Patent ductus arteriozus associated with anomalous origin of the right coronary artery: a case report.

Patent ductus arteriozus (PDA) is the most common type of extracardiac shunt and it usually closes within 2 or 3 days of birth, but it may remain patent for one's lifetime. In this paper, we report a 65-year-old woman with PDA associated with a right coronary arising anomaly. To our knowledge, the anomalous origin of the right coronary artery associated with PDA has not been published to date. In this case report, we used only the standard Judkins type of a left coronary catheter for cannulation of both left and right coronary arteries and as well as PDA.

Iron status and its relationship with lipid peroxidation in patients with acute myocardial infarction.

AIM: The aim of this study was to investigate iron status and its relationships with lipid peroxidation in patients with acute myocardial infarction (MI). METHODS: The study included 30 male patients aged between 32 and 73 years (mean 55 +/- 6) with acute MI. We measured the levels of plasma iron, transferrin (TF), ferritin (FER), ceruloplasmin (CER), cardiac enzymes, and erythrocyte malondialdehyde (e-MDA) in patients with acute MI on the admission and 1st, 3rd, 5th, 7th, 15th, 45th post MI day and investigated the variations of these parameters in acute MI. RESULTS: The e-MDA level started to increase on the admission day and showed a peak value on the post MI 1st day (88 +/- 23 and 98 +/- 26 nmol/g Hb, respectively). Afterwards, the e-MDA level minimally changed until post Ml 45th day, which showed a minimum level (57 +/- 13 nmol/g Hb) (p < 0.05). In addition, the iron concentration of serum reached its maximum level on the 1st post Ml day (99 +/- 30 mg/dl, p < 0.05) and relatively decreased after the 3rd day. Courses of MDA and iron levels were similar. The FER level started to increase from the admission day of the patients (230 +/- 375 mg/dl), showed a mean peak value on the 3rd day (296 +/- 568 mg/dl) and decreased to a minimum level on the 45th day (121 +/- 85 mg/dl) (p < 0.05). Contrarily, the TF level started to decrease on the 1st day (221 +/- 44 mg/dl), decreased minimum level on the 3rd day (211 +/- 37 mg/dl) and continued approximately the same level until the 45th day (244 +/- 45 mg/dl) (p < 0.05). The CER level started to increase from the first day of admission of the patients (43 +/- 12 mg/dl), reached a maximum level on the 7th day (59 +/- 12 mg/dl) and similar levels were observed until the 15th day. On the 45th day, the CER level was higher than on the first day (52 +/- 13 mg/dl) (p < 0.05). CONCLUSION: There was an association of higher iron status with increased lipid peroxidation in patients with myocardial infarction.

C-Reactive protein as a risk factor for left ventricular thrombus in patients with acute myocardial infarction.

BACKGROUND: Elevated C-reactive protein (CRP) has been found to correlate with higher risk for cardiac events in patients with acute myocardial infarction (AMI). It has been suggested that CRP may be involved in initiation process of coagulation; however, the role of CRP level in the formation of left ventricular (LV) thrombus has not been studied. HYPOTHESIS: This study investigated whether CRP is a risk factor for LV thrombus in patients with AMI. METHODS: Clinical, echocardiographic, and biochemical data were analyzed in 141 consecutive patients (aged 57 +/- 13 years; 33 women) with first anterior AMI. Two-dimensional and Doppler echocardiographic examinations were performed on Days 1, 3, 7, 15, and 30. Blood samples were obtained every day during hospitalization. Serum CRP concentrations were measured by an ultrasensitive immunonephelometry method. RESULTS: Left ventricular thrombus was detected in 33 (23.4%) patients. Univariate analysis showed that patients with LV thrombus had a higher peak creatine kinase (CK) level (2,879 +/- 742 vs. 1,693 +/- 1,210 I/U, p = 0.001), higher peak CRP level (14.9 +/- 7.1 vs. 9.2 +/- 6.8 mg/dl, p = 0.001), higher wall motion score index (1.8 +/- 0.2 vs. 1.5 +/- 0.3, p = 0.002), higher apical wall motion score index (2.35 +/- 0.72 vs. 2.07 +/- 0.70, p = 0.001), larger end-diastolic volume (145.2 +/- 43.7 vs. 116.5 +/- 44.2 ml, p = 0.002), larger end-systolic volume (85.4 +/- 37.2 vs. 62.9 +/- 31.6 ml, p = 0.003), and lower ejection fraction (42.1 +/- 12 vs. 47.3 +/- 13, p = 0.04). In multivariate analyses, only peak CK level (p = 0.0001), LV apical wall motion score index (p = 0.001), and CRP levels (p = 0.001) were independent predictors of LV thrombus formation. CONCLUSIONS: These results suggest that CRP is a risk factor for LV thrombus in patients with AMI.

