Prevalence of allergic rhinitis and risk factors in school children

Objective: To evaluate the prevalence and the risk factors of allergic rhinitis in a particular area. Methods: The main study group consisted of all school children in Kemalpasa district aged 13-14 years. Children with current rhinitis based on responses given in ISAAC questionnaire survey were further evaluated for confirmation. Parents responded to a more detailed questionnaire about allergic diseases and risk factors. Then peak nasal inspiratory flow (PNIF) was evaluated to objectively assess nasal patency. Skin-prick test was performed for ten common allergens. Results: The questionnaire was answered by 90.8% (1373) of children. The prevalence of physician-diagnosed AR was 11.1%. Current rhinitis was found to be 31.3%. Of this group, 55.0% were admitted for the parent questionnaire and tests. Precisely, 90.3% of children accepted PNIF evaluation, and %10.1 of them had a nasal obstruction. Skin-prick tests revealed allergy for at least 1 allergen in 16.6% of children. The present study showed that the children with maternal allergic rhinitis history had 2,18 fold, and the children with seasonal allergic rhinitis had 2,11 fold higher possibility of sensitization to an allergen. The probability of perennial allergic rhinitis was 3,1 fold higher in the children who had siblings with allergic rhinitis. Conclusion: We included all children in a specific age group living in an area in our survey. As well as we found the prevalence of current rhinitis with the ISAAC questionnaire; we also evaluated peak nasal inspiratory flow and used skin-prick tests that yielded objective results

Percutaneous closure of large VSD using a home-made fenestrated atrial septal occluder in 18-year-old with pulmonary hypertension

Background: Hemodynamically significant muscular ventricular septal defects in children after the infantile period are a rare occurrence and ideal for transcatheter closure. In cases of severe concomitant pulmonary hypertension, it may be necessary to fenestrate the device. In this report, we present an 18-year old patient with a large mid-trabecular ventricular septal defect and severe pulmonary hypertension that underwent percutaneous closure of the defect with a home-made fenestrated atrial septal occluder.Case presentation: An 18-year-old female patient referred to us with complaints of dyspnea (NYHA score of 2-3). Physical examination revealed an apical rumble and a harsh second heart sound. Echocardiographic examination revealed a large mid-trabecular ventricular septal defect with bidirectional shunt and the widest diameter measuring 22 mm on 2D echocardiography. Left and right heart cavities were enlarged. Before and after the vasoreactivity test performed during cardiac catheterization, average aortic pressure was 65 › 86 mmHg, average pulmonary artery pressure: 58 › 73 mmHg, Qp/Qs: 1.6 › 3.2, PVR: 4.6 › 4.3 Wood/U/m2 and PVR/SVR: 0.5 › 0.2. On left-ventricular angiocardiogram, the largest end-diastolic defect diameter was 21 mm. The closure procedure was performed with transthoracic echocardiographic guidance, using a 24 mm Cera septal occluder and a 14 F sheath dilator to make a 4.5-5 mm opening. Measured immediately after the procedure and during cardiac catheterization one month later, average aortic pressure was 75 › 75 mmHg, average pulmonary artery pressure: 66 › 30 mmHg, Qp/Qs 1.5 › 1.4, PVR: 4.4 › 2.9 Wood/U/m2 and PVR/SVR: 0.4 › 0.2. Transthoracic echocardiographic examination performed 24 hours after the procedure showed a max 35-40 mmHg gradient between the left and right ventricles through the fenestration. After the procedure, we observed sporadic early ventricular systoles and a nodal rhythm disorder that started after approximately 12 hours and spontaneously reverted to normal 9 days later.Conclusion: In patients with large ventricular septal defects, large atrial septal occluders may be used. In cases with risk of pulmonary vascular disease, a safer option would be to close the defect using a manually fenestrated device

Tanı konulamamış nadir bir koroner anomali: Sağ pulmoner arterden çıkan sirkumfleks arter

