Fırat Kardelen

Akdeniz University, Satalia, Antalya, Turkey

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Publications (20)19.99 Total impact

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    ABSTRACT: Cardiovascular (CV) disease remains the most common cause of mortality in chronic kidney disease (CKD). In this cross-sectional study, 43 pediatric patients with CKD were divided into two groups according to their estimated glomerular filtration rate (eGFR): groups 1 and 2 (eGR; 29-75 and 15-29 mL/min/1.73 m(2), respectively). M - mode, conventional pulsed wave Doppler (cPWD) echocardiography and tissue Doppler imaging (TDI) were performed in all patients and 16 healthy controls. Maximal early (E wave) and late (A wave) diastolic flow velocities were assessed by cPWD. Using TDI, the early (E') and late (A') diastolic filling velocities were recorded. Early and late diastoles were evaluated using E' values and E/E' ratios, respectively. Left ventricular hypertrophy (LVH) was determined in 19/43 (44.2%) patients. The E/E' ratio was significantly higher in group 2 than in group 1 and controls. E/E' was found to be positively correlated with left ventricular mass (LVM) index, and negatively with hemoglobin (Hb) levels. Low Hb levels were only independent predictor of E/E' (p = 0.001, β: -0.470, 95% CI: -0.764; -0.196). E' ratio was significantly lower in both patient groups compared to the controls. LVH and diastolic dysfunction are already present in early stages of CKD. Treatment of risk factors, such as anemia, is important to improve the clinical outcome.
    Full-text · Article · Jun 2015 · Renal Failure
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    ABSTRACT: Infantile spasm is an age-dependent epileptic-encephalopathy syndrome. Cardiac autonomic function is frequently altered in epilepsy. In this study, we examined heart rate variability in patients with infantile spasm before and after treatment. Nineteen patients with infantile spasm and 13 healthy comparisons were enrolled in the study. Cardiac rhythm was recorded with a Holter device for 24 hours before adrenocorticotropic hormone (ACTH) (Synacthen depot) and B6 vitamin administration and 1 month after treatment. Heart rate variability analysis found lower heart rate variability parameters in patients with infantile spasm at the onset of the syndrome, prior to treatment with ACTH. The time domain parameters of heart rate variability values showed a statistically significant increase following ACTH treatment. Our data suggest that patients with infantile spasm exhibit lower heart rate variability parameters, and the treatment of spasms with ACTH and B6 together diminished the autonomic dysfunction in our cohort. © The Author(s) 2015.
    Full-text · Article · May 2015 · Journal of child neurology

  • No preview · Article · Jun 2014
  • Article: ABSTRACT 71
    S. Mevlitoglu · O. Dursun · F. Kardelen · H. Tekguc · D. Ozel

    No preview · Article · May 2014 · Pediatric Critical Care Medicine
  • Murat Ciftel · Osman Yılmaz · Fırat Kardelen · Hasan Kahveci
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    ABSTRACT: Right ventricular (RV) dysfunction, pulmonary hypertension, atrial enlargement, and cor pulmonale may be associated with asthma. These pathological conditions may disturb the electrophysiological properties of the right atrium. This study investigated the atrial electromechanical delay and P-wave dispersion (PWD) in patients with asthma. Thirty-four children aged 8-16 years who were being followed up for asthma constituted the patient group, and 34 age- and body mass index-matched patients constituted the control group. Both groups underwent RV tissue Doppler measurements, intra-right atrial conduction time (IRCT-echo) determination, intra-left atrial conduction time (ILCT-echo) determination, inter-atrial conduction time (IACT-echo) determination, and PWD measurement. The IRCT-echo (14.38 ± 5.46 and 8.20 ± 3.90 ms; p < 0.001) and IACT-echo (28.97 ± 6.58 and 22.79 ± 6.28 ms; p < 0.001) were higher in patients with asthma than in the control group. The PWD (44.58 ± 17.51 and 38.11 ± 13.50 ms; p = 0.09), maximum P-wave duration (87.94 ± 18.20 and 82.44 ± 16.36 ms, p = 0.19), minimum P-wave duration (43.58 ± 9.95 and 44.79 ± 9.13 ms; p = 0.60), and ILCT-echo (15.88 ± 5.40 and 14.58 ± 4.94 ms; p = 0.30) were similar between the two groups. The IRCT-echo was positively correlated with the isovolumetric relaxation time of the lateral tricuspid annulus (r = 0.60; p < 0.001) and with the myocardial performance index of the lateral tricuspid annulus (r = 0.59; p < 0.001) in patients with asthma. The IRCT-echo and IACT-echo were higher in patients with asthma than in the control group. The deterioration of the electrophysiological properties of the right atrium may result in a risk of atrial fibrillation in patients with asthma.
