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Öğe Anomaly of the left anterior descending coronary artery arising from the right sinus of valsalva and ventricular septal defect in adult: A rare case(Yonsei Univ College Medicine, 2005) Tacar, O; Karadede, AAnomaly of the left anterior descending (LAD) coronary artery arising from the right sinus of valsalva is frequently seen with tetralogy of Fallot (TOF). The association of the LAD coronary artery with ventricular septal defect (VSD) is uncommon. We described an anomalous origin of the LAD coronary artery from the right sinus of valsalva with ventricular septal defect in a 38-year-old male patient suffering from atypical angina. The LAD coronary artery arose from the right sinus of valsalva, just next to the right coronary artery. There was a single opening in the membranous part of the interventricular septum. From this case, we suggest that angiography is useful for both documenting anomalies of the LAD coronary artery associated with VSD and for determining the safest surgical procedures.Öğe Cardiac hydatid cysts located in both the left ventricular apex and the intraventricular septum: Case report(Springer, 2000) Ulgen, MS; Alan, S; Karadede, A; Aydinalp, O; Toprak, NCardiac hydatid cyst is rarely encountered and constitutes 0.5%-2% of all hydatid cases. Although left ventricular (LV) location for hydatid cysts has been frequently reported, the involvement of both the left ventricle and the interventricular septum (IVS) has not been previously reported in the literature. We present a case of cardiac hydatid cyst with fatal recurrent cerebral embolism and the unusual involvement of both LV and IVS demonstrated by transthoracic echocardiography.Öğe A complicated case of pericardial hydatid cyst manifesting as constrictive pericarditis(Pulsus Group Inc, 2000) Karadede, A; Ülgen, MS; Temamogullari, AV; Toprak, NAlthough cardiac involvement with hydatid cyst is quite rare as a major complication, constrictive pericarditis is even less common. A 55-year-old man is presented in whom a hydatid cyst located in the right cardiophrenic angle anterior to the right ventricle ruptured into the pericardial sac, resulting in constrictive pericarditis.Öğe Contribution of the peak exercise QT dispersion to the accuracy of an exercise test during the evaluation of coronary artery disease(Acta Cardiologica, 2000) Ülgen, MS; Karadede, A; Alan, S; Temamogulari, AV; Karabulut, A; Toprak, NObjective - Regional defects in ventricle repolarization are extremely sensitive to ischaemia which can be measured as QT dispersion (QTd). We investigated the role of QTd calculated at the time of peak exercise during treadmill studies. Methods and results - Thirty-three women and eighty men, whose treadmill test results and coronary angiography studies had been examined, were divided into four groups according to the test results: 1)subjects with a negative treadmill test and without significant stenosis results in the angiography, were considered normal (N; n = 35); 2) subjects with both a positive exercise test and a significant presence of stenotic coronary arteries, were considered true positive (TP; n = 52); 3) subjects with a positive exercise test, but without significant stenosis results in the angiography, were considered false positive (FP; n = 14); 4) subjects with a negative treadmill study, despite significantly stenotic arteries, were considered false negative (FN; n = 12), All subjects were evaluated on the basis of age, significant ST-segment depression, peak heart rate, rest and peak exercise QT, and QpT (measured from the beginning of the QRS complex to the highest point of the T wave) dispersion, and corrected (QTcd, QpTcd) values for heart rate. The most significant differences were observed between the N and the TP groups in terms of QTd and QTcd (p < 0.01), with a higher correlation (r = 0.48). A significant relationship was also observed in terms of QpT and QpTcd values during peak exercise (p < 0.01). The sensitivity of the peak exercise QTcd and QTcd greater than or equal to 70 ms in determining coronary artery disease was found to be 74%. In cases of QTcd greater than or equal to 70 ms, in addition to ST-segment depression, the test was found to be less sensitive, but more specific at 96%. Conclusion - It suggests that when peak exercise QTd and QpTd values are taken into account, with the exception of the ST-segment depression, the accuracy of the exercise test will increase and false positive results will decrease.Öğe The effects of glucose-insulin-potassium therapy on signal-averaged electro-cardiography and heart rate variability in acute myocardial infarction(W B Saunders Co Ltd, 2000) Ulgen, MS; Alan, S; Karadede, A; Iltimür, K; Toprak, N[Abstract Not Available]Öğe Iatrogenic left atrioventricular fistula after aortic valve re-replacement(I C R Publishers, 2005) Iltumur, K; Karabulut, A; Karadede, A; Toprak, NLeft ventriculoatrial fistula is a very rare cardiac disorder. The case is reported of a male patient who was admitted to the authors' clinic with dyspnea and fatigue. The patient had an atrioventricular fistula between the left atrium and left ventricle, and had undergone aortic valve re-replacement for prosthesis malfunction about one year previously. The fistula was considered to be the result of iatrogenic injury related to valve re-replacement surgery.