutive patients with AMI and 72 age- and sex-matched consecutive controls. Of the patients, 38 had ST segment elevation myocardial infarction [STEMI] and 42 had non-ST segment elevation. All patients with STEMI underwent fibrinolytic therapy. Routine laboratory tests included troponin-I, creatinine phosphokinase MB [CK-MB], high-sensitivity C-reactive protein [hs-CRP], vitamin B12, folate, homocysteine and methylmalonic acid analyses. uMMA measurements were made by a spectrophotometric method. uMMA levels were significantly higher in patients with AMI than in controls [10.1 vs. 5.2 mmol/mol creatinine, p < 0.001] and higher in patients with anterior MI compared to those with non-anterior MI [18.9 vs. 8.7 mmol/mol creatinine, p < 0.001]. In addition, uMMA levels were significantly higher in patients without successful reperfusion compared to those with successful reperfusion. In patients with STEMI, a strong positive association was found between urinary MMA and plasma hs-CRP levels [r = 0.81, p < 0.001], symptom duration [r = 0.91, p < 0.001] and wall motion score [r = 0.60, p = 0.006]. More importantly, a strong positive association was observed between uMMA and the size of myocardial infarction in patients without successful reperfusion [for CK-MB r = 0.81, p = 0.013; for wall motion score r = 0.82, p = 0.012]. uMMA levels were elevated in patients with AMI and, as such, may be a candidate biochemical indicator of larger infarct size and enhanced inflammation in patients with AMI

Relationship between P-wave dispersion and effective hemodialysis in chronic hemodialysis patients

To investigate whether or not P-wave dispersion [PWD] can be used as a good indicator of effective hemodialysis. The study included 35 patients [20 males, 15 females, mean age 61 +/- 10 years] who regularly received hemodialysis treatment for chronic renal failure. Following hemodialysis, the patients whose hemodynamic parameters were preserved and who reached dry body weight were included. Twelve-lead resting electrocardiogram [ECG] at a speed of 25-50 mm/s, the value of total body fluid [TBF] and bioelectric impedance using bipedal bioelectric impedance equipment were obtained before and immediately after hemodialysis. Blood samples were also taken for the assessment of blood electrolytes, urea and creatinine. PWD was defined as the difference between the maximum and minimum P-wave duration calculated on a standard 12-lead ECG before and after dialysis. The following parameters were obtained before and after hemodialysis: blood pressure 132 +/- 21 vs. 130 +/- 10 mm Hg [p > 0.05], TBF 33.9 +/- 6 vs. 32 +/- 5.6 liters [p = 0.001], impedance 499 +/- 110 vs. 596 +/- 136 omega [p = 0.001], P-max 103.1 +/- 8.9 vs. 106.3 +/- 12.7 ms [p > 0.05], P-min 70.2 +/- 11 vs. 72.5 +/- 7.9 ms [p > 0.05], PWD 32.2 +/- 11.9 vs. 33.8 +/- 13.4 ms [p > 0.05]. Although statistically significant decreases were observed in urea and creatinine levels after hemodialysis, no such changes were observed in blood electrolytes. The P-max and PWD did not change significantly after hemodialysis, hence these two parameters can be used as an indicator of effective hemodialysis