Assessment of cardiac function and electrocardiographic findings in patients with Wilson's disease.

BACKGROUND: This study evaluated cardiac function using tissue Doppler echocardiography and assessed electrocardiographic findings in children diagnosed with Wilson's disease. METHOD: Asymptomatic patients with a diagnosis of Wilson's disease (n = 43) were compared to healthy controls (n = 37) that were age and gender matched. RESULTS: The standard electrocardiographic and conventional echocardiographic examinations were similar in both groups. The left ventricular ejection fraction, shortening fraction, and diastolic function were not significantly different between the two groups. The Tei index for mitral lateral, mitral septal, tricuspid lateral, tricuspid septal, and inter-ventricular septum on tissue Doppler echocardiography was higher in the patient group, yet it did not reach statistical significance. Mitral lateral and septal systolic annular velocity values were significantly lower in the patient group when compared to the control group (p = 0.02 and 0.04, respectively). Also, mitral lateral and septal isovolumetric contraction time values were higher in the patient group (p = 0.04). Although the left ventricular values were not significantly different, relative left ventricular wall thickness was higher in the patient group when compared to the control group, and concentric remodelling in the left ventricle was found in 7 (16%) of 42 patients. QT interval (p = 0.02) and P-wave dispersion values (p = 0.04) were significantly higher in the patient group compared to the control group, and these tend to predict arrhythmias. CONCLUSION: Our study based on the tissue Doppler echocardiography assessment indicated a subclinical systolic, rather than diastolic, dysfunction in the myocardium with increased QT interval and P-wave dispersion, despite the young age of the patients and short disease duration.

Transcatheter closure of the patent foramen ovale in children: intermediate-term follow-up results.

The patent foramen ovale is almost a normal anatomical hole between the atria with ~30% incidence in the general population. It has been suggested that the patent foramen ovale is the cause of some neurological events, which is explained by paradoxical embolism. Transcatheter closure of the patent foramen ovale is a common procedure in adult patients with cerebral ischaemic events, but there are limited data investigating the results in children. Between January, 2005 and February, 2014, 17 patients' patent foramen ovales were closed by the transcatheter approach in our department. The indications for closure were transient ischaemic attack in 10 patients, stroke in four patients, and migraine in three patients. The mean age and mean weight at the time of the procedure were 11.1±3.7 years and 42.1±15.4 kg, respectively. We asked our patients whether their previous ailments continued. All patients responded to the study survey. In 15 patients, ailments did not continue after patent foramen ovale closure and they significantly decreased in two of them. We suggest that under the right conditions device closure of the patent foramen ovale is a safe solution for these cryptogenic ischaemic events and migraine.

Evaluation of Tissue Doppler Echocardiographic Imaging findings in children with pulmonary hypertension.

Akin A, Alehan D, Aykan HH, Özkutlu S, Özer S, Karagöz T. Evaluation of Tissue Doppler Echocardiographic Imaging findings in children with pulmonary hypertension. Turk J Pediatr 2017; 59: 244-253. Tissue Doppler Imaging has become an important prognostic marker that can be used in follow-up and determination of the prognosis in pulmonary hypertension patients. We compared the Tissue Doppler imaging parameters of 34 patients with pulmonary hypertension and 43 healthy controls. In addition, Brain-Natriuretic Peptide levels, pulmonary artery systolic pressures measured with echocardiography, 6-minute walking tests and New York Heart Association functional classification were compared. Among patients with Eisenmenger syndrome and idiopathic pulmonary hypertension, Tissue Doppler imaging parameters were mostly similar. In patients with New York Heart Association functional class 3, mitral septal annulus E/Ea (p=0.050) and mitral lateral annulus myocardial performance index (p=0.009) were higher than class 2 patients. In patients with higher Brain Natriuretic Peptide level, mitral lateral annulus and tricuspid septal annulus Ea/Aa values were lower (p=0.046 and < 0.001 respectively); tricuspid septal annulus E/Ea and interventricular septum myocardial performance index values were higher than in patients with normal Brain-Natriuretic Peptide level (p=0.006). In conclusion tissue Doppler imaging findings were significantly impaired in children with pulmonary hypertension compared to the control group. Findings were similar in patients with idiopathic pulmonary hypertension and Eisenmenger syndrome. Mitral lateral annulus myocardial performance index value may have a prognostic importance due its significant association with poor functional class. Due to the significant associations between mitral lateral annulus, tricuspid septal annulus Ea/Aa, tricuspid septal annulus Ea and E/Aa, interventricular septum-myocardial performance index values and brain natriuretic peptide levels, these parameters may be used in evaluating response to therapy.

