Superiyor vena kava darlığı nadir görülen fakat ciddi olabilen vasküler bir anomalidir. Olguların... more Superiyor vena kava darlığı nadir görülen fakat ciddi olabilen vasküler bir anomalidir. Olguların büyük çoğunluğu altta yatan malign nedene bağlıdır. Pediatrikolgulargenellikledahaöncedengeçirilmişkardiyakcerrahigirişimlerle ilişkilidir.Literatürdebugünekadar,izoledoğumsalsuperiyorvenakavadarlığı bulunan sadece bir olgu bildirilmiştir. Klinik bulgu olarak baş, boyun ve üst ekstremitelerde ödem görülür. Tanı ekokardiyografi ile konulabilmektedir. Esas tedavisicerrahiolmaklabirliktedarlıkbölgesinebalonanjiyoplastive/veyastent uygulamasıdenenmektedir.Buolgusunumunda,ekokardiyografiiletanıkonulmuş doğumsal superiyor vena kava darlığı bulunan, altta yatan nedeni bulunmayan, tedavide balon anjiyoplasti ve daha sonra cerrahi girişim uygulanan 8 aylık kız hastaincelenmiştir.
Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical rel... more Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical relevance of CAF focuses mainly on the mechanism of 'coronary steal phenomenon', which causes myocardial functional ischaemia even in the absence of stenosis. Common symptoms of this phenomenon are angina, dyspnoea during physical exertion, and heart palpitations. 2-5 The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations such as the electrocardiogram, treadmill test, echocardiography, computed tomography and coronary angiography. Bacterial endocarditis is rarely observed in patients with CAF. 6,7 Small, asymptomatic fistulae can be followed by echocardiography, while treatment of symptomatic or large asymptomatic fistulae is recommended. 2-5,8,9 Coronary angiography is required to plan
Magnetic resonance imaging has become an important diagnostic tool in the differential diagnosis ... more Magnetic resonance imaging has become an important diagnostic tool in the differential diagnosis of lesions for evaluation of cardiovascular disorders. In magnetic resonance tagging (MRt), tissue elements are magnetically labeled so that their positions can be tracked as a function of time. Thus, MRt evaluates heart wall motion both qualitatively and quantitatively. We present herein the case of a 12‐year‐old boy who had chest pain, dyspnea on effort and murmur. On cardiac computed tomography, there was focal thickening of the left ventricular posterior wall, similar to a mass. MRt indicated active displacement and deformation of the tags at the level of the hypertrophic myocardium during systole, as with normal myocardium. Thus, the tagged images supported the diagnosis of focal hypertrophic cardiomyopathy (HCM). In view of these results, MRt should be considered as a useful technique for differentiating between a mass‐like focal lesion such as neoplasm and HCM.
Experimental and Clinical Transplantation, Feb 1, 2022
OBJECTIVES Neurologic complications that can lead to serious mortality and morbidity in pediatric... more OBJECTIVES Neurologic complications that can lead to serious mortality and morbidity in pediatric heart transplant recipients have been reported to range from 23.6% to 45%. In this study, the frequency, time, cause, and characteristics of neurologic complications in pediatric heart transplant recipients were evaluated. MATERIALS AND METHODS We retrospectively reviewed data of 37 pediatric heart transplant recipients aged <18 years who were seen at our hospital between 2007 and 2017. Medical records were reviewed to identify neurologic complications. Clinical features were compared between pediatric heart transplant patients with and without neurologic complications. RESULTS The rate of posttransplant neurologic complications in pediatric heart transplant was 27% (10/37). Median age of patients with neurologic complications was 12 years (range, 11-18 years). Median time for neurologic complications was 3 days (range, 2-46 days). Primary diagnoses of these 10 recipients were dilated cardiomyopathy (n = 7) and restrictive cardiomyopathy (n = 3). There were no significant differences between recipients with and without neurologic complications (P > .05).The etiologies of neurologic complications were posterior reversible encephalopathy syndrome in 3 patients (8.1%), stroke in 2 patients (5.4%), peripheral neuropathy in 2 patients (5.4%), hypertensive encephalopathy in 1 patient (2.7%), and drug encephalopathy in 1 patient (2.7%). CONCLUSIONS Neurologic complications may lead to serious mortality and morbidity in pediatric heart transplant patients. Seizures, posterior reversible encephalopathy syndrome, stroke, peripheral neuropathy, transient ischemic attack, and cerebral infections are the most common neurologic complications, which are seen in the perioperative period in particular. Careful follow-up of pediatric heart transplant patients, with detection and early treatment of neurologic findings, will contribute to lower rates of sequelae. To our knowledge, this is the largest study to show a detailed experience of neurologic complications in pediatric heart transplant patients from a single center in Turkey.
