We examined the effectiveness and safety of performing angioplasty on stenoses adjacent to aneurysmal coronary artery disease. Out of 386 consecutive lesions (270 patients) on which we performed angioplasty, 13 lesions (13 patients) were within one balloon length of aneurysmal disease (group A) and 373 lesions (257 patients) were not (group NA). Angioplasty had previously been performed on 10 lesions (77%) in group A but only on 112 lesions (30%) in group NA (p<0.01). In group A the angioplasty success rate was 100% (13/13). The maximum inflation pressure was 6.5±1.1atm, the frequency of inflation was 6.1±2.8, the average inflation duration was 60±0sec, and the balloon/artery ratio was 1.20±0.11. There were no major complications. Restenosis occurred in only one lesion. There were no significant differences in the angioplasty results, procedures, complications and the incidence of restenosis between both groups. The ratio of the diameter of the aneurysmal disease to the mean diameter of the normal adjacent segments remained unchanged throughout the follow-up period. These data suggest that angioplasty may be an effective and safe treatment for those stenoses that are adjacent to aneurysmal coronary artery disease.

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Coronary artery disease associated with aortitis syndrome was studied in relation to the coronary artery lesions and age. Four (21%) of 19 patients with aortitis syndrome had coronary artery disease and the mean age of the 4 patients was 53±14 years. The coronary artery lesions included ostial stenosis in 2 patients and main branch stenosis in 2, but both types of lesion were isolated. The latter patients were older and had coronary lesions like arteriosclerosis on angiogram. Myocardial infarction and congestive heart failure were not present, but a severe coarctation of the aorta was observed in the latter.
It was suggested that coronary artery disease might not be rare past middle age, and might include coronary ostial stenosis caused by aortitis and coronary main branch stenosis probably based on secondary arteriosclerosis whose onset was past middle age.

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One hundred and fifty-seven patients with complete right bundle branch block (CRBBB) were studied with echocardiography (UCG). In 87 of them, both ECG and UCG of good quality were obtained and analyzed to differentiate the site of the block within the right bundle. Their mean age was 53.2±17.6 (SD) years, and they consisted of 62 males (50.2±16.8 years) and 25 females (60.8±17.3 years), suggesting that males were more susceptible to CRBBB than females, with a male to female ratio of 2.48 among our study group.
In a normal control group, the time interval from the initial deflection of the QRS complex of the ECG to mitral valve closure (QMC) was 52.3±11.6 msec, to tricuspid valve closure (QTC) 87.7±11.5 msec, to the point of full opening of the pulmonary valve (QPO) 124.5±13.7 cosec, from mitral to tricuspid valve closure (MCTC) 35.5±11.2 msec, and from tricuspid valve closure to the maximum opening of the pulmonary valve (TCPO) 38.0±13.8 msec, and in patients with CRBBB, QMC 58.7±13.2 msec, QTC 95.4±24.2 msec, QPO 169.1±24.6 msec, MCTC 36.7±18.2 msec, and TCPO 73.7±23.7 msec. Although prolonged QMC and QTC are characteristic features in CRBBB as a whole, CRBBB was divided into 4 groups in this study depending on the difference in MCTC and TCPO: Proximal block with prolonged MCTC, peripheral block with prolonged TCPO, diffuse block with both MCTC and TCPO prolonged, and non-specific block without prolongation of either of the two. The incidences were 11.5% (10 patients) for proximal block, 64.4% (56 patients) for peripheral block, 16.1% (14 patients) for diffuse block, and 8.0% (7 patients) for non-specific block. Thus, conduction disturbance in the peripheral portion of the right bundle branch was observed in 80.5% of our cases, suggesting that peripheral block is much more common than proximal block in adults.

