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Öğe Association of cardiac changes with serum adiponectin and resistin levels in obese and overweight children(J Cardiovasc Med 2013, 14:228–234., 2013) Akıncı, Ayşehan; Karakurt, Cemşit; Gürbüz, Sibel; Elkıran, Özlem; Nalbantoğlu, Özlem; Koçak, Gülemdar; Güldür, Tayfun; Yoloğlu, SaimObjectives To investigate serum adiponectin and resistin levels in childhood obesity and their relationship with cardiac changes and insulin resistance. Methods Seventy-one obese and 24 overweight children and 40 healthy children and adolescents were selected for the study. Height and weight measurements, BMI values and BMI SD score values were obtained for each individual. After blood pressure measurement, left ventricular wall thickness, left ventricular mass, stroke volume, cardiac output, systolic and diastolic functions of the left ventricle were measured using an M-mode, two dimensional colorcoded echocardiography device. Blood samples of the individuals were obtained for fasting blood sugar, total blood cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol, insulin, C-peptide, adiponectin and resistin values. Results Cholesterol and LDL values, homeostasis model assessment of insulin resistance, fasting insulin and fasting C-peptide values of the obese and overweight groups were higher (P< 0.01). Adiponectin level (P< 0.001) and resistin level (P< 0.05) of the obese and overweight groups were lower than those of the control group (P< 0.05). Echocardiographic evaluation showed diastolic dysfunction in addition to increased left ventricular wall thickness and left ventricle mass values in the obese and overweight children. We also detected a significant positive correlation among left ventricular mass, interventricular septum systolic diameter and resistin in obese children. Among the factors, resistin level was determined as an independent predictor of left ventricular mass in obese children. Conclusion In this study, even in asymptomatic obese and overweight children, cardiac structural and functional changes, such as increased left ventricular mass and diastolic dysfunction, were demonstrated. Although decreased adiponectin level was not related to cardiac changes, it was shown that decreased serum resistin levels in the obese cases lead to left ventricle hypertrophy.Öğe Brucella myocarditis in a 3-month-old: probable transplacental transmission(Ann Trop Paediatr. 2010;30(3):225-8., 2010) Elkıran, Özlem; Koçak, Gülemdar; Karakurt, CemşitA 3-month-old girl presented with myocarditis owing to brucellosis. Her mother had been diagnosed with brucellosis at 28 weeks gestation but did not receive treatment until after delivery. The infant had intrauterine retardation and had gained little weight since birth. It is considered likely that the brucellosis was transmitted transplacentally.Öğe Combined effect of aerosolized iloprost and oxygen on assessment of pulmonary vasoreactivity in children with pulmonary hypertension(Anadolu Kardiyoloji Dergisi-The Anatolian Journal of Cardiology, 2014) Elkıran, Özlem; Karakurt, Cemşit; Koçak, GülemdarObjective: The evaluation of pulmonary vascular reactivity plays a significant role in the management of patients with pulmonary hypertension. Inhaled nitric oxide in combination with oxygen (O2) has become widely used as an agent for pulmonary vasodilator testing. However, inhaled nitric oxide is not available in many developing countries. Recently, aerosolized iloprost was suggested as an alternative to nitric oxide for this purpose. In the present study, aerosolized iloprost was used together with O2 in the pulmonary vasoreactivity test of children with severe pulmonary hypertension. Thus, the synergistic effect of both vasodilators was utilized without extending the duration of cardiac catheterization. Methods: The prospective cohort study registered a total of 16 children with severe pulmonary hypertension whose median age was 4.5 years. Hemodynamic parameters were quantified before and after the vasoreactivity test. Increased left-to-right shunt, pulmonary vascular resistance of <6 Woods units (WU)/m2 and a pulmonary-systemic resistance ratio of <0.3, as well as a decrease >10% in the pulmonary vascular resistance and pulmonary-systemic vascular resistance ratio after the vasoreactivity test were accepted as a positive response. The data were analyzed using Wilcoxon signed-rank and the Mann-Whitney U tests. Results: Eleven children gave a positive response to the vasoreactivity test, while 5 children did not respond. Pulmonary vascular resistance dropped from 9.98±1.39 WU/m2 to 5.08±1.05 WU/m2 (p=0.013) and the pulmonary-systemic vascular resistance ratio fell from 0.68±0.08 to 0.32±0.05 (p=0.003) in the children who were responsive. No side effects were observed related to iloprost administration. Conclusion: Administration of inhaled iloprost in combination with O2 for pulmonary vasoreactivity testing can be useful for correctly identifying pulmonary vasoreactivity without extending the duration of cardiac catheterization. (Anadolu Kardiyol Derg 2014; 14: 383-8) Key words: pulmonary hypertension, iloprost, childrenÖğe Evaluation by N terminal prohormone of brain natriuretic peptide cocentrations and Ross scoring of the efficacy of digoxin in the treatment of heart failure secondary to congenital heart disease with left to right shunts(Pediatr Cardiol, 0–0., 2013) Elkıran, Özlem; Sandıkkaya, Ayse; Koçak, Gülemdar; Karakurt, Cemşit; Taşkapan, Çağatay; Yoloğlu, SaimThis study aimed to evaluate the effectiveness of digoxin in children with heart failure secondary to leftto-right shunt lesions and normal left ventricular systolic function. The study registered 37 such patients (ages 10 days to 24 months, groups 1 and 2) and used 20 healthy children as a control group (group 3). Left ventricular systolic function, as assessed by conventional echocardiography, was normal in all the subjects. Congestive heart failure was diagnosed by clinical evaluation and modified Ross scoring. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations and complete blood counts were assessed in all the children. Group 1 was treated with digoxin, enalapril, and furosemide and group 2 with enalapril and furosemide. Approximately 1 month after starting treatment, the patients were reevaluated by physical and echocardiographic examinations, modified Ross scoring, plasma NT-proBNP concentrations, and complete blood counts. The pre- and posttreatment Ross scores of group 1 (p = 0.377) and group 2 (p = 0.616) did not differ significantly. The NT-proBNP values in both groups decreased after treatment (p = 0.0001). The pre- and posttreatment NT-proBNP values did not differ significantly in group 1 (p = 0.094)) and group 2 (p = 0.372). The pretreatment NT-proBNP values in groups 1 and 2 (p = 0.0001) were significantly higher than in the control group (p = 0.003). A smaller difference was observed between posttreatment NT-proBNP values in group 1 and the control group (p = 0.045). We found no significant difference between the posttreatment NT-proBNP values of group 2 and those of the control group (p = 0.271). The study showed that both treatments currently used to treat heart failure secondary to congenital heart disease with left-to-right shunts and preserved left ventricular systolic function are effective and do not differ significantly. Thus, digoxin does not provide any extra benefit in the treatment of such patients.Öğe Evaluation of the left ventricular function with tissue tracking and tissue Doppler echocardiography in pediatric malignancy survivors after anthracycline therapy(Echocardıography-A Journal Of Cardıovascular Ultrasound And Allıed Technıques, 2008) Karakurt, Cemşit; Koçak, Gülemdar; Özgen, ÜnsalAlthough the anthracyclines have gained widespread use in the treatment of childhood hematologicalmalignancies and solid tumors, cardiotoxicity is the major limiting factor in the use of anthracyclines.The aim of this study was to assess the mitral annular displacement by tissue tracking in pediatricmalignancy survivors who had been treated with anthracycline groups chemotheraphy and comparewith the tissue Doppler and conventional two dimensional measurements and Doppler indices. In thisstudy, 32 pediatric malignancy survivors and 22 healthy children were assessed with 2D, colour-codedechocardiography. Left ventricular ejection fraction, fractional shortening, stroke volume, cardiacoutput, cardiac index and diastolic functions were measured. All subjects were assessed with tissueDoppler echocardiography, mitral annular displacements, and also with tissue tracking method. Wedetected that peak velocity of the early rapid filling on tissue Doppler (E′) was lower (p < 0.05) andthe ratio of early peak velocity of rapid filling on pulse Doppler to tissue Doppler (E/E′) values werestatistically higher in patient group than control group (p < 0.05). Myocardial performance indexvalues were also higher in patient group than the control group (p < 0.01). It appears that MPI isa useful echocardiograghic method than tissue tracking of mitral annular displacement in patientswith pediatric cancer survivors who had subclinical diastolic dysfunction. (ECHOCARDIOGRAPHY,Volume 25, September 2008)Öğe Is edema in minimal change disease of childhood really hypovolemic(Int Urol Nephrol, 0–0., 2008) Tabel, Yılmaz; Mungan, İlke; Karakurt, Cemşit; Koçak, Gülemdar; Güngör, SerdalObjectives In this study, we aimed to find out whether children with minimal change disease can be classified as hypervolemic by objective measures. Methods Eighteen children with minimal change disease diagnosed at our department between November 2005 and May 2007 were included in this study. All patients were newly diagnosed or relapsed but were steroid free for at least 6 months. In the first week of edema and when edema resolved (5–7 days after initiation of therapy), weight, height and blood pressure were obtained from all patients. Serum and plasma samples were taken following a starvation period of 12–14 h. The volume load of all patients was evaluated, measuring the inferior vena cava indices in each stage by echocardiography. Results Average weight at presentation was 8.5% higher than the ideal (dry) weight. There were significant differences between the first and posttreatment body weights, abdomen circumference, and systolic and diastolic blood pressure values (P\0.05 for each). The inferior vena cava index (IVCI) values decreased significantly after diuretic treatment (P\0.001), while inferior vena cava collapsibility index (IVCCI) values increased in the post-treatment period (P\0.001). Conclusion We believe that a close follow-up of hypervolemic children with MCD, treated solely with easy-to-handle diuretics instead of I.V. albumin and diuretics may properly solve the edematous state in these patients.