Derya Çimen

Normal values of left and right ventricular function measured by M‐mode, pulsed doppler and Doppler tissue imaging in healthy term neonates during a 1‐year period

BACKGROUND The measurements of left and right ventricular functions change after birth due to the influence of several hemodynamic changes upon the immature myocardium. AIM The aim of this study was to investigate the changes in left (LV) and right ventricular (RV) functions of healthy term newborns using conventional and Doppler echocardiography during a 1-year period. SUBJECTS AND METHODS Fifty healthy term newborns were examined prospectively on the first day, 3-4, 6-7, 9-10 and 11-12 months of their lives by M-mode, pulsed Doppler (PD) and Doppler tissue imaging techniques (DTI). PD velocities were obtained from mitral and tricuspid valves while DTI velocities were obtained from the lateral annuluses of atrioventricular valves. RESULTS EF and FS did not change significantly by time. Early (E) flow velocity and early myocardial (Em) velocity were higher than late (A) flow velocity and atrial systolic (Am) velocity for LV, while A and Am velocities were higher than E and Em velocities for RV, respectively during the study period. E, A, Em, Am, Sm velocities and Em/Am ratios increased while E/Em ratios decreased significantly by time (P<0.05) for both ventricle. However, E/A ratios of LV and RV did not change significantly by time. Myocardial performance index (MPI), obtained by PD for RV and by DTI for LV, decreased significantly by time (P<0.05) and these DTI values were higher than PD values during the study period. CONCLUSIONS Due to hemodynamic and maturation change of myocardium PD and DTI velocity changes took place during the first year of life which reflects differences in ventricular adaptation.

CARDIAC FUNCTIONS EVALUATED WITH TISSUE DOPPLER IMAGING IN CHILDHOOD CANCERS TREATED WITH ANTHRACYCLINES

Aim: The aim of this study was to assess the cardiac functions using conventional echocardiography and tissue Doppler imaging in childhood cancers treated with anthracyclines. Methods: The study group was selected from the patients admitted to the pediatric oncology department for a treatment protocol that included doxorubicin. Body surface area was calculated and complete 2-dimensional, M-mode, pulse wave Doppler and pulse wave tissue Doppler echocardiographic examinations were performed just before the first treatment and at least 6 months after the last treatment. Results: This study included 20 patients (12 males and 8 females). Mean cumulative antracycline dose was 189 ± 102.90 mg/m2. There were no significant differences between the pre- and post-treatment groups regarding systolic and diastolic blood pressures, heart rates, left ventricular ejection fraction and fractional shortening, right and left ventricular conventional and tissue Doppler diastolic parameters (E and A waves, E/A ratio, E′ and A′ waves, E′/A′ ratio), but there were significant differences between the pre- and post-treatment groups regarding body surface area, right and left ventricular myocardial performance index observed by conventional pulse wave and pulse wave tissue Doppler methods. Conclusion: Tissue Doppler imaging provided additional information on cardiac functions. While systolic and diastolic functions were in normal range, myocardial performance index observed by tissue Doopler method was impaired in children who were treated with anthracyclines.

Release of NT-pro brain natriuretic peptide in children before and after adenotonsillectomy

OBJECTIVES To measure serum B-type natriuretic peptide, especially N-terminal segment of its prohormone (NT-proBNP) and pulmonary arterial pressure levels and to determine whether NT-proBNP concentrations correlate with pulmonary arterial pressure levels in children before and after adenotonsillectomy. METHODS Twenty children with adenoid and tonsil hypertrophy and 20 healthy subjects were included in the study. Transthoracic echocardiography was performed in all patients to assess pulmonary artery systolic and diastolic pressure with cardiac dysfunction. The NT-proBNP was analyzed for correlation with pulmonary artery pressure. RESULTS Our results showed that prohormone serum concentrations and pulmonary arterial pressures were significantly higher in the study group than in the control group at the preoperative evaluation. A significant decrease was detected among patients after surgery (p<0.05). There was no significant difference between the study and control groups for prohormone serum concentration and pulmonary arterial pressure at the postoperative evaluation (p>0.05). CONCLUSION We found increased serum prohormone levels and height pulmonary artery pressures in the children with adenoid and tonsil hypertrophy when comparing with healthy subjects. Our study supported that increased serum prohormone levels and pulmonary artery pressures as a result of adenoid and tonsil hypertrophy are reversible. Pediatric cardiologs and otolaryngologs should keep in mind an increased pulmonary artery pressure during management of children with adenoid and tonsil hypertrophy. Furthermore, Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of surgical outcome of children with adenoid and tonsil hypertrophy.

