Pulmonary Toxicity Secondary to Amiodarone Use

Amiodarone is an antiarrhythmic medication used for the treatment of ventricular tachycardia. In addition to unwanted effects in many tissues, one of the most important side effects of the drug is pulmonary toxicity. Toxicity may develop at any time after administration to the drug, and the risk increases depending on the dose and duration of the treatment. Clinical and laboratory findings are non-specific. In treatment, amiodarone is discontinued. In severe cases, corticosteroid therapy can be started. Here, we present the case of a patient who was followed up for two years for hypertrophic cardiomyopathy and presented to the pediatric emergency department with hemoptysis, dizziness clouding of consciousness and numb tongue. Amiodarone was used for two years to treat ventricular arrhythmia. The findings of the patient at presentation were thought to be due to amiodarone pulmonary toxicity. Amiodarone was stopped and corticosteroid therapy was initiated. Non-invasive mechanical ventilation was applied for 3 days. On the 8th day of hospitalization, the patient was transferred to the ward. The aim of this case report was to draw attention to pulmonary toxicity due to amiodarone administration

Comparison of transcatheter atrial septal defect closure in children, adolescents and adults: Differences, challenges and short-, mid- and long-term results

WOS: 000387737700017PubMed ID: 27826346Background and Objectives: This study aims to compare the characteristics, effectiveness and results of transcatheter closure of atrial septal defect between children, adolescents, and adults. Subjects and Methods: In this study, 683 patients who underwent atrial septal defect closure in the last 10 years were divided into three groups: children (age 16) as group 1, group 2 and group 3, respectively. Results: The average defect size and incidence of complex atrial septal defect were higher in group 3 (p=0.0001 and 0.03 respectively). While the average size of the devic was higher in adults (22.6 +/- 6.4 mm vs. 18.5 +/- 4.9 mm; p=0.0001), the ratio of the device size/total septum was higher in both children and adolescents (Group 1 and 2). In the child and adolescent groups and patients with only complex atrial septal defect, the use of techniques, other than standard deployment, was similar in all three groups (p=0.86 and 0.41, respectively). The ratio of the residual shunt was similar in all three groups. Major complications were seen in 5 cases (4 cases with migration, and 1 case with dislocation) in group 3 and 1 case (migration) in group 1. Conclusion: Depending on the complexity of the defect and age of the patient, transcatheter closure of atrial septal defect might have certain difficulties and complications. Patients must be evaluated in detail to avoid major complications and possible problems during the procedure

Flow reduction of a neonatal stented arterial duct by covered coronary stent

The final flow rate through a stented duct is variable and depends on stent diameter, ductal length, and ductal tissue protrusion after ductal constriction. Typically after duct stenting, there is initially mild overperfusion which may require some antifailure treatment. Severe heart failure is uncommon, but in some cases flow reduction is required. We present a case of overperfusion after arterial duct stent implantation which was successfully managed with implantation of covered stents. © 2015 Wiley Periodicals, Inc.status: publishe

Short-Term Outcomes of Patent Ductus Arteriosus Closure With New Occlutech (R) Duct Occluder: A Multicenter Study

WOS: 000384919800011PubMed ID: 27090770Aim: Over the past 2 decades, transcatheter occlusion of patent ductus arteriosus (PDA) with coils and the duct occluders evolved to be the procedure of choice. A new device, the Occlutech PDA1 occluder (ODO) device has been designed. Herein, we aimed to evaluate the characteristics and short-term results of patients who underwent transcatheter closure of PDA using the ODO. Methods: We reviewed the clinical records of 60 patients from different centers in Turkey between December 2013 and January 2016. The medical records were reviewed for demographic characteristics and echocardiographic findings. Device size was selected on the narrowest diameter of PDA. Results: The median patient age was 2.5 years (6 months-35 years), and median PDA diameter was 2.5mm (1.2-11 mm). Fifty-eight of 60 patients (96.6%) had successful ODO implantation. The occlusion rates were 37/58 (63.7%) at the end of the procedure, 51/58 (87.9%) at 24-48 hours post-procedure, and 57/58 (98.2%) on echocardiography at a median follow-up of 7.6 months. Conclusion: Our results indicate that transcatheter closure of PDA using the ODO is effective. Larger studies and longer follow-up are required to assess whether its shape and longer length make it superior to other duct occluders in large, tubular, or window-type ducts