Background: Brugada syndrome is a disease characterized by a specific electrocardiographic patter... more Background: Brugada syndrome is a disease characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death. We present this case with the updated literature to emphasise the need to consider the diagnosis of Brugada syndrome in patients admitted to the emergency ward with sudden cardiac arrest. Case Report: A 16-year-old female patient was admitted to the emergency ward with complaints of weakness and abdominal pain, and she had four cardiac arrests during her evaluation period. She was referred to our clinic for permanent pacemaker implantation. She was on a temporary pace maker after having had C-reactive protein. Her physical exam was normal except for bilaterally decreased lung sounds. Lung x-ray and computed tomography, which were performed by another institution, revealed minimal pleural effusion and nothing else of significance. Blood and peritoneal fluid samples were sterile. Echocardiographic exam and cardiac enzymes were also in the normal ranges. Electrocardiographic showed incomplete right branch block in leads V1 and V2. An ajmaline test revealed specific electrocardiographic findings of the type I Brugada pattern. We proposed implanting an implantable
Kawasaki disease (KD) is an acute self-limited febrile systemic vasculitis complicated by coronar... more Kawasaki disease (KD) is an acute self-limited febrile systemic vasculitis complicated by coronary and peripheral arterial aneurysms in 20-35% of untreated patients (1, 2). The diagnosis of the disease is based on a combination of symptoms and laboratory data (3). Children with ...
Transesophageal electrophysiologic study (TEEPS) is a semi-invasive method widely used for evalua... more Transesophageal electrophysiologic study (TEEPS) is a semi-invasive method widely used for evaluation of symptoms related to arrhythmia. In this study, we aimed to determine the accuracy of TEEPS in the diagnosis and differentiation of mechanisms of supraventricular tachycardias (SVTs) by comparing results of transesophageal and intracardiac electrophysiologic studies. We performed TEEPS and a subsequent radiofrequency ablation (RFA) procedure in 76 patients. Indications of TEEPS were risk assessment for Wolff-Parkinson-White syndrome in 32 patients and diagnosis and differentiation of tachycardia mechanisms in 44 patients. The procedure was well tolerated in all patients. Positive predictive value of TEEPS in our study was 91% for differentiation of SVT mechanisms. The results suggest that TEEPS is safe, useful and effective in the evaluation of symptoms related to arrhythmia, in differentiation of mechanisms of SVTs, and finally in defining the treatment options of SVT. The technique also provides an opportunity for risk assessment and deciding the treatment modality in Wolff-Parkinson-White patients.
Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment... more Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short-and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. Methods. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Results. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 ± 4.9 years (range: 6 months-19 years). The mean age of the patients at the first ABV was 14.5 ± 10.6 days (range: 1-30 days) and body weight was 3.25 ± 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 ± 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 ± 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. In the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p <0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. Conclusions. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.