    No preview · Article · Jan 2014 · Pediatric Cardiology
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    Abdullah Kocabaş · Fırat Kardelen · Gayaz Akçurin · Halil Ertuğ
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    ABSTRACT: The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries in the absence of stenotic lesion. Herein, we present a 13-year-old boy with recurrent chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with CSFP, which has not been reported previously in the pediatric age group. Coronary angiography revealed only the presence of slow flow in the left anterior descending (LAD) coronary artery. Myocardial perfusion scintigraphy revealed a reversible perfusion defect in the LAD territory, which regressed partially at rest and showed complete improvement after dipyridamole infusion. All the symptoms, electrocardiogram abnormalities and cardiac markers returned to normal after dipyridamole treatment during the follow-up. We conclude that CSFP should be kept in mind in the differential diagnosis of chest pain with myocardial ischemia in the pediatric age group.
    Full-text · Article · Oct 2013 · Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
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    Abdullah Kocabaş · Fırat Kardelen · Gayaz Akçurin · Halil Ertuğ

    Full-text · Article · Sep 2013 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
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    ABSTRACT: The acrofacial dysostosis syndromes, which are characterized by malformations of the craniofacial region and limbs, are a clinically heterogeneous group of disorders. Based primarily on the of the pattern of limb defects two major groups have emerged: Nager syndrome with predominantly preaxial malformations plus mandibulofacial dysostosis (severe micrognathia and malar hypoplasia) and Miller syndrome with postaxial malformations plus mandibulofacial dysostosis. Among these syndromes, Nager syndrome is a rare condition but the most common form of acrofacial dysostosis. Most cases are sporadic, while autosomal dominant and autosomal recessive inheritance patterns have been reported. Recently, heterozygous mutations in the SF3B4 gene on chromosome 1q12-q21 were found to be responsible for a subset of sporadic and autosomal dominant cases. We present a female infant born to consanguineous parents with craniofacial features resembling Nager syndrome and a unilateral preaxial limb malformation. Mutation analysis of coding exons of SF3B4 did not identify any mutations. This couple also had a deceased child who had similar clinical features. We conclude that, the presence of consanguinity and absence of mutation in SF3B4, provides evidence in support of a recessive form of Nager syndrome. © 2013 Wiley Periodicals, Inc.
