Rahmi Özdemir

Are Mean Platelet Volume and Platelet Distribution Width Useful Parameters in Children With Acute Rheumatic Carditis

Rheumatic fever (RF) is an inflammatory disease caused by autoimmune response to a preceding group A streptococcal infection. Mean platelet volume (MPV) reflects the platelet size and the rate of platelet production in bone marrow, and it may be used as an indicator of platelet activation and severity of inflammation. Fifty-three consecutive patients diagnosed with acute rheumatic carditis and 53 control subjects were enrolled into this study. Leukocyte and platelet counts were significantly higher in patients with acute carditis before treatment compared with controls, whereas MPV and platelet distribution width (PDW) values were not significantly different between groups. Platelet counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values were decreased significantly in patients with RF after treatment. There was not a significant difference in terms of platelet count between the controls and the patient group after treatment. ESR was found to be correlated with CRP in patients before and after treatment. In conclusion, the results of our study showed that MPV and PDW levels do not change during acute rheumatic carditis before and after treatment.

Usefulness of Neutrophil to Lymphocyte Ratio in Prediction of Coronary Artery Lesions in Patients with Kawasaki Disease

BACKGROUND Kawasaki disease is an inflammatory condition. Neutrophil to lymphocyte ratio is a marker reflecting inflammation. AIMS The aim of the study is to evaluate usefulness of neutrophil to lymphocyte ratio in diagnosis of Kawasaki disease and in prediction of coronary artery lesions. STUDY DESIGN Retrospective cross-sectional study. METHODS Seventy-five children with Kawasaki disease and 66 controls were retrospectively enrolled. Their leukocyte, neutrophil, and lymphocyte counts were recorded. Abnormally distributed data were shown as median (interquartile range). Cases having coronary artery diameter two standard deviation above mean were diagnosed to have coronary artery lesions. RESULTS Median age of Kawasaki disease patients was 34 months. Twentyfive of those (33.33%) had incomplete Kawasaki disease and twenty-six (34.66%) had coronary artery lesions. Leukocyte [12.61 (6.09)×10(3)/µL vs. 8.48 (5.58)×10(3)/µL], neutrophil [6.73 (4.10) ×10(3)/µL vs. 4.62 (5.47)×10(3)/µL], and lymphocyte [4.04 (2.91)×10(3)/µL vs. 3.02 (2.57) ×10(3)/µL] counts were significantly higher in Kawasaki disease patients compared to controls (all p values <0.01). However, there was not significant difference between patients and controls regarding neutrophil to lymphocyte ratio [1.72 (1.22) vs. 1.71 (1.88)]. Findings of Kawasaki disease and incomplete Kawasaki disease cases did not differ, while comparison of patients with and without coronary artery lesions revealed significantly higher neutrophil to lymphocyte ratio values in former group [2.02 (1.63) vs. 1.50 (1.28), p=0.01]. The cut-off neutrophil to lymphocyte ratio value for prediction of coronary artery lesions was determined as 1.32. CONCLUSION Neutrophil to lymphocyte ratio values in Kawasaki patients with coronary lesions were significantly higher than the ones without and values greater than 1.32 were useful in prediction of coronary lesions.

Risk Factors for Thrombosis, Overshunting and Death in Infants after Modified Blalock-Taussig Shunt

BACKGROUND The Modified Blalock-Taussig shunt procedure can provide increased flow of blood to the lungs for babies born with certain congenital heart defects. We evaluated 44 subjects under 2 years of age who had a Modified Blalock-Taussig shunt (MBTS) procedure performed from 2009-2013, to investigate risk factors for thrombosis, overshunting and death. METHODS The study subjects included in our investigation were severely cyanotic newborns with pulmonary stenosis or atresia and duct dependent circulation, and infants having Tetralogy of Fallot with small pulmonary arteries who underwent a MBTS procedure in our facility from 2009-2013. We duly noted patient preoperative characteristics such as hemoglobin, hematocrit, mean platelet volume, prothrombin time and partial thromboplastin time. Our study investigated the risk factors for post-operative overcirculation, thrombosis and death. RESULTS The age and weight of patients in our study at the time of procedure ranged from 1 day to 20 months old (median 12 days), and 2.4 kg to 12 kg (mean 4.6 kg), respectively. A total of 8 patients died following surgery, and. 4 (9.1%) had shunt thrombosis, of which one died during shunt revision. Partial thromboplastin time was 28.7 seconds in patients with thrombosis, and 35 in all other patients (p = 0.04). Overcirculation was detected in 5 patients; shunt size/body weight was 1.25 in patients who had overcirculation, and 1.06 in all other patients. CONCLUSIONS It is important to assess risk factors associated with the MBTS operation. The results of our study suggest that a preoperative low aPTT value may be an indicator for thrombosis in infants who have undergone MBTS surgery.