Unusual Presentations of Childhood Systemic Lupus Erythematosus to the Emergency Department.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a multisystemic autoinflammatory disease that can involve any organ system; therefore, diagnosis can be challenging. Hereby, we present 4 cases that presented to pediatric emergency department with unusual clinical pictures of SLE. CASES: Case 1 presented with inability to walk or talk for the last 1 week as well as intermittent pain and swelling in her joints. Case 2 presented with generalized edema and severe dyspnea. Case 3 and 4 presented to pediatric emergency department with rashes on the legs. DISCUSSION: Systemic lupus erythematosus may mimic many clinical entities, and differential diagnosis may be difficult, especially if presentation is atypical. In every emergency physician, right diagnosis and prompt treatment are very important especially in life-threatening conditions such as cardiac involvement in SLE.

Midterm Results of Implantable Cardioverter Defibrillators in Children and Young Adults from a Single Center in Turkey.

BACKGROUND: Despite concerns about complications with the implantable cardioverter defibrillator (ICD), it is effective for the prevention of sudden cardiac death (SCD). We aimed to analyze our midterm experience with ICD in children and young adults. METHODS: This retrospective study included patients who were implanted with an ICD between 2001 and 2014. Demographic characteristics, clinical information, shock features, and complications for all patients with ICD were analyzed. The study population was divided into two groups: early-era patients implanted before 2008, and late-era patients implanted after 2008. RESULTS: Sixty-nine patients (median age: 12 years, median follow-up: 52 months) were implanted with an ICD. Diagnostic categories were channelopathy (56.6%), cardiomyopathy (36.2%), congenital heart disease (5.8%), and other (1.4%). We performed implantation for primary prevention in 66.6% (39.3% in early-era patients and 85.4% in late-era patients). Thirty-one (44.9%) received 139 appropriate shocks (66% of total shocks) while 14 (20.2%) received 71 inappropriate shocks. However, there was no statistically significant difference in the use of appropriate shocks in the primary (66.7%) versus the secondary (72.2%) prevention groups. The incidence of appropriate and inappropriate shock was 66.7% and 33.3% in the primary prevention group, and 72.2% and 27.8% in the secondary prevention group, respectively. Two patients died, although only one death was the result of a lead problem. CONCLUSIONS: Although lead integrity problems, inappropriate shocks, and infections are significant issues, ICD therapy appears to be a safe, effective, and necessary option for the prevention of SCD in both children and young adults.

The Impact of Rapid Left Ventricular Pacing during Pediatric Aortic Valvuloplasty on Postprocedural Aortic Insufficiency.

OBJECTIVE: This study aims to determine efficacy and safety of rapid left ventricular pacing (RLVP) during balloon aortic valvuloplasty and effect on development of postprocedural aortic insufficiency (AI) in children. DESIGN: This is a retrospective comparison of 56 children (mean age 18.3 month; 1 day-15 years of age) who underwent valvuloplasty by using RLVP with standard method (without pacing) during same time period (74 children; mean age 12.6 month; 1 day-18 years of age). RESULTS: The systolic valvular gradient decreased from a mean 67 ± 20.4 mm Hg (26-120 mm Hg) before the procedure to a mean 27.6 ± 17.8 mm Hg (0-120 mm Hg) after the procedure. Procedure failed in two of the patients (3.6%) who received the RLVP; only two patients developed severe AI. Among those patients who underwent the standard method procedure failed in 6 patients (8.3%), whereas severe AI was seen in 15 (20.2%). RLVP decreased the incidence of postprocedure severe AI significantly (P < .01) but it had no effect on the gradient reduction of the procedure (P > .05). RLVP did not change the procedure duration, but decreased the duration of fluoroscopy significantly (P < .01). CONCLUSION: RLVP can be used effectively and safely for pacing during balloon aortic valvuloplasty procedures in all age groups; it decreases procedural failure rate, eases the procedure and prevents the development of AI through the stabilization of the balloon.

