Ahmet İrdem

An interesting case of a sewing needle inside the heart: report of a case

Despite being rarely seen, penetrating cardiac injuries are clinically significant, as they are highly lethal. We herein present the case of a 3-year-old male who unintentionally injured himself by pricking his own chest with a sewing needle and introducing it through the left-lower margin of his sternum into his right ventricle. The needle was located anterior-posteriorly over the right ventricle. An anterior thoracotomy was performed, and the needle was safely removed. No hemorrhage or arrhythmia was seen, so the operation was ended. An early diagnosis and intervention proved to be life-saving for this penetrating cardiac injury.

Is there any association between childhood cardiac septal defects and ROCK2 gene polymorphism

Rho/Rho-kinase pathway plays a critical role in the regulation of cellular functions such as proliferation and migration. One of the possible theories of the development of ventricular septal defects is cell migration disorder. The aim of this study was to analyze the genotype distributions and allele frequencies for the ROCK2 gene Thr431Asn polymorphisms in the development of cardiac septal defects in a Turkish population. In this case-control study, 300 patients with cardiac defects (150 patients with ventricular and 150 patients with atrial septal defects) and control group (150 healthy control subjects) were investigated. A single-nucleotide polymorphism in ROCK2 gene Thr431Asn was analyzed by real-time PCR using a Light-Cycler. Neither genotype distributions nor the allele frequencies for the Thr431Asn polymorphism showed a significant difference between the groups. These results suggest that there is no association of the ROCK2 gene Thr431Asn polymorphism with the development of cardiac septal defects in pediatric patients.

Transcatheter Repair of Partial Anomalous Pulmonary Venous Drainage Using an Amplatzer Vascular Plug in a Postoperative Patient With Tetralogy of Fallot

The association of tetralogy of Fallot with a partial anomalous pulmonary vein is rare. Although this combination is generally treated with surgery, in this paper we present the case of an 8-year-old boy whose anomalous venous drainage was successfully closed with an Amplatzer vascular plug after a total correction of a tetralogy of Fallot. The patient was asymptomatic at his last follow-up.

Transcatheter Closure of a Large Left Atrial Aneurysm With a Right Pulmonary Artery-to-Left Atrium Connection Using the Amplatzer Ventricular Septal Occluder

A right pulmonary artery-to-left atrium connection is a very rare cyanotic congenital heart defect. Although it is generally treated with surgery, we describe the case of a 5-year-old girl whose connection was successfully closed the Amplatzer muscular ventricular septal defect occluder. The patient was asymptomatic at last follow-up.

Transcatheter closure of a residual patent ductus arteriosus after surgical ligation in children.

Background and Objectives To assess the safety and efficacy of transcatheter closure of residual ductal flow after initial surgical ligation of the arterial duct. Subjects and Methods Between June 2005 and December 2009, transcatheter occlusion of residual postsurgical ductus arteriosus was performed in six children. Results The mean patient age was 10±5.5 years; mean post-procedural time since the initial surgical closure was 6.3±4.5 years. The mean diameter of the patent ductus arteriosus on angiography was 1.3±0.5 mm (range, 0.8 to 2.4 mm). Three different types of coils were used successfully without any complications. Conclusion Transcatheter occlusion of residual postsurgical arterial duct is a safe and successful procedure. However, attention should be paid due to the distorting shape of the arterial duct.

Thoracoabdominal ectopia cordis: a case report -

Ectopia cordis is a very rarely seen cardiac anomaly. In this anomaly heart settles outside the thorax completely or partially and other cardiac anomalies may be present. Here we aimed to present a one-day newborn with ectopia cordis and atrial septal defect.

Intracardiac thrombus in children with dilated cardiomyopathy

OBJECTIVES The risk of fatal pulmonary and systemic thromboembolism is high in patients with dilated cardiomyopathy with cardiac thrombus. This study was planned to reveal the efficacy of antiaggregant therapy in patients with low left ventricular systolic ejection fraction (LVEF). STUDY DESIGN The present study retrospectively reviewed the files of 83 cases (42 males, 41 females) with dilated cardiomyopathy who were followed between June 2004 and December 2011. RESULTS Intracardiac thrombus was detected in five (6%) cases; of these five patients, dilated cardiomyopathy was idiopathic in four and secondary to chronic renal failure in one. The cases were followed for a mean of 33.6±35.6 months (3 days-168 months). Mean LVEF on transthoracic echocardiography was found as 35.2±2.7% (32-38%) for the cases with intracardiac thrombus, whereas it was 34.7±11.0% (10-55%) for the cases without intracardiac thrombus. No statistically significant difference was found between the groups (p=0.910). Cases with LVEF ≤30% were routinely receiving acetylsalicylic acid at antiaggregant dose. CONCLUSION We think that prophylactic antithrombotic/antiaggregant therapy should be started at the time of diagnosis even in patients with LVEF >30%, as thrombus development was seen in cases with LVEF >30% without any antiaggregant therapy.

