Neonatal transport

Bu çalışmada hastanemiz yenidoğan servisine sevk edilen yenidoğan bebeklerin gönderilme nedenleri ve nakil koşulları incelendi. Bebeklerin %59.9'u term, %40.1'i preterm idi. Nakil aracı olarak term bebeklerin %47.1'inde, pretermlerin %70.3'ünde ambulans, term bebeklerin %52.9'unda, preterm bebeklerin %29.7'sinde otomobil kullanılmıştı. Term (%29.2) ve preterm (%48.0) bebeklerde en sık sevk nedeni solunum sorunları idi. Ambulans ile nakledilen olguların %45.7'sine doktor, %54.3'üne hemşire veya diğer sağlık personeli eşlik etmekteydi. Nakil öncesi olguların %55.3'ü için hastanemize haber verilmemiş, %39'una epikriz yazılmamıştı. Olguların %77.2'si parenteral sıvı desteği sağlanmadan sevk edilmiş, transport sırasında ise olguların %48.2'sine oksijen verilememişti. Preterm bebeklerin %36.2'si küvöz içinde gönderilmişti. Olguların %25.4'ünde hipotermi, %31.2'sinde hipoglisemi ve %33.8'inde hipoksi saptandı. Term bebeklerin %3.8'i, preterm bebeklerin %9.2'si hastanemize geldikten sonraki ilk 24 saat içinde kaybedi i. Bu sonuçlar yenidoğanların nakil öncesi ve nakil sürecinde stabilizasyonunun, nakil öncesi perifer sağlık merkezleri ile yenidoğan merkezimiz arasındaki haberleşmenin, personel eğitiminin, nakil araçlarındaki donanımın yeterli düzeyde olmadığını göstermektedir.In this study the referral reasons and transport conditions of newborns referred to our neonatology unit were investigated. 59.9% of babies were term and 40.1% of babies were preterm. While 47.1% of term and 70.3% of preterm babies were transported by ambulances; 52.9% of term and 29.7% preterm babies were transported by cars. The respiratory distress syndrome was determined as the most common referral diagnosis in term (29.2%) and preterm (48%) babies. In 45.7% of the cases a doctor and in 54.3% of the cases a nurse or other medical personnel escorted the baby during transport by ambulance. Prior to transport no information had been given to our hospital for 55.3% of the cases and 39.0% of the cases had no referral letter. 77.2% of the cases was referred without parenteral fluid support and oxygen was not administred to 48.2% of the cases during transport. Only 36.2% of preterm babies was transported in an incubator. Hypothermia was found in 25.4%, hypoglycemia in 31.2% and hypoxia in 33.8% of the cases. 3.8% of term and 9.2% of preterm babies died within 24 hours after theiradmission to our hospital These results show that stabilization of the newborn before and during transport, communication between community hospital and our neonatology unit prior to transport, personnel training and equipment of the transport vehicle were not adequate

Low oxygen saturation following total correction in a patient with tetralogy of fallot and persistant left superior caval vein - How did we diagnose and manage?

Association of tetralogy of Fallot (TOF) with the other intracardiac pathologies such as atrial septal defect (ASD), atrioventricular canal defect or persistent left superior vena cava (PLSVC), absent pulmonary valve are well known pathologies. The associated pathologies require specifi c attention during surgical treatment. In this manuscript, we present management of a four-month-old girl who was diagnosed with TOF and PLSVC but the diagnosis of unroofed coronary sinus was missed in her. Association of unroofed coronary sinus with TOF is a very rare variant of TOF pathology.Souvislost mezi Fallotovou tetralogií (tetralogy of Fallot, TOF) a jinými intrakardiálními patologiemi, jako jsou defekt septa síní (atrial septal defect, ASD), defekt síňokomorového kanálu nebo perzistentní levostranná horní dutá žíla (persistent left superior vena cava, PLSVC) i absence plicní chlopně, je dobře známa. Během chirurgického výkonu vyžadují přidružená onemocnění obzvláštní pozornost. V tomto článku popisujeme léčbu čtyřměsíční dívky s diagnózou TOF a PLSVC, u níž však byl přehlédnut nezastřešený koronární sinus. Nezastřešený koronární sinus se vyskytuje současně s TOF velmi vzácně

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

Basit büyük arter transpozisyonunda ekstrakorporeal membran oksijenatör destekli geç primer arteriyel switch ameliyatı cerrahi yaklaşımı değiştirir mi?

