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Item Results of Balloon and Surgical Valvuloplasty in Congenital Aortic Valve Stenosis: A 19-Year, Single-Center, Retrospective Study(2021) Yakut, Kahraman; Varan, Birgul; Tokel, Niyazi Kursad; Erdogan, Ilkay; Ozkan, Murat; 0000-0002-6719-8563; 0000-0001-6887-3033; 34104509; ABB-1767-2021; ABB-2220-2021Background: This study aims to compare the success, complications, and long-term outcomes of aortic balloon valvuloplasty and surgical aortic valvuloplasty in pediatric patients with congenital aortic valve stenosis. Methods: Between March 2000 and October 2019, a total of 267 procedures, including 238 balloon valvuloplasties and 29 surgical valvuloplasties, in 198 children (135 males, 63 females; mean age: 57.4 +/- 62.6 months; range, 0.03 to 219 months) were retrospectively analyzed. The hospital records, echocardiographic images, catheterization data, angiography images, and operative data were reviewed. Results: Aortic regurgitation was mild in 73 patients before balloon valvuloplasty, and none of the patients had moderate-to-severe aortic regurgitation. Compared to surgical valvuloplasty, the rate of increase in the aortic regurgitation after balloon valvuloplasty was significantly higher (p=0.012). The patients who underwent balloon valvuloplasty did not need reintervention for a mean period of 46 +/- 45.6 months, whereas this period was significantly longer in those who underwent surgical valvuloplasty (mean 80.5 +/- 53.9 months) (p=0.018). The overall failure rate was 8%. Moderate-to-severe aortic regurgitation was the most important complication developing due to balloon valvuloplasty in the early period (13%). All surgical valvuloplasties were successful. The mean length of hospitalization after balloon valvuloplasty was significantly shorter than surgical valvuloplasty (p=0.026). During follow-up, a total of 168 patients continued their follow-up, and a reinterventional or surgical intervention was not needed in 78 patients (47%). Conclusion: Aortic balloon valvuloplasty can be repeated safely and helps to eliminate aortic valve stenosis without needing sternotomy. Surgical valvuloplasty can be successfully performed in patients in whom the expected benefit from aortic balloon valvuloplasty is not achieved.Item Restrictive cardiomyopathy with ring chromosome 6 anomaly in a child(2021) Erdogan, Ilkay; 34622791; CAE-9097-2022Item 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-3253-2021Background 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.Item Coronary artery fistulae and treatment in children(2020) Yakut, Kahraman; Tokel, N.Kursad; Varan, Birgul; Erdogan, Ilkay; Ozkan, Murat; 32779414Background 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.Item 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-3253-2021Human 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.Item The results of interventional catheterization in infants weighing under 2,000 g(2019) Varan, Birgul; Tokel, N. Kursad; Yakut, Kahraman; Erdogan, Ilkay; Ozkan, Murat; 32082877Background: The aim of this study was to evaluate the early and mid-term results of interventional cardiac catheterization and procedure-related complications in infants weighing <2,000 g. Methods: Between May 1998 and April 2017, 22 patients (14 males, 8 females; mean age 14 +/- 8.4 days; range, 1 to 30 days) weighing < 2,000 g who underwent a total of 23 interventional cardiac catheterization were retrospectively analyzed. Procedures were balloon coarctation angioplasty in 14, balloon atrial septostomy in five, balloon aortic valvuloplasty in one, balloon pulmonary valvuloplasty in one, patent ductus arteriosus closure in one, and stent placement in the ductus in one patient. Another patient underwent balloon coarctation angioplasty and balloon aortic valvuloplasty in the same session. Results: The overall success rate of the interventional procedures was 95.6%. The mean follow-up was 3.2 +/- 1.6 years (range, 1 to 5.5) for 18 patients with available records. The rate of serious complications was 18%. The most frequent complications in the early period were low hemoglobin levels requiring erythrocyte suspension transfusion (54.5%) and vascular injury (54.5%). Two patients required reintervention, one patient required surgery after the second intervention, and three patients required only surgery. Six patients underwent palliative interventional procedures, and interventional procedures led to definitive treatment in five patients. Conclusion: The mortality and morbidity rate of surgery is high in premature under 2,000 g infants and interventional heart catheterization can be life-saving in this patient group, although it is associated with significant complications in low birth weight newborns.Item Asymptomatic giant congenital left atrial aneurysm(2019) Yakut, Kahraman; Varan, Birgul; Erdogan, Ilkay; 31559732Congenital 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.Item 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; 31789610Objective: 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.Item Reversible cardiomyopathy-tachycardiomyopathy in children(2019) Arslan, Alev; Erdogan, Ilkay; Varan, Birgul; Yılmaz, Mustafa; Ozin, Mehmet Bülent; Tokel, Niyazi Kursad; 31990473Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is defined by the presence of a sustained tachycardia that results in left ventricular systolic dysfunction. Restoration of cardiac function is dependent on the control of tachyarrhythmias. We report a series including ten children with tachycardia-induced cardiomyopathy with different etiologies. The medical records of patients with tachycardiomyopathy who were managed in a Pediatric Cardiology Clinic between the years of 2014-2017 were reviewed retrospectively. Ten children (3 female, 7 male) were diagnosed with tachycardiomyopathy. The median age of the patients was 12 years (range: 4-15.8). Five had atrial tachycardia, two had ventricular tachycardia, the others had Mahaim fiber tachycardia, permanent junctional reciprocating tachycardia and atrioventricular reentrant tachycardia. Seven patients had catheter ablation and three patients who had previous heart surgery were treated with antiarrhythmic drugs. Median ejection fraction was 33% (range: 10-48), median left ventricle end-diastolic diameter was 55 mm (range: 30-78). All showed complete recovery with median ejection fraction 60% (range: 55-78). Two patient with severe heart failure required extracorporeal membrane oxygenation support, one of them had ventricular assist device support but the device was removed after successful ablation. After two years this patient required permanent pacemaker implantation due to complete atrioventricular block. Tachycardia-induced cardiomyopathy is a rare and treatable cause of heart failure. Early recognition is critical, aggressive treatment aimed at controlling the arrhythmia results in symptom resolution and recovery of ventricular function.Item 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; 26779972Background: 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.