Tachyarrhythmias are common rhythm disturbances in infants and children. Despite the availability... more Tachyarrhythmias are common rhythm disturbances in infants and children. Despite the availability of diagnostic criteria arrhythmias are sometimes commonly misdiagnosed. Recent reports suggest that an endogenous purine nucleoside, adenosine, has a diagnostic effect in narrow QRS complex tachycardias, in addition to terminating supraventricular tachycardia involving the atrioventricular node. This r e p o n reviews the authors' experience with the use of adenosine for diagnosis of narrow and wide complex tachyarrhythmias in children. Adenosine was administered to 43 patients with several types of tachyarrhythmias (mean age, 8.3 k 5.24 years). Nineteen patients had structural or acquired heart disease-Of the 43 patients there were 28 (65%) several different types of narrow QRS complex tachycardia and 1 4 (33%) ventricular arrhythmias. One patient (2%) had long QT. Adenosine terminated supraventricular tachycardia, in 1 1 of 12 patients (92%), ventricular tachycardia in five of eight patients (63%), and transiently terminated premature ventricular contractions in two of six patients (33%). The diagnostic ability of adenosine was perfect in eight supraventricular tachycardia. In these eight cases the tachycardia mechanism was unclear before the administration of adenosine, which demonstrated three cases of s i n u s tachycardia, three of atrial flutter, one of atrial fibrillation and one of atrial fibrilloflutter. Confirmation of the primary diagnosis by adenosine was perfect in five tachyarrhythmias including three cases of a t r i a l flutter, one of atrial fibrillation and one of ectopic atrial tachycardia. The average effective dose of adenosine was 2 12 pg/kg (range, 100-400 pgkg). There were no serious side-effects except transient dyspnea, chest pain and flushing. These findings demonstrate adenosine to be helpful and safe in the diagnosis of tachyarrhythmias.
We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatr... more We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatric patients to find out the prognostic significance of the presence and size of echocardiographically detected vegetations. Among the children admitted to our institution with endocarditis between January 1987 and October 1999, 16 patients (mean age 9.03 +/- 4.95 years) who met the Duke criteria for the diagnosis of infective endocarditis (IE) were included in this study. Rheumatic valvular disease was the most frequent underlying heart disease (10 patients: 62.5%). Five patients were operated at a mean of 13.9 months before endocarditis, and all had residual defects. Vegetation was detected in 11 cases (69%). Ten patients had major complications (within 2 weeks in 6 patients). Three patients developed congestive heart failure (CHF), six had intracranial and one had lower extremity emboli. Among them four were operated because of complications (CHF: 3 cases, intracranial emboli: 1 case)....
SUMMARY: Çeliker A, Özkutlu S, Karagöz T, Erdoğan İ, Özer S, Aypar E. Device closure of congenita... more SUMMARY: Çeliker A, Özkutlu S, Karagöz T, Erdoğan İ, Özer S, Aypar E. Device closure of congenital ventricular septal defects with Amplatzer devices: first experiences in Turkey. Turk J Pediatr 2008; 50: 106-113. Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its
In conclusion, transesophageal atrial stimulation is a valuable tool in the initial evaluation of... more In conclusion, transesophageal atrial stimulation is a valuable tool in the initial evaluation of patients with symptoms possibly related with arrhythmia or in the management of patients who have any arrhythmia.
Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional me... more Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its relation to other cardiac structures. We report our first experiences of transcatheter closure of perimembranous and muscular VSD. Between May 2005 and September 2006, transcatheter closure of VSD was attempted in 38 patients. Implantation was successful in 37 patients. In one patient, the procedure failed because of the long sheath kinking. We observed important complications in three patients: severe tricuspid valve regurgitation, residual VSD and tricuspid valve regurgitation and right bundle branch block in the short-term follow-up. Transcatheter device closure with Amplatzer device seems to be effective and safe in the treatment of perimembranous and muscular VSDs. Tricuspid valve incompetence may cause problems. Long-term results are required to determine the efficacy and safety.
Transcatheter closure of atrial septal defect (ASD) has been used as an alternative to open heart... more Transcatheter closure of atrial septal defect (ASD) has been used as an alternative to open heart surgery. Although transcatheter closure of ASD with the Amplatzer septal occluder is a safe and feasible method in pediatric patients, there is little published data on arrhythmia analysis following transcatheter device closure of secundum ASD. We evaluated cardiac dysrhythmias with 24-hour ambulatory electrocardiographic (ECG) monitoring after transcatheter closure of ASD with Amplatzer device. A total of 85 consecutive patients with ASD underwent transcatheter closure of secundum ASD with Amplatzer device between October 1998 and December 2003. The study involved 65 of these patients assessed by 24-hour ambulatory ECG monitoring. Seven patients were evaluated a second time by 24-hour monitorization. During the procedure, transient complete atrioventricular (AV) block was seen in two patients. One of them returned to normal sinus rhythm in catheterization lab and the other returned to ...
