Browsing by Author "Gursu, Hazim Alper"

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Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement
(2016) Gursu, Hazim Alper; Varan, Birgul; Sade, Elif; Erdogan, Ilkay; Ozkan, Murat; 26779972
Background: Pulmonary valve insufficiency may develop after surgical treatment of tetralogy of Fallot (ToF). Severe pulmonary valve insufficiency may result in right ventricular dysfunction. We aimed to compare cardiac magnetic resonance (CMR), with echocardiography. Methods: Patients who developed severe pulmonary valve insufficiency after total correction for ToF, were included in the study. CMR was used to measure end-diastolic, end-systolic volumes and ejection fraction of the right ventricle before and 6 months after replacement, and echocardiographic strain imaging was obtained before, and 1, 3, and 6 months after replacement. Results: There were significant differences between pre- and post-replacement QRS durations, and right ventricle end-diastolic and end-systolic volumes measured with CMR (p < 0.05). However, right ventricular ejection fraction (RVEF) did not change. Therefore, CMR determined that right ventricle size and volume increased, and right ventricular function deteriorated before replacement. After replacement, no significant improvement was seen in RVEF. Lower-than-normal right ventricle strain and strain rate before replacement indicated that healthy and dysfunctional myocardium could be differentiated by this method. Pre-replacement strain and strain rate of asymptomatic and symptomatic patients were similar. Strain and strain rate values increased 6 months after replacement (p < 0.05). Conclusions: We suppose that increased experience with strain imaging, and further studies on a larger patient group with a longer follow-up period would show that this method is quite advantageous, and it will take its place in the literature as a non-invasive technique that may be used instead of magnetic resonance.
A case of neonatal arterial thrombosis mimicking interrupted aortic arch
(2015) Gursu, Hazim Alper; Varan, Birgul; Oktay, Ayla; Ozkan, Murat; 26265897
Neonatal arterial thrombosis is a very rare entity with clinical findings resembling coarctation of aorta or interrupted aortic arch. A two day-old male newborn was admitted to another hospital with difficulty in sucking and sleepiness. On echocardiographic examination, a diagnosis of interrupted aortic arch was made and he was treated with prostoglandin E2. On physical examination, on admission to our center, the feet were bilaterally cold. The pulses were not palpable and there were ecchymotic regions in the lower extremities. Echocardiography ruled out interrupted aortic arch. Computerized tomographic angiography revealed a large thrombosis and total occlusion of the abdominal aorta. Since there was no response to treatment with tissue plasminogen activator, we performed thrombectomy. Homozygous Factor V Leiden and Methylenetetrahydrofolate reductase mutations were found in this patient. Neonatal aortic thrombosis which is observed very rarely but which is fatal should be considered in the differential diagnosis of coarctation of aorta and interrupted aortic arch.
Cor Triatriaturn: A Single Institution's Experience
(2015) Gursu, Hazim Alper; Varan, Birgul; Ozkan, Murat; Erdogan, Ilkay; Oktay, Ayla; Aslamaci, Salt; 0000-0002-6719-8563; 0000-0002-0707-2678; 0000-0001-6887-3033; ABB-1767-2021; AHI-4502-2022; ABB-2220-2021; AAJ-2305-2021
Background: This study aims to analyze the data regarding cases diagnosed with cor triatriatum sinistrum at a single pediatric center, highlighting symptoms on presentation of the anomaly, mode of diagnosis, age at the time of diagnosis, any other accompanying cardiac defects, and outcomes. Methods: Records of 21 patients (13 females, 8 males; mean age 32.4 month; range 7 days to 57 years) diagnosed with cor triatriatum sinistrum between January 1997 and January 2012 at the pediatric cardiology clinic were analyzed retrospectively. Medical records including demographic data, clinical progress, diagnostic approach, and surgical interventions were reviewed. Results: The majority of patients (81%) had accompanying cardiac defects, atrial septal defect being the most frequent (33%). Restrictive pattern was detected in five patients. Seven patients (33%) died after diagnosis. We resect the fibromuscular diaphragm in 11 of 21 patients. One patient died after operation. Most common presenting symptoms were lower respiratory tract infections, dyspnea, and early fatigue. Sixteen patients were diagnosed with echocardiography. Conclusion: Despite the diversity in clinical findings at presentation and accompanying cardiac lesions, cor triatriatum sinistrum is a treatable defect with satisfying treatment outcomes.
