Liver stiffness value obtained by point shear-wave elastography is significantly related with atrial septal defect size

PURPOSEThe increase in volume and pressure in the right atrium (RA) and right ventricle (RV) has been shown to increase the liver stiffness (LS). In the literature, there is no information about the changes in LS value in patients with atrial septal defect (ASD). The aim of our study was to investigate the change of LS values obtained by point shear-wave elastography (pSWE) in patients with ASD and the clinical utility of pSWE for this disease.METHODSThis cross-sectional study included 66 patients with ostium secundum ASD: 21 patients with no indication for ASD closure (Group I), 38 patients who underwent ASD closure (Group II), and 7 patients who had ASD with Eisenmenger syndrome (Group III). All patients underwent echocardiography and pSWE. Increased LS was accepted as ≥7 kPa.RESULTSLS values as well as transaminases, clinical signs of heart failure and functional and structural heart abnormalities (increase of RA and RV diastolic dimensions, tricuspid regurgitation pressure gradient [TRPG], ASD size and decrease of ejection fraction, tricuspid annular plane systolic excursion) significantly increased from Group I to Group III (P < 0.001 for all comparisons). Mean LS values for Group I, Group II, and Group III were 5.16±1.55 kPa, 7.48±1.99 kPa, and 13.9±2.58 kPa, respectively. In multivariate linear regression analysis, ASD size and TRPG were significantly associated with LS increase. Only ASD size independently predicted abnormal LS increase ≥7 kPa according to multivariate logistic regression. Clinical value of LS increase was comparable to TRPG for detection of Eisenmenger syndrome; in the receiver operating curve analysis, area under the curve was 0.995 for LS (P < 0.001) and 0.990 for TRPG (P < 0.001). At 10 kPa threshold, LS determined the Eisenmenger syndrome with 100% sensitivity and 91.5% specificity.CONCLUSIONLS value assessed by pSWE was significantly increased in ASD patients with closure indication and Eisenmenger syndrome compared to patients without ASD closure indication and was comparable with TRPG in regards to Eisenmenger syndrome identification. ASD size significantly associated with LS and independently predicted abnormal LS increase ≥7 kPa

The comparison of the actual fire protection and control measures according to the data derived from Istanbul Forest Directorate

The aim of this study is to examine Istanbul Regional Forest Directorate precautions and control measures against the forest fires. With the study it is obvious to see the Regional Directorate of Forestry’s success by means of controlling the fires

Evaluation of newborn patients with patent ductus arteriosus and indomethacin treatment

Yenidoğan Yoğun Bakım Ünitesi'nde 1994-1996 yılları arasında semptomatik duktus arteriozus açıklığı tanısı konulan 34 vaka retrospektif olarak değerlendirildi. Dokuzunda (% 23.5) duktus açıklığı dışında kardiak anomali saptandı. Duktus açıklığı tanısı, postnatal 9.0±6.7 (2-36) günlerde konuldu. Endikasyonu olan 26 (% 76.5) bebeğe, 7.8±3.6 (3-15) günlerde, 3.4±1.9 (1-12) doz (0.2 mg/kg) indometazin intravenöz veya enterai yoldan uygulandı. İndometazin tedavisi ile 21 (% 80.8) vakanın duktusu 1.6±0.5) (0.5-3) günde kapandı ve yan etki gözlenmedi. İndometazinin duktus arteriozus açıklığı tedavisinde önemi tartışıldı.In this study, 34 babies with symptomatic patent ductus arteriosus (PDA) were evaluated and followed up in the neonatal intensive care unit between 1994-1996. The association of other cardiac defects with PDA was seen in eight (23.5%) cases. PDA was diagnosed postnatally between the 2nd and 36th days (mean 9.0±6.7). Indomethacin treatment was given (1-12 doses, mean 3.4±1.9) to 26 babies (76.5%) between the 3rd and 15th days (mean 7.8±3.6). Ductus arteriosus closed in 21 cases (80.8%) after indomethacin treatment. Adverse effects were not seen in any cases. We conclude that of indomethacin therapy is important for treatment of patients with PDA

Double switch procedure and surgical alternatives for the treatment of congenitally corrected transposition of the great arteries

WOS: 000373615400011PubMed ID: 26956686BackgroundWe present our experience with the double switch operation in sixteen patients with congenitally corrected transposition of the great arteries. MethodsWe enrolled 16 patients with congenitally corrected transposition of the great arteries operated by a single surgeon between 1995 and 2015. The mean age was 25 months (range 4 to 72 months) and the mean body weight was 8.9kg (range 4.3 to 19kg) at the time of operation. ResultsWe encountered seven patients with moderate to severe tricuspid regurgitation, five of which had Ebstein anomaly. We performed a combination of atrial and arterial switch procedures in 11 cases, one of which had a concomitant coarctation of the aorta that was repaired along with the double switch procedure. Atrial switch and the Rastelli procedures were performed in three cases with concomitant pulmonary stenosis. A combination of arterial switch, Hemi-Mustard procedure, and bidirectional cavopulmonary anastomosis was performed in two cases. During a mean follow-up period of 67 months (range three months to 18 years), we encountered one early postoperative mortality related to intracerebral bleeding. All but one of the patients are now in NYHA class I-II. ConclusionsCongenitally corrected transposition of the great arteries is a rare congenital cardiac anomaly in which the results of the anatomical repair with double switch operation appear to be superior to that achieved by a physiological repair. doi: 10.1111/jocs.12728 (J Card Surg 2016;31:231-236

