Naci Ceviz

Transcatheter closure of patent ductus arteriosus with Nit-Occlud coils

The detachable coils have been successfully used for transcatheter occlusion of small‐ to moderate‐sized patent ductus arteriosus (PDA). We report our experience regarding the use of the Nit‐Occlud coils (NOCs) for transcatheter PDA and major aortopulmonary collateral (MAPCA) occlusion. Single NOCs were used to close PDA in 26 patients, and one small and two large MAPCAs in two patients. Mean age and weight of the patients were 7.7 ± 5.4 years and 20.6 ± 11.6 kg. Mean minimum duct diameter was 2.8 ± 0.8 mm; ampulla, 8.7 ± 2.4 mm; and PDA length, 9.3 ± 4.4 mm. Mean pulmonary artery pressure ranged from 9 to 51 mm Hg and pulmonary/systemic flow ratio from 1.1 to 5.8. Ductal shape was conical in 24 patients. Route of approach was venous in 23 and arterial in 3. Successful coil implantation was achieved in 24/26 (92.3%). Mean procedure and fluoroscopy time were 67.2 ± 22.1 and 14.9 ± 6.5 min. The three MAPCAs were also successfully occluded using NOC Medium and Flex. Postimplantation angiograms revealed no leak in 3, a trace or small leak in 17, and a medium leak in 4 patients. Mean follow‐up was 7 ± 5 months. Complete occlusion was achieved in 17/24 (71%) at 24 hr, 19/24 (79%) by 1 month, 13/15 (87%) by 3 months, 14/15 (93%) by 6 months, and 10/11 (90%) by 12 months postprocedure. Hemolysis, late embolization, duct recanalization, and flow disturbances were not observed. Transcatheter occlusion of moderate‐sized PDAs and MAPCAs using NOCs seems to offer a safe, simple, and controlled method in pediatric patients. Catheter Cardiovasc Interv 2005

The effects of ondansetron and granisetron on electrocardiography in children receiving chemotherapy for acute leukemia.

5-HT3 receptor antagonists, including granisetron and ondansetron, are widely used in the prophylactic treatment of chemotherapy-induced nausea and vomiting. Although the cardiac safety of granisetron and ondansetron has been investigated in several adult studies, there is no report investigating the effects of those agents on electrocardiography (ECG) in children. The effects of intravenously infused (over 30 seconds) 0.1 mg/kg ondansetron and 40 μg/kg granisetron on ECG were assessed in 22 children receiving high-dose methotrexate therapy for acute lymphoblastic leukemia. The ECG recording was obtained at before and just after the infusion, and repeated at 1, 3, 6, and 24 hours of treatment. Granisetron administration resulted in a statistically significant decrease of mean heart rate at 1 and 3 hours, and significant prolongation of mean QT and QTc dispersions at 1 hour of infusion. In patients treated with ondansetron, no meaningful change was observed. In conclusion, intravenous granisetron but not ondansetron causes clinically asymptomatic and transient changes on ECG measurements in children receiving high-dose methotrexate therapy.

Clinical, Electrocardiographic, and Laboratory Findings in Children With Amitriptyline Intoxication

Background: Amitriptyline is one of the major tricyclic antidepressants, and the data on amitriptyline poisoning in children are limited. Objectives: To present our experiences with amitriptyline poisoning in children, particularly with regard to its effects on electrocardiogram (ECG) and relation with clinical status. Methods: Clinical, laboratory, and electrocardiographic findings in 52 children admitted with amitriptyline poisoning were reviewed. Patients were divided into 2 groups according to age, as 6 years or younger (group A) and older than 6 years (group B). Results: Mean age was 4.6 ± 3.0 years. Thirty-one patients were male, and 41 were 6 years or younger. Ingested amitriptyline dose was known in 23 patients (range, 2.3 mg/kg-27 mg/kg). The most frequent findings were lethargy (76.9%), sinus tachycardia (57.7%), and coma (48.1%). Four patients had a history of convulsion. The most common laboratory abnormalities were hyponatremia (26.9%) and leukocytosis (25%). Elevated transaminase levels were observed in 4 patients. In ECG, 11 (22.4%) patients had QTc prolongation and in 4 (8.2%) of them, it was significant. In 4 patients (8.2%), the QRS duration was 100 ms or longer and in 15 patients, the R wave in aVR was 3 mm or longer. The frequencies of clinical, laboratory, and electrocardiographic findings were similar between the 2 age groups (P > 0.05). No clinically apparent arrhythmias were observed. The positive predictive value of a widened QRS was 100% in terms of coma. None of the patients with an R wave in aVR of less than 3 mm developed convulsion; thus, the negative predictive value of an R wave in aVR of 3 mm or longer was 100% in terms of convulsion. Conclusions: Amitriptyline poisoning may result in severe toxicity. Frequencies of clinical, laboratory, and ECG findings were similar in the 2 age groups. Amitriptyline overdose results in some ECG changes that can possibly help to predict the results of poisoning. Absence of an R wave in aVR of 3 mm or longer predicts seizures with a high negative predictive value, and a QRS duration of 100 or longer ms predicts coma with a high positive predictive value.

