Browsing by Author "Ceylan, Yemlihan"

Now showing 1 - 13 of 13

The Effects of Nebivolol on P Wave Duration and Dispersion in Patients With Coronary Slow Flow
(Turkish Soc Cardiology, 2009) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Ceylan, Yemlihan
Objective: Coronary slow flow (CSF) is characterized by delayed opacification of coronary arteries in the absence epicardial occlusive disease. P wave duration and dispersion have been reported to be longer in patients with CSF Nebivolol, besides its selective beta-blocking activity, causes an endothelium dependent vasodilatation through nitric oxide release. In this study, we searched for the association between left ventricular diastolic functions and atrial conduction dispersion, the effects of nebivolol on P wave duration and dispersion in patients with CSF Methods: This prospective case-controlled study included 30 patients having CSF and 30 subjects having normal coronary arteries in coronary angiography. The patients were evaluated with 12-leads electrocardiography and echocardiography before and three months after treatment with nebivolol. The difference between maximum and minimum P wave durations was defined as P-wave dispersion (PWD). Early diastolic flow (E), atrial contraction wave (A) and E deceleration time (DT) and isovolumetric relaxation time (IVRT) were measured. Unpaired and paired t-tests, Chi-square test, Mann-Whitney's U-test and Pearson correlation analysis were used in statistical analysis. Results: Compared to control group maximum P wave duration (Pmax) (104.3 +/- 12.2 vs. 93.4 +/- 9.8 msec, p<0.001) and PWD (35.0 +/- 8.6 vs. 24.8 +/- 5.4 msec, p<0.001), DT (245.4 +/- 54.9 vs. 198.0 +/- 41.7 msec, p<0.001) and IVRT (112.9 +/- 20.8 vs. 89.5 +/- 18.2 msec, p<0.001) were significantly longer and E/A ratio (0.89 +/- 0.27 vs.1.27 +/- 0.27, p<0.001) was lower in patients with CSF as compared with control subjects. There were no significant correlations of Pmax and PWD with clinical and echocardiographic variables. Systolic and diastolic blood pressures (130.5 +/- 15.5 mmHg to 117.8 +/- 12.3 mmHg and 84.5 +/- 9.8 mmHg to 75.0 +/- 6.2 mmHg, p<0.001), Pmax (to 98.7 +/- 11.7 msec, p=0.038), PWD (to 21.3 +/- 5.1 msec, p<0.001) and DT (to 217.3 +/- 41.4 msec, p<0.001) and IVRT (to 101.2 +/- 17.4 msec, p<0.001) significantly decreased and E/A ratio (to 1.1 +/- 0.23, p<0.001) significantly increased after treatment with nebivolol. Correlation analysis revealed that the change in PWD was not significantly correlated with any of the clinical and echocardiographic variables including decrease in blood pressures. Conclusions: Coronary slow flow is associated with prolonged P wave duration and dispersion and impaired diastolic filling. Nebivolol may be helpful in restoration of these findings. P wave duration and dispersion may not be associated with left ventricular function parameters in patients with CSF (Anadolu Kardiyol Derg 2009, 9: 290-5)
The Effects of Perindopril on Qt Duration and Dispersion in Patients With Coronary Slowflow
(Elsevier Ireland Ltd, 2010) Guntekin, Unal; Gunes, Yilmaz; Gunes, Ahmet; Gumrukcuoglu, Hasan Ali; Ceylan, Yemlihan; Simsek, Hakki; Tuncer, Mustafa
Fixed Dose Combined Antihypertensive Agents Poisoning: Case Report
(Aves, 2011) Karadas, Sevdegul; Aydin, Irfan; Tuncer, Mustafa; Ceylan, Yemlihan
Poisonings are constituted a substantial part of the emergency department. Combined use of antihypertensive drugs in the treatment of essential hypertension is common. Using of these drugs for suicide does not seen so common. One of these combined drugs which are used in clinic is Angiotension Converting Enzyme inhibitors and calcium channel blockers. Sinus bradycardia, severe hypotension an AV blocks can be seen due to excessive using of these drugs. More serious outcome may occur if these conditions do not treated immediately. In this study, we aim at discussing the case of 17-year-old patient in the light literature, who took 13 units of Tarka (R) forte tablets (240 mg + 4 mg Verapamil Trandolapril) in order to commit suicide and applied to our emergency department with AV complete block development of the syncope.
