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Öğe 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.Öğe Association of Vitamin D Deficiency with Increased Pulse Wave Velocity and Augmentation Index in Children With Chronic Kidney Disease(Iranian Soc Nephrolgy, 2018) Conka, Secil; Mir, Sevgi; Dogan, Eser; Tutar, Zulal UlgerIntroduction. It is known that in children with chronic kidney disease (CKD), cardiovascular damage starts in the form of arterial stiffness. There are risk factors other than the traditional ones such as arterial stiffness hypertension, obesity, hypercholesterolemia, and insulin resistance. Vitamin D deficiency is rather common in CKD, and it was introduced as a risk factor for atherosclerosis; however, its relationship with arterial stiffness is not known completely. The purpose of this study was to research the relationship between 25-hydroxyvitamin D levels and arterial stiffness. Materials and Methods. Arterial stiffness was evaluated by measuring augmentation index (AI) and pulse wave velocity (PWV) from the radial and carotid arteries with a Vicorder. The 25-hydroxyvitamin D levels were measured by an immunoassay method. Results. In the 81 CKD patients (mean age, 13.21 +/- 6.02 years; mean body mass index, 19.42 +/- 5.12 kg/m(2); and 56.8% male), the mean vitamin D level was 60.71 +/- 39.52 ng/mL, the mean AI was 7.93 +/- 7.77%, and the mean PWV was 9.79 +/- 4.36 m/s. Serum levels of 25-hydroxyvitamin D was correlated with AI (r = -0.482, P = 0.001) and PWV (r = -0.57, P = .001). Conclusions. In this study, it was proven that vitamin D deficiency in children was related to nondiabetic and nondialysis CKD.Öğe Blalock-Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size?(Springer, 2019) Sisli, Emrah; Tuncer, Osman Nuri; Senkaya, Suat; Dogan, Eser; Sahin, Hatice; Ayik, Mehmet Fatih; Atay, YuekselThe study aimed to revisit the in-hospital predictors of shunt thrombosis (ST) in the foreground of the pulmonary artery size in patients who received modified Blalock-Taussig shunt (mBTS) as the first-stage palliation. Data from 80 patients who received mBTS as their initial palliative procedure between February 2012 and January 2017 was retrospectively collected. The median age and weight of the patients at the time of their mBTS procedure was 4days (IQR 2-22days) and 3.2kg (IQR 2.8-3.7kg), respectively. Of the 80 patients in the study, 11 (13.8%) developed ST. The diameter and corresponding z scores of the pulmonary arteries were significantly lower in patients with ST. The median shunt size/shunted pulmonary artery size (S/PA) ratio was considerably higher in patients with ST. In logistic regression analysis, pulmonary artery hypoplasia (PAH) [odds ratio (OR)=13.7 (0.06-0.21), p<0.001], S/PA ratio0.9 [OR=8.1 (0.03-0.53), p=0.03], prematurity [OR=9.5 (0.05-0.33), p=0.003], and shunt size/weight (S/W) ratio1.3 [OR=6.4 (0.04-0.67), p=0.012] were found to have a significant impact on ST. The best combination of sensitivity and specificity of the S/W (0.73 and 0.75) and the S/PA ratio (0.73 and 0.80) were achieved at the cut-off value of 1.3 and 0.9, respectively. The Youden index of S/PA was 0.52. While the area under the curve (AUC) of the S/W ratio was 0.686 +/- 0.12 (p=0.049), the AUC of the S/PA ratio was 0.791 +/- 0.08 (p=0.002). In conclusion, instead of weight, considering the size of the target pulmonary artery and thereby, the S/PA ratio would be more instructive in determining shunt size. There were a high number of patients in our study who showed PAH having received a shunt size based on their body weight. By contrast, our results showed that the S/PA ratio of 0.9 would be a good predictor of in-hospital ST.