Browsing by Author "Varan, Birgul"

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Acute Respiratory Distress Syndrome and Myocarditis Caused by Human Metapneumovirus in a Child
(2020) Yakut, Kahraman; Varan, Birgul; Erdogan, Ilkay; Tokel, Kursad; 0000-0002-6759-1795; 0000-0002-9221-5636; AAJ-2305-2021; AAF-3253-2021
Human metapneumovirus (hMPV), a recently described paramyxovirus, has commonly been associated with upper and lower respiratory tract infections in young children. Severe infections including cardiovascular disease associated with hMPV have been particularly reported in older and immunocompromised patients; however, there has been no previous report of hMPV causing myocarditis in a child. In this article, we present a rare case with acute respiratory distress syndrome and myocarditis associated with hMPV in a child.
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.
Aortic balloon valvuloplasty and mid-term results in newborns: a single center experience
(2020) Varan, Birgul; Yakut, Kahraman; Erdogan, Ilkay; Ozkan, Murat; Tokel, Kursat; 0000-0002-6759-1795; 32419415; AAJ-2305-2021; AAF-3253-2021
Background and objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short- and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. Methods. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Results. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 +/- 4.9 years (range: 6 months 19 years). The mean age of the patients at the first ABV was 14.5 +/- 10.6 days (range: 1-30 days) and body weight was 3.25 +/- 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 +/- 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 +/- 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. in the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p <0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. Conclusions. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.
Asymptomatic giant congenital left atrial aneurysm
(2019) Yakut, Kahraman; Varan, Birgul; Erdogan, Ilkay; 31559732
Congenital aneurysm of the left atrial appendage can be caused by congenital dysplasia of the pectinate muscles and may be accompanied by a congenital absence of the pericardium. Symptoms generally manifest after two decades and the most common symptom is atrial arrhythmia in the form of atrial fibrillation / flutter. A four year-old patient with no symptoms underwent an echocardiographic examination for the investigation of a heart murmur. Echocardiographic examination revealed a large cystic lesion occupying the left hemithorax and compressing the left ventricle. The patient was referred to our center. The lesion caused displacement of the heart rightward behind the sternum which made the examination difficult. We aimed to present this rare case of giant left atrial appendage aneurysm in the light of current literature.
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.
Case report and the surgical treatment of two cases with pulmonary atresia in which pulmonary arteries is circulated by coronary arteries
(2018) Tokel, Kursad; Yakut, Kahraman; Varan, Birgul; Erdogan, Ilkay; Ozkan, Murat; 0000-0002-6719-8563; 0000-0001-6887-3033; 0000-0002-6759-1795; 29664428; ABB-1767-2021; AAJ-2305-2021; ABB-2220-2021; AAF-3253-2021
Pulmonary atresia (PA) and ventricular septal defect (VSD) can occur in a variety of ways, from simple valve atresia to a condition in which circulation to the pulmonary bed occurs through collateral arteries separated from the aorta and there are no real pulmonary arteries, or they are present but hypoplastic. The size of the pulmonary arteries and concomitant complex cardiac lesions are important in making decisions about treatment and correctional alternatives. While complete correction surgeries in the style of a correction of tetralogy of Fallot are performed in simpler cases, many very invasive procedures are also performed and the resulting quality of life is very variable. The size of the pulmonary artery and its branches and the presence of accompanying collateral vessels are determining factors in the management of the disease. In this report, 2 cases of VSD and PA, in which the circulation of the pulmonary arteries was through the coronary arteries, diagnosed as a result of echocardiography performed following murmurs heard during examination, are described. The first patient was 40 days old and the second was 2 days old. In the second case, diagnosis was confirmed by catheter angiography, and in the first case, the final diagnosis was made during surgery. The aim of this report is to emphasize the importance of pulmonary artery size, the presence of pulmonary confluence, the origin of circulation, and concomitant collateral arteries when considering treatment methods.
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.
