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Myopericarditis is an illness with normally favorable prognosis and mostly seen in young adults. It is known that myopericarditis can be recurrent. However, it cannot be clarified why it is recurrent. We are presenting two cases including a 16-year-old and a 17-year-old patients gone through myopericarditis for 3 times. We did a detailed research to introduce etiological reasons in two patients. We studied infectious reasons, autoimmune diseases, immunological and rheumatic diseases including mainly viral pathogens. During the myopericarditis attacks of patients, no pathological finding was identified other than being monocytosis in full blood counts, moderate sedimentation, CRP increase and raised troponin in laboratory data. We determined all viral pathogens known as agent as negative in both patients of ours. We think that patients particularly with more than one recurrent myopericarditis should be evaluated with a different perspective.

Short QT sydrome (SQT) is one of the rarely seen arythmia causes related to sudden cardiac death. An important part of the patients are diagnosed during the examination due to cardiac arrest. Therefore, diagnosing asymptomatic patients is lifesaving. In this case report, we presented a five-year old asymptomatic female patient how to put the SQT diagnosis. There was no complaint of the patient who had been directed to pediatric cardiology polyclinic due to murmur. In her electrocardiography (EKG), QTc duration was determined in lower limits. However, when the patient's family history was examined in a detailed way, suspicious deaths were recognized. In the patient's 24-hour holter EKG; SQT was diagnosed by establishing average QTc duration as 340 ms together with sharp, narrow T waves. Satolol treatment was initiated to the patient. To diagnose asymptomatic SQT patients, a decent family history must be obtained. Spot EKG is insufficient to rule out the diagnosis. All patients with suspicious death histories in their familieis must be directed to pediatric cardiologists.

D vitamini eksikliği tüm yaş gruplarında yaygın görülen bir sorundur. Pek çok sistem üzerine etkili olduğu bilinmektedir; eksikliği durumunda organ ve dokuların çalışması etkilenmektedir. D vitamini eksikliğinin kardiyovasküler sistem üzerinde de olumsuz etkisi olduğu bilinmektedir. Konjenital kalp hastalarının izlemi son derece dikkatli olarak yapılmaktadır; ancak izlemde bakılan rutin tetkikler arasında D vitamini düzeyi yer almamaktadır. Hastalar D vitamini eksikliği yönünden değerlendirilmediği için tedavi edilmemektedir. Bu çalışma konjenital kalp hastalarının D vitamini düzeylerini değerlendirmek ve izlemdeki yerini belirlemek amacıyla planlanmıştır. Gazi Üniversitesi Tıp Fakültesi Çocuk Kardiyoloji Bilim Dalında izlenen 42 (%54,5) kız, 35 (%45,5) erkek, ortalama yaşları 105±59 ay olan 77 konjenital kalp hastalıklı çocuk değerlendirilmiştir. En sık görülen hastalıklar sırasıyla ASD, VSD ve FT'dir. D vitamini düzeyi ortalaması 19,6±10,9 ug/L olup, hastaların 66 hastada (%85,7) yeterli düzeyin altında bulunmuştur. D vitamini eksik veya yetersiz olan 66 hastadan 40'ı araştırmaya alınmıştır. Hastaların Ross kalp yetmezliği skoru, D vitamini, PTH, kalsiyum, fosfor, ALP, tam kan sayımı ve EKO' ları değerlendirilmiştir. Araştırmaya alınan hastaların D vitamini ortalaması 16,4±6,6 ug/L'dir. Hastalara D vitamini tedavisi başlanıp üç ay sonra Ross skoru, D vitamini, PTH, kalsiyum, fosfor, ALP, tam kan sayımı ve EKO' ları tekrar değerlendirilmiştir. Tedavi sonrası D vitamini düzeyi