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    Arrhythmias in children undergoing orthotopic heart transplantation
    (Frontiers Media Sa, 2024) Dogan, Eser; Ergin, Firat; Beyter, Mehmet B.; Kasikci, Guelcin K.; Oen, Seyma S.; Ay, Oguzhan; Levent, Resit E.
    IntroductionHeart transplantation (HT) is the only treatment option in children with heart failure secondary to cardiomyopathies and non-reparable congenital heart diseases.MethodsWe performed a retrospective clinical data review of all consecutive pediatric patients (aged 2-18 years) who underwent orthotopic HT for advanced heart failure at our institution between January 2007 and January 2023. Clinical, procedural, and follow-up data were collected and comprehensively analyzed.ResultsWe identified 27 children (66.7% males) with a median age of 15 years (IQR: 7-16) and a median weight of 45 kg (IQR: 22-66) at the time of the intervention. 24 patients (88.8%) were diagnosed with dilated cardiomyopathy, 2 (7.4%) with restrictive cardiomyopathy, and 1 (3.7%) with hypertrophic cardiomyopathy. On a median follow-up of 35.07 months (IQR: 13.13-111.87), arrhythmias were detected in 9 (33%) patients. Three patients developed symptomatic sinus node dysfunction at 18, 25, and 38 days and received permanent pacemakers. One patient developed a complete AV block during acute rejection at 76 months and received a temporary pacemaker. Two patients developed chronic sinus tachycardia at 4 and 16 months and were treated with Beta-blockers after eliminating all causes of sinus tachycardia. One patient developed a complete right bundle branch block at 12 months. One patient developed ventricular extrasystole at 10 months and was found to have grade 2 rejection. An Atrial extrasystole was detected in one patient at 96 months. We did not identify significant risk factors for arrhythmias post-HT.DiscussionAfter pediatric HT, early-onset rhythm disturbances, often attributed to surgery-related issues such as sinus node dysfunction, may necessitate invasive treatments like permanent pacemaker therapy. Close monitoring post-transplantation is crucial, and routine follow-up with Holter ECG is necessary to identify potential rhythm disorders even in the absence of symptoms. Rhythm disturbances that develop during follow-up can serve as early indicators of graft rejection and should be carefully evaluated.
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    Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features
    (Springer, 2022) Arslan, Sema Yildirim; Bal, Zumrut Sahbudak; Bayraktaroglu, Selen; Ozenen, Gizem Guner; Bilen, Nimet Melis; Levent, Erturk; Ay, Oguzhan
    Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2-4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2-6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 +/- 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients' MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2-6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.
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    Electrocardiographic changes in hospitalised children with COVID-19
    (Cambridge Univ Press, 2023) Avcu, Gulhadiye; Arslan, Asli; Bal, Zumrut Sahbudak; Ay, Oguzhan; Levent, Erturk; Ozkinay, Ferda; Kurugol, Zafer
    Objectives:Cardiac manifestations of the coronavirus disease 2019 (COVID-19) have mainly been reported in adults. Therefore, we aimed to determine the electrocardiographic abnormalities in hospitalised paediatric patients with COVID-19 and multisystemic inflammatory syndrome in children. Methods:We retrospectively evaluated hospitalised paediatric patients <18 years of age with a diagnosis of COVID-19 (n = 168) and multisystem inflammatory syndrome in children (n = 48) between March 2021 and December 2021. A daily electrocardiography was performed for the patients who had electrocardiographic abnormalities on admission or developed electrocardiographic abnormality on the follow-up. The characteristics of these patients, underlying predisposing conditions, and clinical course were also examined. Results:Two-hundred sixteen paediatric patients (55% were male) with a mean age of 10.7 +/- 4.69 years were evaluated. There was an underlying disease in 84 (38.8%) patients and 51 (23.6%) required paediatric ICU admission. Electrocardiography abnormality was detected in 12 (5.5%) which were as follows: 7 (3.2%) had sinus bradycardia, 3 (1.4%) patients had transient ST elevation and concomitant T negativity, and 2 (0.9%) developed first-degree Atrioventricular (AV) block. The median time from the onset of disease symptoms to detecting electrocardiographic abnormality was 9 days. Electrocardiographic abnormalities returned to normal uneventfully 3 days later. Conclusions:The prevalence of arrhythmia in paediatric patients with COVID-19 was detected in 5.5% of the patients. While two-thirds of the electrocardiography abnormalities were sinus bradycardia, ST elevation was remarkable (1.4%). Clinicians should be aware of electrocardiographic abnormalities and consider electrocardiographic monitoring in paediatric patients with COVID-19 and multisystemic inflammatory syndrome in children.
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    Multidisciplinary Evaluation of Heart Transplantation and Ventricular Assist Device Implantation in a Child with Autism Spectrum Disorder
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2024) Ozbaran, Burcu; Cek, Didem; Dogan, Nurhak; Ay, Oguzhan; Ulger Tutar, Zulal; Ozbaran, Mustafa
    Organ transplantation practices have witnessed tremendous advances all over the world and in T & uuml;rkiye in recent years, and the pre-transplantation preparation, operation and postoperative follow-up procedures are being meticulously handled. However, there is very limited information about follow-up processes of pediatric patients with autism spectrum difficult to manage the arduous and long-term care and follow-up processes in ASD cases undergoing organ transplantation. In this case report, an 11-year-old male patient with a diagnosis of ASD and attention deficit-hyperactivity disorder (ADHD) was reviewed psychiatrically for the suitability of ventricular assist device (VAD) implantation and heart transplantation, and the multidisciplinary council process was evaluated. The council decided that the case was suitable for heart transplantation but not suitable for long-term intracorporeal device implantation due to behaviors such as plucking wounds, playing with vascular access , being nervous about vascular access. The council stated that due to sensory hypersensitivity of the case, implantation of such a device may further increase anxiety, , involuntary damage to the device may result in personal harm. We hope that this case report will guide future endeavors to develop devices suitable for cases with ASD or other behavioral problems.