Use of the advisor™ HD Grid mapping catheter in transcatheter ablation of atrial arrhythmias in palliated CHD and children without CHD.

OBJECTIVE: In this study, we describe our experience utilising Advisor™ High Density (HD) Grid mapping catheter in transcatheter ablation of intraatrial re-entrant and focal atrial tachycardias with or without CHD. METHODS: Forty-five consecutive patients with intraatrial re-entrant and focal atrial tachycardia who underwent a transcatheter ablation procedure by using Advisor™ HD Grid mapping catheter and high-density mapping system in our hospital from January 2017 to January 2023 were included into the study. RESULTS: The mean age of the patients was 14.2 ± 7.3 years (6-32 years), and the mean weight was 48.3 ± 16.2 kg (22-83 kg). Of the total 45 patients, 21 were intraatrial re-entrant tachycardia and 25 were focal atrial tachycardia. Of the 21 re-entrant circuits, 15 were classified as cavotricuspid isthmus-dependent and 5 were non-cavotricuspid isthmus-dependent. In one patient, two re-entrant circuits were identified. A transbaffle ablation was successfully performed from the left atrium in one patient. Of the 25 focal atrial tachycardia, 19 were from right atrium and 6 were from left atrium. A cryoablation was performed in only one patient and radiofrequency ablation in others. The mean procedure time was 180 ± 64 minutes. The mean follow-up period was 69.3 ± 35.3 months. Acute success was 95.5%. Recurrence was noted in two patients (4.4%). CONCLUSION: Advisor™ HD Grid mapping catheter was found to be safe and achieved an acceptable success in transcatheter ablation of patients with intraatrial re-entrant tachycardia and focal atrial tachycardias.

Experience of left ventricular outflow tract arrhythmia ablation in paediatric patients using limited fluoroscopy and three-dimensional mapping technique.

OBJECTIVE: The left ventricular outflow tract is an important source of ventricular arrhythmias. Up to one-third of all idiopathic ventricular arrhythmias in patients with structurally normal hearts may arise from this region. We would like to share the results of our left ventricular outflow tract ablation using three-dimensional mapping and limited fluoroscopy. MATERIALS AND METHODS: This is a single-centre retrospective cohort study. Forty-six consecutive patients who underwent left ventricular outflow tract ablation procedures between January 2015 and June 2023 were included in the study. The EnSite Precision System (Abbott, St. Paul, MN, USA) was used to facilitate mapping and to reduce or eliminate the need for fluoroscopy. RESULTS: The study group comprised 29 males and 17 females, with a mean age of 13.4 ± 4.5 years. The most common location for arrhythmias was the left coronary cusp (n : 21). Other locations, in sequence, included the junction of the right and left coronary commissure (n : 10), right coronary cusp (n : 10), left ventricular outflow tract endocardium (n:4), aorto-mitral junction (n : 1), and great cardiac vein (n : 1). Nine of these patients had previously undergone unsuccessful right ventricular outflow tract ablation at another centre. Cryoablation was performed in three patients, irrigated radiofrequency ablation in three patients, and conventional radiofrequency ablation in the remaining patients. The acute success rate was 100%, and no recurrences were observed. The mean follow-up period was 49.6 ± 24.4 months. All patients were asymptomatic and were being followed without antiarrhythmic medication. CONCLUSION: Although left ventricular outflow tract ablations pose a risk for coronary artery and heart valve complications, they can be performed successfully and safely with the guidance of three-dimensional mapping.

Experience with implantation of Select Secure® leads in paediatric patients.

Objective: In this study, we aimed to investigate the safety, feasibility and efficacy of Select Secure® lead in a pure paediatric cohort and to present our experience with implantation technique, complications, and acute and midterm performance of the lead.Method: From 2014 to 2020, 42 consecutive paediatric patients underwent a cardiac device implantation with Select Secure® lead system. Patient demographics, implantation technique, and locations, sensing and pacing characteristics, impedances and any complications at implant and follow-up were investigated.Results: The mean age and weight of patients were 11.2 ± 3.5 years and 34.7 ± 14.8 kg, respectively. A total of 78 Select Secure® leads were successfully implanted. All ventricular leads were successfully anchored to the right ventricular midseptum. Implantation procedures were uneventful in all patients. We showed that atrial and ventricular sensing, pacing thresholds, and impedance measurements did not change significantly and that adequate pacing parameters were achieved in our patients during a median follow-up period of 47 months (4 - 68). Atrial and ventricular sensing, pacing thresholds and impedance measurements remained almost the same during the study period.Conclusions: In this study, we found that the Select Secure® transvenous pacing system was safe and feasible in paediatric patients without any major complications and with very stable electrical performance in the acute and midterm period.