Anomalous origin of the circumflex coronary artery from the pulmonary artery is a rare congenital cor- onary anomaly. While it generally follows an asymptom- atic course, if undiagnosed it may lead to severe clinical outcomes, including sudden death. The condition can be masked by associated defects, so when it is clinically sus- pected, diagnosis must be confirmed by conventional and/ or magnetic resonance angiography, even if echocardiog- raphy clearly shows coronary roots. This report describes a patient who underwent neonatal surgery for aortic coarcta- tion and was diagnosed with coronary artery anomaly at 15 months old.Sirkumfleks koroner arterin pulmoner arterden köken alması nadir görülen bir doğumsal koroner arter çıkış ano- malisidir. Genellikle semptomsuz seyretmekle birlikte tanı konulamaması durumunda nadiren ciddi klinik bulgulara ve hatta ani ölüme yol açabilir. Tanı koydurucu bulgular eşlik eden lezyonlar nedeni ile maskelenebileceğinden ekokardi- yografik değerlendirmede koroner kökler net izlense de kli- nik şüphe varlığında anjiyografi ve/veya manyetik rezonans anjiyografi ile tanı kesinleştirilmelidir. Bu yazıda, yenidoğan döneminde aort koarktasyonu nedeni ile ameliyat edilen ve takiplerinde 15 aylık iken koroner arter çıkış anomalisi tanısı konulan olguyu sunuyoruz

Comparison of 6-mm versus 8-mm-tip cryoablation catheter for the treatment of atrioventricular nodal reentrant tachycardia in children: A prospective study

WOS: 000405798800018PubMed ID: 28612086Due to its safety profile, cryoablation (Cryo) for atrioventricular nodal reentrant tachycardia (AVNRT) is more commonly preferred over radiofrequency (RF) ablation in children in recent years. Recent studies demonstrated high long-term success rates comparable to radiofrequency ablation. The aim of this prospective study was to compare the efficacy and safety of an 8-mm-tip versus 6-mm-tip Cryo catheter in the treatment of AVNRT in children. A total of 125 consecutive patients over 10 years of age with AVNRT were included. EnSite system (St. JudeMedical, St Paul, MN, USA) was used to reduce or eliminate fluoroscopy. The acute procedural success was 100% in both groups. The prodecure duration for the 8-mm-tip group was shorter (151.6 +/- 63.2 vs. 126.6 +/- 36.7 min, p < 0.01, respectively). Fluoroscopy was used in only 7 patients. The mean follow-up duration was 14.6 +/- 8.4 months (median 13.5 months, min. 3 months and max. 27 months). The recurrence rate for AVNRT was also comparable between the two groups (6-mm tip: 9.6 vs. 8-mm tip: 8%). Cryo of AVNRT is a safe and effective procedure with comparable acute and mid-term follow-up success rates using 6-mm and 8-mm-tip catheters in children. In addition, procedure duration is shorter with an 8-mm-tip Cryo catheter

The use of Chronic Total Occlusion (CTO) wires for perforation of atretic pulmonary valve; two centers experience

Pulmonary valve atresia with intact ventricular septum (PA-IVS) can be treated either surgically or transcatheterly for eligible patients. Perforation of pulmonary valves using chronic total occlusion (CTO) guidewires has been reported as an alternative to radiofrequency (RF) perforation. We sought to report our experience with CTO guidewires for perforation of atretic pulmonary valves and subsequent balloon dilatation (with or without patent ductus arteriosus stenting) in patients with PA-IVS from two centers. A retrospective study was carried out on PA-IVS patients who underwent intervention between March 2014 and September 2019, in which CTO guidewire was employed for pulmonary valve perforation. A total of 26 patients were identified. The median age and weight of the patients were 5.2 days (range 1-21 days) and 3.1 kg (range 2.2-3.8 kg), respectively. All patients were situs solitus, except one patient with left atrial isomerism. The right ventricle (RV) morphology was bipartite in 22/26 patients and tripartite in 4/26 patients. Before the procedure, the mean saturation was 76% (range 70-86%) while the patients were under prostaglandin infusion. The pulmonary valve perforation attempt was performed with the Asahi Conquest Pro 9 CTO wire (n = 6) or Asahi Pro 12 CTO wire (n = 18) and/or Asahi Miracle CTO wire (n = 2). The procedure was successful in 20/26 (77%) patients using CTO wires. We analyzed the efficiency of CTO wire based on the subtypes: Conquest Pro 9 in 6/6 (100%) patients, Conquest Pro 12 in 12/18 (67%) patients, and Miracle in 2/2 (100%) patients. Before CTO wire usage in 3 patients, radiofrequency (RF) perforation was unsuccessful. Among these 3 patients, pulmonary valve perforation was successful in 2 patients with CTO wire; hence, in the remaining patient, perforation was also unsuccessful with CTO wire. After CTO wire perforation was unsuccessful in 6 patients, RF perforation was attempted in 3 patients (2 successful attempts and 1 unsuccessful attempts), and one patient as referred to surgery. Desaturation was persistent in 19 cases, which necessitated ductus arteriosus stenting. Early procedural complication was observed in 3/26 (11%) patients. Two of these patients had vascular complications due to the sheath, which was treated with heparin infusion and streptokinase, and the remaining patient had sudden bradycardia and cardiac arrest during the procedure and did not respond to cardiac resuscitation. CTO wires should be keep in mind for atretic pulmonary valve perforation as a first choice or when RF perforation is unsuccessful