Öğe Predischarge ST segment and T wave patterns in predicting left ventricular function and myocardial viability in Q wave anterior myocardial infarction patients(International Heart Journal Association, 2005) Karadede, A; Aydinalp, O; Sucu, MThe aim of this Study was to investigate the correlation between ECG changes prior to discharge and findings of early low dose dobutamine stress echocardiography (LDSE) performed in 6 +/- 2 days, in patients experiencing their first acute anterior MI. A total of 62 patients admitted with their first acute anterior MI were divided into three groups according, to the findings of electrocardiograms performed oil the 7-10th days: group A, isoelectric ST and negative or positive T wave; group B, ST elevation (>0.1 mV) and negative T wave; and group C, ST elevation and positive T wave. There were no significant differences between the groups with respect to thrombolytic therapy and reperfusion criteria. In addition, 90% of the patients in group A (20/22), 66% in group B (12/18 P < 0.05 versus group A), and only 54% in group C (12/22, P < 0.01 versus group A) responded to LDSE. The infarct zone wall motion score index (WMSI) measured by LDSE was significantly decreased in group A compared to basal values (from 2.71 +/- 0.65 to 2.07 +/- 0.71 P = 0.02), and it was significantly different compared to groups B and C. Moreover, the serum creatinine kinase level of the patients in group C was higher (P < 0.01 versus group A), whereas the ejection fraction was inferior (group A 48% group B 47%, and group C 41%, P = 0.04 versus group A). When the correlations between good left ventricular function and terminal QRS distortion, sum ST elevation, the number of leads with ST elevation, ST elevation shape oil admission, and ST and T alterations in ECG at discharge were investigated, all independent correlation was found between ST and T alteration in ECG and a WMSI value < 2 at rest or after LDSE (P 0.03, OR 3.08, 95%CI 1.05-8.98). At the infarct zone of patients with ST elevation and positive T waves, left ventricular function is worse and the viability is less. This simple classification may be useful in predicting left ventricular function at the time of discharge.Öğe Relation between QT dispersion and ventricular arrhythmias in uncomplicated isolated mitral valve prolapse(Blackwell Science Asia, 1999) Ülgen, MS; Biyik, I; Karadede, A; Temamogullari, AV; Alan, S; Toprak, NComplications of mitral valve prolapse (MVP), among which serious ventricular arrhythmia and sudden death are of major importance, affect many individuals due to the high incidence of MVP itself in the community despite the actual low incidence of these complications. The present study investigated the incidence and distribution of ventricular arrhythmias according to their severity and relationship with the QT interval and dispersion of repolarization in uncomplicated isolated MVP (IMVP) cases. Fifty-eight uncomplicated IMVP patients, 33 patients with accompanying tricuspid valve prolapse (TVP), to compare its relationship with ventricular arrhythmia, and 60 age- and sex-matched control subjects were enrolled in the study. Individuals with accompanying cardiac or systemic disease, or who were on drug therapy that could potentially affect QT characteristics, were excluded. The incidence of ventricular arrhythmia was 48% in the IMVP group and 64% in the TVP group; the difference was statistically insignificant. In addition, the differences of the QT and Q peak T values were insignificant, whereas QT dispersion (QTd) and Q peak T dispersion (QpeakTd) values were significantly higher in the patient group (60+/-14, 54+/-14 ms, respectively) compared with the control group (42+/-10, 38+/-10 ms, respectively, p<0.001). Complex ventricular arrhythmias (Lown Grade greater than or equal to III) in the IMVP group had a significant relationship with QTd and QpeakTd (p<0.001), but not with QT or QpeakT. As a result of the study, it is concluded that TVP accompanying MVP does not increase the incidence of ventricular arrhythmia, that ventricular arrhythmia is related to QT dispersion rather than QT interval in IMVP, that the QT dispersion is a fairly good marker for identifying the high-risk group for serious ventricular arrhythmia and sudden death, and that QpeakT dispersion measurement is an additional indicator that could be an alternative when QT is difficult to determine in conditions such as high heart rate or the presence of U wave.Öğe The relation between ST-segment elevation shape and both of signal-averaged EKG and clinical course in early period of anterior myocardial infarction(W B Saunders Co Ltd, 2001) Karadede, A; Aydynalp, O; Temamogullary, A; Ulgen, MS; Sucu, M; Toprak, N[Abstract Not Available]Öğe The relationship between terminal QRS complex distortion and early low dose dobutamine stress echocardiography in acute anterior myocardial infarction(Japan Heart Journal, Second Dept Of Internal Med, 2004) Sucu, MM; Karadede, A; Aydinalp, O; Ozturk, O; Toprak, NAlthough the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutainine stress echocardiography (LDSE) performed 6 +/- 2 days later was investigated. Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in greater than or equal to 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V-1-V-3). There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria, During LDSE, the infarct zone wall motion score index (WMSI) in the QRS- group was significantly decreased relative to baseline (from 2.93 +/- 0.65 to 2.37 +/- 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33:5% (44/131) in the QRS- group and 17.8% (27/ 151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS- group did not respond to LDSE (P > 0.05). In multiple logistic regression analysis, while. there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P 0.02 and QRS+; r = 0.44 P = 0.01). The viability in the IZ is relatively less in those patients with terminal QRS distortion observed in their ECG on admission. This simple classification would be useful in predicting left ventricular function at the time of discharge.