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Biomedical subjects

S Ozkutlu

Publications and source records attributed to S Ozkutlu.

At least 55 records · Page 3Linked to original sources
PubMed1990

Detection of right-sided endocarditis in children with congenital heart disease by two-dimensional echocardiography.

Right-sided endocarditis is rare in children. Since the clinical picture is nonspecific and the frequency of sterile blood cultures is high, the clinical and laboratory diagnosis is difficult. Recent reports suggest that echocardiography is a useful method to detect the presence of right-sided endocarditis. We studied 8 patients with congenital heart disease and right-sided endocarditis detected by two-dimensional echocardiography. All the patients were shown to have one or more vegetations in the two-dimensional echocardiographic examination. The 4 patients who did not respond to antibiotic therapy underwent elective cardiac surgery. One of these patients additionally had recurrent emboli to the lungs. Another of these 4 patients died during surgery due to myocardial failure. Apart from these 4 cases, urgent surgical intervention had to be carried out in 2 cases because of very large vegetative masses. Surgical confirmation of the diagnosis was available in all 6 cases. According to these results, we can conclude that two-dimensional echocardiography assumes a specific diagnostic role in cases with right-sided endocarditis.

Child↗
PubMed1990

Cardiomyopathies in children. Clinical, epidemiological and prognostic evaluation.

In this article, the clinical and epidemiological characteristics of 137 children with cardiomyopathy admitted to the Hacettepe Pediatric Cardiology Unit were studied and the prognosis was evaluated after a follow-up period of 24 +/- 5 months. It was found that the highest proportion of patients were residents of Ankara, followed by the Northern and the Central Anatolian regions, and consanguinity between their parents was more common than the proportion for Turkey as a whole. Most of the patients had dilated cardiomyopathy (78.9%) and the age at which symptoms appeared varied according to the type of cardiomyopathy. A high proportion of patients came to the hospital with complaints of dyspnea and a decrease in effort capacity. The most common findings on the physical examination were hepatomegaly and tachycardia. Electrocardiographic and echocardiographic evaluations were made for all patients and cardiac catheterization and endomyocardial biopsy were performed when necessary. The outcome was as follows: 34.5% improved, 45.7% remained stable, 9.5% deteriorated and 10.3% died.

Adolescent↗
PubMed1989

Fatal mumps myocarditis.

The case of a 9 year old boy with acute renal failure and myocarditis as complications of mumps is reported. The cardiac rhythm and conduction disorders which appeared after admission were refractory to treatment and the outcome was fatal. On necropsy, minimal interstitial nephritis and myocarditis were seen, confirming the clinical diagnosis.

Acute Kidney Injury↗
PubMed1989

Two-dimensional contrast echocardiography in pulmonary arteriovenous fistula.

Definitive clinical diagnosis of congenital pulmonary arteriovenous fistula is extremely difficult. In order to evaluate the diagnostic value of echocardiography, 2 cases with suspected pulmonary arteriovenous fistula were studied. In the first case, there was a solitary pulmonary arteriovenous fistula, while in the second multiple minute pulmonary arteriovenous fistulas were illustrated. The solitary lesion was demonstrated by two-dimensional and peripheral vein contrast echocardiography. However, in the second case direct visualization of the lesion was not possible but peripheral vein contrast echocardiography showed abnormal filling of the left atrium with echo contrast material.

Angiocardiography↗
PubMed1988

Balloon atrial septostomy using echocardiographic monitoring.

Six patients with d-transposition of the great arteries and 1 patient with tricuspid atresia were diagnosed echocardiographically. Balloon atrial septostomy (BAS) was performed successfully in all cases with the aid of two-dimensional echocardiography. Echocardiography may be superior to fluoroscopy during BAS because it permits easy detection of spontaneous passage of the inflated catheter into the left ventricle spontaneously through the mitral valve (like a left atrial myxoma). With the visualization of related cardiac structures during BAS, obstruction of the IVC with the balloon was also prevented. Using this method, bedside application of BAS is possible.

Catheterization↗
PubMed1988

Echocardiographic diagnosis of congenital left ventricular-right atrial communication.

The clinical diagnosis of congenital left ventricular-right atrial (LV-RA) communication is difficult. Echocardiography appears to be a useful method in the diagnosis of this congenital cardiac defect. In previous reports authors have described M-mode echocardiographic findings of this anomaly. We present here two-dimensional echo findings in a patient with congenital LV-RA communication. A 12 year old boy presented the following echocardiographic findings. A perimembranous septal defect and an abnormal tricuspid septal leaflet were seen. The defect was located at the membranous atrioventricular septum, resulting in a communication between the RA and the LV. Pulsed Doppler echocardiography demonstrated turbulent flow through the defect during systole, suggesting an LV-RA communication. M-mode echo examination of the septal tricuspid leaflet revealed systolic fluttering of the tricuspid valve. Peripheral vein contrast echocardiography showed passage of the echo contrast material from the RA to the LV (positive contrast effect). At the same time there was a negative contrast effect during ventricular systole, indicating a left to right shunt from the LV to the RA. After surgical repair of the anomaly, systolic flutter of the tricuspid valve and the other findings disappeared echocardiographically, as they did in the other reported cases. We can conclude that two-dimensional echocardiography with M-mode evaluation is a reliable method for the diagnosis of congenital LV-RA communication, and that this method should be applied to all cases where this anomaly is suspected clinically.