Comparison Of Pro-BNP Levels And Myocardial Performance Index Before And After Iron Treatment In Children With Congenital Cyanotic Heart Disease With Iron Deficiency Anemia

Introduction: Our aim was to compare NT-proBNP levels and cardiac functions after iron therapy in children with congenital cyanotic heart disease who had iron deficiency anemia.Materials and Methods: We included 40 children with pre-established cyanotic congenital heart disease and accompanying iron deficiency anemia, between the age of 6 months and 17 years, who were admitted to the outpatient clinic of Çukurova University Faculty of Medicine, Department of Pediatric Cardiology between September 2015 and March 2016. We recorded demographic data and performed following investigations: complete blood count, peripheral blood smear, reticulocyte count, measurement of serum iron levels, total iron-binding capacity, ferritin levels, transferrin saturation and NT-proBNP levels, and echocardiographic examination.Results: There was a statistically significant increase in following laboratory parameters after iron therapy: hemoglobin, hematocrit, MCV, MCHC, serum iron and ferritin, transferrin saturation and oxygen saturation. During the follow-up period, RDW and NT-proBNP levels were significantly decreased. In left ventricular tissue doppler; there was a significant difference in MPI measurements before and after treatment. There was no significant difference in other echocardiography findings. Conclusion: Iron therapy has improved cardiac functions in children with cyanotic congenital heart disease, and NT-proBNP levels can be used to evaluate the efficacy of treatment in the follow-up period