Cardiac interventions in pregnant patients without fluoroscopy

WOS: 000357683800028PubMed ID: 25946984Cardiac interventions with fluoroscopy during pregnancy carry significant risks for the fetus. This report reviews three pregnant patients: two of them requiring pacemaker implantation and one underwent diagnostic cardiac catheterization without fluoroscopy. The cases were performed using EnSite system (St. Jude Medical Inc., MN, USA) guidance. The necessary cardiac structure geometries were reconstructed with a deflectable quadripolar electrophysiology catheter without fluoroscopy. In two cases, pacemaker leads were connected to the EnSite system for navigation and fixation of leads. In the third case, long sheaths and electrophysiology catheters were used to access the right ventricle and pulmonary artery. Transthoracic echocardiography was also used in all three cases. A 31-year-old woman at 8-week pregnancy was admitted with ventricular septal defect and significant pulmonary hypertension. The patient underwent catheterization to assess for the risk of continuation of pregnancy. There was partial reactivity, it was decided not to terminate the pregnancy, and an uneventful delivery was succeeded at 35 weeks of gestation without complications. The rest of the two pregnant patients were a 28-year-old pregnant woman at 14 weeks of gestation and a 40-year-old woman at 12-week gestation. Both of them presented with symptomatic complete AV block. A single-chamber pacemaker was implanted in the first one, and a dual-chamber pacemaker was implanted in the latter. Pregnancy continued in both without complications. Successful cardiac catheterization and pacemaker implantation can be performed safely in selected pregnant patients using an electroanatomic mapping system guidance without fluoroscopy

Bronchoscopic findings in children with congenital heart disease

WOS: 000451979401455Introduction: The aim of this study was evaluation of broncoscopic findings in children with congenital heart disease(CHD). Method: Bronchoscopy was performed in 37 patients with CHD who were followed between October 2012–December 2014 in our hospital. The data obtained from these patients were evaluated retrospectively. Results: Twenty-one of the patients were males and 16 were females, median ages 12.5 mo (1-36m). Twenty-seven patients (72.9 %) were operated for congenital heart disease. Twelve of the patients had pulmonary hypertension. Bronchoscopy was performed because of extubation failure, atelectasis, recurrent or persistant pneumonia, stridor and persistant cough; 17,7,7,4 and 2, respectively. Laryngomalacia, tracheomalacia, bronchomalacia, tracheal stenosis, airway branch anomalies, granulation tissue formation and pulsatile airway pressure was determined in flexible bronchoscopy, 13,12,8,4,17,7 and 10, respectively. Twenty-seven of the patients were followed with mechanical ventilation(MV). MV duration before and after bronchoscopy was median 30 and 12 days, respectively. Tracheostomy was performed in 15 cases. After bronchoscopy five of these patients were removed from tracheostomy. Eleven out of the patients had positive culture in bronkoalveolar lavage. Patients were discharged with room air, tracheostomy with room air, only with supplemental oxygen, tracheostomy with supplemental oxygen; 19(51.3%), 6(16.2%), 1(2.7%),1(2.7%), respectively. One patient was following intubated with ventilatory support. Nine patients died. Conclusions: Airway anomalies were more frequently encountered in patients with congenital heart disease