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The initial portion of the QRS complex in WPW syndrome might be represented by a single dipole, since the delta wave corresponds to the localized ventricular activation propagated over the accessory atrioventricular pathway. In order to examine whether the site of the accessory pathway in WPW syndrome could be localized by an equivalent dipole method, the dipole positions during the delta wave were determined in 30 patients using a three dimensional model of the torso and were then compared with the sites of accessory pathways localized by body surface maps. The single dipole approximation during the delta wave appeared to be appropriate since the index of the nondipolarity of the potentials was as low as 28% on average. The dipole positions determined on the atrioventricular ring during the delta wave were compatible with the sites of accessory pathways localized by body surface maps in 22 of the 30 patients. The dipole positions were adjacent to the sites of accessory pathways in 7 of the remaining 8 patients. Thus the equivalent dipole method might be an additional noninvasive tool to determine the site of the accessory pathway in WPW syndrome.

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In this article, the clinical and epidemiological characteristics of 137 children with cardiomyopathy admitted to the Hacettepe Pediatric Cardiology Unit were studied and the prognosis was evaluated after a followup period of 24±5 months. It was found that the highest proportion of patients were residents of Ankara, followed by the Northern and the Central Anatolian regions, and consanguinity between their parents was more common than the proportion for Turkey as a whole. Most of the patients had dilated cardiomyopathy (78.9%) and the age at which symptoms appeared varied according to the type of cardiomyopathy. A high proportion of patients came to the hospital with complaints of dyspnea and a decrease in effort capacity. The most common findings on the physical examination were hepatomegaly and tachycardia. Electrocardiographic and echocardiographic evaluations were made for all patients and cardiac catheterization and endomyocardial biopsy were performed when necessary. The outcome was as follows: 34.5% improved, 45.7% remained stable, 9.5% deteriorated and 10.3% died.

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The acute effects of single doses of captopril (C) 12.5mg, of nifedipine (N) 10mg, or of their combination (C+N) on parameters of left ventricular (LV) function were assessed in 18 elderly hypertensive subjects using radionuclide ventriculography. Blood pressure (BP) was lowered by C from 177/100 to 164/92mmHg, by N from 177/100 to 161/91mmHg (p<0.02/<0.05 for both C and N) and by C+N from 176/100 to 151/83mmHg (p<0.01/<0.01). Nifedipine accelerated heart rate from 74 to 85 and C+N from 74 to 82 beats/min (p<0.01 in both cases), whereas C left it unchanged. Left ventricular ejection fraction (EF) was not significantly affected by either drug alone or by both drugs combined. Peak ejection rate (PER) and peak filling rate (PFR) were slightly, but not significantly, enhanced by all treatments. Captopril shortened the time to peak filling rate (TPFR) by 21msec (p<0.05), N by 26msec (p<0.01) and their combination by 22msec (p<0.05); however, when corrected for RR interval or length of diastole, TPFR was shortened only by C (p<0.05). Tachycardia induced by acute administration of N may have an unwanted effect on LV diastolic function, which can be partially blunted by the concomitant administration of a converting enzyme inhibitor.

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To further study the mechanisms of the renal effects of ANP, we examined the effects of NaCl loading and ANP infusion on nephrogenous cGMP production. Six normotensives (NTs) and 7 essential hypertensives (HTs) were placed on 7-day low (3g/day) and then 7-day high NaCl diets (20g/day). On the last day of each period, the natriuretic and nephrogenous cGMP responses to ANP infusion at 25ng/kg/min for 40min were determined. ANP infusion markedly increased the plasma concentrations of ANP and cGMP and the urinary excretions of Na and cGMP. These changes were accompanied by a rise in nephrogenous cGMP. Increases in nephrogenous cGMP during ANP infusion were not different between HTs and NTs despite a greater natriuretic response in HTs. NaCl loading significantly increased the natriuretic response to ANP infusion in both groups. However, nephrogenous cGMP production induced by ANP infusion was not affected by changes in NaCl intake. Thus, although ANP-induced natriuresis is associated with an increase in nephrogenous cGMP, the natriuretic effect of ANP seems to be modified to a greater extent by indirect mechanisms such as renal perfusion pressure and body fluid volume status.

