Osman Güvenç

Prospective ECG-gated high-pitch dual-source cardiac CT angiography in the diagnosis of congenital cardiovascular abnormalities: Radiation dose and diagnostic efficacy in a pediatric population.

PURPOSE The goal of this study was to investigate the radiation dose and diagnostic efficacy of cardiac computed tomography angiography (CCTA) using prospective ECG-gated high-pitch dual-source computed tomography (DSCT) in the diagnosis of congenital cardiovascular abnormalities in pediatric population. MATERIALS AND METHODS One hundred five pediatric patients who were clinically diagnosed with congenital heart disease with suspected extracardiac vascular abnormalities were included in the study. All CCTAs were performed on a 128×2-section DSCT scanner. CCTA findings were compared with surgical and/or conventional cardiac angiography findings. Dose-length product (DLP) and effective doses (ED) were calculated for each patient. Patients were divided into 4 groups by age, and ED and DLP values were compared among groups. The image quality was evaluated using a five-point scale. RESULTS CCTA showed 173 abnormalities in 105 patients. There were 2 patients with false positive and 3 with false negative findings. The sensitivity and specificity of CCTA were 98.3% and 99.9%, respectively. The positive predictive value and negative predictive value of CCT were 98.9% and 99.9%, respectively. The average DLP and ED values were 15.6±9.6 (SD) mGy.cm and 0.34±0.10 (SD) mSv, respectively. The mean image quality score was 4.8±0.5 (SD) in all patients. The inter-observer agreement for the image quality scores was good (κ=0.80). CONCLUSION CCTA is an excellent imaging modality for evaluation of cardiovascular abnormalities and provides excellent image quality with very low radiation exposure when low-dose prospective ECG-triggered high-pitch DSCT is used.

The usefulness of plasma asymmetric dimethylarginine (ADMA) levels and tissue doppler echocardiography for heart function in term infants born to mothers with gestational diabetes mellitus

Abstract Objective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes. Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group (n = 25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured. Results: In the first analysis, 10 patients (40%) had a septal thickness of 6 mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness ≥6 mm and the group with <6 mm. Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn.

The future of activity-promoting video games in clinical practice: Is it the ultimate exercise test in prepubertal children?

Paediatric exercise testing laboratories should accommodate subjects of various sizes and ages. To this day, games and conventional treadmill exercise tests have not been carried out in pre-pubertal children. Children cannot easily adapt to the treadmill or cycle ergometer. We therefore aim to the use of video games as a form of exercise tests in pre-pubertal children. Twenty healthy children (10 girls and 10 boys, aged 5-11 years old) were enrolled in the study. The physical examination, 12-lead electrocardiography and echocardiography were performed. The heart rate and respiratory rate were measured with systolic blood pressures. Treadmill exercise testing was performed, and electrocardiographic changes were studied during both the treadmill exercise test with Bruce protocol and an activity-promoting video game (Nintendo Wii Boxing), in different time periods. Exercises were stopped at the target heart rate.The mean duration of exercise was 15 minutes in both the Bruce protocol and the activity-promoting video game. Although the data of healthy children (including heart rate and blood pressure responses to exercise) were consistent with the results from several countries using the Bruce protocol, the mean maximal heart rates for all groups were slightly lower than those obtained with the video game. The data obtained from this new exercise test may be used to determine the diagnosis and activation of cardiovascular disease in pre-pubertal children. It can be used as an exercise test especially in young children who are unable to use the treadmill or cycle ergometer

Assessment of P-wave dispersion in children with atrial septal aneurysm

BACKGROUND This was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm. METHODS A total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 ± 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 ± 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio ≥25% was found on echocardiography. RESULTS There was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 ± 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 ± 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters. CONCLUSIONS This study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.

A rare situation in acute rheumatic carditis: involvement of all four valves

Güvenç O, Çimen D. A rare situation in acute rheumatic carditis: Involvement of all four valves. Turk J Pediatr 2017; 59: 497-500. Acute rheumatic fever continues to be an important health problem, especially in countries that are socioeconomically underdeveloped. Carditis, which develops in approximately half of the patients, is responsible for both early-stage mortality as well as late-stage surgical treatment due to heart valve insufficiency or stenosis. The most frequent and severe valve involvement is with the mitral valve, while the aortic valve has the second highest incidence of involvement. Pulmonary and tricuspid valves are rarely involved. The literature cites a few adult cases in which all four valves are affected by rheumatic carditis; however, to the best of our knowledge, there have been no acute-stage rheumatic carditis pediatric cases reported. This article presents a 13-year-old male patient of Syrian origin who escaped to Turkey from the war in his country, and who was in the acute stage of rheumatic carditis in which all four valves were involved.

Co-occurrence of Carpenter syndrome and double outlet right ventricle

Carpenter syndrome (Acrocephalopolysyndactyly type 2, OMIM 201000) is a rarely seen autosomal recessive disorder. In addition to abnormalities such as acrocephaly, craniosynostosis, facial asymmetry, polydactyly and syndactyly, obesity, hypogonadism, mental retardation, and corneal opacity, it may frequently be accompanied by congenital heart diseases such as ventricular septal defect, patent ductus arteriosus and pulmonary stenosis. Double outlet right ventricle is a defect in which both major arteries originate in the morphological right ventricle. To the best of our knowledge, this is the first report in the literature of double outlet right ventricle disease in combination with Carpenter syndrome.

Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome

Sol koroner arterin pulmoner arterden cikis anomalisi olarak tanimlanan ALCAPA sendromu, cocuklarda nadir gorulen bir konjenital kalp hastaligidir. Tedavi edilmedigi zaman konjestif kalp yetmezligi, dilate kardiyomiyopati DKM , iskemik ve aritmik komplikasyonlarla hasta kaybedilebilir. Tani ekokardiyografi bulgulariyla koyulur, tanidan suphelenilen olgularda bilgisayarli tomografi, manyetik rezonans goruntuleme ve kalp kateterizasyonu gibi ileri tetkiklerden faydalanilabilir. Cocukluk caginda DKM tanisi alan hastalarda etiyolojide, cerrahi olarak duzeltme sansi olan ALCAPA sendromu mutlaka dusunulmelidir. Bu yazida, merkezimize DKM tanisiyla sevk edilen, ekokardiyografi ile ALCAPA sendromu tanisi konulup, basarili cerrahi tamir yapilan hasta olgu sunumu yapildi ve son literatur gozden gecirildi