Alper Akın

The efficacy of amiodarone-propranolol combination for the management of childhood arrhythmias.

The aim of this study was to present our data regarding the efficacy and safety of combining amiodarone and propranolol for the management of arrhythmias in infants.

Closure of the patent ductus arteriosus with the Amplatzer Duct Occluder II: a clinical experience.

BACKGROUND The aim of our study was to share our clinical experience on cases with patent ductus arteriosus treated with the Amplatzer Duct Occluder II. METHODS Between 2008 and 2012, 26 of 31 patients with patent ductus arteriosus underwent successful transcatheter closure of patent ductus arteriosus using the Amplatzer Duct Occluder II. Mean age was 3.3 years and mean weight was 15.7 kilograms. The presence of a residual shunt, left pulmonary artery or aortic obstruction was explored by administering contrast material during the procedure. The patients were discharged 24 hours after the procedure. RESULTS The procedure was successful in 26 of 31 patients and failed in five patients. According to the Krichenko classification, 26 patients had type A, one patient had type B and 4 patients had type C ductus. The mean narrowest ductus diameter was 3.2 mm and the mean ductus length was 6.7 mm. Complete angiographic occlusion occurred immediately after the procedure in 22 out of 26 patients in whom the ductus was closed successfully with the Amplatzer Duct Occluder II. Complete occlusion was achieved in the remaining patients with residual shunt one month after the procedure. The procedure was preceded by closure with an Amplatzer Duct Occluder I in two patients and an Amplatzer Vascular Plug I in one patient. CONCLUSION Amplatzer Duct Occluder II is highly effective in transcatheter closure of patent ductus arteriosus. We think that an alternative closure device and alternative techniques can be attempted in patients with type C ductus. The success rate could increase with accumulating experience.

Transcatheter closure of antegrade pulmonary blood flow with Amplatzer muscular VSD occluder after Fontan operation.

The Fontan procedure refers to any operation that results in the flow of systemic venous blood to the lungs without passing through a ventricle. An accessory source of pulmonary blood flow in patients with the Fontan procedure may cause elevation of the pulmonary artery pressure, leading to ventricular failure (1). An 8-year-old-girl with double outlet right ventricle presented with marked pleural effusion on postoperative day 14 after a Fontan procedure with extracardiac conduit without ligation of the pulmonary trunk. Her immediate postoperative course was uneventful. She had prominent pleural effusion with 80% saturation. Echocardiography showed significant antegrade flow from the right ventricle into the pulmonary artery. The superior vena cava and main pulmonary artery pressures were markedly high [26/22 mm Hg (mean 25 mm Hg) and 27/23 mm Hg (mean 24 mm Hg), respectively]. The pulmonary artery angiogram showed normally branched pulmonary arteries with rapid wash-off of the contrast. The diameter of the stenotic pulmonary valve was measured as 11.2 mm. A 12 mm Amplatzer muscular VSD occluder (AGA Medical, MN, USA) device was deployed very close to the pulmonary valve at the infundibular stenotic region (Fig. 1). The pulmonary artery pressure was not decreased immediately [27/21 mm Hg (mean 24 mm Hg)] when compared with the pressure measured before the intervention. Antiaggregant and anticoagulant therapy were started. The patient recovered uneventfully, with an oxygen saturation >90%, and was discharged two weeks later. She has been symptom-free on sildenafil treatment for one year. Although several studies have reported that non-pulsatile pulmonary blood flow results in decreased capillary flow and increased vascular resistance (1), the preservation of antegrade pulmonary blood flow in a patient with a total cavopulmonary shunt may complicate the Fontan procedure, resulting in persistent pleural effusions or progressive ventricular failure (2). Therefore, the benefit of additional sources of systemic to pulmonary artery flow remains controversial. Desai et al. (2) and Petko et al. (3) showed that transcatheter closure of ventriculopulmonary artery communication was a safe and effective technique for the treatment of selected patients after cavopulmonary shunt. Our opinion is also that transcatheter closure of pulmonary flow is an alternative to surgery because it is less invasive, easy to perform, reliable, and more comfortable. Madan et al. (4) reported an 8 year-old boy with thrombus in the pulmonary artery stump after a Fontan operation that included ligation of the main pulmonary artery distally to the pulmonary valve. Devices can be placed across the pulmonary artery band, across pulmonary valve tissue, and above the valve in a relatively large homograft without any focal narrowing (3). However, a thrombus may form if a room remains between the pulmonary valve and the device that can create stasis after the intervention. In this case, our preference is to deploy the device in the infundibular area. Transcatheter closure of antegrade pulmonary blood flow seems a safe and effective alternative method to surgery in the treatment of selected patients who have undergone a Fontan procedure and show early complications such as pleural effusion due to excess pulmonary blood flow.