Experiences of two centers in percutaneous ventricular septal defect closure using konar multifunctional occluder

BACKGROUND: Transcatheter closure of perimembraneous ventricular septal defect still poses a challenge due to the adjacent structures of the tricuspid and aortic valves and the risk of atrioventricular block. We report our experience at 2 centers using the KONAR-MF (multifunctional occluder) ventricular septal defect device, which gained its CE mark in May 2018. METHODS: A retrospective study was carried out on all patients who underwent transcatheter ventricular septal defect closure with the KONAR-MF (multifunctional occluder) ventricular septal defect device at 2 centers. RESULTS: A total of 47 patients were identified. The median age and weight of the patients were 25.8 months and 11 kg. The ventricular septal defects that were closed in 5 cases were post-operative hemodynamically significant residual ventricular septal defects. Forty-eight devices were used in the 47 cases. As for the location of the ventricular septal defect, 40/48 (83.33%) ventricular septal defects were perimembranous and 8/48 (16.66%) were muscular. The percutaneous device closure was successful in 46 procedures (95.8%). Device embolization was observed in 2 patients, and a significant residual shunt was observed in 2 cases. In the follow-up, there was no enhancement in the residual shunt in the remaining cases. Temporary atrioventricular block occurred in 2 cases during the procedure and improved after long sheath withdrawal. CONCLUSION: Soft, flexible, and low-profile KONAR-MF (multifunctional occluder) occluders ensure easy and safe implantation, and small sheath sizes allow for their use in small infants. Although near and mid-term follow-ups did not indicate any permanent atrioventricular block, a larger sample of patients and a longer follow-up period is necessary to understand long-term outcomes

A retrospective analysis of cases with left atrial isomerism

Amaç: Bu çalışmada sol atriyal izomerik hastalarında eşlik eden kardiyak patolojiler değerlendirildi ve takip sonuçları sunuldu. Çalış­ma­ planı:­ Temmuz 2002 - Aralık 2016 tarihleri arasında iki doğumsal kalp hastalıkları merkezinde sol atriyal izomerizmli toplam 72 hasta (25 erkek, 47 kız; ort. yaş 44.6±65.8 ay; dağılım 0 gün - 255 ay) retrospektif olarak incelendi. Olguların klinik, radyolojik, elektrokardiyografik, ekokardiyografik ve anjiyokardiyografik bulguları, cerrahi ve transkateter işlemler ve ameliyat sonrası takip verileri kaydedildi. Bulgu­lar:­ Ortalama takip süresi 108±49.5 (dağılım 12-173) ay idi. Yetmiş iki hastanın dördüne cerrahi gerekmez iken, iki hastaya kalıcı kalp pili takıldı. Cerrahi gereken 68 hastanın 17’si iki ventrikül tamiri adayı iken, geriye kalan 51 hasta tek ventrikül tamiri adayıydı. Yirmi dokuz hastaya Kawashima işlemi uygulandı. Bu hastaların yedisinde pulmoner antegrad akım açık bırakıldı. Dört hastada hepatik venler aynı seansta Fontan dolaşımına dahil edildi. Altı hastada takip sırasında ilerleyici siyanoz nedeniyle hepatik venler, ekstrakardiyak kondüit yardımıyla, pulmoner artere yönlendirildi. Cerrahi sonrasında üç hasta kaybedildi. Hepatik venlerin aynı seansta ya da ikinci bir seansta Fontan dolaşımına dahil edildiği hastalar veya antegrad pulmoner akımın açık bırakıldığı hastalarda mortalite veya ilerleyici siyanoz gözlenmedi. Sonuç:­ İki ventrikül fizyolojisine sahip hastaların genel prognozu mükemmeldir. Ancak, Kawashima işlemi yapılan hastalarda doku oksijenizasyonu düşme eğilimindedir. Bu nedenle, Kawashima işlemi yapılan hastalarda, aynı seansta hepatik venlerin dolaşıma dahil edilmesi veya uygun olgularda antegrad akımın açık bırakılması güvenli bir yaklaşım olarak görünmektedir.Background: In this study, we aimed to evaluate accompanying cardiac pathologies in patients with left atrial isomerism and report the follow-up results. Methods: A total of 72 patients (25 males, 47 females; mean age 44.6±65.8 months; range 0 day to 255 months) with left atrial isomerism in two congenital heart diseases centers were retrospectively analyzed between July 2002 and December 2016. Clinical, radiological, electrocardiographic, echocardiographic, and angiocardiographic findings of the patients, surgical and transcatheter procedures, and postoperative follow-up data were recorded. Results: The mean follow- up was 108±49.5 (range 12 to 173) months. Of 72 patients, four did not require surgery, while a permanent pacemaker was implanted in two patients. Of 68 patients who needed surgery, 17 were the candidates of biventricular correction, while the remaining 51 patients were the candidates of univentricular correction. The Kawashima procedure was performed in 29 patients. The pulmonary antegrade flow was left open in seven of these patients. In four patients, hepatic veins were incorporated into the Fontan circulation at the same session. In six patients, hepatic veins were directed to the pulmonary artery due to progressive cyanosis during follow-up using extracardiac conduit. Three patients died after surgery. Mortality or progressive cyanosis was not observed in any patients in whom the hepatic veins were incorporated into the Fontan circulation at the same or in another session, or in the patients in whom the antegrade flow was left open. Conclusion: The overall prognosis is excellent in patients with biventricular physiology. However, tissue oxygenation tends to fall in patients undergoing Kawashima procedure. Therefore, incorporation of the hepatic veins into the pulmonary circulation at the same session, or leaving the antegrade flow open in suitable cases seems to be a safe approach in patients undergoing Kawashima procedure