A Valuable Tool in Predicting Poor Outcome due to Sepsis in Pediatric Intensive Care Unit: Tp-e/QT Ratio

OBJECTIVE To assess the feasibility of 12-lead electrocardiographic (ECG) measures such as P wave dispersion (PWd), QT interval, QT dispersion (QTd), Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in predicting poor outcome in patients diagnosed with sepsis in pediatric intensive care unit (PICU). METHODS Ninety-three patients diagnosed with sepsis, severe sepsis or septic shock and 103 age- and sex-matched healthy children were enrolled into the study. PWd, QT interval, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were obtained from a 12-lead electrocardiogram. RESULTS PWd, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were significantly higher in septic patients compared with the controls. During the study period, 41 patients had died. In multivariate logistic regression analyses, only Tp-e/QT ratio was found to be an independent predictor of mortality. CONCLUSION The ECG measurements can predict the poor outcome in patients with sepsis. The Tp-e/QT ratio may be a valuable tool in predicting mortality for patients with sepsis in the PICU.

Red blood cell distribution width: can it be a predictive marker for long-term valvular involvement in children with acute rheumatic carditis?

In this study, we aimed to evaluate Red blood cell distribution width (RDW) in patients with acute rheumatic carditis during the acute phase and after anti‐inflammatory therapy.

Mid-term assessment of cardiac autonomic functions in children with transposition of the great arteries after arterial switch operation.

OBJECTIVE It has been documented that impaired heart rate variability (HRV) is related to life threatening arrhythmias in children with surgically repaired congenital heart disease. We aimed to analyze the balance of the cardiac autonomic functions by assessing HRV in children with arterial switch operation (ASO). METHODS In this observational cohort study, HRV analysis using 24-h Holter electrocardiography recordings was examined in 22 patients (mean age: 59.5±38.7 months, 18 male, 4 female) who had undergone ASO during the newborn period and 22 healthy children (mean age: 65.1±39.4 months, 18 male, 4 female). After Kolmogorov-Smirnov testing for normality, Student t-test and Mann-Whitney U test were used when appropriate. Chi-square was used for categorical data. RESULTS In 24-h HRV analysis showed that SDANN and VLF were significantly higher in patient group. Awake SDNN, rMSSD, pNN50, TP and VLF levels of patient group were significantly higher than those of control subjects. Awake LF/HF ratio in patient group was significantly higher than their counterpart in asleep group. In the patient group, awake rMSSD, pNN50, TP, LF and HF were significantly lower than their counterpart in the asleep group. CONCLUSION Children with transposition of the great arteries (TGA) following ASO have not decreased levels of time and frequency HRV parameters in the mid-term follow-up period. All HRV parameters reflecting vagal tone were increased in the patient group. It is suggested that vagal tone is more predominant than sympathetic tone for children with ASO.

An unexpected aortic valve in trisomy 21

Quadricuspid aortic valve (QAV), a rare congenital anomaly [Hurwitz and Roberts, 1973], was first described by Balington in 1862 [Robicsek et al., 1969]. The prevalence of this entity ranges from 0.013% to 0.043% [Holm et al., 2004]. Aortic regurgitation is more prevalent valvular dysfunction than stenosis in these patients [Tutarel, 2004]. Trisomy 21, also calledDown syndrome is themost commonly seen chromosomal abnormality that often associated with congenital heart defect [Stoll et al., 1998]. Some cardiac valvular abnormalities have been reported in patients with Down syndrome but QAV has not been reported previously [Aughton et al., 1995]. Herein we present a patient with Down syndrome and QAV. To best our knowledge this is the first report of co-occurrence of Down syndrome and QAV. A 6-year-old boy with trisomy 21 was referred to our pediatric cardiology department due to the diastolic murmur on physical examination at outpatient clinic. The patient’s medical history was unremarkable for any cardiac abnormality. Physical examination showed appropriate growth for Down syndrome growth charts and cardiac auscultation revealed a early diastolic murmur along the lower left sternal border. Electrocardiography was normal. Transthoracic echocardiographic examination showed structurally normal heart with exception of unexpected QAV with four equal cusps (Fig. 1a,b). Color Doppler imaging showed mild aortic regurgitation (Fig. 1c). Upon this, the patient was followed for aortic regurgitation and given prophylaxis for infective endocarditis. Different type of congenital cardiac anomalies such as atrioventricular septal defects, atrial septal defects, ventricular septal defects, tetralogy of Fallot and patent ductus arteriosus can be components of the 40–50%of patientswith trisomy21whohave structural heart defect [Stoll et al., 1998]. Isolated bicuspid aortic valve associated with Down syndrome was also reported [Aughton et al., 1995]. But coexistence of isolated QAV and trisomy 21 has not been documented previously. A QAV is a rare congenital anomaly and is usually detected incidentally [Hurwitz and Roberts, 1973]. The mechanism of this anomaly is still unexplained, abnormal septation of the embryological arterial trunk can lead to QAV [Formica et al., 2004]. Regurgitation is the more commonly seen valvular dysfunction due to abnormal leaflet coaptation which increases the risk of endocarditis. Coronary artery abnormalities can be