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The maximal exercise capacity of patients with congestive heart failure (CHF) is frequently decreased because of decreased skeletal muscle oxygen utilization. In this study we examined whether forearm oxygen utilization is decreased during dynamic handgrip exercise in patients with CHF and whether captopril improves forearm oxygen utilization. They were divided into 3 groups according to the level of plasma renin activity (PRA) and New York Heart Association functional classification (NYHA): Group 1 consisted of 7 normal (control) subjects (PRA: 0.5±0.2ng/ml/h, NYHA: 0); Group 2, 7 patients with severe CHF (PRA: 11.3±3.9ng/ml/h, NYHA: 3.6±0.3); Group 3, 4 patients with mild CHF (PRA: 2.4±0.2ng/ml/h, NYHA: 2±0). Forearm blood flow was measured by a strain gauge plethysmograph at rest and during dynamic handgrip exercise. Regional arterial venous oxygen content was measured and forearm oxygen consumption was calculated by the Fick principle. Forearm blood flow was less (p<0.05) at rest and during exercise in patients with severe CHF than in control subjects; this was compensated for by increased oxygen extraction, thus maintaining forearm oxygen consumption at a normal level at rest and during submaximal exercise. During maximal exercise, oxygen extraction was not different between normal control subjects and patients with severe CHF, thus forearm oxygen consumption was significantly less (p<0.01) in patients with severe CHF than in control subjects. In patients with mild CHF, forearm blood flow, oxygen extraction and oxygen consumption were not different from those in normal control subjects. Captopril (25mg orally) did not alter forearm hemodynamics at rest and during exercise in control subjects and patients with mild CHF. In patients with severe CHF, captopril lowered systolic and mean blood pressure (p<0.05). Captopril increased forearm oxygen extraction (p<0.05) and tended to increase blood flow and thus increased oxygen consumption (p<0.01) during maximal exercise. Our data indicate that oxygen utilization was impaired in patients with severe CHF and, that captopril improved forearm oxygen utilization during maximal handgrip exercise in patients with severe CHF.

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Mechanocardiography has been in use to evaluate ventricular function and the cardiac effect of drugs. Twenty-five patients with ischemic heart disease (IHD) and 25 patients with IHD and mild hypertension (HTN) were enrolled in a double-blind, placebo controlled study of Abana. Half the patients in each group received Abana-a formulation based on Ayurvedic principles-and the other half received a placebo in a randomized manner. The effect of Abana was evaluated by means of LV apex cardiogram (ACG), phonocardiogram and carotid pulse tracing and ECG (mechanocardiography) before and at the end of 8 weeks of treatment.
As compared to placebo, Abana significantly reduced the frequency and severity of anginal episodes, as judged by clinical improvement and nitrate consumption. Significant improvement in ventricular function was observed as reflected by a decrease in ACG A amplitude and A wave duration, along with a significant increase in LV ejection fraction and VCF. The decrease in double and triple products reflected decreased MVO₂. A significant fall in diastolic blood pressure was noted in patients with mild hypertension. Abana seems to reduce preload and afterload and improve diastolic function and pump function, which may be responsible for the beneficial effects of Abana in ischemic heart disease.

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A new stereophonic stethoscope is presented. It is characterized by a single chest piece construction housing paired open-bell type sound accumulating chambers and paired diaphragm type sound accumulating chambers. A pair of separate ear tubes connected to each of the paired sound chambers establish two cross talk-free channels for collecting and delivering auscultatory sounds. Selective use of the open-bell and diaphragm sound chambers is assured with this new stethoscope. Advantages of stereophonic auscultation are discussed.

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Human growth hormone (hGH) administered alone revealed itself as a useful drug to prevent ventricular aneurysm formation in experimental myocardial infarctions in rats and is also able to diminish and change the usually expected pattern of wall necrosis.
A protective action on the collagen framework of myocytes has been confirmed as one of the main causes responsible for the above mentioned findings. There are other positive metabolic actions on the myocardial cell although not completely known yet. These actions are revealed by an atypical picture of infarction which appears regionally reduced and with a patchy intracellular distribution.
In an opposite fashion, when hGH was administered together with beta blockers, a rapid and extensive deleterious action occurred at the ventricular wall, a very high incidence of ventricular aneurysms and an increased extension of myocardial infarcts were the most outstanding features. The histologic picture in this series resembles that of a rapidly evolving diabetic cardiomyopathy.

