İbrahim Ece

Analysis of maximum P-wave duration and dispersion after percutaneous closure of atrial septal defects: comparison of two septal occluders.

OBJECTIVE Amplatzer septal occluder (ASO) is the most widely used device for closure of atrial septal defect (ASD). Figulla septal occluder (FSO) is a similar device to ASO with some structural innovations. The aim of study is to assess the maximum P-wave duration (Pmax) and dispersion (Pd) in patients who underwent ASD closure with both devices, to determine the effects of structural innovations on atrial electrical inhomogeneity. METHODS The study is a retrospective cohort analysis. Between December 2005 and March 2010, 121 patients underwent percutaneous closure of secundum ASD were included in this study. FSO was used in 79 patients, ASO in 42 patients. Pmax and Pd were measured on the surface electrocardiography before and soon after procedure. For comparison of P-wave parameters initially and after procedure paired t-test was used. Correlation analysis was performed using Pearson correlation test. RESULTS Pmax and Pd were significantly increased immediate after procedure (p<0.001). In FSO and ASO group pre/postprocedural Pd were 38.3 ± 2.7/ 44.1 ± 2.7 msec and 37.5 ± 2.5/ 50.1 ± 2.2 msec respectively. ASO group had a greater postprocedural Pmax and Pd (p<0.001). Left and right atrial disc diameter and device size were the strongest correlates of Pd (r=0.52, p<0.001; r=0.58, p<0.001; r=0.35, p=0.001, respectively). Moderate correlation was found between pre-intervention Pd and age (p=0.008). CONCLUSIONS Pmax and Pd were significantly increased soon after atrial septal defect closure procedure in both devices. Pd is significantly lower in patients closed with FSO device. Difference may be due to the distinctive texture of devices. There was no significant difference in terms of clinically apparent arrhythmia after closure with both device types.

Effects of carvedilol therapy on cardiac autonomic control, QT dispersion, and ventricular arrhythmias in children with dilated cardiomyopathy

Background The purpose of this study was to examine the effects of carvedilol therapy on autonomic control of the heart and QT-interval dispersion (QTd) among children with idiopathic dilated cardiomyopathy (DCM) whose symptoms were not adequately controlled with standard congestive heart failure therapy. Material/Methods Patients with DCM who were treated with carvedilol were enrolled in the study. All patients had undergone carvedilol therapy in addition to standard therapy for at least 6 months. Clinical, echocardiographic, and electrocardiographic parameters, and 24-h Holter records of patients were retrospectively evaluated before and after carvedilol treatment. Results A total 34 patients (mean age: 7.4±4.3 years) with DCM were analyzed in the study. The median follow-up period was 9.5 months. After the 6 months of carvedilol therapy the clinical score significantly improved, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) significantly increased, and left ventricle end-diastolic dimensions and end-systolic dimensions significantly decreased. There were statistically significant increases in mean SDNN, SDANN, rMSSD, and pNN50 (p=0.002, p=0.001, p=0.008, and p=0.026, respectively). After the carvedilol therapy, SDNN was correlated with the clinical score, heart rate, LVEF, LVFS, and total premature ventricular contractions (PVCs). In addition, rMSSD and pNN50 were correlated with heart rate, LVEF and LVFS. A significant reduction was observed in QTc-minimum, QTc-maximum, and QTd values (434.9±40.7 vs. 416.1±36.5, 497.8±43.6 vs. 456.3±41.7, 58.6±17.1 vs. 49.3±15.6; p<0.001, p=0.001, and p=0.008, respectively). QTd was significantly related to PVCs (r=0.62, p=0.02). Conclusions We conclude that the addition of carvedilol to standard therapy can improve clinical symptoms and heart rate variability, and reduce in arrhythmia markers in children with DCM.

Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus

Abstract Background: The purpose of this study was to evaluate whether or not platelet mass contributes to closure of patent ductus arteriosus (PDA) in premature newborns. Study design and subjects: This retrospective study included 115 preterm newborns with hemodynamically significant PDA (hPDA) and 120 newborns without PDA. The newborns’ platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were noted from their files and the platelet mass (platelet count plus MPV/103) was calculated. Patients with congenital abnormality, persistent pulmonary hypertension or sepsis were not included in the study. Results: Platelet count and PDW were found to not be risk factors for closure of hPDA (p > 0.05), but both high platelet mass (OR 1.25; 95% CI 1.12–1.41) and MPV (OR 1.87; 95% CI 2.52–3.85) were determined to be independent risk factors for hPDA. Conclusions: Platelet mass may be a more significant indicator than platelet count of closure of hPDA in preterm newborns.

