Evaluation of cardiac functions of infants of diabetic mothers using tissue Doppler echocardiography.

AIM: Transient cardiac hypertrophy occurs in infants of diabetic mothers. The effect of this state on cardiac functions was investigated with a case-control study using tissue Doppler technique. MATERIAL AND METHODS: In this study, right and left ventricle systolic and diastolic functions of 45 term babies of diabetic mothers and 50 healthy term newborns were examined using tissue Doppler echocardiography. RESULTS: The septum was found to be thick in 16 (36%) of the babies of diabetic mothers. Both the left and right ventricle myocardial velocities were found to be lower in the babies of diabetic mothers compared to the control group. In our study, the Em/Am ratio was found to be below one only in the babies of diabetic mothers in the left ventricle in contrast to the control group. In addition, the Em/Am ratio in the septum and right ventricle was found to be below one both in the babies of diabetic mothers (group 1, 2) and control group. The calculated Tei index was found to be higher in the babies of diabetic mothers who had a thicker interventricular septum compared to the control group. CONCLUSION: Interventricular septal thickening in babies of diabetic mothers disrupt the diastolic function of both ventricles. This can be demonstrated by tissue Doppler echocardiography. These results show that diastolic function is disrupted in both ventricles in babies of diabetic mothers and only in the right ventricle in healthy babies. It was thought that this could be explained by right ventricular dysfunction arising from physiological pulmonary hypertension in the neonatal period. Subclinical right and left ventricular diastolic dysfunctions which we found by tissue Doppler indicate that babies of diabetic mothers especially with a thick septum should be closely monitored.

Cardiovascular MR imaging findings of total anomalous pulmonary venous connection to the portal vein in a patient with right atrial isomerism.

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular anomaly in which the pulmonary veins fail to join to the left atrium and drain directly to the right atrium or to one of the systemic veins. This anomaly is frequently seen together with complex cardiac anomalies especially as a part of right atrial isomerism syndrome. Atrial isomerism is called that the same morphological structure of both atria. We reported a very rare case demonstrating TAPVC between the portal vein and the pulmonary veins in a patient with right atrial isomerism by magnetic resonance imaging.

[Ventricular septal defect developed due to coronary artery injury after blunt chest trauma in childhood]. / Cocukluk döneminde künt gögüs travmasi sonrasi koroner arter zedelenmesine bagli gelisen ventriküler septal defekt.

In the literature, cardiac response associated with blunt chest trauma in children has been reported generally as case reports, and interventricular septal rupture due to trauma is quite rare. Interventricular septal rupture can develop even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present case, a seven-year-old boy with interventricular septal rupture at the mid-muscular region and left ventricle pseudoaneurysm developed due to injury to the left anterior descending coronary artery after a traffic accident is reported. Patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury, and in those with signs of ischemia detected on electrocardiography, it should not be forgotten that the coronary artery may be affected.

[The association between pulmonary arterial hypertension and malnutrition in children with congenital heart diseases with left-to-right shunt: an observational study]. / Sol-sag santli dogustan kalp hastaligi olan çocuklarda pulmoner arteriyel hipertansiyonla malnütrisyonun iliskisi: Gözlemsel bir çalisma.

OBJECTIVE: To evaluate the association between the degree of pulmonary arterial hypertension (PAH) and the level of malnutrition in children with acyanotic congenital heart diseases and left-to-right shunt, and especially to evaluate the development rates of malnutrition in patients with borderline PAH. METHODS: The study was performed with data of 327 patients with acyanotic congenital heart diseases and left-to-right shunt and underwent cardiac catheterization between January 2001-February 2011. The design of the study was retrospective and observational. All patients were evaluated with anthropometric measurements, echocardiography and cardiac catheterization. They were classified according to the mean pulmonary artery pressure and level of malnutrition. Chi-square, ANOVA and Kruskal-Wallis tests were used for statistical analysis. Normally and abnormally distributed data were analyzed with Pearson and Spearman correlation tests respectively. RESULTS: Malnutrition was detected in 94.8% of patients with PAH and 17.2% of no PAH patients according to Gomez classification (p<0.001). In addition, malnutrition was detected in 23.5% (16/68) of borderline PAH group. A negative association was detected between mean pulmonary arterial pressure and body weight for age (Gomez) and z scores of weight (p<0.001 for all). Z scores of weight and height were significantly decreased in patients with PAH in contrast to no PAH group (p<0.001, p<0.01 respectively). There was no statistical difference between no PAH and borderline PAH groups according to Gomez classification and relative body weight formula, however z scores of weight in borderline PAH group were decreased compared with no PAH group (p<0.001). CONCLUSION: A positive association was detected between the degrees of PAH and level of malnutrition in children with a cyanotic congenital heart diseases with left-to-right shunt. Borderline PAH may be a predisposing factor for malnutrition and further studies are needed for this subject.