Echocardiographic evaluation of cardiac functions in newborns of mildly preeclamptic pregnant women within postnatal 24–48 hours

Abstract The aim of this study is to detect preeclampsia-related cardiac dysfunction within 24–48 hours of delivery in newborns born from preeclamptic mothers. Forty newborns from mildly preeclamptic mothers formed the study group and the control group was formed by 40 healthy newborns. Cardiac function for the groups were evaluated using conventional echocardiography and myocardial performance index (MPI) within the first 24–48 hours of their lifetime and the results of both groups were compared. A significant difference between the groups was observed especially in the PW Doppler MPI measurements (the left ventricle MPI 0.37 ± 0.09 and 0.26 ± 0.11, p < .001; the right ventricle MPI 0.29 ± 0.08 and 0.26 ± 0.07, p < .035) for the control group and the study group. Elongation in the left and right ventricle MPI was detected to be more significant in terms of comparing systolic and diastolic functions to determine preeclampsia-related cardiac injury in newborns from preeclamptic mothers within the first 24–48 hours of their lifetime. Impact statement Today, the methods which may detect cardiac injury earlier than conventional echocardiographic methods are used for evaluating cardiac functions. Among them, myocardial performance index (MPI) measurement with PW Doppler is the most common ones. While studies are available in the literature evaluating foetal cardiac functions with MPI in foetuses of preeclamptic women, studies evaluating cardiac functions with MPI index within the first 24–48 hours in postnatal period are not available. This is the first study to detect cardiac injury by measuring cardiac functions of the newborns of preeclamptic babies using conventional echocardiography (EF, SF, mitral and tricuspid E/A) and myocardial performance index within the first 24–48 hours of life and compare these values with those of a control group composed of healthy newborns with similar demographic characteristics. According to the results of the study, elongation in right and left ventricle MPI was detected to be more significant compared to systolic and diastolic functions for determining preeclampsia-related cardiac injury in newborns of preeclamptic mothers within 24–48 hours of delivery. Ventricle functions of the newborns of preeclamptic mothers should also be evaluated with MPI measurement besides conventional echocardiographic measurements.

Assessment of early atherosclerosis and left ventricular dysfunction in children with 21–hydroxylase deficiency

We analysed 25 children with 21‐hydroxylase deficiency who received glucocorticoid and/or mineralocorticoid treatment for at least 12 months to determine the effects of the disease and its treatment on vascular structures and ventricular function.

Modified myocardial performance index is not affected in fetuses with an isolated echogenic focus in the left ventricle

Abstract Objectives: We prospectively investigated the efficacy of modified myocardial performance index (mod-MPI) in the assessment of cardiac functions in fetuses with and without an isolated hyperechogenic focus (IHF) in the left ventricle and compared with conventional fetal echocardiography. Methods: The study group consisted of 50 fetuses with only an IHF in the left ventricle, without any other cardiac or extracardiac anomalies; 50 fetuses without IHF served as controls. All fetal echocardiographic studies were performed between 20th and 24th weeks of gestation. Left ventricular functions were evaluated with both conventional echocardiographic methods (peak velocity of the aortic valve, mitral E/A ratio, fractional shortening) and mod-MPI. Results: There was no statistically significant difference between the groups in terms of maternal age, BMI or gestational age at the time of examination (p > 0.05 for all). No statistically significant differences were found between the findings of conventional echocardiographic measurements and left ventricular mod-MPI between the study and control groups (p > 0.05 for all). Conclusion: Fetal left ventricular mod-MPI is not affected by the presence of an IHF in the fetal left ventricle between 20th and 24th gestational weeks and thus it does not need to be assessed in this situation.