Ageliki A Karatza

Publications (15)47.42 Total impact

• Article: Erratum to: Accuracy of Cardiac Auscultation in Asymptomatic Neonates with Heart Murmurs: Comparison Between Pediatric Trainees and Neonatologists.

  Ageliki A Karatza, Sotirios Fouzas, Sotirios Tzifas, Alexandra Mermiga, Gabriel Dimitriou, Stefanos Mantagos
  Pediatric Cardiology 03/2011; · 1.30 Impact Factor
• Article: Accuracy of cardiac auscultation in asymptomatic neonates with heart murmurs: comparison between pediatric trainees and neonatologists.

  Ageliki A Karatza, Karatza A Ageliki, Sotirios Fouzas, Fouzas Sotirios, Sotirios Tzifas, Tzifas Sotirios, Alexandra Mermiga, Mermiga Alexandra, Gabriel Dimitriou, Dimitriou Gabriel, Stefanos Mantagos, Mantagos Stefanos
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  ABSTRACT: The aim of this study was to assess whether cardiac auscultation performed by pediatric trainees and neonatologists can reliably distinguish innocent from pathologic heart murmurs in asymptomatic neonates. From January 2008 to April 2009 the pediatric trainees of our institution were requested to refer all asymptomatic neonates with a murmur and classify the murmurs as "innocent," "pathologic," or "possibly pathologic." Prior to echocardiography, each neonate was evaluated by two experienced neonatologists. The echocardiographic studies of 169 neonates were analyzed. Abnormal cardiac anatomy was found in 55 neonates (32.6%). The overall ability of pediatric trainees in identifying congenital heart disease (CHD) was moderate [area under the curve (AUC) = 0.855] and significantly lower compared to neonatologists (AUC = 0.919, p = 0.007). However, at "lower" levels of clinical confidence (i.e., clinical diagnosis of possibly pathologic murmurs), pediatric trainees had good ability in excluding CHD (sensitivity 94.6%; negative likelihood ratio = 0.09). The ability of cardiac auscultation for diagnosing CHD in asymptomatic neonates is limited and dependent on the physician's experience and level of clinical confidence. Echocardiography should remain an option for all neonates with a possibly pathologic murmur.
  Pediatric Cardiology 02/2011; 32(4):473-7. · 1.30 Impact Factor
• Article: Transcutaneous bilirubin levels in late preterm neonates.

  Sotirios Fouzas, Ageliki A Karatza, Eleni Skylogianni, Lito Mantagou, Anastasia Varvarigou
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  ABSTRACT: To examine transcutaneous bilirubin (TcB) levels in late preterm neonates. Between July 2006 and December 2009, we performed 4387 TcB measurements with a BiliCheck bilirubinometer in 793 healthy late preterm neonates at designated times up to 120 postnatal hours. TcB percentiles are presented on an hour-specific nomogram. Mean increment TcB rates and the rates of increase for different percentiles are calculated as well. We present a percentile-based nomogram that reflects the natural history of TcB in late preterm neonates up to the fifth day of life. TcB levels demonstrated a different pattern of increase in neonates who developed significant hyperbilirubinemia compared with those who did not. However, the rates of TcB increase were quite similar up to age 48 hours, with a substantial overlap of TcB values between the two groups. We developed of a TcB nomogram designated for hour-specific evaluation of hyperbilirubinemia in neonates born between 35(0/7) and 37(6/7) weeks' gestation.
  The Journal of pediatrics 11/2010; 157(5):762-6.e1. · 4.02 Impact Factor
• Source

  Available from: PubMed Central

  Article: Saw-tooth cardiomyopathy.

  Periklis A Davlouros, Peter G Danias, Ageliki A Karatza, Maria G Kiaffas, Dimitrios Alexopoulos
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  ABSTRACT: We present an unusual case of cardiomyopathy in a two month old male infant with a grade-I systolic murmur. Echocardiographic examination disclosed left ventricular (LV), dysplasia with saw-tooth like inwards myocardial projections extending from the lateral walls towards the LV cavity. There was mild LV systolic dysfunction with apical hypokinesia. Cardiovascular magnetic resonance demonstrated in detail these cross bridging muscular projections originating from the inferior interventricular septum and lateral LV wall, along with areas of hypokinesis at the LV septum and apex in a noncoronary distribution, without any late gadolinium enhancement. We have termed this condition saw-tooth cardiomyopathy because of the very characteristic appearance.
  Journal of Cardiovascular Magnetic Resonance 12/2009; 11:54. · 3.72 Impact Factor
• Article: Periconceptional tobacco smoking and isolated congenital heart defects in the neonatal period.