PHACE syndrome with growth hormone deficiency and absence of bilateral internal carotid arteries: a case report.

PHACE syndrome is characterized by posterior fossa malformations (P), large facial hemangiomas (H), arterial anomalies (A), cardiac anomalies or coarctation of aorta (C), and eye anomalies (E) and has striking female predominance. Endocrine abnormalities have recently been described in these patients, involving the thyroid and pituitary glands. We report the case of a 2-year-old girl with the clinical features of PHACE with absence of bilateral internal carotid arteries and isolated growth hormone deficiency.

[Comparison of left and right ventricular pulsed and tissue Doppler myocardial performance index values using Z-score in newborns with hypoxic-ischemic encephalopathy]. / Hipoksik iskemik ensefalopatili yenidoganlarda sol ve sag ventrikül "pulsed" ve doku Doppler miyokart performans indeks degerlerinin Z-skorla karsilastirmasi

OBJECTIVE: The aim of the study is determination of myocardial performance index (MPI/Tei index) using pulsed (PD) and tissue Doppler (TD) techniques to show cardiac response in newborns with hypoxic-ischemic encephalopathy (HIE) and healthy newborns and eventually evaluation of the differences between these two techniques. METHODS: The study is a prospective observational study. Twenty term newborns diagnosed as perinatal asphyxia during postnatal 24 hours due to the defined criteria and fifty healthy term neonates as control group were included the study. Hypoxic group was divided into two groups with Sarnat stages, Sarnat Stage 1 and 2-3. MPIs (Tei indexes) were calculated with PD and TD echocardiographic techniques in all groups after the 24 hours of birth and one year later. The statistical differences between same techniques were calculated with Kruskal-Wallis test and Z score was used to compare the superiority of two techniques. RESULTS: The MPI values calculated by PD (0.41±0.04, 0.51±0.02) and TD (0.59±0.04, 0.51±0.02) during the first day of life in Sarnat Stage 2-3 in both ventricles were significantly higher than the control group (p<0.01, p<0.02, p<0.03). While the Z score, calculated for MPI measured by PD and TD methods, were found similar in both ventricles in Sarnat Stage 1 and control groups, it was significantly different in other groups of Sarnat stages. CONCLUSION: The degree of cardiac response in neonates with HIE is associated with the severity of hypoxia. MPI values are not different from the controls in newborns received mild hypoxia while they are higher in the patients who were received moderate or severe hypoxia. Any advantage could not be found between two techniques according to the measurement values, but higher variability in the value of MPI, measured by TD method, calculated from moderate and severe hypoxia group was detected.

Release of N-terminal pro-brain natriuretic peptide in children with acute rheumatic carditis.

BACKGROUND: Acute rheumatic carditis is still an important cause of cardiac failure in developing countries. B-type natriuretic peptides, especially N-terminal segment of its prohormone are now recognised as essential parts of cardiologic evaluation. Increased plasma concentrations of B-type natriuretic peptide and its prohormone are markers of cardiac failure and hypoxia in adults. AIM: To measure the prohormone levels in children with acute rheumatic carditis and to determine whether its concentrations correlate with clinical and laboratory findings. METHODS: A total of 24 children with acute rheumatic carditis and 23 age and sex-matched healthy subjects were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve insufficiency and cardiac dysfunction. The prohormone plasma levels were tested for correlation with cardiac dysfunction and other biochemical markers, such as C-reactive protein, erythrocyte sedimentation rate, and anti-streptolysin-O titter. RESULTS: The prohormone plasma concentrations were significantly higher in children with acute rheumatic carditis than in control subjects at the time of diagnosis. A significant decrease of the plasma level was detected among patients after treatments (6-8 weeks). CONCLUSION: We found increased plasma prohormone levels in children with acute rheumatic carditis in the acute stage of illness compared with healthy subjects. Another result is increased plasma prohormone levels as acute rheumatic carditis are reversible.

Prediction of aortic diameter values in healthy Turkish infants, children, and adolescents by using artificial neural network.

