Turkan Ertugrul

MR imaging features of ventricular noncompaction: Emphasis on distribution and pattern of fibrosis

OBJECTIVE The purpose of this study is to describe morphologic features and delayed contrast-enhancement pattern of the noncompaction of the left ventricle in cardiac magnetic resonance (MR) imaging. METHODS We retrospectively reviewed morphological cardiac MR imaging findings of ventricular noncompaction in 15 patients (eight men, seven women, and ages 6 months to 73 years old, mean 22 year). In 10 patients delayed contrast enhanced images were obtained after the morphological examination. RESULTS In all patients, noncompaction was seen in the apical and midventricular-lateral segment. Basal-septal segment involvement was not determined in any patients. Noncompacted/compacted ratio was 2-4.5 (mean 3). In nine patients, right ventricular involvement was observed in addition to left ventricular noncompaction. Delayed contrast-enhancement was seen in eight out of 10 patients not only involved segments but also normal segments of the heart. CONCLUSION Cardiac MR imaging is a valuable imaging method in patients with suspected ventricular noncompaction by showing increased trabeculations, deep intertrabecular recesses and fibrosis. Fibrosis is a common finding in ventricular noncompaction.

Congenital heart disease in children with Down's syndrome: Turkish experience of 13 years.

Background — Down’s syndrome (DS) is the most common chromosomal abnormality due to a trisomy of chromosome 21 commonly associated with congenital heart defects (CHDs). This study aimed to evaluate the frequency and types of CHD patterns in Turkish children with DS. Method — The data relate to paediatric patients with DS who underwent cardiologic screening between 1994 and 2007 and were reviewed in our Paediatric Cardiology unit. Results — Four hundred and twenty-one out of the 1042 paediatric patients with DS studied over a 13-year period had associated CHD. Of these, 320 (77.6%) had a single cardiac lesion, while the remaining 92 patients (22.4%) had multiple defects. The most common single defect was an atrioventricular septal defect (AVSD) found in 141 patients (34.2%), followed by 69 patients (16.7%) showing secundum type atrial septal defect, and ventricular septal defect in 68 patients (16.5%). AVSDs were the leading type, isolated or combined with other cardiac anomalies with an overall occurrence of 19.8% of paediatric patients with DS, and 49.2% of paediatric patients with both DS and CHD. Conclusion — This is the first study concerning the frequency and type of CHD observed in Turkish children with DS.The high frequency of AVSD in Turkish children with DS implied that early screening for CHDs by echocardiography is crucial. The correction of AVSDs in paediatric patients with DS should be performed in the first 6 months of life to avoid irreversible haemodynamic consequences of the defect.

Results of surgical treatment for infective endocarditis in children

OBJECTIVE Infective endocarditis is uncommon condition, with a high degree of morbidity and mortality. It is less common in children, albeit tending to be associated with congenital cardiac malformations. We describe our experience of the need for surgical treatment in children with infective endocarditis. PATIENTS AND METHODS We analyzed retrospectively the records of 9 children aged below 16 years seen between May 2003 and March 2005 with infective endocarditis, reviewing the demographic details, clinical presentation, microbiological and echocardiographic data, operative findings, and outcome. RESULTS Apart from pre-existing renal insufficiency in 1 patient, congenital cardiac malformations were the predisposing factors. Blood cultures were positive in 3, but remained negative in the other 6 patients. The indications for surgical treatment included uncontrolled sepsis, congestive heart failure, recurrent endocarditis, patch or graft dehiscence, and pseudoaneursymal formation. Death due to uncontrolled sepsis resulting in multiorgan failure occurred in 1 patient, who had tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. Another patient died late postoperatively due to cardiac failure after relapse of the endocarditis in the setting of negative blood cultures. CONCLUSION Despite advances in antimicrobial therapy, diagnosis, and measures of treatment for infective endocarditis, complications continue to be responsible for substantial morbidity and mortality. Since blood cultures are frequently negative, clinical and echocardiographic findings should be the major determinants of strategies used for treatment. We believe that our small series of patients seen over the past two years in which surgical treatment was performed will be helpful in guiding the clinical perspectives for children with infective endocarditis.

Electrocardiographic markers for the early detection of cardiac disease in patients with beta-thalassemia major

OBJECTIVE To comparatively evaluate P-wave dispersion (PWD) in patients with beta-thalassemia major (TM) and healthy control subjects for the early prediction of arrhythmia risk. METHODS Eighty-one children with beta-TM, aged 4-19 years, and 74 healthy children (control group) underwent routine electrocardiography and transthoracic echocardiography for cardiac evaluation. PWD was calculated as the difference between the maximum and the minimum P-wave duration. RESULTS There was a statistically significant difference between study and control groups in peak early (E) mitral inflow velocity and E/late (A) velocity ratio. Maximum P-wave duration and PWD were found to be significantly higher in beta-TM patients than in control subjects. CONCLUSIONS Increased PWD in our beta-TM patients might be related to depression of intra-atrial conduction due to atrial dilatation and increased sympathetic activity. These patients should be closely followed up for risk of life-threatening arrhythmias.

