Goksel Cagirci

Coronary perforation is a rare but potentially life‐threatening complication of percutaneous coronary intervention. We report a case of delayed hemorrhagic pericardial effusion caused by an initially occult distal wire‐related perforation after successful covered‐stent sealing of a proximal Ellis type III rupture. A 67‐year‐old man underwent PCI for a severely calcified mid‐right coronary artery lesion complicated by proximal Ellis type III perforation after high‐pressure post‐dilatation. The perforation was immediately sealed with a covered‐stent, and early echocardiographic follow‐up showed only minimal stable pericardial effusion. Seven days later, the patient re‐presented with chest pain and dyspnea. Transthoracic echocardiography demonstrated a large pericardial effusion, and repeat angiography revealed distal contrast extravasation without leakage from the covered‐stent segment. Balloon occlusion was initially performed in the posterior descending artery to localize the bleeding source; persistent extravasation led to reassessment and localization of the perforation to the posterolateral branch. Prolonged balloon occlusion of the posterolateral branch reduced but did not eliminate extravasation. Autologous fat embolization using a Corsair Pro microcatheter achieved complete hemostasis. This case highlights a dual‐site perforation mechanism in which a clinically dominant proximal rupture may mask a concomitant distal wire‐related injury, emphasizing the need for systematic distal vessel reassessment after complicated PCI.

Background: Coronary artery calcification (CAC) is a critical marker of subclinical atherosclerosis, yet its primary diagnostic tool, coronary computed tomography (CT), is limited by cost and radiation. We aimed to develop and validate a robust machine learning framework to identify significant CAC (Agatston score ≥100) using features extracted from routine 12-lead electrocardiograms (ECGs), including legacy archives stored as PDFs. Methods: This retrospective study utilized 382 consecutive patient records. A novel signal-processing pipeline was developed to convert PDF-based ECGs into standardized 500-Hz digital waveforms (WFDB format). From these signals, 360 morphological and temporal features were extracted using the NeuroKit2 library. To ensure clinical reliability and prevent optimistic bias, a Balanced Random Forest (BRF) classifier was integrated into a repeated “inner-outer” nested cross-validation framework combined with Minimum Redundancy Maximum Relevance (mRMR) feature selection. Results: The mRMR-BRF model demonstrated high diagnostic accuracy with a grand mean AUC of 0.8211 (95% CI: 0.8018–0.8404), outperforming standard algorithms. Explainability analysis via SHAP identified age, ST-segment level in lead V4, T/QRS ratio in lead III, and QRS duration dispersion as the most significant predictors. These features suggest that latent electrical signatures of subclinical myocardial remodeling and impaired perfusion are detectable via AI-enhanced ECG analysis. Conclusion: Our framework establishes digitized 12-lead ECGs as a scalable and non-invasive digital biomarker for significant CAC. By enabling the quantitative analysis of legacy PDF archives and providing high predictive stability through nested validation, this approach offers a cost-effective pre-screening tool to prioritize high-risk patients for definitive imaging and early preventive intervention.

Background: In heart failure with reduced ejection fraction (HFrEF), implantable cardioverter-defibrillators (ICDs) are used for the primary prevention of sudden cardiac death, yet many patients never receive appropriate therapy, and left ventricular ejection fraction (LVEF) alone poorly discriminates who will. We investigated whether a cumulative electrical risk score (ERS) derived from the surface electrocardiogram is associated with appropriate ICD therapy. Methods: In this single-center, retrospective study, 205 patients with HFrEF who underwent ICD implantation for primary prevention were classified according to whether they had received appropriate ICD therapy. A modified eight-parameter ERS was calculated from the baseline electrocardiogram. Associations were assessed using receiver operating characteristic (ROC) analysis and logistic regression. Results: The ERS showed moderate-to-good discrimination (AUC 0.795; p < 0.001); a cut-off of 3.5 yielded 91% sensitivity and 71.4% specificity. After adjustment for age, sex, LVEF, cardiomyopathy etiology, BNP and device duration, the ERS remained independently associated with appropriate ICD therapy (adjusted OR 2.189; 95% CI 1.246–3.845; p = 0.006). Conclusions: A cumulative electrical risk score from the standard electrocardiogram was independently associated with appropriate ICD therapy and may add risk information beyond LVEF. These retrospective findings warrant prospective, multicenter validation.

Aims: We aimed to determine whether there is a relationship between the pan-immune inflammatory value (PIV) and the recurrence of atrial fibrillation (AF) after successful direct current cardioversion (DCCV). Methods: The study included 113 patients with persistent AF who underwent successful DCCV between 2015 and 2023.Results: During the 12-month follow-up, AF recurrence was observed in 38 patients (33.6%). Median PIV was significantly higher in patients who developed recurrence than in those who maintained sinus rhythm (SR) (416.1 vs. 277.0; p=0.0012). The optimal PIV cut-off value was 318.6, providing 76.3% sensitivity and 36.5% specificity. Cox regression analysis identified PIV (HR 1.736, p=0.0260) and coronary artery disease (CAD) (HR 2.276, p=0.0332) as independent predictors of AF recurrence.Conclusion: As a simple and cost-effective biomarker, PIV is an independent predictor of recurrence after DCCV in patients with persistent AF. These findings suggest its potential use in clinical practice for risk stratification of patients undergoing DCCV, enabling more personalized post-cardioversion management strategies.

