Burhan Öcal

Myocardial Performance Index Combining Systolic and Diastolic Myocardial Performance in Doxorubicin-Treated Patients and Its Correlation to Conventional Echo/Doppler Indices

AbstractThis study was designed to evaluate the utility of myocardial performance index (MPI) in anthracycline cardiotoxicity. The MPI measures the ratio of total time spent in isovolumic activity (isovolumetric contraction time and isovolumetric relaxation time) to the ejection time, thus giving a global index combining systolic and diastolic myocardial performance. In this study, MPI was measured in 35 doxorubicin-treated children (aged 108.5 ± 55.31 months, 23 males and 12 females) in sinus rhythm and 32 age-matched controls, and it was compared with conventional Doppler echocardiographic parameters. The isovolumetric contraction time was prolonged (38.37 ± 24.43 vs 26.37 ± 15.53, p <0.02) and ejection time was shortened (231.91 ± 28.87 VS 256.21 ± 19.55, P <0.001) in doxorubicin-treated patients compared to that in normal children. The isovolumetric relaxation time did not show significant difference between patients and control group (60.11 ± 10.92 vs 61.06 ± 12.12, P > 0.05). MPI was significantly increased in doxorubicin-treated patients compared with that in control groups (0.42 ± 0.07 vs 0.34 ± 0.06, p <0.001), and significant correlation was observed between MPI and fractional shortening, ejection fraction, and left ventricular end diastolic and end systolic diameters (respectively, R = -0.508, P <0.002; R = -0.532, P <0.001; R = 0.467 P <0.005; R=0.606, P <0.001). Also, a weak correlation was found between MPI and duration of the disease and patient ages (R = 0.393, P <0.02; R = 0.379; P <0.02). However, there was no correlation between MPI and cumulative doxorubicin dose (R = 0.311, P > 0.05) and diastolic Doppler parameters in doxorubicin-treated patients. We think that MPI may be a useful parameter in monitoring left ventricular dysfunction in anthracyline-treated patients.

Left Ventricular Diastolic Functions in Juvenile Rheumatoid Arthritis

Abstract. Cardiac involvement as pericarditis, myocarditis, and endocarditis is common in juvenile rheumatoid arthritis (JRA). Though there are many reports concerning systolic and diastolic functions of adults with rheumatoid arthritis, there are no studies on children with JRA. Thirty patients with JRA without any cardiac symptoms and 30 sex- and age-matched controls were included in the study. M-mode and pulsed-wave Doppler echocardiography were performed on each participant to assess the systolic and diastolic functions of the left ventricle. Left ventricular end-systolic diameter and volume were larger and ejection fraction and fractional shortening were decreased in the JRA group. Among the diastolic parameters, increased late flow velocity, decreased early flow velocity, and prolonged isovolumic relaxation time reflected an abnormal relaxation form of diastolic dysfunction. Mortality rate is increased in adults with rheumatoid arthritis, and ischemic heart disease is the leading cause of cardiovascular mortality. The abnormal relaxation form of diastolic dysfunction found in children with JRA is seen in ischemic heart disease. These children can therefore be candidates for ischemic heart disease in the future even though they are fully asymptomatic at present. In conclusion, children with JRA should be assessed for systolic and diastolic functions with serial echocardiography. In this way it may be possible to reduce the mortality and morbidity of the disease from cardiac causes.

Tolmetin and salicylate therapy in acute rheumatic fever: Comparison of clinical efficacy and side-effects

Abstract Background : The arthritis of rheumatic fever is very responsive to treatment with salicylates, but there are many adverse reactions, especially hepatotoxicity, due to aspirin (acetylsalicylic acid) therapy. These side‐effects change the course and duration of rheumatic fever. Other non‐steroidal anti‐inflammatory drugs may be equally effective, although no reports are available.

Ventricular non-compaction in children: clinical characteristics and course

Isolated left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by prominent trabeculations and deep intratrabecular recesses. In this study, we aimed to identify the clinical characteristics of children with ventricular non-compaction and determine the factors affecting prognosis. We retrospectively evaluated 29 children with LVNC followed at Dr. Sami Ulus Children Hospital Pediatric Cardiology Department from December 2004 to November 2009. There were 13 females (45%) and 16 males (55%) and the mean age at presentation was 4.8±4.6 years (one month-15 years). Although there was no statistical significance; early presentation age and high left ventricular end-diastolic diameter at the diagnosis were associated with poorer prognosis.

Prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy

The aim of our study is to evaluate the prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy (DCM). Twenty-five children with DCM and 24 age- and sex-matched healthy children who were admitted between January 2002 and September 2004, enrolled in this prospective study at our hospital. After the echocardiographic examination, three-channel 24-ambulatory ECG recordings were obtained in all patients with DCM and in the control group. Time domain heart rate variability parameters were obtained in both groups. Heart rate turbulence was measured in DCM patients, but we could not calculate heart rate turbulence in the control group since no ventricular ventricular premature complexes (PVC) were found in the 24-hour ECG monitoring in the control group. The mean follow-up period of the DCM group was 13.4months (3-26months). Five patients died (20%) during the follow-up period.Triangle index, turbulence slope (TS), age and availability of nonsustained ventricular tachycardia (VT) on 24-hour ECG monitoring were prognostic factors according to the correlation analyses. Only triangle index was detected as an independent risk factor among the prognostic factors according to the logistic regression analyses. This study assessed the prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy. Further studies are needed to investigate the prognostic value of heart rate turbulence.