  Ageliki A Karatza, Ioannis Giannakopoulos, Theodore G Dassios, George Belavgenis, Stefanos P Mantagos, Anastasia A Varvarigou
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  ABSTRACT: Tobacco use in pregnancy is considered a human developmental toxicant and potential teratogen. The aim of the study was to test for a possible association between periconceptional tobacco smoking and congenital heart disease (CHD) in the neonatal period. Maternal and infant characteristics of 157 neonates diagnosed with CHD at the University of Patras Medical School were collected and were compared with 208 normal neonates (aged 1-28 days) that were referred for echocardiography during a specified 3-year period. In neonates with CHD 64 of 157 mothers (40.8%) reported smoking in pregnancy, whereas in the control group 41 of 208 mothers (19.7%) were smokers (p=0.000). Logistic regression analysis with pregestational diabetes, history of influenza-like illness in the first trimester, therapeutic drug exposure in pregnancy, maternal age, parity, family history of CHD, infant gender, prematurity and paternal smoking, as potential confounding factors showed that periconceptional tobacco smoking was associated with increased risk of CHD in the offspring (OR=2.750, 95% CI=1.659-4.476, p=0.00001). The incidence of neonatal heart disease in women who were non-smokers or smoked 1-10 and ≥11 cigarettes per day increased with the level of fetal tobacco exposure (35.8% versus 55.3% versus 64.3%, x2-test=20.303, p=0.000), suggesting a dose effect. The results of the study are indicative of an association between periconceptional tobacco exposure and increased risk of CHD in the neonatal period. The potential role of gestational smoking as a risk factor for specific heart defect subgroups requires the conduction of large population based epidemiological studies.
  International journal of cardiology 11/2009; 148(3):295-9. · 7.08 Impact Factor
• Article: Diagnostic role of plasma BNP levels in neonates with signs of congenital heart disease.

  Periklis A Davlouros, Ageliki A Karatza, Ioanna Xanthopoulou, Gabriel Dimitriou, Aikaterini Georgiopoulou, Stefanos Mantagos, Dimitrios Alexopoulos
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  ABSTRACT: Only a few studies have examined the relationship of plasma BNP levels and congenital heart disease (CHD) in neonates and these mainly concern preterm neonates with patent ductus arteriosus. We aimed to investigate the diagnostic role of plasma BNP in neonates admitted in the neonatal intensive care unit, (NICU), with signs of congenital heart disease (CHD). Prospective assessment of plasma BNP levels in 75 consecutive neonates with suspected CHD (heart murmur, respiratory distress, or cyanosis), admitted in the NICU of our university hospital. The final diagnosis was done with echocardiography. Haemodynamically significant Left to Right shunts, (hsLtR), were found in 29 neonates, insignificant LtR shunts in 22, no heart disease in 15 and cyanotic heart disease in 9. BNP levels were significantly higher in neonates with hsLtR shunts vs. all other groups (logBNP 2.9 ± 0.5 pg/ml vs. 1.5 ± 0.4 pg/ml vs. 1.5 ± 0.3 pg/ml vs. 1.6 ± 0.2 pg/ml, p < 0.0001). Plasma BNP levels > 132.5 pg/ml had 93.1% sensitivity and 100% specificity for diagnosing hsLtR shunts (accuracy 99.6%). Plasma BNP is a reliable test for diagnosing hsLtR shunts in the NICU. This will alert the neonatologist for ordering an echocardiographic examination, or if the latter is not available, for transferring the neonate to an appropriate tertiary centre with neonatal-paediatric cardiology facilities. Normal BNP levels imply the absence of a significant LtR shunt, but may not exclude cyanotic heart disease.
  International journal of cardiology 09/2009; 147(1):42-6. · 7.08 Impact Factor
• Article: Course of growth during the first 6 years in children exposed in utero to tobacco smoke.

  Theodoros A Kanellopoulos, Anastasia A Varvarigou, Ageliki A Karatza, Nicholas G Beratis
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  ABSTRACT: Postnatal growth in children exposed in utero to tobacco smoke is not well understood. This study investigated growth during the first 6 years in children whose mothers smoked during pregnancy. Weight, length, and head circumference were measured annually for 6 years in 100 children in each group of smoking (study) and nonsmoking (control) mothers. Weight and head circumference were significantly smaller in the neonates whose mothers smoked >or=15 cigarettes/day, but the difference disappeared by 3 years of life. Length was significantly smaller in the study neonates at birth, followed by increasing divergence from normality up to 2 years, when the mean difference of children whose mothers smoked >or=15 cigarettes/day from control children was -3.4 cm (p <or= 0.0001). Subsequently, they manifested catch-up growth ,and the difference from the controls at 3, 4, 5, and 6 years was -2.5 cm (p <or= 0.0001), -2.2 cm (p = 0.005), -2.1 cm (p = 0.013), and -1.9 cm (p = 0.055), respectively. The delayed growth was related to smoking per se and appeared to be independent of several confounding factors. At birth, there was a significant negative correlation between the number of cigarettes smoked per day and the growth parameters studied; it remained significant up to the 6 year only for length. Length exhibits the most persistent growth delay of the parameters studied, but catch-up growth occurs after the second year of life, and thus, intrauterine exposure to tobacco smoke seems to have no permanent effect on children's growth.
  European Journal of Pediatrics 08/2007; 166(7):685-92. · 1.88 Impact Factor
• Article: Safety and efficacy of Sildenafil therapy in children with pulmonary hypertension.