ortalaması 27,5±9,9 ug/L olmuştur. İstatistiksel olarak anlamlı şekilde PTH düzeyi ve BK sayısında düşüş; PLT sayısı ve IL-10 düzeyinde artış saptanmıştır. EKO bulgularından EF'de artma ve RVMPI' da azalma sağlanmıştır. Proinflamatuar bir belirteç olan PTH düzeyinde azalma, antiinflamatuar bir sitokin olan IL-10 düzeyinde artma ve BK sayısında düşüş görülmesi D vitamininin anatiinflamatuar etkisini göstermiştir. EF'de artış sol ventrikülün kasılmasında iyileşme; RVMPI'da azalma sağ ventrikülün sistolik ve diyastolik fonksiyonlarında iyileşme sağlandığını kanıtlamıştır. D vitamini eksikliği olan hastalara verilen D vitamini tedavisi ile kalp üzerinde olumlu etki sağlandığı gösterilmiştir. Konjenital kalp hastalarının rutin izleminde yaşam kalitesinin artırılması için D vitamini düzeyi mutlaka değerlendirilmeli ve eksiklik saptanması durumunda tedavi verilmelidir. VITAMIN-D LEVELS OF CHILDREN WITH CONGENITAL HEART DISEASE AND ITS SIGNIFICANCE DURING FOLLOW-UP Vitamin D deficiency is a common problem that can be seen in all age groups. It has known impacts on lots of systems; organs and tissues are affected by vitamin-D deficiency. It is also known that Vitamin-D deficiency has adverse effects on cardiovascular system. Follow-up of patients with congenital heart disease are performed very attentively, yet vitamin-D level is not one of the routine measurements during the follow-up of patients. Disease cannot be treated since vitamin-D level of patients is not taken into consideration for evaluations. This study is conducted to follow-up vitamin-D levels of patients with congenital heart disease and evaluate its significance during follow-up. 77 children patients, 42 (54,5%) girls and 35(45,5%) boys, with congenital heart disease who was being followed in Department of Cardiology in Gazi University Medical Faculty was evaluated. The most common diseases were ASD, VSD and FT, respectively. Average Vitamin-D levels were measured as 19,6±10,9 µg/L and it was found below the sufficient level in 66(85,7%) of patients. 40 of the 66 patients with insufficient Vitamin-D level were involved into research. Ross heart failure classification, Vitamin-D levels, PTH, Calcium, Phosphor, ALP, complete blood cell count and ECHO of patients were evaluated. Average Vitamin-D level of patients involved in the research was 16,4±6,6 µg/L. Patients were prescribed to use Vitamin-D and same evaluations, Ross heart failure classification, Vitamin-D levels, PTH, Calcium, Phosphor, ALP, complete blood cell count and ECHO, were performed at the end of 3-month Vitamin-D treatment. Average Vitamin-D level of patients was increased to 27,5±9,9 µg/L. Statistically significant differences were observed as decrease in the PTH level and WBC count, increase in PLT count and IL-10 level. Regarding to ECHO results, increase in EF and decrease in RVMPI level was measured. Decrease in PTH (proinflammatory indicator) level, increase in IL-10(anti-inflammatory cytokine) level and decrease in WBC count shows the anti-inflammatory effects of Vitamin-D. Increase in EF proves recovery of contraction of left ventricles; and decrease in RVMPI proves improvement of systolic and diastolic functions of right ventricles. In conclusion, Vitamin-D treatment administered to patients with Vitamin-D deficiency results in improvements on cardiac functions. Therefore, it is suggested to measure and evaluate Vitamin-D levels during follow-up of patients with congenital heart disease and Vitamin-D treatment should be administered in case deficiency exists in order to improve quality of life.