Öğe Possible association between fluconazole administration and acute hyperkalemia in a critically ill cyanotic infant(Arch Med Sci, 2015) Elkıran, Özlem; Karakurt, Cemşit; Koçak, Gülemdar; Tabel, Yılmaz; Güngör, SerdalFluconazole, an azole antifungal agent, inhibits the fungal cytochrome P450 enzyme. Although in vitro data show that fluconazole is not a potent inhibitor of mammalian P450 enzymes, hyperkalemia secondary to adrenal insufficiency associated with fluconazole has been described rarely [1–3]. However, life-threatening severe hyperkalemia related to administration of intravenous fluconazole without adrenal suppression has not been reported before.Öğe Prenatal diagnosis of a patient with tetralogy of fallot and an absent pulmonary valve(Pediatric Cardiology, 32(2), 241–242., 2011) Karakurt, Cemşit; Koçak, Gülemdar; Elkıran, ÖzlemA 34-week-gestation fetus of a gravid 3 mother 29 years of age was referred to our hospital due to an abnormal vascular image on obstetric ultrasonographic examination. The family history of congenital heart disease was negative. The mother had been using valproate due to epilepsy. Fetal echocardiography showed aneurysm of the pulmonary artery and rudimentary pulmonary valve and pulmonary regurgitation (Figs. 1, 2, movie 1). Tetralogy of Fallot and an absent pulmonary valve was diagnosed (Figs. 3, 4, 5).Öğe Prevalance and outcome of congenital heart disease in patients with neural tube defect(Child Neurol, 0–0., 2008) Koçak, Gülemdar; Önal, Çağatay; Koçak, Ayhan; Karakurt, Cemşit; Ateş, Özkan; Çaylı, Süleyman R.; Yoloğlu, SaimA prospective clinical study was designed to establish the risk factors, the prevalence, and the progress of congenital heart defects in children with neural tube defects. Study included 90 children with a mean age of 13.5 ± 30.4 months. There were 53 (59%) patients with spina bifida occulta and 37 (41%) patients with spina bifida aperta. The overall prevalence of congenital heart disease was 27.8% (40.5% in spina bifida aperta and 18.9% in spina bifida occulta; P = .024). There was no statistically significant difference for maternal age, usage of periconceptional folate, and maternal diabetes between the patient and control groups. The authors conclude that congenital heart defects are more common than reported in neural tube defects, and screening echocardiograms are warranted. This should be kept in mind especially in patients requiring minor or major surgical procedures. Furthermore, routine obstetric examination and therefore the use of periconceptional folic acid during pregnancy is still lacking in our country.Öğe Recanalization of occluded modified Blalock Taussig shunt with balloonangioplasty and intraarterial streptokinase(Anadolu Kardıyolojı Dergısı-The Anatolıan Journal Of Cardıology, 2008) Karakurt, Cemşit; Koçak, Gülemdar; Özgen, ÜnsalProgressive stenosis and acute thrombosis, months to years after surgical creation, are the most known complications of the modified Blalock-Taussig shunt (1, 2). Children who developed acute BlalockTaussig shunt occlusion usually require some form of intervention which includes thrombolytic therapy. Tissue plasminogen activator and streptokinase have been used successfully in some children (3, 4). Balloon angioplasty, stent implantation and surgery are the other therapeutic options (5-7). We report an 11 months old patient with acute modified Blalock-Taussig shunt occlusion. The patient was treated successfully with balloon angioplasty and intraarterial streptokinase.Öğe Subclinical diastolic dysfunction in children with Wilson s disease assessed by tissue Doppler echocardiography a possible early predictor of cardiac involvement(Acta cardiologica, 2013) Elkıran, Özlem; Karakurt, Cemşit; Selimoğlu, Ayşe; Karabiber, Hamza; Koçak, Gülemdar; Çelik, Faruk Serkan; Çolak, CemilBackground The aim of this study was to evaluate the left ventricular systolic and diastolic functions and cardiac rhythm problems for the early detection of myocardial dysfunction in children with Wilson’s disease. Methods We compared patients who had Wilson’s disease (n = 22) with age- and sex-matched healthy control subjects (n = 21). The diagnosis of Wilson’s disease was based on clinical symptoms and laboratory tests (serum ceruloplasmin, urinary and hepatic copper concentrations). Standard echocardiographic examination, as well as pulsed-wave Doppler, tissue Doppler echocardiography examinations of all patients were performed. 