Congenital Partial Pericardial Defect and Herniated Right Atrial Appendage: A Rare Anomaly

A congenital partial defect of the right‐sided pericardium is a rare cardiac anomaly and it represents defective formation of the pleuropericardial membrane. Patients can be asymptomatic, but they may experience chest pain, myocardial ischemia, emboli, arrhythmia, and sudden death. In this report, we present an 8‐month‐old boy with pericardial defect and right atrial appendage herniation. It was diagnosed by echocardiography and cardiac magnetic resonance imaging.

Gastrointestinal system malformations in children are associated with congenital heart defects

OBJECTIVE To determine the frequency of congenital heart defects (CHD) in children with gastrointestinal malformations (GISM) and mortality rates in patients with GISM. METHODS Two hundred and forty two consecutive children patients with GISM followed up in Pediatric Surgery Clinics of our hospital were examined for cardiovascular anomaly by the Department of Pediatric Cardiology, and the CHD incidence was investigated by examining the records of the patients retrospectively. Chi-square test was used for the statistical analysis of data. RESULTS Two hundred and forty two patients with gastrointestinal system malformations were included in the study. Of 242 patients, 135 (55.8%) were male and 107 (44.2%) were female, and their age range was 0-15 years. The most frequent GISM were anorectal malformations (43.2%), atresia involving stomach, ileum or colon (21%) and esophageal atresia/tracheoesophageal fistula (18.3%). Congenital heart defects were observed in 28.5% of the participants. The most frequent defects were as follows; atrial septal defect (31 patients, 44.9%) a, ventricular septal defect (17 patients, 24.6%) and patent ductus arteriosus (5 patients, 7.2%). There was no significant difference (p>0.05) in mortality rate in patients with CHD (16.7%) and without CHD (13.3%) undergoing operations for GISM. CONCLUSION We would like to emphasize the importance of the earliest possible cardiological evaluation of all patients with gastrointestinal system malformations.

Assessment of Ventricular Repolarization in a Large Group of Children with Early Onset Deafness

This study examined the ECG traces of 397 deaf children (age 12.5 ± 2.9 years, range 6–19 years), after exclusion of cases with Jervell and Lange‐Nielsen syndrome (JLNS), and compared them to those of 361 normal hearing counterparts (age 12.5 ± 2.7 years; range 7–18 years). An observer, who was unaware of the hearing status of the subjects, measured QT and QTc intervals and calculated dispersions of QT and QTc from standard 12‐lead ECGs recorded at a speed of 25 mm/s at rest. Although the mean QT was found to be longer in deaf children than that observed in the control group (P < 0.0001), the mean QTc was significantly shorter (P < 0.0001). The mean heart rate was significantly lower in deaf children. When QT and QTc data were recompared after the children were grouped according to the heart rate, the observed difference became less significant or disappeared. In conclusion, there are no major abnormalities for repolarization parameters in children with congenital sensorineural deafness, when compared to hearing counterparts, if heart rates are similar. Based on these results, routine ECG screening of deaf children for repolarization abnormalities may be unnecessary unless they have a history of syncope or positive family history of syncope and/or early sudden death.

Transcatheter occlusion of tortuous feeding vessel with new vascular plug in an infant with pulmonary sequestration with Scimitar syndrome

We report the case of a 9-month-old girl with a Scimitar syndrome which was feeding via an anomalous vessel dividing into three tortuous branches and supplying blood to a localized region of the right lower lobe which was successfully occluded using an Amplatzer® Vascular Plug 4 (AGA Medical, Golden Valley, MN, USA). The percutaneous procedure performed via femoral artery, provided an immediate closure of the vessel, excluding the need for surgical repair. This new device is found to be safe and effective for occlusion of the collaterals, especially large ones in pediatric ages.

OP-136 CLINICAL ANALYSIS OF 204 CASES WITH ACUTE RHEUMATIC FEVER

Objective: This retrospective study aimed to identify clinical findings, etiologies, diagnosis, treatments and prognosis of 316 patients (age range:1 month-18 years) with pericarditis. Methods: The patients with echocardiographically detected pericarditis were admitted to our center between 1996 and 2008. These patients were reviewed according to physical examinations, blood chemistry results, microbiological, radiological and cardiological studies. Results: The mean age was 7.5±4.3 years. There were 156 (49.3%) boys and 160 (50.7%) girls. Although the most common symptoms were dyspnea (58.8%), fever (51.2%), chest pain (39.8%) and cough (35.1%), the physical examination revealed tachypnea (50.9%), hepatomegaly (44.9%), fever (39.5%), murmur (38.9%), tachycardia (34.1%), peripheral edema (21.8%), distant heart sounds (16.7%), ascites (15.2%) and frotman (5.6%). The most frequent causes of the pericarditis were viral/idiopathic (22.2%), malignancy (18.3%) and cardiac diseases (15.5%). Anemia was detected in 54.1% of patients. Cardiomegaly was seen in 55.7% of the cases.Echocardiographic study showed mild pericardial effusion in 45.9% of the patients. Twenty-seven (45%) of 60 patients (19%) who underwent pericardiosentesis had purulent pericarditis. In addition to medical treatment, dialysis, pericardial tube drainage and pericardiectomy were performed in 35, 25, and 7 patients,respectively. Ten patients developed constrictive pericarditis. Conclusions: We emphasized that early diagnosis and treatment is very important in patients who have signs and symptoms of pericarditis.Also echocardiography is essential for the diagnosis. Our study demonstrated that the viral/idiopatic etiology is the most common cause of pericarditis. We considered that improvement of socioeconomic status, preventive health care services, and effective antibiotherapy can decrease the prevalence of the pericarditis.