Transcathether closure of a right pulmonary artery-to-left atrial fistula using Amplatzer muscular ventricular septal defect occluder.

A right pulmonary artery-to-left atrial fistula is a very rare cyanotic congenital heart defect and is characterized by cyanosis and normal auscultation of the heart. Interventional closure of the fistula using occluder devices and coils has been rarely reported. We report the successful closure of a RPA-to-left atrial fistula using an Amplatzer muscular ventricular septal defect occluder in a child with cyanosis. The two-dimensional echocardiogram with bubble contrast study demonstrated the communication between right pulmonary artery and left atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy.

Efficacy and safety of rectal ibuprofen for patent ductus arteriosus closure in very low birth weight preterm infants

Abstract Background: To compare rectal ibuprofen with oral ibuprofen for the closure of hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) preterm infants. Study design and subjects: In a prospective, randomized study, 72 VLBW infants who had hsPDA received either rectal or oral ibuprofen. The plasma concentration of ibuprofen and renal functions were determined in both groups by the high-performance liquid chromatography (HPLC) method and cystatin-C (cys-C), respectively. Results: The hsPDA closure rate of the group that received rectal ibuprofen was similar to oral ibuprofen (86.1% versus 83.3%) after the first course of the treatment (p = 0.745). A statistically significant difference was identified between the mean plasma cys-C levels before and after treatment in both the rectal and oral ibuprofen groups (p = 0.004 and p< 0.001, respectively). The mean plasma ibuprofen concentration was similar in both groups after the first dose (rectal 44.06 ± 12.4; oral, 48.28 ± 22.8) and the third dose (rectal, 45.34 ± 24.3; oral, 48.94 ± 24.8) (p > 0.05 for all values). Conclusions: Rectal ibuprofen is as effective as oral ibuprofen for hsPDA closure in VLBW infants. The rise in the cys-C level with rectal and oral treatment shows that patients with borderline renal function should be evaluated and followed closely.

Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus.

Abstract Background: The aim of the study was the evaluation of the effects of glycemic control in children and adolescents with type 1 diabetes on cardiac functions. Methods: Diabetic patients were divided into two groups as well-controlled and poorly controlled patients. All patients underwent M-mode, two-dimensions (2D), pulsed wave (PW) Doppler, and tissue Doppler (TDI) echocardiography to evaluate systolic and diastolic functions. Results: Early diastolic mitral flow velocity (Em) and the ratio of early to late diastolic mitral flow velocity (Em/Am) obtained with TDI were found to be significantly lower in the well-controlled then the control group and significantly lower in the poorly-controlled group than the well-controlled group. Am, isovolumetric relaxation time (IVRT) and myocardial performance index (MPI) were significantly higher in the poorly controlled group. The ratio of early mitral diastolic flow velocity obtained with PW Doppler (E) to Em (E/Em) was significantly higher in the diabetic group. According to the mitral valve PW Doppler results, 13.6% of the well-controlled group and 31% of the poorly-controlled group had type 1 diastolic dysfunction. According to the mitral TDI results, 18% of the well-controlled group and 40.4% of poorly-controlled group had type 1 diastolic dysfunction. Conclusions: Conventional and TDI echocardiography revealed impairment in left ventricular functions in some patients. Tissue Doppler echocardiography also revealed diastolic impairment in some patients who appeared normal with PW Doppler echocardiography. The present study found that impairment in left ventricular diastolic functions is directly related to glycemic control and the rate of diabetic cardiomyopathy was higher in children with poor metabolic control.

[Echocardiographic evaluation of left ventricular function in normotansive obese children: a comparative analysis according to body mass index].

OBJECTIVES The purpose of our study was to determine structural and functional changes on left ventricular function (LV) according to body mass index (BMI) in normotansive overweight and obese children. STUDY DESIGN Thirty normotansive overweight children (group 2; mean age: 13.2 ± 2.1 years, BMI: 25-30 kg/m²), 30 obese children (group 3; mean age: 13.3 ± 2.0 years, BMI ≥ 30 kg/m²), and 50 healthy controls (mean age: 13.2 ± 1.8 years, BMI: 18-24.9 kg/m²) were included in this study. Continuous ambulatory pressure was monitored in the obese group, while standard and pulsed wave (PW) Doppler echocardiographic examinations were evaluated in all three study groups. RESULTS In overweight and obese children, left atrial volume, left atrial/aortic root diameter ratio, LV interventricular septum, LV posterior wall thickness, LV end-diastolic diameter and volume, and LV mass were significantly higher than those children in the control group (p<0.01). Blood pressure was within the normal range but was increased in the obese groups. Transmitral E/A and pulmonary vein (PV) systolic/diastolic velocity (S/D) ratios were decreased, but E-wave deceleration time, PVA velocities, and the end-diastolic distance from the mitral annulus to the LV apex were increased in both obese groups (p<0.05). BMI was significantly correlated with duration of obesity and LV mass (r=0.527, r=0.506, p<0.01, respectively). Significantly negative correlations were found between BMI, Mitral E/A, and PV S/D ratio (r=-0.230, r=-0.577, p<0.01, respectively). CONCLUSION Subclinical LV myocardial dysfunction was noted in obese subgroups. Determination of diastolic dysfunction by PV PW Doppler can be useful a pre-obese period.

