Yılmaz Yozgat

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.

Hepatoblastoma metastatic to the right atrium responding to chemotherapy alone.

An 18-month-old boy presented with abdominal pain and distension. On physical examination there was a 10 × 7-cm mass in the right upper abdominal quadrant. His alpha-fetoprotein level was 175,000 IU/mL. Abdominal magnetic resonance findings revealed hepatomegaly with multiple tumor masses involving nearly all the segments of the liver (PRETEXT IV). The tumor extended through the inferior vena cava and filled 2/3 of the right atrium. Echocardiography revealed normal cardiac function. Histopathologic findings after liver biopsy were consistent with hepatoblastoma. After 6 courses of chemotherapy including cisplatin and doxorubicin (PLADO, SIOPEL protocol), the cardiac tumor regressed completely. The patients primary tumor was then fully resected; no cardiac surgery was performed. After surgery the AFP level was 4 IU/mL and echocardiography revealed normal cardiac function with no residual tumor. The patient has been in remission for 31 months postdiagnosis.

Cardiac Function in Newborns with Congenital Hypothyroidism: Association with Thyroid-Stimulating Hormone Levels.

Objective: The aims of this study were to demonstrate ventricular function changes in patients with congenital hypothyroidism and to investigate whether there is an association between any such changes and thyroid-stimulating hormone (TSH) levels using M-mode and Doppler electrocardiography (ECG) and tissue Doppler imaging (TDI). Methods: Twenty-seven patients 5-30 days of age with congenital hypothyroidism who were scheduled to receive L-thyroxine treatment and 20 healthy newborns were included in this study. Twelve-lead ECG and M-mode TDI recordings of the patient and healthy groups were obtained. The patient group was divided into two subgroups according to TSH level (>100 uIU/mL or <100 uIU/mL), which were then compared on all parameters. Results: Decreases were observed in the ejection fraction (EF), shortening fraction (SF), and mitral lateral annulus, mitral septal annulus, and tricuspid lateral annulus systolic velocity (Sa) on TDI, whereas left ventricular end-systolic diameter (LVESd) and corrected QT interval (QTc) dispersion were significantly increased in the patient group compared with the control group. No significant differences between the groups were found in left ventricular end-diastolic diameter (LVEDd) or heart rate. When the two patient subgroups (TSH >100 uIU/mL and <100 uIU/mL) were compared, TDI septal annulus Sa wave length and heart rate were significantly lower in the TSH >100 group. Conclusion: Impairment in left ventricular systolic function and increased risk of arrhythmia were observed in newborn infants with congenital hypothyroidism. TSH level was associated with heart rate and interventricular septum velocity.

Diclofenac-induced intrauterine ductal closure.

nac for headache 2 days before. Fetal echocardiographic examination showed mild right ventricular hypertrophy and moderate tricuspid valve regurgitation. A turbulent flow through the constricted DA was seen on color Doppler examination. Pulsed Doppler revealed a significantly increased peak systolic velocity of 2.46 m/s. Any other possible structural lesions that could have caused narrowing of the DA were not found. Due to the proximity of the term gestation and in order to prevent possible fatal complications, an uneventful cesarean section was performed. Patent DA plays a crucial role in the continuation of the fetal circulation in uterine life. Blood flow bypasses the nonfunctional fetal lungs through the DA. Premature constriction can therefore lead to increased stress on the right side of the fetal heart and also result in some serious lifethreatening conditions. Indomethacin is a more prevalent drug that has been described for ductal constriction. In some cases it will cause instant constriction and also even complete closure of the ductus [2] , but in other cases the ductus can remain open in spite of repeated doses [3] . This condition can be caused by differences in drug metabolism. Diclofenac is a NSAID that acts by inhibiting the formation of prostaglandins [4] . It is commonly used for pain relief and Dear Editor, In utero constriction or closure of the patent ductus arteriosus (DA) is a rare condition that has been described secondary to structural heart disease, idiopathic constriction or medication [1] . Non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin are the most commonly seen causative agents and are often used to prevent preterm labor and polyhydramnios. These drugs increase the risk of premature closure of the duct if taken after the 27th week, and the risk increases exponentially after the 34th week of gestation [2] . Premature closure of the DA can lead to some serious life-threatening intrauterine complications such as congestive heart failure, fetal hydrops, oligohydramnios, and even intrauterine death [1] . Herein, we present a case of prenatal ductal closure after ingestion of a single dose of diclofenac at the 37th week of gestation. A 31-year-old woman in her uneventful third pregnancy was referred to our clinic for fetal echocardiography owing to the detection of some evidence of premature ductal closure by routine fetal ultrasound examination at the 37th week of gestation. She had no history of gestational diabetes or congenital heart disease in the current or previous two pregnancies. She also had no history of preterm labor requiring any NSAIDs. It was learned from the patient that she had taken a single dose of diclofeReceived: March 5, 2013 Accepted: March 19, 2013 Published online: June 5, 2013

Assessment of the Influence of Hyperechogenic Focus Detected on Fetal Echocardiographic Examination on Cardiac Functions Through Analyzing Ductus Venous Blood Flow

Ya z›fl ma Ad re si/Ad dress for Cor res pon den ce Dr. Rahmi Ozdemir, Behcet Uz Cocuk Hastanesi, Cocuk Kardiyoloji Klinigi, Izmir, Turkiye Tel.: +90 232 489 56 56/6186 E-posta: rahmiozdemir35@gmail.com Ge lis ta ri hi/Re cei ved: 05.05.2014 Ka bul ta ri hi/ Ac cep ted: 13.08.2014 Yilmaz Yozgat1, Rahmi Ozdemir1, Cem Karadeniz1, Secil Kurtulmus2, Mustafa Demirol1, Mehmet Kucuk1, Utku Karaarslan3, Timur Mese1, Nurettin Unal1 1Dr. Behcet Uz Cocuk Hastanesi, Cocuk Kardiyoloji Klinigi, Izmir, Turkiye 2Katip Celebi Universitesi Tip Fakultesi, Perinatoloji Anabilim Dali, Izmir, Turkiye 3Dr. Behcet Uz Cocuk Hastanesi, Cocuk Yogun Bakim Unitesi, Izmir, Turkiye

Absent Right Superior Vena Cava with Persistent Left Superior Vena Cava Which Drains to Unroofed Coronary Sinus in a Child with Atrioventricular Septal Defect and Cor Triatriatum Sinister: Preop Correct Diagnosis and Successful Surgery in a Single Session: Unique Combination of Congenital Heart Defects

We report a unique case of a 4-year-old boy with intermediate-type atrioventricular septal defect, cor triatriatum sinister, persistent left superior vena cava, unroofed coronary sinus, and absent right superior vena cava. Persistent left vena cava draining into the unroofed coronary sinus was demonstrated easily using the agitated saline-contrast echocardiography. After conformation with angiographic evaluation, surgery was performed at a single session. Roofing of the coronary sinus with polytetrafluoroethylene patch, mitral cleft repair, tricuspid annuloplasty, atrioventricular defect repair with pericardial patch, and resection of the membrane in the left atrium was succeeded without complication.

Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA.