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Öğe Assessment of P-wave dispersion in children with atrial septal aneurysm(CAMBRIDGE UNIV PRESS, 2014) Arslan, Derya; Cimen, Derya; Guvenc, Osman; Oran, Bulent; Yilmaz, Fatma HilalBackground: This was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm. Methods: A total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 +/- 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 +/- 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio >= 25% was found on echocardiography. Results: There was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 +/- 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 +/- 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters. Conclusions: This study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.Öğe Beta-blocker treatment in an adolescent with amitriptyline intoxication(GALENOS YAYINCILIK, 2007) Baysal, Tamer; Oran, Buelent; Dogan, Mustafa; Cimen, Derya; Elmas, Sefika; Karaaslan, Sevim[Abstract not Available]Öğe Case Presentation: Approach To Acute Rheumatic Fever Patient With Hepatotoxicity Due To Acetylsalicylic Acid(GALENOS YAYINCILIK, 2017) Guvenc, Osman; Cimen, Derya; Aslan, Eyup; Emiroglu, Haldun; Arslan, Derya; Oran, BulentTreatment with acetylsalicylic acid is the first choice for arthritis and mild carditis of acute rheumatic fever which is a common disease in our country. There may be many adverse reactions during treatment. 10 year-old male patient diagnosed as acute rheumatic fever had hepatotoxicity due to acetylsalicylic acid therapy. This clinic manifestation has the possibility that can be seen always in pediatric cardiology practice. This case is presented due to limited literature on the treatment of patients with hepatotoxicity.Öğe Co-occurrence of Carpenter syndrome and double outlet right ventricle(TURKISH SOC CARDIOLOGY, 2017) Guvenc, Osman; Cimen, Derya; Arslan, Derya; Guler, IbrahimCarpenter syndrome (acrocephalopolysyndactyly type 2, OMIM 201000) is a rarely seen autosomal recessive disorder. In addition to abnormalities such as acrocephaly, craniosynostosis, facial asymmetry, polydactyly and syndactyly, obesity, hypogonadism, mental retardation, and corneal opacity, it may frequently be accompanied by congenital heart diseases such as ventricular septal defect, patent ductus arteriosus and pulmonary stenosis. Double outlet right ventricle is a defect in which both major arter-ies originate in the morphological right ventricle. To the best of our knowledge, this is the first report in the literature of double outlet right ventricle disease in combination with Carpenter syndrome.Öğe Coronary Arteriovenous Fistula in a Child Presenting with Chest Pain(DERMAN MEDICAL PUBL, 2016) Arslan, Derya; Cimen, Derya; Oran, Bulent; Aygul, NazifCoronary arteriovenous fistula is an incidental finding in 0.1% to 0.2% of coronary angiograms. A 15-year-old famale patient presented with a three years history of chest pain on exertion. Echocardiography was performed previously and a small muscular ventricular septal defect was detected. The electrocardiogram was normal sinus rhythm together with normal axis. On echocardiography, left ventricular function was normal and there was continuous flow into the right ventricle. Therefore, coronary angiography was performed for considering the coronary artery fistula. Coronary artery fistula was observed between the first septal perforating branch of the left anterior descending coronary artery with right ventricle. The patient's clinical follow-up was decided since a significant shunt could not be identified.Öğe The future of activity-promoting video games in clinical practice: Is it the ultimate exercise test in pre-pubertal children?(AVES PRESS LTD, 2015) Oran, Bulent; Akkurt, Alper; Arslan, Derya; Cimen, DeryaPaediatric exercise testing laboratories should accommodate subjects of various sizes and ages. To this day, games and conventional treadmill exercise tests have not been carried out in pre-pubertal children. Children cannot easily adapt to the treadmill or cycle ergometer. We therefore aim to the use of video games as a form of exercise tests in pre-pubertal children. Twenty healthy children (10 girls and 10 boys, aged 5-11 years old) were enrolled in the study. The physical examination, 12-lead electrocardiography and echocardiography were performed. The heart rate and respiratory rate were measured with systolic blood pressures. Treadmill exercise testing was performed, and electrocardiographic changes were studied during both the treadmill exercise test with Bruce protocol and an activity-promoting video game (Nintendo Wii Boxing), in different time periods. Exercises were stopped at the target heart rate.The mean duration of exercise was 15 minutes in both the Bruce protocol and the activity-promoting video game. Although the data of healthy children (including heart rate and blood pressure responses to exercise) were consistent with the results