The aorta is the largest vessel in the systemic circuit. Its diameter is very important to guess for child before adult age, due to growing up body. Aortic diameter, one of the cardiac values, changes in time. Evaluation of the cardiac structures and generating a valid regional curve requires a large study group experience for accurate data on normal values. In this study, our aim is to estimate aortic diameter values without curve of charts. Using real sample of the all groups has been predicted using a hybrid system based on combination of Line Based Normalization Method (LBNM) and Artificial Neural Network (ANN) with Levenberg-Marquardt (LM) algorithm. In this study, aortic diameter values dataset divided into two groups as 50% training-50% testing of whole dataset. In order to show the performance of the proposed method, two fold cross validation and prevalent performance measuring methods, Mean Square Error (MSE), Absolute Deviation (AD), Root Mean Square Error (RMSE), statistical relation factor T and R2, have been used. The obtained MSE results from combination of Min-Max normalization and ANN, combination of Decimal Scaling and ANN, combination of Z-score and ANN, and combination of LBNM and ANN (the proposed method) are 0.00517, 0.001299, 0.006196, and 0.000145, respectively. For the suggested method, error's results have been given discretely for every age up to adult age. The results are compared to real aortic diameter values by expert with nine year experiences in medical area. These results have shown that the proposed method can be confidently used in the prediction of aortic diameter values in healthy Turkish infants, children and adolescents.

Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever.

The aim of this study was to assess the left ventricular diastolic function using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. This study included 29 (13 males and 16 females) patients and 30 healthy subjects as controls. Body mass index was calculated and arterial blood pressure was monitored. After an overnight fast, venous blood samples were taken and serum amyloid A protein, C-reactive protein, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol levels were measured. A complete 2-dimensional, M-mode, pulse wave Doppler, and pulse wave tissue Doppler echocardiographic examination was performed. There were no significant differences between the groups regarding age, body mass index values, systolic and diastolic blood pressures, heart rates, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol. Serum levels of inflammatory markers were higher in patients' group (C-reactive protein and serum amyloid A protein levels were 10.84 mg/dl, 22.32 mg/l in patients' group, respectively, and 4.11 mg/dl, 3.65 mg/l, respectively, in the healthy controls.) Peak mitral A wave, E and A wave ratio differed significantly in both groups. There were statistically significant differences regarding parameters observed by tissue Doppler imaging such as E'm, A'm, E'm, and A'm ratio between patients' group and controls. Tissue Doppler imaging provided additional information on left ventricular diastolic function. While systolic functions were in normal range, some of the diastolic function parameters were impaired in patients with familial Mediterranean fever during childhood.

Sydenham's chorea: a clinical follow-up of 65 patients.

Sydenham's chorea, the neurological manifestation of rheumatic fever, is the most common acquired chorea of childhood. In this retrospective study, the authors aim to present the clinical and laboratory findings of 65 Sydenham's chorea patients, followed up in a clinic over less than 7 years. The mean age at the onset of the symptoms was 11.7 +/- 2.6 years (range, 6-17 years). Of the patients, 63% were female and 37% were male (male/female: 1.7/1). Chorea was generalized in 78.5% of the patients, right hemichorea in 12.3%, and left hemichorea 9.2%. There was a history of rheumatic fever in 30.8% of the patients. Echocardiographic study showed cardiac valve involvement in 70.5% of 61 patients. Brain magnetic resonance imaging, which was performed on only 18 patients, was evaluated as normal in all. Electroencephalography was also performed on only 18 patients and showed abnormal waves in 50% of them. Pimozide was mostly the first choice of drug therapy. Nevertheless, drug therapy was not needed in 18.5% of the patients. The recovery period of the first attack of the chorea was 1 to 6 months in 51.7% of the patients. The recurrence rate was 37.9%. In conclusion, Sydenham's chorea is still an important health problem in Turkey with respect to its morbidity.

Prevalence and distribution of children with congenital heart diseases in the central Anatolian region, Turkey.

Congenital heart diseases (CHD) are the most frequent malformation at birth. The aims of this study were to assess the prevalence of congenital heart disease, their different types, and the detection rate among children in the central Anatolian region in Turkey. The study was conducted during an eight-year period (March 1995-December 2002). The prevalence of CHD in a large tertiary care hospital in the central Anatolian region in Turkey was studied. The diagnosis of a structural defect was based on echocardiographic study. The following age groups were considered: neonates, infants and toddlers, preschool children, schoolchildren, and adolescents. In the study period, 1,693 children were found to have CHD; 1253 patients were neonates and infants. Total prevalence of CHD over the study period was 7.77 per 1000 live-born. The prevalence increased from 6.35 to 9.65 per 1000 live births between 1995 and 2002 (p < 0.05). The average age at diagnosis was 2.2 +/- 3.64 years (1 day to 18 years, median 5 months). There were 863 (51%) boys and 830 (49%) girls, with a male/female ratio of 1:1. Isolated ventricular septal defect (32.6%) was the most frequent acyanotic anomaly, and tetralogy of Fallot (5.8%) was the most frequent cyanotic anomaly. The commonest non-cardiac anomalies with CHD were musculoskeletal anomalies. Down syndrome was determined in 83 patients (78.3%) from all syndromic CHD cases. Congenital heart disease is a very significant health problem. It requires urgent measures in terms of organization of early diagnosis and proper management. The prevalence rate is comparable to that of similar developed countries. Increasing incidence of CHD might be attributed to more diagnoses with new technologic development or it may indicate a real increase in the defects.

