Assessment of ventricular septal defects by real-time three-dimensional echocardiography and comparison with surgical measurements

Peer reviewe

Evaluation of Mean Platelet Volume in Children with Hypertension

Background. Childhood hypertension, a disease with increasing prevalence, can lead to severe health problems. With the increased pressure on the vascular endothelium in hypertension, lesions in the endothelium result in endothelial activation and a process of inflammation, which causes platelet activation and in the bone marrow the release of platelet precursor cells into the peripheral blood stream. During inflammation, changes in the number and size of platelets are observed. With the release of platelet precursors into the peripheral blood stream due to platelet activation, an increase in mean platelet volume (MPV) is also seen. Aim. Our aim in this study is the evaluation of MPV changes in the hemogram of children suffering from hypertension, a condition causing severe cardiovascular problems. Material and Methods. This research is a descriptive retrospective cross-sectional study. It consists of a patient group diagnosed with hypertension and a control group of children presenting for routine check-ups with no diagnosed hypertension. Demographic characteristics, arterial pressure values, and hemogram parameters have been evaluated. Results. A total of 90 cases were enrolled in the study, including a patient group of 45 cases with hypertension (19 females, 26 males) and a control group of 45 cases (27 females, 18 males). The median age was 15 years in the hypertension group and 13 years in the control group. In the hypertension cases, the thickness of the carotis intima media was statistically significantly greater than in the control group (p < 0.001). Echocardiographic findings (IVSd, LVDd, LVPWd, IVSs, LVDs, LVPWs, and LV mass) were significantly higher in the hypertension group compared to the control group (p < 0.001). A statistically significant difference in platelet count and MPV values between the groups was not found (p = 0.151, p = 0.405, respectively). Conclusion. While MPV is hypothesized to be higher in hypertensive individuals, there was no statistically significant difference between the hypertensive and non-hypertensive groups in this study

Revisiting subclavian flap repair for neonates and small infants.

Objective: We have utilized subclavian flap angioplasty (SFA) frequently in infants with coarctation particularly in patients with arch hypoplasia which is quite frequent. We have followed these patients with serial echocardiography and have analyzed our results in this study to determine recoartation rates, recurrent hypertension and left arm development

Evaluation of left ventricular functions by speckle-tracking echocardiography in coarctation patients

Background/Aim Two-dimensional speckle-tracking echocardiography (2D-STE) is a novel method that allows the assessment of regional myocardial function. The aim of our study was to use 2D-STE to assess left ventricular deformation in patients with coarctation of the aorta (CoA). Methods In this prospective study, patients with CoA (n = 42) and healthy controls (n = 39) were recruited. Children with CoA who visited the outpatient clinic between 2013 and 2014 were included. The data were compared with those obtained from the sex- and age-matched controls. Results The mean age of the patients was 5.8 +/- 4.5 years. Global longitudinal strain based on all three apical views and total global strain values did not appear to be different between the patient and the control groups (P = .59, P = .51, P = .15, P = .38). Hypertension was detected in 14 (33.3%) patients with CoA. There were significant differences between the global longitudinal strain values of the normotensive CoA subgroup and the hypertensive CoA subgroup (P < .05). Conclusions In our study, we found that 2D-STE total strain analysis of patients with CoA was not different from comparative healthy controls. However, we determined that 2D-STE parameters were lower in the hypertensive CoA subgroup compared to the normotensive CoA subgroup

Tissue Doppler and speckle tracking echocardiography assessment of left ventricular function in children with cystic fibrosis

Background Cystic fibrosis may lead to left ventricular (LV) dysfunction. This dysfunction can be documented by methods such as tissue Doppler echocardiographic (TDI) imaging and two-dimensional speckle tracking echocardiography (STE) in early stage. Study design This was prospective cohort study. Methods A total of 34 patients diagnosed with cystic fibrosis (mean age and SD 9.9 +/- 4.9 years) and 37 healthy control subjects with a comparable gender and age distribution (mean age 9.8 +/- 4.3) were studied. The results for the two groups were compared along with the results of published reports. Results No significant relationship was found between the groups in terms of systolic and diastolic measurements of the interventricular septum and posterior left ventricular wall, and ejection fraction (P > .05). Myocardial performance indexes of left ventricular free wall and interventricular septum increased in the patient group compared with the controls (P .05). Longitudinal strain rates and circumferential strain rates were both lower in five segments in the patient group (P < .05). Conclusions Tissue Doppler echocardiographic imaging and STE may help identifying subclinical LV dysfunction in cystic fibrosis patients with unremarkable conventional echocardiography. They may be considered for the routine follow-up of cystic fibrosis patients

Risk factors for community-acquired urinary tract infection caused by ESBL-producing bacteria in children

Background: The aim of the present study was to investigate the risk factors of antimicrobial resistance in children with urinary tract infection caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria

Coronary artery bypass graft in a 10-year-old child with familial hypercholesterolemia