Heart Rate Recovery After Exercise and Its Relation With Neutrophil-To Ratio in Patients With Cardiac Syndrome X
(Lippincott Williams & Wilkins, 2014) Yurtdas, Mustafa; Yaylali, Yalin T.; Aladag, Nesim; Ozdemir, Mahmut; Ceylan, Yemlihan; Gencaslan, Murat; Akbulut, Tayyar
Objectives The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are measures of systemic inflammation. Heart rate recovery (HRR) after exercise is influenced by autonomic function. The aim of this study was to ascertain whether HRR and the Duke Treadmill Score (DTS) values are related to NLR and PLR in patients with cardiac syndrome X (CSX). Methods A total of 350 participants were enrolled in the study. Complete blood counts and high-sensitivity C-reactive protein (hsCRP) were obtained. All participants underwent an exercise test. HRR and DTS were calculated after exercise. Abnormal HRR was defined as 12 beats/min or less. Results CSX and coronary artery disease (CAD) groups had higher NLR, PLR, and hsCRP, and lower HRR and DTS values than the control group (for all, P<0.05). In both CSX and CAD groups, HRR was positively correlated with DTS (r=0.468, P<0.001 and r=0.491, P<0.001, respectively) and negatively correlated with NLR (r=-0.519, P<0.001 and r=-0.612, P<0.001, respectively), PLR (r=-0.422, P<0.001 and r=-0.438, P<0.001, respectively), and hsCRP (r=-0.553, P<0.001 and r=-0.521, P<0.001, respectively). NLR and hsCRP were important two predictors of the presence of lower HRR in both CSX [NLR: odds ratio (OR), 0.395; 95% confidence interval (CI), 0.168-0.925; P=0.032 and hsCRP: OR, 0.748; 95% CI, 0.591-0.945; P=0.015], and CAD groups (NLR: OR, 0.115; 95% CI, 0.026-0.501; P=0.004 and hsCRP: OR, 0.637; 95% CI, 0.455-0.892; P=0.009). Conclusion CSX patients have higher NLR and PLR and slower HRR and lower DTS, similar to CAD patients, suggesting that CSX patients may be at a higher risk for developing cardiovascular events in the future. NLR may predict autonomic imbalance assessed by HRR in CSX. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Investigation of the Effect of Iv Ferric Carboxymaltose Therapy on Left Ventricle Longitudinal Strain Values in Low Ejection Fraction Heart Failure
(2023) Sanli, Sıddık; Ceylan, Yemlihan
AMAÇ: Düşük ejeksiyon fraksiyonlu kalp yetmezliğinde uygulanan demir III karboksimaltoz tedavisinin sol ventrikül sistolik fonksiyonlarına etkisini objektif ve etkili bir yöntem olan longitudinal strain ekokardiyografi ile değerlendirmek. GEREÇLER VE YÖNTEM: Çalışmamız Van Yüzüncü Yıl Üniversitesi kardiyoloji polikliniğine başvuran ve düşük ejeksiyon fraksiyonlu kalp yetmezliği nedeniyle takip edilen 49 hasta birey ile yapıldı. Hastaların tedavi öncesi hemoglobin, demir düzeyi, demir bağlama kapasitesi, transferrin satürasyonu (TSAT) ve BNP düzeyi bakıldı, ferritin<100 ng/ml ya da ferritin 100-299 ng/ml olup TSAT<%20 olan hastalar çalışmaya dahil edildi. Tüm hastaların tedavi öncesi konvansiyonel ekokardiyografi, 2D global longitudinal strain (GLS) ekokardiyografi yapıldı. Tedavi sonrası 12. Haftada tüm hastalarda tedavi hedefine ulaşıldı ve 2D GLS ekokardiyografi, BNP düzeyi kontrol edildi. Tedavi öncesi ve sonrası bu parametreler arasında istatiksel fark araştırıldı. Tüm analizlerde p<0.05 anlamlı kabul edildi. BULGULAR: Toplamda 49 hasta (35 erkek, 14 kadın, ortalama yaş 65,3±9,4) çalışmaya dahil edildi. Hastaların tedavi öncesi apikal 3 boşluk GLS değeri -9,34±3,52 iken, tedavi sonrası -9,09±3,49 (p=0,370) olduğu ve bu farkın istatiksel olarak anlamlı olmadığı görüldü. Hastaların tedavi öncesi apikal 4 boşluk GLS değeri -8,5±3,24 iken, tedavi sonrası -8,39±5,45 (p=0,983) olduğu ve bu farkın istatiksel olarak anlamlı olmadığı görüldü. Hastaların tedavi öncesi apikal 2 boşluk GLS değeri -9,08±4,77 iken, tedavi sonrası -9,51±5,22 (p=0,154) olduğu ve bu farkın istatiksel olarak anlamlı olmadığı görüldü. Hastaların tedavi öncesi ortalama GLS değeri -8,36±4,76 iken tedavi sonrası -8,32±5,62 (p=0,634) olduğu ve bu farkın istatiksel olarak anlamlı olmadığı görüldü. Benzer şekilde anemik olan hastalarda da tedavi sonrası GLS değerlerinde anlamlı bir değişiklik izlenmedi (p=0,342). EF<%25 olan İleri evre kalp yetmezliği olan gurupta da tedavi GLS değerlerinde anlamlı bir değişiklik göstermedi (p=0,352). Hastaların tedavi öncesi BNP değeri 590±847 pg/ml iken tedavi sonrası 467±308 pg/ml (p=0,165) olduğu ve bu farkın istatiksel olarak anlamlı olmadığı görüldü. XII SONUÇ: Çalışmamız sonucunda kalp yetmezliğinde demir eksikliği anemisinde uygulanan demir III karboksimaltoz tedavisinin kısa dönemde sol ventrikül GLS değerlerini ve BNP düzeyini etkilemediği görüldü.
