Browsing by Author "Ece, Ibrahim"

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Acute Immune Thrombocytopenic Purpura Following Oral Polio Vaccination
(Taylor & Francis inc, 2015) Akbayram, Sinan; Karaman, Kamuran; Ece, Ibrahim; Akbayram, Tuba Hatice
Assessment of Cardiac Function in Absence of Congenital and Acquired Heart Disease in Patients With Down Syndrome
(Zhejiang Univ Sch Medicine, 2016) Balli, Sevket; Yucel, Ilker Kemal; Kibar, Ayse Esin; Ece, Ibrahim; Sen Dalkiran, Eylem; Candan, Sukru
Background: Extra genetic material in patients with Down syndrome (DS) may affect the function of any organ system. We evaluated cardiac functions using conventional tissue Doppler and two-dimensional speckle tracking echocardiography in patients with DS in the absence of congenital and acquired heart disease in patients. Methods: A total of 115 patients with DS between 6 and 13 years of age with clinically and anatomically normal heart and 55 healthy children were included in this cross-sectional study. DS was diagnosed by a karyotype test. Patients with mosaic type were not included in this study. Systolic and diastolic functions were evaluated by echocardiography. Results: Pulsed waved Doppler transmitral early/late inflow velocity (E/A), tissue Doppler mitral annular early/late diastolic peak velocity (Ea/Aa), transtricuspid E/A and tricuspid valve annulus Ea/Aa, pulmonary venous Doppler systolic/diastolic (S/D) wave ratio were lower in patients with Down syndrome than in the control group (P=0.04, P=0.001, P<0.05, P<0.001, P<0.001, respectively). Mitral and tricuspid annular Ea were lower in patients with DS (P<0.001). The right and left ventricular myocardial performance indexes were higher in patients with DS than in the controls (P<0.01). They had significantly higher left ventricular mass, ejection fraction, the mitral annular plane systolic excursion values. However, the Down syndrome group compared with the controls had a lower strain values examined by two-dimensional longitudinal speckle-tracking strain echocardiography. Conclusion: These findings suggest conventional tissue Doppler and two-dimensional longitudinal speckle tracking strain echocardiography were useful methods of investigating ventricular function and identifying a higher incidence of biventricular dysfunction in patients with Down syndrome compared with the healthy controls.
Assessment of Cardiac Functions in Fetuses of Gestational Diabetic Mothers
(Springer, 2014) Balli, Sevket; Pac, Feyza Aysenur; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Kandemir, Omer
We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E (a)-wave (p = 0.02), A (a)-wave (p = 0.04), and S (a)-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E (a) (p = 0.02) and A (a) (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E (a)/A (a) ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E (a) ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.
Assessment of Fetal Cardiac Function in Mild Preeclampsia
(Springer, 2013) Balli, Sevket; Kibar, Ayse Esin; Ece, Ibrahim; Oflaz, Mehmet Burhan; Yilmaz, Ozcan
This study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26-40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.
Brucellar Aortitis and Meningoencephalitis in an Adolescent
(Lippincott Williams & Wilkins, 2016) Bayhan, Gulsum Iclal; Ece, Ibrahim; Oner, Ahmet Faik
Brucellosis can affect any organ system and result in possible complications. We present an adolescent male who had brucellar aortitis and meningitis simultaneously. Brucellar aortic involvement is a rare complication of brucellosis and can occur without concomitant endocarditis. Here, the patient was managed with prolonged antibiotic therapy without any surgery.