Effect of coronary angiography on plasma endothelin-1 and nitric oxide concentrations.

Endothelium takes part in the regulation of vascular tone through the production of endothelium-derived relaxing factor, nitric oxide (NO), and the contracting factor endothelin-(ET-1). Induction of ET-1 and NO is influenced by many stimuli including hypoxia and shear stress. Some of these stimuli may arise during coronary angiography (CAG). In this study, the authors aimed to show endothelial response in patients undergoing CAG by evaluating plasma ET-1 and NO end-products including nitrite and nitrate concentrations. Twenty-four male patients with a mean age of 54.3 years (age range: 37-70) were included in the study. The patients had no coronary atherosclerotic lesions established by CAG. The mean time of the CAG procedures was 24.8 minutes, with a range of 19-33 minutes. Immediately before blood sampling, systolic and diastolic blood pressures were recorded. The mean blood pressures before and after CAG were 140/90 and 150/95, respectively. End products of NO radical, nitrite and nitrate (NOx), in plasma were used as a marker for the production of NO radical. ET-1 concentrations were measured by ELISA method. Significant increases in ET-1 concentrations were observed during CAG while no change observed in NOx concentrations. Duration of the CAG procedure was found to be correlated with the percent increase of the plasma ET-1 concentrations during CAG (r = 0.45, p<0.05, Figure 1), but not with NOx concentrations. Plasma ET-1 concentrations in patients who were cigarette smoking were found higher than those of patients who were nonsmokers (1.26 +/- 0.38 and 2.97 +/- 0.87 fmol/L, respectively). It was concluded that endothelial cells show increased ET-1 production as a response of some mechanical or emotional stimuli during CAG procedure that may play an important role in the regulation of vascular tonicity and some pathological processes. The authors suggest that duration and manipulation of CAG may be an important factor in plasma ET-1 concentrations.

Serum lipoprotein(a) and its relation to left ventricular thrombus in patients with acute myocardial infarction.

It is well known that the incidence of left ventricular (LV) thrombosis is high in patients with acute myocardial infarction (AMI). Due to the high degree of structural homology with plasminogen, lipoprotein(a) may produce thrombogenic effects by modulating the fibrinolytic system. However, the role of Lp(a) level in the formation of LV thrombus has not been studied. This study sought to determine whether Lp(a) is a risk factor for LV thrombus in patients with AMI. We have analyzed clinical, echocardiographic and biochemical data in 102 consecutive patients (aged 58+/-12 years, 92 men / 10 women) with first anterior AMI. Two-dimensional examination was performed on days 1, 3, 7, 15, and 30. Blood samples were obtained within 12 h after the onset of symptoms and before beginning the therapy. Plasma levels of fibrinogen and Lp(a) were measured using enzyme-linked immunosorbent assay and immunonephelometric methods, respectively. LV thrombus was detected in 20 (20.3%) patients. No significant difference was found for admission Lp(a) levels between patients with or without thrombus (30.5+/-17.2 vs 32.3+/-22.4 mg/dl, p = 0.7). Univariate analysis showed that patients with LV thrombus had a higher wall motion score index (1.8+/-0.3 vs 1.4+/-0.3, p = 0.002), a higher peak creatine kinase level (2945+/-898 vs 1805+/-1336, I / U p = 0.004), a larger end-diastolic volume (139.7+/-38.6 vs 114.1+/-41.8 ml, p = 0.04), a larger end-systolic volume (83.1+/-34.3 vs 59.2+/-30.6 ml, p = 0.02 ), and a lower ejection fraction (38+/-12 vs 47+/-11, p = 0.04). In multivariate analyses, only peak creatine kinase level (p = 0.04) and LV wall motion score index (p = 0.002) were independent predictors of left ventricular thrombus formation. These results suggest that Lp (a) is not a risk factor for LV thrombus in patients with AMI. Our data demonstrate that the best predictors of LV thrombus formation after AMI are a high peak creatine kinase level and a high LV wall motion score index.

Behçet's disease with a large intracardiac thrombus: a case report.

Behçet's disease is recognised as a chronic multisystem disorder with vasculitis as its underlying pathological process. Cardiac involvement is rare and often associated with poor prognosis. A case of a 33 year old man with Behçet's disease, presenting with a large right ventricle and right atrial thrombus, is reported. Two dimensional (cross sectional), colour Doppler, and transoesophageal echocardiography, angiography, computed tomography, and magnetic resonance imaging were used to diagnose the disease. With cyclophosphamide and dexamethasone treatment, the cardiac lesions progressively resolved.