Noninvasive Assessment of Atherosclerosis in Patients With Isolated Hypertension
(Wiley, 2010) Guntekin, Unal; Gunes, Yilmaz; Gunes, Ahmet; Ceylan, Yemlihan; Gumrukcuoglu, Hasan Ali; Yucel, Yavuz; Tuncer, Mustafa
Background: Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima-media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M-mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. Methods: Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima-media thickness, FMD, and AVP were measured. Results: Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r = -0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r = -0.600, P < 0.001). Carotid intima-media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. Conclusions: In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD. (ECHOCARDIOGRAPHY 2010;27:155-160).
Percutaneous Closure of Secundum Atrial Septal Defects in Pediatric and Adult Patients: Short-, and Mid-Term Follow-Up Results
(Kare Publ, 2013) Kaya, Yuksel; Yurtdas, Mustafa; Ceylan, Yemlihan; Bulut, Mustafa Orhan; Soylemez, Nihat; Guvenc, Tolga Sinan; Ozkan, Mehmet
Objectives: We aimed to evaluate the shortand mid-term results of patients with atrial septal defect (ASD) who were treated with percutaneous closure. Study design: Seventy-nine patients with a diagnosis of secundum ASD (54 female and 25 male; mean age 26.2+/-17.2; range 3 to 71] years) were included in this study. All patients were evaluated by transthoracic (TTE) and/or transesophageal echocardiography (TEE). Amplatzer septal occluder (ASO) was used for percutaneous closure in all patients. In 76 patients, the procedure was performed under local anesthesia with TTE, while in the other 3 patients, it was performed with general anesthesia under the guidance of TEE. Patients were followed up at the 1st, 3rd, 6th and 12th months and annually thereafter. Mean followup period was 13.6+/-6.6 months. Results: Mean diameter of ASDs was 18.2+/-7.5 mm and stretched diameter was 20.7+/-8.04 mm during balloon dilatation, and mean diameter of implanted devices was 22.7+/-8.5 mm. Procedural time was 40.2+/-12.6, and fluoroscopy time was 10.9+/-4.1 minutes. The procedure was successfully performed in all patients (100%). One patient with cardiac tamponade died seven days after cardiac surgery. In two patients, the implanted devices embolized to the pulmonary circulation. Residual flow was found in three patients immediately after the procedure, without residual shunts one month after closure. Mild pericardial effusion in one patient and significant residual shunt due to device malposition in another were discovered at 1 and 6 months of the postprocedural follow- up period, respectively. Conclusion: Our findings showed that percutaneous closure of ASDs is successful in most patients with a low complication rate, and demonstrated that residual shunts do not develop in the majority of patients in the shortand mid- term.