Pulmonary arterial pressure in children with croup syndrome.

PURPOSE: Croup syndrome or laryngotracheitis is one of the frequent causes of transient upper airway obstruction by laryngeal and tracheal blockage in infants and children. Upper airway obstruction may lead to increased pulmonary arterial pressure in children. In this study, the relationship between croup syndrome and pulmonary arterial pressure was investigated. MATERIALS AND METHODS: Forty children with croup syndrome and 14 healthy, age- and sex-matched control subjects were enrolled in this study. Of all patients, 12 with severe symptoms, such as dyspnea, cyanosis, hypoventilation, were accepted as "high croup score" (croup score >or=6). All patients with high croup score were treated with dexamethasone. We assessed pulmonary arterial pressure of patients during therapy using serial echocardiographic measurements. RESULTS: Our results showed that children with croup syndrome have significantly higher pulmonary arterial pressures than healthy subjects at the time of diagnosis. Pressure values of patients with high croup score were found to be significantly higher when compared with those of the low -core group (P < .05). However, there was no difference between 2 groups at the end of therapy. CONCLUSIONS: It is suggested that pulmonary arterial pressure increased to different extents in the acute stage of illness and that the degree of increase was related to the severity of disease and average hospital stay. In addition, increased pulmonary arterial pressure due to croup syndrome is reversible. Furthermore, evaluation of children with croup syndrome by using Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of their therapy.

PISA method for assessment of mitral regurgitation in children.

OBJECTIVE: The purpose of this study was to determine the feasibility and significance of the proximal isovelocity surface area (PISA) method in children with rheumatic mitral regurgitation (MR). METHODS: Thirty-one children (mean age 12.3+/-3.1 years), with chronic MR, were evaluated by semiquantitative and quantitative Doppler, quantitative two-dimensional echocardiography and the PISA methods. Also, we compared the effective regurgitant orifice area, regurgitation volume and systolic left ventricular functions in mild-moderate and severe MR. RESULTS: There were no statistically significant differences in the regurgitant orifice area and regurgitant volume values obtained by the PISA method and the quantitative Doppler (p>0.05) but they were different from the same values obtained by two dimensional echocardiography (p<0.05). There were excellent correlations between the regurgitant orifice area, regurgitant volume and the radius of the proximal flow convergence hemisphere (r=0.882, r=0.925, r=0.880; p<0.05). We found a very good correlation between the regurgitant orifice area obtained by the PISA and left ventricular end-diastolic diameters, the ratio of the jet/left atrial area, grading with color Doppler imaging (r=0.763, r=0.745, r=0.618; p<0.05). CONCLUSION: It is concluded that MR can be accurately predicted in children by using the PISA method as like as the Doppler method.

The myocardial performance index in children with isolated left-to-right shunt lesions.

OBJECTIVE: The myocardial performance index (MPI) measures the ratio of isovolumic time intervals to ventricular ejection time. The effects of altered ventricular preload or afterload on MPI have yet to be determined. This study was designed to determine the impact of altered preload on left and right ventricular myocardial performance index in the clinical setting of left-to-right lesions. METHODS: The left and right ventricular myocardial performance indexes were measured in 17 patients with atrial septal defect (ages 6 to 148 months), 23 patients with ventricular septal defect (ages 2 to 160 months), and 24 healthy children (ages 3 to 160 months). A complete 2- dimensional and Doppler echocardiographic examination was performed in all study groups. RESULTS: In patients with atrial septal defect, ventricular septal defect, and control group subjects, the left ventricular MPI was 0.38, 0.37 and 0.32, respectively, and the right ventricular MPI was 0.24, 0.21, and 0.20, respectively. No significant differences in the left and right ventricular myocardial performance indexes were seen between patients with left-to-right shunt lesions and control subjects. CONCLUSION: This study documents that the myocardial performance index is a quantitative measure of ventricular function that appears to be relatively independent of changes in preload.

Cardiac troponin I elevation in paediatric cardiac catheterization.