Coronary artery fistulae and treatment in children
(2020) Yakut, Kahraman; Tokel, N.Kursad; Varan, Birgul; Erdogan, Ilkay; Ozkan, Murat; 32779414
Background and objectives. In this study, we aimed to review the treatment options and long-term problems of patients who were diagnosed with coronary artery fistulae (CAF) in our institution. We also tried to determine the most appropriate time for treatment of this condition. Method. From 2000 to 2018, the medical records of 56 patients (33 males and 23 females) who had CAF diagnoses were retrospectively reviewed. Results. The mean age of the patients at the time of diagnosis was 3.9 +/- 4.6 years (range, 1 month to 18 years) and the mean duration of the follow-up period was 7.4 +/- 4.5 years (range, 1 year to 17.5 years). The right coronary artery (RCA) was the most common origin site for CAF, the left main coronary artery (LMCA) was the second most common origin site whereas the left anterior descending coronary artery (LAD) was the third most common origin site. Catheter angiography showed that right ventricle (RV) was the site of termination for CAF in 23 patients (41.1%) while the CAF drained to the pulmonary artery in 16 patients (28.6%). Transcatheter intervention was performed in ten patients, while CAF were corrected surgically in five patients. Transcatheter intervention was initially attempted in two out of the five surgically-treated patients, but the procedure was unsuccessful. A vascular plug was deployed in six patients, a platinum coil was used in three patients, and a platinum coil with tissue adhesive was placed in one patient using a catheter. Early complications were seen in two patients during transcatheter intervention and in one patient during surgery. There were no instances of death or late complications in patients treated surgically or via transcatheter. Conclusions. Coronary artery fistulae are usually asymptomatic, and medical therapy with long term follow up is the first line treatment. Fistulae that cause hemodynamically significant shunting, chamber enlargement, or visible symptoms should be closed at an early age. This study shows that transcatheter closure is a safe treatment option for CAF that may be performed with high success. Also, it should be known that surgery may be performed effectively with low rates of complications. Because complications can develop in treated and untreated patients of all ages, follow-up should occur during the patient's lifetime.
Diagnosis and treatment of abnormal left coronary artery originating from the pulmonary artery: A single-center experience
(2019) Yakut, Kahraman; Tokel, Niyazi Kursad; Ozkan, Murat; Varan, Birgul; Erdogan, Ilkay; Aslamci, Mehmet Sait; 31789610
Objective: We aimed to review symptoms, findings, surgical treatment options, short- and mid-term outcomes, and reoperation rate of patients diagnosed with of left coronary artery from the pulmonary artery (ALCAPA) of an anomalous origin in our institution. Methods: From May 2000 to March 2018, 33 patients who had left coronary artery originating from the pulmonary artery were retrospectively examined. The clinical features of patients, diagnostic tools and their efficacy, outcomes of surgical repair, and problems during follow-up were evaluated. Results: Thirty-three patients (22 females, 11 males) were included in the study. At the time of surgery, the median age and weight of patients were 6 months (minimum/maximum, 1-166 months) and 6.5 kg (minimum/maximum, 3-38.5 kg), respectively. The mean follow-up was 5 +/- 3.5 years (range, 1-16 years). Dyspnea, tachypnea, diaphoresis, prolonged feeding time, and developmental delay were common presenting signs and symptoms. It was determined that all the patients who were diagnosed at another center reached our center for surgical treatment within 1 month. Twenty-three (69.7%) patients had pathologic 1:1 wave with anterior and/or anterolateral myocardial infarction signs on an electrocardiogram (ECG), whereas 22 (66.6%) patients had ST-T segment changes. Twenty-one (63.6%) patients had cardiomegaly on the telecardiogram. A reimplantation surgery was performed to 22 patients and 10 patients underwent the Takeuchi procedure. In addition to ALCAPA repair, 5 patients needed mitral valve plasty. Atrial septal defect (ASD) and ventricular septal defect (VSD) were closed in one patient, and Tetralogy of Fallot was totally corrected in another. At discharge, there was a significant improvement in left ventricular (LV) systolic functions. At the last visit, all patients had normal LV systolic functions except four who had mild dysfunction. The mean follow-up of the four patients was 2.8 years. In the early postoperative period, complications were seen in 10 patients. Five patients died in the early postoperative period, while one patient died 9 months after the ALCAPA surgery because of low cardiac output syndrome that developed after mitral repair. Conclusion: Patients with ALCAPA commonly present with congestive heart failure symptoms. When the diagnosis is confirmed in these patients, surgical treatment should not be delayed. The availability of surgical center and surgery outcomes for ALCAPA diagnosed patients are comparable with other countries, but the delay in the diagnosis of disease is still a problem in our country.
Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience
(2020) Surucu, Murat; Erdogan, Ilkay; Varan, Birgul; Ozkan, Murat; Tokel, N.Kursad; Aslamaci, Sait; 0000-0002-6759-1795; 32063236; AAF-3253-2021; AAJ-2305-2021
Objective: Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery. Methods: We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated. Results: Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 +/- 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1). Conclusion: The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.
Embolization of Pulmonary Sequestration with Onyx: An Unusual Application
(2014) Gursu, Alper Hazim; Boyvat, Fatih; Varan, Birgul; Erdogan, Ilkay; https://orcid.org/0000-0002-0707-2678; https://orcid.org/0000-0002-6719-8563; https://orcid.org/0000-0001-6887-3033; 24643150; AHI-4502-2022; F-4230-2011; ABB-1767-2021; ABB-2220-2021
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.
Evaluation of acute kidney injury after surgery for congenital heart disease in neonates: a tertiary hospital experience
(2022) Oktener Anuk, Ezgi; Erdogan, Ilkay; Ozkan, Murat; Baskin, Esra; Varan, Birgul; Tokel, Kursad N.; 0000-0001-6887-3033; 0000-0003-3991-8479; 35382696; ABB-2220-2021
Purpose of the article Acute kidney injury (AKI) after cardiac surgery in children with congenital heart disease (CHD) is a serious complication closely associated with high morbidity and mortality. Despite numerous studies on AKI in children, most studies have excluded neonates. We sought to characterize AKI associated with cardiac surgery in neonates, determine its incidence, perioperative and postoperative risk factors, and short-term results. Materials and methods This retrospective study included 177 neonates who were operated on for CHD in our hospital between January 2015 and December 2019. Data of the patients were analyzed according to nKDIGO (neonatal Kidney Disease Improving Global Outcomes) and nRIFLE (neonatal Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria for evaluating AKI retrospectively. Data of groups with and without AKI were analyzed. Results The average age of 177 neonates were 8.2 +/- 6.1 (1-28) days. Twenty-two (12.4%) neonates had CS-AKI defined according to nKDIGO criteria. Four (2.3%) neonates reached nKDIGO stage I, 1 (0.6%) reached stage II, 17 (9.6%) reached stage III. Thirty-eight (21.5%) neonates had CS-AKI defined according to nRIFLE criteria. Twenty-four (13.6%) neonates reached nRIFLE stage risk(R), 6 (3.4%) reached stage injury(I), 8 (4.5%) reached stage failure (F). The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) in neonates was 12.5% and 21.5% for nKDIGO and nRIFLE, respectively. The percentage difference between nKDIGO and nRIFLE for AKI assessment was due to the criteria for nRIFLE stage risk(R) urine output < 1.5 mL/kg/h for 24 h. In both classifications, the duration of cardiopulmonary bypass, operation, inotropic treatment, and mechanical ventilation, length of intensive care unit (ICU), and hospital stay were significantly higher in the AKI group than those without AKI group (p<.05). The mortality rate in the groups with AKI was found to be significantly higher (p<.05) than in the groups without AKI. In Kappa analysis, when two classifications were compared according to AKI stages, a significant agreement was found between nKDIGO and nRIFLE classifications (p<.05) (Kappa: 0.299). Conclusion AKI and mortality rates were similar between groups according to the nKDIGO and nRIFLE criteria. For early prediction of AKI and adverse outcomes, diagnostic reference intervals might be specified in more detail in neonates undergoing cardiac surgery for CHD.
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.
