The Relationship between Arterial Elasticity Parameters of Ascending Aorta, Abdominal Aorta and Carotid Arteries with Carotid Intima Media Thickness in Children with Bicuspid Aortic Valve.

BACKGROUND: Bicuspid aortic valve is a congenital cardiac malformation that affects not only the valve and ascending aorta but also the abdominal aorta and large central arter-ies like carotid arteries by damaging the elasticity of the vessel resulting in increased stiffness and reduced distensibility. Deterioration of aortic compliance disturbs functions of the left ventricle and triggers atherosclerosis determined with carotid intima-media thickness. The aim of this study was to assess the effect of the bicuspid aortic valve on the elastic properties of these parts of the arterial system in children. METHODS: Thirty-four children with bicuspid aortic valves with normal valvular functions or mild valvular dysfunction and a control group of 34 individuals with tricuspid aortic valves were included in the study. Echocardiographic measurements of the left ventri- cle, ascending aorta, and ultrasonographic measurements of the abdominal aorta and carotid arteries were performed, and elasticity indexes were calculated. RESULTS: The bicuspid aortic valve group had higher stiffness and lower distensibility in ascending aorta, abdominal aorta, and carotid arteries with higher carotid intima- media thickness values than the tricuspid aortic valve group. Aortic valvular z scores and ascending aorta and abdominal aorta stiffness were higher in patients with bicus- pid aortic valves irrespective of valvular functions than in controls. Valvular dysfunction affected stiffness in carotid arteries. Dilatation of ascending aorta increased stiffness in the abdominal aorta. Distensibility was lower in ascending aorta and left carotid artery, with increased carotid intima-media thickness independent from ascending aorta dila- tation. Stiffness of abdominal aorta revealed a positive correlation with the stiffness of the ascending aorta and the carotid arteries (P < .05, for all). CONCLUSIONS: Elasticity indexes of children with bicuspid aortic valves were impaired in ascending aorta, abdominal aorta, and carotid arteries with an increase in carotid intima-media thickness.

Asymptomatic cardiac tumour with premature ventricular contraction in an athlete: case report.

Cardiac fibromas are the second most common benign primary tumour of the heart in the children; the clinical features include chest pain, arrhythmia, low cardiac output due to outflow tract obstruction, and sudden cardiac death. Sports are associated with an increased risk for sudden death in athletes who are affected by cardiovascular conditions predisposing to life-threatening arrhythmias. We present a case report of 10-year-old asymptomatic boy who was referred to the paediatric cardiology department by his general practitioner for cardiac examination before participation in competitive sports. The electrocardiogram showed premature ventricular contractions originated from inferior of left ventricle. A mass was detected by 2D transthoracic echocardiography, and it was found to be compatible with fibroma on MRI. In some cases, cardiac tumours are asymptomatic as in our patient. Electrocardiogram abnormalities require detailed cardiac imaging with echocardiogram, and if necessary CT/MRI. In this article, we emphasise that detailed cardiac examination of individuals before participating in competitive sports is vital.

Early and long-term results of heart transplantation with reoperative sternotomy.

BACKGROUND: This study aims to investigate the effects of reoperative sternotomy on early and long-term outcomes after heart transplantation. METHODS: We retrospectively reviewed data of a total of 92 patients (72 males, 20 females; mean age 36 years; range, 3 to 61 years) who underwent orthotopic heart transplantation between May 1998 and July 2014. The patients were divided into three groups. Group A (n=23) included patients who underwent previous cardiac surgery with sternotomy other than ventricular assist device implantation; Group B (n=12) included patients who were bridged-to-transplant with a ventricular assist device; and Group C (n=57) included patients who for the first time underwent heart transplantation without previous sternotomy. Preoperative and operative data of the three groups were compared. The short- and long-term outcomes of all groups were analyzed. RESULTS: There was no significant difference among the groups, except for the age and preoperative international normalized ratio. Total ischemia time in the ventricular assist device group was longer than Group C. The length of intensive care unit stay was also longer in the ventricular assist device group than the other groups. The amount of postoperative chest tube drainage and blood transfusion was higher in Group A. Early mortality rate was significantly higher in Group A. There was no significant difference in survival among the three groups in the long-term. According to the logistic regression analysis, no variable was found to be a significant risk factor for mortality. CONCLUSION: Reoperative sternotomy other than ventricular assist device implantation was found to be a risk factor for early mortality; however, mid and long-term survival rates were similar to patients in whom transplantation was the primary procedure. In patients with reoperative sternotomy, heart transplantation can be performed with similar risks to patients without resternotomy with careful selection and accurate pre- and intraoperative surgical approach.

