[Show abstract][Hide abstract] ABSTRACT: We report our clinical experience with the Amplatzer device in transcatheter closure of 80 atrial septal defects (ASD) in children.
Among 99 patients (mean age: 7.2+/-3.8 years) with ASD selected by transthoracic echocardiography, procedures were performed in 80 patients under general anesthesia with fluoroscopic and transesophageal echocardiographic (TEE) guidance. Optimal device size was selected after stretched balloon sizing of the ASD's. The patients were discharged at 24 hours after an evaluation with X-ray, electrocardiography and echocardiography.
The mean follow-up period (FUP) was 38+/-14 months. Mean ASD size was 11.5+/-3.7 mm at TEE (stretched size: 17.6+/-3.9 mm). The mean size of the device was 18.6+/-4.0 mm. Procedure and fluoroscopy time were 52.1+/-17.8 minutes and 11.0+/-4.9 minutes, respectively. Immediately after the procedure 35 patients (43.8%) had residual shunts. Trivial shunt remained in only 2 of them (2.5%) after FUP. None of the patients had major complications. Minor and transient rhythm abnormalities were observed in 5 patients and trivial mitral regurgitation was seen in 6 patients.
Amplatzer is an effective and safe device for transcatheter closure of ASD especially in pediatric patients.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 10/2005; 5(3):159-64. · 0.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Doppler indexes have been used successfully to determine the severity of aortic regurgitation (AR) in adults but have not been evaluated in children. To determine the accuracy of pulsed, color, and continuous-wave (CW) Doppler echocardiographic indexes in assessing the degree of AR in children, the correlation between the non-invasive measurements and angiographic grading of the regurgitant flow (1+ to 4+) was examined in 14 children (mean age 11 +/- 3 years) with chronic AR. Forward and reverse flows in the aortic arch were evaluated from the suprasternal notch using pulsed Doppler. Aortic time-velocity integrals (TVI) were measured during systole (forward flow) and diastole (reverse flow), and the ratio of reverse to forward TVI (%) was calculated. Doppler color flow mapping was used to detect and assess the severity of AR (which appears as mosaic turbulent signals extending in the left ventricular outflow tract during diastole) by using four color Doppler grades of severity. The envelope of the flow velocity pattern in diastole was recorded from the CW Doppler signal of AR with the transducer in the lower sternal border to determine the peak flow velocity and deceleration slope (alpha) indexes. The ratio of reverse to forward aortic TVI and color flow mapping grading showed strong correlation with angiographic grade (r=0.92 and r=0.86, respectively) but AR slope (alpha) and peak flow velocity did not correlate well with the angiographic grade (r=-0.039 and r=0.74, respectively). We concluded that the severity of AR in children as determined by angiographic grading can be estimated with reasonable accuracy by noninvasive technique based on color and pulsed wave Doppler. Use of these indexes may obviate the need for angiography to detect the severity of AR in children.
The Turkish journal of pediatrics 01/2003; 45(1):15-20. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study analyzed 28 thrombotic children with various cardiac disorders. They comprise 17% of a total of 168 patients with thrombosis from a single center. Among the 28 patients, 21 had congenital heart disease and 7 were diagnosed with cardiomyopathy. The patients with thrombosis were evaluated for congenital and acquired thrombotic risk factors. In addition to cardiac disorders, two, three, or more risk factors were present in 61% of the children with thrombosis. Two common mutations, namely factor V Leiden and prothrombin G20210A mutations, were found in 6 patients (22%). Nine patients (32%) died of infection, congenital heart disease, cardiomyopathy, thrombosis, operation, or a combination of these; two patients required surgical intervention. Following cardiac angiography, due to necrosis, amputation of the right index finger and right lower extremity was performed on 1 patient. The second patient's index fingers had to be amputated and resection of the bowel was performed following the operation on coarctation of the aorta. This study indicates that congenital heart disease and cardiomyopathy are two common cardiac disorders that may lead to the development of thrombosis. The majority of thrombosis develops within the heart and/or its great vessels. The second predominant site for thromboembolic symptoms is in the brain, including sinovenous thrombosis.