Öğe Blalock-Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size? (vol 40, pg 38, 2019)(Springer, 2019) Sisli, Emrah; Tuncer, Osman Nuri; Senkaya, Suat; Dogan, Eser; Sahin, Hatice; Ayik, Mehmet Fatih; Atay, YuekselÖğe Evaluation of Heart Rate Variability in Children with Stutter(Galenos Publ House, 2024) Ulubeli, Pelin Ozcan; Dogan, Eser; Sahin, Mustafa; Tutar, Zulal Ulger; Ogut, Mehmet FatihAim: The autonomic nervous system has a direct or indirect effect on motor speech and its development. The results of studies evaluating autonomic functions in stuttering individuals show that further research is needed in different age groups. In this study, the aim was to evaluate autonomic function by analysing heart rate variability (HRV) in children with stutter. Materials and Methods: In this study, a total of 41 individuals (11 females, 30 males) between the ages of 6-17 years (mean age: 10.17 +/- 2.75), diagnosed with stuttering were evaluated. The control (healthy/normal) group comprised 41 individuals (12 female, 29 male) between the ages of 6-17 years (mean age: 10.78 +/- 2.78), who did not have any speech disorder complaints and no family history. The level of stuttering was designated by applying the Turkish version of the Stuttering Severity Instrument Fourth Edition to the diagnosed group. All cases were tested for HRV and analysed using the 24-hour Holter electrocardiography recording method. Correlations between stuttering severity and the HRV parameters of the stuttering group, and correlations of HRV parameters in both groups were examined. Results: A positive significant correlation was found between secondary behaviours in the stuttering group and the standard deviation of the mean NN intervals in 5-minute recordings (SDANN) of the HRV test. Additionally, when the correlation of HRV parameters between the groups was examined, the SDANN parameter in the stuttering group was statistically significantly higher (p<0.05). The other parameters were not statistically significantly different between the groups. Conclusion: In this study, when the HRV parameters of the stuttering children were compared with the non-stuttering children, no significant differences were found to prove autonomic nervous system dysregulation.Öğe Evaluation of Vascular Involvement in Children with Celiac Disease(Galenos Publ House, 2023) Tasci, Ezgi Kiran; Taner, Sevgin; Dogan, Eser; Karakoyun, Miray; Bulut, Ipek Kaplan; Kabasakal, Caner; Levent, ErturkAim: Celiac disease is associated with an increased risk of cardiovascular disease due to inflammation and autoimmunity involved in its pathophysiology. We aimed to evaluate vascular involvement in children with celiac disease based on their augmentation index, carotid pulse wave velocity, carotid intima-media thickness, echocardiographic findings, and blood pressure. Materials and Methods:This cross-sectional and controlled study was performed at a single center between 2018 and 2019. The study population consisted of 44 patients with celiac disease who had been on a gluten-free diet for at least one year. Results: We compared celiac patients with a healthy group. While the celiac patients had significantly higher carotid intima media thickness and carotid pulse wave velocity values, there was no difference in the augmentation index values. There was no significant difference in carotid artery intimal medial thickness, augmentation index and carotid pulse wave velocity values between the diet-compliant and non-compliant groups. Conclusion: Although hypertension was not detected, arterial stiffness and carotid intima media thickness measurements were higher in the celiac disease patients compared to the healthy controls. This showed that these parameters can be used in early vascular damage assessment. These measurements, which are non-invasive and repeatable, can be a guide for the monitoring of the development of preclinical atherosclerosis in the follow-up of the pediatric patients diagnosed with celiac disease.Öğe Interleukin-8 is increased in chronic kidney disease in children, but not related to cardiovascular disease(Soc Brasileira Nefrologia, 2021) Tuncay, Secil Conkar; Dogan, Eser; Hakverdi, Gulden; Tutar, Zulal Ulger; Mir, SevgiIntroduction: In this study, we aimed to detect the cytokine that is involved in the early stage of chronic kidney disease and associated with cardiovascular disease. Methods: We included 50 patients who were diagnosed with predialytic chronic kidney disease and 30 healthy pediatric patients in Ege University Medical Faculty Pediatric Clinic, Izmir/Turkey. Interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-13 (IL-13), and transforming grow factor-beta 1 (TGF-beta 1) levels (pg/mL) were measured by