from several countries using the Bruce protocol, the mean maximal heart rates for all groups were slightly lower than those obtained with the video game. The data obtained from this new exercise test may be used to determine the diagnosis and activation of cardiovascular disease in pre-pubertal children. It can be used as an exercise test especially in young children who are unable to use the treadmill or cycle ergometerÖğe Growth-differentiation factor-15 and tissue doppler imaging in detection of asymptomatic anthracycline cardiomyopathy in childhood cancer survivors(PERGAMON-ELSEVIER SCIENCE LTD, 2013) Arslan, Derya; Cihan, Tugba; Kose, Dogan; Vatansev, Husamettin; Cimen, Derya; Koksal, Yavuz; Oran, BulentObjectives: Anthracyclines have led to an increased risk of cardiac morbidity and mortality. Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Tissue Doppler imaging (TDI) also has potential as a clinically useful technique for the assessment of myocardial function. Biochemical markers may be used to detect cardiac damage growth-differentiation factor-15 (GDF-15) and are emerging as a biomarker of cardiac dysfunction. The aim of this study is to assess the value of the plasma levels of GDF-15 and TDI in detecting late myocardial dysfunction in childhood cancer survivors (CCS) who were treated with anthracyclines. Design and methods: Thirty-eight CCS who had completed chemotherapy treatment with anthracyclines were included in this study. Control group consisted of 32 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. However, GDF-15 and cardiac troponin-I (cTnI) were measured. Results: Although, systolic function of the left ventricular was similar in all groups, there were significant differences between parameters of diastolic function of the heart. The mitral valve E wave, E/A ratio, left ventricular E'm wave, and E'm/A'm ratio were different in the patients than in the controls (p = 0.049, p = 0.037, p < 0.0001, p = 0.001, respectively). The tricuspid valve E/A ratio, right ventricular E't wave, and E't/A't ratio in the patients were also different from those of the controls (p = 0.031, p < 0.0001, p < 0.0001, respectively). Mean plasma GDF-15 was significantly higher in patients than healthy controls (p = 0.027). There were no significant differences in cTnI between both groups. Conclusions: Growth-differentiation factor-15 level may be used as a biomarker of anthracycline-induced cardiovascular disease severity in the CCS. (c) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.Öğe Heparin-Induced Thrombocytopenia Association with Impaired Liver Function Tests(DERMAN MEDICAL PUBL, 2016) Arslan, Derya; Guvenc, Osman; Cimen, Derya; Oran, BulentHeparin-induced thrombocytopenia is an intensely procoagulant disorder and carries significant morbidity and mortality. However, the elevations in serum aminotransferases are characteristically asymptomatic and reversible with treatment termination. The serious liver injury due to heparins has not been reported but liver function should be monitored closely since potential severe liver damage with hepatocyte necrosis can occur. In this case report, we present a one-year-old male patient who developed a left lower extremity arterial thrombosis following an pulmonary artery banding procedure. Our case was taking unfractionated heparin for anticoagulation. On the third day of heparin therapy, routine blood analysis revealed deranged hepatic function tests and thrombocytopenia. Unfractionated heparin treatment was discontinued and he was treated with therapeutic doses of low-molecular-weight heparin for arterial thrombosis. His platelet count and liver function tests had normalised 2 weeks later.Öğe Hypertrophic cardiomyopathy with Jeune syndrome: The first reported case(TURKISH SOC CARDIOLOGY, 2016) Guvenc, Osman; Uygun, Saime Sundus; Cimen, Derya; Aslan, Eyup; Annagur, AliJeune syndrome (Asphyxiating thoracic dysplasia) is a rare dystrophy of the skeleton, inherited as an autosomal recessive condition. Patients develop a narrowed thorax, rhizomelic dwarfism, and hepatic, renal, and pancreatic abnormalities. High rates of pulmonary hypoplasia and pulmonary hypertension have been reported. Some patients die in early stages of life due to respiratory failure. The case of a patient referred with a history of severe asphyxiating birth, who had been diagnosed with Jeune syndrome and later hypertrophic cardiomyopathy (HCM) upon echocardiographic examination is described in the present report. This rare disease is discussed with respect to the current literature, as the present is the first reported case to be accompanied by HCM.