Turkish Journal of Thoracic and Cardiovascular Surgery, Apr 26, 2021
Bu çalışmada, doğumsal aort kapak darlığı olan çocuk hastalarda aort balon valvuloplasti ve cerra... more Bu çalışmada, doğumsal aort kapak darlığı olan çocuk hastalarda aort balon valvuloplasti ve cerrahi aort valvuloplastinin başarısı, komplikasyonları ve uzun dönem sonuçları karşılaştırıldı.
Pacing and Clinical Electrophysiology, Nov 1, 2009
Background: Radiofrequency ablation has become first-line therapy for supraventricular tachycardi... more Background: Radiofrequency ablation has become first-line therapy for supraventricular tachycardia in all age groups, but there has been a concern regarding the long-term effectiveness of the procedure in children. This study aimed to determine the inducibility after successful ablation of supraventricular tachycardia in children; assessment was performed using a transesophageal electrophysiologic study. Results: A total of 63 patients who had been treated successfully for supraventricular tachycardia with radiofrequency ablation were included in the study. A transesophageal electrophysiologic study was performed 2 months after radiofrequency ablation. Tachycardia was induced in nine of 34 symptomatic and five of 29 asymptomatic patients by a transesophageal electrophysiologic study. Ten patients had recurrence of the same type of supraventricular tachycardia seen previously, and two had a new type of arrhythmia during a transesophageal electrophysiologic study. Tachycardia inducibility rate was 16% in all patients, 22.8% in patients with atrioventricular reentrant tachycardia, and 8% in patients with atrioventricular nodal reentrant tachycardia. Conclusion: Radiofrequency ablation is a safe and effective method to manage children with supraventricular tachycardia, but patients must be observed for recurrence and new arrhythmias. Sustained tachycardia may also be induced in asymptomatic patients. A transesophageal electrophysiologic study is effective and safe for follow-up of radiofrequency ablation for assessment, diagnosis, and treatment of patients.
Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is defined by the presence of a sustaine... more Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is defined by the presence of a sustained tachycardia that results in left ventricular systolic dysfunction. Restoration of cardiac function is dependent on the control of tachyarrhythmias. We report a series including ten children with tachycardia-induced cardiomyopathy with different etiologies. The medical records of patients with tachycardiomyopathy who were managed in a Pediatric Cardiology Clinic between the years of 2014-2017 were reviewed retrospectively. Ten children (3 female, 7 male) were diagnosed with tachycardiomyopathy. The median age of the patients was 12 years (range: 4-15.8). Five had atrial tachycardia, two had ventricular tachycardia, the others had Mahaim fiber tachycardia, permanent junctional reciprocating tachycardia and atrioventricular reentrant tachycardia. Seven patients had catheter ablation and three patients who had previous heart surgery were treated with antiarrhythmic drugs. Median ejection fraction was 33% (range: 10-48), median left ventricle end-diastolic diameter was 55 mm (range: 30-78). All showed complete recovery with median ejection fraction 60% (range: 55-78). Two patient with severe heart failure required extracorporeal membrane oxygenation support, one of them had ventricular assist device support but the device was removed after successful ablation. After two years this patient required permanent pacemaker implantation due to complete atrioventricular block. Tachycardia-induced cardiomyopathy is a rare and treatable cause of heart failure. Early recognition is critical, aggressive treatment aimed at controlling the arrhythmia results in symptom resolution and recovery of ventricular function.