The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect

IntroductionAtrial septal defect (ASD) is one of the most common congenital heart diseases in children. P-wave dispersion has been reported to be associated with non-homogeneous propagation of sinus impulses. The heterogeneity of atrial conduction time may predispose the atria to arrhythmias. The aim of this study was to determine the impact of surgical repair on P-wave indices in children with isolated secundum ASD.MethodsChildren with isolated secundum ASD undergoing surgical repair (n=50; mean age, 7.0±3.0 years) and healthy controls (n=51; mean age, 7.6±2.7 years) were compared. Maximum P-wave duration (Pmax), shortest duration (Pmin) and P-wave dispersion (Pd) were measured using 12-lead surface electrocardiography.ResultsMean Pmax was found to be significantly higher in children with ASD compared with controls (95.2±10.8 vs 84.1±9.2 msec; P<0.001), and Pd before surgery was significantly higher compared with controls (47.4±12.0 vs 38.8±9.7 msec; P<0.001). Both P-wave indices were significantly decreased within the first year after surgical closure — the values decreased to those comparable to healthy controls (Pmax, 86.2±9.7 msec; Pd, 39.8±10.7 msec; P>0.05).ConclusionSurgical closure of ASD in children decreases Pmax and P-wave conduction time. We speculate that earlier closure of the defect may play an important role in avoiding permanent changes in the atrial myocardium and atrial fibrillation in adulthood.

Can cystinosis cause coronary artery dilatation

In children, dilated coronary arteries are usually caused by Kawasaki’s disease. We report four children with dilated coronary arteries and nephropathic cystinosis.

Electrocardiographic and echocardiographic findings in street children known to be substance abusers

Substance abuse is prevalent in adolescent street children, and death is reported as secondary to aspiration, accidental trauma, asphyxia, cardiac arrhythmia, anoxia, vagal inhibition and respiratory depression. In this study, we examined electrocardiographic and echocardiographic findings from 53 street male adolescents, comparing our findings to those obtained from 61 controls in the same age group. The street children smoked cigarettes (98.1%) and had used, or were using, thinner (73.6%), glue (75.5%), hashish (79.2%), morphine or its products (24.5%), ecstasy (37.7%), anti-emetics (13.2%) and alcohol (60.4%). On examination, their blood pressures were lower than the control group. Electrocardiographically, PR, QRS, QT were found to be longer (p less than 0.05) than the values for healthy controls. Although it was not statistically significant, QTc duration was also longer than the control group. Echocardiography revealed increased diameters of the left ventricle and atrium, the aorta, and the coronary arteries as compared to the healthy children (p less than 0.05).

Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma

Aim: Vasovagal syncope neurocardiogenic is the most common cause of syncope in childhood It is generally more common among adolescent girls and rare before the age of 10 years Head up tilt table test provides the ability to provoke vasovagal test and helps to document the type of response by cardiac rhythm and blood pressure monitorization If basal tilt test is negative pharmacologic stimulation with isoproterenol or isosorbide dinitrate ISDN administiration may increase the sensitivity of the test Material and Method: In this study 88 patients aged 9 18 years having repeated unexplored syncope were evaluated by tilt test at 70° for 30 minutes The patients who did not develop syncope by this test were given 400 micrograms of ISDN spray sublingually and were kept under close monitoring until the findings were seen or if not for 15 minutes Results: Twentyfour patients 37 had a positive basal tilt test Forty patients 46 had syncope following ISDN administiration No side effect related to ISDN administirastion was observed The types of positive responses were mixed type in 37 patients 58 cardioinhibitory without asystole in six patients 9 cardioinhibitory with asystole in seven patients 11 and vasodepressor types in 14 patients 22 respectively Conclusions: This study concludes that pharmacological stimulation with sublingual ISDN is safe and easy to perform in children considered to have vasovagal syncope clinically and helps to increase the diagnostic value of tilt testing Turk Arch Ped 2009; 44: 94 8 Key words: Isosorbide dinitrate spray tilt test vasovagal syncope

Son Üç Yıldaki Balon Atrial Septostomi Uygulamaları ve Sonuçlarımız

Bu calismada Istanbul Tip Fakultesi Cocuk Sagligi ve Hastaliklari Anabilim Dali Cocuk Kardiyolojisi Bilim Dalinda son 3 yil icinde balon atrial septostomi uygulanan 30 bebek ile ilgili sonuclar sunulmustur Yaslari 1 ile 88 gun arasinda degisen 30 hastanin 26 si buyuk arter transpozisyonu dordu ise trikuspid atrezisi tanisi almislardir Bebeklerin agirliklari 3674 0±61617;653 7 gr idi Girisim 14 olguda Rashkind tipi septostomi kaleleri ile ve V femoralis yolu ile; 16 olguda ise Fogarty Edwards lipi kateter ile bu gruptaki 11 olguda V femoralis 5 olguda ise V umblicalis yolu ile uygulandi Her iki grupta da girisim takiben oksijen saturasyonlarinda saglanan artis istatistiki olarak anlamli bulundu Bebekler ayrica yaslarina gore 3 gruba ayrilarak 0 7 gun 8 30 gun 31 gun ve uzeri incelendiginde ise her uc grupta da oksijen saturasyonlarinda saglanan artis istatistiki olarak anlamli olup ilk 7 gun icindeki uygulamada saglanan artis digerlerinden daha yuksek idi Uygulama sonrasi takipte uc bebek ilk 24 saat icinde kaybedildi 10 Diger hastalar ise cerrahi girisim icin sevk edildiler Anahtar kelimeler: Balon Septostomi Buyuk Arter Transpozisyonu Trikuspid Atrezisi