Using cardiovascular imaging modalities to determine cardiac disorders before starting sports activities.

OBJECTIVE: We re-examined children who had previously been declared eligible to participate in competitive sports activities for cardiac disorders, using cardiac investigation protocol. METHODS: Total of 250 children (224 males [89.6%], and 26 females [10.4%]) between the ages of 8 and 17 years who had just started or were already engaged in sports activities were included in the study. Participants had detailed physical examination evaluated by a pediatric cardiologist. Those with findings suggesting cardiac disorder in their history and/or physical examinations, and/or 12-channel electrocardiography (ECG) were examined with echocardiography (ECHO), 24-hour Holter monitoring, and exercise test. RESULTS: Mean duration of participation in sports activities was 13 months. Among all, 10.4% of the children had abnormalities on ECG. ECHO demonstrated cardiomyopathy in 1, mitral valve prolapse in 2, tricuspid insufficiency in 2, and mitral insufficiency in 1 participant. Holter monitoring revealed non-sustained ventricular tachycardia attacks in 1, and supraventricular tachycardia in another child. Three were ultimately disqualified from partaking in competitive sports. CONCLUSION: Sports and medical communities must work together to establish study protocols to prevent sudden death related to sports and to make these activities safer for athletes. Pediatric cardiology consultation for young athletes before they start sports activities is needed.

[Correlation between Haller index and echocardiographic and spirometric findings in children with pectus excavatum]. / Pektus ekskavatumlu çocuklarda Haller indeksi ile ekokardiyografik ve spirometrik bulgularin korelasyonu.

OBJECTIVES: In this study, we evaluated the correlation between severity of deformity and cardiopulmonary function with regards to echocardiographic and spirometric findings. STUDY DESIGN: Twenty-five children, mean age 13.6 years, presenting with pectus excavatum between August 2012 and May 2013, were included. Haller index (HI) was calculated for each patient. Patients with an index of <2.5 were accepted as Group 1, 2.5-3.6 as Group 2, and >3.6 as Group 3. Left ventricle dimension, ejection fraction, and shortening fraction were evaluated with echocardiography. Using spirometry, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC ratio were calculated. Groups were compared using these parameters. RESULTS: There were 18 males and 7 females. The mean index was 3.48±0.78. Though there was no significant difference in the index with regards to sex, the index increased with age. Eight percent of patients were in Group 1, 52% in Group 2 and 40% in Group 3. A significant decrease in ejection and shortening fractions was evident as the index increased. A statistically significant relation between HI and cardiac dysfunction was evident (p<0.01). As the index increased, there was significant decrease in FEV1 and the FEV1/FVC ratio, while there was no significant difference in FVC. As the deformity worsened, incidence of pulmonary dysfunction was found to be higher. CONCLUSION: This study revealed that pectus excavatum leads to cardiac and pulmonary problems, and functions of the left ventricle may be affected by the deformity. Furthermore, the relation between the severity of the deformity and cardiovascular function is evident.

Embolization of pulmonary sequestration with Onyx: an unusual application.

We report a baby with intralobar pulmonary sequestration who was successfully treated with a new embolization agent, Onyx. A 1.5-month-old female infant was admitted to our hospital with sweating and fatigue. Telecardiography showed cardiomegaly, dextrocardia, and increased pulmonary vascular markings. In thoracic computerized tomography, pulmonary sequestration, right pulmonary hypoplasia, and large collateral arteries were seen. The collateral arteries were originating from the celiac trunk and aorta. Echocardiography revealed enlargement of the left atrium and ventricle and left ventricle systolic dysfunction. Angiography revealed a large feeding artery and three branches originating from the aorta and another feeding artery originating from the celiac trunk. We performed embolization of the feeding arteries and their branches, with coils and Onyx. The procedure was performed without complications, and all feeding arteries were completely occluded. The infant started to gain weight. One year later, the infant's body weight had increased and she had no respiratory problems or signs of congestive heart failure. In this case report, we suggest that embolization with Onyx is a reliable alternative method to surgery for infants with pulmonary sequestration. With future studies, pulmonary sequestration embolization with Onyx may become an acceptable and easy treatment option in pediatric patients.

[Efficacy of gonadal shielding in pediatric pelvis X-rays]. / Pediatrik pelvis röntgenlerinde gonad koruyucu kullaniminin etkinligi.

OBJECTIVES: In this study, we evaluated the efficacy of using gonadal shielding in pediatric patients. PATIENTS AND METHODS: Between October 2011 and February 2012, 1137 pelvic X-rays of 675 consecutive patients (323 boys, 352 girls; mean age 6.8 years; range 6 month to 17 years) in our hospital were evaluated in terms of gonadal shielding use by a team including an orthopedist, a gynecologist and a pediatrician. RESULTS: Gonadal shields were used in 566 (49.8%) pelvic X-rays of 1137 patients and important anatomical landmarks were left open in 506 (44.5%) of them. In 104 (9.1%) X-rays, the shields were placed in correct position. It was observed that a total of 293 (25.7%) X-rays were partially protective, while 109 (9.6%) X-rays were placed in a totally wrong position. Nineteen X-rays (3.3%) were repeated due to malposition of the gonadal shielding. In X-rays of boys, gonadal shields were used for 193 (17%); however only 74 (6.5%) of them were placed in correct position. In X-rays of girls, gonadal shields were used for 373 (32.8%); however only 30 (2.6%) of them were protective. CONCLUSION: If we take into consideration that use of pelvic X-rays is essential and indispensable for the diagnosis of many pediatric pelvic diseases, we believe that technicians who are responsible for taking these X-rays should be better trained on the use of gonadal shields and designs of gonadal shields should be improved.

Postinfarction ventricular septal defect following blunt chest trauma in a 7-year-old child.

Blunt cardiac injury may result in traumatic ventricular septal defect (VSD) in the pediatric population, but presence of postinfarction VSD with accompanying coronary artery thrombosis has not been reported in the literature thus far. We present a seven-year-old patient who underwent surgery for posttraumatic VSD closure and bypass grafting of thrombotic left anterior descending coronary artery (LAD) occlusion following blunt chest trauma. A high index of suspicion and early use of the appropriate imaging studies are essential for diagnosis and surgical treatment of this condition.

A case of infantile scurvy treated only with vitamin C: a forgotten disease.

Scurvy is a rare disease occurring because of a nutritional deficiency of vitamin C. In the paediatric age group the disease is usually characterized by musculoskeletal manifestations. Treatment is straightforward and consists of vitamin C administration. However, if the patient is left untreated, scurvy may be life-threatening. We report here the case of a 16-month-old infant with scurvy. After proper treatment, the complaints disappeared in a very short time period and the boy grew up as a completely normal child during the 12 years follow-up. Nowadays only few physicians have experience with this disease, and ascorbic acid deficiency can thus easily be overlooked. With this paper we aimed to remind of the efficacy of vitamin C administration for patients with scurvy.