Scimitar syndrome: different clinical presentations and results

Amaç: Bu çalışmada Scimitar sendromu tanısı konulmuş hastalar değerlendirildi.Ça­lış­ma­pla­nı:­Çalışmaya Ocak 2003 - Aralık 2011 tarihleri arasında kliniğimizde Scimitar sendromu tanısı konulmuş ortalama ağırlıkları 16.7±21.8 kg olan, 12 hasta (8 kız, 4 erkek; ort. yaş 4.0±4.8 yıl; dağılım 1 ay - 16 yıl), alındı. Hastaların klinik bulguları, fizik muayene, telekardiyografi, ekokardiyografi, kalp kateterizasyonu ve cerahi bulguları ve izlem verileri geriye dönük olarak gözden geçirildi.Bul gu lar: On iki hastadan beşi (%42) infantil tip ve yedisi (%58) çocuk/erişkin tip Scimitar sendromu olarak değerlendirildi. İnfantil tipteki hastaların tümünde taşipne ve kalp yetersizliği bulguları varken, çocuk/erişkin tipteki hastaların birinde tekrarlayan alt solunum yolu enfeksiyonu öyküsü vardı. Ek kardiyak defektler hastaların yedisinde atriyal septal defekt, birinde aort koarktasyonu, ikisinde patent duktus arteriyozus ve birinde ventriküler septal defekt ile pulmoner atrezi idi. Bir hastada iki taraflı Scimitar sendromu vardı. İnfantil Scimitar sendromlu hastaların tümü şiddetli pulmoner hipertansiyonlu iken, çocuk/erişkin tipteki hastalardan biri hafif pulmoner hipertansiyonlu idi. Aortopulmoner kollateral arter saptanan dokuz hastadan altısında arter transkateter yolla kapatıldı. On hastaya (%83) cerrahi girişim uygulandı. İnfantil Scimitar sendromlu bir hasta ameliyat sonrası erken dönemde, ameliyat edilmeyen iki taraflı Scimitar sendromlu diğer bir hasta ise takipte akciğer enfeksiyonu nedeniyle kaybedildi.So nuç: Scimitar sendromu farklı klinik tablolarla seyredebilen nadir bir sendromdur. Çocuk/erişkin tip hastalığı olan hastalar sıklıkla asemptomatiktir; ancak tekrarlayan akciğer enfeksiyonları da izlenebilir. Aortopulmoner kollateral oklüzyon semptomatik iyileşme sağlayabilse de özellikle Scimitar veni tıkanmış ve ilave kardiyak anomalisi bulunan hastalarda cerrahi gerekir.Background: This study aims to evaluate patients diagnosed with Scimitar syndrome. Methods: Twelve patients (8 girls, 4 boys; mean age: 4.0±4.8 years; range 1 month to 16 years) with a mean weight of 16.7±21.8 kg who were diagnosed with Scimitar syndrome in our clinic between January 2003 and December 2011 were included. Clinical findings of the patients, physical examination, telecardiography, echocardiography, cardiac catheterization, and surgical findings and follow-up data were retrospectively reviewed. Results: Of 12 patients, five (42%) were considered with infantile type and seven (58%) with child/adult type Scimitar syndrome. All patients of infantile type presented with tachypnea and cardiac failure findings, while one patient with child/adult type had a history of recurrent lower respiratory tract infection. Additional cardiac defects were atrial septal defect in seven, coarctation in one, patent ductus arteriosus in two, and ventricular septal defect with pulmonary atresia in one patient. Bilateral Scimitary syndrome was present in one patient. All infantile type patients had severe pulmonary hypertension, while only one of the child/adult type patients had mild pulmonary hypertension. Six of nine patients with aortopulmonary collateral artery underwent transcatheter closure of the artery. Surgery was performed in 10 patients (83%). One patient with infantile type in the early postoperative period and another patient with bilateral Scimitar syndrome who was not operated during follow-up died due to pulmonary infection. Conclusion: Scimitar syndrome is a rare syndrome which may present with different clinical presentations. Patients with child/ adult type disease are often asymptomatic, however, may present with recurrent pulmonary infections. Although aortopulmonary collateral occlusion may provide symptomatic relief, surgery is indicated in patients with obstructed Scimitar vein and additional cardiac anomalies, in particular

Diagnosis, Treatment and Outcomes of Patients with Aortopulmonary Window

Background: Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. Aims: To present our experience with the diagnosis and outcome of APW cases. Study Design: Retrospective cohort study. Methods: Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. Results: Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. Conclusion: In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect

Konjenital midaortik sendromlu bir bebek

Midaortic syndrome is an uncommon disease characterized by segmental or diffuse narrowing of abdominal or distal descending thorasic aorta. Majority of the cases are idiopathic but some are secondary to fibromuscular dysplasia, giant cell arteritis, Moyamoya disease or genetic diseases such as neurofibromatosis, Williams’ syndrome and Alagille syndrome. It is very rare in newborn period. Here we present a 40 days old infant who admitted to hospital for respiratory distress, hypertension, heart failure and was diagnosed as midaortic syndrome. She had medical treatment but unfortunately died due to heart failure when she was two months old age.Midaortik sendrom nadir bir hastalık olup abdominal veya distal inen aortanın segmental veya difüz darlığı ile karakterizedir. Olguların çoğu idiyopatik olmakla birlikte bir kısmı da fibromüsküler displazi, dev hücreli aterit, Moyamoya hastalığı veya nörofibramatozis, Williams’ sendromu ve Alagille sendromu gibi genetik hastalıklara ikincildir. Burada 40 günlük iken hastaneye solunum sıkıntısı, kalp yetmezliği tablosunda başvuran ve midaortik sendrom tanısı alan bir olgu sunulmuştur. Olguda medikal tedavi tercih edilmiş ancak bebek iki aylık iken eksitus olmuştur