A total of 135 consecutive pediatric patients (pts) with tachyarrhythmia ranging from two to 21 y... more A total of 135 consecutive pediatric patients (pts) with tachyarrhythmia ranging from two to 21 years of age (median age 11 years) underwent electrophysiological study (EPS) between January 1994 and July 2001. Tachycardia could not be induced in 38 of 135 pts (28%) and studies in these patients were accepted as the normal EPS. Supraventricular tachyarrhythmia mechanisms were atrioventricular (AV) accessory pathways in 47 patients (manifest accessory pathways in 23 patients, concealed accessory pathways in 17 patients, permanent junctional reciprocating tachycardia in 7 patients), re-entry without accessory pathway in 26 patients (AV nodal reentry tachycardia in 20 patients, atrial flutter in 5 patients, sinus node re-entry tachycardia in 1 patient) and atrial ectopic tachycardia in eight patients. The diagnosis of ventricular tachycardia (VT) was made in 16 patients. Seventy-three of the 97 patients with the diagnosis of tachyarrhythmia as a result of EPS underwent radiofrequency (R...
Background : Dual chamber pacemakers (single chamber pacing dual chamber sensing cardiac pacemake... more Background : Dual chamber pacemakers (single chamber pacing dual chamber sensing cardiac pacemaker (VDD) and dual chamber pacing and sensing cardiac pacemaker (DDD)) are being used frequently in children and adolescents. The aim of this study was to verify the safety and performance of the VDD and DDD pacing systems, and to evaluate the differences between two pacing modes with regard to atrial sensing and tracking functions. Methods : In this study, we evaluated 14 patients with VDD pacing and 15 patients with DDD pacing between 1994 and 2000. In the patient group with VDD pacing, all had congenital or acquired atrioventricular (AV) block. In the patient group with DDD pacing, 11 had congenital or acquired AV block, three had sinus node dysfunction with AV conduction disturbance and one had idiopathic hypertrophic subaortic stenosis. Twentyeight devices were implanted in the subpectoral area using the transvenous route. After implantation the atrial tracking capabilities of the pacing systems were analyzed by telemetry, Holter monitoring, and treadmill exercise testing. Results : The mean age of patients in the VDD pacing group was younger. The percentage of congenital heart disease was higher in the DDD pacing group. There was no significant difference regarding fluoroscopy time during implantation and follow-up time between the two groups. During implantation, in the VDD pacing group the mean sensed atrial signal was 3.1 ± 1.3 mV and this decreased to 1.37 ± 0.68 mV ( P < 0.05) during follow-up. This pattern was also observed in DDD group (3 ± 2 mV vs 1.9 ± 1.5 mV, P < 0.05). Although the P wave measurement at implantation did not differ between the two groups, it was significantly higher in the DDD pacing group at the last control. Three patients with VDD pacing were reprogrammed to VVI or single chamber pacing and sensing, rate adaptive cardiac pacemaker because of complete loss of AV synchrony. There was no atrial sensing problem in the DDD pacing group. During the follow-up, one patient with VDD pacing developed diaphragmatic stimulation and required lead revision. In one patient with DDD pacing, venous thrombosis occurred in the right subclavian vein and was treated with thrombolytic therapy. During treadmill exercise testing, in one patient with VDD and one patient with DDD pacing temporary failure of atrial sensing occurred. At 24 h Holter monitoring, intermittent loss of atrial sensing was documented in two patients with VDD pacing. Conclusions : Dual chamber pacing in children with DDD or VDD pacemakers is a suitable method for bradycardia treatment. Atrial sensing problems may occur in VDD pacemakers. Therefore, DDD pacing mode should be preferred whenever suitable for the patient to maintain the AV synchrony.