OBJECTIVE: The aim of this study is to investigate prospectively whether intracardiac catheterization produces myocardial damage in paediatric heart. METHODS: The study was performed in all patients undergoing diagnostic cardiac catheterization at our institute. A baseline serum sample was drawn before the procedure. The second serum sample was obtained 4-6 hours after the procedure. Cardiac troponin-I and creatine kinase isoenzyme MB fraction levels were determined quantitatively. RESULTS: Diagnostic cardiac catheterization was performed in 30 patients. There were 17 males and 13 females in the study group. The median age was 12 months (range 1 to 204 months); the median body weight was 8 kilograms (range 2.1 to 45 kilograms). The increase in cardiac troponin I (0.21+/-0.04 ng/ml to 1.16+/-1.40 ng/ml, p<0.05) and creatine kinase isoenzyme MB (26.68+/-7.53 U/L to 41.65+/-22.12 U/L, p< 0.05) levels after the procedure was significant. CONCLUSION: This study shows that serum elevations of cardiac troponin I and creatine kinase isoenzyme MB occur after the most of paediatric diagnostic cardiac catheterization procedures.

Congenital aneurysm of the muscular interventricular septum in a child.

Congenital aneurysms of the muscular interventricular septum without ventricularseptal defect are extremely rare. We describe a five-month-old girl patient with congenital aneurysm, pathological ST changes and minimal right ventricular outflow tract obstruction. The electrocardiogram showed Wolf-Parkinson-White syndrome, pathological ST changes and combined ventricular hypertrophy criteria. The transthoracic echocardiography and cardiac catheterization demonstrated a septal aneurysm which was bulging into the right ventricle and systolic pressure gradients between the main pulmonary artery and right ventricle outflow tract with normal coronary arteries. The patient has shown no symptoms, but some rhythm disturbances may be expected because of her electrocardiographic anomalies. Therefore, these patients should be followed carefully because of possible complications.

Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers.

AIM: To compare echocardiographic findings of infants of diabetic mothers (IDMs), macrosomic infants of nondiabetic mothers and healthy full term appropriate-for-gestational-age (AGA) infants. METHODS: Included in this study were 83 infants, admitted to our Neonatology Unit. Thirty-three IDMs, including both macrosomic and nonmacrosomic, comprised Group A, 25 macrosomic infants of nondiabetic mothers comprised group B, and 25 healthy full term AGA infants comprised group C. Echocardiographic measurements were performed in the first three days after birth and compared by using one-way ANOVA, Post Hoc Tukey HSD and Student's t tests. RESULTS: The left ventricular end-systolic/left ventricular end-diastolic diameter ratio of group A was significantly smaller than that of group C (P<0.05). The interventricular septum/posterior wall thickness ratios of groups A and B were greater than those of group C (P<0.05). The left ventricular mass index of group A was greater than those of groups B and C (P<0.05). The shortening fraction and ejection fraction of group A were increased in comparison to group C (P<0.05). When comparing the values of echocardiographic measurements of macrosomic IDMs (n=9) with nonmacrosomic ones (n=24), and infants of pregestational diabetic mothers (n=11) with those of gestational diabetes mothers (n=22), no statistical difference was found. CONCLUSION: The present study suggests that underlying mechanisms common to both macrosomic infants of nondiabetic mothers and IDMs lead to less cardiac alterations in the macrosomic infants of nondiabetic mothers than in IDMs.

Pulmonary arterial pressure in children with allergic rhinitis.

BACKGROUND: Chronic upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Allergic rhinitis is one of the frequent causes of upper airway obstruction by nasal blockage. The aims of the study were to evaluate the pulmonary arterial pressures in children with allergic rhinitis and the effect of topical corticosteroid therapy. METHODS: Forty-nine children composed of 27 subjects with seasonal and 22 subjects with perennial allergic rhinitis were enrolled in this study. The pulmonary arterial pressures were measured by using Doppler echocardiography. RESULTS: The pretreatment pulmonary arterial systolic, mean, and diastolic pressures of study group were significantly higher than in healthy controls (p < 0.05). The pulmonary arterial systolic and mean pressures of the patient group significantly decreased at the end of study (p < 0.05), whereas the decrease of the diastolic pressure was not statistically significant (p > 0.05) after the treatment of a topical corticosteroid, mometasone furoate (100 microg per day), for 8 weeks. CONCLUSION: Our results showed that children with allergic rhinitis have higher pulmonary arterial pressure levels compared with healthy controls and that increased pulmonary arterial pressure levels due to allergic rhinitis are reversible by using nasal topical corticosteroids. Further studies are needed to determine the clinical aspect of increased pulmonary arterial pressure.