NRG™ RF powered transseptal needle: a useful technique for transcatheter atrial septostomy and Fontan fenestration: report of three cases.

Transseptal puncture (TSP) is a frequently performed procedure for gaining access to the left atrium for catheter ablation, hemodynamic assessment of the left heart, left ventricular assist device implantation, percutaneous left atrial appendage closure or mitral valvuloplasty during childhood and adulthood. The standard technique for transseptal puncture applies mechanical pressure on the fossa ovalis with a Brockenbrough needle. However, this method is not feasible when the fossa ovalis is thick and aneurysmatic. In such patients, the radiofrequency ablation energy systems can be offered as a better alternative for TSP. Here, we aimed to demonstrate the outcome of transseptal puncture performed with an NRG™ RF powered transseptal needle in three patients.

Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization

Akın A, Bilici M, Demir F, Yılmazer MM, İpek MŞ, Kara H. Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization. Turk J Pediatr 2018; 60: 191-193. Umbilical vein catheterization is frequently preferred and a safe route of venous access especially in newborns. However, some cases with breaking and embolization of those catheters have been rarely reported. Herein we present a two-and-a-half-month-old infant being catheterized within first postnatal week and diagnosed to have embolization of the catheter fragment to conjunction of hepatic vein and right atrium. Percutaneous withdrawal of broken catheter was achieved despite several months after the embolization took place. We suggest that transcatheter removal of catheter fragment embolizations may be safe even in late diagnosis cases.

Cytomegalovirus myocarditis with rapid response to intravenous immunoglobulin therapy

Miyokardit; kalp kasinin enflamatuar bir hastaligidir. Olgularin cogunda etken enterovirusler ve adenovirusler gibi viral ajanlardir. Sitomegalovirus viral miyokarditin daha nadir gorulen nedenlerinden biridir. Bu makalede Sitomegalovirus enfeksiyonuna bagli viral miyokardit tanisi konulan ve intravenoz immunglobulin tedavisine cok hizli yanit veren bir olgu sunuldu. Sitomegalovirus miyokarditinde intravenoz immunglobulin tedavisi sonuclari ile ilgili yeterli veri olmamasi nedeniyle bu olgu sunumunun literature katkida bulunacagini dusunuyoruz.

Evaluation of tissue Doppler echocardiographic imaging findings in children with pulmonary hypertension

Akın A, Alehan D, Aykan HH, Özkutlu S, Özer S, Karagöz T. Evaluation of Tissue Doppler Echocardiographic Imaging findings in children with pulmonary hypertension. Turk J Pediatr 2017; 59: 244-253. Tissue Doppler Imaging has become an important prognostic marker that can be used in follow-up and determination of the prognosis in pulmonary hypertension patients. We compared the Tissue Doppler imaging parameters of 34 patients with pulmonary hypertension and 43 healthy controls. In addition, Brain-Natriuretic Peptide levels, pulmonary artery systolic pressures measured with echocardiography, 6-minute walking tests and New York Heart Association functional classification were compared. Among patients with Eisenmenger syndrome and idiopathic pulmonary hypertension, Tissue Doppler imaging parameters were mostly similar. In patients with New York Heart Association functional class 3, mitral septal annulus E/Ea (p=0.050) and mitral lateral annulus myocardial performance index (p=0.009) were higher than class 2 patients. In patients with higher Brain Natriuretic Peptide level, mitral lateral annulus and tricuspid septal annulus Ea/Aa values were lower (p=0.046 and < 0.001 respectively); tricuspid septal annulus E/Ea and interventricular septum myocardial performance index values were higher than in patients with normal Brain-Natriuretic Peptide level (p=0.006). In conclusion tissue Doppler imaging findings were significantly impaired in children with pulmonary hypertension compared to the control group. Findings were similar in patients with idiopathic pulmonary hypertension and Eisenmenger syndrome. Mitral lateral annulus myocardial performance index value may have a prognostic importance due its significant association with poor functional class. Due to the significant associations between mitral lateral annulus, tricuspid septal annulus Ea/Aa, tricuspid septal annulus Ea and E/Aa, interventricular septum-myocardial performance index values and brain natriuretic peptide levels, these parameters may be used in evaluating response to therapy.

