Left ventricular pseudoaneurysm (LVPA) due to incomplete or late rupture after mitral valve replacement is a rare condition but can be life threatening if it develops into perdicardial tamponade. LVPA may develop de novo after the surgical procedure or may be a sequela of an earlier rupture. Clinical presentation includes shortness of breath, heart failure, chest pain, endocarditis, and pericardial tamponade. However, it can also have an asymptomatic course. The recommended treatment for LVPA is surgical repair. Conservative follow-up is an alternative for patients who refuse surgical treatment or are considered high risk for re-operation. We conducted a review of all the available literature on cases of LVPA after mitral valve replacement and present the findings here.
Cardiomyopathy is a disease of the heart muscle resulting from genetic defects, cardiac myocyte injury, or infiltration of the myocardium. Cardiomyopathies are traditionally defined as dilated, restrictive, and hypertrophic cardiomyopathy. Today, the genetic basis of most diseases has been clearly defined and has influenced the approach to familial diseases such as cardiomyopathies. Traditional definitions of cardiomyopathies, such as those by the American Heart Association and the European Society of Cardiology, do not consider the genetic basis of cardiomyopathies. In 2013, the World Heart Federation added the genetic basis of cardiomyopathies and proposed a descriptive genotype-phenotype nosology system termed "MOGE(S)." The MOGE(S) system resembles the TNM classification system for malignancy, and therefore it can be useful for the diagnosis, management, and treatment of cardiomyopathies in a similar manner to cancer management.
We read the article entitled ''Association of Glomerular Filtration Rate With Slow Coronary Flow in Patients With Normal to Mildly Impaired Renal Function'' by Akin et al 1 with interest. The authors 1 concluded that estimated glomerular filtration rate (eGFR) was significantly correlated with slow coronary flow in patients with normal to mildly impaired kidney function.The Kidney Disease: Improving Global Outcomes organization developed clinical practice guidelines 2 in 2012, recommending that the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is used for reporting eGFR, particularly in patients with a GFR 60 mL/min/1.73 m 2 . Compared with the Modification of Diet in Renal Disease (MDRD) equation, the CKD-EPI equation may be more accurate in patients with measured 3 GFR 60 mL/min/1.73m 2 . Additionally, the CKD-EPI study equation more appropriately categorizes individuals at risk of CKD and cardiovascular disease in a middle-aged population with normal or near-normal kidney function. 4 It has been shown in several communitybased cohorts that people who were reclassified to a higher GFR stage using the CKD-EPI study equation compared with the MDRD study equation had lower risk of adverse events. 5,6 Estimated glomerular filtration rate overestimates measured GFR when serum creatinine is rising and underestimates measured GFR when serum creatinine is falling. 7 Altered muscle mass (eg, reduced by amputation, paraplegia, immobilization, or a neuromuscular disorder and increased by dietary protein intake or creatine dietary supplements), some medications (like aminoglycosides or trimethoprim), and dietary intake (eg, vegetarians) can affect the creatinine levels and eGFR. 7 Akin et al 1 did not mention these factors as exclusion criteria.Finally, the National Kidney Disease Education Program recommends calibrating serum creatinine measurement to isotope dilution mass spectrometry. 8 In the ''Laboratory Measurements'' section of the article, Akin et al 1 mention cholesterol, uric acid, and hemoglobin measurements but the most important parameter of this study, creatinine, was not mentioned.In conclusion, in the light of recently published data, it is probably better to use the CKD-EPI equation to calculate eGFR in patients with near-normal or mildly impaired renal function.
Doğumsal bir koroner arter anomalisi olan Miyokardiyal Bridge (MB), epikardiyal koroner arterlerden birinin bir segmentinin miyokardiyum içerisinde seyretmesi ile karakterize bir durumdur. MB tarafından oluşturulan koroner obstrüksiyonun derecesi, MB'nin lokalizasyonuna, kalınlığına, uzunluğuna ve kardiyak kontraktilitenin derecesine bağlıdır. Otopsi çalışmalarında prevalansı %80 kadar yüksek bulunmasına rağmen, koroner anjiografi çalışmalarında prevalansı %0,5 ile %16 arasında değişmektedir. Hastalar ve Yöntem: Çalışmamız retrospektif olarak yapıldı. 2011 Kasım ve 2013 Ekim tarihleri arasında Dumlupınar Üniversitesi Tıp Fakültesi Evliya Çelebi Eğitim ve Araştırma Hastanesi'nde koroner anjiografi yapılan 3835 hastanın anjiografik kayıtları MB'nin prevalansını araştırmak için retrospektif olarak tarandı. Bulgular: Koroner anjiografi yapılan toplam 3835 hastanın 62'sinde MB bulundu ve anjiografik prevalansı %1,61 olarak hesaplandı. Hastaların yaş ortalaması 57,1 iken, en küçük yaş 30, en büyük yaş 82 olarak bulundu. Toplam hastaların 12'si (%19) kadın iken, 50'si (%81) erkek olarak bulundu. MB en sık olarak sol ön inen (LAD) arterde bulundu. Mid LAD'de 30 hastada (%48), distal LAD'de 30 hastada (%48), sirkumfleks (Cx) arterde bir hastada (%2) ve sağ koroner arterde (RCA) bir hastada (%2) olarak tespit edildi. Sonuç: Çalışmamızda MB'nin prevalansı literatürdeki anjiografi çalışmalarına benzer olarak bulundu. Erkeklerde belirgin olarak daha yaygın tespit edildi. Ayrıca MB en sık olarak LAD arterde tespit edildi. Anahtar Kelimeler: Koroner arter hastalığı; koroner anjiografi; miyokardiyal köprüleşme Introduction: Myocardial Bridge (MB), which is a congenital coronary artery anomaly, is characterized by remaining of a segment of an epicardial coronary artery in the myocardium. The degree of coronary obstruction caused by MB depends on its location, thickness, length and the degree of cardiac contractility. Although its prevalence in autopsy studies is reported to be as high as 80%, coronary angiography studies report a varying prevalence between 0.5% and 16%. Patients and Methods: The study was conducted retrospectively between
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