Fetal aorta larger than the main pulmonary artery on the three-vessel view: Correlation with postnatal echocardiographic findings.

PURPOSE: This study investigated postnatal cardiac anomalies determined by postnatal echocardiography in fetuses with the ascending aorta (AA) diameter larger than that of the main pulmonary artery (MPA) on the three-vessel view (3VV). METHODS: The study included 17 pregnancies. The diameters of the AA and MPA were assessed on the 3VV in second-trimester sonographic screening, and all the patients underwent postnatal echocardiography to assess the cardiac outcome. RESULTS: In the study population, the mean AA diameter was 3.7 mm (range, 2.2-5.6 mm), and the mean MPA diameter was 3.2 mm (range, 1.8-5.2 mm). The mean AA/MPA ratio was 1.2 (range, 1.1-1.9). According to the postnatal echocardiograms, one of the patients had tetralogy of Fallot. This patient had the highest prenatal AA/MPA ratio (1.9). Among the remaining 16 cases, five had secundum atrial septal defects, with two having concomitant dilatation of the AA. There was one case of isolated dilatation of the AA. CONCLUSIONS: Although an AA with a diameter larger than that of the MPA on the 3VV does not usually indicate severe congenital heart disease involving the ventricular outflow tract and/or great arteries, careful prenatal and postnatal echocardiographic examinations are mandatory to determine the presence of congenital heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:423-428, 2016.

Is transesophageal electrophysiologic study valuable in children with successful radiofrequency ablation of supraventricular tachycardia on follow-up for recurrence?

OBJECTIVE: The aim of this study was to evaluate the efficacy of transesophageal electrophysiologic study (TEEPS) for the determination of supraventricular tachycardia (SVT) recurrences in symptomatic and asymptomatic children after successful radiofrequency ablation (RFA) for SVT. METHODS: A total of 66 patients who underwent TEEPS after successful RFA were included. The demographic features, symptoms of the patients, and the characteristics of the recurrences induced by TEEPS were evaluated. The arrhythmia types induced during RFA were compared with those induced by TEEPS in terms of the compatibility of the diagnosis. RESULTS: Forty-two (63.6%) girls and 24 (36.4%) boys with a mean age of 11.8±3.4 years were followed-up for 44.1±15.7 months. The average time between RFA and TEEPS was 5.2±5.9 months. The diagnoses during RFA were atrioventricular nodal reentrant tachycardia (AVNRT) in 47 of 66 patients, atrioventricular reentrant tachycardia (AVRT) in 18 of 66 patients, and ectopic atrial tachycardia in 1 of 66 patients. SVT was induced by TEEPS in 2 of 25 symptomatic and 5 of 41 asymptomatic patients. The SVT inducibility rate was 5.5% (1/18) and 12.7% (6/47) in patients with AVRT and AVNRT, respectively. In addition, 85.7% (6/7) of all recurrences occurred within 3.5 months. The recurrences as AVNRT in 2 of 25 symptomatic patients occurred in the first month after RFA. AVNRT in 4 of 41 and AVRT in 1 of 41 asymptomatic patients were induced within 3.5 months and 15 months, respectively. CONCLUSION: TEEPS seems to be a valuable screening and diagnostic method for the determination of recurrence in symptomatic and asymptomatic children who underwent successful RFA.

Interventional cardiac catheterization in infants weighing less than 2500 g.