Prospective ECG-gated high-pitch dual-source cardiac CT angiography in the diagnosis of congenital cardiovascular abnormalities: Radiation dose and diagnostic efficacy in a pediatric population.

PURPOSE The goal of this study was to investigate the radiation dose and diagnostic efficacy of cardiac computed tomography angiography (CCTA) using prospective ECG-gated high-pitch dual-source computed tomography (DSCT) in the diagnosis of congenital cardiovascular abnormalities in pediatric population. MATERIALS AND METHODS One hundred five pediatric patients who were clinically diagnosed with congenital heart disease with suspected extracardiac vascular abnormalities were included in the study. All CCTAs were performed on a 128×2-section DSCT scanner. CCTA findings were compared with surgical and/or conventional cardiac angiography findings. Dose-length product (DLP) and effective doses (ED) were calculated for each patient. Patients were divided into 4 groups by age, and ED and DLP values were compared among groups. The image quality was evaluated using a five-point scale. RESULTS CCTA showed 173 abnormalities in 105 patients. There were 2 patients with false positive and 3 with false negative findings. The sensitivity and specificity of CCTA were 98.3% and 99.9%, respectively. The positive predictive value and negative predictive value of CCT were 98.9% and 99.9%, respectively. The average DLP and ED values were 15.6±9.6 (SD) mGy.cm and 0.34±0.10 (SD) mSv, respectively. The mean image quality score was 4.8±0.5 (SD) in all patients. The inter-observer agreement for the image quality scores was good (κ=0.80). CONCLUSION CCTA is an excellent imaging modality for evaluation of cardiovascular abnormalities and provides excellent image quality with very low radiation exposure when low-dose prospective ECG-triggered high-pitch DSCT is used.

Cardiac hydatid cyst case recovered with medical treatment.

Sir, the recent report on cardiac hydatid cyst is very interesting (1). Tekin et al. (1) noted for importance on concern of this disease and concluded that “In case of refusal of surgical treatment, medically inoperable patients and surgical high risks (because of the critical localization of the cyst), medical treatment is an available alternative treatment technique. ”The skipping of surgical removal of the cyst is very challenging. Indeed, the use of surgical removal accompanied with the medical treatment is widely used for the cardiac hydatid cyst (2). The long term following up to determine the recurrence and complication of medical treatment without surgical removal of the cyst is very interesting. Finally, seeking for possible cystic lesions at other sites in the body is required since multiple organ involvement is possible (3).

Release of N-terminal pro-brain natriuretic peptide in children with acute rheumatic carditis.

BACKGROUND Acute rheumatic carditis is still an important cause of cardiac failure in developing countries. B-type natriuretic peptides, especially N-terminal segment of its prohormone are now recognised as essential parts of cardiologic evaluation. Increased plasma concentrations of B-type natriuretic peptide and its prohormone are markers of cardiac failure and hypoxia in adults. AIM To measure the prohormone levels in children with acute rheumatic carditis and to determine whether its concentrations correlate with clinical and laboratory findings. METHODS A total of 24 children with acute rheumatic carditis and 23 age and sex-matched healthy subjects were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve insufficiency and cardiac dysfunction. The prohormone plasma levels were tested for correlation with cardiac dysfunction and other biochemical markers, such as C-reactive protein, erythrocyte sedimentation rate, and anti-streptolysin-O titter. RESULTS The prohormone plasma concentrations were significantly higher in children with acute rheumatic carditis than in control subjects at the time of diagnosis. A significant decrease of the plasma level was detected among patients after treatments (6-8 weeks). CONCLUSION We found increased plasma prohormone levels in children with acute rheumatic carditis in the acute stage of illness compared with healthy subjects. Another result is increased plasma prohormone levels as acute rheumatic carditis are reversible.

