The relationship between microalbuminuria and isolated coronary artery ectasia.

AIM: Coronary artery ectasia (CAE), is at least 1.5 fold dilatation of at least one coronary segment due to congenital or acquired causes. In this study, we aim to investigate the relation of CAE with microalbuminuria, which is a marker of endothelial dysfunction shown to be associated with increased cardiovascular mortality and morbidity. PATIENTS AND METHODS: Patients with CAE detected during routine coronary angiogram (CAG) and individuals with normal CAG findings have been included in our study. Urine albumin levels were measured by immunoturbidimetric method from samples collected in the morning. Patients with an albumin/creatinine (A/C) ratio less than 0.03 were normal and the ones between values 0.03-0.3 were considered to be microalbuminuric. Patients whose A/C ratios > 0.3 had macroalbuminuria and were excluded. RESULTS: A total of 105 patients (60 with CAE and 45 with normal CAG) were included in the study. Serum creatinine, low-density lipoprotein cholesterol and homocysteine levels were increased in the CAE group. Urine A/C ratio was 0.036 ± 0.040 in the CAE group and 0.018 ± 0.013 in the controls; the difference was statistically significant (p = 0.002). CONCLUSIONS: Blood homocysteine levels and urinary albumin levels are significantly increased in patients with CAE when compared to individuals with normal CAG. Microalbuminuria and hyperhomocysteinemia, two markers of endothelial dysfunction might be associated with pathophysiologic processes leading to CAE.

Coronary arterial anomalies in a large group of patients undergoing coronary angiography in southeast Turkey.

BACKGROUND: The prevalence of coronary artery anomalies (CAA) are reported between 0.6-1.3% in the literature. CAA are usually asymptomatic incidental findings, but they may deteriorate coronary circulation, cause symptoms and lead to sudden cardiac death; especially in young athletes. Since interventional procedures are increasing rapidly for treatment of coronary artery disease (CAD) in the modern era, comprehensive understanding of CAA is becoming progressively critical element in dealing with CAD. MATERIALS AND METHODS: We reviewed the database of the Cardiac Catheterisation Laboratory of Sani Konukoglu University Hospital in Gaziantep, Turkey. All patients who were subjected to coronary angiography from 1998 to 2006 were included. RESULTS: Among 53,655 coronary angiographies performed, CAA were found in 653 patients (incidence of 1.21%); 590 (90.3%) patients had anomalies of origin and distribution and 63 (11.7%) had coronary fistulae. Separate origins of left anterior descending (LAD) and left circumflex (LCX) coronary artery from the left sinus of Valsalva was the most common anomaly (64.1%). Coronary arteries branching from anomalous aortic origin was the second most common anomaly(16.5%). Right coronary artery (RCA) originating from left sinus of Valsalva or left main coronary artery (LMCA) was observed in 55 (8.4%) patients, LCX arising from RCA or right sinus of Valsalva (RSV) was seen in 52 (7.9%) patients and LMCA orLAD originating from RSV was seen in 14 (0.2%) patients. There were 16 (2.45%) patients with single coronary artery and 1 (0.15%) patient with LMCA originating from pulmonary artery. CONCLUSIONS: The incidence and the pattern of CAA in our patient population were similar with previous studies. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery.

[Comparative assessment of risk factors and hospital results in male and female patients underwent to coronary artery bypass surgery].