The aim of our study was to share our clinical experience regarding cases of interventional cardiac catheterization in low-weight infants. We retrospectively reviewed all interventional catheterizations performed in infants weighing 2500 g or less between March 2001 and October 2012. Twenty patients were included in the study. The procedures included balloon atrial septostomy in 8 patients, balloon pulmonary valvuloplasty in 7 patients, balloon aortic valvuloplasty in 3 patients and balloon angioplasty for coarctation in 2 patients. The mean age at catheterization was 11.9 ± 9.6 days (range, 1 to 31 days) and the mean weight, 2038 ± 480 g (range, 1100 to 2500 g). The mean procedure time was 80.3 ± 32 minutes, and the mean fluoroscopy time was 17.5 ± 12 minutes. Only two patients had no benefit from the intervention. One patient died at day 4 after catheterization, due to sepsis. Complications occurred in 3 patients: one patient developed atrial flutter and respiratory arrest, one patient developed apnea episodes, and one patient developed anemia that required transfusion. In conclusion, although studies investigating complications related to invasive cardiac catheterization in infants weighing less than 2500 g have reported increased complication rates, such complications were less likely to result in permanent sequelae. We did not observe significant complications related to the procedure; therefore, we would like to suggest that invasive cardiac catheterization can appropriately be performed in low-weight infants.

Comparison of Transesophageal and Intracardiac Electrophysiologic Studies for the Diagnosis of Childhood Supraventricular Tachycardias.

In this study, we aimed to compare the results of transesophageal electrophysiologic studies (TEEPS) and intracardiac electrophysiologic studies (IEPS) in a cohort of pediatric patients with SVTs. The medical records of children aged between 0 and 18 years who underwent TEEPS between January 2007 and June 2012 were systematically reviewed, and those without pre-excitation and who underwent subsequent IEPS were identified. Post-procedural diagnoses were compared for compatibility. A total of 162 patients were included in the study with a mean age at diagnosis 11.6 ± 3.6 years. Tachycardia was induced in 152 patients by TEEPS and in 154 patients by IEPS. Overall, in 147 patients, tachycardia was induced by both TEEPS and IEPS. Diagnoses were compatible in 135 out of 147 patients (91.8 %). Nine out of the 12 patients with discrepant results were diagnosed with atrioventricular-reentrant tachycardia (AVRT) and three with atrioventricular nodal reentrant tachycardia (AVNRT) after TEEPS. Following IEPS, TEEPS diagnosis of AVRT was revised to typical AVNRT in 5 patients and atypical AVNRT in 4 patients. Two of the 3 patients who were diagnosed as having AVNRT following TEEPS were confirmed to have atrial tachycardia after IEPS, while the other patient was diagnosed with AVRT. Tachycardia terminated spontaneously in 3 patients, while overdrive pacing was attempted to terminate the tachycardia in 149 patients, with a success rate of 93.2 % (139/149). The diagnostic compatibility between TEEPS and IEPS is quite high. A diagnostic discrepancy mostly occurs in patients diagnosed with AVRT by TEEPS, and the possibility of atypical AVNRT should be considered in patients with a VA ≥70 ms to avoid such discrepancies.

Clinical and electrophysiological evaluation of pediatric Wolff-Parkinson-White patients.

OBJECTIVE: Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized by electrocardiographic (ECG) findings of a short PR interval and a delta wave. The objective of this study was to evaluate the electrophysiological properties of children with WPW syndrome and to develop an algorithm for the management of these patients with limited access to electrophysiological study. METHODS: A retrospective review of all pediatric patients who underwent electrophysiological evaluation for WPW syndrome was performed. RESULTS: One hundred nine patients underwent electrophysiological evaluation at a single tertiary center between 1997 and 2011. The median age of the patients was 11 years (0.1-18). Of the 109 patients, 82 presented with tachycardia (median age 11 (0.1-18) years), and 14 presented with syncope (median age 12 (6-16) years); 13 were asymptomatic (median age 10 (2-13) years). Induced AF degenerated to ventricular fibrillation (VF) in 2 patients. Of the 2 patients with VF, 1 was asymptomatic and the other had syncope; the accessory pathway effective refractory period was ≤180 ms in both. An intracardiac electrophysiological study was performed in 92 patients, and ablation was not attempted for risk of atrioventricular block in 8 (8.6%). The success and recurrence rate of ablation were 90.5% and 23.8% respectively. CONCLUSION: The induction of VF in 2 of 109 patients in our study suggests that the prognosis of WPW in children is not as benign as once thought. All patients with a WPW pattern on the ECG should be assessed electrophysiologically and risk-stratified. Ablation of patients with risk factors can prevent sudden death in this population.

Serum Bcl-2 values in children with pulmonary hypertension.

