Heart rate variability (HRV) is one of the promising emerging noninvasive modalities that are extensively used nowadays in research and risk stratification of several diseases. Reduced HRV has been linked to several cardiovascular risk factors such as hypertension (HTN) and diabetes mellitus (DM) also; it has been linked and used for years now in the risk stratification of congestive heart failure, coronary artery disease (CAD), and acute myocardial infarction (AMI). Controversial data are present about the effect of coronary artery bypass graft (CABG) on HRV and the use of HRV for risk stratification in post-CABG patients while percutaneous coronary intervention was linked to a dramatic improvement in HRV and improved survival of CAD patients. Although experimental data are present correlating reduced HRV with increased risk for cardiovascular morbidity and mortality, extensive research is required for further implementation in daily clinical use. In this review, we will discuss the current cardiovascular clinical implications and highlight the limitations of usage and future perspective of HRV.

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Introduction: We compared transcatheter and surgical closure of secundum atrial septal defects (ASDs) in terms of cost in this study. Materials and Methods: Between 2006 and 2015, 291 consecutive patients having secundum ASD, in whom percutaneous or surgical closure was performed, were included in this study. We compared the in-hospital cost of transcatheter versus surgical ASD closure in these patients. Results: We collected totaly 291 patients, 214 transcatheter and 77 surgical closure procedures, retrospectively. Patients with a surgical closure had a longer length of stay (11.8 ± 3.8 days vs. 2.8 ± 1.6 days, P < 0.001). There was no in-hospital mortality in two groups. Costs denominated in Turkish lira (TL) and United States Dollar (USD) of transcatheter closure were higher than that of surgical closure (TL 10955.6 ± 183.4 vs. TL 6016.7 ± 371.9 P < 0.001; USD 6531.2 ± 149.62 vs. USD 3896.2 ± 234.7 P < 0.001). The cost of percutaneous ASD closure increase does not correlate with the dollar rate on the annual basis. This with the supplier firms has excessive profits in the first year of the study. Conclusion: Compared with other countries with regard to cost, transcatheter ASD closure is a more expensive treatment than surgical closure in our country.

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Sinus venous atrial septal defect (SVD) is highly difficult to diagnose because of its location. Below, we report a case of SVD which is misdiagnosed as pulmonary hypertension and anomalous pulmonary venous return. A 57-year-old female patient was referred to congenital disease outpatient clinic of a tertiary center. She was admitted to the hospital with complaints of fatigue and exercise dyspnea which had started a year ago. She had transthoracic echocardiography (TTE) examination done in another hospital which showed dilated right heart chambers and pulmonary hypertension. She underwent transesophageal echocardiography (TEE) examination with the suspicion of atrial septal defect (ASD), but no defect was seen. As her symptoms persisted, we repeated the TTE and TEE examination in our center. TEE revealed 0.6 cm ASD on the upper side of the interatrial septum. All four pulmonary veins were draining into the left atrium. Right heart catheterization (RHC) confirmed the diagnosis. A left-to-right shunt was detected and localized by a significant step-up in blood oxygen saturation found between mid and upper segments of the right atrium. According to our TEE and RHC results, we planned the surgical closure of the defect. Sinus venous ASD is deficiency of the superior portion of atrial septum adjacent to superior vena cava. Diagnosis of SVD is often more difficult than other forms of ASD and may require special imaging such as TEE, magnetic resonance imaging, or computed tomographic scanning. In conclusion, cardiologists must be aware about the possibility of SVD patients who have unexplained exertional dyspnea and fatigue, dilated right atrium and ventricle, pulmonary hypertension, paradoxical embolism, or atrial arrhythmias in their respective populations.