[Show abstract][Hide abstract] ABSTRACT: Valvar aortic stenosis is a common congenital heart defect for which surgical procedures can be done with low risk except in infants whose conditions are seriously compromised. The purpose of this report was to present our experience with the results of surgical aortic valvotomy for congenital valvar aortic stenosis performed at our hospital. The study group consisted of 24 patients, 3 females and 21 males, with ages ranging from 1 to 15.5 years (mean age 8.5 years), who underwent aortic valvotomy for valvar aortic stenosis. The case records of all the patients were retrospectively reviewed. They were followed for 1-10.5 years (mean 5.02+/-2.38 years) after relief of aortic stenosis, and were scheduled for reevaluation. Sixteen of the 24 patients were recatheterized and 15 (93.7%) were found to have aortic regurgitation on angiography. Peak systolic pressure gradients (mean+/-SD) were 65.9+/-19.5 mmHg before and 36.7+/-14.8 mmHg (p<0.05) after the operatilon. Of the 24 patients, 45.8% had a new postoperative diastolic murmur. Twenty patients (83.3%) had residual stenosis and three (12.5%) had recurrent stenosis. Two patients (8.3%) had undergone reoperation six to seven years after the initial aortic valvotomy, and most of the others will require reoperation in the future. No sudden deaths occurred in this series. Timely relief of obstruction prevents sudden death and produces symptomatic improvement in valvar aortic stenosis, but aortic valvotomy is only a palliative measure.
The Turkish journal of pediatrics 01/2002; 44(4):304-11. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A late complication of the CardioSEAL atrial septal defect (ASD) occluder is reported. Although left atrial umbrella was completely epithelialized and occluded ASD without residual defect, the right atrial umbrella protruded toward the center of right atrium after 18 months. We believe this may be associated with the structural abnormality of the device.
Catheterization and Cardiovascular Interventions 12/2001; 54(3):335-8. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: With transesophageal echocardiography (TEE), a new echocardiographic window is obtained which enables cardiologists to explore the heart from the esophagus and stomach. However, the procedure, when first undertaken, may present certain difficulties for the cardiologist in interpreting the anatomical findings and approaching a diagnosis. We thus convey our first experiences and results of TEE in 107 pediatric patients. Transesophageal echocardiography (TEE) was performed in 107 pediatric patients at our institution between December 1998-February 2001, using the standard techniques and following the standard criteria suggested by the American heart Association. The mean age of 54 male (50.5%) and 53 female (49.5%) patients was 7.8 years. Intubation difficulty was experienced in four cases. In one case, while drawing the transducer back from the esophagus, it kinked at the hypopharynx. None of the cases had major hemorrhage or esophageal rupture, and only a few cases had minor pharyngeal injuries or hemorrhages. We used TEE in detecting vegetations in patients with possible endocarditis, and evaluating the prosthetic valves and abnormal pulmonary venous return. We also used TEE to clarify preooperative anatomical details, postoperative complications and residual defects of complex congenital cardiac anomalies. Transcattheter closure of 47 secundum atrial septal defects (ASD)'s and a muscular ventricular septal defect (VSD) (both during patient selection and during the procedure) were accomplished under TEE guidance. As the pediatric cardiologists gain more experience in performing TEE, this technique will have a wider and more effective use in the pediatric population.
The Turkish journal of pediatrics 01/2001; 43(3):201-4. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.
The Turkish journal of pediatrics 01/2001; 43(1):12-8. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the immediate and short-term results of endovascular stent implantations from our center. We performed stent implantations in four patients (3, 12, 18 and 20 years old) with different stenoses or obstructions: right ventricular outflow conduit obstruction, left Blalock-Taussig obstruction, post-operative recoarctation and cavopulmonary anastomosis obstruction. Stent were implanted successfully. The mean diameters of stenoses were expanded from 4.5 +/- 3.5 (2-7) mm to 9 +/- 1. 2 (8-10) mm, and the complaints of patients were improved significantly by stent implantation. There was no complication related to the procedures. All patients are living except one who died from cerebrovascular event unrelated to the stent implantation. The mean follow-up period of three living patients is 6.3 +/- 5.5 (1-2) months. As of the last control, all have remained at the caliber achieved at original placement. In light of our limited experience and previous reported studies, we conclude that intravascular stents are safe and can be used effectively in selected patients with congenital heart defects.
The Turkish journal of pediatrics 01/2001; 43(1):59-64. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case of truncus arteriosus type II is reported. Truncus arterious is an uncommon congenital cardiac defect where a single great vessel exits the heart. Truncus arteriosus is usually fatal, if untreated. This defect occurs when the conus arteriosus and the truncus divide erroneously in the embryo. Palliative surgery in truncus arteriosus has been unsuccessful. Pulmonary banding has been tried and was ineffective and usually fatal. We operated on a nine-month-old (6200 g) male infant with a type II (Edwards-Collett) defect and a large ventricular septal defect. The pulmonary artery average pressure was 51 mmHg. We performed a cardiopulmonary bypass in the usual manner. Pulmonary arteries were resected from the truncal root, and primary end-to-end anastomosis of the truncal root to the ascending aorta was performed. Right ventricle to pulmonary artery continuity was provided using a valveless Gore-Tex graft. We lost our patient due to intractable pulmonary hypertension on the first postoperative day.
The Turkish journal of pediatrics 01/1998; 40(4):619-25. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the efficacy of transcatheter closure of patent arterial ducts using controlled-release coils.
