Mehmet Kervancioglu

P-wave dispersion between transcatheter and surgical closure of secundum-type atrial septal defect in childhood

Patients with atrial septal defect have an increased risk for atrial fibrillation. Increased P-wave dispersion predicts the development of atrial fibrillation. The aim of this study was to determine difference in P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure in childhood. A total of 68 children (the mean age was 7.2 plus or minus 3.3 years; the mean secundum atrial septal defects diameter was 17.3 plus or minus 5.4 millimetres) were evaluated in this study. Transcatheter closure was attempted in 41 children with secundum atrial septal defects, and the defect in 27 patients was closed by surgical techniques. P maximum, P minimum and P dispersion were measured by the 12-lead surface electrocardiography. P maximum, P minimum and P dispersion were found to be similar in patients with pre- and post-procedure (98.0 plus or minus 19.3 versus 95.1 plus or minus 23.0 milliseconds; 68.0 plus or minus 20.8 versus 67.6 plus or minus 24.3 milliseconds, 29.9 plus or minus 11.0 versus 27.1 plus or minus 12.1 milliseconds, respectively). There was no statistical significance in the comparison of P dispersion between the two groups. But in the surgical group, P-wave dispersion was decreased more significantly compared with baseline values (p-value equal to 0.03). In conclusion, there is no P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure of secundum atrial septal defect.

Transjugular closure of a two-hole atrial septal defect in a child with iliac vein thrombosis

The internal jugular vein is not a typical vascular access line during the percutaneous closure of an atrial septal defect. We report the closure of a double atrial septal defect with a single device, using a transjugular venous approach, in a child with an inferior vena cava obstructed by a thrombosis due to previous cardiac catheterization. That the transjugular venous approach can be used as a possible alternative during the transcatheter closure of an atrial septal defect in children, when the inferior vena cava access is not possible.

Transcatheter closure of a residual patent ductus arteriosus after surgical ligation in children.

Background and Objectives To assess the safety and efficacy of transcatheter closure of residual ductal flow after initial surgical ligation of the arterial duct. Subjects and Methods Between June 2005 and December 2009, transcatheter occlusion of residual postsurgical ductus arteriosus was performed in six children. Results The mean patient age was 10±5.5 years; mean post-procedural time since the initial surgical closure was 6.3±4.5 years. The mean diameter of the patent ductus arteriosus on angiography was 1.3±0.5 mm (range, 0.8 to 2.4 mm). Three different types of coils were used successfully without any complications. Conclusion Transcatheter occlusion of residual postsurgical arterial duct is a safe and successful procedure. However, attention should be paid due to the distorting shape of the arterial duct.

Left Ventricular Mass in Normal Children and its Correlation with Weight, Height and Body Surface Area

La medicion ecocardiografica de la masa ventricular izquierda (LVM) se utiliza para el diagnostico de la hipertrofia ventricular izquierda en los ninos con diversas enfermedades cardiovasculares. Los objetivos de este estudio fueron establecer los valores normales de MVI en funcion del peso, altura y area de superficie corporal (BSA) en ninos y determinar las diferencias entre sexos. Se evaluaron 208 ninos (143 varones y 65 mujeres), con edades entre 1 dia a 14 anos de edad que presentaban enfermedades cardiovasculares. Se determinaron los valores interno al final del diastole ventricular izquierdo (LVIDd), el espesor de la pared posterior (LVPWd) y el tabique interventricular (IVSd) mediante el examen ecocardiografico en modo M. Utilizando estos valores, fue calculada la masa ventricular izquierda. Las diferencias de los valores LVIDd, LVPWd LVM entre ninos y ninas no fueron estadisticamente significativas. Observamos diferencias estadisticamente significativas entre los sexos en relacion con los valores IVSd y LVM/BSA. La masa ventricular izquierda y sus componentes presentaron una buena correlacion con la edad, peso, altura y BSA. Este estudio nos permitio conocer los limites superior e inferior de las dimensiones cardiacas, junto a la LVM obtenidas mediante ecocardiografia en ninos turcos normales de acuerdo con el BSA. Ademas, como los valores LVM/BSA muestran diferencias entre sexos en los ninos, el sexo se deberia tomar en consideracion al evaluar la hipertrofia ventricular izquierda.

Retrograde transcatheter closure of large coronary fistulas with the Amplatzer vascular plug in children

We report a retrograde approach for the successful closure of large left coronary artery fistulas in the cases of two children using the Amplatzer vascular plug. This method simplified the procedure by eliminating the need for making an arteriovenous loop.

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism

This study aimed to evaluate ventricular diastolic dysfunction, inter‐ and intraatrial conduction delay, and P‐wave dispersion in pediatric patients with subclinical hypothyroidism.

Intracardiac thrombus in children with dilated cardiomyopathy

OBJECTIVES The risk of fatal pulmonary and systemic thromboembolism is high in patients with dilated cardiomyopathy with cardiac thrombus. This study was planned to reveal the efficacy of antiaggregant therapy in patients with low left ventricular systolic ejection fraction (LVEF). STUDY DESIGN The present study retrospectively reviewed the files of 83 cases (42 males, 41 females) with dilated cardiomyopathy who were followed between June 2004 and December 2011. RESULTS Intracardiac thrombus was detected in five (6%) cases; of these five patients, dilated cardiomyopathy was idiopathic in four and secondary to chronic renal failure in one. The cases were followed for a mean of 33.6±35.6 months (3 days-168 months). Mean LVEF on transthoracic echocardiography was found as 35.2±2.7% (32-38%) for the cases with intracardiac thrombus, whereas it was 34.7±11.0% (10-55%) for the cases without intracardiac thrombus. No statistically significant difference was found between the groups (p=0.910). Cases with LVEF ≤30% were routinely receiving acetylsalicylic acid at antiaggregant dose. CONCLUSION We think that prophylactic antithrombotic/antiaggregant therapy should be started at the time of diagnosis even in patients with LVEF >30%, as thrombus development was seen in cases with LVEF >30% without any antiaggregant therapy.