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Background: Atherosclerotic cardiovascular disease influences young patients as well as the elderly. A large proportion of patients with coronary artery disease (CAD) have metabolic syndrome (MS), although the frequency and association of its different components are not clear. To the best of our knowledge, there is no any study about the prevalence of MS among young patients with ST-elevation myocardial infarction (STEMI). We sought to determine the prevalence of MS in patients below 46 years of age who presented with STEMI and underwent primary percutaneous coronary intervention. Methods: In the present prospective study, 141 consecutive patients with STEMI <46 years of age admitted to intensive coronary care unit. STEMI was defined according to the ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. All patients were grouped presence of MS. In the second step, the components of MS were analyzed, excluding patients with diabetes mellitus (DM). Results: The total prevalence of MS was 46.8% (n = 66). In MS group, the most frequent component of MS was low high-density lipoprotein (HDL) levels (84.8%), followed by elevated triglycerides (TGs) (78.1%). A total of 121 patients did not have DM and 51 (42.1%) of these patients presented with MS. Conclusions: The prevalence of MS in young patients with STEMI is high. Low HDL cholesterol (HDLc) concentrations and high TG levels are cardiovascular risk factors, regardless of low-density lipoprotein cholesterol levels and they are found too often in our study. These results highlight the need to implement preventative strategies for reducing overall cardiovascular risk in young patients as well as elderly.

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Prevalence of heart failure (HF) increases over time and is associated with high mortality. Shortness of breath, exercise intolerance, and low quality of life related to health are the common problems in HF patients despite optimum pharmacological therapy. Exercise training counteracts the progression of devastating compensatory mechanisms of HF, leading to improvement in functional capacity and quality of life. Resistance training improves peak oxygen uptake, quality of life, and walking performance in HF patients. Adherence is central to training for the best result. Any exercise training program whether continuous or interval training is sufficient to improve the prognosis, quality of life, and anatomic function.

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Objective: Widely used method is blinded puncture of subclavian vein, but the complication rate is high in this method. In this study, we aimed to demonstrate the effect of roadmap use during implantation of permanent pacemaker on the success rate, speed of puncture and complications. Methods: The study was designed as a prospective randomized controlled study. Totally, 125 devices were implanted to the patients included in the study, and 518 punctures were performed for implantation of these devices. 186 punctures were performed in roadmap group and 332 punctures were performed in conventional group. Two groups were compared with regard to clinical and demographic features, speed and success of puncture and complications. Results: Baseline characteristics were similar between groups. Median duration of intervention for each puncture was 27 (15/46) s in roadmap group and 56 (30/100) s in conventional group. The number of attempts for a successful puncture was detected as 1 (1/2) in roadmap group and 2 (2/4) in conventional group. Arterial puncture incidence was 10.3% in roadmap group and 37% in conventional group (P < 0.001 for all). Considering complications, the incidence of pneumothorax and intramuscular puncture was seen lower significantly (P = 0.046 and P = 0.006, respectively). Conclusion: Number of attempts for successful puncture, time needed for successful puncture, number of arterial puncture and complication rate was significantly lower in patients undergoing pacemaker implantation by roadmap technique. Based on these data, roadmap technique may take the place of conventional method of puncture.

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Brugada syndrome is a congenital channelopathy in cardiac ion transmembrane causing an alteration in the electrical conduction of the heart. ST-elevation, as well as right bundle-branch block in anterior precordial electrocardiography (ECG), is pathognomonic in this syndrome. The patient might be asymptomatic or with a history of syncope and prone to develop ventricular tachyarrhythmia which may spontaneously recover or degenerates to ventricular fibrillation, cardiac arrest and even sudden death. Nevertheless, this can be prevented by implantable cardioverter defibrillator implantation. Therefore, it is of paramount importance that clinical suspicion and identification, interpretation of its characteristic ECG pattern and risk stratification to be properly done to diagnose and to manage Brugada syndrome. The author has also done a systematic review (included in the article) for several noninvasive ECG parameters for risk stratification with promising results. Epicardial ablation is an emerging therapy that may “cure” Brugada syndrome.

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In this case, we report a successful closure of secundum atrial septal defect in a 32-year-old female patient with an interrupted inferior vena cava (IVC). Interrupted IVC was detected coincidentally during right heart catheterization. The defect was successfully closed through transjugular vein approach as an alternative to surgery.

