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Öğe A rare cardiac anomaly in Goldenhar's syndrome: Isolated partial anomalous pulmonary venous return(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2014) Balli, Sevket; Ece, Ibrahim; Kibar, Ayse Esin; Oflaz, Mehmet Burhan; Bulut, GoncaGoldenhar syndrome is a rare congenital abnormality characterized by incomplete development of the ear, nose, soft palate, lip, and mandible. It is associated with anomalous development of the first and second branchial arch. Common clinical manifestations include limbal dermoids, preauricular skin tags, and strabismus. Here we present a case of a four months old female with Goldenhar's syndrome and partial anomalous pulmonary venous return.Öğe Assessment of Cardiac Functions in Fetuses of Gestational Diabetic Mothers(SPRINGER, 2014) Balli, Sevket; Pac, Feyza Aysenur; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Kandemir, OmerWe investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E (a)-wave (p = 0.02), A (a)-wave (p = 0.04), and S (a)-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E (a) (p = 0.02) and A (a) (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E (a)/A (a) ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E (a) ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.Öğe Assessment of Fetal Cardiac Function in Mild Preeclampsia(SPRINGER, 2013) Balli, Sevket; Kibar, Ayse Esin; Ece, Ibrahim; Oflaz, Mehmet Burhan; Yilmaz, OzcanThis study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.Öğe Bronchogenic Cyst: An Unexpected Cause of Respiratory Complaints and a Solid Chest Mass in an Infant(Cukurova Univ, Fac Medicine, 2013) Kibar, Ayse Esin; Ece, Ibrahim; Oflaz, M. Burhan; Balli, SevketBronchogenic cysts are congenital anomalies that result from abnormal budding of the tracheobronchial tree. Congenital bronchogenic cystic disease of the lung in infant is rare, generally benign lesions, which tend to produce few to no symptoms. The cyst can produce cough and dyspnea. Chest, radiograph shows usually a round or oval soft tissue mass in the lower mediastinum. They can occur in infants and children, they are frequently detected coincidentally. In this article, we present a case with bronchogenic cyst of the right middle lobe (14 month) causing cough, dyspnea and radiologic findings.Öğe Early Subclinical Left-Ventricular Dysfunction in Obese Nonhypertensive Children: A Tissue Doppler Imaging Study(SPRINGER, 2013) Kibar, Ayse Esin; Pac, Feyza Aysenur; Balli, Sevket; Oflaz, Mehmet Burhan; Ece, Ibrahim; Bas, Veysel Nejat; Aycan, ZehraA direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 +/- A 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI a parts per thousand yen 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 +/- A 2 cm/s), peak early myocardial velocity (Am = 8.7 +/- A 1.3 cm/s), Em/Am ratio (1.8 +/- A 0.3), isovolumetric relaxation time (IVRT = 59.2 +/- A 8.2 ms), MPI (0.39 +/- A 0.03), and DI (25.5 +/- A 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 +/- A 1.2 cm/sn, 6.9 +/- A 0.6 cm/sn, 2.6 +/- A 0.2, 51.2 +/- A 9.6 ms, 0.34 +/- A 0.03, and 33.13 +/- A 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.Öğe Effect of Antiepilepsy Drug Therapy on Ventricular Function in Children With Epilepsy: A Tissue Doppler Imaging Study(SPRINGER, 2014) Kibar, Ayse Esin; Unver, Olcay; Oflaz, Mehmet Burhan; Guven, Ahmet Sami; Balli, Sevket; Ece, Ibrahim; Erdem, Sevcan; Icagasioglu, Fusun DilaraImpaired cardiac myocardial function may contribute to the risk for sudden unexpected death of a patient with epilepsy. This study aimed to investigate the effect of antiepilepsy drugs (AEDs) on cardiac function in pediatric epileptic patients using standard and tissue Doppler imaging (TDI) echocardiography. This hospital-based, prospective cross-sectional study investigated 52 epileptic children (mean age 9.3 +/- A 3.1 years) treated with AEDs (duration 2.4-10.0 years) and 36 healthy children (mean age 9.5 +/- A 4.0 years). In the epilepsy group, standard echocardiography showed increased left ventricular (LV) end-diastolic and end-systolic diameters, an increased LV mass index, and preserved ejection fraction. The patients also exhibited increased mitral peak A-wave velocity and mitral E-wave deceleration time as well as a decreased mitral E/A ratio. The E/Em ratio was significantly higher in the epilepsy group (5.6 +/- A 1.2) than in the control group (5.2 +/- A 1.1) (p = 0.016). In the epilepsy group, TDI showed an increased isovolumetric relaxation time and myocardial performance index (MPI). It also exhibited decreased early diastolic velocity (Em) and a decreased mitral annular displacement index in these patients. There were positive correlations between the LV lateral wall MPI (r = 0.231), septal MPI (r = 0.223), and LV mass index (p < 0.05) but no correlation with the duration of AED treatment. The authors detected subclinical ventricular dysfunction associated with AEDs at a preclinical stage. They suggest that TDI can be useful for determining the short- and long-term cardiac effects of AEDs.