Myocardial infarction in an 11-year-old child with systemic lupus erythematosus.

SLE is a chronic autoimmune disease that can affect almost every organ (1). Risk of cardiovascular diseases such as pericarditis, myocarditis, valvular heart disease, and myocardial infarction is increased in SLE, but the latter is observed rarely in childhood. An 11-year-old girl who had been followed-up at our pediatric nephrology clinic for SLE was admitted to our emergency room with chest pain followed by cardiac arrest. We detected 2–3 mm ST elevations in the DII, DIII, aVF, V5, and V6 leads of electrocardiography. Creatine kinase MB fraction (CKMB) was 7.75 ng/mL (range, 0.6–6.3) and troponin I level was 0.88 ng/mL (range, 0–0.04). Transthoracic echocardiography revealed areas of dyskinesia in the left ventricular apical region, paradoxical movement in the interventricular septum, and minimal aortic insufficiency. Coronary angiography revealed total occlusion of the Anatol J Cardiol 2016; 16: 364-8 Letters to the Editor 367

Delayed right-ventricular perforation by pacemaker lead; a rare complication in a 12-year-old girl.

Developments in the diagnosis and treatment of congenital heart diseases have led to an increase in the need for intracardiac pacemaker and implantable cardioverter defibrillator (ICD) implantation. Various complications related to these interventions can be seen in the short term (pneumothorax, pericardial effusion, cardiac perforation, etc…) and in the long term (infection, subclavian vein thrombosis, sensing and pacing problems, battery erosion and cardiac perforation). In this report, we present a rare case of cardiac perforation occurring 2 years after pacemaker implantation.

Is transesophageal electrophysiologic study valuable in children with successful radiofrequency ablation of supraventricular tachycardia on follow-up for recurrence?

Objective: The aim of this study was to evaluate the efficacy of transesophageal electrophysiologic study (TEEPS) for the determination of supraventricular tachycardia (SVT) recurrences in symptomatic and asymptomatic children after successful radiofrequency ablation (RFA) for SVT. Methods: A total of 66 patients who underwent TEEPS after successful RFA were included. The demographic features, symptoms of the patients, and the characteristics of the recurrences induced by TEEPS were evaluated. The arrhythmia types induced during RFA were compared with those induced by TEEPS in terms of the compatibility of the diagnosis. Results: Forty-two (63.6%) girls and 24 (36.4%) boys with a mean age of 11.8±3.4 years were followed-up for 44.1±15.7 months. The average time between RFA and TEEPS was 5.2±5.9 months. The diagnoses during RFA were atrioventricular nodal reentrant tachycardia (AVNRT) in 47 of 66 patients, atrioventricular reentrant tachycardia (AVRT) in 18 of 66 patients, and ectopic atrial tachycardia in 1 of 66 patients. SVT was induced by TEEPS in 2 of 25 symptomatic and 5 of 41 asymptomatic patients. The SVT inducibility rate was 5.5% (1/18) and 12.7% (6/47) in patients with AVRT and AVNRT, respectively. In addition, 85.7% (6/7) of all recurrences occurred within 3.5 months. The recurrences as AVNRT in 2 of 25 symptomatic patients occurred in the first month after RFA. AVNRT in 4 of 41 and AVRT in 1 of 41 asymptomatic patients were induced within 3.5 months and 15 months, respectively. Conclusion: TEEPS seems to be a valuable screening and diagnostic method for the determination of recurrence in symptomatic and asymptomatic children who underwent successful RFA.