To assess the efficacy of a serotonin re-uptake inhibitor, sertraline hydrochloride, in preventin... more To assess the efficacy of a serotonin re-uptake inhibitor, sertraline hydrochloride, in preventing recurrent neurocardiogenic syncope, we studied 15 patients (10 female; mean age 12.9 ± 2 years) with positive head-upright tilt test and resistant to standard pharmacotherapy, atenolol or disopyramide. The patients were given 50 mg oral sertraline hydrochloride daily for 6 weeks. Intolerance to the drug was seen in 3 patients
Noncompaction of myocardium is a rare and recently defined entity that may cause cardioembolism d... more Noncompaction of myocardium is a rare and recently defined entity that may cause cardioembolism during childhood. We report an 18-month-old girl with noncompaction of the left ventricular myocardium presenting with fatal cardioembolic stroke. The patient had a high factor VIII level, which is known to cause an increased tendency to thromboembolic events. To our knowledge, this is the youngest case with stroke associated with noncompaction of the myocardium. Patients with noncompaction should be considered for prophylactic antithrombotic treatment to prevent mortality and morbidity owing to systemic thromboembolic events, especially if they carry additional risk factors that make them prone to hypercoagulation.
Background: Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA... more Background: Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA) has evolved to be the procedure of choice. Gianturco and Flipper coils are the most commonly used coils in the United States for closure of small and moderate size PDAs. For larger PDAs, interventionalists in the United States commonly use the Amplatzer Duct Occluder (ADO) and those in Europe use the ADO or the Nit-Occlud Coils (NOC). A comparison between Gianturco coils, Flipper coils, ADO, and NOC has never been made. Objective: To compare the success and complication rate associated with the four different devices used for transcatheter closure of PDA. Success was defined as complete closure of PDA with absence of a residual shunt (R.S.) at six months follow-up. Methods: Two institutions collaborated in combining their data to evaluate the results of transcatheter closure of PDA. Results: Totally, 546 patients underwent successful PDA occlusion at both institutions. Gianturco and Flipper coils were used in 120 (22%) and 119 (22%) patients respectively. A total of 152 (28%) patients received ADO and 155 (28%) patients received NOC. Immediate R.S. were noted in 226 (41.4%) patients in the entire study group with the NOC group having the highest percentage of R.S. (80/155, 51.6%, P 5 0.004). Of the 484 patients with follow-up echocardiograms at 6 months, 35 (7.2%) patients had persistent R.S. The NOC (3/143, 2.1%) and ADO (5/150, 3.3%) groups had the least R.S. at six months follow-up. Conclusion: Per our definition of success, the Nit-Occlud coils and the Amplatzer duct-occluder devices had significantly higher success rate for PDA occlusion versus the coils. V C 2009 Wiley-Liss, Inc.
Detection of coronary artery is important when considering surgical treatment of a congenital hea... more Detection of coronary artery is important when considering surgical treatment of a congenital heart disease (CHD) such as tetralogy of Fallot (TF). Cardiac catheterization plays an important supplementary role in the evaluation of patients with CHD. In a few reports, it has been proposed that multidetector computed tomography (MDCT) can be helpful for the visualization of coronary arteries. We sought to demonstrate the feasibility and usefulness of MDCT angiography for anatomical evaluation of coronary arteries in CHD patients with suspected coronary artery anomalies. A total of 10 patients, 9 pediatric and 1 adult, underwent MDCT angiography for the investigation of coronary artery anomalies and mediastinal vascular structures. Seven patients had TF; 5 of these patients were suspected of having coronary artery anomalies and 2 were suspected of having pulmonary artery atresia or a nonconfluent pulmonary artery. The other 3 patients had truncus arteriosus and severe left pulmonary artery stenosis (n = 1), double outlet right ventricle (n = 1), and Kawasaki disease (n = 1) with suspected coronary artery aneurysms. The entire heart, major vascular structures, and coronary artery anomalies were preoperatively scanned in patients with cyanotic heart disease. Examinations were performed by 16-MDCT with 1-mm slice thickness. A breath-holding test was performed in 5 patients. Nonionic iodinated contrast material (2 cc/kg) was administered by a power injector. Major vascular structures and the proximal part of the right and left coronary arteries were visualized successfully in all patients. Mid and/or distal segments of the coronary arteries were visualized in 5 patients with TF. Pulmonary vascular bed findings were also confirmed during surgery in patients with TF and in one patient with truncus arteriosus type I and severe left pulmonary artery stenosis. Kawasaki disease was diagnosed by the presence of aneurysms in one patient. Pulmonary artery atresia was confirmed in one patient and diameter of the pulmonary arteries (4 mm and 4.5 mm) was determined in the other 2 patients by MDCT. The advantage of MDCT for cardiac imaging is the shortened scanning time for imaging the entire heart without long breath-holding times. Selective conventional coronary angiography is invasive and technically difficult in pediatric patients. We suggest that MDCT angiography can be performed as a noninvasive method in patients with CHD for the evaluation of coronary artery anatomy and anomalies and mediastinal vascular structures.