Diastolic Dysfunction in Patients With Brucellosis Despite the Absence of Infective Endocarditis
(Cambridge Univ Press, 2020) Ece, Ibrahim; Epcacan, Serdar; Bayhan, Gulsum Iclal; Ture, Mehmet
Background: Brucellosis is an important systemic infectious disease, especially in developing countries. Every organ and system of the human body can be affected; however, cardiovascular complications of brucellosis are rare. Aim: To assess cardiac functions in patients with acute brucellosis without overt cardiac involvement and to answer the following question: Is there any cardiac dysfunction despite the absence of endocarditis in these patients? Methods: This cross-sectional study included 67 children with brucellosis and 40 healthy children. We performed a detailed echocardiographic examination in individuals at the beginning of the treatment. Patients with infective endocarditis were excluded from the study. Results: Echocardiography revealed no difference of ejection fraction, mitral and tricuspid annular plane systolic excursion, pulsed-wave Doppler-derived early diastolic peak velocity (E)/late diastolic peak velocity (A) ratios in mitral and tricuspid valves between the two groups. The deceleration time of early mitral inflow was longer in patients with brucellosis. Early diastolic peak velocity of the mitral and tricuspid annuluses obtained by tissue Doppler imaging (Ea) was significantly lower in children with brucellosis. The peak velocity obtained by tissue Doppler imaging during late diastole (Aa), Ea and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall and right ventricle free wall was lower in patients with brucellosis than in the control group. The E/Ea ratio, isovolumic relaxation time, right ventricle and left ventricle myocardial performance indices were higher in patients with brucellosis. Conclusion: Patients with acute brucellosis may have diastolic dysfunction without overt cardiac involvement and infective endocarditis.
Early Subclinical Left-Ventricular Dysfunction in Obese Nonhypertensive Children: a Tissue Doppler Imaging Study
(Springer, 2013) Kibar, Ayse Esin; Pac, Feyza Aysenur; Balli, Sevket; Oflaz, Mehmet Burhan; Ece, Ibrahim; Bas, Veysel Nejat; Aycan, Zehra
A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 +/- A 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI a parts per thousand yen 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 +/- A 2 cm/s), peak early myocardial velocity (Am = 8.7 +/- A 1.3 cm/s), Em/Am ratio (1.8 +/- A 0.3), isovolumetric relaxation time (IVRT = 59.2 +/- A 8.2 ms), MPI (0.39 +/- A 0.03), and DI (25.5 +/- A 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 +/- A 1.2 cm/sn, 6.9 +/- A 0.6 cm/sn, 2.6 +/- A 0.2, 51.2 +/- A 9.6 ms, 0.34 +/- A 0.03, and 33.13 +/- A 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.
Effect of Antiepilepsy Drug Therapy on Ventricular Function in Children With Epilepsy: a Tissue Doppler Imaging Study
(Springer, 2014) Kibar, Ayse Esin; Unver, Olcay; Oflaz, Mehmet Burhan; Guven, Ahmet Sami; Balli, Sevket; Ece, Ibrahim; Icagasioglu, Fusun Dilara
Impaired cardiac myocardial function may contribute to the risk for sudden unexpected death of a patient with epilepsy. This study aimed to investigate the effect of antiepilepsy drugs (AEDs) on cardiac function in pediatric epileptic patients using standard and tissue Doppler imaging (TDI) echocardiography. This hospital-based, prospective cross-sectional study investigated 52 epileptic children (mean age 9.3 +/- A 3.1 years) treated with AEDs (duration 2.4-10.0 years) and 36 healthy children (mean age 9.5 +/- A 4.0 years). In the epilepsy group, standard echocardiography showed increased left ventricular (LV) end-diastolic and end-systolic diameters, an increased LV mass index, and preserved ejection fraction. The patients also exhibited increased mitral peak A-wave velocity and mitral E-wave deceleration time as well as a decreased mitral E/A ratio. The E/Em ratio was significantly higher in the epilepsy group (5.6 +/- A 1.2) than in the control group (5.2 +/- A 1.1) (p = 0.016). In the epilepsy group, TDI showed an increased isovolumetric relaxation time and myocardial performance index (MPI). It also exhibited decreased early diastolic velocity (Em) and a decreased mitral annular displacement index in these patients. There were positive correlations between the LV lateral wall MPI (r = 0.231), septal MPI (r = 0.223), and LV mass index (p < 0.05) but no correlation with the duration of AED treatment. The authors detected subclinical ventricular dysfunction associated with AEDs at a preclinical stage. They suggest that TDI can be useful for determining the short- and long-term cardiac effects of AEDs.