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Pulmonary thromboembolism (PTE) is usually caused by deep vein thrombosis (DVT) in the lower extremities; which can be as varied clinical spectrum as asymptomatic embolism detected incidentally to serious disease with massive embolism causing death. A 44 year-old female patient was admitted to emergency department with complaints of general condition impairment, hypotension and marked dyspnea. She had a fracture on the right femur proximal region after falling a month ago. Lower extremity Doppler ultrasonography revealed findings consistent with acute deep vein thrombosis in the right lower extremity. Emergency pulmonary CT angiography revealed bilateral massive pulmonary thromboembolism extending especially from the main pulmonary artery to the right pulmonary artery. IV thrombolytic was contraindicated as a result of head trauma and subdural hematoma history a month ago. The patient was taken to the catheter laboratory and we performed a selective thrombus aspiration and fragmentation. The vital signs and hemodynamics of the patient improved rapidly after the procedure. This case report is important for demonstrating rapid percutaneous management of a young female patient with a life-threatening condition and favourable outcome of percutaneous intervention despite many comorbid conditions.

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Background: The aim of this study was to investigate the relationship between neutrophil to lymphocyte ratio (NLR) platelet to lymphocyte ratio (PLR), mean platelet volume to lymphocyte ratio (MPVLR), MPV to platelet ratio (MPVPR) and the complexity of coronary artery disease (CCAD) in patients with acute coronary syndrome (ACS) using the SYNTAX score (SS) algorithm. Materials and Methods: A total of 599 patients with ACS undergoing coronary arteriography were enrolled and divided into three groups according to their SS: low SS group ≤22 (low-SSG,); intermediate SSG ≥23 and ≤32 (in-SSG,); and high- SSG ≥33 (high-SSG). Routine complete blood count parameters were analyzed at hospital admission. Results: There were significant differences between three groups in terms of PLR and MPVLR values (P = 0.007 and P = 0.029). Correlation analysis showed that PLR and MPVLR were positively correlated with CCAD (r = 0.095, P = 0.018 and r = 0.112, P = 0.005, respectively). In multivariate logistic regression analysis, MPVLR was not an independent predictor of CCAD, whereas PLR was found to be a weak independent predictor of CCAD (odds ratio = 1.003 [1.001–1.006], P = 0.021). Receiver operating characteristics analysis showed that PRL had low sensitivity (56.2%) and specificity (51.6%) for prediction of CCAD. Conclusion: Our study showed that NLR, MPVPR, and MPVLR were not independent predictors of CCAD in patients with ACS. PLR had such a weak relationship with CCAD that it could not be used for prediction of CCAD in these patients.

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Introduction: Stroke was the second-leading global cause of death accounting for 11.8% of total deaths worldwide and a leading cause of disability. Stroke was the leading cause of death in Indonesia accounting for 21.1% of them. Knowledge is essential for the prevention of stroke and minimizing delay in receiving proper treatment. Methods: This was a cross-sectional observational study using a questionnaire consisting of questions about signs, symptoms, and risk factors for stroke in the Indonesian Language with a minimal amount of technical jargon. There were 113 respondents, 49 has a medical background (11 was medical doctors) and 64 was from a nonmedical background. Results: Majority of the nonmedical personnel knew that hemiparesis is a symptom of stroke, but only a third knew that hemihypesthesia is one of the symptoms. Approximately half knew that dysarthria and uneven face is a symptom of stroke. Only a few knew that sudden loss of vision is a symptom of stroke. Hypertension and hypercholesterolemia were the two most popular risk factors among nonmedical personnel, other risk factors were only known to <40% of the respondents. After comparing the results between medical and nonmedical personnel, medical personnel was more confident about their knowledge (P < 0.001). The difference was also statistically significant in hemihypesthesia (P = 0.029) and sudden loss of vision (P = 0.032). The difference was statistically significant when assessing several risk factors such as arrhythmia (P = 0.004), smoking (P = 0.004), hypertension (P = 0.001), diabetes (P < 0.001), and atrial fibrillation (P < 0.001). Disappointingly, both groups performed poorly in recognizing menopause as a risk factor. Conclusion: The knowledge about the symptoms and signs of stroke other than hemiparesis was poor in nonmedical personnel. Medical personnel was only slightly better than nonmedical personnel. This is a wake-up call to emphasize the importance of stroke, its prevention and early recognition.

