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  • Küçük Resim
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    Arrhythmia during diagnostic cardiac catheterization in pediatric patients with congenital heart disease
    (Ali Cangül, 2018) Kasar, Taner; Cansaran Tanıdır, İbrahim; Öztürk, Erkut; Gökalp, Selman; Tunca Şahin, Gülhan; Topkarcı, Mehmet Akın; Ergül, Yakup; Güzeltaş, Alper
    Objective: Diagnostic and interventional cardiac catheterization procedures for congenital heart diseases (CHD) are becoming increasingly more popular, and arrhythmia is a well-known complication. This study was an evaluation of the incidence and causative agents of arrhythmia and the subsequent treatment strategies applied during cardiac catheterization. Methods: The catheterization data of all of the patients who underwent diagnostic cardiac catheterization for CHD between January 2012 and 2018 at a single center were examined retrospectively. Results: A total of 1316 children underwent diagnostic cardiac catheterization due to CHD. The median age and body weight was 18 months (6 days-21 years) and 9.9 kg (2.2–135 kg), respectively. Patients with ventricular septal defect (281 patients) and those with tetralogy of Fallot (257 patients) represented 2 major groups of the study population. In 93 (7%) patients, arrhythmia developed during cardiac catheterization. Among them, there were 58 (62%) cases of bradyarrhythmia and 35 (38%) cases of tachyarrhythmia. Arrhythmia was classified as low, high, or major, according to the adverse event severity score; the rates were 2.7%, 4.3%, and 1.2%, respectively. In 36 (39%) patients, there was no need for therapy, whereas 57 (61%) required treatment to eliminate the arrhythmia. Treatment modalities included catheter manipulation in 15, pharmacological therapy in 24, and cardioversion in 3 patients. Eleven patients required cardiopulmonary resuscitation. Temporary pacemaker implantation was required in 2 patients, while 2 others underwent permanent pacemaker implantation secondary to catheterization-related arrhythmia. There were no cases of mortality secondary to catheterization-related arrhythmia. Conclusion: Diagnostic cardiac catheterization in CHD may result in various types of cardiac arrhythmias. The proper management of arrhythmias may reduce morbidity and mortality related to cardiac catheterization.
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    Cardiac Catheterization in the Early Post-Operative Period after Congenital Heart Surgery
    (TAIWAN SOC CARDIOLOGY13F-1, NO. 11, MIN-CHUAN WEST ROAD, TAIPEI 104, TAIWAN, 2018) Kasar, Taner; Cansaran Tanıdır, İbrahim; Öztürk, Erkut; Kafalı, Candaş; Şahin, Murat; Yıldız, Okan; Haydin, Sertaç; Güzeltaş, Alper
    Background: The number of diagnostic and interventional cardiac catheterization procedures are increasing in the post-operative period of congenital heart diseases (CHD). The aim of this study was to evaluate data of patients who underwent cardiac catheterization in the early post-operative period after congenital heart surgery (CHS). Methods: We retrospectively evaluated the data of patients who underwent cardiac catheterization within 30 days after CHS. Results: Between 2010 and 2016 in our hospital, 2584 children had operations, and 2911 children underwent cardiac catheterization due to CHD. Cardiac catheterization was performed in 50 (1.9% of the surgeries) of these patients during the early post-operative period. Twenty-nine (58%) of the patients were males. The median age was 7.5 months (range: 15 days-12.5 years), and the median body weight was 6 kg (range: 3-35 kg). Twenty-eight (56%) of the patients had two-ventricle, and 22 (44%) had single ventricle physiology. The median RACHS-1 score was 3 (range: 1-6). Cardiac catheterization was performed under extracorporeal membrane oxygenation (ECMO) support in 16 of the patients. Twenty-four (48%) patients underwent diagnostic catheterization, while 26 (52%) had interventional procedures. Fifteen (30%) patients had a reoperation due to anatomic problems identified during catheterization. Major complications developed in 4 (8%) patients. There was no cases of procedural mortality due to catheterization. Conclusions: Cardiac catheterization should be performed in post-operative cardiac patients without hesitation, even under ECMO, if significant hemodynamic or clinical problems cannot be identified clearly by other noninterventional diagnostic techniques.
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    Examining the Correlation Between the GOSE Index and Atrial Arrhythmia Development with Electrocardiographic P-wave Properties in Patients with Ebstein’s Anomaly
    (Kartal Koşuyolu Yüksek İhtisas EAH, 2019) Kasar, Taner; Tanıdır, Cansaran; Ayyıldız, Pelin; Öztürk, Erkut; Ergül, Yakup; Güzeltaş, Alper
    Introduction: Ebstein’s anomaly (EA) is a congenital malformation of the tricuspid valve. In the present study, the aim was to examine the relationship between the Great Ormond Street Score (GOSE) index and P-wave characteristics in patients with EA. Patients and Methods: Unoperated patients with EA were evaluated retrospectively. Echocardiographic GOSE indices were calculated for each patient. The P-wave characteristics on the 12-channel electrocardiography (ECG) were also evaluated simultaneously. Results: There were EA 24 cases in the study. The median age was 12 months (range, 1 day-8 years). The median P-wave dispersion was 18 msn (range, 8-36 msn), median P-max duration was 86 msn (range, 58-104 msn), median P-min duration was 62 ms (range, 18-88 msn), and median P amplitude was 2.7 mm (range, 1.2-5 mm). Atrial arrhythmia was detected in eight cases. In the arrhythmia group, the P dispersion and P-max duration were significantly higher than in the non-arrhythmic group (p< 0.05). The median GOSE index was measured as 0.62 (range, 0.2-1.3). The GOSE index grade was detected as Grade 1 in 8 cases, Grade 2 in 12 cases, and Grade 3 in 4 cases. When the patients’ GOSE index and P-wave characteristics were evaluated, a positive correlation was found between the P-max (r= 0.5, p= 0.02) and P amplitude (r= 0.780, p= 0.001). There was no significant correlation between the P dispersion and P-min durations (p> 0.05). Conclusion: In EA cases, the GOSE index can be estimated, especially by evaluating the P-wave maximum duration and amplitude. Thus, clinicians may have an idea about the prognosis of cases with EA by evaluating the P-wave changes in ECG and especially the development of supraventricular arrhythmia.