ELISA. Carotid-femoral pulse wave velocity (PWV), augmentation index (Aix), carotid intima media thickness (cIMT), and left ventricular mass index (LVMI) were evaluated as markers of cardiovascular disease. The presence of a cardiovascular disease marker was defined as an abnormality in any of the parameters (cIMT, PWV, Aix, and left ventricular mass index (SVKI)). The patient group was divided into two groups as with and without cardiovascular disease. Results: Mean Aix and PWV values were higher in CKD patients than controls (Aix: CKD 32.8 +/- 11.11%, healthy subjects: 6.74 +/- 6.58%, PWV CKD: 7.31 +/- 4.34m/s, healthy subjects: 3.42 +/- 3.01m/s, respectively; p=0.02, p=0.03). The serum IL-8 levels of CKD were significantly higher than of healthy subjects 568.48 +/- 487.35pg/mL, 33.67 +/- 47.47pg/ mL, respectively (p<0.001). There was no statistically significant difference between IL-8, IL-10, IL-13, TGF-1, in CKD patients with and without cardiovascular disease (p>0.05). Discussion: IL-8 is the sole cytokine that increases in pediatric patients with chronic kidney disease among other cytokines (IL-10, IL-13 and TGF-beta 1). However, we did not show that IL-8 is related to the presence of cardiovascular disease.Öğe Long-Term Results of Percutaneous Balloon Aortic Valvuloplasty in Children With Aortic Stenosis: A Single-Center Experience(Springernature, 2024) Dogan, Eser; Levent, ErturkPurpose: Congenital aortic stenosis is a common pathology in the childhood age group and its clinical spectrum varies between asymptomatic and severe heart failure. In our study, we planned to evaluate the long-term results of patients who underwent balloon aortic valvuloplasty (BAV) due to critical aortic valve stenosis in our clinic. Materials and methods: Patients aged 0-18 years who underwent aortic balloon valvuloplasty due to aortic stenosis in our clinic between January 2002 and January 2022 were retrospectively evaluated. Results: Among the 48 patients who underwent balloon valvuloplasty due to aortic stenosis, 13 (27%) were female, and 35 (73%) were male. The median age at the time of the procedure was 27.5 months (IQR: 4-96), the median weight was 9.9 kg (IQR: 5.40-29.50), and the median height was 79 cm (IQR: 54-133). The median follow-up duration was 93.5 months (IQR: 38-132). Angiographic assessments in all patients revealed a median left ventricular pressure of 160 mmHg (IQR: 140-200) and a median pressure gradient between the left ventricle and the aorta of 60 mmHg (IQR: 42-80). The median balloon diameter used was 10 mm (IQR: 8-12). Post-procedural measurements showed a median mean gradient of 30 mmHg (IQR: 2035) between the left ventricle and the aorta. The procedure was successful in 45 (93.5%) patients. During follow-up, 11 patients required surgical intervention. Ross procedure was performed in five patients, homograft in five patients, and mechanical valve implantation in one patient. Risk factors for the need for surgical intervention were evaluated in detail. During the follow-up, the risk factor for intervention was determined to be aortic insufficiency. Conclusion: Aortic valve balloon valvuloplasty is a safe and successful treatment method for critical aortic stenosis. It should be the first choice of treatment option in suitable patients.Öğe Native valve endocarditis due to Candida albicans in two children: Two new case reports(Wiley, 2019) Guner, Gizem; Bal, Zumrut Sahbudak; Dogan, Eser; Umit, Zuhal; Levent, Erturk; Polat, Suleyha Hilmioglu; Özkınay, Ferda; Kurugol, ZaferCandida endocarditis (CE) is a rare and serious complication of candidemia. Using current diagnostic tools a confirmed diagnosis is often delayed and outcomes remain poor. The majority of new cases occur following cardiac valvular surgery, and/or in patients with the following risk factors: intravenous drug use, cancer chemotherapy, prolonged presence of central venous catheters, and prior history of bacterial endocarditis. It is not a common complication in non-neutropenic patients particularly with the absence of a prosthetic valve, and very few reports in the literature are available. Attempting to add to the limited data, 211 candidemia episodes from 172 nonneutropenic pediatric cases between January 2008 and December 2017 were evaluated. All patients were considered asymptomatic for underlying heart disease. However, 2 (0.9%) patients with a central venous catheter were determined as having endocarditis following echocardiography.