Effect of Obesity on Left Ventricular Longitudinal Myocardial Strain by Speckle Tracking Echocardiography in Children and Adolescents
(Galenos Publ House, 2015) Kibar, Ayse Esin; Pac, Feyza Aysenur; Ece, Ibrahim; Oflaz, Mehmet Burhan; Balli, Sevket; Bas, Veysel Nejat; Aycan, Zehra
Background: Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity. Aims: The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE). Study Design: Case-control study. Methods: Sixty normotensive obese children aged 1016 years (mean age, 13.9 +/- 2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)>= 95th percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis. Results: Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: -16.0 +/- 3.9% vs-21.9 +/- 2.4%, p<0.001) and lateral wall (average strain: -15.6 +/- 2.3% vs -22.9 +/- 3.5%, p<0.001); regional SR of both the septal wall (average SRsys: -0.7 +/- 0.22 s(-1) vs -1.3 +/- 0.32 s(-1), p<0.001) and lateral wall (average SRsys: -0.67 +/- 0.19 s(-1) vs-1.33 +/- 0.31 s(-1), p<0.001); regional SR E/A of both the septal wall (average SR E/A : 1.8 +/- 0.83 vs. 2.2 +/- 0.91, p: 0.004) and lateral wall (average SR E/A : 1.4 +/- 0.43 vs. 2.4 +/- 1.21, p<0.001); and global strain (-14.6 +/- 7.34% vs -20.9 +/- 3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain. Conclusion: Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease.
The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children
(Korean Soc Otorhinolaryngol, 2016) Acar, Onur Caglar; Uner, Abdurrahman; Garca, Mehmet Fatih; Ece, Ibrahim; Epcacan, Serdar; Turan, Mahfuz; Kalkan, Ferhat
Objectives. The purpose of the present study is to emphasize the efficacy of the myocardial performance index and tricuspid annular plane systolic excursion (TAPSE) in the determination of impaired cardiac functions and recovery period following the treatment in children with adenoid and/or tonsillar hypertrophy. Methods. Fifty-three healthy children after routine laboratory, imaging and clinical examinations, with adenoid and/or tonsillar hypertrophy were evaluated before and 3 months after adenotonsillectomy for cardiac functions using M mode and Doppler echocardiography. Results. The mean age of cases was 6.4 +/- 3.0 years, 34 (65%) were male, and 19 (35%) were female. Pulmonary hypertension was observed to be mild in 3 patients and moderate in 1 patient preoperatively. When the preoperative and postoperative echocardiographic measurements of the patients were compared, the tricuspid valve E wave velocity, the E/A ratio (E, early diastolic flow rate; A, late diastolic flow rate), and the TAPSE values were determined to be significantly higher postoperatively (P < 0.05). The tricuspid valve deceleration time, the isovolumetric relaxation time and the systolic pulmonary artery pressure were found to be significantly lower compared to the preoperative values (P < 0.05). Conclusion. Adenoidectomy and/or tonsillectomy may prevent cardiac dysfunctions that can develop in the later periods due to adenoid and/or tonsil hypertrophy in children, before the appearance of the clinical findings of cardiac failure.
The Effects of Pre-Pregnancy Obesity on Fetal Cardiac Functions
(Springer, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Kibar, Ayse Esin; Oflaz, Mehmet Burhan; Kurdoglu, Mertihan
Obesity is a substantial public health problem with a rapidly increasing prevalence in numerous industrialized nations. The objective of this study was to evaluate the effects of maternal pre-pregnancy obesity on fetal cardiac functions. We studied 55 fetuses of obese mothers and 44 fetuses of healthy mothers at 26-38 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, gestational age, estimated birth weight, serum lipids, and systolic-diastolic blood pressure. Fetal heart rate, diameters of the aortic and pulmonary valve annulus, aortic and pulmonary peak systolic velocities, ventricular systolic function, and cardiothoracic ratio were similar in the two groups. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the obese mothers. In the interventricular septum, left ventricle posterior wall, and right ventricle free wall, the E (a) and A (a) were higher, and E (a)/A (a) ratios were significantly lower in the study group than in the control group. The E/E (a) ratio was higher in the obese group than in the control group. The isovolumic relaxation time and the right and left ventricle myocardial performance indices were higher in the fetuses of the obese mothers than in the fetuses of the healthy mothers. We believe that maternal obesity has an important influence on fetal cardiac diastolic functions.