The evaluation of right ventricular systolic function in patients with repaired Tetralogy of Fallot by conventional echocardiographic methods and speckle tracking echocardiography: Compared with the gold standard cardiac mangenetic resonance.

BACKGROUND: Right ventricular (RV) function is one of the important prognostic factors in patients with repaired Tetralogy of Fallot (TOF). We aimed to assess RV function by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE) in patients with repaired TOF. METHODS: Twenty-seven (male 17) adolescents and young adult patients (mean age 22.7 ± 6.7 years) operated on for TOF and age- and gender-matched healthy controls were included. RV systolic function in both groups were evaluated by fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (RVMPI) and tricuspid annular peak systolic velocity by pulsed tissue Doppler (tricuspid S'), and also RV global longitudinal strain (RV GLS) obtained from STE. These results were compared with RV ejection fraction (RVEF) measured by cardiac magnetic resonance imaging (CMRI) performed within 3 months in patient group. RESULTS: Systolic RVGLS values were significantly lower in patients compared to controls (-17.4 ± 3.1% vs -25.6 ± 3%). Among the echocardiographic parameters, RVGLS had the best correlation with RV EF derived from CMRI (r: -.6). By receiver operating characteristics analysis (ROC), an RV GLS cutoff value of -17.4% had 75% sensitivity and 68.4% specificity in identifying RVEF <45% with an area under curve 0.743 (P < .05). The intra- and inter-observer agreement for RV GLS was excellent. CONCLUSION: RVGLS is an easy, effective, feasible, and reproducible tool in the evaluation of RV systolic function. So, RVGLS measurement by STE may be one of the routine echocardiographic parameters in the evaluation of RV systolic function in patients with repaired TOF.

Tp-e interval and Tp-e/QT ratio in clinically stable pediatric heart transplant recipients.

OBJECTIVE: A study of the T wave peak-to-end (Tp-e) interval, the Tp-e/QT ratio, and the Tp-e/QTc ratio in pediatric heart transplant recipients (HTRs), a group which has a higher risk of sudden cardiac death than the normal population, has not previously been reported. The aim of this study was to assess alterations in ventricular repolarization using the Tp-e interval, Tp-e/ QT ratio, and Tp-e/QTc ratio in clinically stable pediatric HTRs. METHODS: A total of 13 clinically stable HTRs, 13 patients who had undergone cardiac surgery (CS) under cardiopulmonary bypass, and 16 healthy controls under 18 years of age were retrospectively evaluated. RESULTS: No significant differences were observed between the HTR, CS, and control groups in terms of QTc, JTc interval, and T wave amplitude (p>0.05). The Tp-e interval (p=0.001), Tp-e/QT ratio (p<0.001), and Tp-e/QTc ratio (p=0.001) were significantly higher in the HTR group compared with the CS and normal control participants. CONCLUSION: The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were elevated in stable HTRs compared with the normal and CS groups.

Electroanatomic mapping-guided pediatric catheter ablation with limited/zero fluoroscopy.