Doppler-derived mitral deceleration time as an early predictor of left ventricular thrombus after first anterior acute myocardial infarction.

BACKGROUND: The relation between left ventricular (LV) diastolic function and LV thrombus has not yet been fully investigated. The aim of this study was to determine whether early assessment of Doppler-derived mitral deceleration time (DT), a measure of LV compliance and filling, may predict LV thrombus formation after acute myocardial infarction. METHODS AND RESULTS: Two-dimensional and Doppler echocardiographic examinations were performed in 98 consecutive patients (aged 57 +/- 12 years; 8 women) with first acute myocardial infarction. The patients were studied within 24 hours and at days 3, 7, 15, and 30 after arrival to the coronary care unit. Mitral flow velocities were obtained from the apical 4-chamber view with pulsed Doppler. LV thrombus was detected in 20 of 98 patients. Patients were divided into 2 groups according to LV thrombus formation: group 1 (n = 20) with thrombus and group 2 (n = 78) without thrombus. Mitral E-wave DT was significantly shorter in group 1 than group 2 (134 ms vs 175 ms; P <.001). Patients in group 1 had significantly larger LV end-diastolic and end-systolic volumes and a higher wall motion score index than patients in group 2 (133 +/- 39 mL vs 112 +/- 41 mL, P =.03; 83 +/- 34 mL vs 59 +/- 30 mL, P =.003; and 1.8 +/- 0.3 mL vs 1.5 +/- 0.3 mL, P =.007, respectively). The LV ejection fraction was significantly lower in group 1 than in group 2 (39% +/- 13% vs 48% +/- 12%; P =.004). In a multivariate regression analysis, mitral E-wave DT was identified as an independent variable related to development of LV thrombus (P =.04). CONCLUSIONS: Doppler-derived mitral DT is superior to conventional clinical and 2-dimensional echocardiographic assessment in estimating the risk of left ventricular thrombosis after myocardial infarction.

Two-dimensional color doppler echocardiographic imaging of a Gerbode defect: a case report.

A Gerbode defect is a ventricular septal defect that communicates directly between the left ventricle and the right atrium. The pathology may be due to a congenital defect, can result from trauma, or can occur after endocarditis or aortic valve replacement. We report the case of a 20-year-old man who has a defect between the left ventricle and the right atrium (Gerbode defect) that was diagnosed with two-dimensional color Doppler echocardiography.

Rupture of the right sinus of valsalva into the right ventricle: echocardiographic and angiographic imaging.

We report a 16-year-old girl with acute rupture of the sinus of Valsalva. This case is unique in that the right coronary sinus of Valsalva ruptured into both the right and left ventricles, producing severe aortic insufficiency. The diagnosis was made with two-dimensional and color Doppler echocardiography which showed an abnormal jet flow from the aortic root into both ventricles. The diagnosis was confirmed by magnetic resonance imaging and aortic root angiography. Early diagnosis is important so that urgent surgical treatment can be taken.

Mitral valve prolapse and mitral insufficiency in two siblings with Gaucher's disease.

Gaucher's disease is an autosomal recessive storage disorder. We report two siblings with Gaucher's disease, both of which had mitral valve prolapse and mitral insufficiency. One of the siblings died of bacterial endocarditis and pneumonia, while the other continues under followup.

The significance of autoantibodies against oxidatively modified low-density lipoprotein (LDL) in patients with psoriasis.

Psoriasis is associated with changes in plasma lipid and lipoproteins, which may play a role in the development of occlusive vascular disease. The oxidation of low-density lipoprotein (LDL) is considered a key event in the development and progression of atherosclerosis. Autoantibodies against oxidized LDL (auAb-oxLDL) may contribute to understanding the relationship between oxidative processes and development of atherosclerosis. Thirty-three patients with psoriasis and 30 matched control subjects were investigated. LDL oxidation was evaluated as the presence of autoantibodies against LDL oxidatively modified with Cu++, by an ELISA system in the patients and control sera. AuAb-ox LDL levels of the patients were found to be significantly increased compared with a control group. 42% of the patients and 3.3% of the control subjects had higher auAb-ox LDL levels than the cut-off point (352 mU/ml). The levels of auAb-ox LDL were found to be correlated with PASI score (r = 0.67, p < 0.01). Also, The antibody level was found to be correlated with polymorphonuclear elastase and alpha-1 antitrypsin levels (r = 0.58, p < 0.05; r = 0.51, p < 0.05, respectively). It was concluded that increased levels of auAb-oxLDL in the psoriatic patients may be a consequence of the interaction between imbalance of oxidant-antioxidant system and lipoproteins, and the measurement of auAb-oxLDL in the patients may mirror in vivo occurrence of oxidative processes.