Early outcomes of usage of cryoFORM® probe for cryomaze procedure in congenital heart surgery.

OBJECTIVES: This study aimed to evaluate the early outcomes of patients who underwent a concomitant therapeutic maze procedure for congenital heart surgery. MATERIALS AND METHODS: Between 2019 and 2020, eight patients underwent surgical cryoablation by using the same type of cryoablation probe. RESULTS: Three patients had atrial flutter, two had Wolf-Parkinson-White syndrome, two intra-atrial reentrant tachycardia, and one had atrial fibrillation. Four patients underwent electrophysiological study. Preoperatively, one patient was on 3, two were on 2, five were on 1 antiarrhythmic drug. Six patients underwent right atrial maze and two underwent bilateral atrial maze. Five out of six right atrial maze patients underwent right atrial reduction. Nine different lesion sets were used. Some of the lesions were combined and applied as one lesion. In Ebstein's anomaly patients, the lesion from coronary sinus to displaced tricuspid annulus was delicately performed. The single ventricle patient with heterotaxy had junctional rhythm at the time of discharge and was the only patient who experienced atrial extrasystoles 2 months after discharge. Seven of the eight patients were on sinus rhythm. No patient needed permanent pacemaker placement. CONCLUSION: Cryomaze procedure can be applied in congenital heart diseases with acceptable arrhythmia-free rates by selecting the appropriate materials and suitable lesion sets. The application of cryomaze in heterotaxy patients can be challenging due to differences in the conduction system and complex anatomy. Consensus with the electrophysiology team about the choice of the right-left or biatrial maze procedure is mandatory for operational success.

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience.

OBJECTIVE: Focal atrial tachycardia accounts for up to 10-15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia. METHODS: Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study. RESULTS: The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5-18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%). CONCLUSION: The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.

Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience.

OBJECTIVE: Fascicular tachycardia is a common form of sustained idiopathic left ventricular tachycardia. This study aimed to achieve successful results with catheter ablation procedures performed through three-dimensional electroanatomic mapping using near-zero fluoroscopy in fascicular tachycardia patients. METHODS AND RESULTS: In this study, we included 33 consecutive children with fascicular tachycardia, for whom we performed a transcatheter radiofrequency ablation procedure using the EnSite® system. Activation mapping was performed in all patients during tachycardia, and the earliest presystolic purkinje potentials were the target site for radiofrequency lesions. RESULTS: Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg, and the mean age was 13.6 ± 2.5 years. The mean procedure time was 121.3 ± 44.3 minutes. The mean follow-up period was 18.4 ± 6.5 months. No fluoroscopy was needed in 30 patients. The mean fluoroscopy time in the remaining patients was 166.6 ± 80 seconds. All of the patients had left posterior fascicular tachycardia except for one who had left anterior fascicular tachycardia. The acute success rate was perfect (100%). No patients developed left bundle branch block or complete atrioventricular block. Recurrence developed in one patient. CONCLUSION: We suggest that radiofrequency ablations via an electroanatomic mapping system are quite safe and effective, with high success rates in paediatric patients with fascicular tachycardia. This method has the advantage of avoiding ionising radiation exposure for both the patient and operator, thus reducing the lifetime risk of malignancy in the paediatric population.

Systolic dysfunction of systemic ventricle in patients who underwent a Fontan operation.