Amaç: Çalışmada antrasiklin kullanılarak tedavi edilmiş pediatrik kanser hastalarının uzun dönem takiplerinde görülebilen subklinik kardiyotoksisite ile fonksiyonel egzersiz kapasitesi arasındaki ilişki incelenmiştir.Gereç ve Yöntemler: Kemoterapi tedavisi 9-16 yıl önce tamamlanmış ve kalp yetmezliği bulguları olmayan 16 hasta ile 16 sağlıklı kontrol çalışmaya alındı. Ejeksiyon fraksiyonu, fraksiyonel kısalma ve miyokardiyal performans indeksi ölçümleri ekokardiyografik olarak alındı. Subklinik kardiyotoksisite açısından miyokardiyal performans indeks sınırı 0.37 olarak kabul edildi. Fonksiyonel egzersiz kapasitesi 6-dakika yürüme testi ile değerlendirildi.Bulgular: Hastaların miyokardiyal performans indeks değerleri belirgin olarak kontrol grubundan daha yüksek saptandı (p, Objective: We aimed to evaluate the functional exercise capacity and its relation to echocardiographic measurements in pediatric cancer survivors who were treated with anthracyclines.Material and Methods: Sixteen patients who completed chemotherapy 9-16 years ago and who have no symptoms of heart failure were enrolled in the study, together with 16 healthy subjects. Ejection fraction, fractional shortening, and myocardial performance index were calculated by echocardiographic evaluation. Patients with a myocardial performance index > 0.37 were accepted as having subclinical cardiotoxicity. Functional exercise capacity was evaluated by the sixminute walk test. results: Patients had significantly higher values of myocardial performance index than control subjects (p < 0.001). The six-minute walking distance was found to be lower in patients than that of the control subjects (p= 0.02). Furthermore, in patients with subclinical cardiotoxicity, the difference was more significant (p= 0.001). Six minute walking distance and myocardial performance index were well correlated with each other (r= -0.6 p= 0.03) and with cumulative anthracycline dosage (r= -0.6 p= 0.04 and r= 0.6 p= 0.02 respectively).conclusion: Long-term pediatric cancer survivors may have subclinicalcardiotoxicity despite having no clinical symptoms. Patients with subclinical cardiotoxicity should be taken into account for having impaired functional exercise capacity and correspondingly low quality of life. Six-minute walk test could be a useful indicator for subclinical cardiotoxicity since it is well correlated with myocardial performance index

To describe the epidemiology and geographical distribution of congenital heart disease. A retrospective population-based study was conducted using data collected in a large tertiary care hospital in Turkey. Materials and methods: The medical records of 1300 patients with congenital heart disease admitted to the Gazi University Department of Pediatric Cardiology for catheter angiography from 1997-2007 were reviewed. The patients were divided into 7 groups according to geographical distribution, and each group was further divided into 2 groups, for simple (group 1) and complex (group 2) congenital heart disease. Results: Among the 1300 cases, there was no difference between the regions regarding mean age, mean diagnostic age, and female/male (F/M) ratio. In 3 regions that have similar geographic and climatic features, a high incidence of complex cardiac malformations was observed (P < 0.05). Conclusion: This is the first epidemiological study of the distribution of congenital heart disease in Turkey. Although etiological data is not sufficient to explain the findings, this study may play an important role in further prospective studies about this issue.