OBJECTIVE: The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. In this study, we present the efficiency and reliability of the electroanatomic mapping system in nonfluoroscopic pediatric catheter ablation. METHODS: The medical records of patients aged <18 years who underwent ablation between November 2016 and April 2018 were evaluated. Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture or retroaortic approach/coronary angiography. RESULTS: A total of 76 patients underwent catheter ablation for 78 supraventricular and ventricular tachyarrhythmia substrates under the guidance of EnSite Velocity system. Fluoroscopy was used in only 14 (18.4%) of these substrates. The mean fluoroscopy duration in these 14 procedures was 5.4±3.15 min. No complications were noted, except a temporary right bundle branch block in one patient and pericardial effusion in another following cryoablation. The acute success rate in achieving complete elimination of arrhythmia substrates was 97.4% (76/78). The recurrence rate was 5.1% (4/78) at follow-up. CONCLUSION: Fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems by achieving high acute success rates and acceptable low complication rates.

Heart rate variability parameters in children with ventricular preexcitation.

INTRODUCTION: The autonomic nervous system has a regulatory effect on cardiac electrophysiology and arrhythmogenesis. We aimed to assess cardiac autonomic status using heart rate variability (HRV) parameters in children with ventricular preexcitation. METHODS: The electrocardiography, Holter monitoring, transesophageal electrophysiological study (TEEPS), and invasive electrophysiological study (EPS) results of ventricular preexcitation patients obtained over a 7-year period in our clinic were evaluated. According to the TEEPS results, patients' accessory pathway conduction was classified as adverse (n = 40) or nonadverse (n = 25). The HRV parameters of patients were compared according to tachycardia inducibility that assessed by TEEPS and EPS. Also, HRV parameters were compared in patients with adverse and nonadverse pathway conduction. Further, the HRV parameters of preexcitation patients were compared with those of healthy controls. RESULTS: LF/HF, the best measure of sympathovagal balance, was statistically higher in patients with adverse conduction than in patients without adverse conduction and controls (P  =  0.001). The LF/HF ratio was higher in ventricular preexcitation patients with inducible tachycardia than those without in EPS (P  =  0.001). In addition, the LF/HF ratio was higher in symptomatic ventricular preexcitation patients than asymptomatic ones (P  =  0.001). No difference in HRV parameters was found between preexcitation patients and controls. CONCLUSION: Autonomic tonus in patients with ventricular preexcitation may affect accessory pathway conduction properties, tachycardia inducibility, and symptomology. The indicator of sympathovagal balance, LF/HF ratio, increased in ventricular preexcitation patients with inducible tachycardia and those that were symptomatic.

Third Generation Ventricular Assist Device: Mid-Term Outcomes of the HeartWare HVAD in Pediatric Patients.

The HeartWare HVAD is a small, third generation continuous flow pump that is intracorporeally placed for support of a failing ventricle in adult patients. This device is small in size when compared to other left ventricular assist devices and can therefore be used in smaller sized pediatric patients. We present our initial experience using the HVAD as a bridge to heart transplantation in the pediatric population. We performed a retrospective, single center, nonrandomized review of 17 pediatric patients who underwent HVAD implantation between June 2013 and March 2016. The primary endpoints evaluated in this study were overall survival to heart transplantation, ongoing device support, or death. In this patient cohort, nine (53%) of 17 patients were male. The median age of the patients was 13.4 ± 3.8 (range 5-17) years. The median body surface area was 1.4 ± 0.4(0.7-2) m2 . Etiologies of heart failure requiring HVAD support were dilated cardiomyopathy (n = 8), myocarditis (n = 5) and noncompaction cardiomyopathy (n = 4). The overall mean length of HVAD support was 254 ± 298 (range 2-804) days. A successful outcome (bridge to transplant and ongoing mechanical support) was achieved in 13 patients (76.5%). Of the 13 patients, nine (69.2%) were bridged to heart transplantation and four continue to receive support (30.7%) and are eligible for transplantation. Post-transplant survival has been 100%, with a mean follow-up of 296 ± 264.5 (range 18-785) days. The most common complication was pump thrombosis (23.5%) in follow-up. Four patients (23.5%) experienced no complications. The HVAD continuous flow ventricular assist device can be safely used to bridge pediatric patients to cardiac transplantation. Favorable outcomes of this device are comparable to the adult population. This analysis demonstrated safe and effective implantation of the HVAD System in a child with a BSA of 0.7 m2 .