In this study, we aimed to assess levels of serum B cell lymphoma 2 (sBcl-2) in children, which has been implicated in the etiopathogenesis of pulmonary hypertension (PH), as well its association with tissue Doppler echocardiographic imaging (TDI) data and parameters used in the follow-up of PH. The sBcl-2 level was assessed in 35 children with PH (24 had eisenmenger syndrome, and 11 had idiopathic PH) and in 38 healthy children as controls. TDI was performed on 25 patients whose cardiac anatomy allowed the test. The respective sBcl-2 values in patients and controls were 35.69 ± 18.83 and 2.66 ± 7.95 ng/ml (p < 0.001). The sBcl-2 levels were significantly greater in the New York Heart Association (NYHA) functional class 3 patients than those in the NYHA class 2 patients (p = 0.033). The sBcl-2 value in patients who walked <475 m in the 6-min walk distance (6MWD) test was significantly greater than in those who walked ≥475 m (p = 0.038). The sBcl-2 level showed a negative correlation with ejection time measured at the septal anulus (p = 0.026) and a positive correlation with interventricular septum-Tei (p = 0.018). The results of this study showed for the first time that there is an increase in the levels of sBcl-2 as an inflammatory marker and that the sBcl-2 levels are associated with prognostic parameters in children with PH. Because sBcl-2 levels were greater in patients who walked <475 meters during the 6MWD test, we suggest 475 ms as the cut-off value for the 6MWD test to differentiate between a good and a bad prognosis.

Sensitivity of transesophageal electrophysiologic study in children with supraventricular tachycardia on electrocardiography.

INTRODUCTION: The aim of this study was to evaluate the inducibility of tachycardia by transesophageal electrophysiologic study (TEEPS) in patients with documented supraventricular tachycardia (SVT) on electrocardiography and to investigate the accuracy of TEEPS records by comparing with intracardiac electrophysiologic study (IEPS). MATERIAL AND METHODS: The TEEPS records of patients having documented electrocardiography during SVT were reviewed. The results of TEEPS in 43 of 85 patients were compared with results of IEPS for compatibility of diagnosis. RESULTS: A total 85 patients, 46 male and 39 female, mean weight 35.1 kg (36-87), aged 1 month-17 years, were included. Tachycardia was induced by TEEPS in 79 of 85 patients with documented electrocardiography (sensitivity 92.9%). IEPS for diagnosis or ablation was conducted in 40 patients having inducible tachycardia and three of six who had no inducible tachycardia by TEEPS. Tachycardia was induced by IEPS in 39 of 40 (97.5%) patients who had inducible tachycardia and two of three who had no inducible tachycardia by TEEPS. Mechanisms of tachycardias were similar in 97.5% of patients (37/39) who had inducible tachycardia in TEEPS and IEPS. One of the patients with atrioventricular reentry tachycardia by TEEPS was diagnosed as atrioventricular nodal reentry tachycardia (AVNRT) and the other one was diagnosed as atypical AVNRT and atrial tachycardia by IEPS. CONCLUSION: The rates of inducibility and mechanisms of tachycardias by TEEPS in children having documented SVT were similar with those obtained from IEPS.

Cardiac rhabdomyomas in childhood: six cases from a single institution.

Primary cardiac tumors are rare during childhood. The most frequently encountered tumors are rhabdomyomas. We reviewed the clinical characteristics, treatment results, and outcomes of six pediatric patients with primary cardiac rhabdomyomas. The mean age was 16.8 days. Only one patient was symptomatic. The tumors mostly originated from the left ventricle. The diagnosis was established by magnetic resonance imaging (MRI) plus echocardiography with or without histopathology. Total tumor resection was performed in two patients. After a median follow-up of 39 months, one patient had a stable tumor, two patients had marked tumor regression and one had complete tumor regression. Considering the fact that rhabdomyomas often show spontaneous regression, close follow-up may be sufficient in hemodynamically stable cases. Although rhabdomyomas do not cause any symptoms at the time of diagnosis, they may lead to sudden death; thus, further studies may be required for the decision of surgery and/or followup. The localization and infiltrative characteristics of the tumor are critical factors for decision-making in children with symptomatic rhabdomyoma even if surgery is indicated in such cases.

Transcatheter interatrial septal defect closure in a large cohort: midterm follow-up results.

