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   2018| April-June  | Volume 4 | Issue 2  
    Online since June 11, 2018

 
 
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ORIGINAL ARTICLES
In-Hospital cost comparison of transcatheter closure versus surgical closure of secundum atrial septal defect
Emre Ozdemir, Eser Variş, Tuncay Kiriş, Sadik Volkan Emren, Cem Nazli, Mehmet Tokaç
April-June 2018, 4(2):28-31
DOI:10.4103/IJCA.IJCA_12_18  
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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Does pulmonary endarterectomy have arrhythmia prevention effect?
Tarik Kivrak, Bedrettin Yıldızeli, Bülent Mutlu
April-June 2018, 4(2):23-27
DOI:10.4103/IJCA.IJCA_8_18  
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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The association of uncarboxylated matrix gla protein with mitral annular calcification in patients without significant coronary artery disease
Zeki Simsek, Elnur Alizade, Firdovsi Ibrahimov, Ali Metin Esen
April-June 2018, 4(2):19-22
DOI:10.4103/IJCA.IJCA_7_18  
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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CASE REPORTS
Is it a new late complication of transcatheter aortic valve implantation?
Özgen Safak, Ilgın Karaca, Murat Özgüler
April-June 2018, 4(2):32-34
DOI:10.4103/IJCA.IJCA_9_18  
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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Thrombus in transit causing acute massive pulmonary emboli treated successfully with reteplase administration
Muhammet Bugra Karaaslan, Aziz Inan Celik, Caglar Emre Cagliyan, Mesut Demir
April-June 2018, 4(2):35-36
DOI:10.4103/IJCA.IJCA_11_18  
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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A snare retrieval experience of coil migration in a large coronary artery fistula
Mithat Selvi, Hasan Gungor, Sevil Gulasti
April-June 2018, 4(2):37-39
DOI:10.4103/IJCA.IJCA_13_18  
A 45-year-old female patient was referred due to the abnormal myocardial perfusion scintigraphy showing ischemia in the inferior and lateral wall. Coronary arteries were normal, and a large fistula was detected from the proximal portion of the circumflex coronary artery (Cx) draining into the pulmonary artery. Percutaneous closure of the coronary artery fistula (CAF) was considered, and a 3 mm × 50 mm-Balt coil was planned to place the proximal portion of the fistulized artery. Unfortunately, during placement of the coil, it was opened early and migrated to the proximal segment of the Cx, the left anterior descending artery, and the distal part of the left main coronary artery. A snare was moved into the extra backup guiding catheter immediately. The migrated coil was retrieved with the snare successfully. Subsequently, 4 mm × 12 mm and 2 mm × 25 mm-Balt coils were placed in the mid portion of the fistulized artery until total occlusion was obtained. A CAF is described as a direct connection between one or more of the coronary arteries and a cardiac chamber or great vessel. The fistula may cause serious hemodynamic disturbances such as myocardial ischemia, high-flow heart failure, right ventricle volume overload, endocarditis, rupture, thrombosis, embolism, and arrhythmias. Percutaneous closure is the prior technique, in the absence of complex conditions such as multiple fistulas and large fistula branches and in cases where the fistula can be simply reached. There have been very rare data which contain complications about the percutaneous closure of CAFs.
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