Intravenous Paracetamol for Patent Ductus Arteriosus in Premature Infants - A Lower Dose Is Also Effective

babies with hsPDA. The first patient was a 29-week premature infant (birth weight 1,045 g, postnatal age 3 days). Oral ibupro-fen was contraindicated in this patient due to suspected necrotizing enterocolitis (NEC). We started IV paracetamol with the dose regimen suggested by Oncel et al. [1] . After the first 4 doses, transaminase levels were checked and a significant increase was detected compared to pretreatment levels (aspartate aminotransferase (AST) 43 vs. 260 U/l, alanine aminotransferase (ALT) 11 vs. 180 U/l). The drug was ceased and transaminase levels normalized over the following 4 days. After this experience, we decreased each dose to 10 mg/kg (3 doses/day). An echocardiographic study was per-formed after each of the 3 doses. If the duc-tal shunt had disappeared, treatment was stopped, but if it persisted, an additional 3 doses were given, for a maximum of 4 days. In 6 additional patients, IV paracetamol was used with this dosing regimen. All were very low birth weight infants. The gesta-tional ages were <28 weeks (1 patient) and 28–31 weeks (5 patients). Oral ibuprofen could not be given to 2 patients due to Dear Sir, We read with great interest the recent article by Oncel et al. [1] entitled ‘Intrave-nous paracetamol treatment in the man-agement of patent ductus arteriosus in ex-tremely low birth weight infants’. It is the first study to report the results of intrave-nous (IV) paracetamol in premature in-fants where a 3-day treatment (15 mg/kg dose, 4 doses/day) is offered. In the case of treatment failure at the end of the third day, a second course is administered. Palmer et al. [2] reported the following dose regimen for IV acetaminophen to be safe in premature infants: 28–32 weeks, 10 mg/kg; 32–36 weeks, 12.5 mg/kg, and 36 weeks, 15 mg/kg. Although the gestational ages of the patients in the study of Oncel et al. [1] were low, they used a higher dose; no side effect related to IV paracetamol was re-ported. In our clinical practice, prematures with hemodynamically significant patent ductus arteriosus (hsPDA) and contraindi-cations for oral ibuprofen present a great challenge. For these patients, IV para ce ta-mol seems to be a good alternative. We ad-ministered IV paracetamol in 7 preterm

Patient- and lead-related factors affecting lead fracture in children with transvenous permanent pacemaker

AIMS Fracture in transvenous pacing leads is one of the most common reasons for lead abandonment. Although the factors affecting lead failure rates have been investigated, there is no study evaluating the clinical parameters that affect lead fracture in children. We report our experience with lead fracture in children with transvenous pacemakers. METHODS AND RESULTS The follow-up results of 264 leads from 184 patients were evaluated using pacemaker follow-up data. Underlying conditions, implant data, and lead features were evaluated for the analysis of lead fracture. During a mean follow-up of 72.8 +/- 39.7 months (range 3.2-160.6, median 70), lead fracture developed in 19 leads (7.2%) from 18 patients. The mean duration between implantation and lead fracture was 57.3 +/- 35 months (range 6.8-130, median 51). All fractures occurred in the leads implanted by the infraclavicular subclavian approach. Cumulative survival at the end of 5 years was 92.7% in terms of lead fracture. None of the patient-related risk factors correlated with lead fracture. Multivariate analyses of lead-related risk factors revealed a significant correlation only between lead fracture and fixation mechanism (P < 0.05). CONCLUSION Our results indicated that none of the patient-related risk factors was correlated with lead fracture. Among lead-related risk factors, only the fixation mechanism was found to be correlated with lead fracture; thus, it seems that passive fixation mechanism is safer in terms of lead fracture. Although all fractures occurred in the leads implanted by the intrathoracic subclavian approach, statistical analysis revealed no significance for this parameter. The effect of the extrathoracic approach should be investigated in a large group of patients.

Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: imaging modalities and literature review.

Congenital eventration of the diaphragm, as a cause of mediastinal mass, is an unusual condition and it may be unilateral or bilateral. Although this entity is frequently asymptomatic and firstly detected on the chest radiography, it may be difficult to distinguish a partial eventration from the other diaphragmatic lesions or mediastinal pathologies on the chest radiographs. US may present valuable information about diaphragm integrity with eventration content or the other diaphragmatic pathologies. Although the other imaging modalities such as fluoroscopy, computed tomography, and MR imaging may be performed as adjunct techniques in cases of the diagnosis still in doubt, they are frequently unnecessary after US. Our goal is to present imaging features and management of this entity together with a literature review.

Dilated cardiomyopathy secondary to rickets-related hypocalcaemia: eight case reports and a review of the literature.

INTRODUCTION Dilated cardiomyopathy is usually idiopathic and may arise secondary to infections or metabolic or genetic causes. Another rare cause is hypocalcaemia. Owing to the fact that calcium plays an essential role in excitation and contraction of myocardial muscle, myocardial contractility may decline in patients with hypocalcaemia. MATERIALS AND METHODS Patients with symptoms of congestive heart failure and rickets-related hypocalcaemia were assessed clinically and by echocardiography in a paediatric cardiology clinic. Echocardiography was performed for all patients. Rickets was diagnosed according to the clinical, laboratory, and radiologic findings. Maternal lifestyle and living conditions were investigated, and the maternal 25-OH vitamin D3 blood level was measured. RESULTS We evaluated eight patients who developed heart failure as a result of severe hypocalcaemia associated with rickets between August, 1999 and June, 2012. The age distribution of the patients was 3-12 months. Laboratory results were consistent with advanced-stage rickets. Severe hypocalcaemia was detected in all patients. The maternal 25-OH vitamin D3 levels were low. Echocardiography revealed increased pre-treatment left ventricle end-systolic and end-diastolic diameters for age and reduced ejection fraction and fractional shortening. After clinical improvement, the patients were discharged. CONCLUSIONS Severe hypocalcaemia associated with rickets must always be kept in mind among the causes of dilated cardiomyopathy and impaired cardiac function in infants. If diagnosed and treated in time, dilated cardiomyopathy and severe heart failure related to rickets respond well.

Successful treatment of Epstein–Barr virus infection associated with myocarditis

Epstein‐Barr virus (EBV) is one of the herpes viruses that cause infectious mononucleosis. This disease mostly affects adolescents, but may occur at an earlier age in developing countries. 1,2 It has been postulated that clinical symptoms are due to EBV-induced humoral and cellular immunity and that only limited pathology is caused by viral replication. 2 In symptomatic cases, after an incubation period of 3‐7 weeks, the classical triad of fever, pharyngitis and adenopathy is seen. Mononucleosis is usually a benign, self-limited, lymphoproliferative disorder with rare complications involving hematologic, hepatorenal, splenic, dermatologic, immunologic and cardiopulmonary systems. Myocarditis is an unusual complication of infectious mononucleosis, occurring with an incidence of 0‐6% in several large clinical series. 1 The EBV infection is mostly managed with supportive care. There are clinical trials of steroid therapy, with and without acyclovir, for selected cases. 3‐6 Acyclovir is a nucleoside analog with antiviral activity against the herpes viruses. Steroid therapy may inhibit T cell activation, cytokine production and EBV-induced autoantibody production that may be responsible for some complications of infectious mononucleosis. 2 Nevertheless, there is a general reluctance to use steroids routinely in the treatment of EBV infection, because of unknown long-term effects on the natural immunity to EBV and the possible complications of encephalitis and myocarditis. 3,6‐8

Clinical characteristics of neonates With VACTERL association

Background:  The VACTERL association (VA) is the non‐random co‐occurrence of vertebral anomalies, anal atresia, cardiovascular malformations, tracheoesophageal fistula and/or esophageal atresia, renal anomalies, and/or limb anomalies, and is referred to by the first letters of its components. Studies investigating the clinical characteristics of VA patients and probing of the observed current six component types are limited, and none of them is focused on neonates. We investigated the clinical characteristics of our patients diagnosed as having VA in the newborn period.

Carotid intima‐media thickness: is it correlated with stroke side?

Objective – The objective of the present study was to investigate the possible correlation between the common carotid artery (CCA) intima‐media thickness (IMT) and the infarct side.