Coming from behind to win - A Qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services

Reference values for echocardiographic measurements of healthy newborns

Objective: To assess the reference values of M-mode echocardiographic measurements in healthy newborns according to body weight. Methods: From January, 2008 to June, 2008, a total of 250 - 130 female and 120 male - term healthy newborns were included in the study. M-mode echocardiographic measurements were recorded by a paediatric cardiologist in accordance with the American Society of Echocardiography recommendations. Right ventricular anterior wall end-diastolic thickness, right ventricular end-diastolic diameter, interventricular septum end-diastolic thickness, left ventricular end-diastolic diameter, left ventricular posterior wall end-diastolic thickness, interventricular septum end-systolic thickness, left ventricular end-systolic diameter, left ventricular posterior wall end-systolic thickness, aortic root dimension, left atrium dimension, left ventricular ejection, and shortening fraction were measured. Results: The values of echocardiographic measurements revealed a good correlation with body weight. When body weight increased, the measured values also increased in parallel. The measured values were not influenced by gender. Ejection and shortening fraction parameters did not change with body weight and gender. Conclusion: In this study, normative values related to body weight for cardiac chambers and wall thickness were determined in healthy newborns. These reference values can be used to evaluate whether newborns have normal or abnormal echocardiographic measurement

Relationships between Left Heart Chamber Dilatation on Echocardiography and Left-to-Right Ventricle Shunting Quantified by Cardiac Catheterization in Children with Ventricular Septal Defects

Left atrium and/or left ventricle dilatation on echocardiography is considered to be an indication for closure of ventricular septal defects (VSD). No study has addressed the accuracy of using dilated left heart chambers when defining significant left-to-right shunting quantified by cardiac catheterization in isolated small or moderate VSDs. In this study, the relation between dilated left heart chambers, measured by echocardiography, and left-to-right ventricle shunting, quantified by cardiac catheterization, was evaluated in patients with isolated VSD. The medical records of all patients with isolated VSD who had undergone catheterization from 1996 to 2010 were examined retrospectively. Normative data for left heart chambers adjusted for body weight (BW) and body surface area (BSA) were used. The pulmonary-to-systemic flow ratio (Qp:Qs) was calculated by an oximetry technique. A total of 115 patients (mean age 7.3 +/- A 5 years) fulfilled the inclusion criteria. There was a statistically significant difference in terms of Qp:Qs between the patient groups with normal and dilated left heart chambers, when adjusted for BW and BSA (p = 0.001 and p = 0.002, respectively). But the relationships between Qp:Qs and left heart chamber sizes on echocardiography were not strong enough to be useful for making surgical decisions, as left heart chamber dilatation was not significantly associated with Qp:Qs a parts per thousand yen 2 (p = 0.349 when adjusted for BW, p = 0.107 when adjusted for BSA). Left heart chamber dilatation was significantly associated with Qp:Qs a parts per thousand yen 1.5 only when it was adjusted for BSA (for BW p = 0.022, for BSA p = 0.006). As a result, left heart chamber dilatation measured by echocardiography does not show significant left-to-right ventricle shunting, as quantified by catheterization. We still advocate that catheter angiography should be undertaken when left heart chambers are dilated in echocardiography in order to make decisions about closing small- to moderate-sized VSD

Voriconazole Induced Bradycardia

Voriconazole is a triazole antifungal drug that is used to treat invasive fungal infections, especially aspergillus. Here, we report two children who had severe bradycardia associated with voriconazole at a dose of 12 mg/kg per day. Bradycardia resolved in 24 hours in both after decreasing the dose to 10 mg/kg per day. Heart rates were in normal limits on follow-up. Bradycardia may be a side effect of voriconazole treatment in children under immunosuppressive treatment. Heart rate should be monitored in patients receiving voriconazole and other triazole treatments