Metin Sungur

Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer duct occluder II additional sizes: Multicenter study

To evaluate safety and efficacy of closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder II Additional Sizes (ADO II AS) and to report early and midterm results of the device in children and very young symptomatic infants.

Charcoal haemoperfusion in Amitriptyline poisoning: Experience in 20 children

Aim:  Tricyclic antidepressant (TCA) toxicity is common among children and adults due to widespread use. Amitriptyline (AT) is one of the most commonly prescribed TCAs. Current guidelines do not recommend charcoal haemoperfusion (HP) for AT overdose due to high protein binding and large volume of distribution. However evidence regarding the efficacy of charcoal HP in addition to supportive measures is accumulating in the published reports.

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.

Effects of different doses of remifentanil infusion on hemodynamics and recovery in children undergoing pediatric diagnostic cardiac catheterization.

OBJECTIVE The present study aimed to compare 2 different doses of remifentanil infusion on hemodynamics, recovery period, and complications in children undergoing diagnostic pediatric cardiac catheterization. DESIGN A prospective study. SETTING A university hospital. PARTICIPANTS Children undergoing diagnostic cardiac catheterization (n = 60). INTERVENTIONS Children (2-12 years of age) scheduled for elective diagnostic cardiac catheterization under sedation were included in this study. The patients were assigned randomly to 2 groups as follows: patients in group 1 (n = 30) received a remifentanil infusion of 0.1 μg/kg/min, and patients in group 2 (n = 30) received a remifentanil infusion of 0.2 μg/kg/min. Heart rate (HR), systolic and diastolic blood pressures (BPs), oxygen saturation (SpO(2)), respiratory rate (RR), sedation, and recovery scores were recorded. MEASUREMENTS AND MAIN RESULTS There were no significant differences between the groups in terms of systolic and diastolic BPs, HR, SpO(2), and RR during the study period. Additional drugs were required for 15 children in group 1; however, 27 patients maintained a satisfactory level of sedation with the 0.2-μg/kg/min remifentanil infusion. The time to achieve a recovery score of ≥5 was significantly shorter in group 2 than in group 1 (4.1 ± 0.3 minutes v 6.8 ± 0.8 minutes). No postoperative complications were reported in either group. CONCLUSION After oral midazolam premedication and local prilocaine infiltration, 0.2 μg/kg/min of remifentanil provided adequate sedation without any hemodynamic compromise during pediatric diagnostic cardiac catheterization.

The relationship between migraine and right-to-left shunt in children.

Migraine is the most common headache in childhood, and there are some reports that suggest the relationship between migraine and right-to-left shunt. The aim of this study was to evaluate the frequency of right-to-left shunt in children with migraine with aura and compare it with children with migraine without aura, and in healthy children. In a cross-sectional case–control study, we assessed 20 children with migraine with aura, 20 migraine without aura and 20 healthy age, and gender-matched control group. We determined the frequency of right-to-left shunt by transcranial doppler with contrast and transthoracic echocardiography without contrast. The dopplers and echocardiograms were performed blindly by the same examiners during headache-free periods. The presence of right-to-left shunt was found in 13/20 patients with migraine with aura compared with five of 20 migraine without aura and four of 20 control subjects. The frequency of right-to-left shunt in migraine with aura was statistically different from the other two groups (P < 0.005). There was no association between right-to-left shunt and frequency of attacks, duration and intensity of attacks, uni/bilateral occurence, familial occurrence, gender and age of patients. Conclusion: our findings suggest possible association of migraine with aura and right-to-left shunt. It seems that right-to-left shunt does not influence the clinical features of migraine.

Intracardiac thrombus case caused by blunt trauma due to child abuse

Intracardiac thrombus is a rare condition in children, although there has recently been an increase in case reports in the literature. We here report an asymptomatic intracardiac thrombus caused by blunt trauma due to child abuse in a 4-year-old girl. On the echocardiogram, one can see pericardial fluid surrounding all of the heart, and a mobile mass, a thrombus of 5.8 × 9 mm in diameter, was observed in the right atrium and on the free border of the tricuspid valve. The thrombus and pericardial fluid disappeared on the follow-up echocardiogram performed after the 10-day heparin therapy.

Severe myopathy caused by the new pandemic influenza A (H1N1) in a child

Myopathy is a rare complication of influenza infections. Here, we report on an eight-year-old girl with severe myopathy due to new pandemic influenza A (H1N1). She presented with severe myopathy following generalized tonic-clonic seizure and recovered completely within a few days.