Efficacy and Safety of Rectal Ibuprofen for Patent Ductus Arteriosus Closure in Very Low Birth Weight Preterm Infants
(Taylor & Francis Ltd, 2017) Demir, Nihat; Peker, Erdal; Ece, Ibrahim; Balahoroglu, Ragip; Tuncer, Oguz
Background: To compare rectal ibuprofen with oral ibuprofen for the closure of hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) preterm infants.Study design and subjects: In a prospective, randomized study, 72 VLBW infants who had hsPDA received either rectal or oral ibuprofen. The plasma concentration of ibuprofen and renal functions were determined in both groups by the high-performance liquid chromatography (HPLC) method and cystatin-C (cys-C), respectively.Results: The hsPDA closure rate of the group that received rectal ibuprofen was similar to oral ibuprofen (86.1% versus 83.3%) after the first course of the treatment (p=0.745). A statistically significant difference was identified between the mean plasma cys-C levels before and after treatment in both the rectal and oral ibuprofen groups (p=0.004 and p<0.001, respectively). The mean plasma ibuprofen concentration was similar in both groups after the first dose (rectal 44.0612.4; oral, 48.28 +/- 22.8) and the third dose (rectal, 45.34 +/- 24.3; oral, 48.94 +/- 24.8) (p>0.05 for all values).Conclusions: Rectal ibuprofen is as effective as oral ibuprofen for hsPDA closure in VLBW infants. The rise in the cys-C level with rectal and oral treatment shows that patients with borderline renal function should be evaluated and followed closely.
Evaluation of Cardiac Functions of Patients With Benign Joint Hypermobility Syndrome
(Springer, 2014) Balli, Sevket; Aydin, Mehmet Zafer; Gerdan, Vedat; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Sen Dalkiran, Eylem
We sought to investigate whether echocardiography with tissue Doppler imaging identifies myocardial dysfunction in children with benign joint hypermobility syndrome (BJHS). This cross-sectional study enrolled 75 children with BJHS and 70 healthy children. We performed detailed echocardiography in individuals with BJHS without inherited connective tissue disorders. Any congenital or acquired cardiac disease was excluded by clinical and echocardiographic examination. Both groups were similar in terms of age, sex, and body mass index. The diameter of the aortic annulus and sinus valsalva were wider in patients with BJHS. There was no significant differences in ejection fraction or mitral and tricuspid annular plane systolic excursion between the two groups. Pulsed-wave Doppler-derived E/A ratios in mitral and tricuspid valves were similar in both groups. Deceleration time of early mitral inflow was prolonged in patients with BJHS. Mitral and tricuspid annulus Ea velocity were significantly lower in children with BJHS. Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in patients with BJHS than in the control group. The E/Ea ratio was greater in patients with BJHS than in the control group. Isovolumic relaxation time and right-ventricular (RV) and left-ventricular (LV) myocardial performance indices (MPIs) were greater in patients with BJHS. This study showed the diastolic dysfunction in patients with BJHS. In addition, we detected increased LV and RV MPI. We believe that BJHS may affect proteins of the myocardial cytoskeleton and extracellular matrix.
Evaluation of Left and Right Ventricular Functions Using Conventional and Tissue Doppler Echocardiography in Children With Type 1 Diabetes Mellitus
(Walter de Gruyter Gmbh, 2016) Acar, Onur Caglar; Epcacan, Serdar; Uner, Abdurrahman; Ece, Ibrahim; Dogan, Murat
Background: The aim of the study was the evaluation of the effects of glycemic control in children and adolescents with type 1 diabetes on cardiac functions. Methods: Diabetic patients were divided into two groups as well-controlled and poorly controlled patients. All patients underwent M-mode, two-dimensions (2D), pulsed wave (PW) Doppler, and tissue Doppler (TDI) echocardiography to evaluate systolic and diastolic functions. Results: Early diastolic mitral flow velocity ( Em) and the ratio of early to late diastolic mitral flow velocity (Em/Am) obtained with TDI were found to be significantly lower in the well-controlled then the control group and significantly lower in the poorly-controlled group than the well-controlled group. Am, isovolumetric relaxation time (IVRT) and myocardial performance index (MPI) were significantly higher in the poorly controlled group. The ratio of early mitral diastolic flow velocity obtained with PW Doppler (E) to Em (E/Em) was significantly higher in the diabetic group. According to the mitral valve PW Doppler results, 13.6% of the well-controlled group and 31% of the poorly-controlled group had type 1 diastolic dysfunction. According to the mitral TDI results, 18% of the well-controlled group and 40.4% of poorly-controlled group had type 1 diastolic dysfunction. Conclusions: Conventional and TDI echocardiography revealed impairment in left ventricular functions in some patients. Tissue Doppler echocardiography also revealed diastolic impairment in some patients who appeared normal with PW Doppler echocardiography. The present study found that impairment in left ventricular diastolic functions is directly related to glycemic control and the rate of diabetic cardiomyopathy was higher in children with poor metabolic control.