Öner T, Balli S, Hekim Yilmaz E, Bulut MO, Sasmazel A, Çelebi A. Systolic dysfunction of systemic ventricle in patients who underwent a Fontan operation. Turk J Pediatr 2019; 61: 925-930. The aim of the study was to report the clinical and echocardiographic data of patients who underwent a Fontan operation, and define the group with systolic dysfunction in the systemic ventricle observed during postoperative follow-up. The medical records of 183 patients [mean age: 10.93 ± 5.89 years (range: 2.5-45 years)] who were referred to our center and underwent a Fontan operation were retrospectively reviewed. The clinical, echocardiographic, and postoperative follow-up data of the patients were recorded. Preoperatively, 68 (37.2%) patients experienced pulmonary stenosis, while 41 (22.4%) had pulmonary atresia and 74 (40.4%) had pulmonary hypertension. The most common pathology in patients who were ineligible for biventricular repair was tricuspid atresia, seen in 51 patients (27.9%), followed by double-inlet left ventricle pathologies in 40 patients (21.9%). In total, 38 (20.7%) patients had a biventricular structure; among those with a single ventricular structure, the systemic ventricle involved was the right ventricle in 51 (27.9%) patients and the left ventricle in 94 (51.4%) patients. During follow-up, a total of 31 (16.9%) patients underwent catheterization and ventricular systolic functions were preserved in 168 (91.8%) patients. In Fifteen (8.2%) patients developed systolic dysfunction (ejection fraction < 50%). The mean age of the group developing systolic dysfunction was 15.6 ± 2.63 years (median, 13 years; range: 5-45 years). Of this group, 10 patients had a left ventricular structure of the systemic ventricle, 14 had atrial situs solitus, and 4 had moderate atrioventricular valve insufficiency. Even if the systemic ventricle is in the left ventricular structure, systolic dysfunction in the systemic ventricle develops, especially after the first 10 years, and this makes us think rudimentary ventricle function should also be carefully monitored for intra-univentricular diastolic asynchrony.

Transcatheter Cryoablation Procedures without Fluoroscopy in Pediatric Patients with Atrioventricular Nodal Reentrant Tachycardia: A Single-Center Experience.

BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common supraventricular tachycardia substrates. The aim of this study was to demonstrate the excellent outcomes of cryoablation without fluoroscopy in pediatric patients with AVNRT. METHODS: From September 2015 to October 2016, a transcatheter cryoablation procedure was performed in 109 patients using the EnSite® system. After electrophysiologic studies, a cryoablation catheter was advanced for the purpose of ablation of the slow pathway. Six to eight lesions were delivered in 240-300 seconds at -70 °C, with special effort being paid to obtain an eyeball formation around the first effective lesion. RESULTS: The mean weight and age of the patients were 24.6 ± 5.3 kg (15-68 kg) and 9.8 ± 2.6 years (5-18 years), respectively. The mean procedure time was 109.8 ± 46 minutes, and the acute procedural success rate was excellent (100%). Ablation procedures were performed during induced tachycardia in 67 patients and during sinus rhythm in 42. The mean follow-up period was 13.3 ± 5.8 months (4-17 months). Recurrence was noted in one patient during the follow-up period who received the ablation procedure with a 6-mm tip catheter. No recurrence was noted among the patients treated with an 8-mm cryocatheter. No permanent cryoablation-related complications occurred. CONCLUSIONS: Cryoablation using an electroanatomic mapping system is safe and effective in pediatric patients with AVNRT, and has the advantage of avoiding ionizing radiation.

Stenting of the ductus arteriosus in infants with functionally univentricular heart disease and ductal-dependent pulmonary blood flow: A single-center experience.