Öğe Outcomes of HeartMate 3 in pediatric patients with end-stage heart failure: a single-center preliminary experience from Turkey(Frontiers Media SA, 2024) Dogan, Eser; Ulger Tutar, Zulal; Tuncer, Osman Nuri; Levent, Resit E.; Engin, Cagatay; Yagdi, Tahir; Atay, Yuksel; Ozbaran, MustafaObjectives We aim to evaluate our initial experience with the HeartMate 3 (HM3) device (Abbott, USA) for palliating pediatric patients with end-stage heart failure (ESHF).Methods We conducted a retrospective review of clinical data from pediatric patients (aged 7-18 years) who underwent HM3 implantation for ESHF at our institution between 2022 and 2024. Patient demographics and follow-up data were comprehensively analyzed.Results We identified 11 patients (45% males) with a median age of 14 years (IQR 11-17), a median weight of 47 kg (IQR 28-50), a median height of 159 cm (IQR 135-165), and a median body surface area of 1.36 m2 (IQR 1.07-1.53) at the time of the intervention. All patients were diagnosed with dilated cardiomyopathy and categorized with PEDIMACS profiles ranging from one to three. The median ICU stay was 14 days (IQR 6-32), with 11 patients receiving inotropic support for a median of four postoperative days (IQR 3-8). The median follow-up period was 150 days (IQR 90-210). Early complications included two cases of pleural effusion, 1 case of cardiac tamponade, 3 cases of polyuria, and one instance of positive blood cultures. One patient, who was non-compliant with warfarin therapy, developed a thrombus in the right atrium that was resolved with a revision of anticoagulant therapy, and did not experience pump thrombosis. During follow-up, one patient died after 28 days from sepsis, one underwent heart transplantation after 10 days, and nine patients remained alive on the device. Notably, there were no reported cases of pump thrombosis, ischemia, or stroke post- implantation.Conclusions The HM3 device appears to be a safe and effective palliative option for pediatric patients with ESHF.Öğe Parotitis coexisting with Kawasaki disease in a child: a rare presentation of Kawasaki disease(Sage Publications Inc, 2019) Gokce, Sule; Uysal, Nida; Erkmen, Hasret; Dogan, Eser; Koc, FeyzaKawasaki disease (KD), also known as mucocutaneous lymph node syndrome and infantile polyarteritis nodosa, is known to present in multiple ways. Although inflammatory changes in several systems have been reported in KD, there are few documented child patients presenting with parotitis. We report such a case in a five-year-old.Öğe Periodic fever syndromes: a patient diagnosed with recurrent Kawasaki disease(Cambridge Univ Press, 2020) Turk, Sena; Aydin, Derya; Dogan, Eser; Levent, Erturk; Kutukculer, NecilKawasaki disease, known as mucocutaneous lymph node syndrome, is a multi-system disease of unknown aetiology that occurs in young children under 5 years of age. the recurrence rate of Kawasaki disease is as rare as 1-3%. Especially in cases with coronary artery involvement, recurrent Kawasaki disease should be investigated in terms of underlying rheumatologic diseases such as periodic fever syndromes, microscopic polyangiitis, polyarteritis nodosa, and systemic-onset juvenile arthritis. in this study, we report homozygote mutations in mevalonate kinase and familial Mediterranean fever genes in a recurrent Kawasaki disease with coronary dilatation.