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Purpose Our aim in this study was to investigate the prenatal and postnatal prognosis of double outlet right ventricle (DORV) cases diagnosed prenatally by performing subtype analysis. Methods Patients diagnosed with DORV through prenatal ultrasound in the maternal-fetal medicine department of our hospital between 2014 and 2022 were included in the study group. In this study, the diagnosis of DORV was determined by the ventriculoarterial connection type. Cases of which at least 50% of both great arteries originate from the morphological right ventricle were included. Results Between 2014-2022, 104 fetal DORV cases were diagnosed prenatally. The mean gestational age of the patients at the time of their first visit to our clinic was 23+4 weeks. The cases were categorized according to subtypes which are TGA, fallot, VSD, remote and heterotaxy types. The cases constitute of 32.3% TGA type,19.1% fallot type, 11.1% VSD type, 2% remote type and 35.3% heterotaxy type. Major cardiac anomaly was observed in 87% of DORV cases. Major extracardiac anomaly was observed in 54% of the cases. When we excluded the heterotaxy type without chromosomal anomaly, additional genetic anomalies were detected in 42% of the remaining cases. In 26 cases, pregnancy termination was performed upon the request of the family. Cardiac surgical repair was performed in 48 postnatal cases. The postoperative survival rate was 81.2%. Conclusion The prognosis in DORV depends on the anatomical subtype, the presence and severity of associated additional anomalies. In this disease, which has a high incidence of additional cardiac and extracardiac anomalies, the survival rate is high when these anomalies are absent and genetic problems are not observed. While informing the family about fetal prognosis, the long treatment and follow-up period waiting for them should be emphasized.

Pulmonary atresia with ventricular septal defect is a complex congenital cardiac anomaly. The blood is supplied to the lungs through a patent ductus arteriosus, a major aortopulmonary collateral artery, or in very rare cases from a coronary artery–pulmonary artery fistula. We present two cases with coronary artery–pulmonary artery fistula which underwent surgical intervention. In our first patient, the main pulmonary artery was supplied from the left main coronary artery. In the second patient, the right pulmonary artery originated from the left main coronary artery and continued to the right lung posteriorly to the aorta, while the left pulmonary artery originated from the patent ductus arteriosus. The difference in our cases is that the coronary artery pulmonary artery fistulas behave like major aortopulmonary collateral arteries originating from the coronary arteries. These fistulas were the main source of pulmonary blood flow.

Objective The aim of this study was to investigate fetal echocardiographic findings in predicting the need for surgical repair in fetuses with coarctation of the aorta (CoA) and to evaluate perinatal outcomes. Study Design In this retrospective study, fetuses diagnosed with CoA in a tertiary center between January 2015 and June 2021 were analyzed. Fetal echocardiographic measurements and quantitative findings, middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices, and perinatal outcomes were recorded. Results A total of 57 fetuses with CoA were included in the study. In total, 51 (89.5%) pregnancies resulted in live births and 32 (62.8%) of the neonates underwent surgical repair. The left ventricle/right ventricle width ratio and aortic isthmus z-score were significantly lower in fetuses who underwent surgical repair (p = 0.004 0.001, respectively). Retrograde flow in the aortic isthmus (odds ratio [OR]:7.43; 95% confidence interval [CI]: 1.98–27.76), left-to-right foramen ovale shunt (OR: 8.50; 95% CI: 1.68–42.98), and ventricular septal defect (OR: 9.63; 95% CI: 1.90–48.74) were associated with the need for surgical repair. A new scoring system integrating these echocardiographic findings had 89% specificity and 54% sensitivity in predicting surgical repair. Fetal growth restriction rates, preterm birth rates, mean MCA pulsatility index (PI), and mean UA PI were similar in fetuses with and without surgical repair. Conclusion A scoring system integrating echocardiographic findings in fetuses with CoA may improve the prediction of surgical repair need. There is no evidence of an increased risk of FGR, preterm birth, and brain sparing effect in fetuses with CoA who require surgical repair. Key Points

In patients with critical coarctation of the aorta, percutaneous balloon angioplasty and/or stent placement is usually performed via the femoral route. When femoral access is not suitable for intervention, the trans-axillary approach can be chosen as an alternative access. We hereby present the first case of a patient who had a successful percutaneous stent placement via trans-axillary access in our institution.

