Ahmet Çelebi

The Natural Course of Isolated Ventricular Septal Defect During Adolescence

Abstract. Serial changes in patients with isolated VSD during adolescence have not previously been investigated. Hemodynamic status, diameter of the defect, and growth were studied yearly in 106 children with VSD. The mean duration of the follow-up was 13.16 years and ranged in 80% of subjects from 7 to 19 years (1395 patient years). The mean ages at pre- and postpuberty were 8.62 and 16.67, respectively. The presented longitudinal study, in which losses due to death and operation were minimal (4%), ideally reflected the natural history of VSD. Although weight showed retardation during prepuberty, this lag was caught up by the end of adolescence. Stature showed no retardation in pre- and postpuberty. Cardiothoracic ratio decreased significantly from a mean of 0.48 to 0.44 and showed normal variation. Although the mean defect diameter at prepuberty was 5.33 mm, this decreased to 2.7 postpubertally. The individual decrease (1.7 ± 2.34 mm) was significant (t= 5.349, p < 1/105). The defect closed spontaneously in 24 (22.6%). In the 75 patients without pulmonary hypertension and with mild left-to-right shunting, 52 remained in the same class and spontaneous closure was observed in 23. In the 24 patients with moderate to severe left-to-right shunt, this decreased in 23 and only one remained stable. The 2 patients (1.9%) with Eisenmenger syndrome remained stable and 1 died. Aortic regurgitution developed in 10 patients (9.4%); however, this was of mild degree in most of them. No infective endocarditis was observed. It is concluded that patients with VSD should be followed closely through adolescence, because the diameter of the defect, as well as left-to-right shunting, can decrease, and it is concluded that the spontaneous closure of the defect is to be expected in a considerable 23%, and aortic prolapse or mild regurgitation may develop in approximately 10%.

Cardiac functions in children with coeliac disease during follow-up: insights from tissue Doppler imaging.

BACKGROUND The identification of a coeliac disease in patients with idiopathic dilated cardiomyopathy raises critical questions on the relationship between the two entities. But cardiac functions have not been studied in patients with coeliac disease. The present study was undertaken to assess cardiac functions by Tissue Doppler Echocardiography in patient with coeliac disease. METHODS We studied 45 clinically stable patients; twenty-five patients with positive serum IgA Antiendomysial Antibody levels (Group 1), twenty patients with negative serum IgA Antiendomysial Antibody levels (Group 2) at the time of echocardiographic study. Control group consisted of 30 healthy children free of any disease. RESULTS Myocardial systolic wave velocity of the mitral annulus was significantly lower (p<0.001), myocardial precontraction and contraction time were slightly longer in Group 2 when compared control group (p=0.015, p=0.044, respectively). There was a negative correlation between the serum IgA Antiendomysial Antibody levels titers and myocardial systolic wave levels of all patients included in the study (r = -0.633; p<0.001). A myocardial systolic wave velocity of <8.9 cm/s had a 92% sensitivity and 80% specificity in predicting serum IgA Antiendomysial Antibody levels positive patients. CONCLUSIONS We detected subclinical systolic dysfunction of the left ventricle in children with coeliac disease in whom serum IgA Antiendomysial Antibody reactivity is prominent. Tissue Doppler echocardiography provides a quantifiable indicator useful for cardiac monitoring of disease during follow up.

The effect of low‐carbohydrate diet on left ventricular diastolic function in obese children

Background:  This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions.

Can analysis of the bispectral index prove helpful when monitoring titration of doses of midazolam and ketamine for sedation during paediatric cardiac catheterization.

OBJECTIVE We investigated the use of the bispectral index for monitoring sedation during cardiac catheterization. The scores for the bispectral index may not reflect correct values in children, but may be helpful during titration of sedatives such as midazolam and ketamine. METHODS We conducted a prospective randomized clinical trial in 126 patients scheduled for cardiac catheterization in a teaching hospital. They ranged in age from 4 months to 15 years. In 66 patients, sedation was performed without use of the bispectral index, while the index was used in the other 60 patients. The data collected included heart rate, mean arterial pressure, respiratory rate, saturation of oxygen, amount of sedatives, awakening time and adverse effects. We subdivided the patients into age-related groups for each parameter. RESULTS The demographic data were not statistically different. Monitoring with the bispectral index in those aged from 1 to 3 years revealed use of lower doses of midazolam, at 2.09 mg per kg per hr, with standard deviation of 0.36, and similarly lowers doses of ketamine, at 2.07 mg per kg per hr, with standard deviation of 0.22, the values in those not monitored being 2.93, with standard deviation of 0.45, and 2.96 with standard deviation of 0.51 respectively, these difference being statistically significant (p = 0.001 and p = 0.04, respectively). In those aged from 3 to 6 years of age, dosage of midazolam was 2.09, with deviation of 0.36, and of ketamine 1.78, with deviation of 0.27, following use of the bispectral index, compared to 2.89 with deviation of 0.28, and 2.62 with deviation of 0.69 respectively, when the bispectral index was not used, these again being significant differences (p = 0.033 and p = 0.04). The requirements for respiratory support and adverse effects were also significantly lower when using the bispectral index (p less than 0.05). No significant difference was found regarding dosages at the ages of 4 months to 1 year, and 6 to 15 years. The awakening time, however, was shorter with use of the index in those aged from 1 to 6 years. CONCLUSIONS When using the bispectral index for monitoring sedation during catheterization in children, we noted decreased need for doses of midazolam and ketamine, a lower need for respiratory support and less adverse effects.

Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma.

Background: The aim of the present study was to evaluate the role of tissue Doppler echocardiography in assessment of ventricular function in pediatric patients with bronchial asthma (BA).

A comparative study of Cardi‐O‐Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects

Aim: We sought to investigate the safety and efficacy of Cardio‐O‐Fix septal occluder (CSO) in percutaneous closure of atrial septal defects (ASD) as compared to the Amplatzer septal occluder (ASO). Methods: A consecutive of 351 patients received transcatheter ASD closure with CSO or ASO from July 2004 to October 2010 were studied. The ASDs were divided into simple‐ (isolated defects <26 mm) or complex‐types (isolated defect ≥26 mm, double or multifenestrated defects). The procedures were guided by fluoroscopy and transthoracic or transesophageal echocardiography. Clinical and echocardiographic follow‐ups were arranged before discharge, at 1 month and then every 6‐month after implantation. Results: During the study period, 185 (125 males, aged 18.5 ± 15.6 years) and 166 (103 males, aged 21.0 ± 15.7 years) patients attempted CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions (17 vs. 16%, P = 0.796), procedural times and success rates (97% vs. 96%, P = 0.635) as compared to the ASO group. Acute residual shunts were less prevalent in CSO than ASO group and most shunts closed spontaneously at 6‐month follow‐ups. The average equipment cost per patient was lower in CSO group (US

Lung perfusion studies after transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder

4,100 vs. US

QT dispersion in acute rheumatic fever

5,900, P < 0.001). The prevalence of device embolization and atrial arrhythmia (all <2%) were similar in both patient groups. Conclusion: Transcatheter ASD occlusion with CSO is safe and effective and it appeared to be an attractive alternative to ASO in closing simple‐type ASD because of its relatively low cost.

Embolization of the Systemic Arterial Supply via a Detachable Silicon Balloon in a Child with Scimitar Syndrome

Background: Reduced left lung perfusion has been described after transcatheter closure of the patent ductus arteriosus (PDA) with several prostheses. Although the Amplatzer ductal occluder (ADO) device is currently the most widely used occluder for closure of large‐sized PDAs, the potential consequences of flow distribution to the lungs of this device have not been completely clarified. We evaluated lung perfusion following occlusion of PDA with the ADO device. Methods: Forty‐seven patients underwent successful transcatheter PDA occlusion using the ADO device were included in this study. Lung perfusion scans were performed 6 months after the procedure. Results: Decreased perfusion to the left lung (defined as < 40% of total lung flow) was observed in 17 patients (36%), 5 of whom were low‐weight symptomatic infants. Ductal ampulla length was significantly shorter and minimal ductal diameter to ampulla diameter ratio was significantly higher in patients with decreased left lung perfusion and correlated well with left lung perfusion values (r = 0.516 and r = −0.501, respectively). A cut‐off value of ≤5.8 mm for the ductal ampulla length and ≥1.9 for ampulla diameter to ampulla length ratio showed high sensitivity and specificity for reduced lung perfusion. Conclusions: The incidence of abnormal left lung perfusion is high 6 months after transcatheter closure of PDA with the ADO, more likely in the low weight symptomatic infants and in patients with a short duct or a relatively shallow duct having abrupt narrowing of a large ampulla.

A multicentre, comparative study of Cera septal occluder versus AMPLATZER Septal Occluder in transcatheter closure of secundum atrial septal defects

BACKGROUND Disturbances of conduction are well known in the setting of acute rheumatic fever. The aim of this study is to investigate the QT dispersion as seen in the surface electrocardiogram of children with acute rheumatic fever. METHODS QT dispersion was quantitatively evaluated in 88 children with acute rheumatic fever. Patients were divided into two groups based on the absence or presence of carditis. As a control group, we studied 36 healthy children free of any disease, and matched for age with both groups. Repeat echocardiographic examinations were routinely scheduled in all patients at 3 months after the initial attack to study the evolution of valvar lesions. RESULTS The mean QT dispersion was significantly higher in children with rheumatic carditis. But there was no statistical difference between children without carditis and normal children. Among the children with carditis, the mean dispersion was higher in those with significant valvar regurgitation. Dispersion of greater than 55 milliseconds had a sensitivity of 85%, and specificity of 70%, in predicting rheumatic carditis, while a value of 65 milliseconds or greater had sensitivity of 81% specificity of 85% in predicting severe valvar lesions in acute rheumatic carditis. At follow-up examination, a clear reduction on the QT dispersion was the main finding, reflecting an electrophysiological improvement. CONCLUSIONS These observations suggest that QT dispersion is increased in association with cardiac involvement in children with acute rheumatic fever.