Evaluation of regional left ventricular function with strain rate echocardiography at the percutaneous ventricular septal defect closure at the childhood

The objective of this study is to evaluate changing of regional left ventricle function after percutaneous closure of ventricular septal defect in the children. In this study, echocardiographic analysis of conventional, tissue velocity imaging and strain/strain rate imaging of the left ventricle were evaluated in 29 children with before and after percutaneous ventricular septal defect closure. Study group was consisted 17 girls (58.6%), 12 boys (41.4%) mean age 9.89 ± 5.19 years, mean weight 31.79 ± 17.97 kg, mean ventricular septal defect size 7.08 ± 3.16 mm. Tissue velocity imaging of left ventricular basal septal and lateral wall was not changed significantly (P>0.05). Longitudinal strain pattern of left ventricular basal septal and lateral wall, and mid-septal region was not changed significantly (P>0.05). Left ventricular longitudinal strain of mid-lateral wall was increased significantly (P=0.032). Strain rate imaging study of the left ventricle was not shown any differences between before and after closure (P>0.05). We found that superior systolic strain of mid-lateral wall of the left ventricle indicated the increase of regional systolic function in the left ventricular wall. Changing of longitudinal strain of the left ventricle may represent a response to altered ventricular loading conditions. Strain rate imaging seems to be less dependent on it. Also strain indexes could provide new, noninvasive, clinically informant technique.

CHARGE syndrome together with middle aortic syndrome

CHARGE syndrome is a rarely encountered syndrome characterized by eye and ear anomalies, as well as cardiac defects, genital hypoplasia, coanal atresia, and brain anomalies. Multidisciplinary approach is mandatory in such patients. In particular, detailed cardiac and ophthalmologic examination should be performed, and the patient should be evaluated in terms of audiometric test and genital organs. A two-month-old baby was brought to our clinic with weakness, fatigue, irritability, vomiting, feeding difficulty, and rapid respiration picture. On her physical examination, general status was poor; arrhythmia, tachycardia, and gallop rhythm were detected on cardiac examination and a 5-6 cm hepatomegaly was detected on abdominal examination. In chest radiograph revealed cardiomegaly; In electrocardiography (ECG) revealed atrial flutter attacks with 1:1 rhythm; transthoracic echocardiography revealed dilated cardiomyopathy (EF; 35%, FS; 16%), aortic coarctation in the aortic arch and in the thin, classical part of descending aorta (mean gradient; 30-35 mmHg), and fine patent ductus arteriosus. During the catheterization, tubular hypoplasia of the aortic arch and istmic aortic coarctation, and hypoplasia was observed in the thoracic and abdominal aorta. The patient was considered to have middle aortic syndrome. Moreover, ocular coloboma and retardation of growth and development were identified in the patient. Cardiac and ophthalmic signs together with the signs of retardation of growth and development were considered probable CHARGE syndrome according to the diagnostic criteria reviewed in 2003. Dilated cardiomyopathy secondary to aortic coarctation is a common condition. Dilated cardiomyopathy improves with appropriate and effective therapy. The prevalence of concurrency of CHARGE syndrome and congenital cardiac disease is 60-70%. Different pictures of congenital cardiac disease can be seen. We, here, introduced a case considered to have CHARGE syndrome together with middle aortic syndrome, the concurrency of which has been seen very little.

Evaluation of P-Wave Dispersion, Ventricular Functions and Atrial Electromechanical Coupling in children with Type 1 Diabetes Mellitus

Objective: The present study aimed to evaluate ventricular diastolic function, interand intra-atrial conduction delay, and P wave dispersion in pediatric patients with type 1 diabetes mellitus (DM). Methods: This study comprised 30 pediatric patients with type 1 DM and 30 healthy children served as the control group. P wave dispersion (Pd )was measured on a 12-channel ECG. Both systolic and diastolic functions of both ventricles were evaluated using conventional and tissue doppler imaging (TDI) echocardiography (ECHO). Atrial electromechanical delay was measured using TDI accompanied with electrocardiography (ECG). Results: On conventional transthoracic echocardiography (ECHO), the mitral E/A ratio and isovolumetric relaxation times (IVRT) were different between the patients with type 1 DM and the control group (1.67±0.46 vs. 1.95±0.43, p=0.017 and 74.5±7.0 vs. 63.3±5.2, p<0.001, respectively). On TDI, LV septal peak systolic (Sm) and early diastolic (Em) velocities and Em/Am ratio were found to be significantly lower in the patients with type 1 DM than in the control group (p=0.047, p=0.003, and p=0.001, respectively). Regarding atrial electromechanical conduction, prolongation was detected in PA lateral, PA septal, PA tricuspid, and inter-atrial (PA lateral–PA tricuspid) and intra-atrial (PA septal–PA tricuspid) conduction delay (p<0.001, p<0.001, p<0.001, p<0.001, and p<0.05, respectively). Conclusion: Our findings suggest that intraand inter-atrial conduction delay, p wave dispersion, and ventricular diastolic functions are abnormal in patients with type 1 DM.