There are controversial data on relatively unfavorable effect of female gender on postoperative mortality of patients underwent to coronary artery bypass grafting (CABG). In order to assess risk factors and hospital outcomes after elective CABG we studied retrospectively data on patients who had undergone CABG in Sani Konuogly medical center (Gasiatep, Turkey) during the period from March 2002 to March 2010. For elimination of unfavorable effect of old age we included into analysis data from patients younger than 65 years. In accordance with study aim all patients (n=2692) were divided into two gender groups 1966 men (mean age 54,01 years) and 726 women (mean age 54.35 years). Diabetes (48.3 and 26.9%; p=0.0001), arterial hypertension (76.6 and 28.4%; p=0.00001), and obesity (50 42%; p=0.03) were more frequent among women while smoking (44.5 and 10.3%; p=0.0001), hyperlipidemia (37.6 and 21.5%; p=0.0002), and history of myocardial infarction (31.3 and 17.3%; p=0.06) were more often registered among men. Mortality was insignificantly higher in women (1.6 and 0.9%; p=0.06). Perioperative Q-wave myocardial infarction was more frequent among men than among women (1.5 and 0.4% respectively; p=0.04). It is necessary to conduct prospective well controlled study for exclusion of gender influences on perioperative outcomes in patients subjected to CABG .

[Two years experience of the use of a penetration catheter (Tornus) recanalization during percutaneous coronary interventions on chronic total occlusions].

We included in this study 43 patients chronic total occlusions (CTO) subjected percutaneous coronary interventions (PCI) with the use of penetration catheter (Tornus) in 2009-2010. Penetration catheter was applied only in those cases when it was not possible to introduce low profile coronary dilatation catheter into the site of occlusion. After penetration of CTO by a guide wire a channel was formed by a manually rotated penetration catheter. The Tornus catheter was successfully passed into distal part of an artery in 81.4% of cases. In other.

[Clinical and angiographical factors influencing improvement of left ventricular function after implantation of dare-metal stents in patients with chronic total occlusions of coronary arteries].

INTRODUCTION: Effect on left ventricular (LV) contractility of percutaneous coronary interventions (PCI) with implantation of bare-metal stents in patients with chronic total occlusions (CTO) of coronary arteries (CA) has not been completely studied. Aim of this study was to assess effect of PCI with implantation of bare-metal stents ("L+", Relisys, U) on LV ejection fraction (EF) and to investigate clinical and angiographical factors capable to affect restoration of LVEF. MATERIAL AND METHODS: We included in this study 154 patients after successful implantation of bare-metal stents in CTO of main epicardial CA. For assessment of LV function we performed echocardiographical examination before and in 6 months after PCI. RESULTS: Significant increase of LV EF (from 50.4 +/- 10.7 to 56.1+/-11.3%, p<0.0001), decreases of LV end diastolic (from 86.2+/-17.9 to 80,8+/-18,1 ml/m2, p<0.001) and end systolic (from 41.4+/-14.9 t 34.7+/-13.8 ml/m2 (p<0,001) volumes took place after implantation of stents. Multivariate analysis showed that initial LVEF <50%, duration of occlusion <2 months and absence of diabetes mellitus were independent predictors of improvement of LVEF. CONCLUSION: Implantation of bare-metal stents in patients with CTO CA affects positively LVEF during first 6 months after PCI especially in patients with lowered LVEF, in patients without diabetes mellitus, and duration of occlusion less or equal 2 months.

Single right coronary artery-R-I subtype: a report of an extremely rare case.

A single coronary ostium with no associated congenital cardiac disease is a rare congenital coronary-artery anomaly. However, a single right coronary artery has a much rarer incidence. We report here the antemortem diagnosis of a case with R-I subtype single coronary artery supplying the entire myocardium. A 36-year-old female with chest pain and dyspnea on exertion was admitted to the hospital, whose coronary angiography revealed a single, large coronary artery originating in the right aortic sinus. No observable change was detected in her electrocardiogram and her angiographic examination did not reveal any significant luminal narrowing although she experienced chest pain and dyspnea on exertion. R-I type of single coronary artery is an anomaly with a very rare incidence, which may cause myocardial ischemia and sudden death and whose recognition might be of use to physicians when diagnosing and treating this anomaly.

[Rheolytic thrombectomy with AngioJet catheter during transluminal coronary revascularization in patients with acute myocardial infarction]. / Reoliticheskaia trombéktomiia kateterom AngioJet vo vremia transliuminal'noi koronarnoi revaskuliarizatsii u bol'nykh ostrym infarktom miokarda.