The usefulness of plasma asymmetric dimethylarginine (ADMA) levels and tissue doppler echocardiography for heart function in term infants born to mothers with gestational diabetes mellitus

Abstract Objective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes. Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group (n = 25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured. Results: In the first analysis, 10 patients (40%) had a septal thickness of 6 mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness ≥6 mm and the group with <6 mm. Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn.

Evaluation of cardiac functions of infants of diabetic mothers using tissue Doppler echocardiography.

AIM Transient cardiac hypertrophy occurs in infants of diabetic mothers. The effect of this state on cardiac functions was investigated with a case-control study using tissue Doppler technique. MATERIAL AND METHODS In this study, right and left ventricle systolic and diastolic functions of 45 term babies of diabetic mothers and 50 healthy term newborns were examined using tissue Doppler echocardiography. RESULTS The septum was found to be thick in 16 (36%) of the babies of diabetic mothers. Both the left and right ventricle myocardial velocities were found to be lower in the babies of diabetic mothers compared to the control group. In our study, the Em/Am ratio was found to be below one only in the babies of diabetic mothers in the left ventricle in contrast to the control group. In addition, the Em/Am ratio in the septum and right ventricle was found to be below one both in the babies of diabetic mothers (group 1, 2) and control group. The calculated Tei index was found to be higher in the babies of diabetic mothers who had a thicker interventricular septum compared to the control group. CONCLUSION Interventricular septal thickening in babies of diabetic mothers disrupt the diastolic function of both ventricles. This can be demonstrated by tissue Doppler echocardiography. These results show that diastolic function is disrupted in both ventricles in babies of diabetic mothers and only in the right ventricle in healthy babies. It was thought that this could be explained by right ventricular dysfunction arising from physiological pulmonary hypertension in the neonatal period. Subclinical right and left ventricular diastolic dysfunctions which we found by tissue Doppler indicate that babies of diabetic mothers especially with a thick septum should be closely monitored.

The future of activity-promoting video games in clinical practice: Is it the ultimate exercise test in prepubertal children?

Paediatric exercise testing laboratories should accommodate subjects of various sizes and ages. To this day, games and conventional treadmill exercise tests have not been carried out in pre-pubertal children. Children cannot easily adapt to the treadmill or cycle ergometer. We therefore aim to the use of video games as a form of exercise tests in pre-pubertal children. Twenty healthy children (10 girls and 10 boys, aged 5-11 years old) were enrolled in the study. The physical examination, 12-lead electrocardiography and echocardiography were performed. The heart rate and respiratory rate were measured with systolic blood pressures. Treadmill exercise testing was performed, and electrocardiographic changes were studied during both the treadmill exercise test with Bruce protocol and an activity-promoting video game (Nintendo Wii Boxing), in different time periods. Exercises were stopped at the target heart rate.The mean duration of exercise was 15 minutes in both the Bruce protocol and the activity-promoting video game. Although the data of healthy children (including heart rate and blood pressure responses to exercise) were consistent with the results from several countries using the Bruce protocol, the mean maximal heart rates for all groups were slightly lower than those obtained with the video game. The data obtained from this new exercise test may be used to determine the diagnosis and activation of cardiovascular disease in pre-pubertal children. It can be used as an exercise test especially in young children who are unable to use the treadmill or cycle ergometer

Assessment of P-wave dispersion in children with atrial septal aneurysm

BACKGROUND This was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm. METHODS A total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 ± 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 ± 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio ≥25% was found on echocardiography. RESULTS There was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 ± 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 ± 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters. CONCLUSIONS This study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.