Evaluation of Morphological Characteristics of Septal Rims Affecting Successful Transcatheter Atrial Septal Defect Closure in Children and Adults
(Termedia Publishing House Ltd, 2013) Oflaz, Mehmet Burhan; Pac, Feyza Aysenur; Kibar, Ayse Esin; Balli, Sevket; Ece, Ibrahim
Introduction: Determining other echocardiographic predictors along with the measured atrial septal defect (ASD) size and evaluating the closure together with these predictors would increase the chance of success for transcatheter closure of ASD. Aim: To evaluate echocardiographic parameters affecting defect closure in children and adult patients with secundum ASD. Material and methods: In all patients, size of ASD, total length of atrial septum (TS), superior-posterior, inferior-posterior, superior-anterior and inferior-anterior rims surrounding the defect were measured by transesophageal echocardiography (TEE), and several measurement ratios were derived on the basis of TEE parameters. Results: A total 216 patients with secundum ASD were included in this study. The device was successfully implanted in 65 children and 65 adults. Both in pediatric and adult cases, the ratio of successful closure was found to be significantly higher when the ratio of defect size to TS was <= 0.35, the ratio of superior-anterior (SA) rim to the defect size was > 0.75 and the ratio of inferior-posterior (IP) rim to the defect size was > 1.0. It was found that having more than one of these predictors in a single case increased the chance of closure success significantly (p < 0.001). Conclusions: We concluded that a ratio of the defect size to TS <= 0.35, a ratio of SA rim to defect size > 0.75 and a ratio of IP rim to defect size > 1.0 were found to be echocardiographic predictors that could be used in successful transcatheter ASD closure both in children and adults.
Evaluation of the Doppler Flow Patterns of Patent Ductus Arteriosus in Preterm Infants
(Dr Behcet Uz Cocuk Hastaliklari ve Cerrahisi, 2013) Balli, Sevket; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Bulut, Gonca
Objective: Aim of study was to evaluate both ductal diameter (Dd) and pulsed wave Doppler (PWD) patterns of patent ductus arteriosus (PDA), the treatment requirement of different patterns. Methods: In this retropective study evaluation and classification of PDA of 139 preterms born before 34 weeks gestation was performed by color Doppler and PWD. Ratio of left atrium/aortic root were evaluated in parasternal long axis. Ductal patterns were compared with both Dd and left atrium/aortic root ratio. PDA was treated by ibuprofen. The treatment requirement and thrombocyte count of patterns was evaluated. Results: 85,5% of preterms were very low birth weight (< 1500 g). Median gestational age was 28,5 (23-34) weeks. Median birth weight was 1050 (750-1850) g. 39 (17,3%) pulmonary hypertension (PH), 43 (19,1%) growing, 68 (30,3%) pulsatile, 75 (33,3%) closing pattern were observed. PH pattern was more often in first three days (p< 0,001). There was significantly difference among patterns in term of Dd (p< 0,001). The largest Dd was observed in PH pattern the smallest Dd was observed in closing pattern. The need for treatment was higher in pulsatile pattern (52,4% of patients). There was a positive corelation between left atrium/aortic root and ductal diameter in pulsatil, growing and closing pattern except PH pattern. There was no relation between platelet count and flow paterns (p> 0,05). Conclusion: We determined significant relationship between Dd and flow pattern. There was no relationship between ductal pattern and thrombocyte count. Pulsatile pattern were hemodynamically significant. Despite greater Dd, treatment requirement in PH pattern was less due to low left-right shunt. Both ductal diameter and pattern together is important to identify hemodynamically of hemodynamically significant PDA.