    No preview · Article · Sep 2013 · American Journal of Medical Genetics Part A
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    ABSTRACT: We aimed to assess early-onset chronic progressive cardiotoxicity in the left and right ventricles with increasing cumulative anthracycline doses. We evaluated 72 patients within the first year after doxorubicin and/or daunorubicin treatment (median 1.3 months; range 0.3-11.5) and 31 healthy controls. Pretreatment and posttreatment QT interval analyzes were performed in 27 newly diagnosed patients. The echocardiographic data of all examinations of 72 patients were classified into three groups according to instant cumulative anthracycline doses: treatment group (TG)-I (≤120 mg/m2; n = 26), TG-II (120-240 mg/m2; n = 39), and TG-III (≥240 mg/m2; n = 40). Diastolic and systolic parameters were analyzed by conventional echocardiography and tissue Doppler imaging (TDI) and compared with those of healthy controls. The mean age for patients and controls was 8.2 ± 4.5 and 9.6 ± 4.2 years, respectively (p > 0.05). QTc dispersion significantly increased after anthracycline treatment (p = 0.02). TDI showed decreased E′ velocity (p < 0.001) and E′/A′ ratio (p < 0.001) at lateral tricuspid annulus segment in TG-I, and these findings continued in TG-II and -III. In addition, S′ velocity decreased in TG-I, -II, and -III at lateral mitral annulus (10.5 ± 2.6 cm/s, p < 0.05; 9.9 ± 2.2 cm/s, p < 0.001; and 10.1 ± 2.3 cm/s, p < 0.01, respectively). However, decrease in left-ventricular ejection fraction was statistically significant in TG-II and -III (p < 0.001). Although myocardial performance index was significantly increased in all treatment groups in both segments, it was primarily due to significant increases in isovolumic relaxation time at the lateral tricuspid annulus and isovolumic contraction time at the lateral mitral annulus. Abnormalities in diastolic function in right ventricle and systolic function in the left ventricle were observed even with a cumulative anthracycline dose <120 mg/m2 by TDI. In addition, anthracycline treatment led to an increase in QTc dispersion.
    Full-text · Article · Jul 2013 · Pediatric Cardiology
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    Murat Ciftel · Osman Yılmaz · Fırat Kardelen · Abdullah Kocabaş
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    ABSTRACT: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) constitute important public health problems in developing countries. Inflammation is present both in the early and late stages of the diseases. Chronic inflammation is known to be associated with atherosclerosis. We hypothesize that subclinical atherosclerosis and arterial stiffness may increase due to the ongoing inflammation as well as the increased pulse pressure and left-ventricular systolic dysfunction in RHD. The purpose of the present study was to investigate carotid intima media thickness (CIMT) and carotid artery stiffness in patients with ARF. Forty patients in follow-up due to ARF in the age group of 7-16 years (disease duration 1-10 years) and 36 volunteered subjects with similar body mass index were included in the study. The subjects included in the present study were compared regarding M-mode echocardiographic parameters and CIMT as well as carotid arterial strain (CAS), carotid artery distensibility (CAD), beta stiffness index (βSI), and pressure-strain elasticity modulus (Ep) as carotid artery stiffness parameters. CIMT (0.52 ± 0.08 and 0.48 ± 0.07 mm, p = 0.01), βSI (5.29 ± 2.98 and 3.02 ± 1.30, p < 0.001), and Ep (426.53 ± 210.50 and 254.44 ± 104.69 p < 0.001) were increased, whereas CAS (0.11 ± 0.01 and 0.19 ± 0.09, p < 0.001) and CAD (10.27 ± 4.69 and 17.76 ± 14.41, p < 0.001) were decreased in patients with ARF compared with the control group. There was a positive correlation between pulse pressure and βSI (r = 0.25, p = 0.02) and Ep (r = 0.28, p = 0.01) in addition to a correlation between left atrial dilatation and CIMT (r = 0.55 p < 0.001) in patients with ARF. CIMT and carotid artery stiffness were increased in patients with ARF. Patients with ARF may have an increased risk of subclinical atherosclerosis and cardiovascular events.