BACKGROUND: Although balloon angioplasty and stenting are effective in the treatment of acute myocardial infarction (M1), reduced coronary flow and distal embolization frequently complicate interventions when thrombus is present. Adjunctive treatment with mechanical thrombectomy devices was suggested to reduce these complications. METHODS: We evaluated immediate angiographic, in-hospital and 30-day follow-up clinical outcomes of 185 patients with acute MI and angiographically evident thrombus who were treated with AngioJet rheolytic thrombectomy followed by immediate definitive treatment. RESULTS: Procedural success (residual diameter stenosis <50% and thrombolysis in myocardial infarction [TIMI] flow >2 after final treatment) was 97%. Rheolytic thrombectomy success was achieved in 7% of patients. Subsequent definitive treatment included stenting in 67% and balloon angioplasty alone in 26% of patients. Final TIMI 3 flow was achieved in 89%. AngioJet treatment resulted in mean thrombus area reduction from 69.6 mm(2) at baseline to 17.3 mm(2) post-thrombectomy (p<0.001). Procedural complications included distal embolization (7.6%) and perforation (1.1%). Clinical success (procedure success without major in-hospital cardiac events) rate was 88%, in-hospital mortality - 7.0%. There were no further major adverse events during 30-day follow-up. CONCLUSION: Rheolytic thrombectomy can be performed safely and effectively in patients with acute MI, allowing for immediate definitive treatment of thrombus-containing lesions.

[Efficacy and safety of the TAIS coronary stent implantation: nine month multicenter study]. / Effektivnost' i bezopasnost' ispol'zovaniia koronarnogo stenta TAIS: rezul'taty 9-mesiachnogo mnogotsentrovogo issledovaniia.

AIM: Assessment of clinical and angiographic results of a balloon-expandable steel matrix stent TAIS in patients with atherosclerosis of the coronary arteries with no history of previous interventions in the course of an open non-randomized multicenter trial. MATERIAL AND METHODS: The TAIS stent was implanted in 187 patients into 199 stenoses. 47% patients had clinical manifestations of unstable angina pectoris. 29% cases were complicated. The length of the stenoses reached 11.3 +/- 5.4 mm, 22% stenoses were prolonged. RESULTS: This coronary stenting was effective in 100% cases, neither acute nor subacute thromboses were seen. Myocardial infarction without occlusion of the stent developed in 3 patients. The incidence of cardial complications (death, angina, restenosis, repeated revascularization) in 6 month follow-up was 11.8%. An angiographic control in 6 months was made in 184 patients (194 stenoses). The vascular diameter loss index was 0.40 +/- 0.21, a restenosis level--10.7%. A logistic regression analysis has revealed significant correlations between the length of the stent and a target vascular diameter with subsequent restenosis. Repeated revascularization was performed in all the patients with stent restenosis. After control angiography cardiac complications developed in 13.9% patients. Nine month follow-up registered cardiac complications in 17.6% cases. CONCLUSION: The TAIS stent was found effective in prevention of thrombosis and restenosis in patients with a relatively high risk of intervention.

Congenital coronary artery fistulas in Turkish patients undergoing diagnostic cardiac angiography.

A coronary artery fistula is a direct communication between a coronary artery and one of the cardiac chambers or vessels around the heart. The present study was undertaken to define the incidence, clinical findings and angiographic characteristics of congenital coronary artery fistula in Turkish adults who underwent diagnostic cardiac angiography. A consecutive series of 11,350 coronary angiography, performed between January 2000 and December 2001, was retrospectively examined for the presence of coronary artery fistulas. The incidence of congenital coronary artery fistulas was 0.08%. All the patients had chest pain during exertion or at rest. All the fistulas were single and most arose from the proximal left anterior descending coronary artery and drained into the pulmonary artery. All the fistulas were small. Surgical treatment was not indicated. A congenital coronary artery fistula in adults is a distinct though rare entity, variable in its incidence and commonly associated with coronary artery obstructive disease. Diagnosis is mostly incidental during routine coronary angiography.