Öğe Effects of carvedilol therapy on cardiac autonomic control, QT dispersion, and ventricular arrhythmias in children with dilated cardiomyopathy(INT SCIENTIFIC LITERATURE, INC, 2013) Oflaz, Mehmet Burhan; Balli, Sevket; Kibar, Ayse Esin; Ece, Ibrahim; Akdeniz, Celal; Tuzcu, VolkanBackground: The purpose of this study was to examine the effects of carvedilol therapy on autonomic control of the heart and QT-interval dispersion (QTd) among children with idiopathic dilated cardiomyopathy (DCM) whose symptoms were not adequately controlled with standard congestive heart failure therapy. Material/Methods: Patients with DCM who were treated with carvedilol were enrolled in the study. All patients had undergone carvedilol therapy in addition to standard therapy for at least 6 months. Clinical, echocardiographic, and electrocardiographic parameters, and 24-h Holter records of patients were retrospectively evaluated before and after carvedilol treatment. Results: A total 34 patients (mean age: 7.4 +/- 4.3 years) with DCM were analyzed in the study. The median follow-up period was 9.5 months. After the 6 months of carvedilol therapy the clinical score significantly improved, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) significantly increased, and left ventricle end-diastolic dimensions and end-systolic dimensions significantly decreased. There were statistically significant increases in mean SDNN, SDANN, rMSSD, and pNN50 (p=0.002, p=0.001, p=0.008, and p=0.026, respectively). After the carvedilol therapy, SDNN was correlated with the clinical score, heart rate, LVEF, LVFS, and total premature ventricular contractions (PVCs). In addition, rMSSD and pNN50 were correlated with heart rate, LVEF and LVFS. A significant reduction was observed in QTc-minimum, QTc-maximum, and QTd values (434.9 +/- 40.7 vs. 416.1 +/- 36.5, 497.8 +/- 43.6 vs. 456.3 +/- 41.7, 58.6 +/- 17.1 vs. 49.3 +/- 15.6; p<0.001, p=0.001, and p=0.008, respectively). QTd was significantly related to PVCs (r=0.62, p=0.02). Conclusions: We conclude that the addition of carvedilol to standard therapy can improve clinical symptoms and heart rate variability, and reduce in arrhythmia markers in children with DCM.Öğe Evaluation of Cardiac Functions of Patients with Benign Joint Hypermobility Syndrome(SPRINGER, 2014) Balli, Sevket; Aydin, Mehmet Zafer; Gerdan, Vedat; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Sen Dalkiran, EylemWe sought to investigate whether echocardiography with tissue Doppler imaging identifies myocardial dysfunction in children with benign joint hypermobility syndrome (BJHS). This cross-sectional study enrolled 75 children with BJHS and 70 healthy children. We performed detailed echocardiography in individuals with BJHS without inherited connective tissue disorders. Any congenital or acquired cardiac disease was excluded by clinical and echocardiographic examination. Both groups were similar in terms of age, sex, and body mass index. The diameter of the aortic annulus and sinus valsalva were wider in patients with BJHS. There was no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the two groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Deceleration time of early mitral inflow was prolonged in patients with BJHS. Mitral and tricuspid annulus Ea velocity were significantly lower in children with BJHS. Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in patients with BJHS than in the control group. The E/Ea ratio was greater in patients with BJHS than in the control group. Isovolumic relaxation time and right-ventricular (RV) and left-ventricular (LV) myocardial performance indices (MPIs) were greater in patients with BJHS. This study showed the diastolic dysfunction in patients with BJHS. In addition, we detected increased LV and RV MPI. We believe that BJHS may affect proteins of the myocardial cytoskeleton and extracellular matrix.