Transesophageal and invasive electrophysiologic evaluation in children with Wolff-Parkinson-White pattern.

BACKGROUND: Risk stratification for Wolff-Parkinson-White (WPW) pattern either by noninvasive or invasive tests is important to determine whether an ablation is necessary or not. The aim was to compare noninvasive tests and invasive studies in a pediatric WPW population. METHODS: A total of 71 WPW patients (median age 14 years [interquartile range, 11-16 years]; 43 male) underwent Holter monitoring, exercise stress test (EST), and transesophageal electrophysiological study (TEEPS). In the case of a ≤270-ms effective refractory period of accessory pathway or induction of supraventricular tachycardia using TEEPS, patients were classified as high risk and underwent invasive electrophysiological study (EPS). RESULTS: Nine of 23 patients with low risk by Holter and eight of 26 patients with low risk by EST had high risk in TEEPS. Risky TEEPS results were detected in 42 of 71 patients and those patients underwent EPS. High-risk characteristic in EPS was detected in seven of nine patients with low risk by Holter and in seven of eight with low risk by EST. Both tests yielded moderate specificity (52-69%) and negative predictive value (61-69%) according to TEEPS. CONCLUSION: Holter and EST have low predictive value in WPW risk stratification. However, TEEPS and EPS are extremely valuable in WPW risk stratification. TEEPS may reveal important and useful results for WPW risk determination, especially in small children not having undergone EPS in order to avoid its complications.

Clinical improvement and no further need of transplant after closure of PDA with transcatheter approach in an end-stage heart failure patient with hypertrabeculation.

Although heart failure is managed medically most of the time, heart transplantation is still last resort for selected end-stage heart failure patients with noncompaction cardiomyopathy. Presently described for the first time is case of pediatric patient with noncompaction cardiomyopathy who was initially referred to our hospital for heart transplant but underwent PDA repair and improved clinically without need for heart transplant.

Effect of obesity on left ventricular longitudinal myocardial strain by speckle tracking echocardiography in children and adolescents.

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 10-16 years (mean age, 13.9±2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)≥95(th) 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 SRE/A of both the septal wall (average SRE/A: 1.8±0.83 vs. 2.2±0.91, p: 0.004) and lateral wall (average SRE/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.

Assessment of cardiac functions in fetuses of gestational diabetic mothers.

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.

Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study.

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 ± 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 ≥ 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 ± 2 cm/s), peak early myocardial velocity (Am = 8.7 ± 1.3 cm/s), Em/Am ratio (1.8 ± 0.3), isovolumetric relaxation time (IVRT = 59.2 ± 8.2 ms), MPI (0.39 ± 0.03), and DI (25.5 ± 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 ± 1.2 cm/sn, 6.9 ± 0.6 cm/sn, 2.6 ± 0.2, 51.2 ± 9.6 ms, 0.34 ± 0.03, and 33.13 ± 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.

Evaluation of morphological characteristics of septal rims affecting successful transcatheter atrial septal defect closure in children and adults.

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.

[Echocardiographic evaluation of left ventricular function in normotansive obese children: a comparative analysis according to body mass index]. / Normotansif obez çocuklarda sol ventrikül fonksiyonunun ekokardiyografiyle degerlendirilmesi: Beden kütle indeksine göre karsilastirmali analiz.