Child↗
PubMed1986

[Treatment of infectious endocarditis with trimethoprim-sulfamethoxazole and cardiac surgery].

A 12 year old boy was admitted to hospital with fever, general malaise, cough and peripheral edema. The patient who have had rheumatic heart diseases-mitral insufficiency was found to be in congestive cardiac failure. In blood cultures Staphylococcus aureus and Alpha-hemolytic streptococcus grew. The regimens of Cephalothin-Gentamicin, Methicillin-Tobramicin, to which the organism were sensitive were given intravenously. On these therapy the patient continued to have fever. He was put on Trimethoprim-Sulfomethoxazole intramuscularly. He became afebril for the first time. After two weeks fever recurred. In spite of medical treatment, the infection persisted and the indication for surgery was considered. Mitral valve replacement with a Starr-Edwards prosthesis was carried out. Postoperatively, the patient was treated with TMP-SMZ. For the past 10 months the patient has remained afebril and without evidence of congestive heart failure.

Child↗
PubMedDate not supplied

Parameters of iron deficiency in children with cyanotic congenital heart disease.

A group of 67 children with cyanotic congenital heart disease (CCHD) were studied, and 35 were given iron treatment according to a regimen that gives iron to patients with a hematocrit (Hct) below 60%. The patients were categorized as iron-deficient and iron-sufficient according to their transferrin saturation and ferritin values. The pretreatment hemoglobin (Hb) and Hct values of the groups were similar. The mean Hct was nearly three times as much as the mean Hb in the iron-sufficient group and more than three times as much as the Hb in the iron-deficient group. Excessive erythrocytosis in the iron-deficient group was impressive. Mean corpuscular volume (MCV) values were below 72.7 fl in all of the iron-deficient patients. After treatment the Hb, Hct, transferrin saturation, and ferritin increased significantly in both groups, with the increments greater in the iron-deficient group. Increments in the erythrocyte (RBC) count were significant in the iron-sufficient group but insignificant in the iron-deficient one. Increments of MCV in the iron-deficient group were significant but insignificant in the iron-sufficient group. Our study demonstrated that prediction of Hb, RBC count, and MCV, measurements of which are easy and inexpensive and require little blood, can suffice for the diagnosis of iron deficiency in patients with CCHD without altering systemic perfusion.

Anemia, Hypochromic↗
PubMedDate not supplied

Noonan syndrome with double-chambered right ventricle.

The association of Noonan syndrome and a double-chambered right ventricle has not been reported previously in the medical literature. We report two patients with Noonan syndrome associated with pulmonary valve stenosis and double-chambered right ventricle due to anomalous hypertrophied muscle bundles. Pulmonary valve stenosis was operated on. However, hypertrophied muscle bundles were not resected, as they caused no obstruction to blood passage. Postoperative follow-up examinations revealed no symptoms. In conclusion, in those with Noonan syndrome there may be anomalous muscle bundles in the right ventricular cavity. It may not be necessary to resect them if they do not obstruct the right ventricular outflow tract.

Adolescent↗
PubMedDate not supplied

A case of superoinferior ventricular heart with situs ambiguus, dextroventricular loop, and levo transposition of the arteries: prenatal and postnatal echocardiographic diagnosis.

A unique case of superoinferior ventricles, left atrial isomerism, concordant atrioventricular connection, and discordant ventriculoarterial connection is described. The associated anomalies were azygous vein continuation, large subpulmonary and apical ventricular septal defects, and left ventricular outflow tract obstruction (pulmonary stenosis). The diagnosis was mostly made by fetal echocardiography and the superoinferior location of the ventricles was confirmed by postnatal echocardiography. Fetal and postnatal echocardiography facilitated the precise morphologic diagnosis and segmental analysis of this defect.

Abnormalities, Multiple↗
PubMedDate not supplied

Echocardiography for the diagnosis of congenital cardiac anomalies with multiple lesions.

The purpose of this study was to determine the sensitivity and specificity of echocardiography for the diagnosis of congenital cardiac abnormalities with multiple lesions. The study was carried out on 80 patients (ages 1 day to 14 years). After clinical evaluation all patients were studied by echocardiography. Cardiac catheterization and angiocardiography were performed, and echocardiographic findings were compared with those obtained by cardiac catheterization. The sensitivity and specificity of echocardiographic diagnosis were determined based on the false-negative and false-positive results. Of the 80 patients, 19 had double-outlet right ventricle, 17 transposition of the great arteries, 10 common atrium, 9 atrioventricular septal defect, 7 single ventricle, 7 corrected transposition, 6 tricuspid atresia, 3 Ebstein's anomaly, and 2 cor triatriatum. All of these entities were visualized correctly by echocardiography (sensitivity 100%, specificity 100%). There were also 12 instances of atrial isomerism with one false-negative diagnosis, 6 pulmonary atresia with two false-negative diagnoses, and 5 total anomalous pulmonary venous connections with one false-negative diagnosis. The total number of individual cardiac lesions was 291. Nineteen false-negative and four false-positive echocardiographic diagnoses were obtained (sensitivity 93%, specificity 99%). It is concluded that double-outlet right ventricle, transposition of the great arteries, atrioventricular septal defect, single ventricle, corrected transposition, and tricuspid atresia can be accurately diagnosed by echocardiography. However, the role of echocardiography is limited for evaluation of right ventricular outflow tract and small patent ductus arteriosus, especially when associated with pulmonary hypertension.