Öğe Evaluation of morphological characteristics of septal rims affecting successful transcatheter atrial septal defect closure in children and adults(TERMEDIA PUBLISHING HOUSE LTD, 2013) Oflaz, Mehmet Burhan; Pac, Feyza Aysenur; Kibar, Ayse Esin; Balli, Sevket; Ece, IbrahimIntroduction: Determining other echocardiographic predictors along with the measured atrial septal defect (ASD) size and evaluating the closure together with these predictors would increase the chance of success for transcatheter closure of ASD. Aim: To evaluate echocardiographic parameters affecting defect closure in children and adult patients with secundum ASD. Material and methods: In all patients, size of ASD, total length of atrial septum (TS), superior-posterior, inferior-posterior, superior-anterior and inferior-anterior rims surrounding the defect were measured by transesophageal echocardiography (TEE), and several measurement ratios were derived on the basis of TEE parameters. Results: A total 216 patients with secundum ASD were included in this study. The device was successfully implanted in 65 children and 65 adults. Both in pediatric and adult cases, the ratio of successful closure was found to be significantly higher when the ratio of defect size to TS was <= 0.35, the ratio of superior-anterior (SA) rim to the defect size was > 0.75 and the ratio of inferior-posterior (IP) rim to the defect size was > 1.0. It was found that having more than one of these predictors in a single case increased the chance of closure success significantly (p < 0.001). Conclusions: We concluded that a ratio of the defect size to TS <= 0.35, a ratio of SA rim to defect size > 0.75 and a ratio of IP rim to defect size > 1.0 were found to be echocardiographic predictors that could be used in successful transcatheter ASD closure both in children and adults.Öğe Evaluation of the Doppler flow patterns of patent ductus arteriosus in preterm infants(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2013) Balli, Sevket; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Bulut, GoncaObjective: Aim of study was to evaluate both ductal diameter (Dd) and pulsed wave Doppler (PWD) patterns of patent ductus arteriosus (PDA), the treatment requirement of different patterns. Methods: In this retropective study evaluation and classification of PDA of 139 preterms born before 34 weeks gestation was performed by color Doppler and PWD. Ratio of left atrium/aortic root were evaluated in parasternal long axis. Ductal patterns were compared with both Dd and left atrium/aortic root ratio. PDA was treated by ibuprofen. The treatment requirement and thrombocyte count of patterns was evaluated. Results: 85,5% of preterms were very low birth weight (< 1500 g). Median gestational age was 28,5 (23-34) weeks. Median birth weight was 1050 (750-1850) g. 39 (17,3%) pulmonary hypertension (PH), 43 (19,1%) growing, 68 (30,3%) pulsatile, 75 (33,3%) closing pattern were observed. PH pattern was more often in first three days (p< 0,001). There was significantly difference among patterns in term of Dd (p< 0,001). The largest Dd was observed in PH pattern the smallest Dd was observed in closing pattern. The need for treatment was higher in pulsatile pattern (52,4% of patients). There was a positive corelation between left atrium/aortic root and ductal diameter in pulsatil, growing and closing pattern except PH pattern. There was no relation between platelet count and flow paterns (p> 0,05). Conclusion: We determined significant relationship between Dd and flow pattern. There was no relationship between ductal pattern and thrombocyte count. Pulsatile pattern were hemodynamically significant. Despite greater Dd, treatment requirement in PH pattern was less due to low left-right shunt. Both ductal diameter and pattern together is important to identify hemodynamically of hemodynamically significant PDA.Öğe Noninvasive evaluation of cardiac autonomic modulation in children with primary Raynaud's phenomenon: a controlled study(SPRINGER LONDON LTD, 2014) Oflaz, Mehmet Burhan; Ece, Ibrahim; Kibar, Ayse Esin; Balli, Sevket; Alaygut, Demet; Guven, Ahmet Sami; Bolat, Fatih; Duksal, Fatma; Cevit, OmerThis study aimed to objectively evaluate autonomic nervous function in children with primary Raynaud's phenomenon (PRP). Thirty-two children with PRP and 30 healthy subjects were included in the study. We analyzed heart rate variability (HRV) in the time domain by the following six standard time-domain measures: standard deviation of all normal R-R intervals during 24 h (SDNN), standard deviation of all normal R-R intervals for all 5-min segments (SDNNi), standard deviation of the average normal R-R intervals