OBJECTIVES: The purpose of our study was to determine structural and functional changes on left ventricular function (LV) according to body mass index (BMI) in normotansive overweight and obese children. STUDY DESIGN: Thirty normotansive overweight children (group 2; mean age: 13.2 ± 2.1 years, BMI: 25-30 kg/m²), 30 obese children (group 3; mean age: 13.3 ± 2.0 years, BMI ≥ 30 kg/m²), and 50 healthy controls (mean age: 13.2 ± 1.8 years, BMI: 18-24.9 kg/m²) were included in this study. Continuous ambulatory pressure was monitored in the obese group, while standard and pulsed wave (PW) Doppler echocardiographic examinations were evaluated in all three study groups. RESULTS: In overweight and obese children, left atrial volume, left atrial/aortic root diameter ratio, LV interventricular septum, LV posterior wall thickness, LV end-diastolic diameter and volume, and LV mass were significantly higher than those children in the control group (p<0.01). Blood pressure was within the normal range but was increased in the obese groups. Transmitral E/A and pulmonary vein (PV) systolic/diastolic velocity (S/D) ratios were decreased, but E-wave deceleration time, PVA velocities, and the end-diastolic distance from the mitral annulus to the LV apex were increased in both obese groups (p<0.05). BMI was significantly correlated with duration of obesity and LV mass (r=0.527, r=0.506, p<0.01, respectively). Significantly negative correlations were found between BMI, Mitral E/A, and PV S/D ratio (r=-0.230, r=-0.577, p<0.01, respectively). CONCLUSION: Subclinical LV myocardial dysfunction was noted in obese subgroups. Determination of diastolic dysfunction by PV PW Doppler can be useful a pre-obese period.

Analysis of maximum P-wave duration and dispersion after percutaneous closure of atrial septal defects: comparison of two septal occluders.

OBJECTIVE: Amplatzer septal occluder (ASO) is the most widely used device for closure of atrial septal defect (ASD). Figulla septal occluder (FSO) is a similar device to ASO with some structural innovations. The aim of study is to assess the maximum P-wave duration (Pmax) and dispersion (Pd) in patients who underwent ASD closure with both devices, to determine the effects of structural innovations on atrial electrical inhomogeneity. METHODS: The study is a retrospective cohort analysis. Between December 2005 and March 2010, 121 patients underwent percutaneous closure of secundum ASD were included in this study. FSO was used in 79 patients, ASO in 42 patients. Pmax and Pd were measured on the surface electrocardiography before and soon after procedure. For comparison of P-wave parameters initially and after procedure paired t-test was used. Correlation analysis was performed using Pearson correlation test. RESULTS: Pmax and Pd were significantly increased immediate after procedure (p<0.001). In FSO and ASO group pre/postprocedural Pd were 38.3 ± 2.7/ 44.1 ± 2.7 msec and 37.5 ± 2.5/ 50.1 ± 2.2 msec respectively. ASO group had a greater postprocedural Pmax and Pd (p<0.001). Left and right atrial disc diameter and device size were the strongest correlates of Pd (r=0.52, p<0.001; r=0.58, p<0.001; r=0.35, p=0.001, respectively). Moderate correlation was found between pre-intervention Pd and age (p=0.008). CONCLUSIONS: Pmax and Pd were significantly increased soon after atrial septal defect closure procedure in both devices. Pd is significantly lower in patients closed with FSO device. Difference may be due to the distinctive texture of devices. There was no significant difference in terms of clinically apparent arrhythmia after closure with both device types.

[Double aortic arch with dominant left arch: case report]. / Sol dominansi olan çift arkus aorta: Olgu sunumu.

A vascular ring is defined as an anomaly of the great arteries (aortic arch and its branches) that compresses the trachea or esophagus. Double aortic arch is the most common vascular ring. Double aortic arch is very rare and typically becomes symptomatic in infancy or early childhood. We present a 7-year-old girl admitted to our clinic for evaluation of recurrent respiratory infection with dysphagia. Double aortic arch was suspected from echocardiography and diagnosed with cardiac computed tomography. Left aortic arcus was larger than the right at computed tomography and cardiac catheterisation. After surgery the symptoms improved strikingly. We conclude that vascular ring should be considered in the patients presenting with recurrent pulmonary infections and dysphagia. Early diagnosis and treatment may prevent chronic, irreversible complications.