Homozygous familial hypercholesterolemia (HoFH) is a result of a defect in low-density lipoprotein (LDL) receptor gene located on the short arm of chromosome 19 which leads to inadequate clearance of lipoproteins from blood circulation. Homozygous and heterozygous types are available. In homozygous types coronary lesions emerge due to early atherosclerosis in the first decade of life, and untreated patients are lost generally when they are 20 years of age. Our patient was admitted to our outpatient clinic with the complaint of exertional chest pain six months after diagnosis of familial hypercholesterolemia. Coronary angiography was performed because of the patological exercise stress test. Significant coronary artery stenosis was detected. Then the patient successfully underwent coronary bypass grafting. This case is presented to highlight that coronary lesions may develop at an early disease stage of the patients with hyperlipidemia

Evaluation of left ventricular systolic functions in two-dimensional speckle-tracking echocardiography in children with chronic renal failure

Background and aim: Chronic kidney disease may lead to left ventricular dysfunction. Early detection of cardiovascular disease in children with chronic kidney disease is essential to prevent cardiovascular morbidity and mortality in early adulthood. This study aimed to document the dysfunction using methods such as two-dimensional speckle-tracking echocardiography in the early stage. Methods: A total of 34 patients diagnosed with chronic kidney disease (mean age +/- standard deviation, 10.5 +/- 4.1 years) and 37 sex- and age-matched (mean age 9.8 +/- 4.2 years) healthy controls were studied. The results of the two groups were compared along with those of the published studies. Results: The echocardiography measurements had no significant difference in the end-diastolic and end-systolic diameter values of left ventricular, ejection fraction, shortening fraction, mitral E value, mitral A value, and E/A ratio between the groups. Pulmonary artery systolic and diastolic pressure and left ventricular mass index were significantly higher in the patient group (p < 0.01). The longitudinal global strain values in the apical four-chamber, three-chamber, and two-chamber views and the total global strain values were significantly lower in the patients (p < 0.01). The circumferential global strain values in the apical, mid, basal, and total global strain were lower in the patient group, but this difference was statistically significant in the apical global and total global strain values (p < 0.05). Conclusions: Speckle-tracking echocardiography might help identify subclinical left ventricular dysfunction in patients with chronic kidney disease with unremarkable conventional echocardiography

A 10-year-old child who underwent coronary artery bypass graft with the indication of familial hypercholesterolemia

Homozygous familial hypercholesterolemia (HoFH) is a result of a defect in low-density lipoprotein (LDL) receptor gene located on the short arm of chromosome 19 which leads to inadequate clearance of lipoproteins from blood circulation. Homozygous and heterozygous types are available. In homozygous types coronary lesions emerge due to early atherosclerosis in the first decade of life, and untreated patients are lost generally when they are 20 years of age. Our patient was admitted to our outpatient clinic with the complaint of exertional chest pain six months after diagnosis of familial hypercholesterolemia. Coronary angiography was performed because of the patological exercise stress test. Significant coronary artery stenosis was detected. Then the patient successfully underwent coronary bypass grafting. This case is presented to highlight that coronary lesions may develop at an early disease stage of the patients with hyperlipidemia

Can ambulatory blood pressure monitoring detect early diastolic dysfunction in children with type 1 diabetes mellitus: correlations with B-type natriuretic peptide and tissue Doppler findings

Aim: To evaluate the relationship between 24- h blood pressure ( BP) measurements and diastolic heart function evaluated by Doppler tissue imaging and B- type natriuretic peptide ( BNP) levels in children with type 1 diabetes mellitus ( DM). Patients and methods: A total of 32 diabetic and 18 healthy children were enrolled. Spectral Doppler analysis and tissue Doppler measurements were performed by conventional echocardiography. The 24- h ambulatory BP and serum BNP levels were measured. Results: Analysis of ambulatory blood pressure monitoring ( ABPM) recordings showed that median daytime diastolic BP load were significantly higher in diabetic patients compared to controls [ 12.35 ( 4.23- 27.23) vs. 2.5 ( 0- 8.7), p= 0.007]. Patients with elevated daytime systolic and diastolic BP loads had significantly higher BNP values compared to patients with normal BP load ( 31.4 +/- 24.36 vs. 11.84 +/- 11.25 pg/ mL, p= 0.03 and 23.21 +/- 15.12 vs. 12.12 +/- 14.65 pg/ mL, p= 0.03, respectively). Isovolemic contraction time ( 47.43 +/- 7.84 vs. 42.27 +/- 7.47, p= 0.045), isovolemic relaxation time ( 68.84 +/- 10.43 vs. 58.77 +/- 10.02, p= 0.02), and myocardial performance index ( 0.45 +/- 0.10 vs. 0.37 +/- 0.09, p= 0.02) as determined by tissue Doppler echocardiography were significantly high in diabetic patients compared to that of control cases. Ratio of mitral peak early diastolic flow velocity ( E) to peak early diastolic myocardial velocities by tissue Doppler echocardiography ( E') was also higher in patients with elevated daytime systolic BP load ( E/ E ', 6.71 +/- 1.97 vs. 4.91 +/- 1.02, p= 0.04). Conclusion: Elevated BP loads detected by 24- h ambulatory BP measurements in children with type 1 diabetes are associated with increased BNP levels and abnormal tissue Doppler echocardiography indices, indicating early stage cardiac dysfunction