Öğe Successful Orthotopic Heart Transplantation in Patients with Becker Muscular Dystrophy(Galenos Yayincilik, 2021) Aydin, Derya; Dogan, Eser; Ulger, Zulal; Levent, ErturkCardiomyopathy is a major factor contributing to mortality and morbidity in patients with Duchenne and Becker muscular dystrophies (DMD/BMD), and is therefore among the increasingly important findings. These X-linked recessive disorders involve the deficiency or absence of dystrophin in the skeletal muscle as well as the myocardium. This defect brings about changes in the cardiac muscle in three phases: an initial hypertrophic stage, followed by an arrhythmogenic stage, and finally end-stage dilated cardiomyopathy due to increased loss of myocytes. While cardiac involvement can be observed in carriers of BMD and DMD, the incidence of dilated cardiomyopathy is reported to be higher in BMD patients than DMD patients. The only curative treatment option for medically refractory dystrophinopathicend-stage heart failure is heart transplantation. in this report, we present two patients, 14 and 15 years of age, who presented with dilated cardiomyopathy and were diagnosed with muscular dystrophy. One of the patients remains under follow-up with a left ventricular assist device as a bridge-to-transplantation, while the other underwent successful orthotopic heart transplantation.Öğe Transcatheter Closure of Secundum Atrial Septal Defects in Pediatric Patients: A 15-Year Single-Center Experience(Springernature, 2024) Dogan, Eser; Levent, ErtuerkPurpose: Transcatheter closure is the first -line treatment option for hemodynamically significant secundum atrial septal defects (ASDs). This study examines our center's experience with this procedure over the last 15 years. Materials and methods: Pediatric patients aged 0-18 years with secundum ASDs who were planned for transcatheter closure in our clinic between January 2007 and January 2023 were retrospectively evaluated. Results: Transcatheter secundum ASD closure was planned for a total of 334 patients during the study period: 191 girls (57.2%) and 143 boys (42.8%). Their mean age was 8.08 +/- 3.9 years, and their mean weight was 30 +/- 15.6 kg. Defect diameter measured transesophageally ranged from 5 to 35 mm, with a mean of 12.56 +/- 4.02 mm. Transesophageal echocardiographic examination revealed a single secundum ASD in 319 patients (95.5%) and multiple secundum ASDs in 15 patients (4.5%). In 11 patients (3.3%), the procedure was terminated before initiating transcatheter ASD closure because of insufficient vena cava rims or a very large or multi -fenestrated defect. The 323 patients (96.7%) who underwent transcatheter ASD closure had a mean pulmonary artery pressure of 15.1 +/- 4.0 mmHg and a mean Qp/Qs ratio of 1.97 +/- 0.56. The procedure failed in four patients (1.3%) because of device embolization (n=2) or the inability to properly position the device (n=2). Major complications other than device embolization observed during or after transcatheter closure included anesthetic -induced respiratory depression (n=1) and total atelectasis of the lung (n=1). No new major complications were detected during the patients' long-term follow-up. Conclusion: With appropriate patient and device selection, transcatheter closure is a safe and effective treatment for secundum ASD and should be the first treatment of choice.Öğe Transcatheter Ductus Arteriosus Closure with Various Devices in the Pediatric Patient Group and Long-term Outcomes: Experience from a Single Center(Galenos Publishing House, 2024) On, Seyma Sebnem; Dogan, Eser; Ergin, Firat; Beyter, Mehmet Baki; Kafikci, Gulcin Kayan; Yilmaz, Meral; Levent, Refit Erturk; Acar, Burcu Bufra; Beci, Burcugul Karasulu; Tutar, Zulal UlgerAim: The emergence of advanced duct occluder devices has made transcatheter patent ductus arteriosus (PDA) closure the preferred treatment for pediatric patients. This study compared the effectiveness, safety, and long-term outcomes of various transcatheter PDA closure devices. Materials and Methods: This study involved 320 patients aged 0 to 18 years who underwent transcatheter PDA closure at our hospital from 2004 to 2023. We retrospectively reviewed their records in order to assess procedure success, demographic information, clinical features, angiographic parameters, and complications. Patients were categorized by closure type: Group I for coil closure, Group II for Amplatzer Duct Occluder (ADO)-I closure, and Group III for ADO-II closure. Results: In this study of 320 patients, 203 (63.4%) were female and 117 (36.4%) male. The average age was 56.5 months (+/- 49.6), with a median weight of 15 kg (interquartile range 10.5-23 kg). The median diameter of the PDA at its narrowest point was 2.0 mm (interquartile range 2-3 mm). Ductal anatomy distribution was as follows: Type A (176 patients, 