Transcatheter closure of patent arterial ducts was attempted in 52 patients using controlled-release coils.
For the study, four tertiary paediatric cardiology units were used, two of which were in the U.K., one in Italy and one in Turkey.
The 52 patients ranged in age between 3-5 months and 61 years (median 3-5 years), and weighted between 4.5 kg and 62 kg. The duct diameters were 1 mm to 6.5 mm.
In four patients the ducts were too large for safe release of the coils. In the remaining 48, one coil was inserted in 33 patients, two coils in nine, three coils in four and four coils in two patients. Immediately at the end of the procedure, the duct was completely occluded in 26/47 (55%) patients. Haemolysis occurred in one patient, in whom the coil was removed by a snare catheter and a large umbrella device was implanted with resolution of the haemolysis. Coil embolization to the pulmonary artery occurred in five (10%) patients. All were easily retrieved and replaced by larger coils. At the latest follow-up by colour Doppler echocardiography, the duct was completely occluded in 44/47 (94%) patients.
Transcatheter closure of patent arterial ducts by controlled-release coils is effective and safe. Even when more than one coil is inserted the technique is still less cumbersome and considerably cheaper than transcatheter umbrella closure.
European Heart Journal 04/1997; 18(3):450-4. · 14.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the cardiac anatomy of patients with double-outlet right ventricle by angiocardiography. A total of 73 patients between the ages of one day and 11 years were examined. The aorta was on the right side of the pulmonary artery in 23 cases (32%), right anterior in 20 (27%) and right posterior in 17 cases (23%). Pulmonary stenosis was found in 53 patients (73%) and subaortic stenosis in six cases. Ventricular septal defect (VSD) was subaortic in 39 cases (52%), remote type in 17 (23%), doubly committed in 10 (13%), and subpulmonic in 9 (12%). Double VSD was noted in two patients. Pulmonary hypertension was more frequent in subpulmonic ventricular septal defect (78%). The most common associated anomalies were atrial septal defect (34%), anomalous coronary arteries (12%) and endocardial cushion defect (10%). Aortic root angiography was not satisfactory in half of the cases with coronary arterial anomaly. In conclusion, double-outlet right ventricle is a complex anomaly, all of whose cardiac features can be successfully demonstrated in detail by echocardiography and angiocardiography. However, in order to determine the anatomy of the coronary arteries, selective coronary angiography may be necessary in some patients.
The Turkish journal of pediatrics 01/1997; 39(1):27-33. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Controlled-release coils have become available recently for the closure of patent ductus arteriosus (PDA). Transcatheter closure of patent arterial ducts was attempted in 13 patients, ranging in age from 5 months to 15 years, mean 4.1 years. Implantation of controlled-release PDA coils was attempted via the femoral artery through 5 Fr catheters in all cases except one, in whom both the femoral arterial and venous routes were used. The procedure was successful in 10 of the 13 patients. In these, the pulmonary artery systolic pressure ranged between 25 and 42 mmHg and the duct diameter varied from 1.5 to 6 mm at its narrowest point. Six of the patients received a single coil. Two coils were inserted in three patients and three coils in one patient. In three patients the ducts were too large for safe release of the coils, despite attempted implantation of up to three coils simultaneously. These coils were easily withdrawn into the catheter. Immediately at the end of the procedure, the duct was completely occluded in nine of the 10 patients, and in one patient there was a small residual flow. The procedure time varied between 35 min and 2.5 h, mean 81 min and the fluoroscopy time varied from 5 to 78 min, mean 25 min. None of the patients experienced hemorrhage, diminished lower extremity pulse, hemolysis or infection. In one patient, a 5 mm coil embolized into the right pulmonary artery soon after release. It was retrieved with a snare, then 8 mm and a 5 mm coil were implanted satisfactorily in the arterial duct. At follow-up by color Doppler echocardiography, the duct was completely occluded in all patients. Transcatheter closure of patent arterial ducts by controlled-release PDA coils is effective and safe. Even when more than one coil is inserted, it is still cheaper than transcatheter umbrella closure. This method is therefore of great value, particularly in less affluent countries.
[Show abstract][Hide abstract] ABSTRACT: 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 iron-sufficient 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 iron-sufficient 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.
[Show abstract][Hide abstract] ABSTRACT: A 4-year-old boy with abnormal connection of the inferior vena cava to the left atrium and double outlet right ventricle and right atrial isomerism is presented. The anomalies were detected by echocardiography and angiography, and later verified through surgical intervention.
Catheterization and Cardiovascular Diagnosis 04/1996; 37(3):287-9.