Percutaneous Mitral Commissurotomy in Women With Asymptomatic Severe Mitral Stenosis Before Pregnancy
(Taylor & Francis Ltd, 2021) Cakir, Cayan; Ceylan, Yemlihan; Karagoz, Ali; Okten, Mehmet Sefa; Kaya, Yuksel
Objectives:Performing percutaneous mitral commissurotomy (PMC) in the women with asymptomatic severe mitral stenosis (MS) who plan a pregnancy is recommended. However the data regarding this recommendation is limited in the literature. We aimed to investigate maternal and fetal outcomes of women with asymptomatic severe MS who underwent PMC before a planned pregnancy. Methods:We retrospectively analysed the procedural, pregnancy related, and fetal outcomes of 33 consecutive women with severe asymptomatic MS, age 27.97 +/- 2.86 years, who underwent PMC before a planned pregnancy between 2014 and 2019. The control group comprised of 66 pregnant women, age 29.09 +/- 3.00 years, without a cardiac disease. Results:The PMC procedure was successful in all patients and no major complication occurred. There were no deaths, pulmonary oedema, heart failure, atrial fibrillation, and thromboembolism during pregnancy. Maternal arrhythmia (p < .001), deterioration in NYHA class (p = .08), and use of cardiovascular medication (p < .001) was significantly higher in the study group. Maternal hospitalisation (p = .435), preeclampsia (p = 1), abortus (p = 1), fetal death (p = 1), and preterm delivery (p = .746) was similar between groups. Birth weight was significantly lower in the PMC group 2890 g (229) vs 3120 g (255) <0.001, however small for gestational age newborns were similar between groups (p = .12). Conclusions:PMC is safe in asymptomatic women with severe MS planning a future pregnancy. In selected patients with favourable valve anatomy PMC may improve maternal and fetal outcomes.
Radiofrequency Catheter Ablation Reduces the Severity of Anxiety in Patients With Atrioventricular Nodal Reentry Tachycardia, Regardless of Age, Sex, Tachycardia Type, and Laboratory Findings
(2024) Duz, Ramazan; Ceylan, Yemlihan; Babat, Naci; Çıbuk, Salıh
Assess pre and postinterventional anxiety levels in radiofrequency catheter ablation recipients (RFCA) for atrioventricular nodal reentry tachycardia (AVNRT) and investigate whether changes are associated with demographic and clinical characteristics and AVNRT subtypes. This was a single-centre prospective study conducted from September 2019 to March 2020. A total of 51 patients who were to undergo RFCA due to newly diagnosed symptomatic AVNRT were included. Electrophysiological studies were performed on all patients, the AVNRT subtype was determined, and the RFCA procedure was applied. The severity of anxiety before RFCA and 3 months after the procedure was determined by the state-trait anxiety inventory. The mean age was 50.1±17.3 years and 70.6% (n=36) were women. The median STAI-State score after ablation (37 [33–42]) was significantly lower than before (63 [52–72]) (p<0.001). Similarly, median STAI-Trait scores after ablation (45 [39–49]) were found to be significantly lower than before the procedure (59 [46–69]) (p<0.001). There were no significant relationships between the decrease in STAI-State or STAI-Trait scores and analyzed parameters such as age, sex, AVNRT type and other laboratory values. Administration of RFCA in AVNRT can improve AVNRT-induced anxiety and could eliminate the potential need for antiarrhythmic or anxiolytic therapy. Therefore, RFCA may also positively impact quality of life, and reduce unnecessary treatments, and healthcare costs associated with AVNRT.
The Relation Between the Color M-Mode Propagation Velocity of the Descending Aorta and Coronary and Carotid Atherosclerosis and Flow-Mediated Dilatation
(Wiley, 2010) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Ceylan, Yemlihan; Simsek, Hakki; Sahin, Musa; Yildirim, Mustafa
Background: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). Methods: CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction < 40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. Results: Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r = -0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r = -0.530, P < 0.001). Conclusions: The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function. (Echocardiography 2010;27:300-305).