OBJECTIVES: We evaluated immediate and midterm results of transcatheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO) using various closure devices. MATERIALS AND METHODS: The study included four hundred fourteen patients (one hundred eighty-two men, two hundred thirty-two women; mean age 39 ± 12.3 years; range 17-67 years) who underwent transcatheter closure of secundum ASD (n = 193) or PFO (n = 221). All the patients were evaluated by transthoracic echocardiography and transesophageal echocardiography before the procedure. Transcatheter closure was performed by using Amplatzer (n = 184), Occlutech Figulla (n = 209), or BioSTAR (n = 21) devices. Closure of ASDs was performed under general anesthesia with transesophageal echocardiography guidance, and closure of PFOs was performed under local anesthesia with transthoracic echocardiography guidance. Follow-up controls were at 1, 6, and 12 months and annually thereafter. The median follow-up periods of ASD and PFO patients were 43 and 30 months. RESULTS: The mean device size was 19.3 ± 6.2 mm for ASD patients and 24.6 ± 2.6 mm for PFO patients. The mean procedural and fluoroscopy times were 22.3 ± 4.7 and 4.1 ± 1.9 minutes for ASD closure and 12.4 ± 3.2 and 3.1 ± 1.2 minutes for PFO closure, respectively. Procedural device embolization occurred in only two patients (0.48%). During follow-up, recurrent embolic events occurred in four patients (1.8%) after PFO closure, and no residual shunts were seen after ASD closure. Device thrombosis developed in two ASD patients during the procedure and in one PFO patient at 12th month of the follow-up (0.72%). CONCLUSION: Transcatheter closure of PFOs and secundum-type ASDs using the Amplatzer, Occlutech Figulla, and BioSTAR devices is an efficacious and safe therapeutic option.

The efficacy of amiodarone-propranolol combination for the management of childhood arrhythmias.

BACKGROUND: The aim of this study was to present our data regarding the efficacy and safety of combining amiodarone and propranolol for the management of arrhythmias in infants. METHODS: Children aged between 0 and 18 years who received combination therapy with amiodarone and propranolol for persistent monotherapy resistance tachyarrhythmia between 2007 and 2011 were included in the study. Treatment efficacy and adverse effects were evaluated by review of clinical signs and symptoms, 12-lead electrocardiogram, 24-hour Holter monitorization, liver enzymes, thyroid function tests, chest x-ray, and ophthalmologic examination. RESULTS: A total of 25 patients (15 male and 10 female) were enrolled in this study with a mean age of 17.9 months (0-132) and a mean weight of 8.65 kg (2.2-25). In 18 patients, treatment was started before their first age. Tachyarrhythmia persisted in two patients despite combination therapy, and treatment regimen was changed. Complete control of the arrhythmia was achieved within the first 2 months of combination treatment in 20 patients, whereas in the remaining three patients short attacks of tachycardia who responded to dose increases were controlled beyond 2 months of treatment and no recurrence were observed. Overall, success of amiodarone-propranolol combination treatment was 92%. Mild elevation in thyroid-stimulating hormone level was observed in one patient that required discontinuation of treatment. CONCLUSION: Our results suggest that a combination of amiodarone and propranolol is an effective and safe option for the treatment of persistent arrhythmias in neonates and infants, and may serve as a bridge to ablation therapy in older children.

Anesthesia for percutaneous transcatheter closure of atrial and ventricular septal defects in pediatric patients.

We aimed to investigate the anesthetic management of percutaneous closure of atrial and ventricular septal defects (ASD/VSD) in pediatric patients. A retrospective review of the anesthetic data of 351 patients who underwent transcatheter closure of ASD/VSD was conducted. The mean age was 8.42 ± 5.71 years (4 months-18 years). VSD closure was performed in 52 patients and the remaining 299 had a procedure for ASD closure. All patients were premedicated with midazolam. All procedures were performed under general anesthesia in the catheterization laboratory. After anesthesia induction with sevoflurane or intravenous anesthetics, all patients were intubated. The procedure was completed without any complications in 98.3% of patients. Many anesthetic drugs have been used for pediatric cardiac catheterization, but it cannot be concluded whether there is an ideal anesthetic method. Regardless of the method, the anesthesiologist must consider not only the need for adequate analgesia and immobility but also that for hemodynamic stability during the procedure.