Yenidoğan ve infant döneminde sağ ventrikül çıkım yoluna stent yerleştirilmesi: Çok merkezli, retrospektif çalışma

Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein's anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity.Amaç: Bu çalışmada yenidoğan ve infant döneminde palyasyon amaçlı sağ ventrikül çıkım yoluna stent uygulanan olguların değerlendirilmesi amaçlandı. Ça­lış­ma pla­nı: Ocak 2013 ve Ocak 2018 tarihleri arasında, üç merkezde, sağ ventrikül çıkım yoluna transkateter yoldan stent yerleştirilen toplam 38 hasta (20 erkek, 18 kadın; medyan yaş 51 gün; dağılım 3 gün-9 ay) retrospektif olarak incelendi. Hastaların demografik özellikleri, kardiyak patolojileri, anjiyografi işlem ve klinik izlem verileri kaydedildi. Bulgular: Tanılar Fallot tetralojisi (n=27), çift çıkışlı sağ ventrikül (n=8), kompleks doğumsal kalp hastalığı (n=2) ve Ebstein anomalisi (n=1) idi. Stent yerleştirme sırasında medyan ağırlık 3.5 (dağılım, 2-10) kg idi. Beş olguda genetik anormallikler mevcuttu. İşlem öncesi medyan oksijen satürasyonu %63 (dağılım, %44-80) ve medyan işlem süresi 60 (dağılım, 25-120) dk. idi. Akut işlem başarısı %87 idi. Takip döneminde stent daralması nedeniyle yedi hastaya tekrar girişim uygulandı. Takip döneminde, yedi olgu kaybedildi. Hastaların 26’sına mortalite olmaksızın tam düzeltme ameliyatı yapıldı. Yirmi iki hastada transanüler yama kullanılırken, iki hastada kapak koruyucu tam düzeltme ve iki hastada çift yönlü Glenn operasyonu gerçekleştirildi. So­nuç: Çalışma sonuçlarımıza göre, sağ ventrikül çıkım yoluna stent yerleştirilmesi, özellikle morbidite nedeni ile tam düzeltme ameliyatı yapılamayan olgularda akla gelmesi gereken bir palyasyon çeşididir