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The mortality of sepsis/septic shock continues to be high in newborns. However, there is no established method in its treatment. Although calcium channel blockers ameliorate the hemodynamic deterioration of adult circulatory shock, their effects on newborn endotoxic shock have not been elucidated. This study was performed in newborn dogs to investigate the effects of diltiazem on newborn endotoxic shock. Endotoxic shock was induced in newborn dogs (2-10 days old, 300-800g) by an intravenous injection of E. coli lipopolysaccharide (LPS; 1.5mg/kg), and diltiazem (DZ) at the dose of 300, 600 or 1200μg/kg was administered intravenously 20min prior to LPS injection. Hemodynamic changes were serially observed until 120min after LPS injection. The heart rate, mean arterial pressure and cardiac output decreased after LPS injection, and systemic vascular resistance decreased. DZ at the dose of 600μg/kg attenuated the decreases of MAP and cardiac output, but 300 and 1200μg/kg of DZ exacerbated them. DZ at the dose of 1200μg/kg decreased the heart rate, and DZ at all three doses attenuated the increase of systemic vascular resistance. Therefore, 600μg/kg of DZ is beneficial in the treatment of endotoxic shock in newborn dogs.

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The case of a 4-year-old boy with dipyridamole-induced ischemia is herein reported. The patient developed typical Kawasaki syndrome at 2 years of age, accompanied by coronary aneurysms in the left coronary artery (LCA) and the right coronary artery (RCA). The LCA was totally occluded at segment 6 and a distal area of the left anterior descending artery (LAD) was supplied by collaterals from the conus branch and the posterior descending artery (PD). Thallium-201 (T1-201) myocardial scintigraphy was performed with intravenous administration of dipyridamole (DIP). DIP was infused at a dosage of 0.6mg/kg for 5min. Three minutes after the injection, myocardial ischemia occurred. Although 4mg/kg of aminophyllin was administered, the symptoms lasted for 20min. Electrocardiogram suggested that ischemic lesions were located in the anteroseptal and inferior wall. Collaterals from PD could be recognized as jeopardized vessels and these collaterals probably participated in the ischemic attack. DIP could have increased the coronary flow into the uninvolved proximal branches of RCA. Subsequently DIP reduced coronary flow in the distal region of the stenotic RCA. Although T1-201 myocardial scintigraphy with DIP is a useful technique to estimate viability of the ischemic myocardium, it should be performed prudently in patients with multivessel diseases, such as those with jeopardized collaterals secondary to Kawasaki syndrome.

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In this report 5 patients between the ages of 5-14 years admitted to the Department of Pediatric Cardiology, Hacettepe University, and diagnosed as having pseudocoarctation of the aorta are presented. The clinical and angiographic findings of this rare abnormality of childhood are discussed, the importance of differential diagnosis of this entity from coarctation of the aorta is emphasized, and the literature reviewed.

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Two cases of double superior vena cava were found among 300 Japanese cadavers dissected at Kyoto University from 1980 to 1989. Case 1 was an 82-year-old male patient who died of cerebral infarction. Case 2 was a 39-year-old well-developed male patient who died of sepsis. They had no history of cardiovascular disorders. Common features in both cases are as follows: In addition to a right superior vena cava with normal appearance located in the normal position, on the left side, a normal-looking extra superior vena cava persisted and descended vertically in front of the aortic arch between the left pulmonary vein and the left auricle, traversed the coronary sulcus and finally drained into the right atrium. No differences in diameter were found between right and left venae cavae. No communicating vessels were present between them. Therefore, both cases, which had a persistent left superior vena cava draining into the coronary sinus, may be classified as McCotter's 1st type (1916) or Donadio's 3rd type (1925). Furthermore, in Case 2, the double azygos vein persisted symmetrically, suggesting the 4th type of Nandy and Blair (1965). In addition to venous anomalies, Case 2 had arterial anomalies such as the right subclavian artery arising as the last branch of the aortic arch similar to the G type of Adachi (1928), and the right vertebral artery arising from the right common carotid artery. The present cases are considered to be the 53rd and 54th cases of double superior vena cava found in Japanese cadavers, and the 18th and 19th cases of double superior vena cava without communicating vessels between them.

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