Scimitar syndrome is a rare congenital cardiac anomaly in which pulmonary veins are drained to th... more Scimitar syndrome is a rare congenital cardiac anomaly in which pulmonary veins are drained to the inferior vena cava (IVC) instead of the left atrium and it is often associated with additional cardiac and pulmonary anomalies. In this article, the different clinical features of pediatric patients with Scimitar syndrome are reported. Material and methods: All patients with scimitar syndrome were diagnosed in our hospital between 2000 and 2020. The clinical findings, angiographic and surgical procedures, and follow-up of the patients are evaluated. Results: Five pediatric patients aged between 1.5 months and 10 years were diagnosed as Scimitar syndrome. All patients were symptomatic. One patient had cor triatriatum and pulmonary venous stenosis, one patient had left atrial isomerism and absence of the IVC (azygous continuity), and another patient had coarctation of the aorta. One patient had dual drainage: the IVC and left atrium with meandering pulmonary veins, which we determined as a Scimitar variant. One infant patient with pulmonary hypertension and two patients with pulmonary to systemic flow ratio (Qp/Qs)>1.5 were treated surgically with the reanastomosis technique. Vascular embolization of the aortopulmonary collaterals was performed in two patients using vascular plugs, coils, and onyx. Conclusion: Treatment should be planned individually in this syndrome due to Scimitar syndrome has a wide range of anatomic and clinical variations.
Introduction Posterior reversible encephalopathy syndrome (PRES), is a clinicoradiological syndro... more Introduction Posterior reversible encephalopathy syndrome (PRES), is a clinicoradiological syndrome that manifested with various neurological signs such as seizure, headache, altered mental function and visual disturbances in organ transplant patients. Hypertension, metabolic derangements and use of calcineurin inhibitors in heart transplant patient are reported as strongly factors which linked to adult PRES however data about PRES after pediatric heart transplant (PHT) is limited. In present study, we aim to determine the prevalence and clinical features of PRES in PHT recipients. Materials and Methods We performed a retrospective review of 37 PHT recipients <22 yo, who received their transplant at our institution between 2007-2017. Medical records were reviewed to identify for PRES diagnosis. Demographic and clinical risk factors were analyzed in development of PRES. Results Seven of 37 (18.9%) recipient developed PRES at a median of 5 days (1-42) after transplant. The median age of recipients with PRES was 14 years (12-18). Recipients with PRES did not differ from those without PRES when comparing age, gender, BMI, total allograft ischemic time, aortic cross-clamp time or cardiopulmonary bypass time. All patients has presented with seizure, 4 patients had elevated blood pressure (<95 percentile) and one patient had CNI levels higher than their target range. Conclusion The prevalence of PRES in PHT recipients appear higher than reported in adult patients. Awareness of PRES in PHT patients should became more important, therefore neurological signs, blood pressure and level of calcineurin inhibitors should be closely monitored in these patients
Objective: Coronary artery fistula (CAF) is defined as a direct communication of a coronary arter... more Objective: Coronary artery fistula (CAF) is defined as a direct communication of a coronary artery with a cardiac chamber, great vessel or other vascular structure, bypassing the myocardial capillary bed. Among CAF, multiple coronary artery fistulae between coronary arteries and left ventricle are very rare and little is known of their anatomic, hemodynamic and clinical features. Methods: A 55-year-old man complained of chest pain and shortness of breath on exertion for six months was admitted to our hospital. A 12-lead resting electrocardiogram and routine biochemical values were within normal limits. On two-dimensional echocardiography, left ventricular dimensions and function were normal. During treadmill exercise test, 2 mm downsloping ST segment depression in leads V5 and V6 was observed at the stage-4. Subsequently, the patient underwent selective coronary angiography. Coronary angiography showed no stenotic lesion of epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left coronary artery (Figures 1A,B). Then, the patient was discharged with proper medical treatment of oral isosorbide mononitrate, beta-blocker, aspirin and angiotensin converitng enzyme inhibitor. The clinical diagnosis of coronary artery left ventricular microfistulae is difficult because the clinical presentation, laboratory and ECG findings are nonspecific. Myocardial ischemia and diastolic volume overload of the left ventricle are the most commonly reported hemodynamic consequences. CAF with large shunt can cause heart failure, myocardial ischemia, arrhythmia, infective endocarditis or aneurysm, progressive enlargement and rupture. Interestingly, most patients with CAF present with typical or atypical angina pectrois during advanced adulthood (older than 40 years) despite the assumed congenital origin of this malformation.