for all 5-min segments (SDANN), root mean square of the successive normal R-R interval difference, percentage of successive normal R-R intervals longer than 50 ms, and triangular index (integral of the density distribution of NN intervals divided by the maximum of the density distribution). The mean heart rate throughout 24 h was significantly higher in the PRP group than in the control group (p = 0.001). Although heart rate during the activity period was not significantly different from that during the night period, it was higher in the PRP group than in the control group (p = 0.002). In children with PRP, HRV analysis showed significantly lower values of SDNN (p = 0.01), SDNNi (p = 0.005), SDANN (p = 0.02), and HRV triangular index (p = 0.02) compared with the control group. HRV analysis for sympathovagal balance demonstrated a preponderance for the sympathetic component in patients with PRP. We conclude that all time-domain parameters evaluated in HRV analysis are significantly lower in children with PRP than in healthy subjects.Öğe Rhythm and Conduction Analysis of Patients With Acute Rheumatic Fever(SPRINGER, 2013) Balli, Sevket; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Ece, IbrahimVarious rhythm and conduction abnormalities can develop in acute rheumatic fever. This study investigated rhythm and conduction abnormalities in children with acute rheumatic fever using a standard 12-lead electrocardiogram and 24-h rhythm Holter recordings. This multicenter retrospective study, performed between August 2011 and March 2012, enrolled 73 consecutive children with acute rheumatic fever. Standard electrocardiography was used to measure PR and corrected QT intervals. Holter recordings were evaluated for all the patients, and 52 of the patients (71.2 %) had carditis that was either isolated or together with other major criteria. A positive correlation was detected between carditis and the mean PR interval on standard electrocardiography, but this was not significant (p > 0.05). Standard electrocardiography showed a significant positive correlation between PR and corrected QT intervals (p = 0.03; r = 0.55). Standard electrocardiography showed only three patients (4.2 %) with premature contractions, whereas 24-h electrocardiography showed 26 patients (35.6 %) with premature contractions. Carditis was positively correlated with premature contractions (p < 0.01; r = 0.57). One patient with junctional rhythm and one patient with left bundle block were detected by standard electrocardiography. Whereas some patients with carditis exhibited no arrhythmic evidence on standard electrocardiograms, complete atrioventricular block, supraventricular tachycardia, and Mobitz type 1 block were observed on 24-h Holter recordings. A positive correlation also was observed between the presence of premature contractions and serum levels of acute-phase reactants (p = 0.03; r = 0.62). These findings led to the conclusion that rhythm and conduction disorders in acute rheumatic fever are more common than previously thought.Öğe The Effects of Pre-pregnancy Obesity on Fetal Cardiac Functions(Springer, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Kibar, Ayse Esin; Oflaz, Mehmet Burhan; Kurdoglu, MertihanObesity is a substantial public health problem with a rapidly increasing prevalence in numerous industrialized nations. The objective of this study was to evaluate the effects of maternal pre-pregnancy obesity on fetal cardiac functions. We studied 55 fetuses of obese mothers and 44 fetuses of healthy mothers at 26-38 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, gestational age, estimated birth weight, serum lipids, and systolic-diastolic blood pressure. Fetal heart rate, diameters of the aortic and pulmonary valve annulus, aortic and pulmonary peak systolic velocities, ventricular systolic function, and cardiothoracic ratio were similar in the two groups. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the obese mothers. In the interventricular septum, left ventricle posterior wall, and right ventricle free wall, the E (a) and A (a) were higher, and E (a)/A (a) ratios were significantly lower in the study group than in the control group. The E/E (a) ratio was higher in the obese group than in the control group. The isovolumic relaxation time and the right and left ventricle myocardial performance indices were higher in the fetuses of the obese mothers than in the fetuses of the healthy mothers. We believe that maternal obesity has an important influence on fetal cardiac diastolic functions.