Aortic Intracardiac Echocardiography Guided Septal Puncture During Mitral Valvuloplasty

Aims Transoesophageal echocardiography (TEE) and venous intracardiac echocardiography (ICE) are traditionally used to visualize the interatrial septum (IAS) and the tenting effect of the fossa ovalis in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). The aim of the present study was to assess the comparative efficacy and safety of arterial (intra-aortic) ICE and venous ICE, compared with TEE (traditional approach), in the patients undergoing PBMV. Methods and results TEE, aortic ICE, and venous ICE were consecutively performed in 50 patients (40+ 9 years, 86 % female). The images of intracardiac structures were obtained from both aortic and right atrial loci. The IAS was visualized using TEE, aortic ICE, and venous ICE. The mean mitral valve area was 1.14+0.2 cm2, and the mean left atrial volume index was 57.5+ 12 mL/m2. The mean size of the visualized septal length was 48+5 mm by TEE, 51+5 mm by aortic ICE, and 33+6 mm by venous ICE. The Bland–Altman test indicated that the 95 % limits of agreement for the measurement of septal diameter ranged from 211.0 to +5.9 mm (mean –2.5 mm) between TEE and aortic ICE, 22.8 t

The comparison of early and late effectiveness of systemic and high dose inhaled glucocorticoids in the management of acute asthma attacks in children

Amaç: Bu çalışmada akut astım atağı ile başvuran ço- cuklarda sistemik steroidler ile yüksek doz inhale steroid- lerin etkinliğinin karşılaştırılması amaçlandı. Gereç ve yöntem: Akut astım atağı ile gelen çocuklar randomize olarak iki gruba ayrıldı. Hastalara 1 mg/kg oral yoldan metilprednisolon (Sistemik Steroid Grubu, Grup 1, n=27) veya bir kez 4000 ?g inhale flutikazon (İnhale Steroid Grubu, Grup 2, n=35) verildi. Tedaviyi izleyen birer saat aralıklarla dört saat boyunca astım skoru, birinci saniyede üflenen zorlu ekspiratuar hacim (FEV1) ve zirve ekspiratuar akım (PEF) değerleri ölçüldü. Birincil sonuç hastaneye yatış oranı, ikincil sonuçlar ise astım skoru, FEV1 ve PEF sonuçları ve oksijen saturasyonu ile değerlendirildi. Bulgular: Hastaların geliş anı ile tedavinin dördüncü saati ve hastaların rahat olduğu dönemde PEF değerleri Grup 1’de sırasıyla, 173, 223, 220 L/dk (p0,05).Sonuç: Çocuklarda akut astım atağı tedavisinde, erken ve geç etkinlikleri açısından yüksek doz inhale flutikazon ile sistemik metilprednizolon tedavileri arasında astım skoru, FEV1 ve PEF parametreleri bakımından anlamlı farklılık saptanmadı.Objective: In this study it was aimed to compare effec- tiveness of systemic steroids and inhaled corticosteroids in children who applied with acute asthmatic attack. Materials and methods: Children with acute asthmatic at- tack were randomly allocated to two groups; 1 mg/kg per oral methylprednisolone was given to Group 1 (Systemic steroid group, n=27), and 4000 &amp;#956;g inhaled fluticasone to Group 2 (Inhaled steroid group, n=35). Following treat- ment patients were evaluated for four hours, at one-hour intervals by asthma score, forced expiratory volume in first-second (FEV1) and peak expiratory flow (PEF). Pri- mary outcome of this study was the rate of hospital admis- sions and secondary outcome were asthma score, FEV1, PEF and oxygen saturation. Results: Significant improvements were obtained in mea- sured parameters in both Group 1 and Group 2. Values of measured parameters at hospital admission, 4th hour of treatment and while patients were in comfort were as fol- low: PEF values (Group 1: 173, 223, 220 L/min, p &lt;0.001): Group 2 113, 141 , 192 L/min, p &lt;0.001); FEV 1 (Group 1: 74.9%, 89.5%, 85.6%, p &lt;0.0001; Group 2: 96, 89.8, 93.2 %, p &lt;0.0001); O2 saturation (Group 1:93.2%, 95.6%, 96.8%, p &lt;0.0001, Group 2: 93%, 95.2%, 96.6%, p&lt;0.001); and asthma score (Group 1: 9.4, 6.6, 5.7, p&lt;0.001, Group 2: 9.3, 6.8, 6.5, p&lt;0.001). In all measured parameters significant improvements were observed with treatment modalities within both groups. No significant differences were found in all parameters between Group 1 and Group 2 (p&gt;0.05). Conclusion: No significant differences were found in asth- ma score, FEV 1 and PEF parameters between systemic high-dose methylprednisolone and inhaled fluticasone treatment modalities in acute asthmatic attacks of children