Öğe Left ventricular rhabdomyoma with severe left ventricular outflow tract obstruction(WILEY, 2007) Sarigul, Ali; Oezkara, Ahmet; Narin, Cueneyt; Cimen, Derya; Sarkular, Gamze; Sahsivar, Orkun; Toy, HaticeThe incidence of cardiac tumors increased with the improvement of imaging techniques in infants. Rhabdomyomas are the most common tumors in this group of patients. We herein report a 40-day-old male patient with left ventricular rhabdomyoma. The tumor caused syncope attack and supraventricular tachycardia. An emergency operation was planned and the life-threatening lesion was excised via left ventriculotomy. The patient was extubated on postoperative sixth hour and discharged from hospital on the sixth day of the postoperative period without any problem. This successful operation encourages us not to hesitate to perform an operation in newborns with cardiac neoplasms causing hemodynamic instability.Öğe Myocardial Ventricular Noncompaction: Recent Literature Due to its Rarity in Childhood(GALENOS YAYINCILIK, 2015) Guvenc, Osman; Cimen, Derya; Arslan, Derya; Sivri, Mesut; Koplay, Mustafa; Oran, BulentMyocardial noncompaction is a rare form of congenital cardiomyopathy. The disorder represents an arrest of normal embryogenesis of myocardium in utero. It is characterized by deep trabecular structures anatomically and deep intratrabecular recesses. Congestive heart failure, thromboembolism and cardiac arrhythmias are main clinical findings. On the other hand patients may be asymptomatic. We describe a case of myocardial noncompaction presenting with decreased exercise capacity in our clinic. We would like to remind this rare disorder and search recent literatures.Öğe N-terminal-pro brain natriuretic peptide levels in children with allergic rhinitis(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2016) Artac, Hasibe; Vatansev, Husamettin; Cimen, Derya; Arslan, Derya; Kaya, Fatma; Kayis, Seyit Ali; Oran, BulentBackground/aim: Persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). The aim of this study was to evaluate N-terminal pro brain natriuretic peptide (NT-proBNP) concentrations and PAP values in children with allergic rhinitis. Materials and methods: Sixty-six patients with allergic rhinitis and 22 healthy children were prospectively enrolled in this study. Plasma NT-proBNP levels were measured at first admission and after treatment. Simultaneously, echocardiography was done to assess pulmonary arterial hypertension, and rhinitis symptom scores were recorded. Results: The median age of the study group was 9.0 (5.0. 17.0) years; 26 were female. PAP was found to be normal in all the patients. There was a negative correlation between age and NT-proBNP levels (r = -0.452, P < 0.01). Nasal blockage levels affected NT-proBNP levels mildly (P = 0.067). No significant difference between before and after nasal steroid treatment was observed in NT-proBNP levels. Conclusion: These results suggest that NT-proBNP level and PAP may not be affected in children with allergic rhinitis, and primarily this influence may be associated with the severity of nasal obstruction.Öğe Normal M mode values in healthy Turkish children(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2014) Oran, Bulent; Bodur, Abdurrahman Said; Arslan, Derya; Cimen, Derya; Guvenc, OsmanAim: Evaluation of cardiac structures requires a large study group for accurate data on normal values. The aim of the study was to obtain normal M mode echocardiographic values in a substantial sample of healthy term neonates and children to develop centile charts. Materials and methods: Data were obtained over 2 years from a single center in Turkey, from 1200 healthy infants and children aged 1 day to 17 years. Using echocardiographic investigation, measurements were obtained of the following: left ventricular dimension at end diastole and end systole; thickness of interventricular septum and posterior wall of the left ventricle; aortic and pulmonary root diameter; and left atrial dimension. The influence of systematic errors as statistical noise in this large sample was decreased using third-degree polynomial curves. Results: Measurements are presented graphically as curved lines of centiles with respect to body weight for healthy term neonates and children. The values showed a good correlation with body weight and allowed the construction of percentile curves (5%, 25%, 50%, 75%, and 95%). Higher values were observed in boys during adolescence. Conclusion: The presented charts and tables make it possible to judge the echocardiographic measurements of a particular patient as normal or abnormal.