  Ageliki A Karatza, Andrew Bush, Alan G Magee
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  ABSTRACT: Sildenafil is a selective Phosphodiesterase-5 inhibitor that has been reported to be a potent pulmonary vasodilator. We evaluated the safety, efficacy and pharmacokinetics of oral Sildenafil in a case series of children with pulmonary hypertension. Three children, 1 with primary pulmonary hypertension (patient 1) and 2 with pulmonary hypertension associated with congenital heart disease (patients 2 and 3) were enrolled. Sildenafil was started at 0.5 mg/kg 4-hourly and the dose increased to 1.0 and then to 2.0 mg/kg/dose. Patients were assessed at baseline and then monthly for a total of 6 visits. All patients reported increased exercise capacity with improvement in New York Heart Association functional class. The distance walked during the 6-min test increased by 74% (patient 1), 75% (patient 2) and 25% (patient 3) and oxyhaemoglobin saturations increased from 79%, 97% and 80% to 93%, 100% and 93%, respectively. There were no side effects and no fall in systemic blood pressure. Sildenafil plasma levels 1 h after a 0.5, 1.0 and 2 mg/kg dose of Sildenafil were 109+/-87, 150+/-62 and 368+/-200 ng/ml, respectively. They fell to 211+/-106 ng/ml 3 h after the 2.0 mg/kg dose. Medium term Sildenafil therapy improves oxyhaemoglobin saturations and exercise tolerance in children with pulmonary hypertension without any side effects. Mean plasma levels 1 h after doses of 0.5-2.0 mg/kg are similar to the maximum plasma concentrations reported in adults receiving doses within the therapeutic range. Sildenafil use in children appears to be safe and may be beneficial in the management of pulmonary arterial hypertension.
  International Journal of Cardiology 05/2005; 100(2):267-73. · 7.08 Impact Factor
• Article: Effects of two nebulization regimens on heart rate variability during acute asthma exacerbations in children.

  Michael B Anthracopoulos, Ageliki A Karatza, Periklis A Davlouros, John A Chiladakis, Antonis S Manolis, Nicholas G Beratis
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  ABSTRACT: Analysis of heart rate variability (HRV) has been used to evaluate changes in sympathovagal balance. The present study was designed to investigate the influence of two therapeutic regimens on autonomic cardiovascular regulation during acute asthma exacerbations (AAE). Twenty children, 7-13 years of age, with moderate or severe AAE were randomized in two equal groups to receive either 0.15 mg/kg/dose salbutamol (group 1) or a combination of lower-dose salbutamol (0.10 mg/kg/dose) and ipratropium bromide (5 mcg/kg/dose) (group 2). Exacerbations were treated with three nebulizations (Tx) of either regimen given 20 minutes apart. HRV indices [total power, high-frequency component (HF), low-frequency component (LF), and LF:HF ratio] were analyzed at specific time intervals during the management of AAE. Therapy had a significant time-dependent main effect on total power (p = 0.001), LF (p < 0.0001), and HF (p = 0.005) but reached only borderline significance for LF:HF ratio (p = 0.053). The decrease in LF was more pronounced in group 2 vs. group 1 at 10 minutes post-Tx1 (p = 0.034) and at 10 minutes post-Tx2 (p = 0.05), but there was no significant difference between groups at 10 and 20 minutes post-Tx3. There were no significant differences between groups in any of the other HRV indices. Both regimens improved FEV1 (p = 0.0001) to the same magnitude. During AAE, three consecutive inhalation treatments with either high-dose salbutamol-only or lower-dose salbutamol plus ipratropium bromide combination, resulting in similar FEV1 improvement, cause domination of sympathetic over parasympathetic nervous system of similar overall magnitude but distinct patterns of HRV indices.
  Journal of Asthma 05/2005; 42(4):273-9. · 1.52 Impact Factor
• Article: Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot.