Noncompaction of the ventricular myocardium is a rare disorder that represents numerous prominent... more Noncompaction of the ventricular myocardium is a rare disorder that represents numerous prominent trabeculations and intratrabecular recesses in the ventricles. It is believed to represent not only an arrest in endomyocardial morphogenesis but also an unclassified cardiomyopathy. The pathology has been almost invariably associated with other congenital cardiac malformations. A female patient with noncompaction of the myocardium of both ventricles and congenitally corrected transposition of the great arteries (cTGA), situs inversus totalis, and atrial and ventricular septal defects is described. When she was 7 days old a permanent pacemaker was implanted because of complete heart block. Prazosin (Minipress), an α-receptor blocker, was administered, and the cardiac ejection fraction showed a striking increase from 20% to 42%. Despite careful and regular follow-up evaluations, the general condition of the patient slowly worsened. Five months after surgery she died of hepatorenal failure and low cardiac output. This case report is thought to be the first description of congenital complete heart block, cTGA, and situs inversus totalis with noncompaction of the myocardium of both ventricles.
We report the usefulness of multidetector CT angiography (CTA) in the diagnosis of interrupted ao... more We report the usefulness of multidetector CT angiography (CTA) in the diagnosis of interrupted aorta of a neonate. CTA is useful for evaluating malformations of the aortic arch, particularly in cases that cannot undergo conventional angiography or in which detailed information cannot be provided by echocardiography.
A group of 67 children with cyanotic congenital heart disease (CCHD) were studied, and 35 were gi... more A group of 67 children with cyanotic congenital heart disease (CCHD) were studied, and 35 were given iron treatment according to a regimen that gives iron to patients with a hematocrit (Hct) below 60%. The patients were categorized as iron-deficient and ironsufficient according to their transferrin saturation and ferritin values. The pretreatment hemoglobin (Hb) and Hct values of the groups were similar. The mean Hct was nearly three times as much as the mean Hb in the ironsufficient group and more than three times as much as the Hb in the iron-deficient group. Excessive erythrocytosis in the iron-deficient group was impressive. Mean corpuscular volume (MCV) values were below 72.7 fl in all of the iron-deficient patients. After treatment the Hb, Hct, transferrin saturation, and ferritin increased significantly in both groups, with the increments greater in the iron-deficient group. Increments in the erythrocyte (RBC) count were significant in the iron-sufficient group but insignificant in the iron-deficient one. Increments of MCV in the iron-deficient group were significant but insignificant in the iron-sufficient group. Our study demonstrated that prediction of Hb, RBC count, and MCV, measurements of which are easy and inexpensive and require little blood, can suffice for the diagnosis of iron deficiency in patients with CCHD without altering systemic perfusion.
Unexplained syncope may cause diagnostic and therapeutic problems in children. The head-up tilt t... more Unexplained syncope may cause diagnostic and therapeutic problems in children. The head-up tilt test has been shown to be a useful tool for investigating unexplained syncope, especially for diagnosis of neurally mediated syncope. In this study 20 patients aged 9-18 years (12.0 ± 2.5 years) with syncope of unknown origin and 10 healthy age-matched children were evaluated by head-up tilt to 60°for 25 minutes. The test was considered positive if syncope or presyncope developed in association with hypotension, bradycardia, or both. If tilting alone did not induce symptoms (syncope or presyncope), isoproterenol infusion was administered with increasing doses (0.02-0.08 g/kg per minute). During the tilt test, symptoms were elicited in 15 (75%) of the patients with unexplained syncope but in only one (10%) of the control group (p < 0.001). The sensitivity of the test was 75% and its specificity 90%. Three patterns of response to upright tilt were observed in symptomatic patients: vasodepressor pattern with an abrupt fall in blood pressure in 67%; cardioinhibitory pattern with profound bradycardia in 6%; and mixed pattern in 27%. In patients with positive head-up tilt, there were sudden decreases in systolic blood pressure (from 130 ± 15 to 61 ± 33 mmHg) and in mean heart rate (from 147 ± 26 to 90 ± 38 beats per minute) (p < 0.001) during symptoms. Treatments with atenolol 25 mg/day has shown complete suppression of syncope in positive responders during a mean follow-up period of 18 ± 6 months. The head-up tilt test is a noninvasive, sensitive, specific diagnostic tool for evaluating children with unexplained syncope.
Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart ra... more Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life-threathening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children.
Tachyarrhythmias are common rhythm disturbances in infants and children. Despite the availability... more Tachyarrhythmias are common rhythm disturbances in infants and children. Despite the availability of diagnostic criteria arrhythmias are sometimes commonly misdiagnosed. Recent reports suggest that an endogenous purine nucleoside, adenosine, has a diagnostic effect in narrow QRS complex tachycardias, in addition to terminating supraventricular tachycardia involving the atrioventricular node. This r e p o n reviews the authors' experience with the use of adenosine for diagnosis of narrow and wide complex tachyarrhythmias in children. Adenosine was administered to 43 patients with several types of tachyarrhythmias (mean age, 8.3 k 5.24 years). Nineteen patients had structural or acquired heart disease-Of the 43 patients there were 28 (65%) several different types of narrow QRS complex tachycardia and 1 4 (33%) ventricular arrhythmias. One patient (2%) had long QT. Adenosine terminated supraventricular tachycardia, in 1 1 of 12 patients (92%), ventricular tachycardia in five of eight patients (63%), and transiently terminated premature ventricular contractions in two of six patients (33%). The diagnostic ability of adenosine was perfect in eight supraventricular tachycardia. In these eight cases the tachycardia mechanism was unclear before the administration of adenosine, which demonstrated three cases of s i n u s tachycardia, three of atrial flutter, one of atrial fibrillation and one of atrial fibrilloflutter. Confirmation of the primary diagnosis by adenosine was perfect in five tachyarrhythmias including three cases of a t r i a l flutter, one of atrial fibrillation and one of ectopic atrial tachycardia. The average effective dose of adenosine was 2 12 pg/kg (range, 100-400 pgkg). There were no serious side-effects except transient dyspnea, chest pain and flushing. These findings demonstrate adenosine to be helpful and safe in the diagnosis of tachyarrhythmias.
We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatr... more We retrospectively assessed the clinical course and outcome of left-sided endocarditis in pediatric patients to find out the prognostic significance of the presence and size of echocardiographically detected vegetations. Among the children admitted to our institution with endocarditis between January 1987 and October 1999, 16 patients (mean age 9.03 +/- 4.95 years) who met the Duke criteria for the diagnosis of infective endocarditis (IE) were included in this study. Rheumatic valvular disease was the most frequent underlying heart disease (10 patients: 62.5%). Five patients were operated at a mean of 13.9 months before endocarditis, and all had residual defects. Vegetation was detected in 11 cases (69%). Ten patients had major complications (within 2 weeks in 6 patients). Three patients developed congestive heart failure (CHF), six had intracranial and one had lower extremity emboli. Among them four were operated because of complications (CHF: 3 cases, intracranial emboli: 1 case)....
SUMMARY: Çeliker A, Özkutlu S, Karagöz T, Erdoğan İ, Özer S, Aypar E. Device closure of congenita... more SUMMARY: Çeliker A, Özkutlu S, Karagöz T, Erdoğan İ, Özer S, Aypar E. Device closure of congenital ventricular septal defects with Amplatzer devices: first experiences in Turkey. Turk J Pediatr 2008; 50: 106-113. Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its
In conclusion, transesophageal atrial stimulation is a valuable tool in the initial evaluation of... more In conclusion, transesophageal atrial stimulation is a valuable tool in the initial evaluation of patients with symptoms possibly related with arrhythmia or in the management of patients who have any arrhythmia.
Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional me... more Ventricular septal defects (VSD), which cause volume overload, may be closed by interventional method. The success depends on the precise anatomic definition of the defect and its relation to other cardiac structures. We report our first experiences of transcatheter closure of perimembranous and muscular VSD. Between May 2005 and September 2006, transcatheter closure of VSD was attempted in 38 patients. Implantation was successful in 37 patients. In one patient, the procedure failed because of the long sheath kinking. We observed important complications in three patients: severe tricuspid valve regurgitation, residual VSD and tricuspid valve regurgitation and right bundle branch block in the short-term follow-up. Transcatheter device closure with Amplatzer device seems to be effective and safe in the treatment of perimembranous and muscular VSDs. Tricuspid valve incompetence may cause problems. Long-term results are required to determine the efficacy and safety.
Transcatheter closure of atrial septal defect (ASD) has been used as an alternative to open heart... more Transcatheter closure of atrial septal defect (ASD) has been used as an alternative to open heart surgery. Although transcatheter closure of ASD with the Amplatzer septal occluder is a safe and feasible method in pediatric patients, there is little published data on arrhythmia analysis following transcatheter device closure of secundum ASD. We evaluated cardiac dysrhythmias with 24-hour ambulatory electrocardiographic (ECG) monitoring after transcatheter closure of ASD with Amplatzer device. A total of 85 consecutive patients with ASD underwent transcatheter closure of secundum ASD with Amplatzer device between October 1998 and December 2003. The study involved 65 of these patients assessed by 24-hour ambulatory ECG monitoring. Seven patients were evaluated a second time by 24-hour monitorization. During the procedure, transient complete atrioventricular (AV) block was seen in two patients. One of them returned to normal sinus rhythm in catheterization lab and the other returned to ...