Demir eksikliği anemisi, gelişmekte olan ülkelerin en sık görülen halk sağlığı sorunudur. Demir eksikliği yetersiz beslenme göstergesidir; bilişsel fonksiyonları, motor kapasiteyi ve öğrenme becerisini olumsuz etkilemektedir. Bu çalışmada asiyanotik KKH olan çocukların nörogelişimsel izleminde Türkiye'de sık görülen DE, DEA ve tedavisinin bilişsel ve motor fonksiyonlara etkisinin gösterilmesi planlanmıştır. Gazi Üniversitesi Tıp Fakültesi Çocuk Kardiyolojisi Bilim Dalı Polikliniğine 02.05.2013 ile 23.08.2013 tarihleri arasında başvuran asiyanotik KKH tanısı almış 132 olgunun katılımıyla gerçekleşmiştir. Tam kan sayımı, serum demir, demir bağlama kapasitesi, transferin saturasyonu ve ferritin düzeyleri ölçülmüştür. Ferritin Düşük olgulara 4mg/kg oral demir tedavisi verilmiş; tedavi öncesi ve sonrası psikometrik testler ve büyüme parametreleri ile değerlendirilmiştir. Ferritin Normal Grup 58(%43,9) olgu, Ferritin Düşük Grup 74 [ DE Grup: 53 (%40,2) ve DEA Grup 21 (%15,9)] olgudan oluşmaktadır. Olguların boy, kilo, baş çevresi 3-97 persentil arasındadır. Kilo ortalaması ferritine göre değerlendirildiğinde başvuru anında anlamlı fark saptanmamıştır; ancak iki yaş altı Ferritin Düşük grup tedavisi sonrası ortalama kilosu Normal gruptan anlamlı yüksektir. DEA grubu kilosu DE grubundan anlamlı düşüktür. Tedavi sonrası her iki grupta kilo artışı olup DEA grup kilosu tedavi sonrası da düşük kalmıştır. Psikometrik testler ile olguların %84'ü normal aralıkta bulunmuştur. Kişisel Sosyal, Dil, İnce ve Kaba Motor Gelişim alanı değerlendirmesinde ferritine göre gruplar arasında anlamlı fark saptanmamıştır. Ferritin Düşük grup psikometrik testler ile değerlendirildiğinde tüm yaş gruplarında DEA grubu psikometrik test puanları DE grup puanlarından düşük saptanmıştır. Demir eksikliği ve DEA gruplarında Tedavi öncesi-sonrası psikometrik test puan karşılaştırması yapıldığında iki yaş altı olgularda anlamlı puan artışı görülürken iki yaş üstü olgularda tedavi sonrası anlamlı puan artışı saptanmamıştır. Bu sonuçlar özellikle iki yaş altındaki KKH olan çocukların DE ve DEA açısından incelenmesi gerektiğini düşündürmektedir. Böylece bilişsel ve hareket gelişim alanlarında erken dönemde oluşabilecek etkilenmeler düzeltilebilecektir. In developing countries iron deficiency anemia(IDA) is the most common public health problem. Due to iron deficiency as indication of malnutrition, cognitive functions, learning capacity and motor skills are adversely affected. In this study we aimed to show affects of iron deficiency anemia and oral iron therapy on cognitive and motor functions of children with acyanotic congenital heart disease. A hundred and thirty-two children diagnosed as acyanotic congenital heart disease by Gazi University Medical Hospital Pediatric Cardiology Department between the dates 2/5/2013 and 23/8/2013 were included in this study. We analyzed complete blood count, serum iron level, transferin saturation and serum ferritin levels of patients. We supplied 4mg /kg of oral iron to patients with low serum iron levels and we evaluated patients with growth charts and psychometric tests before and after treatment with iron therapy. We divided cases in 3 groups as; Normal iron level group 58 (%43,9), Low iron level 74 [ iron deficiency(ID) Group: 53 (%40,2), IDA Group: 21 (%15,9)]. According to growth charts, weight, height and head circumference percentils of cases were between 3 and 97 percentils. When evaluated according to ferritin, no difference was found in weight averages, but in group aged smaller than 2 years with low ferritin level, average weight was found significantly high than group Normal group after treatment with iron. Average weight IDA group was significantly lower than ID group. After iron treatment iron we obtained weight gain in both groups but, weight remained low after treatment in IDA group. According to psychometric tests 84 % of cases were found in the normal range. According to ferritin levels we found no statistically significant difference betweeen groups in personal, social, language, fine and gross motor development. Considering the low ferritin group in their own, IDA scores in all age groups were lower than ID scores. Treatment of iron deficiency and IDA group pre-post comparison with psychometric test scores under the two cases observed a significant increase in scores In cases older than 2 years did not appear to increase significantly after treatment scores. This results in children with congenital heart disease suggest that especially under two years of age should be examined in terms of ID and IDA. Thus, the development of cognitive and movement of affected areas may be corrected at an early stage that may occur.