    Full-text · Article · Jun 2013 · Pediatric Cardiology
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    ABSTRACT: Objectives: To evaluate if cardiac dysfunctions are important in assessing the outcome in newborns with Bronchopulmonary Dysplasia (BPD), by evaluating cardiac functions with N-terminal prohormone of brain natriüretic peptide (NT-proBNP) levels, M-mode and tissue doppler echocardiography at 6-12 mo of age. Methods: Twenty eight patients were retrospectively classified as mild, moderate and severe according to the diagnostic criterias for BPD. All cases were assessed with standard M-mode, tissue doppler echocardiography and NT-proBNP levels. Control group consisted of 28 healthy infants, having similar postnatal ages as patients and were assessed with standard M-mode and tissue doppler echocardiography. Results: The age of patients with BPD was 9.8 ± 2.3 mo and control group was 9.5 ± 2.6 mo. There was no significant difference between the postnatal ages of two groups (p > 0.05). Neither pulmonary hypertension nor pulmonary/tricuspid regurgitation was detected. The M-mode echocardiography measurements did not differ between patients and control group (p > 0.05). Tissue doppler echocardiography, tricuspid valve medial segment early diastolic myocardial relaxation velocity (TME') measurements of patients were found significantly lower, peak transtricuspid filling velocity in the early diastole (TE)/TME' ratios and isovolumetric relaxation time (IVRT) measurements were found significantly higher than control group (p < 0.05). Tricuspid E, TE/TLE' (Tricuspid valve lateral segment early diastolic myocardial relaxation velocity), TE/RVLE'(Right ventricular lateral segment early diastolic myocardial relaxation velocity), TE/TME' levels were also found as significantly abnormal in patients with severe BPD. A significant correlation was found between right ventricular diastolic disfunctions and severity of BPD (p < 0.05). No statistically significant difference was found between NT-proBNP levels, BPD stages and tissue doppler echocardiography measurements (p > 0.05). Conclusions: This is the first study evaluating cardiac findings in patients with BPD by tissue doppler echocardiography and NT-proBNP at the same time. On the basis of cardiac evaluations, tissue doppler echocardiography measurements were found as significant and specific for the early assessment of right ventricular diastolic disfunctions.
    Full-text · Article · Mar 2013 · The Indian Journal of Pediatrics
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    ABSTRACT: Kawasaki Disease (KD) is a vasculitic disease and can affect any organ system in the body. The development of coronary artery aneurysms is the most common and life threatening complication of KD and makes this disease the leading cause of acquired heart disease in children in the developed world. Facial nerve palsy has been reported as a possible marker of more severe disease and increased risk of coronary artery involvement in KD. Herein, the authors report an 8-mo-old infant who had left sided facial nerve palsy and multiple coronary aneurysms associated with KD.
    Full-text · Article · Feb 2013 · The Indian Journal of Pediatrics

  • No preview · Article · Jan 2013
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    ABSTRACT: Purpose: There may be an increase in the risk of atrial arrhythmia due to left atrial enlargement and the influence on conduction system in acute rheumatic fever. The aim of this study is to investigate atrial electromechanical delay and P-wave dispersion in patients with acute rheumatic fever. Patients: A total of 48 patients diagnosed with acute rheumatic fever and 40 volunteers of similar age, sex, and body mass index were included in the study. The study groups were compared for M-mode echocardiographic parameters, interatrial electromechanical delay, intra-atrial electromechanical delay, and P-wave dispersion. Results: Maximum P-wave duration, P-wave dispersion, and interatrial electromechanical delay were significantly higher in patients with acute rheumatic fever compared with the control group (p < 0.001). However, there was no difference in terms of intra-atrial electromechanical delay (p > 0.05). For patients with acute rheumatic fever, a positive correlation was identified between the left atrium diameter and the P-wave dispersion and interatrial electromechanical delay (r = 0.524 and p < 0.001, and r = 0.351 and p = 0.014, respectively). Furthermore, an important correlation was also identified between the P-wave dispersion and the interatrial electromechanical delay (r = 0.494 and p < 0.001). Conclusion: This study shows the prolongation of P-wave dispersion and interatrial electromechanical delay in acute rheumatic fever. Left atrial enlargement can be one of the underlying reasons for the increase in P-wave dispersion and interatrial electromechanical delay.