A total of 135 consecutive pediatric patients (pts) with tachyarrhythmia ranging from two to 21 y... more A total of 135 consecutive pediatric patients (pts) with tachyarrhythmia ranging from two to 21 years of age (median age 11 years) underwent electrophysiological study (EPS) between January 1994 and July 2001. Tachycardia could not be induced in 38 of 135 pts (28%) and studies in these patients were accepted as the normal EPS. Supraventricular tachyarrhythmia mechanisms were atrioventricular (AV) accessory pathways in 47 patients (manifest accessory pathways in 23 patients, concealed accessory pathways in 17 patients, permanent junctional reciprocating tachycardia in 7 patients), re-entry without accessory pathway in 26 patients (AV nodal reentry tachycardia in 20 patients, atrial flutter in 5 patients, sinus node re-entry tachycardia in 1 patient) and atrial ectopic tachycardia in eight patients. The diagnosis of ventricular tachycardia (VT) was made in 16 patients. Seventy-three of the 97 patients with the diagnosis of tachyarrhythmia as a result of EPS underwent radiofrequency (R...
Background : Dual chamber pacemakers (single chamber pacing dual chamber sensing cardiac pacemake... more Background : Dual chamber pacemakers (single chamber pacing dual chamber sensing cardiac pacemaker (VDD) and dual chamber pacing and sensing cardiac pacemaker (DDD)) are being used frequently in children and adolescents. The aim of this study was to verify the safety and performance of the VDD and DDD pacing systems, and to evaluate the differences between two pacing modes with regard to atrial sensing and tracking functions. Methods : In this study, we evaluated 14 patients with VDD pacing and 15 patients with DDD pacing between 1994 and 2000. In the patient group with VDD pacing, all had congenital or acquired atrioventricular (AV) block. In the patient group with DDD pacing, 11 had congenital or acquired AV block, three had sinus node dysfunction with AV conduction disturbance and one had idiopathic hypertrophic subaortic stenosis. Twentyeight devices were implanted in the subpectoral area using the transvenous route. After implantation the atrial tracking capabilities of the pacing systems were analyzed by telemetry, Holter monitoring, and treadmill exercise testing. Results : The mean age of patients in the VDD pacing group was younger. The percentage of congenital heart disease was higher in the DDD pacing group. There was no significant difference regarding fluoroscopy time during implantation and follow-up time between the two groups. During implantation, in the VDD pacing group the mean sensed atrial signal was 3.1 ± 1.3 mV and this decreased to 1.37 ± 0.68 mV ( P < 0.05) during follow-up. This pattern was also observed in DDD group (3 ± 2 mV vs 1.9 ± 1.5 mV, P < 0.05). Although the P wave measurement at implantation did not differ between the two groups, it was significantly higher in the DDD pacing group at the last control. Three patients with VDD pacing were reprogrammed to VVI or single chamber pacing and sensing, rate adaptive cardiac pacemaker because of complete loss of AV synchrony. There was no atrial sensing problem in the DDD pacing group. During the follow-up, one patient with VDD pacing developed diaphragmatic stimulation and required lead revision. In one patient with DDD pacing, venous thrombosis occurred in the right subclavian vein and was treated with thrombolytic therapy. During treadmill exercise testing, in one patient with VDD and one patient with DDD pacing temporary failure of atrial sensing occurred. At 24 h Holter monitoring, intermittent loss of atrial sensing was documented in two patients with VDD pacing. Conclusions : Dual chamber pacing in children with DDD or VDD pacemakers is a suitable method for bradycardia treatment. Atrial sensing problems may occur in VDD pacemakers. Therefore, DDD pacing mode should be preferred whenever suitable for the patient to maintain the AV synchrony.