A rare case of infective endocarditis caused by Candida albicans

Despite significant advances in medical, surgical, and critical care interventions, infective endocarditis (IE) remains a disease associated with considerable morbidity and mortality. Fungal endocarditis is relatively unusual in children although it is one of the most feared forms of endocarditis. Candida species are the most common organisms recovered. In neonates, this infection may be a complication of intensive care measures, including hyperalimentation fluid infusion, use of broad-spectrum antibiotics for a prolonged time, and extended use of indwelling venous catheters. The mortality rate from fungal endocarditis is high, even with intensive medical and surgical therapy. The present paper aimed to present a third-month-old girl baby with candida infective endocarditis (fungus ball) diagnosed and surgically operated.

CHARGE syndrome together with middle aortic syndrome

CHARGE syndrome is a rarely encountered syndrome characterized by eye and ear anomalies, as well as cardiac defects, genital hypoplasia, coanal atresia, and brain anomalies. Multidisciplinary approach is mandatory in such patients. In particular, detailed cardiac and ophthalmologic examination should be performed, and the patient should be evaluated in terms of audiometric test and genital organs. A two-month-old baby was brought to our clinic with weakness, fatigue, irritability, vomiting, feeding difficulty, and rapid respiration picture. On her physical examination, general status was poor; arrhythmia, tachycardia, and gallop rhythm were detected on cardiac examination and a 5-6 cm hepatomegaly was detected on abdominal examination. In chest radiograph revealed cardiomegaly; In electrocardiography (ECG) revealed atrial flutter attacks with 1:1 rhythm; transthoracic echocardiography revealed dilated cardiomyopathy (EF; 35%, FS; 16%), aortic coarctation in the aortic arch and in the thin, classical part of descending aorta (mean gradient; 30-35 mmHg), and fine patent ductus arteriosus. During the catheterization, tubular hypoplasia of the aortic arch and istmic aortic coarctation, and hypoplasia was observed in the thoracic and abdominal aorta. The patient was considered to have middle aortic syndrome. Moreover, ocular coloboma and retardation of growth and development were identified in the patient. Cardiac and ophthalmic signs together with the signs of retardation of growth and development were considered probable CHARGE syndrome according to the diagnostic criteria reviewed in 2003. Dilated cardiomyopathy secondary to aortic coarctation is a common condition. Dilated cardiomyopathy improves with appropriate and effective therapy. The prevalence of concurrency of CHARGE syndrome and congenital cardiac disease is 60-70%. Different pictures of congenital cardiac disease can be seen. We, here, introduced a case considered to have CHARGE syndrome together with middle aortic syndrome, the concurrency of which has been seen very little.

Evaluation of P-Wave Dispersion, Ventricular Functions and Atrial Electromechanical Coupling in children with Type 1 Diabetes Mellitus

Objective: The present study aimed to evaluate ventricular diastolic function, interand intra-atrial conduction delay, and P wave dispersion in pediatric patients with type 1 diabetes mellitus (DM). Methods: This study comprised 30 pediatric patients with type 1 DM and 30 healthy children served as the control group. P wave dispersion (Pd )was measured on a 12-channel ECG. Both systolic and diastolic functions of both ventricles were evaluated using conventional and tissue doppler imaging (TDI) echocardiography (ECHO). Atrial electromechanical delay was measured using TDI accompanied with electrocardiography (ECG). Results: On conventional transthoracic echocardiography (ECHO), the mitral E/A ratio and isovolumetric relaxation times (IVRT) were different between the patients with type 1 DM and the control group (1.67±0.46 vs. 1.95±0.43, p=0.017 and 74.5±7.0 vs. 63.3±5.2, p<0.001, respectively). On TDI, LV septal peak systolic (Sm) and early diastolic (Em) velocities and Em/Am ratio were found to be significantly lower in the patients with type 1 DM than in the control group (p=0.047, p=0.003, and p=0.001, respectively). Regarding atrial electromechanical conduction, prolongation was detected in PA lateral, PA septal, PA tricuspid, and inter-atrial (PA lateral–PA tricuspid) and intra-atrial (PA septal–PA tricuspid) conduction delay (p<0.001, p<0.001, p<0.001, p<0.001, and p<0.05, respectively). Conclusion: Our findings suggest that intraand inter-atrial conduction delay, p wave dispersion, and ventricular diastolic functions are abnormal in patients with type 1 DM.