[Show abstract][Hide abstract] ABSTRACT: Discrete subvalvular aortic stenosis is a progressive lesion. In this report we presented nine patients who had no significant left ventricular-aortic obstruction at initial cardiac catheterization or echocardiographic examination, but later developed significant subvalvular aortic stenosis. Associated lesions included ventricular septal defect in three, patent ductus arteriosus in two, aorticopulmonary window in one, tetralogy of Fallot in one, supramitral membrane in one, and ventricular septal defect and patent ductus arteriosus in one case. Nine patients were diagnosed with subvalvular aortic stenosis 18 months to eight years after surgical correction. Eight of the patients required surgery for subvalvular obstruction. In conclusion, discrete subaortic stenosis is a rare, late complication of the surgical repair of several congenital heart defects. It is a progressive lesion after surgery; therefore these patients require careful follow-up.
The Turkish journal of pediatrics 01/1996; 38(2):177-82. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Blade atrial septostomy was performed in 18 patients, including 14 with transposition of the great arteries, three with tricuspid atresia and one with severe mitral stenosis and ventricular septal defect. The patients' ages ranged from 25 to 210 days (mean: 108 +/- 64 days), and weights ranged from 3.0 to 6.0 kg. Following blade septostomy, partial arterial pressure of oxygen (PaO2) increased from an average of 22 +/- 3.3 mmHg to 38.9 +/- 7.6 mmHg (p < 0.001), and prompt clinical improvement was observed in the majority of patients. Significantly decreased atrial pressures (from 8.16 +/- 6.1 to 3.93 +/- 2.2 mmHg, p < 0.01) and significantly enlarged inter-atrial openings (from 1.6 +/- 0.9 to 7.5 +/- 1.8 mm, p < 0.001) were achieved with successful blade atrial septostomy. Blade atrial septostomy is an effective and life-saving procedure in patients who require nonrestrictive inter-atrial communication.
The Turkish journal of pediatrics 01/1996; 38(4):459-66. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The presence of anomalous muscle bundles may produce a pressure gradient between the inflow and outflow portions of the right ventricle, thus resulting in double-chambered right ventricle bearing troublesome clinically in its diagnosis. The aim of the present study was to review the diagnostic criteria. Fifty-two patients with a double-chambered right ventricle were seen during an 8-year period. They ranged in age at the catheterization from 4 months to 17 years (mean 7.5 +/- 4.4 years). Diagnosis was confirmed in 51 patients at cardiac catheterization and in other one on operation. The majority of the patients had associated cardiac anomalies: there were 33 ventricular septal defect (63%), 21 pulmonary valve stenosis (40%), nine atrial septal defect (17%), and four double-outlet right ventricle. The electrocardiograms revealed upright T waves alone in right precordial leads suggesting right ventricular hypertrophy in 33% of the patients. At cardiac catheterization, there was a pressure gradient of 20-160 mmHg between the right ventricular inflow and outflow portions. Forty patients have had surgery and four have undergone balloon pulmonary valvuloplasty. Surgical treatment was planned for two patients and other six had no indication for treatment.
International Journal of Cardiology 07/1995; 50(1):19-29. · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A three-year-old girl was admitted to Hacettepe Children's Hospital due to sweating and poor feeding. Echocardiography demonstrated ostium primum atrial septal defect with a cleft mitral valve. After two months of medical follow-up with digitalis, she was subjected to open-heart surgery, and a primum-type atrial septal defect with double mitral orifice was found. To avoid creating acute mitral stenosis, the cleft was only partially sutured and the septal defect was closed with a patch. Her postoperative recovery was uneventful. It is emphasized that surgical intervention should be individualized in each case.
The Turkish journal of pediatrics 01/1995; 37(2):173-6. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Splenic anomalies frequently accompany conotruncal and atrioventricular septal malformations. Asplenia is a major factor in the mortality of newborns with the heterotaxy syndrome, requiring an early and accurate diagnosis. We evaluated the splenic status of five consecutive patients with heterotaxy syndrome by radionuclide splenic scanning with 99mTc-labelled and denatured red blood cells (RBCs) and by real-time abdominal ultrasonography. Examination and comparison of the findings using these diagnostic methods suggest that the former has some diagnostic pitfalls which arise from the symmetrical location of the liver in the abdomen. This leads to difficulty in the interpretation of overlapping signals from the blood pool of the liver and from the spleen.
[Show abstract][Hide abstract] ABSTRACT: Partial anomalous pulmonary venous return (PAPVR) is a congenital anomaly in which one or more, but not all, of the pulmonary veins are connected to a systemic vein or to the right atrium directly. Its incidence is higher in autopsy series than in clinical series. We report 51 cases of PAPVR diagnosed by cardiac catheterization and evaluated from the aspects of age, sex, type and associated anomalies and diseases.
Japanese Heart Journal 02/1994; 35(1):43-50. · 0.40 Impact Factor