24-hour ECG Holter monitoring was also performed in all subjects. Results All patients were asymptomatic on cardiological examination and had sinus rhythm on electrocardiography. Left ventricular ejection fraction, fractional shortening, wall thickness and left ventricular mass were similar in both groups. In comparison to healthy subjects, children with Wilson’s disease had signifi cantly lower mitral E velocity, mitral E/A ratio (P = 0.046, P= 0.021, respectively) and longer isovolumetric relaxation time values (P = 0.015) as estimated by pulsed wave Doppler echocardiography. Wilson patients had longer isovolumetric relaxation time (IVRT) values estimated by tissue Doppler echocardiography (P = 0.006) compared to the controls. On 24-hour ECG Holter monitoring, none of the Wilson patients showed life-threatening cardiac arrhythmia. Conclusion Our study showed results that might be consistent with subclinical diastolic dysfunction in cardiologically asymptomatic Wilson’s disease children which probably represents an early stage of cardiac involvement. Therefore it may be useful to monitor these signs in the follow-up of the patients.Öğe Subclinical diastolic dysfunction in children with Wilson s disease assessed by tissue Doppler echocardiograpy a possible early predictor of cardiac involvement(Acta Cardiol, 2013) Elkıran, Özlem; Karakurt, Cemşit; Selimoğlu, Ayşe; Karabiber, Hamza; Koçak, Gülemdar; Çolak, CemilBackground: The aim of this study was to evaluate the left ventricular systolic and diastolic functions and cardiac rhythm problems for the early detection of myocardial dysfunction in children with Wilson’s disease. Methods: We compared patients who had Wilson’s disease (n = 22) with age- and sex-matched healthy control subjects (n = 21). The diagnosis of Wilson’s disease was based on clinical symptoms and laboratory tests (serum ceruloplasmin, urinary and hepatic copper concentrations). Standard echocardiographic examination, as well as pulsed-wave Doppler, tissue Doppler echocardiography examinations of all patients were performed. 24-hour ECG Holter monitoring was also performed in all subjects. Results: All patients were asymptomatic on cardiological examination and had sinus rhythm on electrocardiography. Left ventricular ejection fraction, fractional shortening, wall thickness and left ventricular mass were similar in both groups. In comparison to healthy subjects, children with Wilson’s disease had significantly lower mitral E velocity, mitral E/A ratio (P = 0.046, P = 0.021, respectively) and longer isovolumetric relaxation time values (P = 0.015) as estimated by pulsed wave Doppler echocardiography. Wilson patients had longer isovolumetric relaxation time (IVRT) values estimated by tissue Doppler echocardiography (P = 0.006) compared to the controls. On 24-hour ECG Holter monitoring, none of the Wilson patients showed life-threatening cardiac arrhythmia. Conclusion: Our study showed results that might be consistent with subclinical diastolic dysfunction in cardiologically asymptomatic Wilson’s disease children which probably represents an early stage of cardiac involvement. Therefore it may be useful to monitor these signs in the follow-up of the patients.Öğe Tissue Doppler strain and strain rate measurement assessed by two dimensional speckle tracking echocardiograpy in healthy newborns and infants(Cardiology in the Young (2014), 24, 201–211., 2014) Elkıran, Özlem; Karakurt, Cemşit; Koçak, Gülemdar; Karadağ, AhmetTo evaluate cardiac maturational and haemodynamic alteration in healthy newborns and infants and determine reference values in this period using tissue Doppler, strain, and strain rate echocardiography. Material and Methods: The study included 149 healthy subjects. Babies from 1 day to 3 months were selected from the well-baby nursery department, and infants were selected from paediatric clinics during routine visits for health maintenance. Subjects were allocated to four groups: preterm (36–37 weeks, n 5 32), term (Z38 weeks, n 5 32), 1 month of age (n 5 47), and 3 months of age (n 5 38). Standard echocardiographic evaluations, pulsed wave Doppler, tissue Doppler echocardiography, strain, and strain rate studies were applied by the same person using a MyLab50 echo machine. Longitudinal and circumferential systolic strain and strain rate measurements were assessed by two-dimensional speckle-tracking echocardiography in all subjects. Results: The longitudinal systolic velocity, strain, and strain rate values derived from left ventricle apical four-, three-, and two-chamber images, and circumferential systolic velocity, strain, and strain rate values derived from left ventricle short-axis images decreased from the base to the apex in all subjects (p , 0.001). Conclusion: Significant cardiac haemodynamic alterations occurred during the newborn and early infancy periods and were detected by tissue Doppler, strain, and strain rate echocardiography. Although two-dimensional speckle-tracking echocardiography is useful and can produce improved, reliable results in clinical practice, it has some limitations. Therefore, more studies on this issue are required.
