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Öğe Dispersion Durations of P-wave and QT Interval in Children With Congenital Heart Disease and Pulmonary Arterial Hypertension(Springer, 2013) Sap, Fatih; Karatas, Zehra; Altin, Hakan; Alp, Hayrullah; Oran, Bulent; Baysal, Tamer; Karaarslan, SevimThis study aimed to investigate homogeneity disorders of ventricular repolarization and atrial conduction via QT dispersion and P-wave dispersion in children with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH). Three groups of 20 each were generated and involved in this study. The first group included 20 children with both CHD and PAH. The second group consisted of 20 children with CHD but no PAH, and the third group was composed of 20 age- and sex-matched healthy children. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. The pulmonary hypertension group compared with the group having no pulmonary hypertension and the control group showed a significantly longer P-wave dispersion duration (39.10 +/- A 9.54 vs. 26.30 +/- A 4.99 ms, p < 0.001; and 24.80 +/- A 6.94 ms, p < 0.001, respectively) and QT dispersion duration (52.80 +/- A 15.11 vs. 37.60 +/- A 6.00 ms, p < 0.001; and 35.00 +/- A 7.77 ms, p < 0.001, respectively). In addition, the durations of maximum QTc and QTc dispersion were significantly longer in pulmonary hypertension group than in the other two groups. The risk of atrial and ventricular arrhythmia was found to be increased in the patients with both CHD and PAH. Physicians should pay close attention to possible atrial and ventricular arrhythmias during the treatment and follow-up evaluation of these patients.Öğe Evaluation of cardiac functions in term small for gestational age newborns with mild growth retardation: A serial conventional and tissue Doppler imaging echocardiographic study(Elsevier Ireland Ltd, 2012) Altin, Hakan; Karaarslan, Sevim; Karatas, Zehra; Alp, Hayrullah; Sap, Fatih; Baysal, TamerBackground: The aim of this study is to evaluate the cardiac functions of term small for gestational age (SGA) babies with mild growth retardation by echocardiography during the postnatal period. Methods and results: Thirty term SGA (2271 +/- 207 g/38-41 weeks (mean 39.5 weeks)) and 30 term AGA (3298 +/- 338 g/38-41 weeks (mean 39 weeks)) newborns as the control group, with normal general health status and with no nutritional problems were evaluated at three time points, on the 3rd postnatal day, at the 3rd and the 6th months. In the initial analysis, heart rate, left ventricular end diastolic diameter index (LVEdDI), cardiac index (CI), all E/A, Em/Am and E/Em ratios, pulsed wave Doppler myocardial performance index (MPI), and tissue Doppler imaging MPI values were higher in SGA babies than the control group. In the last analysis, only heart rate, LVEdDI and CI values were different between SGA and control groups. Conclusions: Systolic and diastolic cardiac dysfunctions were determined in SGA babies with mild growth retardation during the first 6 months of postnatal period. Any disease that affects the hemodynamic stability of these patients during postnatal period may lead to early progressive deterioration in cardiac functions. Furthermore, many of the cardiac functions of these babies have been improved about the 6th month period, and high levels of heart rate and LVEdDI may be suggested as an indicator of cardiac remodeling. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Öğe Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents(Walter De Gruyter Gmbh, 2014) Alp, Hayrullah; Eklioglu, Beray Selver; Atabek, Mehmet Emre; Karaarslan, Sevim; Baysal, Tamer; Altin, Hakan; Karatas, ZehraBackground: Childhood obesity is a cardiovascular risk factor. Objective: Epicardial adipose tissue (EAT) thickness, carotid intima-media thickness (IMT) and cardiac functions of obese children and their correlations were evaluated. Subjects: Five hundred obese children and 150 age-and sex-matched healthy controls. Methods: Anthropometric, laboratory data and echocardiographic measurements of IMT, EAT and cardiac functions were determined. Results: Increased M-mode echocardiographic measurements, E/e' ratios, Tei index values and decreased E/A and e'/a' ratios (where E and A are early and late mitral/tricuspid diastolic velocities, respectively, and e' and a' are peak early diastolic and peak atrial systolic myocardial velocities, respectively), were determined in the obese group. Also, carotid artery IMT and EAT thickness were significantly higher in obese children. Carotid artery IMT, EAT thickness and left ventricular mass (LVM) were found to be strongly associated with Tei index values. Conclusion: Obesity is a major risk factor for cardiovascular diseases. In our study, we showed that obese children have early subclinical systolic and diastolic dysfunctions. Also, these cardiac impairments are correlated with the increase in IMT, EAT thickness and LVM.