Evaluation of Acute Rejection by Measuring Strain and Strain Rate in Children With Heart Transplant: A Preliminary Report
(2017) Gursu, Hazim Alper; Varan, Birgul; Sade, Elif; Erdogan, Ilkay; Sezgin, Atilla; Aslamaci, Sait; 0000-0002-0707-2678; 0000-0002-6719-8563; 0000-0001-6887-3033; 27310367; AHI-4502-2022; ABB-1767-2021; ABB-2220-2021
Objectives: Asymptomatic rejection after heart transplant is difficult to detect by noninvasive methods. The present study investigated the efficacy of echocardiographic strain and the strain rate imaging method in detecting rejection after pediatric heart transplant. Materials and Methods: Fourteen pediatric patients with heart transplant were examined both with endomyocardial biopsy and strain imaging. Patients were divided into 2 groups: group 1 included patients with rejection, and group 2 included patients without rejection. Patients underwent endomyocardial biopsy at regular intervals. Regional systolic function was evaluated by longitudinal myocardial peak systolic values of strain and of strain rate. Differences between the 2 groups were assessed with unpaired t test or Mann-Whitney U test. Results: Acute rejection was detected in 7 patients (4 were female patients). Cardiac diagnosis was restrictive cardiomyopathy in 3 patients, dilated cardiomyopathy in 3 patients, and complex congenital heart disease in 1 patient. After heart transplant, 6 patients had rejection once and 1 patient had rejection twice. Evaluation of biopsy samples revealed grade IB rejection in all patients in group 1. Systolic functions of the 6 patients were determined as normal in standard echocardiographic examination. There were no significant differences in deformation and deformation rates between group 1 and 2 except in midseptal region (P<.05). Conclusions: One of the most significant complications in patients with heart transplant is rejection. Our results suggested that myocardial strain imaging may be valuable in defining low-grade rejection.
Evaluation of right ventricular function in operated tetralogy of Fallot patients with tissue Doppler imaging before and after pulmonary valve replacement
(2018) Varan, Birgul; Gursu, Hazim Alper; Erdogan, Ilkay; Ozkan, Murat; 32082764
Background: This study aims to investigate the efficacy of tissue Doppler echocardiography for the diagnosis of right ventricular dysfunction and for the evaluation of the response to pulmonary valve replacement. Methods: Between December 2008 and December 2010, a total of 15 patients (8 males, 7 females; mean age: 14.5 +/- 4.5 years; range, 7 to 22 years) with pulmonary valve insufficiency in the follow-up of total correction of tetralogy of Fallot who underwent pulmonary valve replacement were included in the study. Echocardiographic imaging was performed before and one, three, and six months after replacement. Using pulse wave Doppler, early diastolic E and late diastolic A waves were measured in the flow velocity curve of tricuspid valve. Tissue Doppler measurements were made from the basal segment of right ventricular free wall and interventricular septum. S, e, and a myocardial velocities, isometric contraction time, isovolumetric relaxation time and ejection time were measured. Myocardial performance index was calculated for each patient. Results: In pre-pulmonary valve replacement phase, s, e, a velocities and ejection time were lower in the interventricular septum compared to the basal segment of right ventricular free wall, while isometric contraction time, isovolumetric relaxation time and myocardial performance index values were higher. In the first post-replacement month, there was a significant decrease in the s value of interventricular septum, compared to pre-pulmonary valve replacement period; isometric contraction time decreased and myocardial performance index increased in the first post-pulmonary valve replacement month in the free wall of right ventricle, while isovolumetric relaxation time decreased in the postoperative third month, and s velocity, isometric contraction time and myocardial performance index increased in the postoperative sixth month. Pre-pulmonary valve replacement tissue Doppler values at the septum showed that myocardial systolic and diastolic dysfunction developed earlier than the basal segment of right ventricular free wall. This result showed that right ventricular recovery was not complete in the sixth post-pulmonary valve replacement month. Conclusion: Tissue Doppler can show right ventricular dysfunction before replacement, but it may be insufficient to visualize right ventricular recovery until six months after treatment.
Mid-Term Results of Patients with Transposition of Great Arteries Who Underwent Senning Procedure
(2014) Gursu, Hazim Alper; Varan, Birgul; Ozkan, Murat; Tokel, Kursat; Erdogan, Ilkay; https://orcid.org/0000-0002-0707-2678; https://orcid.org/0000-0002-6719-8563; https://orcid.org/0000-0002-6759-1795; https://orcid.org/0000-0001-6887-3033; AHI-4502-2022; ABB-1767-2021; AAF-3253-2021; ABB-2220-2021
Background: This study aims to evaluate mid-term follow-up results for patients with transposition of great arteries to whom Senning procedure was performed. Methods: Files of 95 child patients (63 boys, 22 girls; mean age 15.2 +/- 23.9 months; range 1 month to 12.5 years), who were diagnosed with transposition of great arteries and underwent atrial switch operation in our institute, were retrospectively evaluated. In the follow-ups; physical examination, electrocardiography, and echocardiography were performed. In addition, ambulatory electrocardiography monitorization was conducted on 25 patients. Results: Out of 95 patients who were performed atrial switch operation, 10 died in the postoperative period. The mean follow-up period was 33.4 +/- 43.7 months (1-16 years; mean 18 months). During the follow-ups, arrhythmia was detected in 25.8% of the patients, stenosis of pulmonary venous baffle was detected in 21.2%, systolic dysfunction of the right ventricle was detected in 19%, severe tricuspid valve insufficiency was detected in 18.9%, and baffle leak was detected in 15.3%. Of the patients, 11.7% were operated a second time, and 8.2% were reoperated due to stenosis of pulmonary venous baffle. Conclusion: Short and mid-term results of Senning procedure are not satisfactory. Patients should be monitored for possible right ventricle dysfunction, arrhythmia, systemic valve insufficiency, and stenosis of the tunnel.