F. Sedef Tunaoglu

Late cardiac evaluation of children with solid tumors after anthracycline chemotherapy.

The therapeutic potential of anthracycline antibiotics is limited by their cardiotoxicity. Electrocardiography, exercise testing, and two‐dimensional echocardiography are non‐invasive techniques used in the follow‐up of children for cardiotoxicity. Plasma B‐type natriuretic peptide (BNP) levels are thought to be useful markers in the early detection of AC induced cardiomyopathy.

Early diagnosis of anthracycline toxicity in asymptomatic long-term survivors: dobutamine stress echocardiography and tissue Doppler velocities in normal and abnormal myocardial wall motion

AIMS Asymptomatic long-term cancer survivors treated with anthracycline were investigated for late anthracycline cardiotoxicity using dobutamine stress echocardiography (DSE) and tissue Doppler (TD) velocities. METHODS AND RESULTS The study comprised 20 asymptomatic patient and 18 healthy children as the control group. Twenty patients were divided into two groups according to the myocardial wall motion during DSE: Group 1 (normal myocardial wall motion; six girls and five boys) and Group 2 (abnormal myocardial wall motion: nine boys). Intravenous dobutamine infusion was started at a dose of 5 µg/kg/min (D5) and gradually increased to 10 (D10), 15 (D15) and 20 µg/kg/min (D20). Echocardiographic assessment was performed at rest and after each dose of dobutamine infusion. Abnormal myocardial wall motion was observed at rest in 3 patients and during DSE in six patients. There were no significant differences between the patients and control groups at rest except the end systolic wall stress and mitral deceleration time measured by conventional methods; however, both patients group showed significant differences of systolic and diastolic functions at D20. In patients groups, systolic and diastolic functions of interventricular septum (IVS) and systolic function of left ventricle (LV) and right ventricle (RV) TD velocities showed significant changes compared with control group at rest. Significant differences of diastolic functions of IVS and RV were noted during dobutamine infusion in abnormal myocardial wall motion compared with other groups. CONCLUSION LV, RV and IVS TD velocities systolic function at rest and during DSE can provide valuable information for early detection of subclinical cardiac toxicity. TD velocities of diastolic functions during DSE are a valuable parameter for assessment of subclinical cardiac toxicity in patient with abnormal wall motion.

Atrial natriuretic peptide concentrations in children with pulmonary hypertension: Correlation with hemodynamic measurements

SummaryTo define the relation between atrial natriuretic peptide (ANP) and hemodynamic parameters in children with pulmonary artery hypertension, we measured the ANP concentrations of the femoral vein, right atrium, pulmonary artery, left atrium and left ventricle, or femoral artery in 32 patients during right or left heart catheterization. There is a strong correlation among the ANP levels obtained from different locations (p<0.001), and these ANP levels are positively correlated with pulmonary arterial pressures and pulmonary resistance. Patients were divided into two groups according to their pulmonary arterial pressure. The group with pulmonary arterial systolic pressure higher than 31 mmHg had higher ANP levels than the group with pulmonary arterial systolic pressure lower than 31 mmHg. When patients were grouped according to their pulmonary resistance, ANP levels in the group with pulmonary resistance over 2 U/m2 were higher than those in the group with pulmonary resistance lower than 2 U/m2. In this study ANP levels showed a correlation with the right ventricular systolic pressure. A correlation was not seen between ANP levels and the flow ratios or the presence of shunt. The results of our study suggest that ANP should be considered an important factor in pulmonary hypertension, independent of other factors.

Quantitative Evaluation of Right Ventricle Function by Transthoracic Echocardiography in Childhood Congenital Heart Disease Patients with Pulmonary Hypertension

Introduction and Objective: The present study aims to quantitatively evaluate the right ventricle (RV) function by means of transthoracic echocardiography in normal children and childhood congenital heart disease patients with pulmonary hypertension. Patients and Methods: This study was conducted in a cohort including 40 healthy children and 30 pediatric patients with pulmonary hypertension who were diagnosed under close surveillance at the study center between October 2009 and November 2010. Results: Statistically significant differences were found between the patient and control groups for the right ventricle myocardial performance index (RVMPI), the left ventricle myocardial performance index (LVMPI), the tricuspid valve systolic flow velocity (Ts), the ratio of systolic pulmonary artery pressure to the right ventricle outflow tract systolic flow velocity time integral (sPAP/RVOT VTI), and the ratio of systolic pulmonary artery pressure to right ventricle outflow tract systolic flow velocity time integral × heart rate (sPAP/[RVOT VTI×HR]). When the children were divided into three groups based on their pulmonary vascular resistance significant differences emerged that predicted an increasing severity of RV dysfunction. Significant differences were also observed for the RVMPI, the LVMPI, and the Ts as well as for echocardiographic pulmonary flow (Qp) and systemic flow (Qs). Discussion: The present study demonstrates that echocardiographic parameters can be used for the quantitative detection of RV dysfunction in childhood congenital heart disease patients with high pulmonary artery pressure (systolic, diastolic, and mean) or pulmonary vascular resistance.

Temporary Blindness Due to Sodium Nitroprusside Overdosage in a Postoperative Patient: an Unusual Adverse Effect

Sodium nitroprusside dihydrate (SNP) is a powerful and easily managed vasodilator which is administered by intravenous infusion following appropriate dilution. Although it was first used in 1951 for treating hypertensive crises in adults, its use in children for this indication was first reported in 1969. 1 Since this report, it has been widely used in various cardiovascular and other disorders amenable to hypotensive therapy. The drug must be used carefully because it has some undesirable effects like fatigue, syncope, and shock due to rapid fall in blood pressure. Also, if the drug is administered in high dosage, symptoms of cyanide (CN) poisoning may appear. 2 Symptoms and signs of nitroprusside toxicity in children have been underemphasized in the medical literature. In this article, a child is presented who had temporary blindness due to SNP intoxication in the postoperative period after correction of coarctation of the aorta.

Congenital heart disease and pulmonary tuberculosis

A 13-year-old boy with atrial septal defect and tricuspid valve abnormality was reported. He had crepitan ralles and signs of heart failure. He was treated with digital, diuretic and antimicrobial therapies. After clinical improvement he underwent surgery. The atrial septal defect was closed, and ringplasty was applied to the tricuspid valve. After the operation, he could not be extubated because of respiratory failure. On the seventh day following the surgery, he developed pneumothorax and hyportension and died. Postmortem examination showed bilateral diffuse pulmonary tuberculosis. The aim of this report is to emphasise the association of tuberculosis and congenital heart disease.