Öğe Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents(Walter De Gruyter Gmbh, 2014) Alp, Hayrullah; Eklioglu, Beray Selver; Atabek, Mehmet Emre; Karaarslan, Sevim; Baysal, Tamer; Altin, Hakan; Karatas, ZehraBackground: Childhood obesity is a cardiovascular risk factor. Objective: Epicardial adipose tissue (EAT) thickness, carotid intima-media thickness (IMT) and cardiac functions of obese children and their correlations were evaluated. Subjects: Five hundred obese children and 150 age-and sex-matched healthy controls. Methods: Anthropometric, laboratory data and echocardiographic measurements of IMT, EAT and cardiac functions were determined. Results: Increased M-mode echocardiographic measurements, E/e' ratios, Tei index values and decreased E/A and e'/a' ratios (where E and A are early and late mitral/tricuspid diastolic velocities, respectively, and e' and a' are peak early diastolic and peak atrial systolic myocardial velocities, respectively), were determined in the obese group. Also, carotid artery IMT and EAT thickness were significantly higher in obese children. Carotid artery IMT, EAT thickness and left ventricular mass (LVM) were found to be strongly associated with Tei index values. Conclusion: Obesity is a major risk factor for cardiovascular diseases. In our study, we showed that obese children have early subclinical systolic and diastolic dysfunctions. Also, these cardiac impairments are correlated with the increase in IMT, EAT thickness and LVM.Öğe Evaluation of Serum Ischemia Modified Albumin Levels in Acute Rheumatic Fever Before and After Therapy(All India Inst Medical Sciences, 2014) Toker, Aysun; Karatas, Zehra; Altin, Hakan; Karaarslan, Sevim; Cicekler, Humeyra; Alp, HayrullahTo investigate ischemia modified albumin (IMA) levels in children with acute rheumatic fever (ARF) before and after therapy and compare them with those of controls. Twenty seven patients with ARF and 18 healthy, age and sex matched children were included in the study. The diagnosis of ARF was established according to the modified Jones criteria. Follow-up studies were made when acute phase reactants [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] levels returned normal. IMA levels were measured using the rapid and colorimetric method with the albumin cobalt binding test. IMA levels were significantly higher in ARF group (p < 0.001) compared with controls at the time on admission. IMA (absorbance units) was measured as 0.41 +/- 0.10 in the control group, 0.55 (0.44-1.13) in the study group before treatment and 0.48 +/- 0.12 in the study group after treatment. After treatment, statistically important decrements were determined in the levels of ESR (p < 0.001), CRP (p < 0.001) and IMA (p < 0.01). There was no significant difference for IMA levels between after treatment and control group. IMA levels at the time on admission correlated positively with ESR (r = 0.605, p < 0.01) and CRP (r = 0.543, p < 0.01). The present study shows that increased serum IMA levels in patients with ARF at the time of diagnosis is a sign of increased inflammation. Thus, serum IMA levels may be used as a follow-up marker like CRP and ESR for evaluating the efficacy of treatment in ARF.Öğe Increased ischaemia-modified albumin is associated with inflammation in acute rheumatic fever(Cambridge Univ Press, 2014) Karatas, Zehra; Baysal, Tamer; Sap, Fatih; Alp, Hayrullah; Mehmetoglu, IdrisIntroduction: Ischaemia-modified albumin, a novel biochemical marker for tissue ischaemia, was found to be associated with oxidative stress. The purpose of this study was to assess the role of ischaemia-modified albumin in the diagnosis of acute rheumatic fever and also to evaluate the ischaemia-modified albumin levels in children with heart valve disease. Methods: The study groups, aged 5-18 years, consisted of 128 individuals - 40 with acute rheumatic fever, 35 with congenital heart valve disease, 33 with chronic rheumatic heart disease, and 20 healthy control subjects. Results: The ischaemia-modified albumin, erythrocyte sedimentation rate, and C-reactive protein levels of the acute rheumatic fever group were significantly higher than those in the chronic rheumatic heart disease, congenital heart valve disease, and control groups, separately (p < 0.001). The ischaemia-modified albumin levels in both carditis and isolated arthritis subgroups of children with acute rheumatic fever were significantly higher than in the control group (p < 0.001, p < 0.01, respectively). However, there was no statistically significant difference between the chorea subgroup and control subjects. In addition, significant correlations were observed between ischaemia-modified albumin and acute phase reactants of patients with acute rheumatic fever (p < 0.001 for both erythrocyte sedimentation rate and C-reactive protein). The ischaemia-modified albumin levels of chronic rheumatic heart disease, congenital heart valve disease, and control subjects were similar. Conclusions: The increased level of ischaemia-modified albumin in children with acute rheumatic fever seems to be associated with inflammation. However, further studies are needed to provide stronger evidence.Öğe QT and P-wave dispersions in rheumatic heart disease: Prospective long-term follow up(Wiley-Blackwell, 2014) Alp, Hayrullah; Baysal, Tamer; Altin, Hakan; Karatas, Zehra; Karaarslan, SevimBackgroundSimple electrocardiogram (ECG) markers have been used to evaluate conduction times. Acute rheumatic fever (ARF) is an autoimmune disease that affects these conduction times. The aim of this prospective long-term follow-up study was to evaluate QT, QTc and P-wave dispersions in children with ARF and chronic rheumatic heart disease (CRHD). MethodsSixty-four patients with ARF, 33 patients with CRHD and 41 healthy, age- and sex-matched control subjects were included in the study. The ARF patients were divided into two subgroups: carditis and arthritis. Echocardiographic and ECG measurements at the onset of diagnosis and final evaluation were included. ResultsQT, QTc and P-wave dispersions were significantly greater in both the ARF carditis and CRHD groups than the ARF arthritis and control subjects during the initial and final analysis (for all, P < 0.001). There was no significant statistical difference in QT, QTc and P-wave dispersion between the initial and final analysis in each groups. Severity of mitral regurgitation and left atrial enlargement were found to be positively correlated with P-wave dispersion (r = 0.438, P < 0.001; r = 0.127, P < 0.001, respectively). QT, QTc and P-wave dispersion greater than 52, 60 and 57 ms, respectively, had higher sensitivity and specificity for predicting ARF carditis. ConclusionThese ECG measurements can be used in the diagnosis of ARF carditis as minor criteria with modified Jones criteria. In contrast, this increase in the dispersions is permanent in patients with ARF carditis.Öğe Serum Tenascin-C: A Novel Biomarker for Diagnosis and Predicting Prognosis of Rheumatic Carditis?(Oxford Univ Press, 2013) Karatas, Zehra; Baysal, Tamer; Alp, Hayrullah; Toker, AysunObjective: To evaluate the serum TnC level in acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD) during childhood. Methods: Twenty-five patients with ARF, 25 patients with CRHD and 20 control subjects were included in the study. The TnC levels were analyzed using the enzyme-linked immunosorbent assay method in the ARF group. Results: The TnC levels were lower in the acute carditis group compared with the control group (p < 0.001). The cut-off level was estimated as 2.08 ng/ml for diagnosing carditis with 93.3% sensitivity and 95% specificity. On second analysis, prominent decrease was detected in valve insufficiency patients with markedly elevated TnC levels. In the CRHD group, TnC level was significantly lower in cases with severe valve insufficiency (p < 0.001). Conclusions: Serum TnC level can be used as a new biochemical marker for diagnosis and predicting the prognosis of rheumatic carditis.Öğe Successful pericardiectomy in Hennekam syndrome(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Karatas, Zehra; Karaarslan, Sevim; Alp, Hayrullah; Sarigul, Ali; Baysal, TamerHennekam syndrome is an autosomal recessive disorder, characterized by lymphangiectasia in internal organs with lymphedema. Pleural or pericardial effusions may present with lymphedema on extremities in the course of the disease. Although a poor long-chain fatty diet is given for treatment, its success rate is low. In this article, we report the results of a successful pericardiectomy performed on a 21-month-old boy who was diagnosed with Hennekam syndrome.Öğe Transient Severe Isolated Right Ventricular Hypertrophy in Neonates(Medknow Publications & Media Pvt Ltd, 2014) Alp, Hayrullah; Karatas, Zehra; Baysal, TamerIsolated right ventricular hypertrophy (RVH) is a rare form of hypertrophic cardiomyopathy and premature closure of the patent ductus arteriosus in utero is a probable etiologic factor. We reported transient isolated RVH in three neonates and ventricular hypertrophy resolved within 8-10 weeks period without any specific therapy in all cases.