Superiyor vena kava darlığı nadir görülen fakat ciddi olabilen vasküler bir anomalidir. Olguların... more Superiyor vena kava darlığı nadir görülen fakat ciddi olabilen vasküler bir anomalidir. Olguların büyük çoğunluğu altta yatan malign nedene bağlıdır. Pediatrikolgulargenellikledahaöncedengeçirilmişkardiyakcerrahigirişimlerle ilişkilidir.Literatürdebugünekadar,izoledoğumsalsuperiyorvenakavadarlığı bulunan sadece bir olgu bildirilmiştir. Klinik bulgu olarak baş, boyun ve üst ekstremitelerde ödem görülür. Tanı ekokardiyografi ile konulabilmektedir. Esas tedavisicerrahiolmaklabirliktedarlıkbölgesinebalonanjiyoplastive/veyastent uygulamasıdenenmektedir.Buolgusunumunda,ekokardiyografiiletanıkonulmuş doğumsal superiyor vena kava darlığı bulunan, altta yatan nedeni bulunmayan, tedavide balon anjiyoplasti ve daha sonra cerrahi girişim uygulanan 8 aylık kız hastaincelenmiştir.
Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical rel... more Coronary artery fistulae are rarely seen, and they are usually asymptomatic. 1-5 The clinical relevance of CAF focuses mainly on the mechanism of 'coronary steal phenomenon', which causes myocardial functional ischaemia even in the absence of stenosis. Common symptoms of this phenomenon are angina, dyspnoea during physical exertion, and heart palpitations. 2-5 The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations such as the electrocardiogram, treadmill test, echocardiography, computed tomography and coronary angiography. Bacterial endocarditis is rarely observed in patients with CAF. 6,7 Small, asymptomatic fistulae can be followed by echocardiography, while treatment of symptomatic or large asymptomatic fistulae is recommended. 2-5,8,9 Coronary angiography is required to plan
Magnetic resonance imaging has become an important diagnostic tool in the differential diagnosis ... more Magnetic resonance imaging has become an important diagnostic tool in the differential diagnosis of lesions for evaluation of cardiovascular disorders. In magnetic resonance tagging (MRt), tissue elements are magnetically labeled so that their positions can be tracked as a function of time. Thus, MRt evaluates heart wall motion both qualitatively and quantitatively. We present herein the case of a 12‐year‐old boy who had chest pain, dyspnea on effort and murmur. On cardiac computed tomography, there was focal thickening of the left ventricular posterior wall, similar to a mass. MRt indicated active displacement and deformation of the tags at the level of the hypertrophic myocardium during systole, as with normal myocardium. Thus, the tagged images supported the diagnosis of focal hypertrophic cardiomyopathy (HCM). In view of these results, MRt should be considered as a useful technique for differentiating between a mass‐like focal lesion such as neoplasm and HCM.
Experimental and Clinical Transplantation, Feb 1, 2022
OBJECTIVES Neurologic complications that can lead to serious mortality and morbidity in pediatric... more OBJECTIVES Neurologic complications that can lead to serious mortality and morbidity in pediatric heart transplant recipients have been reported to range from 23.6% to 45%. In this study, the frequency, time, cause, and characteristics of neurologic complications in pediatric heart transplant recipients were evaluated. MATERIALS AND METHODS We retrospectively reviewed data of 37 pediatric heart transplant recipients aged <18 years who were seen at our hospital between 2007 and 2017. Medical records were reviewed to identify neurologic complications. Clinical features were compared between pediatric heart transplant patients with and without neurologic complications. RESULTS The rate of posttransplant neurologic complications in pediatric heart transplant was 27% (10/37). Median age of patients with neurologic complications was 12 years (range, 11-18 years). Median time for neurologic complications was 3 days (range, 2-46 days). Primary diagnoses of these 10 recipients were dilated cardiomyopathy (n = 7) and restrictive cardiomyopathy (n = 3). There were no significant differences between recipients with and without neurologic complications (P > .05).The etiologies of neurologic complications were posterior reversible encephalopathy syndrome in 3 patients (8.1%), stroke in 2 patients (5.4%), peripheral neuropathy in 2 patients (5.4%), hypertensive encephalopathy in 1 patient (2.7%), and drug encephalopathy in 1 patient (2.7%). CONCLUSIONS Neurologic complications may lead to serious mortality and morbidity in pediatric heart transplant patients. Seizures, posterior reversible encephalopathy syndrome, stroke, peripheral neuropathy, transient ischemic attack, and cerebral infections are the most common neurologic complications, which are seen in the perioperative period in particular. Careful follow-up of pediatric heart transplant patients, with detection and early treatment of neurologic findings, will contribute to lower rates of sequelae. To our knowledge, this is the largest study to show a detailed experience of neurologic complications in pediatric heart transplant patients from a single center in Turkey.