55%), type B (49 patients, 15.3%), type C (30 patients, 9.3%), type D (5 patients, 1.56%), type E (57 patients, 17.8%), and type F (4 patients, 1.25%). Arterial access was used in 263 patients (82.1%), and venous plus arterial access in 57 patients (17.8%). Closure techniques included the ADO-II in 107 cases (33.4%), ADO-I in 12 cases (3.75%), and coils in 201 cases (62%). The early closure rate was 97.5%, with initial shunt rates of 0.6% and 0.3% at one month. Device embolization occurred in 5 patients (1.87%). By the six-month follow-up, all PDAs had closed, resulting in an overall transaction success rate of 97.5%. The average followup period was 105.8 +/- 55 months. Conclusion: Percutaneous closure of PDA in children is safe and effective, with a high success rate. Key factors include the patient's age, weight, duct dimensions, and the type and size of the PDA. ADO-I devices are ideal for larger defects, while coil or ADO-II devices are preferable for smaller ones. Proper patient selection is critical for successful outcomes.Öğe Two siblings with Gaucher type 3c: different clinical presentations(Walter De Gruyter Gmbh, 2019) Karakoyun, Miray; Canda, Ebru; Tasci, Ezgi Kiran; Dogan, Eser; Coker, Mahmut; Aydogdu, SemaBackground: Gaucher disease (GD) is a lysosomal storage disorder caused by autosomal recessive mutations in the glucocerebrosidase (GBA) gene, which encodes acid beta-glucosidase. GD type 3c is a rare group characterised by cardiovascular involvement, and homozygous D448H is the most-frequent mutation. Case presentation: We describe two patients who had homozygous D448H mutations. The index patient had hepatosplenomegaly, liver insufficiency and cardiac involvement and her sister had severe cardiac involvement with cardiomyopathy and diffuse aortic calcification. The index case's liver was transplanted at the age of 6 months from a related donor and her sister who had severe cardiovascular disease died at the age of 12 years. Conclusions: Our patients had clinical variability. We need to discuss whether liver involvement could be the initial signs in patients with GD type 3c.Öğe The Use of Mean Platelet Volume, Plateletcrit, and N-terminal Brain Natriuretic Peptide as Biomarkers of Coronary Artery Involvement in Atypical Kawasaki Disease(Galenos Publ House, 2023) Dogan, Eser; Turan, Caner; Yurtseven, Ali; Eman, Gamze; Saz, Eylem UlasObjective: Coronary artery aneurysm and ectasia develop in approximately 15% to 25% of children with untreated Kawasaki disease (KD). Atypical KD has a higher incidence of coronary artery involvement compared to typical KD. Our aim in this study was to identify new markers to support early diagnosis and prevent complications associated with delayed treatment in atypical KD. Method: The patients' demographic characteristics, presenting complaints, clinical findings, mean platelet volume (MPV), plateletcrit (PCT), and N-terminal brain natriuretic peptide (NT-proBNP) levels were analyzed. Coronary artery abnormalities were evaluated using two-dimensional echocardiography. Results are expressed as mean (+/- standard deviation). Results: Sixty children between the ages of 3 and 96 months who were diagnosed with atypical KD were included. Forty consecutive normal children were included as a control group. NT-proBNP, MPV, and PCT values were 381.7 (+/- 272.7 ) pg/mL, 5.8 (+/- 0.93 ) fL, and 0.266% (+/- 0.9 2%) in the patient group and 48.5 (+/- 28.5 ) pg/mL, 8.29 (+/- 1.12 ) fL, and 0.227% (+/- 0.7 8%) in the control group, respectively (p<0.00 1 for all). In the comparison of atypical KD patients with coronary artery involvement (CAI subgroup) and without (non-CAI subgroup), the NT-proBNP values in these subgroups were 542.9 (+/- 226.8 ) and 171 (+/- 161.7 ) pg/mL (p<0.001), MPV values were 5.8 (+/- 0.77 ) and 6.54 (+/- 0.95 ) fL (p<0.005), and PCT values were 0.264% (+/- 0. 1%) and 0.269% (+/- 0.0 8%), respectively. Conclusion: The simultaneous evaluation of MPV, PCT, and NT-proBNP was useful for the diagnosis of atypical KD. NT-proBNP and MPV can be used as markers of CAI in atypical KD.