Assessment of cardiac function in absence of congenital and acquired heart disease in patients with Down syndrome

BackgroundExtra genetic material in patients with Down syndrome (DS) may affect the function of any organ system. We evaluated cardiac functions using conventional tissue Doppler and two-dimensional speckle tracking echocardiography in patients with DS in the absence of congenital and acquired heart disease in patients.MethodsA total of 115 patients with DS between 6 and 13 years of age with clinically and anatomically normal heart and 55 healthy children were included in this cross-sectional study. DS was diagnosed by a karyotype test. Patients with mosaic type were not included in this study. Systolic and diastolic functions were evaluated by echocardiography.ResultsPulsed waved Doppler transmitral early/late inflow velocity (E/A), tissue Doppler mitral annular early/late diastolic peak velocity (Ea/Aa), transtricuspid E/A and tricuspid valve annulus Ea/Aa, pulmonary venous Doppler systolic/diastolic (S/D) wave ratio were lower in patients with Down syndrome than in the control group (P=0.04, P=0.001, P<0.05, P<0.001, P<0.001, respectively). Mitral and tricuspid annular Ea were lower in patients with DS (P<0.001). The right and left ventricular myocardial performance indexes were higher in patients with DS than in the controls (P<0.01). They had significantly higher left ventricular mass, ejection fraction, the mitral annular plane systolic excursion values. However, the Down syndrome group compared with the controls had a lower strain values examined by two-dimensional longitudinal speckle-tracking strain echocardiography.ConclusionThese findings suggest conventional tissue Doppler and two-dimensional longitudinal speckletracking strain echocardiography were useful methods of investigating ventricular function and identifying a higher incidence of biventricular dysfunction in patients with Down syndrome compared with the healthy controls.

Evaluation of cardiac functions of patients with benign joint hypermobility syndrome.

We sought to investigate whether echocardiography with tissue Doppler imaging identifies myocardial dysfunction in children with benign joint hypermobility syndrome (BJHS). This cross-sectional study enrolled 75 children with BJHS and 70 healthy children. We performed detailed echocardiography in individuals with BJHS without inherited connective tissue disorders. Any congenital or acquired cardiac disease was excluded by clinical and echocardiographic examination. Both groups were similar in terms of age, sex, and body mass index. The diameter of the aortic annulus and sinus valsalva were wider in patients with BJHS. There was no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the two groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Deceleration time of early mitral inflow was prolonged in patients with BJHS. Mitral and tricuspid annulus Ea velocity were significantly lower in children with BJHS. Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in patients with BJHS than in the control group. The E/Ea ratio was greater in patients with BJHS than in the control group. Isovolumic relaxation time and right-ventricular (RV) and left-ventricular (LV) myocardial performance indices (MPIs) were greater in patients with BJHS. This study showed the diastolic dysfunction in patients with BJHS. In addition, we detected increased LV and RV MPI. We believe that BJHS may affect proteins of the myocardial cytoskeleton and extracellular matrix.

Assessment of Cardiac Functions in Infants with Cow’s Milk Allergy

Background Cow’s milk allergy is the most common food allergy in children, with rates estimated at 1.9% to 4.9%. Clinical phenotypes of cow’s milk allergy are varied and involve 1 or more target organs, with the main targets being the skin, respiratory system, and gastrointestinal tract. To date, no studies have investigated detailed cardiac function in children with cow’s milk allergy. The current study aimed to investigate cardiac function in infants with cow’s milk allergy. Material/Methods We studied 42 infants with cow’s milk allergy and 30 age- and sex-matched healthy subjects. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Results There were no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the 2 groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Ea/Aa ratios in the left ventricle posterior wall and right ventricle free wall were lower in patients with cow’s milk allergy than in the control group. The E/Ea ratio in the left ventricle, isovolumic relaxation time, deceleration time, and right and left ventricular myocardial performance indices were higher in patients in the study group. Conclusions Our study identified reduced early diastolic tissue Doppler velocities in infants with cow’s milk allergy.