A comparative study of Cardi-O-Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects

Aim: We sought to investigate the safety and efficacy of Cardio-O-Fix septal occluder (CSO) in percutaneous closure of atrial septal defects (ASD) as compared to the Amplatzer septal occluder (ASO). Methods: A consecutive of 351 patients received transcatheter ASD closure with CSO or ASO from July 2004 to October 2010 were studied. The ASDs were divided into simple- (isolated defects Aim: We sought to investigate the safety and efficacy of Cardio-O-Fix septal occluder (CSO) in percutaneous closure of atrial septal defects (ASD) as compared to the Amplatzer septal occluder (ASO). Methods: A consecutive of 351 patients received transcatheter ASD closure with CSO or ASO from July 2004 to October 2010 were studied. The ASDs were divided into simple- (isolated defects &nbsp; &lt;26 mm) or complex-types (isolated defect 26 mm, double or multifenestrated defects). The procedures were guided by fluoroscopy and transthoracic or transesophageal echocardiography. Clinical and echocardiographic follow- ups were arranged before discharge, at 1 month and then every 6-month after implantation. Results: During the study period, 185 (125 males, aged 18.5 &nbsp; 6 15.6 years) and 166 (103 males, aged 21.0 &nbsp; 6 15.7 years) patients attempted CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions (17 vs. 16%, &nbsp; P 5 0.796), procedural times and success rates (97% vs. 96%, P 5 0.635) as compared to the ASO group. Acute residual shunts were less prevalent in CSO than ASO group and most shunts closed spontaneously at 6-month follow-ups. The average equipment cost per patient was lower in CSO group (US$4,100 vs. US$ 5,900, &nbsp; P &lt; 0.001). The prevalence of device embolization and atrial arrhythmia (all &nbsp; &lt;2%) were similar in both patient groups. Conclusion: Transcatheter ASD occlusion with CSO is safe and effective and it appeared to be an attractive alternative to ASO in closing simple-type ASD because of its relatively low cost.</p

Clinical features and echocardiographic findings of isolated foramen ovale restriction in foetuses

Isolated restrictive foramen ovale (rFO) without complex heart defects is a rare pathology. There may be difficulties in managing this situation, which can lead to right heart enlargement, tricuspid regurgitation and hydrops findings in the foetus. We conducted a retrospective analysis of 8451 foetuses. 7883 (93.2%) had a structurally normal heart or minor heart disease, 18 (0.22%) of which had a diagnosis of isolated rFO. Nine patients with neonatal echocardiographic examination were included in the study. In 8 (88.8%) patients, it was stated that a decision to give birth should be made at the time of presentation. Evaluating postpartum echocardiographic examinations, 7 (77.7%) patients had normal or minor defects. The decision of delivery made at the right time during follow-up is critical to determine the prognosis.IMPACT STATEMENT What is already known on this subject? The data about the prenatal diagnosis of isolated rFO is limited. What the results of this study add? We conducted a retrospective analysis of 8451 foetuses. 7883 (93.2%) foetuses had a structurally normal heart or minor heart disease, 18 (0.22%) of which had a diagnosis of rFO. Nıne patients with foetal and postnatal follow-up and echocardiographic findings were examined in the study. The group's median gestational age at admission was 35.0 weeks (range: 27.0–39.0 weeks). The delivery decision was made in 8 (88.8%) patients at the time of admission. Evaluating postpartum echocardiographic examinations, 7 (77.7%) patients had normal or minor defects. Additionally, one patient was diagnosed with cardiomyopathy, and the other patient was diagnosed with functional pulmonary atresia. No death occurred in any foetus during follow-up. What the implications are of these findings for clinical practice and/or further research? Isolated rFO, a rare condition in the foetus, is generally well-tolerated in foetal life. However, the right heart enlargement, tricuspid regurgitation, or hydrops findings can be seen in patients. The decision of delivery made at the right time during follow-up is critical to determine the prognosis