Öğe The relationship of ST segment elevation shape with preserved myocardium and signal-averaged electrocardiography in acute anterior myocardial infarction(Springer-Verlag, 2002) Karadede, A; Aydinalp, O; Temamogullari, AV; Toprak, NAlthough a relation between magnitude of ST segment elevation and myocardial damage has been shown in the early period of acute myocardial infarction (AMI), such a relation between the shape of the ST segment elevation, myocardial damage, and the clinical course remains obscure. For this purpose 62 first anterior AMI patients admitted in the first 6h were enrolled for the study. On the basis of precordial V3 derivation prior to thrombolytic therapy, the shape of the ST elevation was separated into three groups: concave (n = 26). straight (n = 24), or convex types (n = 12). The relation between the shape of the ST elevation recorded on admission, and the results of pre-discharge low-dose dobutamine stress echocardiography (LDE) performed (n = 53) and signal-averaged ECG values were investigated. The basal wall motion score index (WMSI) and response to LDE in the concave group were better in the infarct zone. Additionally, the average akinetic segment number in the infarct zone was higher, and improvement in these segments was less in the convex and straight groups (concave 3.78 +/- 2 vs 2.17 +/- 2.1. P < 0.01: straight 5.15 +/- 2.7 vs 4.45 +/- 2.8, not significant (NS) convex 5.4 +/- 2.3 vs 4.8 +/- 2.1, NS: basal vs LDE), While only 13% (3/23) of the patients did not respond to LDE (P < 0.05 vs group B and P < 0.01 vs group C), 35% (7/20) of group B and 60% (6/10) of group C patients did not respond to LDE. Although no relation was found between better left ventricular function (WMSI < 2) and shape of the ST elevation in basal evaluation by multiple logistic regression analysis (P = 0.06), an independent relation was found between them following LDE (P = 0.01, odds ratio (OR) 4.5, 95% Confidence Interval (CI) 1.3-14.7). The incidence of ventricular late potential (LP) positivity was 11% (3/26) in the concave group, 16% (4/24) in the straight group. and 58% (7/12) in the convex group (P < 0.001 vs concave and P < 0.05 vs straight groups). We found that shape of the ST elevation could significantly predict the presence of late potentials in multiple logistic regression analysis (P = 0.003, OR 10.7, 95% CI 2.2-51.7). There was no in-hospital death in the concave group, whereas five patients died in either the straight or the convex group. Furthermore, arrhythmia was lower in the concave group during this period (P < 0.05), and exercise capacity was lower. In conclusion, we determined that there wits it higher viable myocardium, and lower LP(positivity) and in-hospital mortality in patients with concave ST elevation on admission.Öğe Replacement of circumflex branch of left coronary artery originating from the right aortic sinus(Springer France, 2001) Karadede, A; Tacar, O; Akkus, MReplacement of the circumflex branch of the left coronary artery is extremely rare. We conducted a retrospective study to determine the incidence of this anomaly of circumflex branch of the left coronary artery. Two such patients were identified from 850 adults undergoing cardiac catheterization procedures. The circumflex branch of the left coronary artery was replaced by a vessel arising from the right aortic sinus. The course of this vessel was retroaortic. A knowledge of this anomaly is important for coronary artery bypass surgery.Öğe The value of hemodynamic changes induced by carotid sinus massage on the diagnosis of coronary artery disease(Westminster Publ Inc, 2001) Ulgen, MS; Karadede, A; Alan, S; Toprak, NThe aim of this study is to investigate the value of hemodynamic changes induced by Carotid sinus massage (CSM) on the diagnosis of coronary artery disease (CAD). A total 108 patients (mean age, 54 +/- 10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonography (USG) and no history of syncope were included in this study. Carotid sinus massage was performed before coronary angiography with monitoring of electrocardiography and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in blood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease between 10 and 20 bpm; and group 3 patients had > 20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all patients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cases, and three-VD in 35 cases. Coronary angiography results were normal in 26 cases. The changes in systolic and diastolic blood pressures and heart rate before and after CSM correlated with number of VD. These changes were highest in patients with three-VD, but lowest in patients with normal coronary angiography. The number of diseased vessels and total coronary artery score were lowest in group 1, but highest in group B. The specificity and sensitivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm changes in heart rate in the diagnosis of CAD were 85% and 71%, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induced the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomized values, the decrease of > 10 mm Hg in blood pressure and/or > 10 bpm has highest specificity, sensitivity, and positive predictive value in the diagnosis of CAD.