OBJECTIVE: To determine the short- and medium-term outcomes of ductal stenting (DS) in patients with functionally univentricular hearts (FUHs) and ductal-dependent pulmonary blood flow. BACKGROUND: Several studies have evaluated the outcomes of DS in a limited number of patients with FUHs. Nonetheless, there is still no consensus regarding the indications for this procedure, and no appropriate patient selection criteria have been devised. METHODS: From 2005 to 2015, cardiac catheterization for DS was performed in 68 patients with FUHs. Of these patients, 49 had single source pulmonary blood flow from ductus arteriosus. Procedural and follow-up data were evaluated. RESULTS: The median weight of the patients was 3.6 kg (2.3-6.8 kg), and the median age was 26 days (3 days-8 months). The technical success rate of the procedure was 95% (65 of 68 patients). Mean oxygen saturation increased from 70% ± 7.6% to 87% ± 4.6% (P < 0.0001). Among patients in whom DS was successful, 55 (84.6%) were bridged to a Glenn procedure after a median of 9.1 months (6.4-14 months), and 41 (63%) were successfully bridged to a Glenn procedure without additional interventions. Of the 16 patients with preexisting mild pulmonary artery stenosis, five required a surgical shunt due to progressive branch pulmonary artery stenosis, while nine were bridged to a Glenn operation without shunt placement. Five (7.3%) patients died, including patients who were sent to surgery. CONCLUSION: DS is a reasonable and effective alternative to surgical shunt placement as a first-stage palliative procedure in patients with FUHs. © 2016 Wiley Periodicals, Inc.

Treatment of severe hemolysis following Nit-Occlud Lê VSD coil implantation with Amplatzer Duct Occluder II.

Hemolysis after percutaneous device closure of ventricular septal defect (VSD) is a rare complication that can be conservatively managed in the majority of cases. However, surgery or transcatheter occlusion may be necessary. Presently described is the successful treatment of hemolysis that developed after implantation of the Nit-Occlud Lê VSD coil, using the Amplatzer Duct Occluder II (ADO II) in a patient with aneurysmatic perimembranous VSD. Systolic murmur and symptoms immediately disappeared after the procedure.

Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I.

When total correction is not possible in infants who have a cyanotic congenital heart disease, creation of a palliative aortopulmonary shunt is essential. A central aortopulmonary shunt is preferable, because of its technical and hemodynamic advantages. Overcirculation, thrombosis, and stenosis of the shunt are the main postoperative sequelae that necessitate urgent reintervention. Percutaneous transcatheter closure of aortopulmonary shunts can eliminate the need for reoperation and substantially decrease postoperative morbidity and mortality rates. We report our successful transcatheter closures of central aortopulmonary shunts in a 3-month-old infant and a 15-year-old girl, with use of an Amplatzer Duct Occluder II and an Amplatzer Vascular Plug I, respectively. To our knowledge, this is the first report of the transcatheter closure of central aortopulmonary shunts with these 2 devices.

Initial Experience with the Nit-Occlud ASD-R: Short-Term Results.

We aim to assess the safety, feasibility and efficacy of the new Nit-Occlud ASD-R (NOASD-R) device. From 2014 to 2015, transcatheter closure of atrial septal defect (ASD) using the NOASD-R was performed in 30 consecutive patients. The standard deployment technique as the left upper pulmonary vein approach was used in 25 patients. Right upper pulmonary vein approach was required in five. The median age was 6 years (range 3.5-60 years), and median weight was 21.5 kg (14-79 kg). Implantation was successful in all patients. The median size of devices was 16 mm (12.0-26.0 mm). The mean device size/2D defect diameter ratio was 1.26 ± 0.09 (1.12-1.40). The mean device size/color flow diameter ratio was 1.07 ± 0.06 (range 1.0-1.22). Releasing problem was encountered in three patients. A device-related erosion on the day after the closure was observed in one patient. No further device-related complication (erosion, embolization or dislodgement of the device) was encountered in a median follow-up period of 10 months (range 2-14 months). Complete occlusion has occurred in all at follow-up. NOASD-R is a feasible and effective device for use in the transcatheter occlusion of moderate to large secundum ASDs in selected patients. The occurrence of the erosion on the right atrial roof may be due to the high localization of the device and the larger size of the right disk.

Use of steerable delivery catheter to successfully deliver a Ceraflex septal occluder to close an atrial septal defect in a child with interrupted inferior vena cava with azygos continuation.

The closure of a secundum atrial septal defect through the jugular vein in a child with interrupted inferior vena cava with azygos continuation by steerable delivery catheter is described in the present report. The steerable catheter can be used to correct the perpendicular position of the device over the margins of the defect, and is particularly useful in cases of large defects.

A different approach to treatment of failing Fontan: Transcatheter covered stent implantation.