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The coexistence of atrial septal defect (ASD) and mitral stenosis (MS) is defined as Lutembacher's syndrome (LS). LS was originally defined as the development of MS in a patient having a congenital ASD diagnosis. However, as the percutaneous interventions for MS have become widespread, the persistence of associated iatrogenic ASDs caused has given rise to a different form of the disease. LS may occur as spontaneous or iatrogenic ASD concomitant with acquired MS; this form is known as “acquired LS.” This report presents two cases illustrating congenital LS and “acquired LS.”

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A 56-year-old male patient was admitted to our clinic due to persistent fever despite the use of antibiotics for 2 weeks, chest pain, and presyncope. His medical history revealed that the patient underwent modified Bentall-De Bono procedure 2 months ago due to ascending aortic aneurysm and severe aortic insufficiency. Transthoracic apical 5 chamber view showed that mobile vegetation prolapsed into the left ventricular outflow tract during ventricular diastole and that mechanical prosthetic valve was superior to the aortic annulus. Transesophageal echocardiography revealed normal aortic mechanical prosthetic valve function; however, the valve was positioned more superior to the annular plane and a dense vegetation was observed. Moreover, a complete dehiscence of the prosthetic valve was attached to aortic annulus with a single stitch in an area between noncoronary sinus and left coronary sinus. Dense thrombus formation was observed in the perivalvular region. Many cases with prosthetic valve endocarditis and partial dehiscence as its complication have been reported in the literature. However, to the best of our knowledge, there is no reported case of complete dehiscence secondary to infective endocarditis following complete ascending aortic graft and prosthetic aortic valve replacement (modified Bentall-De Bono procedure).

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Electrocardiographic (ECG) abnormalities are often indicative of acute coronary artery occlusion. Early detection of these abnormalities is important for the identification of patients who may be candidates for emergent percutaneous coronary revascularization (PCR). In most cases, ST-segment elevation is the key factor in selecting patients for PCR. However, some cases with acute coronary artery occlusion do not have ST-segment elevation, resulting in delays in coronary reperfusion treatment. A 37-year-old male presented to the emergency department with typical chest pain. The patient indicated that he was a heavy marijuana user. Even though his admission ECG did not reveal ST-segment elevation, he was hemodynamically stable, and he did not develop life-threatening arrhythmias, he was immediately taken to the catheterization laboratory for urgent angiography with the diagnosis of acute myocardial infarction. The occluded left anterior descending artery seen in angiography was successfully revascularized with percutaneous coronary intervention. Herein, we present a case of a patient who was admitted to the emergency department with chest pain and ECG demonstrating the de Winter pattern. Based on this case, we present a detailed evaluation regarding the de Winter ECG pattern, which is equivalent to ST-segment elevation.

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Premature atrial complexes (PACs) have long been considered a benign electrophysiological phenomenon unlikely to result in a severe clinical consequence. However, recent evidence had challenged this notion. Several studies showed that excessive PAC leads to the development of atrial fibrillation and subsequent hospitalization. The PAC is also associated with mortality, cardiovascular hospitalization, permanent pacemaker implantation, and nonlacunar ischemic stroke. The cutoff for excessive PAC differs from one study to another ranging from 76 PACs per 24 h to >32 PACs per hour. Increased adverse cardiovascular events demonstrated by recent studies had challenged the long-held paradigm that PACs are unlikely to result in serious clinical consequences.

