Adnan Akçoral

Platelet activation in congenital heart diseases

The research presented here investigated platelet activation in cyanotic and acyanotic congenital heart diseases (CHD). Children with cyanotic CHD are prone to both thrombosis and hemorrhage. However, patients with acyanotic CHD may also have a mild bleeding disorder. The platelet activation in CHD was investigated in support of a hypothesis that platelet activation may play a role in the hemostatic abnormalities reported in these patients. Platelet activation was determined by using flow cytometry with anti‐CD62 monoclonal antibody (mAb), which has been shown to be a specific marker of platelet activation. Thirteen children with cyanotic CHD, 33 children with acyanotic CHD and 17 healthy children serving as controls were studied. Platelet activation was significantly higher in the cyanotic group and also in the acyanotic group compared with the healthy children (P = 0.0000 and P = 0.019, respectively). In the cyanotic group, platelet activation showed a direct correlation with arterial O2 saturation (SaO2) (P = 0.014). There was no correlation between platelet activation and erythrocyte related parameters in either group. Platelet activation occurs in CHD, particularly in patients with cyanotic CHD (even in patients with no evidence of clinical thrombosis) and it may play a role in the pathogenesis of thrombotic disorders seen in these patients.

Transient right sided hypertrophic cardiomyopathy in an infant born to a diabetic mother

Hypertrophie cardiomyopathy (HCM) is a rare primary myocardial disease, characterized by hypertrophy of the left and/or right ventricle. Infants of diabetic mothers (IDM) are at risk for development of HCM, respiratory distress and persistent pulmonary hypertension. A case of severe right sided HCM in an infant born to a diabetic mother is presented. The patient’s findings were complementary to the previous observations reporting HCM in IDM. The presence of disproportionate septal hypertrophy in the echocardiography of an infant born to a diabetic mother is highly suggestive of HCM in IDM. In our opinion, further cardiac evaluation is not indicated unless other cardiac abnormalities are suspected.

Ranitidine administration in Henoch-Schonlein vasculitis

In this study, we discuss 12 patients with gastrointestinal (GI) bleeding who were diagnosed as having Henoch Schoenlein vasculitis (HSV) in Dr Behçet Uz Childrens Hospital, Izmir, between January 1991 and January 1992. Seven male and five female patients were included in the study. Their ages ranged between 6–14 years. The patients were separated into two identical groups and were given ranitidine or a placebo. Both groups were followed up for abdominal pain and GI bleeding. In the group administered ranitidine the duration and severity of abdominal pain and gastrointestinal bleeding decreased significantly as compared to the group taking placebo (P <0.05). No side effects of ranitidine were observed. As a result, it was concluded that ranitidine could be used to treat HSV with GI symptoms.

Dilated Cardiomyopathy as the First Early Complication in a 14 Year-Old Girl with Diabetes Mellitus Type 1

Diabetic cardiomyopathy (DC) has been reported in type 2 diabetics with short duration of clinically overt diabetes. Impaired left ventricular function has been reported in young patients with diabetes mellitus type 1 (IDDM), but severe cardiomyopathy as the first early major complication of IDDM is very rare. We report a 14 year-old girl with a 5-year history of IDDM and very poor compliance with treatment and follow-up. She was referred to our clinic upon the development of congestive heart failure and dilated cardiomyopathy was diagnosed based on clinical findings, electrocardiogram, chest X-ray and echocardiography. She had no evidence of other major complications of IDDM such as retinopathy, nephropathy or neuropathy.

Effects of high‐dose intravenous methylprednisolone in children with acute rheumatic carditis

In order to measure the effects of high‐dose intravenous methylprednisolone (HIVMP) and compare its efficiency with that of oral prednisolone (OP), 18 patients with active rheumatic carditis were studied. Ten patients received OP, while eight patients were treated with HIVMP. Clinical and laboratory responses to treatment were followed by sleeping pulse rate, systolic blood pressure, erythrocyte sedimentation rate (ESR), cardiothoracic ratio (CTR), PR interval on electrocardiogram, spectral and color flow imaging and Doppler echocardiographic findings; mitral and aortic regurgitant jet flow area, left atrial area, proximal width of mitral regurgitant jet area and regurgitation fractions.

Takayasu’s arteritis with bilateral renal artery stenosis: Unilateral kissing balloon angioplasty

Takayasu’s arteritis is a systemic non-specific vasculitis artery and bilateral stenosis at main renal arteries (Fig. 1). In primarily affecting the walls of large vessels. Renal arterial stenosis may be bilateral and usually seen with coexisting aortic involvement [1]. Percutaneous transluminal renal balloon angioplasty (PTRBA) is successful in up to 90% of cases and blood pressure control is achieved in approximately 68%. PTRA alone or supported with stent implantation has also been helpful in patients with suboptimal results after PTRBA and for managing recurrent restenosis [2]. Renal arterial bifurcational stenosis can be dilated by the kissing balloons technique, thus rendering difficult vascular surgery unnecessary [3]. In this article, a case with Takayasu arteritis that received the kissing balloon technique for a bifurcational renal artery stenosis was reported. An eleven-year-old girl was admitted to our clinic with complaints of malaise, headache, and exercise intolerance and diminished weight gain since she was four. Her physical examination showed right arm blood pressure of 110/70 mmHg, right leg blood pressure of 230/110 mm Hg. Her left radial, brachial and carotid pulses were not palpable and the pulses that belong to the lower extremities were palpable bilaterally. All laboratory findings were normal. Angiographic examination revealed narrowing of the right subclavian artery, bilateral carotid arteries, total occlusion of the left subclavian artery, normal left and right coronary arteries and minimal aortic insufficiency (Fig. 1). There was no stenosis at the pulmonary arteries. Aortography showed a bifurcational stenosis at an upper segment of the right renal

Pseudoaneurysm of the Right Ventricular Outflow Tract Complicating Balloon Dilatation for Tetralogy of Fallot

Balloon dilatation is one of the treatment options in symptomatic infants with tetralogy of Fallot and hypoplastic pulmonary annulus and pulmonary artery. A balloon dilatation was performed on a 28-day-old infant with tetralogy of Fallot with an appropriate balloon. The patient developed two pseudoaneurysms on the right ventricular outflow tract after the procedure which were diagnosed when the patient was admitted for total correction at 20 months of age. This case demonstrates an unusual but potentially life-threatening long-term complication of this procedure.

Fresh Homografts Obtained Through a National Organ-sharing Programme for Repair of Congenital Heart Disease

Homografts have been used in congenital cardiac surgery for over 30 years. We utilized the resources of a national organsharing programme to obtain fresh homografts and report their use in correcting cardiac pathologies in 20 children between March 2001 and May 2003. In 16 patients, a valved conduit was used to form a connection between the pulmonary ventricle and the pulmonary artery. In three patients, a non-valved aortic conduit was used to form an extracardiac Fontan circulation and in one patient, non-valved pulmonary and aortic conduits were used to repair an infected aortic aneurysm. Three patients died following surgery. Survivors were followed up using echocardiography between 2 and 24 months post-surgery. Results demonstrate that, with the help of a national organ-sharing programme, the use of fresh homograft conduits is feasible in a paediatric patient population with reasonable waiting times.