Risk Factors of Coronary Artery Disease in Patients Admitted With Acute Coronary Syndrome
(2010) Ceylan, Yemlihan; Tuncer, Mustafa
Koroner arter hastalığı (KAH), dünya çapında mortalite ve morbiditenin majör nedeni olma yolunda gittikçe artan bir rol üstlenmektedir. Akut koroner sendrom (AKS), ortak sonucun akut myokard iskemisi olduğu ST elevasyonlu myokard enfarktüsü, ST elevasyonsuz myokard enfarktüsü, unstabil angina pektoris ve ani kardiyak ölümden oluşan genel bir tanım olmakla birlikte koroner arter hastalığının akut klinik tablosu şeklinde ortaya çıkmaktadır.Biz bu çalışmamızda tersiyer bir merkez olan üniversite hastanemize başvuran AKS hastalarının geleneksel KAH risk faktörleri prevalansını belirlemeyi amaçladık. Çalışmamızda ortaya çıkan sonuç; genç yaş gruptaki en sık görülen risk faktörlerinin sigara içiciliği ve aile öyküsü, yaşlı gruptaki en sık risk faktörlerinin ise hipertansiyon ve sigara içiciliği olduğudur. Yani KAH için önemli bir risk faktörü olduğu bilinen yaş faktörüne rağmen sigara kullanımının bölgemizde yaygın olduğu ortaya çıkmaktadır. TEKHARF çalışmasına göre erkeklerde %43, kadınlarda %18 oranlarında olan sigara kullanımı bizim çalışmamızda erkeklerde %67.8, kadınlarda %14.5 olarak saptanmıştır.İNTERHEART çalışmasına göre (278) akut koroner sendromlu hastalarda DM prevalansı erkeklerde %16, kadınlarda %26 olarak gösterilmiştir. Bizim çalışmamızda erkeklerde benzer şekilde %16.6, kadınlarda ise %35 oranında yani daha yüksek oranda saptanmıştır. İNTERHEART çalışmasında hipertansiyon erkeklerde %35, kadınlarda %53 oranında saptanmıştır. Bizim çalışmamızda erkeklerde hipertansiyon prevalansı %31.2, kadınlarda ise %68.4 olarak saptanmıştır. Kadınlardaki DM ve hipertansiyon prevalansının bölgemizde daha yüksek olduğu görülmektedir. TEKHARF çalışmasında gösterildiği gibi ülkemizde batılı toplumlarla karşılaştırıldığında kolesterol değerleri daha düşük değerlerde seyretmektedir. Çalışmamızda da kolesterol değerlerinin bu çalışmayla uyumlu olduğu görülmüştür. Yine aile öyküsünün literatürle uyumlu olarak genç yaş grubunda önemli bir risk faktörü olduğu ortaya çıkmaktadır.Yaş, cinsiyet, aile öyküsü gibi modifiye edilemeyen risk faktörlerinin aksine modifiye edilebilir risk faktörleri olan DM, hipertansiyon, sigara kullanımı ve hiperlipideminin kontrol altına alınmasıyla KAH ve buna bağlı gelişen komplikasyonların önüne geçilebileceği açıktır.Bu konuda Halk sağlığı uygulamalarının ve koruyucu hekimlik çalışmalarının daha etkin bir şekilde yürütülmesiyle KAH geleneksel risk faktörlerinin kontrol altına alınabilme imkanı olabilecektir.
Sol Ventriküldeki Hareketli Trombüsün Düşük Doz ve Yavaş İnfüzyonla Verilen Doku Plazminojen Aktivatörüyle Başarıyla Çözülmesi
(2010) Gunes, Yilmaz; Ceylan, Yemlihan; Tuncer, Mustafa
İntrakardiyak mural trombüslerin tedavisi konusunda görüş birliği bulunmamaktadır. Elli dokuz yaşındaki erkek hastada sağ ayak ağrısı yakınması ve sağ alt ekstremitesinde nabız alınamaması üzerine yapılan ekokardiyografik incelemede ağır sol ventrikül sistolik disfonksiyonu ve sol ventrikül apeksinde çan benzeri, hareketli bir trombüs saptandı. Cerrahinin yüksek riskli olması nedeniyle 50 mgr rekombinan doku plazminojen aktivatörü (rt-PA) sekiz saatte uygulandı. Seri ekokardiyografik takipte, rt-PA infüzyonuna başlanmasından sonraki ilk saatlerden itibaren trombüs büyüklüğünün giderek küçüldüğü ve 24 saat sonra tamamen kaybolduğu görüldü. Cerrahi tedavinin mümkün olmadığı durumlarda, yavaş infüzyonla düşük dozda trombolitik tedavi sol ventrikül trombüs tedavisinde etkili bir seçenek olabilir.
Successful Lysis of a Mobile Left Ventricular Thrombus by Slow Infusion of Low-Dose Tissue Plasminogen Activator
(Turkish Soc Cardiology, 2010) Gunes, Yilmaz; Ceylan, Yemlihan; Tuncer, Mustafa
There is no consensus on the management of intracardiac mural thrombi. A 59-year-old man underwent echocardiographic examination for right leg pain and pulse deficits in the right lower extremity, which showed severe left ventricular systolic dysfunction and a bellshaped protruding mobile thrombus in the left ventricular apex. Due to high risk of surgery, 50 mg recombinant tissue-type plasminogen activator (rt-PA) was slowly infused over eight hours. Serial echocardiographic examinations showed a progressive decrease in the size of the thrombus within the first hours of rt-PA infusion, resulting in complete lysis after 24 hours. Lowdose and slow-infusion thrombolytic therapy may be an alternative therapy for left ventricular thrombi when surgery is not feasible.