Adolescent↗
PubMedDate not supplied

The accuracy of antenatal fetal echocardiography.

The purpose of this study was to evaluate our experience with a group of patients who were either selected by us or referred by an obstetrician or geneticist with the indication of fetal echocardiography. This prospective study was done on 128 cases between 1996-1998. Maternal age range was between 16 and 41 years (mean: 28.79). Gestational age range was between 15 and 37 weeks (mean: 26). In the postnatal period the newborn babies were reevaluated for cardiovascular system abnormalities by physical examination, ECG, telecardiogram and, if it was necessary, by echocardiography, cardiac catheterization and angiography. By comparing prenatal and postnatal findings, sensitivity and specificity of fetal echocardiographic diagnosis were determined. Among the total cases studied, nine had major congenital heart disease in postnatal evaluation. Two cases had false negative; there were no false positive prenatal diagnoses. Sensitivity of echocardiographic diagnosis was 100 percent and specificity 78 percent. Three patients had paroxysmal atrial tachycardia and two atrioventricular block We concluded that the fetal echocardiography is a very useful technique in the evaluation of the fetal cardiovascular system. However, awkward fetal position, severe maternal obesity, and technologic insufficiency of the echo machine may result in unfavorable scanning conditions. Minuteness of anomaly may also result in a false negative prenatal evaluation.

Adolescent↗
PubMedDate not supplied

The angiocardiographic analysis of 73 patients with double-outlet right ventricle.

The purpose of this study was to determine the cardiac anatomy of patients with double-outlet right ventricle by angiocardiography. A total of 73 patients between the ages of one day and 11 years were examined. The aorta was on the right side of the pulmonary artery in 23 cases (32%), right anterior in 20 (27%) and right posterior in 17 cases (23%). Pulmonary stenosis was found in 53 patients (73%) and subaortic stenosis in six cases. Ventricular septal defect (VSD) was subaortic in 39 cases (52%), remote type in 17 (23%), doubly committed in 10 (13%), and subpulmonic in 9 (12%). Double VSD was noted in two patients. Pulmonary hypertension was more frequent in subpulmonic ventricular septal defect (78%). The most common associated anomalies were atrial septal defect (34%), anomalous coronary arteries (12%) and endocardial cushion defect (10%). Aortic root angiography was not satisfactory in half of the cases with coronary arterial anomaly. In conclusion, double-outlet right ventricle is a complex anomaly, all of whose cardiac features can be successfully demonstrated in detail by echocardiography and angiocardiography. However, in order to determine the anatomy of the coronary arteries, selective coronary angiography may be necessary in some patients.

Angiocardiography↗
PubMedDate not supplied

Ventricular diastolic filling indices in pulmonary stenosis.

Children with valvar pulmonary stenosis have right ventricular diastolic filling abnormalities that may be due to either right ventricular hypertrophy or right ventricular outflow obstruction. In order to investigate the reason for this abnormality, 23 consecutive cases with pulmonary stenosis (mean age 7.94 +/- 3.33 years) undergoing transluminal pulmonary balloon valvuloplasty without significant tricuspid or pulmonary valvar regurgitation were studied prospectively. Right ventricular diastolic filling indices and pulmonary valvar systolic gradients were measured in these children one day before and after pulmonary balloon valvuloplasty and were re-examined six months later. Right ventricular diastolic indices based on rapid early diastolic filling peak velocity (peak E), peak velocity during atrial contraction (peak A), and ratio of E/A were determined by pulsed Doppler echocardiography. In conclusion, right ventricular diastolic filling indices in patients with pulmonary stenosis did not improve after pulmonary balloon valvuloplasty in the first day but when re-examined by the sixth month there was a significant improvement. These data suggest that diastolic filling abnormalities are more likely a result of right ventricular hypertrophy than of right ventricular outflow obstruction.

Adolescent↗
PubMedDate not supplied

Unguarded tricuspid orifice diagnosed by echocardiography: a clinical study.

Complete absence of tricuspid valve tissue and apparatus with a normal orifice between the right atrium and the right ventricle is defined as "unguarded tricuspid orifice". Very few case report of this anomaly have appeared in the literature. In this article, we present five cases of unguarded tricuspid orifice, isolated or in combination with other anomalies. All patients were males, aged six days to five years; only one case is alive at present. In our opinion, this anomaly is not so infrequent as it is believed to be, and the diagnosis can be made easily with echocardiography if it is kept in mind.

Child, Preschool↗
PubMedDate not supplied

Transcatheter closure of secundum atrial septal defects, a ventricular septal defect, and a patent arterial duct.

We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.

Adolescent↗