To assess the efficacy of a serotonin re-uptake inhibitor, sertraline hydrochloride, in preventin... more To assess the efficacy of a serotonin re-uptake inhibitor, sertraline hydrochloride, in preventing recurrent neurocardiogenic syncope, we studied 15 patients (10 female; mean age 12.9 ± 2 years) with positive head-upright tilt test and resistant to standard pharmacotherapy, atenolol or disopyramide. The patients were given 50 mg oral sertraline hydrochloride daily for 6 weeks. Intolerance to the drug was seen in 3 patients
Noncompaction of myocardium is a rare and recently defined entity that may cause cardioembolism d... more Noncompaction of myocardium is a rare and recently defined entity that may cause cardioembolism during childhood. We report an 18-month-old girl with noncompaction of the left ventricular myocardium presenting with fatal cardioembolic stroke. The patient had a high factor VIII level, which is known to cause an increased tendency to thromboembolic events. To our knowledge, this is the youngest case with stroke associated with noncompaction of the myocardium. Patients with noncompaction should be considered for prophylactic antithrombotic treatment to prevent mortality and morbidity owing to systemic thromboembolic events, especially if they carry additional risk factors that make them prone to hypercoagulation.
Background: Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA... more Background: Over the past three decades, transcatheter occlusion of patent ductus arteriosus (PDA) has evolved to be the procedure of choice. Gianturco and Flipper coils are the most commonly used coils in the United States for closure of small and moderate size PDAs. For larger PDAs, interventionalists in the United States commonly use the Amplatzer Duct Occluder (ADO) and those in Europe use the ADO or the Nit-Occlud Coils (NOC). A comparison between Gianturco coils, Flipper coils, ADO, and NOC has never been made. Objective: To compare the success and complication rate associated with the four different devices used for transcatheter closure of PDA. Success was defined as complete closure of PDA with absence of a residual shunt (R.S.) at six months follow-up. Methods: Two institutions collaborated in combining their data to evaluate the results of transcatheter closure of PDA. Results: Totally, 546 patients underwent successful PDA occlusion at both institutions. Gianturco and Flipper coils were used in 120 (22%) and 119 (22%) patients respectively. A total of 152 (28%) patients received ADO and 155 (28%) patients received NOC. Immediate R.S. were noted in 226 (41.4%) patients in the entire study group with the NOC group having the highest percentage of R.S. (80/155, 51.6%, P 5 0.004). Of the 484 patients with follow-up echocardiograms at 6 months, 35 (7.2%) patients had persistent R.S. The NOC (3/143, 2.1%) and ADO (5/150, 3.3%) groups had the least R.S. at six months follow-up. Conclusion: Per our definition of success, the Nit-Occlud coils and the Amplatzer duct-occluder devices had significantly higher success rate for PDA occlusion versus the coils. V C 2009 Wiley-Liss, Inc.
Detection of coronary artery is important when considering surgical treatment of a congenital hea... more Detection of coronary artery is important when considering surgical treatment of a congenital heart disease (CHD) such as tetralogy of Fallot (TF). Cardiac catheterization plays an important supplementary role in the evaluation of patients with CHD. In a few reports, it has been proposed that multidetector computed tomography (MDCT) can be helpful for the visualization of coronary arteries. We sought to demonstrate the feasibility and usefulness of MDCT angiography for anatomical evaluation of coronary arteries in CHD patients with suspected coronary artery anomalies. A total of 10 patients, 9 pediatric and 1 adult, underwent MDCT angiography for the investigation of coronary artery anomalies and mediastinal vascular structures. Seven patients had TF; 5 of these patients were suspected of having coronary artery anomalies and 2 were suspected of having pulmonary artery atresia or a nonconfluent pulmonary artery. The other 3 patients had truncus arteriosus and severe left pulmonary artery stenosis (n = 1), double outlet right ventricle (n = 1), and Kawasaki disease (n = 1) with suspected coronary artery aneurysms. The entire heart, major vascular structures, and coronary artery anomalies were preoperatively scanned in patients with cyanotic heart disease. Examinations were performed by 16-MDCT with 1-mm slice thickness. A breath-holding test was performed in 5 patients. Nonionic iodinated contrast material (2 cc/kg) was administered by a power injector. Major vascular structures and the proximal part of the right and left coronary arteries were visualized successfully in all patients. Mid and/or distal segments of the coronary arteries were visualized in 5 patients with TF. Pulmonary vascular bed findings were also confirmed during surgery in patients with TF and in one patient with truncus arteriosus type I and severe left pulmonary artery stenosis. Kawasaki disease was diagnosed by the presence of aneurysms in one patient. Pulmonary artery atresia was confirmed in one patient and diameter of the pulmonary arteries (4 mm and 4.5 mm) was determined in the other 2 patients by MDCT. The advantage of MDCT for cardiac imaging is the shortened scanning time for imaging the entire heart without long breath-holding times. Selective conventional coronary angiography is invasive and technically difficult in pediatric patients. We suggest that MDCT angiography can be performed as a noninvasive method in patients with CHD for the evaluation of coronary artery anatomy and anomalies and mediastinal vascular structures.