WOS: 000385271000023Currently, arterial switch operation appears as a standard surgical management for patients under three weeks of age with transposition of the great arteries with an intact ventricular septum, while, beyond three weeks of age, there is no such standard approach and surgical procedures may vary among the health care centers. Low cardiac output and left ventricle failure may also develop after three weeks due to the progressive involution of left ventricle after arterial switch operation. Therefore, the Senning or Mustard procedure, or two-stage repair arterial switch operation are optional surgical management modalities in this patient population. However, due to the potential complications of these procedures in the short-and long-term, there has been an increased interest in performing primary arterial switch operation with extracorporeal membrane oxygenator support in patients older than three weeks of age. This report presents two cases in whom primary arterial switch operation with extracorporeal membrane oxygenator support was performed at the age of 110 days and 60 days, respectively. Primary arterial switch operation with extracorporeal membrane oxygenator support appears to be a more effective option in the short-term than alternative surgical management modalities.Günümüzde ventriküler septumu intakt, üç haftadan küçük basit büyük arter transpoziyonu olan hastalarda standart cerrahi tedavi primer arteriyel switch ameliyatı iken, üç haftadan büyüklerde bu tür bir standart yaklaşım yoktur ve cerrahi işlemler merkezler arasında değişiklik gösterebilmektedir. Üç haftadan sonra sol ventrikülün ilerleyici involüsyonu nedeniyle, arteriyel switch ameliyatı sonrası düşük kalp debisi ve sol ventrikül yetmezliği de gelişebilir. Bu nedenle, Senning veya Mustard işlemi veya iki aşamalı arteriyel switch ameliyatı, bu hasta popülasyonunda alternatif cerrahi tedavi yöntemleridir. Bununla birlikte, bu işlemlerin kısa ve uzun dönemde muhtemel komplikasyonları nedeniyle, üç haftadan büyük olan hastalarda ekstrakorporeal membran oksijenatörü desteği altında primer arteriyel switch ameliyatına karşı ilgi giderek artmaktadır. Bu yazıda, ekstrakorporeal membran oksijenatörü desteği altında primer arteriyel switch ameliyatı yapılan 110 günlük ve 60 günlük iki olgu sunuldu. Kısa dönemde ekstrakorporeal membran oksijenatörü desteği ile yapılan arteriyel switch ameliyatının, diğer seçeneklere kıyasla, daha etkili bir seçenek olabileceği düşünülmektedir

The different cutaneous presentations in three cases of Kawasaki disease as confounding factor of diagnosis

WOS: 000386138300031PubMed ID: 27654745We report three paediatric cases of Kawasaki disease (KD). Erythema multiforme (EM) was the presenting cutaneous feature in two patients, with young age (43 days old), macular rash and meningitis in the third patient. Diagnosis of KD was difficult due either to initial misdiagnosis of drug eruption, incomplete presentation, or the young age of the patient. Clinicians should be aware of these cutaneous presentations to prevent KD complications

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

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

The relationship between idiopathic chest pain, Vitamin D deficiency and insufficiency in school children and adolescents

Objective: The aim of this study is to determine an association between vitamin D status and idiopathic chest pain in school children and adolescents. Methods: Included in the study were a control group of 60 healthy children for comparison with 120 school children and adolescents referred to our pediatric cardiology department, after being diagnosed with idiopathic chest pain. A patient’s examination included taking a history and doing a physical examination, chest radiograph, electrocardiogram, echocardiogram complete blood count, and 25-hydroxyvitamin D and troponin I levels. Results: Age, gender distribution, and body mass index were not statistically different between the control and study groups (p=0.7, p=0.2 and p=0.3, respectively). Histories of the patients with idiopathic chest pain revealed 22% with heart disease and 6% with recent death in the family. Chest pain was present for 1 month in 19.2%, and for <1 month in 79.2% of the patients. Location of the patients’ chest pain was in the left precordium (64%), right precordium (32%) and midsternal area (18%). Frequency and duration of the pain were variable. Serum vitamin D levels were significantly lower in the study group than in the controls (p<0.0001), but except for alkaline phosphatase, other biochemical parameters did not differ to a statistically significantly degree. The duration of symptoms and episodes increased as vitamin D levels decreased (r= 0.621, p=0.002 and r=0.213, p=0.02, respectively). Conclusion: In pediatric patients, there is a significant association between vitamin D deficiency/ insufficiency and the duration and frequency of idiopathic chest pain in pediatric patients

Homozigot ailesel hiperkolesterolemi sonucu dokuz yaşındaki hastada koroner arter bypass cerrahisi: Olgu sunumu

Homozigot ailesel hiperkolesteroleminin çocukluk çağında bile koroner arter bypass cerrahisi gerektirebileceği pek çok yayında bildirilmiştir. Bu yazıda bir aydır eforla birlikte göğüs ağrısı ve solunum sıkıntısı nedeniyle kliniğimize başvuran dokuz yaşında kız olgu sunuldu. Hastaya koroner arter hastalığı şüphesi ile yapılan koroner anjiyografide sol ana koroner arterde bifurkasyon öncesi %90 darlık ve sağ koroner arterde osteal %90 darlık belirlendi. Hasta koroner arter hastalığı nedeniyle koroner arter bypass ameliyatına alındı ve hastaya iki taraflı internal meme arterleri kullanılarak revaskülarizasyon yapıldı.It is well documented that homozygous familial hypercholesterolemia might necessitate coronary bypass surgery in children. in this Article, we present a nine-year-old girl admitted to our clinic due to respiratory distress and chest pain due to exertion which she had suffered for one month. the patient was suspected to have coronary artery disease and coronary angiography was done, revealing 90% narrowing in the left main coronary artery before the bifurcation point and osteal 90% narrowing in the right coronary artery. the patient underwent coronary artery bypass surgery and bilateral internal mammary arteries were used for the treatment of coronary artery disease