A 5-year-old male with a double outlet right ventricle with noncommitted ventricular septal defect and pulmonary stenosis underwent a bidirectional Glenn operation at 2 years and a Fontan operation with ligation of the pulmonary trunk at 5 years. He presented with pleural effusion 3 months after the Fontan operation. Physical examination revealed a grade 3/6 systolic murmur in the pulmonary area. Echocardiographic evaluation revealed an antegrade pulmonary flow (APF) of gradient 80 mmHg across the ventriculopulmonary communication. Cardiac catheterization and angiography demonstrated the presence of residual antegrade pulmonary flow and stenosis at the pulmonary artery bifurcation. Both pathologies were treated using a single covered stent. Relief of the pulmonary artery stenosis and total occlusion of the residual APF was demonstrated on a control angiogram.

Assessment of cardiac function in absence of congenital and acquired heart disease in patients with Down syndrome.

BACKGROUND: Extra genetic material in patients with Down syndrome (DS) may affect the function of any organ system. We evaluated cardiac functions using conventional tissue Doppler and two-dimensional speckle tracking echocardiography in patients with DS in the absence of congenital and acquired heart disease in patients. METHODS: A total of 115 patients with DS between 6 and 13 years of age with clinically and anatomically normal heart and 55 healthy children were included in this cross-sectional study. DS was diagnosed by a karyotype test. Patients with mosaic type were not included in this study. Systolic and diastolic functions were evaluated by echocardiography. RESULTS: Pulsed waved Doppler transmitral early/late inflow velocity (E/A), tissue Doppler mitral annular early/late diastolic peak velocity (Ea/Aa), transtricuspid E/A and tricuspid valve annulus Ea/Aa, pulmonary venous Doppler systolic/diastolic (S/D) wave ratio were lower in patients with Down syndrome than in the control group (P=0.04, P=0.001, P<0.05, P<0.001, P<0.001, respectively). Mitral and tricuspid annular Ea were lower in patients with DS (P<0.001). The right and left ventricular myocardial performance indexes were higher in patients with DS than in the controls (P<0.01). They had significantly higher left ventricular mass, ejection fraction, the mitral annular plane systolic excursion values. However, the Down syndrome group compared with the controls had a lower strain values examined by two-dimensional longitudinal speckle-tracking strain echocardiography. CONCLUSION: These findings suggest conventional tissue Doppler and two-dimensional longitudinal speckletracking strain echocardiography were useful methods of investigating ventricular function and identifying a higher incidence of biventricular dysfunction in patients with Down syndrome compared with the healthy controls.

Intervention in Patients with Critical Pulmonary Stenosis in the Ductal Stenting Era.

We aimed to assess early and midterm outcomes of balloon valvuloplasty (BVP) procedure in patients with critical pulmonary stenosis (CPS) and to describe the predictors of the need for additional pulmonary flow and reintervention in this subgroup of patients. From 2005 to 2014, 56 neonates were diagnosed with CPS and were included in this study. All echocardiographic, catheterization and angiographic data obtained prior to the initial BVP and at follow-up were reviewed. BVP was successful in 55 neonates (98 %). Twenty-one neonates needed pulmonary blood flow augmentation after BVP (38 %). Ductal stenting (DS) was performed in 20. The patients' mean tricuspid valve (TV) annulus diameter was 10.4 ± 2 mm, and the Z score was -1.29 ± 1 (-3.7 to 0.78). The mean pulmonary valve (PV) annulus diameter was 6 ± 0.9 mm, and the Z score was -1.74 ± 1 (-4.34 to 0.05). A transcatheter or surgical reintervention was performed in 11 patients. A TV Z score < -1.93 SD predicted the need for pulmonary blood flow augmentation after a successful BVP, with a sensitivity of 63.2% and a specificity of 84.4%. A PV Z score < -1.69 SD predicted the need for pulmonary flow augmentation, with a sensitivity of 74 %. The presence of bipartite RV was found to be a significant predictor of the need for reintervention (odds ratio 9.6). Our study showed the excellent immediate outcomes of BPV and DS in a pure cohort of patients with CPS. Prophylactic DS in selected cases seems reasonable and safe.

Percutaneous transcatheter closure of a descending aorta to vertebral venous plexus fistula using an Amplatzer Vascular Plug 2: a case report.