Siyanotik doğuştan kalp hastalarında arteriyel oksijen saturasyonunun düşük olması nedeniyle sekonder eritrositoz görülmektedir; hastaların Hb, Hct düzeyleri yaş gurubuna göre beklenenden yüksek değerlerdedir. Sekonder eritrositozun doğal bir sonucu olarak hastalarda demir tüketimi artmıştır. Siyanotik doğuştan kalp hastalarında demir eksikliği sık görülen bir durum olup hastaların izleminde demir tedavisi sıklıkla önerilmektedir. Ancak demir tedavisi ile birlikte hastalarda Hb, Hct düzeyleri de artmaktadır. Siyanotik doğuştan kalp hastalarında en önemli klinik sorunlardan biri olan hiperviskozite yüksek Hb ve Hct düzeyleri ile doğrudan ilişkilidir. Bu çalışma siyanotik doğuştan kalp hastalarında demir tedavisinin viskozite üzerindeki etkisini araştırmak amacı ile planlanmıştır. Gazi Üniversitesi Tıp Fakültesi Çocuk Kardiyoloji Bilim Dalında izlenen 20(%51) kız, 19(%49) erkek, ortalama yaşları 9,9 ± 6,2 yıl, ortalama ağırlıkları 33 ± 18,4 kg olan 39 siyanotik doğuştan kalp hastalıklı hasta değerlendirilmiştir. Hastalar ferritin düzeylerine göre demir eksikliği olan ve olmayan iki guruba ayrılmış; demir eksikliği saptanan guruba 4 mg/kg/gün dozda iki değerlikli demir tedavisi 3 ay süre ile uygulanmıştır. Demir eksikliği saptanmayan guruba ise herhangi bir tedavi verilmemiştir. Her iki gurubun da başlangıçta ve üç ay sonra klinik ve laboratuvar bulguları değerlendirilmiş, viskozite ölçümleri yapılmıştır. Otuzdokuz hastanın 21(%53,8)?inde demir eksikliği saptanmıştır. demir eksikliği ile MCH, MCV düşüklüğü ve RDW yüksekliği arasında korelasyon bulunmuştur. Üç ay süre ile demir tedavisi uygulandıktan sonra hastaların Hb ve Hct değerlerinde artış olmasına karşın viskozite değerlerinde artış görülmemiştir. Demir tedavisinden sonra hastaların hiperviskozite semptomlarında azalma, ortalama oksijen saturasyonlarında ise artış görülmüştür. Bu çalışma siyanotik doğuştan kalp hastalığı olan çocuklarda demir tedavisinin gerekli ve güvenli olduğunu göstermiştir. Demir eksikliği olmayan hastaların 3 ay sonra yapılan kontrol değerlendirmelerinde ise; demir eksikliği anemisi gelişmese bile Hb, Hct, serum demir, ferritin düzeylerinin anlamlı olarak düştüğü görülmüştür. Bu sonuç hastaların izleminde idame dozdan demir desteğini gündeme getirmelidir. Secondary erythrocytosis is seen in cyanotic congenital heart disease (CCHD) patients which leads Hb and Hct levels to be above the expected values. Iron consumption is increased as a natural result of secondary erythrocytosis. Iron deficiency is a common problem and supplementation is frequently recommended during follow-up. Levels of Hb and Hct also increases with iron replacement therapy and hyperviscosity, one of the most importatnt clinical problems of CCHD is directly related with elevated Hb and Hct levels. This study was designed to evaluate the effects of iren supplementation on viscosity in CCHD. Thirty nine CCHD patients 20 girls (51 %) and 19 boys (49%), followed up in Gazi University Department of Pediatric Cardiology with mean age 9,9 ± 6,2 years and mean wight 39 33 ± 18,4 kg were evaluated. Patients were divided into two groups according to their ferritine levels as iron deficient and non-iron deficient, and 4 mg/kg/day Fe +2 therapy was applied for 3 months. Non-iron deficient group were not given any therapy. Clinical and laboratory findings of both groups at the beginning of the study and after 3 months were evaluated and viscosity measurements were performed. Iron deficiency was detected in 21 out of 39 patients (53,8 %) and a correlation was found between iron deficiency, low MCH-MCV and high RDW values. Although Hb and Hct levels increased after 3 month therapy, no increase in viscosity was detected. Hyperviscosity symptoms decreased after iron supplementation and average oxygen values of patients have increased. This study showed iron replacement therapy is essential anf safe in pediatric CCHD. Follow up after 3 months of non-iron deficient group showed signifiicant decrease in Hb, Hct and ferritine levels although iron deficiency anemia did not occur. This situation supports the importance of iron supplementation in CCHD.

