The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

Amaç: Çalışmamızda polikliniğimize başvuran hastalar arasında trombositoz sıklığını ve nedenlerini araştırmayı planladık. Yöntem: Mayıs 2014-Mayıs 2015 tarihleri arasında Mersin Üniversitesi Tıp Fakültesi Çocuk Hematoloji BD’na başvuran, 3400 hastanın laboratuar parametreleri incelendi. Bu inceleme sırasında trombositozu olan 319 (%11.0) hasta saptandı ve bu hastaların yaş, cinsiyet, laboratuar parametreleri (hemoglobin, beyaz küre, trombositler) ve tanıları dosyalarından kaydedildi. Bulgular: Çalışmanın konusunu oluşturan 319 trombositozlu hastanın 197’si (%61.8) erkek, 122’si (% 38.2) kız, yaşları ortalama 72.0±69.0 (1-216 ay) aydı. Hastalarımızın ortalama trombosit sayısı 596 430±286 120/μL (450 000-1 523 000) olarak bulundu. Hastaların hepsinde sekonder trombositoz mevcutken en sık neden %37.9 ile enfeksiyonlardı. Diğer sık nedenler arasında orak hücre anemisi (%21.2), demir eksikliği anemisi (%15.4), kollojen doku hastalıkları (%6.6), hemolitik anemiler (%5.0), splenektomi (%4.4) ve diğer nedenler (%9.7) olarak belirlendi. Tartışma: Çalışmamızda en sık trombositoz nedeni, literatürle uyumlu olarak enfeksiyonlara bağlı bulurken, demir eksikliği ve orak hücreli anemi sekonder trombositozun diğer sık nedenleri arasında yer aldı. Bölgemizde demir eksikliği anemisinin %70-80 gibi çok yüksek oranlarda olması nedeniyle, bu yüksek oranları görmüş olabileceğimiz ve bölgesel farklılıklara bağlı olarak orak hücreli anemi gibi hemolitik anemilerin de ayırıcı tanıda akılda tutulması gerektiğini düşünmekteyiz.

Background and Objectives: Patients with heart failure (HF) are at risk of increased morbidity and mortality related to pneumococcal pneumonia, and routine vaccination with a conjugated pneumococcal vaccine (PCV) for HF patients is strongly endorsed by all major international guidelines. Despite this, data on the factors associated with vaccine uptake remain scarce. The aim of this study was to understand the demographic and clinical factors associated with vaccine uptake in patients with HF and analyze the all-cause mortality in the vaccinated and unvaccinated cohorts. Materials and Methods: Four hundred and fifty patients with HF and a reduced ejection fraction followed up at a single center were enrolled. Patients were followed up for a median of 164.0 (148.0–181.0) days. Results: In total, 193 of the 450 patients (42.9%) were vaccinated with PCV-13 at enrollment. Vaccinated patients were more likely to have an implantable device, namely an implantable cardioverter/defibrillator (ICD), cardiac resynchronization treatment (CRT) or left ventricular assist device (LVAD), and less likely to have a past medical history of hypertension and chronic obstructive pulmonary disease (COPD) at baseline. After multivariable adjustment, the presence of an ICD (OR: 3.17, 95% CI: 1.98–5.08), CRT (OR: 2.75, 95% CI: 1.45–5.20) and COPD (OR: 0.42, 95% CI: 0.19–0.94) remained as determinants of vaccination. All-cause mortality was not different across vaccinated or unvaccinated patients either in the unmatched (log-rank p = 0.67) or matched (log-rank p = 0.52) cohorts. Conclusions: The presence of implantable devices and coexisting COPD was associated with a higher and lower likelihood of vaccination with PCV-13, respectively. No difference in mortality across cohorts was observed in this observational analysis.

Post-myocardial infarction ventricular septal defect (PMIVSD) remains a lethal complication despite modern reperfusion. In patients with preserved or mildly reduced ejection fraction, higher shear across residual jets may increase the risk of device instability and hemolysis after transcatheter closure. A 48-year-old man presented with PMIVSD 15 days after chest pain. Echocardiography showed a left ventricular ejection fraction of 50% and a 13-mm apicoseptal defect. Surgery was advised but was declined. Percutaneous closure with an 18-mm muscular ventricular septal defect occluder via an arteriovenous loop was performed; however the device embolized to the right ventricular apex hours later. It was retrieved using a snared guidewire loop, and a 28-mm septal occluder was implanted. Severe intravascular hemolysis due to residual shunt developed, and despite intensive supportive therapy the patient died from septic shock. Surgery remains the preferred treatment for PMIVSD. In patients with preserved or mildly reduced ejection fraction, hyperdynamic ventricular mechanics and high left ventricular-right ventricular gradients increase risks of device embolization, residual shunt, and hemolysis after transcatheter closure. Surgical repair for PMIVSD should be prioritized when feasible; if transcatheter closure is pursued, stabilization, delayed timing, and careful device sizing are essential.