Analysis of idiopathic ventricular tachycardia in childhood.

Idiopathic ventricular tachycardia (VT) is a relatively benign and rare form of VT. It is seen in young people without demonstrable cardiac pathology. The aim of our study was to review the clinical picture of idiopathic VT, before evaluating the indications for antiarrhythmic treatment and the efficacy of radiofrequency ablation (RFA). The notes of patients diagnosed with idiopathic VT in the last 13 years (n: 22) were included in the study. The median age of onset was 11 years (1 month-16 years). We evaluated the findings regarding the diagnosis, treatment and prognosis of these patients. The most common initial symptom was palpitation, in 15 cases. Five children with idiopathic VT were symptom-free. VT was of right ventricular origin in 10 patients and left ventricular origin in 8 patients. Beta-blockers were the mainstay of medical treatment in right VT and calcium channel blockers (Ca-channel blocker) were mostly used in left VT cases. The success rate of RFA was 57% in right VT and 100% in left VT. The median follow-up was 41 months (9 months-60 months), and all patients are alive currently with no symptoms. VT without demonstrable cardiac pathology is associated with a good prognosis. Treatment is unnecessary for asymptomatic non-sustained VT. RFA is useful in patients with symptomatic drug-refractory idiopathic VT arising from the left or right ventricle.

Early-mid term follow-up results of percutaneous closure of the interatrial septal defects with occlutech figulla devices: a single center experience.

BACKGROUND: Percutaneous closure of secundum type atrial septal defect (ASD) and patent foramen ovale (PFO) has gained widespread use in recent years. Herein, we evaluated the safety and efficacy of the Occlutech® Figulla devices for PFO and ASD closure in a reference tertiary center. METHODS: All 143 patients (46.9% male, mean age 39.3 ± 12.2 years) who underwent transcatheter PFO (n = 85) and ASD (n = 58) closure with Occlutech® Figulla devices between February 2009 and October 2011 were included in this study. An echocardiographic follow-up examination was performed at the 1st, 6th, and 12th month visits. RESULTS: The devices were successfully implanted in all 143 patients (100%). In-hospital periprocedural complications were device embolization (0.7%; 1 ASD patient), atrial fibrillation (1.4%; 1 ASD and 1 PFO patients), supraventricular tachycardia (0.7%; 1 PFO patient), and vascular access hematoma (0.7%; 1 ASD patient). Among ASD patients, 2 patients had trivial (jet width <1 mm in diameter) and 1 patient had small (1-2 mm) residual shunts before hospital discharge, which disappeared after the 6-month visit. During the mean 15.4 ± 9.6 months follow-up, all patients were asymptomatic and no ischemic stroke, cardiac perforation, device erosion, embolization, thrombus formation, or malposition of the device was observed. CONCLUSIONS: Percutaneous PFO and secundum type ASD closure with the novel Occlutech® Figulla Occluder devices without left atrial central pin and with significantly reduced meshwork was safe, feasible, and effective.

Clinical features and mid- and long-term outcomes of pediatric patients with subclinical carditis.

A study to examine mid- and long-term outcomes in patients with subclinical carditis was conducted. Data obtained at the time of diagnosis and during the follow-up of 158 patients diagnosed with subclinical carditis were retrieved and analyzed. Most patients had isolated mitral insufficiency. Frequency of morphological changes in the mitral valve was significantly lower in patients with at least one additional Jones criterion both at baseline (10.3% vs. 48.8%, p < 0.01) and at the end of the follow-up (27.8% versus 43.5%, p = 0.11). Mean jet size for mitral (12.0 +/- 8.8 versus 18.2 +/- 5.5 mm, p < 0.01) and aortic (4.1 +/- 4.0 versus 14.0 +/- 5.8 mm, p = 0.008) insufficiency were decreased compared to baseline. Improvement in mitral insufficiency was more frequent among patients with more than five years of follow-up (82.6% versus 60.0%, p = 0.039). Subclinical carditis due to acute rheumatic fever is not a benign and temporary condition. These patients should be given secondary prophylaxis.