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Objective: We aimed to determine the prevalence, predictors, and mortality rate of premature clopidogrel discontinuation within 30 days of successful coronary stenting. Methods: All consecutive patients who underwent successful coronary stent implantation at our hospital between December 2006 and December 2007 were prospectively included in this study. Patients were interviewed by telephone 30 days after stent implantation. Premature clopidogrel discontinuation was defined as follows: patients who did not continue clopidogrel after discharge were defined as “never used” and patients who received clopidogrel for <20 days or interrupted therapy for at least 5 successive days within the first 30 days were defined as “partially used.” Results: Follow-up data were available for 381 patients and 58 (15.2%) patients reported premature clopidogrel discontinuation. No mortality and only 1 (0.3%) stent thrombosis occurred in adherent patients, whereas there were 2 (3.4%) mortalities and 6 (10.3%) stent thrombosis in the patients who prematurely discontinued clopidogrel. Those who discontinued clopidogrel therapy were older (P = 0.02), more likely to be female (P = 0.02), single (P = 0.03), of lower economic (P < 0.05) and educational status (P < 0.01), more likely to have chronic disease (P = 0.04), less likely to have undergone previous stenting (P = 0.01), and were more likely to be receiving a larger number of drugs (P < 0.05). In multivariate analysis, low- or intermediate-economic status, no history of previous stent implantation, and total number of prescribed drugs using were factors independently associated with premature clopidogrel discontinuation. Conclusion: This study demonstrates several predictors of premature clopidogrel discontinuation. This data may help clinicians pay particular attention to these patients in an attempt to improve the outcomes of coronary stenting.

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Background: Heart failure (HF) is an important public health problem. We aimed to investigate the predictors of long-term hospitalization in Turkish HF population. Materials and Methods: Journey-HF-TR study is a multicenter, cross-sectional, noninvasive, and observational study that was conducted in intensive care unit (ICU), coronary care unit (CCU), and cardiology wards in seven geographical regions of Turkey. In this subgroup analysis, patients were classified as two groups according to inhospital stay called the patient with the shorter length of stay (S-LOS) (inhospital stay <5 days; S-LOS) and patients with longer LOS (L-LOS) (inhospital stay ≥5 days; L LOS). Results: The study group was consisted of 1606 patients (57.2% male, mean age: 67. 8 ± 13.0 years old). One thousand and thirty seven patients, whom in-hospital stay duration were recorded in case report form, were included in this analysis. There were 487 patients (32.1%) in S LOS group and 1030 patients (67.9%) in L LOS group. In multivariate analysis, correlation was present for NYHA functional capacity, CKD, ACS related HF, right HF, cardiogenic shock, invasive and noninvasive ventilation, and hemodynamic monetarization. The longer inhospital stay increases the probability of morbidity and mortality. Conclusion: We demonstrated that there was positive correlation between longer hospital stay and HF severity (NYHA III-IV), CKD, cardiogenic shock, right ventricular HF, and HF related to ACS. HFpEF patients have less in-hospital stay than HFrEF and HFmrEF patients.

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Introduction: The reciprocal ST-segment depression in the electrocardiography (ECG) leads overlying noninfarcting areas was studied previously in acute myocardial ischemia. Multi-vessel disease (MVD) subset of patients have more vague and confusing presentations on ECG; they usually show less ST-segment elevation and profound and diffuse ST-segment depression compared to ST-segment elevation myocardial infarction (STEMI) patients with single-vessel disease (SVD) involving occlusion of one coronary artery only, namely the infarct-related artery (IRA). Aim of the Work: The aim was to study and compare the pattern of reciprocal ECG changes in STEMI patients presenting with SVD versus MVD. Methods and Results: A total of 125 consecutive patients admitted from April 2014 to August 2015 from the emergency room with the diagnosis of acute STEMI and treated by primary percutaneous coronary intervention (PPCI) at our cath lab at Ainshams University Hospitals (a 24/7 tertiary referral center for PPCI) were included. ST-segment deviations were measured at the J-point. Reciprocal ST-segment changes were identified as per guidelines published by the European Society of Cardiology and the American College of Cardiology, i.e., ST-segment depression ≥0.1 mV in any ECG lead other than aVR, while the cutoff value is different for leads V2 and V3 being only 0.05 mV. Coronary angiographies were evaluated by two independent operators blinded to the clinical and electrocardiographic data. Regarding the left anterior descending (LAD) occlusion, the reciprocal ST-segment depression magnitudes in lead III and in lead arteriovenous fistula (aVF) were significantly less in the MVD group compared to the SVD group, i.e., lead III (−0.08 ± 0.10 mV vs. −0.19 ± 0.15, P = 0.015) and lead aVF (−0.07 ± 0.06 mV vs. −0.15 ± 0.11, P = 0.02); while regarding the left circumflex coronary artery (LCX) occlusion, the reciprocal ST-segment depression extended significantly in V4 chest lead in the MVD group compared to the SVD group (−0.16 ± 0.08 mV vs. −0.1 ± 0.04, P = 0.025); and finally regarding the right coronary artery (RCA) occlusion, the reciprocal ST-segment depression extended significantly in V3 chest lead in the MVD group compared to the SVD group (−0.18 ± 0.07 mV vs. −0.1 ± 0.06, P = 0.02). Conclusion: The pattern of reciprocal ST-segment depression was more profound when the LAD was the culprit artery causing the anterior STEMI compared to the same case if the LAD was a part of MVD; this does not apply to the LCX and RCA when they were the culprit in cases of inferior STEMI where the MVD group showed more reciprocal ST-segment depression.