Hypomagnesemia in Pediatric Heart Transplant Patients Treated with Tacrolimus
(2018) Erdogan, Ilkay; Gursu, Hazim A.; Varan, Birgul; Ozkan, Murat; Sezgin, Atilla; 0000-0001-6887-3033; 0000-0002-0707-2678; 0000-0002-6719-8563; 27364480; ABB-2220-2021; AHI-4502-2022; ABB-1767-2021
Objectives: We aimed to investigate the frequency of hypomagnesemia and urinary magnesium excretion in pediatric heart transplant recipients. Materials and Methods: In this study, 22 pediatric patients who underwent heart transplanted at a single center between March 2014 and April 2015 and who were treated with oral tacrolimus were analyzed prospectively. Serum magnesium, creatinine, and tacrolimus levels and total amount of urinary magnesium excretion were measured. Serum tacrolimus levels were measured 12 hours after the last dose of tacrolimus. Results: Our patient group included 11 boys (50%) and 11 girls (50%) with a mean age of 16.72 +/- 4.78 years. Serum tacrolimus levels were in the therapeutic range, with a mean of 1.48 +/- 0.13 ng/mL (range, 1.2-1.69 ng/mL), mean fractional magnesium excretion was 8.59 +/- 5.9% (range, 3%-22%), and 24-hour urinary magnesium excretion was 90.2 +/- 62.95 mg/d. Hypermagnesuria was assessed in 80% of patients. We found 24-hour urinary magnesium excretion to be higher than normal in 27% of patients. There was no association between serum tacrolimus levels and serum magnesium levels or urinary magnesium excretion. Conclusions: Serum magnesium levels should be periodically measured in pediatric heart transplant patients treated with tacrolimus.
Infective Endocarditis in Childhood: a Single-Center Experience of 18 Years
(2021) Yakut, Kahraman; Ecevit, Zafer; Tokel, Niyazi Kursad; Varan, Birgul; Ozkan, Murat; 0000-0002-6759-1795; 0000-0002-6719-8563; 33113327; AAF-3253-2021; ABB-1767-2021
Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6 +/- 4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.
Management of pediatric cardiac transplantation candidates with pulmonary hypertension and high pulmonary vascular resistance
(2020) Yakut, Kahraman; Varan, Birgul; Erdogan, Ilkay; Cindik, Nimet; Gokdemir, Mahmut; Gumus, Ayten; Tokel, N. Kursad; Sezgin, Atilla; 0000-0002-6759-1795; 32558420
Background and objectives. Right ventricular failure is an important cause of mortality and morbidity after orthotopic heart transplantation (OHT). The right ventricle of the donor may fail to accommodate to the high pulmonary vascular resistance (PVR) of the recipient. Pulmonary hypertension (PH) due to chronic heart failure with PVRi > 4 Wood units.m(2), transpulmonary gradient > 15 mmHg adversely affect the outcome of OHT. In this study we aimed to evaluate management strategies in our pediatric cardiac transplantation candidates with PH and high PVR prior to OHT. Method. Twenty-six cardiac transplantation candidates (age: 10.2 +/- 4.6, 1-17 years) underwent cardiac catheterization for the determination of PVR and pulmonary arterial pressure. They were admitted to the hospital and received 1-3 days of intravenous (IV) vasodilator therapy; 0.5-3 mu g/kg/min nitroglyserin and/or 0.5-3 mu g/kg/min nitroprusside, 5-15 mu g/kg/min dobutamin and/or dopamin to keep systolic blood pressure above 80 mmHg. Results. Thirteen patients had dilated cardiomyopathy (CMP), 11 had restrictive CMP, one had hypertrophic CMP and one had congenital heart disease (CHD). Nineteen of the 26 patients underwent OHT. Mean pulmonary arterial pressure of the patients ranged between 11 and 82 mmHg (30.4 +/- 16 mmHg) and PVRi between 0.41-21.4 Wood units.m(2) (5.3 +/- 5.7). Nine patients had PVRi above 4 Wood units.m(2). Six of these patients had IV treatment for longer than three days and some received specific anti-PH treatment. Eventually they underwent a pulmonary vasoreactivity test with IV iloprost and six had PVRi <4 Wood units.m(2). Five of them underwent OHT. Conclusion. Cardiac transplantation candidates with PH and high PVR should be evaluated after conditioning with vasodilator and inotropic treatment. Specific treatment for PH and vasoreactivity testing may help selected patients reenter the transplantation list.
