The Relationship between Arterial Elasticity Parameters of Ascending Aorta, Abdominal Aorta and Carotid Arteries with Carotid Intima Media Thickness in Children with Bicuspid Aortic Valve.

BACKGROUND: Bicuspid aortic valve is a congenital cardiac malformation that affects not only the valve and ascending aorta but also the abdominal aorta and large central arter-ies like carotid arteries by damaging the elasticity of the vessel resulting in increased stiffness and reduced distensibility. Deterioration of aortic compliance disturbs functions of the left ventricle and triggers atherosclerosis determined with carotid intima-media thickness. The aim of this study was to assess the effect of the bicuspid aortic valve on the elastic properties of these parts of the arterial system in children. METHODS: Thirty-four children with bicuspid aortic valves with normal valvular functions or mild valvular dysfunction and a control group of 34 individuals with tricuspid aortic valves were included in the study. Echocardiographic measurements of the left ventri- cle, ascending aorta, and ultrasonographic measurements of the abdominal aorta and carotid arteries were performed, and elasticity indexes were calculated. RESULTS: The bicuspid aortic valve group had higher stiffness and lower distensibility in ascending aorta, abdominal aorta, and carotid arteries with higher carotid intima- media thickness values than the tricuspid aortic valve group. Aortic valvular z scores and ascending aorta and abdominal aorta stiffness were higher in patients with bicus- pid aortic valves irrespective of valvular functions than in controls. Valvular dysfunction affected stiffness in carotid arteries. Dilatation of ascending aorta increased stiffness in the abdominal aorta. Distensibility was lower in ascending aorta and left carotid artery, with increased carotid intima-media thickness independent from ascending aorta dila- tation. Stiffness of abdominal aorta revealed a positive correlation with the stiffness of the ascending aorta and the carotid arteries (P < .05, for all). CONCLUSIONS: Elasticity indexes of children with bicuspid aortic valves were impaired in ascending aorta, abdominal aorta, and carotid arteries with an increase in carotid intima-media thickness.

The evaluation of right ventricular systolic function in patients with repaired Tetralogy of Fallot by conventional echocardiographic methods and speckle tracking echocardiography: Compared with the gold standard cardiac mangenetic resonance.

BACKGROUND: Right ventricular (RV) function is one of the important prognostic factors in patients with repaired Tetralogy of Fallot (TOF). We aimed to assess RV function by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE) in patients with repaired TOF. METHODS: Twenty-seven (male 17) adolescents and young adult patients (mean age 22.7 ± 6.7 years) operated on for TOF and age- and gender-matched healthy controls were included. RV systolic function in both groups were evaluated by fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (RVMPI) and tricuspid annular peak systolic velocity by pulsed tissue Doppler (tricuspid S'), and also RV global longitudinal strain (RV GLS) obtained from STE. These results were compared with RV ejection fraction (RVEF) measured by cardiac magnetic resonance imaging (CMRI) performed within 3 months in patient group. RESULTS: Systolic RVGLS values were significantly lower in patients compared to controls (-17.4 ± 3.1% vs -25.6 ± 3%). Among the echocardiographic parameters, RVGLS had the best correlation with RV EF derived from CMRI (r: -.6). By receiver operating characteristics analysis (ROC), an RV GLS cutoff value of -17.4% had 75% sensitivity and 68.4% specificity in identifying RVEF <45% with an area under curve 0.743 (P < .05). The intra- and inter-observer agreement for RV GLS was excellent. CONCLUSION: RVGLS is an easy, effective, feasible, and reproducible tool in the evaluation of RV systolic function. So, RVGLS measurement by STE may be one of the routine echocardiographic parameters in the evaluation of RV systolic function in patients with repaired TOF.

Effects of Long-Term Use of Prescription Methylphenidate on Myocardial Performance in Children with Attention-Deficit/Hyperactivity Disorder: A Tissue Doppler Imaging Study.

OBJECTIVE: Many children diagnosed with attention-deficit/hyperactivity disorder are treated with methylphenidate (MPH). The purpose of this study was to evaluate the relationship between long-term use of osmotic-release oral system methylphenidate (OROS MPH) and cardiac functions. METHODS: The study involved 116 subjects 6-18 years of age. Fifty-eight of these were in the case group and were using OROS MPH (extended-release capsules). Fifty-eight children not receiving treatment were included in the control group. Participants were also assessed using 12-channel electrocardiography (ECG), transthoracic 2D echocardiography, Doppler echocardiography, and tissue Doppler imaging (TDI). The findings obtained were compared using statistical methods. RESULTS: No significant differences were determined between the case and control groups in terms of systolic blood pressure and diastolic blood pressure or 12-channel ECG findings. There was also no difference in 2D and M-mode measurements among the echocardiography findings. Of the TDI parameters obtained, only E' septal values differed significantly between the case and control groups. However, this was not at such a level as to indicate cardiac function impairment. CONCLUSIONS: The study data showed that the echocardiographic parameters we measured resulted in no clinical difference between the children using MPH and the healthy controls. We conclude that MPH use in children does not impair cardiovascular functions at short-term follow-up.

Clinical improvement and no further need of transplant after closure of PDA with transcatheter approach in an end-stage heart failure patient with hypertrabeculation.

Although heart failure is managed medically most of the time, heart transplantation is still last resort for selected end-stage heart failure patients with noncompaction cardiomyopathy. Presently described for the first time is case of pediatric patient with noncompaction cardiomyopathy who was initially referred to our hospital for heart transplant but underwent PDA repair and improved clinically without need for heart transplant.