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Background: In the present study, we aimed to evaluate the factors that might be caused by adequate anticoagulation control in patients treated with warfarin for any reason. Methods: The WARFARIN-TR (The Awareness, Efficacy, Safety, and Time in Therapeutic Range of Warfarin in Turkish Population) study included 4987 patients using warfarin between January 1, 2014 and December 31, 2014. Time in therapeutic range (TTR) was calculated according to F. R. Roosendaal's algorithm with linear interpolation. The study population divided into two groups; adequate international normalized ratio (INR) control when TTR ≥70% (Group 1, n = 1068, 21.4%) and inadequate INR control when TTR <70% (Group 2, n = 3919, 78.6%). All demographic and clinic characteristics of the patients were compared to determine possible factors that might be cause adequate warfarin use. Results: The mean age of the study population was 60.7 ± 13.5 years, and there was no significant difference between groups. The mean TTR value of Group 1 was significantly higher than Group 2 (80 ± 8.5 vs. 40.9 ± 17.2; P < 0.001). The traditional cardiovascular risk factors were similar between groups except hypertension (Group 1 51.4% and Group 2 56.4%; P = 0.004) and chronic kidney disease (Group 1 8.3% and Group 2 5.5%; P = 0.001). There were no significant differences between groups regarding bleeding. The awareness of warfarin use was significantly higher in Group 1 patients than Group 2 patients. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.007; P = 0.014), hypertension (OR, 0.821; P = 0.01), atrial fibrillation (OR, 1.180; P = 0.033), chronic kidney disease (OR, 1.697; P < 0.001), to know warfarin use reason (OR, 1.699; P < 0.001), and know to food-drug interaction with warfarin (OR, 1.583; P < 0.001) were independent predictors of adequate coagulation. Conclusion: Our study demonstrated that a low proportion of patients taking warfarin achieve an adequate TTR in daily practice. Furthermore, the patients with adequate TTR are more aware of warfarin use.

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Objective: The objective of this study was to determine nebivolol's inhibitory effect on endothelial dysfunction in hyperhomocysteinemic rats, based on heart pathology and biochemical analysis of serum samples. Methods: Male Wistar albino rats weighing between 200 g and 450 g were randomly divided into four groups of equal number (n = 7) as follows: control group, nebivolol group, methionine group, and methionine + nebivolol group. After 28 days, homocysteinemia (Hcy), asymmetric dimethylarginine (ADMA), malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), superoxide dismutase (SOD), and catalase (CAT) levels were measured in blood samples and compared between groups. Each rat's hearts were dissected to observe cardiomyocyte degeneration; findings were compared between groups. Results: Moderate hyperHcy (hHcy) (Hcy 35.62 ± 7.60 μmol/L) was noted in methionine group (P < 0.001). The levels of the antioxidant molecules CAT, GSH, GPx, GR, and SOD were lower, and the levels of the oxidant molecules ADMA, Hcy, and MDA were higher in methionine group (P < 0.001). A decrease in antioxidants and also increase in oxidants did not occur in the methionine + nebivolol group (P < 0.001). Cardiomyocyte degeneration was more severe in methionine group (P = 0.01). Conclusion: Endothelial dysfunction induced through short-term hHcy can be prevented through the administration of nebivolol. Nebivolol can prevent elevation of the Hcy levels, and hHcy might cause cardiomyocyte degeneration.