Background: Brugada syndrome is a disease characterized by a specific electrocardiographic patter... more Background: Brugada syndrome is a disease characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death. We present this case with the updated literature to emphasise the need to consider the diagnosis of Brugada syndrome in patients admitted to the emergency ward with sudden cardiac arrest. Case Report: A 16-year-old female patient was admitted to the emergency ward with complaints of weakness and abdominal pain, and she had four cardiac arrests during her evaluation period. She was referred to our clinic for permanent pacemaker implantation. She was on a temporary pace maker after having had C-reactive protein. Her physical exam was normal except for bilaterally decreased lung sounds. Lung x-ray and computed tomography, which were performed by another institution, revealed minimal pleural effusion and nothing else of significance. Blood and peritoneal fluid samples were sterile. Echocardiographic exam and cardiac enzymes were also in the normal ranges. Electrocardiographic showed incomplete right branch block in leads V1 and V2. An ajmaline test revealed specific electrocardiographic findings of the type I Brugada pattern. We proposed implanting an implantable
Kawasaki disease (KD) is an acute self-limited febrile systemic vasculitis complicated by coronar... more Kawasaki disease (KD) is an acute self-limited febrile systemic vasculitis complicated by coronary and peripheral arterial aneurysms in 20-35% of untreated patients (1, 2). The diagnosis of the disease is based on a combination of symptoms and laboratory data (3). Children with ...
Transesophageal electrophysiologic study (TEEPS) is a semi-invasive method widely used for evalua... more Transesophageal electrophysiologic study (TEEPS) is a semi-invasive method widely used for evaluation of symptoms related to arrhythmia. In this study, we aimed to determine the accuracy of TEEPS in the diagnosis and differentiation of mechanisms of supraventricular tachycardias (SVTs) by comparing results of transesophageal and intracardiac electrophysiologic studies. We performed TEEPS and a subsequent radiofrequency ablation (RFA) procedure in 76 patients. Indications of TEEPS were risk assessment for Wolff-Parkinson-White syndrome in 32 patients and diagnosis and differentiation of tachycardia mechanisms in 44 patients. The procedure was well tolerated in all patients. Positive predictive value of TEEPS in our study was 91% for differentiation of SVT mechanisms. The results suggest that TEEPS is safe, useful and effective in the evaluation of symptoms related to arrhythmia, in differentiation of mechanisms of SVTs, and finally in defining the treatment options of SVT. The technique also provides an opportunity for risk assessment and deciding the treatment modality in Wolff-Parkinson-White patients.
Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment... more Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short-and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. Methods. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Results. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 ± 4.9 years (range: 6 months-19 years). The mean age of the patients at the first ABV was 14.5 ± 10.6 days (range: 1-30 days) and body weight was 3.25 ± 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 ± 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 ± 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. In the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p <0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. Conclusions. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.