Öğe The use of N-terminal (1-76) pro-brain natriuretic peptide in the aetiology of severe respiratory distress in the paediatric emergency department(Cambridge Univ Press, 2022) Dogan, Eser; Turan, Caner; Yurtseven, Ali; Turan, Benay; Saz, Eylem UlasIntroduction: Acute respiratory distress is one of the most common reasons for paediatric emergency visits. Paediatric patients require rapid diagnosis and treatment. Our aim in this study was to use N-terminal (1-76) pro-brain natriuretic peptide to differentiate respiratory distress of cardiac and pulmonary origin in children. Our aim was to investigate the role of N-terminal (1-76) pro-brain natriuretic peptide in the detection of patients with new-onset heart failure in the absence of an underlying congenital heart anomaly. Methods: All children aged 0-18 years who presented to the paediatric emergency department due to severe respiratory distress were included in the study prospectively. The patients' demographic characteristics, presenting complaints, clinical findings, and N-terminal (1-76) pro-brain natriuretic peptide concentrations, were investigated. In patients with severe Pediatric Respiratory Severity Score, congestive heart failure score was calculated using the modified Ross Score. Results: This study included 47 children between the ages of 1 month and 14 years. The median N-terminal (1-76) pro-brain natriuretic peptide concentration was 5717 (IQR:16158) pg/mL in the 25 patients with severe respiratory distress due to heart failure and in the 22 patients with severe respiratory distress due to lung pathology was 437 (IQR:874) pg/mL (p < 0.001). In the 25 patients with severe respiratory distress due to heart failure, 8281 (IQR:8372) pg/mL in the 16 patients with underlying congenital heart anomalies, and 1983 (IQR:2150) pg/mL in the 9 patients without a congenital heart anomaly (p < 0.001). The 45 patients in the control group had a median N-terminal (1-76) pro-brain natriuretic peptide concentration of 47.2 (IQR:56.2) pg/mL. Conclusion: Using scoring systems in combination with N-terminal (1-76) pro-brain natriuretic peptide cut-off values can help direct and manage treatment.Öğe Usefulness of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) as a marker for cardiotoxicity and comparison with echocardiography in paediatric carbon monoxide poisoning(Cambridge Univ Press, 2020) Turan, Caner; Dogan, Eser; Yurtseven, Ali; Saz, Eylem UlasObjectives: To demonstrate the usefulness of N-Terminal Pro-B-Type natriuretic peptide (NT-proBNP) as an early biomarker of carbon monoxide-induced myocardial injury in children. It also aimed to identify the correlation between NT-proBNP and left ventricular systolic dysfunction findings shown by echocardiography. Methods: Prospective, observational study conducted at a paediatric emergency department between October 2017 and April 2019 which involved children aged 0-17 years. the patients were divided into three groups based on severity; mild, moderate and severe groups. the patient characteristics, carboxyhaemoglobin, CK-MB Mass (CKMB-M), troponin-T, and NT-proBNP levels were measured, and echocardiography was performed and left ventricular ejection fraction was measured. Results: Sixty-nine patients and 60 healthy controls were included. Male gender, younger age, higher carboxyhaemoglobin levels, and altered mental status were found as independent predictors of carbon monoxide-induced myocardial injury. If the cut-off value for NT-proBNP level is >480 pg/ml, the sensitivity-specificity for decreased left ventricular ejection fraction, which is the strongest carbon monoxide-induced myocardial injury sign, were 100-96%, respectively. A high negative correlation was found between NT-proBNP levels and left ventricular ejection fraction (r = -0.769, p < 0.01) in the carbon monoxide poisoning group, and there was a positive correlation between the carboxyhaemoglobin and NT-proBNP levels (r = 0.583, p < 0.01). Conclusion: Echocardiography is an ideal tool and very sensitive, but its routine use is limited due to its non-availability. An increased level of NT-proBNP (>480pg/ml) may be useful as an ideal biomarker for early detection of carbon monoxide-induced myocardial injury sign and reduced left ventricular ejection fraction which is the most crucial point in making a decision on hyperbaric oxygen therapy.