Noncompaction of the ventricular myocardium is a rare disorder that represents numerous prominent... more Noncompaction of the ventricular myocardium is a rare disorder that represents numerous prominent trabeculations and intratrabecular recesses in the ventricles. It is believed to represent not only an arrest in endomyocardial morphogenesis but also an unclassified cardiomyopathy. The pathology has been almost invariably associated with other congenital cardiac malformations. A female patient with noncompaction of the myocardium of both ventricles and congenitally corrected transposition of the great arteries (cTGA), situs inversus totalis, and atrial and ventricular septal defects is described. When she was 7 days old a permanent pacemaker was implanted because of complete heart block. Prazosin (Minipress), an α-receptor blocker, was administered, and the cardiac ejection fraction showed a striking increase from 20% to 42%. Despite careful and regular follow-up evaluations, the general condition of the patient slowly worsened. Five months after surgery she died of hepatorenal failure and low cardiac output. This case report is thought to be the first description of congenital complete heart block, cTGA, and situs inversus totalis with noncompaction of the myocardium of both ventricles.
We report the usefulness of multidetector CT angiography (CTA) in the diagnosis of interrupted ao... more We report the usefulness of multidetector CT angiography (CTA) in the diagnosis of interrupted aorta of a neonate. CTA is useful for evaluating malformations of the aortic arch, particularly in cases that cannot undergo conventional angiography or in which detailed information cannot be provided by echocardiography.
A group of 67 children with cyanotic congenital heart disease (CCHD) were studied, and 35 were gi... more A group of 67 children with cyanotic congenital heart disease (CCHD) were studied, and 35 were given iron treatment according to a regimen that gives iron to patients with a hematocrit (Hct) below 60%. The patients were categorized as iron-deficient and ironsufficient according to their transferrin saturation and ferritin values. The pretreatment hemoglobin (Hb) and Hct values of the groups were similar. The mean Hct was nearly three times as much as the mean Hb in the ironsufficient group and more than three times as much as the Hb in the iron-deficient group. Excessive erythrocytosis in the iron-deficient group was impressive. Mean corpuscular volume (MCV) values were below 72.7 fl in all of the iron-deficient patients. After treatment the Hb, Hct, transferrin saturation, and ferritin increased significantly in both groups, with the increments greater in the iron-deficient group. Increments in the erythrocyte (RBC) count were significant in the iron-sufficient group but insignificant in the iron-deficient one. Increments of MCV in the iron-deficient group were significant but insignificant in the iron-sufficient group. Our study demonstrated that prediction of Hb, RBC count, and MCV, measurements of which are easy and inexpensive and require little blood, can suffice for the diagnosis of iron deficiency in patients with CCHD without altering systemic perfusion.
Unexplained syncope may cause diagnostic and therapeutic problems in children. The head-up tilt t... more Unexplained syncope may cause diagnostic and therapeutic problems in children. The head-up tilt test has been shown to be a useful tool for investigating unexplained syncope, especially for diagnosis of neurally mediated syncope. In this study 20 patients aged 9-18 years (12.0 ± 2.5 years) with syncope of unknown origin and 10 healthy age-matched children were evaluated by head-up tilt to 60°for 25 minutes. The test was considered positive if syncope or presyncope developed in association with hypotension, bradycardia, or both. If tilting alone did not induce symptoms (syncope or presyncope), isoproterenol infusion was administered with increasing doses (0.02-0.08 g/kg per minute). During the tilt test, symptoms were elicited in 15 (75%) of the patients with unexplained syncope but in only one (10%) of the control group (p < 0.001). The sensitivity of the test was 75% and its specificity 90%. Three patterns of response to upright tilt were observed in symptomatic patients: vasodepressor pattern with an abrupt fall in blood pressure in 67%; cardioinhibitory pattern with profound bradycardia in 6%; and mixed pattern in 27%. In patients with positive head-up tilt, there were sudden decreases in systolic blood pressure (from 130 ± 15 to 61 ± 33 mmHg) and in mean heart rate (from 147 ± 26 to 90 ± 38 beats per minute) (p < 0.001) during symptoms. Treatments with atenolol 25 mg/day has shown complete suppression of syncope in positive responders during a mean follow-up period of 18 ± 6 months. The head-up tilt test is a noninvasive, sensitive, specific diagnostic tool for evaluating children with unexplained syncope.
Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart ra... more Background: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life-threathening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children.
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