Turkish Journal of Thoracic and Cardiovascular Surgery, Apr 26, 2021
Bu çalışmada, doğumsal aort kapak darlığı olan çocuk hastalarda aort balon valvuloplasti ve cerra... more Bu çalışmada, doğumsal aort kapak darlığı olan çocuk hastalarda aort balon valvuloplasti ve cerrahi aort valvuloplastinin başarısı, komplikasyonları ve uzun dönem sonuçları karşılaştırıldı.
Pacing and Clinical Electrophysiology, Nov 1, 2009
Background: Radiofrequency ablation has become first-line therapy for supraventricular tachycardi... more Background: Radiofrequency ablation has become first-line therapy for supraventricular tachycardia in all age groups, but there has been a concern regarding the long-term effectiveness of the procedure in children. This study aimed to determine the inducibility after successful ablation of supraventricular tachycardia in children; assessment was performed using a transesophageal electrophysiologic study. Results: A total of 63 patients who had been treated successfully for supraventricular tachycardia with radiofrequency ablation were included in the study. A transesophageal electrophysiologic study was performed 2 months after radiofrequency ablation. Tachycardia was induced in nine of 34 symptomatic and five of 29 asymptomatic patients by a transesophageal electrophysiologic study. Ten patients had recurrence of the same type of supraventricular tachycardia seen previously, and two had a new type of arrhythmia during a transesophageal electrophysiologic study. Tachycardia inducibility rate was 16% in all patients, 22.8% in patients with atrioventricular reentrant tachycardia, and 8% in patients with atrioventricular nodal reentrant tachycardia. Conclusion: Radiofrequency ablation is a safe and effective method to manage children with supraventricular tachycardia, but patients must be observed for recurrence and new arrhythmias. Sustained tachycardia may also be induced in asymptomatic patients. A transesophageal electrophysiologic study is effective and safe for follow-up of radiofrequency ablation for assessment, diagnosis, and treatment of patients.
Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is defined by the presence of a sustaine... more Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is defined by the presence of a sustained tachycardia that results in left ventricular systolic dysfunction. Restoration of cardiac function is dependent on the control of tachyarrhythmias. We report a series including ten children with tachycardia-induced cardiomyopathy with different etiologies. The medical records of patients with tachycardiomyopathy who were managed in a Pediatric Cardiology Clinic between the years of 2014-2017 were reviewed retrospectively. Ten children (3 female, 7 male) were diagnosed with tachycardiomyopathy. The median age of the patients was 12 years (range: 4-15.8). Five had atrial tachycardia, two had ventricular tachycardia, the others had Mahaim fiber tachycardia, permanent junctional reciprocating tachycardia and atrioventricular reentrant tachycardia. Seven patients had catheter ablation and three patients who had previous heart surgery were treated with antiarrhythmic drugs. Median ejection fraction was 33% (range: 10-48), median left ventricle end-diastolic diameter was 55 mm (range: 30-78). All showed complete recovery with median ejection fraction 60% (range: 55-78). Two patient with severe heart failure required extracorporeal membrane oxygenation support, one of them had ventricular assist device support but the device was removed after successful ablation. After two years this patient required permanent pacemaker implantation due to complete atrioventricular block. Tachycardia-induced cardiomyopathy is a rare and treatable cause of heart failure. Early recognition is critical, aggressive treatment aimed at controlling the arrhythmia results in symptom resolution and recovery of ventricular function.