Is Platelet Mass a More Significant Indicator Than Platelet Count of Closure of Patent Ductus Arteriosus
(Taylor & Francis Ltd, 2016) Demir, Nihat; Peker, Erdal; Ece, Ibrahim; Agengin, Kemal; Bulan, Keziban Asli; Tuncer, Oguz
Background: The purpose of this study was to evaluate whether or not platelet mass contributes to closure of patent ductus arteriosus (PDA) in premature newborns.Study design and subjects: This retrospective study included 115 preterm newborns with hemodynamically significant PDA (hPDA) and 120 newborns without PDA. The newborns' platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were noted from their files and the platelet mass (platelet count plus MPV/10(3)) was calculated. Patients with congenital abnormality, persistent pulmonary hypertension or sepsis were not included in the study.Results: Platelet count and PDW were found to not be risk factors for closure of hPDA (p>0.05), but both high platelet mass (OR 1.25; 95% CI 1.12-1.41) and MPV (OR 1.87; 95% CI 2.52-3.85) were determined to be independent risk factors for hPDA.Conclusions: Platelet mass may be a more significant indicator than platelet count of closure of hPDA in preterm newborns.
Myocarditis With Hypotonic-Hyporesponsive Episode After Multiple Vaccination
(All india inst Medical Sciences, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Kibar, Ayse Esin
Noninvasive Evaluation of Cardiac Autonomic Modulation in Children With Primary Raynaud's Phenomenon: a Controlled Study
(Springer London Ltd, 2014) Oflaz, Mehmet Burhan; Ece, Ibrahim; Kibar, Ayse Esin; Balli, Sevket; Alaygut, Demet; Guven, Ahmet Sami; Cevit, Omer
This study aimed to objectively evaluate autonomic nervous function in children with primary Raynaud's phenomenon (PRP). Thirty-two children with PRP and 30 healthy subjects were included in the study. We analyzed heart rate variability (HRV) in the time domain by the following six standard time-domain measures: standard deviation of all normal R-R intervals during 24 h (SDNN), standard deviation of all normal R-R intervals for all 5-min segments (SDNNi), standard deviation of the average normal R-R intervals for all 5-min segments (SDANN), root mean square of the successive normal R-R interval difference, percentage of successive normal R-R intervals longer than 50 ms, and triangular index (integral of the density distribution of NN intervals divided by the maximum of the density distribution). The mean heart rate throughout 24 h was significantly higher in the PRP group than in the control group (p = 0.001). Although heart rate during the activity period was not significantly different from that during the night period, it was higher in the PRP group than in the control group (p = 0.002). In children with PRP, HRV analysis showed significantly lower values of SDNN (p = 0.01), SDNNi (p = 0.005), SDANN (p = 0.02), and HRV triangular index (p = 0.02) compared with the control group. HRV analysis for sympathovagal balance demonstrated a preponderance for the sympathetic component in patients with PRP. We conclude that all time-domain parameters evaluated in HRV analysis are significantly lower in children with PRP than in healthy subjects.
P-Wave and Qt Interval Dispersion Analysis in Children With Eisenmenger Syndrome
(Turkish Soc Cardiology, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Sal, Ertan
Objectives: P-wave and QT dispersion are increased and associated with atrial and ventricular arrhythmia and an increase in sudden death in a variety of diseases. This study aimed to investigate P-wave and QT dispersion in children with Eisenmenger syndrome (ES). Study design: The study group included 27 children (15 females, 12 males) with both congenital heart disease (CHD) and ES. The control group consisted of 30 children with CHD without pulmonary arterial hypertension. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. 24-hour (h) rhythm Holter was fitted in all patients. Atrial volumes, ventricular dimensions and tricuspid annular plane systolic excursion (TAPSE) were measured by echocardiography Results: There was no difference between groups with regard to age, sex, weight, and body surface area (p>0.05). Right atrial volume was significantly larger in the ES group than in the control group. P-wave, QT and QTc dispersions were higher in the patients with ES (50.10 +/- 11.12 vs. 26.32 +/- 8.90, p<0.001; 57.40 +/- 24.21 vs. 38.20 +/- 8.92 ms, p<0.001; and 78.20 +/- 16.02 vs. 56.52 +/- 13.92 ms, p<0.001, respectively). Ventricular and supraventricular ectopy were significantly more frequent in the ES group. Four patients (14.8%) in the study group had tachyarrhythmias during 24-h Holter monitoring. Conclusion: In our study, P-wave and QT dispersion were found to be greater in children with ES than in the healthy control subjects.