An unexpected complication during stent implantation for coarctation of the aorta: Longitudinal stent compression

We report a 17-year-old adolescent with diagnosis of the coarctation of aorta (CoA) underwent stent implantation in which complicated with non expansion and longitudinal compression of the stent.

Transcatheter closure of multiple atrial septal defects in an adolescent

Transcatheter closure of secundum atrial septal defect (ASD) using percutaneous approach has become accepted treatment in many cardiac centers. The majority of patients with ASD require a single device for closure, but a small proportion of ASD patients may have multiple defects and these are often considered unsuitable for device closure. Although spatial imaging to understand the relationship between the defects and adjacent structures is provided on 2-D and 3-D trans-esophageal echocardiography (TEE) 1 and cardiac magnetic resonance imaging can help determine the type, location, and size of the ASD and provide direct visualization of the atrial septum anatomy, 2 little is known about the use of devices to close multiple ASD. Here we report the case of a patient with two separate moderate-sized secundum ASD that were successfully closed using two Amplatzer septal occluders, with emphasis on angiography. Case report A 17-year-old asymptomatic boy was referred due to heart murmur. The patient’s chest X-ray showed mild cardiomegaly with increased pulmonary vascular markings and prominent pulmonary conus. The electrocardiogram showed an incomplete right bundle branch block. Transthoracic 2-D color Doppler echocardiography (TTE) showed features of mild right ventricular volume overload and two different defects in the atrial septum with left-to-right shunts. The patient then was prepared for transcatheter closure of both defects with Amplatzer septal occluders. Defect closure was performed under general anesthesia and endotracheal intubation. After hemodynamic work-up was completed the right superior pulmonary vein was entered using a 6 Fr NIH catheter and angiography was performed in the fourchamber position. TEE was performed before, during and after the procedure to provide continuous multiplane imaging of the atrial septum. The upper defect was situated in the superior– anterior part of the interatrial septum with a margin of approximately 13 mm separating it from the entrance of the superior vena cava. The defect was measured to be 14 mm on TEE. Below this, in a more inferior–posterior plane, another moderate-sized ASD was seen, approximately 13 mm, separated from the higher ASD by septal tissue measuring 16 mm in length (Fig. 1). The inferior rim was 6.3 mm. Both ASD were crossed using a 6 Fr multipurpose catheter that was exchanged for super stiff Amplatzer wires (AGA, Golden Valley, MN, USA). Balloon sizing of posterior–inferior ASD was then performed and the stretched balloon diameter was 15 mm. It was decided to close this ASD using a 16 mm device. We then proceeded to perform the same procedure for the upper ASD. On balloon sizing this defect was 14 mm in size. Under fluoroscopic and echocardiographic guidance the left disk was deployed in the left atrium, the whole assembly was pulled back gently against the septum and then the right atrial disc was deployed. The same procedure was followed as for deploying the first device. At this point the device was not released. On TEE it was seen to be properly positioned with the anterior limbs straddling the aorta. We decided to use a 15 mm device to close this defect. Before release of devices from delivery cable there was superimposition of the second device over the first one due to centering characteristics of the attached devices (Fig. 2). With both devices in place, but not released, the TEE was reviewed. It was confirmed that the devices were not interfering with the mitral and tricuspid valves. After release of both devices there was no superimposition or contact of the devices with each other (Fig. 3). Repeat TEE showed proper positioning of the devices with small residual shunt through the lower margin of the inferior device. The patient was discharged 24 h after the procedure on evaluation with chest X-ray, electrocardiography and TTE. At the time of discharge no residual shunt or rhythm disturbance were observed. Acetylsalicylic acid was prescribed 3 mg/kg daily for 6 months. At 13 month follow up, TTE showed complete device occlusion of both ASD and without obstruction of superior or inferior vena cava, coronary sinus, or right upper pulmonary vein. Although during follow up no communication was observed on TTE, possible friction between the two devices could cause a new defect. Contrast echocardiography was performed 18 months after the procedure and no shunt was observed.

Anomalous Systemic Arterial Supply to Normal Basal Segments of the Left Lower Lobe of the Lung: Therapeutic Implication

We describe a 5-month old infant who presented with a continuous murmur and enlargement of the left heart. The patients diagnosis was an anomalous systemic arterial supply to basal segments of the left lower lobe characterized by a lack of a pulmonary arterial supply. This condition was treated without lobectomy. To our knowledge, this report is the first to describe an anomalous systemic arterial supply to basal segments of the lower lobe of the left lung with a single arterial supply that was treated in childhood without lung resection. Our case offers an alternative treatment to surgical lobectomy for this abnormality.