Scimitar syndrome is a rare congenital cardiac anomaly in which pulmonary veins are drained to th... more Scimitar syndrome is a rare congenital cardiac anomaly in which pulmonary veins are drained to the inferior vena cava (IVC) instead of the left atrium and it is often associated with additional cardiac and pulmonary anomalies. In this article, the different clinical features of pediatric patients with Scimitar syndrome are reported. Material and methods: All patients with scimitar syndrome were diagnosed in our hospital between 2000 and 2020. The clinical findings, angiographic and surgical procedures, and follow-up of the patients are evaluated. Results: Five pediatric patients aged between 1.5 months and 10 years were diagnosed as Scimitar syndrome. All patients were symptomatic. One patient had cor triatriatum and pulmonary venous stenosis, one patient had left atrial isomerism and absence of the IVC (azygous continuity), and another patient had coarctation of the aorta. One patient had dual drainage: the IVC and left atrium with meandering pulmonary veins, which we determined as a Scimitar variant. One infant patient with pulmonary hypertension and two patients with pulmonary to systemic flow ratio (Qp/Qs)>1.5 were treated surgically with the reanastomosis technique. Vascular embolization of the aortopulmonary collaterals was performed in two patients using vascular plugs, coils, and onyx. Conclusion: Treatment should be planned individually in this syndrome due to Scimitar syndrome has a wide range of anatomic and clinical variations.
Introduction Posterior reversible encephalopathy syndrome (PRES), is a clinicoradiological syndro... more Introduction Posterior reversible encephalopathy syndrome (PRES), is a clinicoradiological syndrome that manifested with various neurological signs such as seizure, headache, altered mental function and visual disturbances in organ transplant patients. Hypertension, metabolic derangements and use of calcineurin inhibitors in heart transplant patient are reported as strongly factors which linked to adult PRES however data about PRES after pediatric heart transplant (PHT) is limited. In present study, we aim to determine the prevalence and clinical features of PRES in PHT recipients. Materials and Methods We performed a retrospective review of 37 PHT recipients <22 yo, who received their transplant at our institution between 2007-2017. Medical records were reviewed to identify for PRES diagnosis. Demographic and clinical risk factors were analyzed in development of PRES. Results Seven of 37 (18.9%) recipient developed PRES at a median of 5 days (1-42) after transplant. The median age of recipients with PRES was 14 years (12-18). Recipients with PRES did not differ from those without PRES when comparing age, gender, BMI, total allograft ischemic time, aortic cross-clamp time or cardiopulmonary bypass time. All patients has presented with seizure, 4 patients had elevated blood pressure (<95 percentile) and one patient had CNI levels higher than their target range. Conclusion The prevalence of PRES in PHT recipients appear higher than reported in adult patients. Awareness of PRES in PHT patients should became more important, therefore neurological signs, blood pressure and level of calcineurin inhibitors should be closely monitored in these patients
Objective: Coronary artery fistula (CAF) is defined as a direct communication of a coronary arter... more Objective: Coronary artery fistula (CAF) is defined as a direct communication of a coronary artery with a cardiac chamber, great vessel or other vascular structure, bypassing the myocardial capillary bed. Among CAF, multiple coronary artery fistulae between coronary arteries and left ventricle are very rare and little is known of their anatomic, hemodynamic and clinical features. Methods: A 55-year-old man complained of chest pain and shortness of breath on exertion for six months was admitted to our hospital. A 12-lead resting electrocardiogram and routine biochemical values were within normal limits. On two-dimensional echocardiography, left ventricular dimensions and function were normal. During treadmill exercise test, 2 mm downsloping ST segment depression in leads V5 and V6 was observed at the stage-4. Subsequently, the patient underwent selective coronary angiography. Coronary angiography showed no stenotic lesion of epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left coronary artery (Figures 1A,B). Then, the patient was discharged with proper medical treatment of oral isosorbide mononitrate, beta-blocker, aspirin and angiotensin converitng enzyme inhibitor. The clinical diagnosis of coronary artery left ventricular microfistulae is difficult because the clinical presentation, laboratory and ECG findings are nonspecific. Myocardial ischemia and diastolic volume overload of the left ventricle are the most commonly reported hemodynamic consequences. CAF with large shunt can cause heart failure, myocardial ischemia, arrhythmia, infective endocarditis or aneurysm, progressive enlargement and rupture. Interestingly, most patients with CAF present with typical or atypical angina pectrois during advanced adulthood (older than 40 years) despite the assumed congenital origin of this malformation.
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