Introduction and Objective: The present study aims to quantitatively evaluate the right ventricle (RV) function by means of transthoracic echocardiography in normal children and childhood congenital heart disease patients with pulmonary hypertension. Patients and Methods: This study was conducted in a cohort including 40 healthy children and 30 pediatric patients with pulmonary hypertension who were diagnosed under close surveillance at the study center between October 2009 and November 2010. Results: Statistically significant differences were found between the patient and control groups for the right ventricle myocardial performance index (RVMPI) , the left ventricle myocardial performance index (LVMPI), the tricuspid valve systolic flow velocity (Ts), the ratio of systolic pulmonary artery pressure to the right ventricle outflow tract systolic flow velocity time integral (sPAP/RVOT VTI), and the ratio of systolic pulmonary artery pressure to right ventricle outflow tract systolic flow velocity time integral X heart rate (sPAP/[RVOT VTI x HR]). When the children were divided into three groups based on their pulmonary vascular resistance significant differences emerged that predicted an increasing severity of RV dysfunction. Significant differences were also observed for the RVMPI, the LVMPI, and the Ts as well as for echocardiographic pulmonary flow (Qp) and systemic flow (Qs). Discussion: The present study demonstrates that echocardiographic parameters can be used for the quantitative detection of RV dysfunction in childhood congenital heart disease patients with high pulmonary artery pressure (systolic, diastolic, and mean) or pulmonary vascular resistance. ( Echocardiography 2012; 29: 840-848)

WOS: 000298589000046 PubMed: 21810152 Background: The aim of this study was to assess the prevalence of persistent left superior vena cava (PLSVC) in patients with all types of congenital heart defects and to determine the congenital heart anomalies accompanying PLSVC. Methods: The present study is based on a retrospective review of 1205 children who consecutively underwent cardiac catheterization from 2000 to 2007. In order to determine the existence of PLSVC, all the subjects routinely underwent superior vena cava (SVC) injection during angiography at the catheter laboratory of the study center. Results: The prevalence of PLSVC was computed to be 6.1% for the present study population. Transthoracic echocardiography was able to detect PLSVC in 32 children (2.6%) whereas angiography diagnosed PLSVC in 74 children (6.1%). The mean age of the patients with PLSVC was 40.09 +/- 50.21 months. A communication between the right and left SVC was determined in 27% of the children who were diagnosed with PLSVC after angiography was performed (20 out of 74). A statistically significant association was present between PLSVC and other congenital cardiac anomalies, including ventricular septal defect (n = 42, 56.8%), atrial septal defect (n = 31, 41.9%), pulmonary stenosis (n = 19, 25.7%), atrioventricular septal defect (n = 10, 13.5%), patent ductus arteriosus (n = 6, 8.1%) and cor triatriatum (n = 3, 4.1%). Conclusion: Transthoracic echocardiography usually visualizes dilated coronary sinus in association with PLSVC. However, SVC injection should be performed in patients undergoing angiography so that morbidity and mortality related with persistent left superior vena cava can be avoided during cardiovascular surgery.

Isolated congenital heart block, frequently seen in mothers who have connective-tissue disease, can be transmitted to the fetus through transplacental passage of anti-Ro/SSA and anti-La/SSB autoantibodies. Even if the antibodies appear transiently in the fetal circulation, the block is permanent and can require pacemaker implantation. Complete congenital heart block is seen in 1% to 5% of neonates born to mothers who carry these autoantibodies. Herein, we report the case of a baby born to a 31-year-old asymptomatic woman who manifested congenital heart block in utero, at 30 weeks of gestation. During gestation and following birth, no further problems were detected. At her last follow-up appointment, 8 years later, the girl still had no clinical symptoms, and exercise increased her heart rate despite complete heart block. We report this case for its unique presentation, and we discuss isolated congenital heart block within the context of the inadequate literature on its pathogenesis and treatment. (Tex Heart Inst J 2010;37(5):579-83)