Maternal and cord blood homocysteine, vitamin B12, folate, and B-type natriuretic peptide levels at term for predicting congenital heart disease of the neonate: A case-control study
(2019) Sahin-Uysal, Nihal; GUlumser, Cagri; Kocaman, Eda; Varan, Birgul; Bayraktar, Nilufer; Yanik, Filiz; 0000-0001-5385-5502; 0000-0002-7886-3688; 0000-0002-1741-7035; 0000-0002-4066-9038; 31256695; AAA-9475-2020; Y-8758-2018; C-6543-2018
Objective: To investigate the effectiveness of the metabolic markers homocysteine, vitamin B12, folate, and B-type natriuretic peptide in maternal and cord blood for detecting congenital heart disease. Methods: Homocysteine, vitamin B12, folate, and B-type natriuretic peptide concentrations in maternal and cord blood samples at term were measured in the case (n = 42) and control (n = 43) groups with and without fetal congenital heart disease, respectively. Additionally, newborns with congenital heart disease were divided into two subgroups: those with (n = 30) and without (n = 8) 6-month infant survival. The case and control groups and case subgroups were compared with each other with respect to maternal age, gravidity, parity, gestational age at delivery, birth weight, maternal and cord blood levels of homocysteine, vitamin B12, folate, and B-type natriuretic peptide, and arterial cord blood pH and base excess values. Statistical analyses were performed using SPSS for Windows, version 22.0. The Student's t-test, the Mann-Whitney U test, and the chi(2) test were used where appropriate. A p value of < .05 was considered statistically significant. Results: Mean maternal age, birth weight and median gravidity, parity and gestational age at delivery were not significantly different between the case and control groups, as well as between the case subgroups (all p > .05). Concentrations of metabolic markers in maternal blood were not significantly different between the two groups (p > .05). Homocysteine and B-type natriuretic peptide levels in cord blood samples were significantly higher, whereas folate levels were significantly lower in the case group compared with the control group (all p < .05). Cord blood B-type natriuretic peptide levels were significantly higher (p < .05) and arterial cord blood pH values were significantly lower (p < .05) in the case subgroup without 6-month infant survival compared with the case subgroup with 6-month infant survival. Conclusion: High cord blood B-type natriuretic peptide and homocysteine levels and low cord blood folate levels at term may be useful for predicting congenital heart disease in the neonate. Neonates with congenital heart disease who have high cord blood B-type natriuretic peptide and low pH values may have adverse outcomes.
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.
Multiple Giant Aneurysms and Stenoses of the Coronary and Systemic Arteries in an Infant with Kawasaki Disease at the Early Stage of Convalescent Period
(2014) Ekici, Filiz; Varan, Birgul; Kocabas, Abdullah; Erdogan, Ilkay; Eminoglu, Sancar; Aktas, Dogukan; https://orcid.org/0000-0002-6719-8563; 24528198; ABB-1767-2021; AAD-2644-2019; AAJ-2305-2021
Myocardial infarction and systemic arterial aneurysms are rarely seen during the course of the Kawasaki disease (KD). Herein, we report the case of a 4-month-old Turkish infant who was diagnosed with KD on the 17th day of the illness. On admission, echocardiogram showed multiple coronary arterial aneurysms (CAAs) and massive pericardial effusion. He was given intravenous immunoglobulin, aspirin and anticoagulant drugs. However, the aneurysms progressed to super giant CAAs, multiple huge coronary arterial thromboses developed recurrently and caused myocardial ischemia. Furthermore, the conventional angiography revealed multiple giant aneurysms and stenoses in the subclavian, celiac, and iliac arteries, besides CAAs. Mini-Abstract We report the case of a 4-month-old Turkish infant who was diagnosed with Kawasaki disease associated with multiple super giant coronary aneurysms, huge coronary thromboses, and massive pericardial effusion. Multiple systemic arterial aneurysms and stenoses were also detected in subclavian, axillary, renal, and iliac arteries as well as coronary arteries at the beginning of convalescent period.