    No preview · Article · Nov 2012 · Cardiology in the Young
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    Preview · Article · Apr 2012 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
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    ABSTRACT: Bicuspid aortic valve (BAV) affects 1-2 percent of the general population and is the most common congenital heart disease. The incidence of BAV is increased in patients who have a first degree relative with BAV. Although it occurs sporadically, many familial cases have also been reported. Mendelian inheritance was suggested for familial cases. However, the role of genetics in BAV is more complicated. The role of different genetic mutations has been recently suggested. One of these genes is NOTCH-1. Except for the NOTCH1 gene, 18q, 5q and 13q chromosome locations have been implicated in the occurrence of BAV and/or BAV-associated cardiovascular complications. It is asymptomatic in childhood but may, however, cause aortic valve dysfunction, aorta dissection and infective endocarditis in adults. The role of genetics is not clear in the occurrence and progression of the complications. Early diagnosis of BAV is of vital importance in preventing complications and the initiation of early treatment. Therefore, familial screening is recommended in cases of BAV. We present a familial case of BAV in a man and his two sons together with the literature, in order to emphasize the role of genetics in patients with BAV.
    No preview · Article · Jan 2012 · Turkiye Klinikleri Cardiovascular Sciences
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    ABSTRACT: Trisomy 18 is the second most common autosomal trisomy in liveborn infants. Various congenital malformations, mental retardation, and high rate of infant mortality in the first year of life are characteristic features of trisomy 18. Congenital heart disease occurs in over 90% of these patients and the most common cardiac lesions are ventricular septal defect, patent ductus arteriosus and atrial septal defect. This is a case report of a baby born with trisomy 18 (postnatal diagnosis) in whom there was an unusual echocardiographic appearance of a mobile structure ("flap-like") around the area of a VSD-which was imaged prenatally.
    Full-text · Article · Sep 2011 · Echocardiography
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    ABSTRACT: Acute rheumatic fever (ARF) is an endemic disease observed in children of developing countries. The purpose of this study was to test if it was possible to identify myocardial involvement in cases with rheumatic carditis by the measurement of serum cardiac TnT. 30 patients diagnosed as ARF underwent echocardiography and their cardiac troponin T (cTnT) serum levels were measured. Patients were divided into group 1: Arthritis alone, group 2: carditis, and group 3 carditis with congestive heart failure (CHF). cTnT serum levels were normal in all except one patient with in group 3. Two patients in carditis (group 2) and three patients in CHF (group 3) had dilation in left ventricular end diastolic diameter. Normal cTnT levels in our patient group suggests that inflammation rather than myocardial necrosis is predominant in ARF carditis.
    Full-text · Article · Jul 2011 · Annals of Pediatric Cardiology
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    ABSTRACT: Congenital heart disease (CHD) associated with thyroid disease has been reported in Down syndrome (DS). The purpose of this work was to assess abnormalities of the thyroid in relation to the frequency and type of CHD on admission among children with DS. This retrospective study included 187 children with DS between August 1993- December 2005. Karyotype analysis, thyroid function tests and echocardiographic studies were performed in all children with DS. If necessary, hemodynamic study by catheterization was carried out. Thyrotropin releasing hormone (TRH) stimulation test was performed in having elevated thyroid stimulating hormone (TSH) level. Statistical analyses were performed using Chi-square, "t" test for independent samples or Mann-Whitney U test. It was found that 136 (72.73%) patients with DS had CHD. The age difference at the time of admission was statistically significant for these two groups (p=0.001) in children with /without CHD. There were 12 (11.88%) patients with congenital hypothyroidism and DS, of whom 11 had CHD. There were statistically significant differences in the levels of TSH and total thyroxine (tT4) between congenital and subclinical hypothyroid and euthyroid groups (p=0.001 for TSH and p= 0.001 for tT4). But, there was no significant relationship between having any kind of CHD and levels of TSH and tT4. Our data suggest that all patients with DS should be evaluated with careful physical and echocardiographic examination on admission. In addition, congenital or subclinical hypothyroidism should also be kept in mind in children with DS and monitored accordingly.
    Full-text · Article · Oct 2010 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
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    O. Duman · F. Kardelen · A. Kocabaş · N. D. Olgaç · S. Haspolat

    Full-text · Article · Sep 2007 · European Journal of Paediatric Neurology