Öğe P-wave duration and dispersion in children with uncomplicated familial Mediterranean fever(TAYLOR & FRANCIS LTD, 2013) Arslan, Derya; Oran, Bulent; Yazilitas, Fatma; Peru, Harun; Cimen, Derya; Vatansev, HusamettinObjectives This was a prospective controlled study to determine the P-wave duration (Pdu) and P-wave dispersion (Pd) in patients with familial Mediterranean fever (FMF). Methods The study group consisted of 26 children with uncomplicated FMF and 25 age-and sex-matched healthy controls. We performed electrocardiography (ECG) with Doppler echocardiography on patients and controls. All participants underwent 12-lead electrocardiography under strict standards. Pdu and Pd were computed from a randomly selected beat and from an averaged beat constructed from 12 beats, included in a 10-s ECG. Results The left ventricle (LV) dimensions, LV ejection fraction (LVEF), and LV fractional shortening (LVFS) values, left atrium dimension, and aortic dimension were in normal range in both groups. There were significant differences between the groups regarding LV-isovolumic relaxation time (IRT), LV-isovolumic contraction time (ICT), right ventricle (RV)-ICT, RV-IRT, and Pd (all p < 0.0001). However, highly significant positive correlation was detected between LV-ICT, LV-IRT, RV-ICT, RV-IVT, C-reactive protein (CRP), and Pd (r = 0.505, p < 0.0001; r = 0.483, p < 0.0001; r = 0.433, p = 0.001; r = 0.421, p = 0.001; r = 0.452, p = 0.001; r = 0.478, p < 0.0001, respectively). Conclusions Uncomplicated FMF children who are continuously treated with colchicine and do not develop amyloidosis have abnormal atrial dispersion and therefore seemingly have an increased electrocardiographic risk of atrial fibrillation.Öğe Platelet Distribution Width and Mean Platelet Volume in Children With Pulmonary Arterial Hypertension Secondary to Congenital Heart Disease With Left-to-Right Shunt: New Indices of Severity?(SPRINGER, 2013) Arslan, Derya; Cimen, Derya; Guvenc, Osman; Kaya, Fatma; Sert, Ahmet; Oran, BulentThe majority of patients with congenital heart disease (CHD), particularly those with relevant systemic-to-pulmonary shunts, if left untreated, will experience the development of pulmonary arterial hypertension (PAH). Previous studies have shown that platelet activation occurs in patients with PAH. In response, this study aimed to investigate the platelet indices, including platelet distribution width (PDW) and mean platelet volume (MPV), in patients with PAH. The study was conducted in the pediatrics cardiology unit of Selcuk University Medical Faculty between July 2010 and January 2012. The patients' clinical and laboratory data were obtained retrospectively from hospital recordings. The study enrolled 57 children with CHD (all with left-to-right shunting). The patients who had undergone diagnostic cardiac catheterization were analyzed according to the presence or absence of PAH. Group 1 had CHD with PAH, and group 2 had CHD without PAH. Compared with the group 2 patients, a significant decrease in PDW (p < 0.0001) was noted in the group 1 patients (with PAH). Likewise, a significant difference was found in the MPV of group 1 (p < 0.0001). Statistically, groups 1 and 2 did not differ in terms of platelet count (p = 0.3). Patients who had pulmonary hypertension secondary to CHD with left-to-right shunting exhibited a lower PDW and MPV.Öğe Prolonged QT Dispersion in the Infants of Diabetic Mothers(SPRINGER, 2014) Arslan, Derya; Guvenc, Osman; Cimen, Derya; Ulu, Havva; Oran, BulentMyocardial hypertrophy and cardiac dysfunction frequently occur in newborns of diabetic mothers. The authors hypothesized that wall hypertrophy or disproportionate left ventricular wall thickness in newborns of diabetic mothers may affect both QT and QTc dispersion. This study aimed to assess whether left ventricular hypertrophy affects the QT variables of infants born to diabetic mothers. This prospective cross-sectional study was conducted with 47 consecutively selected neonates of gestational diabetic mothers and 30 healthy neonates born to healthy mothers. All the subjects were evaluated during the neonatal period. Electrocardiography with echocardiography was performed for the patients and the control subjects. The newborns of the diabetic mothers were classified according to septal thickness as group 1 (16 newborns with septal hypertrophy) or group 2 (31 newborns without septal hypertrophy). The study group consisted of three cohorts: groups 1, 2, and 3 (control group). Both QT and QTc dispersion were computed from a randomly selected beat as well as from an average beat derived from 12 beats included in a 10-s electrocardiography. A total of 16 infants (34 %) had a septal thickness of 6 mm or greater. The left ventricular end-systolic diameter in group 1 was smaller (p = 0.0029) than in groups 2 and 3 (p = 0.003). The interventricular septal thickness at end diastole (IVSTd) and the left ventricular posterior wall thickness at end diastole in group 1 were higher than in of groups 2 and 3. The QT and QTc dispersion intervals were longer in group 1 than in groups 2 and 3 (p < 0.001), and a highly significant positive correlation was detected between IVSTd and QT dispersion (r = 0.514, p = 0.042). Elevated QT and QTc dispersions may be risk factors for the development of arrhythmias in newborns of diabetic mothers. These patients may critically need systematic cardiac screening.