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A double orifice mitral valve (DOMV) represents a rare congenital malformation characterized by two valve orifices with two separate subvalvular apparatus. We present an interesting case of an asymptomatic 1 year and 8 months old male child with DOMV who successfully underwent surgery.

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Background: The aim of the present study was therefore to evaluate the evolution of electrocardiography (ECG) markers indicator of morbidity and mortality after pulmonary endarterectomy (PEA). It may be a good predictor of mortality and morbidity in chronic thromboembolic pulmonary hypertension (CTEPH) with patients who underwent PEA. PEA may be reduced risk of arrhythmia in patients with CTEPH. However, this claim must to be supported with long-term results. Materials and Methods: We collected demographic, ECG, and echocardiographic parameters data (baseline and after the operation) in patients undergoing PEA for CTEPH at our institution from 2009 to 2013.We assessed 62 CTEPH patients who underwent PEA. Results: P wave amplitude in DII, PR interval, P and QT dispersion changed significantly at 3 months after surgery. The P dispersion (17.66 ± 6.2, P < 0.04) and QT dispersion (23.75 ± 11.37, P < 0.015) were longer in before operation than in after operation. Conclusions: In our study, we found in ECG analyses of CTEPH with patients who are undergoing PEA that P dispersion, QT dispersion were changed when compared with before operation. For this reason, we think that PEA reduces the risk of atrial fibrillation and malignant arrhythmia.

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Acute pulmonary thromboembolism (PTE) is a leading cause of mortality and morbidity. Observation of the right atrial thrombi is a rare condition, which usually accompanies to massive PTE. Urgent treatment strategies for rapid thrombus removal are mandatory in patients presenting with acute massive PTE. In this paper, we present a patient admitting with acute massive PTE to our emergency department, in whom concomitant right atrial thrombus was successfully treated with reteplase.

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Transcatheter aortic valve implantation (TAVI) is a novel method for patients with severe aortic stenosis at high surgical risk. Although short- and medium-term outcomes after TAVI are encouraging, long-term data on valve function and clinical outcomes are limited. Hence, our case can make a contribution to literature. An 80-year-old patient with severe aortic stenosis underwent TAVI in our clinic in October 2015. After 5 months, she admitted to our emergency department with severe dyspnea. Her symptoms were started within 2 days and getting worse day by day. Echocardiography revealed us a severe aortic regurgitation due to dislocation of the valve to the left ventricular outflow tract side. After diagnosis, aortic regurgitation was treated by valve-in-valve technique. TAVI may provide an alternative therapeutic approach to ineligible or poor surgical candidates of degenerative aortic stenosis. However, this technique also has some complications such as mortality, atrioventricular (AV) block, stroke, and coronary obstruction. Valve embolization is an another rare complication of this procedure and usually can be prevented by careful preprocedure annulus measurements, stable lead positioning for rapid pacing, optimal valve positioning, full balloon inflation at the time of valve deployment, and complete balloon deflation before stopping rapid pacing. At this point, our case became important for the complication literature with its time, about 5 months. Because it is the more recently used technique, we need much more time to detect the usefulness and complications of TAVI and learn how to avoid these complications.

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Objective: Mitral annular calcification (MAC) is associated with systemic calcification and cardiovascular disease (CVD) events. Matrix Gla protein (MGP) is a strong inhibitor of vascular and soft-tissue calcification and reduced levels of its circulating precursor, uncarboxylated MGP (ucMGP), was found associated with vascular calcification in pilot studies. Methods and Results: In this study, which includes 86 outpatients with no significant coronary artery and chronic kidney diseases, we measured serum ucMGP levels and evaluated MAC using echocardiography. In participants with MAC (n = 44), serum ucMGP levels were lower than the control group (n = 42) (216.1 ± 154.1 vs. 390.2 ± 256.3, P = 0.001, respectively). The patients with MAC were divided into two groups: mild MAC group and moderate MAC group. Serum ucMGP levels were significantly lower in the moderate MAC group than the mild MAC group (139.0 ± 121.8 vs. 248.4 ± 156.3, P = 0.03, respectively). Conclusions: In patients with MAC, serum ucMGP level was significantly low, and this association has been detected for the first time in patients with no significant coronary artery disease (CAD).

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