A descending aorta to vertebral venous plexus fistula is an extremely rare form of arteriovenous fistula. A 10-month-old infant was referred to the hospital for evaluation of a murmur. On examination, a continuous murmur was heard in the entire back. Transthoracic echocardiography revealed left heart chamber dilatation in the presence of preserved left ventricle systolic function. Computerized tomography angiography with 3-dimensional reconstruction, and lateral projection aortography revealed a descending aorta-vertebral venous plexus fistula measuring 4.8 mm in the aortic orifice. The fistula was embolized using an Amplatzer Vascular Plug 2.

Effect of obesity on left ventricular longitudinal myocardial strain by speckle tracking echocardiography in children and adolescents.

BACKGROUND: Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity. AIMS: The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE). STUDY DESIGN: Case-control study. METHODS: Sixty normotensive obese children aged 10-16 years (mean age, 13.9±2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)≥95(th) percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis. RESULTS: Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: -16.0±3.9% vs -21.9±2.4%, p<0.001) and lateral wall (average strain: -15.6±2.3% vs -22.9±3.5%, p<0.001); regional SR of both the septal wall (average SRsys: -0.7±0.22 s(-1) vs -1.3±0.32 s(-1), p<0.001) and lateral wall (average SRsys: -0.67±0.19 s(-1) vs -1.33±0.31 s(-1), p<0.001); regional SRE/A of both the septal wall (average SRE/A: 1.8±0.83 vs. 2.2±0.91, p: 0.004) and lateral wall (average SRE/A: 1.4±0.43 vs. 2.4±1.21, p<0.001); and global strain (-14.6±7.34% vs -20.9±3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain. CONCLUSION: Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease.

Assessment of cardiac functions in infants with cow's milk allergy.

BACKGROUND: Cow's milk allergy is the most common food allergy in children, with rates estimated at 1.9% to 4.9%. Clinical phenotypes of cow's milk allergy are varied and involve 1 or more target organs, with the main targets being the skin, respiratory system, and gastrointestinal tract. To date, no studies have investigated detailed cardiac function in children with cow's milk allergy. The current study aimed to investigate cardiac function in infants with cow's milk allergy. MATERIAL/METHODS: We studied 42 infants with cow's milk allergy and 30 age- and sex-matched healthy subjects. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. RESULTS: There were no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the 2 groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Ea/Aa ratios in the left ventricle posterior wall and right ventricle free wall were lower in patients with cow's milk allergy than in the control group. The E/Ea ratio in the left ventricle, isovolumic relaxation time, deceleration time, and right and left ventricular myocardial performance indices were higher in patients in the study group. CONCLUSIONS: Our study identified reduced early diastolic tissue Doppler velocities in infants with cow's milk allergy.

P-wave and QT interval dispersion analysis in children with Eisenmenger syndrome.

OBJECTIVES: P-wave and QT dispersion are increased and associated with atrial and ventricular arrhythmia and an increase in sudden death in a variety of diseases. This study aimed to investigate P-wave and QT dispersion in children with Eisenmenger syndrome (ES). STUDY DESIGN: The study group included 27 children (15 females, 12 males) with both congenital heart disease (CHD) and ES. The control group consisted of 30 children with CHD without pulmonary arterial hypertension. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. 24-hour (h) rhythm Holter was fitted in all patients. Atrial volumes, ventricular dimensions and tricuspid annular plane systolic excursion (TAPSE) were measured by echocardiography. RESULTS: There was no difference between groups with regard to age, sex, weight, and body surface area (p>0.05). Right atrial volume was significantly larger in the ES group than in the control group. P-wave, QT and QTc dispersions were higher in the patients with ES (50.10±11.12 vs. 26.32±8.90, p<0.001; 57.40±24.21 vs. 38.20±8.92 ms, p<0.001; and 78.20±16.02 vs. 56.52±13.92 ms, p<0.001, respectively). Ventricular and supraventricular ectopy were significantly more frequent in the ES group. Four patients (14.8%) in the study group had tachyarrhythmias during 24-h Holter monitoring. CONCLUSION: In our study, P-wave and QT dispersion were found to be greater in children with ES than in the healthy control subjects.