  Periklis A Davlouros, Ageliki A Karatza, Michael A Gatzoulis, Darryl F Shore
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  ABSTRACT: Repaired tetralogy of Fallot (rTOF) has an excellent long-term prognosis; however, survival is somewhat less than normal. Of all the residual lesions and sequellae after rTOF, pulmonary regurgitation (PR) is the most important, correlating with right ventricular (RV) size, exercise intolerance and serious ventricular arrhythmias. Pulmonary valve replacement (PVR) has beneficial effects on RV size and function, provided it is performed early, before irreversible RV dysfunction ensues. Moreover, PVR is associated with an improvement in patients' symptoms and exercise tolerance and combined with arrhythmia surgery (cryoablation) it leads to a dramatic decrease in the incidence of fatal ventricular arrhythmias. Associated lesions, especially branch pulmonary artery stenosis, which aggravates PR, and tricuspid regurgitation, which further impacts on RV size and function, need addressing. Large right ventricular outflow (RVOT) akinetic and aneurysmal regions are frequent and further compromise RV function; therefore, resection during PVR should be attempted. Despite excellent mid-term results, homografts and xenografts, usually used for RVOT reconstruction, suffer late dysfunction and failure, committing patients and surgeons to further operations. Therefore, the decision to operate should be based on the balance between progressive RV dilatation, exercise intolerance, symptoms, arrhythmias and the fact that further reoperations will be needed. Research on the ideal valve for RVOT reconstruction is ongoing. Prospective follow-up of patients with rTOF with exercise testing and assessment of RV size and function, preferably with magnetic resonance, will define better the natural history of the disease and will probably provide firm guidelines for PVR timing especially in asymptomatic patients.
  International Journal of Cardiology 01/2005; 97 Suppl 1:91-101. · 7.08 Impact Factor
• Article: Images in congenital heart disease. Reversal of shunting in pulmonary hypertension after treatment with oral Sildenafil.

  Ageliki A Karatza, Andrew Bush, Alan G Magee
  Cardiology in the Young 01/2003; 12(6):561-2. · 0.76 Impact Factor
• Article: Reversal of shunting in pulmonary hypertension after treatment with oral Sildenafil

  Ageliki A.  Karatza , Andrew  Bush 
  Cardiology in the Young 11/2002; 12(06):561 - 562. · 0.76 Impact Factor
• Article: An uncommon cause of neonatal respiratory distress.

  Gabriel Dimitriou, Ageliki A Karatza, Alexandra Mermiga, Ioannis Giannakopoulos, Markos Marangos, Stefanos P Mantagos
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  ABSTRACT: We describe a term infant without any features of congenital infection, who presented with respiratory distress at birth. Respiratory distress persisted despite change of antibiotics, and chest radiography showed bilateral diffuse patchy infiltrates. Congenital infections screening obtained on the 10th day of life was reported positive for syphilis. The infant was started on penicillin G and came off oxygen within five days. Although the presentation of congenital syphilis as pneumonitis in the absence of other clinical signs is unusual, in view of the re-emergence of the disease, syphilitic involvement of the lungs should be considered in any infant presenting with persistent diffuse lung disease of unknown etiology.
  The Turkish journal of pediatrics 52(6):642-4. · 0.44 Impact Factor
• Article: Growth up to 2 years in relationship to maternal smoking during pregnancy.

  Ageliki A Karatza, Anastasia Varvarigou, Nicholas G Beratis
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  ABSTRACT: Smoking during pregnancy causes intrauterine growth retardation, but the subsequent growth of these children is not well understood. Two hundred four newborns of mothers who smoked during pregnancy and 204 control neonates were studied. Children were re-examined at 1 and 2 years. Newborns of mothers who smoked 1-9 cigarettes/day had similar anthropometric parameters with the controls. Significant retardation in weight, length, and head circumference was present in the newborns whose mothers smoked > or = 10 cigarettes/day. At follow-up, in children of smoking mothers the retardation of weight improved, head circumference remained stable, and length retardation increased even in children whose mothers smoked < 10 cigarettes/day.
  Clinical Pediatrics 42(6):533-41. · 1.15 Impact Factor
• Article: Treatment of primary pulmonary hypertension with oral sildenafil.

  Ageliki A Karatza, Indra Narang, Mark Rosenthal, Andrew Bush, Alan G Magee
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  ABSTRACT: Sildenafil, a selective phosphodiesterase-5 inhibitor, was administered orally to a 14-year-old girl with primary pulmonary hypertension (PPH) at a dose of 0.5 mg/kg/4 h on a daily basis, increased to doses of 1 and 2 mg/kg at monthly intervals. Following therapy, oxygen saturation increased and exercise capacity improved significantly, but with no change in pulmonary haemodynamics. No side-effects were noted. Sildenafil may be beneficial in children with PPH, but the mechanism of benefit is unclear.
  Respiration 71(2):192-4. · 2.26 Impact Factor