Aim: This study aimed to evaluate the intraoperative and postoperative analgesic effectiveness of ultrasound‐guided clavipectoral fascial plane block in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods: In this prospective observational study, 35 adult patients scheduled for CIED implantation received an ultrasound‐guided clavipectoral fascial plane block. Intraoperative analgesic adequacy was assessed by the requirement for supplemental local anesthetic. Additional intraoperative fentanyl use, block performance time, and surgical duration were recorded. Postoperative pain was evaluated using the numerical rating scale (NRS) at 1, 6, 12, and 24 h. Postoperative analgesic consumption and patient satisfaction, assessed using a 5‐point Likert scale, were also documented. Results: Supplemental local anesthetic was required in 16 patients (45.7%), while 19 patients (54.3%) completed the procedure without additional local anesthetic. Among patients requiring supplementation, the median volume of local anesthetic administered was 6 mL (IQR 6–10). Intraoperative fentanyl was administered in seven patients (20.0%). Median block performance time was 6 min (IQR 5–8), and median surgical duration was 39 min (IQR 33–43). Postoperative pain scores remained low over 24 h. Rescue tramadol was required in 11 patients (31.4%), with a median consumption of 0 mg (IQR 0–50). Patient satisfaction was high, with 71.4% of patients reporting satisfaction or high satisfaction. Conclusion: Clavipectoral fascial plane block appears to provide clinically relevant intraoperative and postoperative analgesia in patients undergoing CIED implantation, with low opioid requirements and high patient satisfaction. This technique may represent a practical component of multimodal analgesia for CIED procedures. Further randomized studies are needed to confirm these findings.

Balloon-assisted detection and treatment of the origin of saccular aneurysms in ivy-like coronary arteries - Turkish Journal of Thoracic and Cardiovascular Surgery

Aim: The aim was to determine the prevalence and predictors of prilocaine-induced methemoglobinemia during the cardiac implantable electronic device (CIED) implantation procedure. Methods: One hundred patients who underwent CIED implantation procedures under local anesthesia with prilocaine were included in the study. Patients were divided into two groups according to the percentage of methemoglobin (MetHb) in arterial blood gas analysis. Data regarding patients, laboratory, and procedure-related factors were compared between the two groups. Results: The mean age of the patients was 70.97 ± 11.54 years, and 42% were female. Based on the criterion of MetHb level above 3%, the prevalence of pathologic methemoglobinemia was 47%. Multivariate logistic regression analyses were performed to identify independent predictors for the development of prilocaine-induced abnormal methemoglobinemia. In multivariate analysis, the presence of low body mass index (BMI) and chronic obstructive pulmonary disease (COPD) (OR: 0.876; 95% CI 0.781-0.981; p=0.022 and OR: 5.170; 95% CI 1.535-17.411; p=0.008) independently predicted the development of abnormal methemoglobinemia. Conclusion: Abnormal MetHb levels were found in almost half of patients who underwent the CIED implantation procedure after subcutaneous prilocaine injection. Methemoglobinemia may occur even at doses lower than the recommended maximum dose, especially in patients with low BMI and COPD.

Aim: Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion.Methods: PECS II blocks were performed on the left side using the ultrasound‐guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block‐related complications.Results: Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4‐10 [2.5‐12]) mL. Two patients needed additional IV analgesics in the first 24 h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure.Conclusions: PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24 h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.

Background: The newly described bendopnea in heart failure (HF) is associated with increased cardiac filling pressures. The aim of the study was to show the effect of bendopnea follow-up on reaching optimal medical treatment doses in HF. Methods: A total of 413 patients were screened, and we included 203 patients with HF who were previously evaluated for bendopnea. Demographic data, presence or absence of bendopnea, medical history, laboratory findings, and medical treatments were evaluated. Optimal medical therapy target doses at baseline and 3rd month were compared in groups with and without bendopnea. Results: On admission, 64 patients (31.5%) had bendopnea. The rate of patients with bendopnea decreased in the 3rd month (n=42, 20.7%). The proportion of patients who used at least 50% of the recommended medical treatment dose on admission and in the 3rd month was compared; angiotensin-converting enzyme inhibitor /angiotensin receptor blockers use increased from 40.6% to 71.9% in those with bendopnea (P=0.013), from 56.1% to 81.3% in those without bendopnea (P<0.001) and beta-blockers use increased from 28.2% to 60.9% in those with bendopnea (P=0.042), from 31.6% to 69.8% in those without bendopnea (P<0.001). However, aldosterone antagonists use decreased from 70.3% to 67.2% in those with bendopnea (P=0.961), from 68.4 % to 64.1% in those without bendopnea (P=0.334). Bendopnea was independently effective in achieving ACE-I/ARB target doses (OR: 0.359, CI 95%: 0.151–0.854, P=0.020). Conclusion: Bendopnea follow-up in HF patients can provide a significant improvement in reaching the recommended treatment target doses.