Öğe Release of NT-pro brain natriuretic peptide in children before and after adenotonsillectomy(ELSEVIER IRELAND LTD, 2013) Oran, Bulent; Ozturk, Kayhan; Cimen, Derya; Vatansev, Husamettin; Bulut, Serap; Arslan, DeryaObjectives: To measure serum B-type natriuretic peptide, especially N-terminal segment of its prohormone (NT-proBNP) and pulmonary arterial pressure levels and to determine whether NT-proBNP concentrations correlate with pulmonary arterial pressure levels in children before and after adenotonsillectomy. Methods: Twenty children with adenoid and tonsil hypertrophy and 20 healthy subjects were included in the study. Transthoracic echocardiography was performed in all patients to assess pulmonary artery systolic and diastolic pressure with cardiac dysfunction. The NT-proBNP was analyzed for correlation with pulmonary artery pressure. Results: Our results showed that prohormone serum concentrations and pulmonary arterial pressures were significantly higher in the study group than in the control group at the preoperative evaluation. A significant decrease was detected among patients after surgery (p < 0.05). There was no significant difference between the study and control groups for prohormone serum concentration and pulmonary arterial pressure at the postoperative evaluation (p > 0.05). Conclusion: We found increased serum prohormone levels and height pulmonary artery pressures in the children with adenoid and tonsil hypertrophy when comparing with healthy subjects. Our study supported that increased serum prohormone levels and pulmonary artery pressures as a result of adenoid and tonsil hypertrophy are reversible. Pediatric cardiologs and otolaryngologs should keep in mind an increased pulmonary artery pressure during management of children with adenoid and tonsil hypertrophy. Furthermore, Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of surgical outcome of children with adenoid and tonsil hypertrophy. (C) 2013 Elsevier Ireland Ltd. All rights reserved.Öğe Serum Asymmetric Dimethylarginine Levels in Patients with Acute Rheumatic Fever(GEORG THIEME VERLAG KG, 2015) Sert, Ahmet; Cimen, Derya; Arslan, Derya; Aypar, Ebru; Vatansev, Husamettin; Kaya, Fatma; Kilicaslan, CengizhanAsymmetric dimethylarginine (ADMA) is an analogue of L-arginine, a naturally occurring product of metabolism found in human circulation. It is an endogenous inhibitor of nitric oxide production. Acute rheumatic fever (ARF) is a delayed immunologically mediated autoimmune sequel of throat infection by group A beta-hemolytic streptococci. As serum ADMA levels have not previously been assessed in patients with ARF, we aimed to investigate ADMA levels in patients with ARF during the acute stage and after anti-inflammatory treatment and compared results with healthy control subjects. The study population consisted of 34 children with ARF (30 patients with carditis and 4 patients without carditis) and 31 healthy control subjects. Erythrocyte sedimentation rate and C-reactive protein values were significantly higher and serum ADMA values were lower, but not statistically significant in patients with ARF during the acute stage when compared with controls. Serum C-reactive protein and erythrocyte sedimentation rate values were significantly decreased in patients with ARF after the treatment when compared with baseline and ADMA levels were increased after the treatment compared with baseline, but this change was not statistically significant. Our study has demonstrated that resolution of acute inflammation in patients with ARF may lead to a mild increase in serum concentration of ADMA. Comprehensive prospective and observational studies are required to confirm our findings and to assess potential interactions between ARF and ADMA levels.Öğe An Unusual Presentation of Acute Rheumatic Fever(MODESTUM LTD, 2015) Arslan, Derya; Guvenc, Osman; Cimen, Derya; Oran, BulentAcute rheumatic fever (ARF) is a multisystem disease caused by an immunological response to group A streptococcus infection. Its sequel rheumatic heart disease continue to cause a large burden of morbidity and mortality in developing countries. Early detection of ARF is paramount to the prevention of rheumatic heart disease. We report a case of ARF with presenting epistaxis. The variety of clinical manifestations, which may be the presenting signs and symptoms of ARF, are not included in the updated-revised Jones criteria. Therefore, a careful examination and awareness of the disease can play an important role in identifying ARF.Öğe The usefulness of plasma asymmetric dimethylarginine (ADMA) levels and tissue doppler echocardiography for heart function in term infants born to mothers with gestational diabetes mellitus(TAYLOR & FRANCIS LTD, 2013) Arslan, Derya; Oran, Bulent; Vatansev, Husamettin; Cimen, Derya; Guvenc, OsmanObjective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes. Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group (n=25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured. Results: In the first analysis, 10 patients (40%) had a septal thickness of 6mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness >= 6mm and the group with <6 mm. Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn.