The aim of this study is to define cardiac and extracardiac malformations in fetuses with heterotaxy syndrome and to determine perinatal and childhood prognosis.In this retrospective study, fetuses diagnosed with heterotaxy syndrome on antenatal ultrasonography in a tertiary center between January 2014 and January 2021 were analyzed. Fetuses with heterotaxy syndrome were grouped as right atrial isomerism (RAI) and left atrial isomerism (LAI).A total of 62 fetuses, 32 (51.6%) with RAI and 30 (48.4%) with LAI, were included in the study. Extracardiac anomaly was detected in 25% of fetuses with RAI and 44% of fetuses with LAI (p = 0.13). Patients with univentricular repair had a higher childhood mortality than patients with biventricular repair (p = 0.031). The presence of conotruncal anomaly was an independent factor affecting mortality (HR = 5.09, CI 95% 1.09-23.71, p = 0.039).Hydrops fetalis, univentricular physiology and conotruncal anomalies are associated with poor outcomes in heterotaxy syndrome. The severity of the cardiac malformation is the main determinant of the outcomes. The presence of extracardiac malformations is associated with increased morbidity and mortality.

Background: The aim of this study was to evaluate the predictability of postoperative pulmonary artery pressure (PAP) using intraoperative flow study in patients undergoing bidirectional Glenn operation. Methods: Patients who underwent Glenn operation under cardiopulmonary bypass (CPB) were included in the study. During the operation, after the completion of additional procedures under CPB, an intraoperative flow study was performed prior to Glenn anastomosis. After the completion of bidirectional Glenn, the patient was separated from the CPB and PAP was measured. The relationship between this pressure and flow study measurement was analyzed. Results: Nine patients who underwent bidirectional Glenn operation with additional procedures under CPB between July 2018 and January 2019 were included in the study. The median PAP was 9 mm Hg (interquartile range [IQR]: 7-10 mm Hg) in the flow study and 10 mm Hg (IQR: 8-11 mm Hg) after CPB, and the median difference between these pressures was 1 mm Hg (IQR: 1-3 mm Hg). There was a strong correlation between these two measurements ( r = 0.732; P = .025). Conclusion: The results of this study show that PAP after the Glenn procedure can be estimated using an intraoperative flow study. We believe that this method may be useful in intraoperative decision-making for Glenn operation in single ventricular patients who require extensive pulmonary artery (PA) reconstruction due to limited PA development, branch PA stenosis, or nonconfluent PAs. Also, this method can be used as a sort of intraoperative pulmonary resistance reversibility study in patients with high preoperative pulmonary vascular resistance due to surgically correctable pulmonary venous hypertension.

Background:Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion.Methods:One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation.Results:There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1.Conclusion:The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.

Objective This study aims to present our experience with single-stage complete unifocalization and intraoperative flow study for the repair of ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. Methods This study was conducted through retrospective chart review of all the patients who underwent complete single-stage midline unifocalization in a single tertiary-care institution. Results Twenty-two patients underwent midline single-stage unifocalization. The median age was 11 months (IQR: 5-21 months). The number of collateral arteries unifocalized was between one and three (median two). In-hospital mortality was 5%. Follow-up was complete; and the median follow-up regarding survival was 20 months (IQR: 10-28 months). There were three late deaths, and the estimated survival rate was 80% at 10 months and on. Out of 22 patients, ventricular septal defect was closed in the first surgery in three patients (14%) and the second surgery in four patients (19%). Total seven patients underwent surgical total repair (32%). Additionally, one out of four patients whose ventricular septal defects were closed with a fenestrated patch is under follow-up with a small ventricular septal defect, while two are waiting for ventricular septal defect closure. Therefore, total eight patients (36%) have reached total correction. Conclusion Single-stage unifocalization is a feasible treatment option in ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. This cohort had unfavorable results regarding the rate of complete repair. The pitfalls encountered were related to problems with meticulous surgical technique, complete unifocalization, and correct implementation of the flow study.

Introduction:The CeraFlexTM PDA occluder is a new flexible device with a unique delivery system that may be beneficial with regard to not changing the device position after releasing. We prospectively evaluate the efficacy of the device and also the device behaviour patterns during release.Methods:The study included 21 patients. Their median age was 1.2 years (from 6 months to 28 years) and weight was 9.6 kg (from 5.4 to 82 kg). All of the ducts were conical except one atypical ductus. Median ductal diameter at the pulmonary end was 3.8 mm (from 2.2 to 8.2 mm). The ductus was closed using an antegrade approach, but special attention was paid to the patterns of device behaviour during and just after releasing.Results:Three different modes of device behaviour were observed during and just after releasing: (1) Neither difficulty nor change of position in 13 patients (62%), (2) a little difficulty in releasing but no change of position in 6 (29%), and (3) change of the device position in 2 (9%). There was no residual shunt on the next day except in one patient, in whom late device embolisation occurred. The device was retrieved and another, bigger device implanted.Conclusion:The CeraFlexTM PDA occlude device seems to be safe and efficacious for patent ductus arteriosus closure. Its unique delivery system generally fixes the device in a stable position that does not change after release (91%). Minor difficulty in releasing is not uncommon; however, the major disadvantage is the need for larger sheaths for delivery.

Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein's anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity. Amaç: Bu çalışmada yenidoğan ve infant döneminde palyasyon amaçlı sağ ventrikül çıkım yoluna stent uygulanan olguların değerlendirilmesi amaçlandı. Ça­lış­ma pla­nı: Ocak 2013 ve Ocak 2018 tarihleri arasında, üç merkezde, sağ ventrikül çıkım yoluna transkateter yoldan stent yerleştirilen toplam 38 hasta (20 erkek, 18 kadın; medyan yaş 51 gün; dağılım 3 gün-9 ay) retrospektif olarak incelendi. Hastaların demografik özellikleri, kardiyak patolojileri, anjiyografi işlem ve klinik izlem verileri kaydedildi. Bulgular: Tanılar Fallot tetralojisi (n=27), çift çıkışlı sağ ventrikül (n=8), kompleks doğumsal kalp hastalığı (n=2) ve Ebstein anomalisi (n=1) idi. Stent yerleştirme sırasında medyan ağırlık 3.5 (dağılım, 2-10) kg idi. Beş olguda genetik anormallikler mevcuttu. İşlem öncesi medyan oksijen satürasyonu %63 (dağılım, %44-80) ve medyan işlem süresi 60 (dağılım, 25-120) dk. idi. Akut işlem başarısı %87 idi. Takip döneminde stent daralması nedeniyle yedi hastaya tekrar girişim uygulandı. Takip döneminde, yedi olgu kaybedildi. Hastaların 26’sına mortalite olmaksızın tam düzeltme ameliyatı yapıldı. Yirmi iki hastada transanüler yama kullanılırken, iki hastada kapak koruyucu tam düzeltme ve iki hastada çift yönlü Glenn operasyonu gerçekleştirildi. So­nuç: Çalışma sonuçlarımıza göre, sağ ventrikül çıkım yoluna stent yerleştirilmesi, özellikle morbidite nedeni ile tam düzeltme ameliyatı yapılamayan olgularda akla gelmesi gereken bir palyasyon çeşididir.

Objective: The incidence of patent ductus arteriosus (PDA) is greater among patients living at high altitude. In this po-pulation, the ductal diameter is often larger and pulmonary hypertension is more frequent. The aim of this study was to evaluate the hemodynamic and morphological features of PDA and transcatheter closure procedures performed with various devices in a group of patients living at high altitude in Turkey. Methods: The data of 327 patients who lived at an altitude of at least 1600 m above sea level and who had undergone cardiac catheterization for isolated PDA between May 2010 and July 2018 were retrospectively analyzed. Results: The mean age was 7.33+-7.67 years, and 62.4% of the patients were female. The mean ductal diameter was 3.74+-2.14 mm. Pulmonary hypertension was present in 57.8%. Transcatheter closure was performed in 322 patients, with a 97.3% success rate. The Amplatzer duct occluder I (ADO I) was used most often, as well as off-label use of the Amplatzer vascular plug II (AVP) and the Amplatzer muscular ventricular septal defect occluder (AMVSDO). Pulmonary artery pressure decreased immediately in the vast majority after percutaneous closure. Transient left ventricular systolic dysfunction after ductal closure was seen only rarely. Follow-up was uneventful. Conclusion: Transcatheter PDA closure can be performed with high success rate in highlanders. Off-label devices may be required for these procedures. Pulmonary hypertension is frequent but regresses after ductal closure. Transient left ventricular dysfunction after transcatheter closure is rarely seen in these patients and resolves without any medication.

Objective To determine the short- and medium-term outcomes of ductal stenting (DS) in patients with functionally univentricular hearts (FUHs) and ductal-dependent pulmonary blood flow. Background Several studies have evaluated the outcomes of DS in a limited number of patients with FUHs. Nonetheless, there is still no consensus regarding the indications for this procedure, and no appropriate patient selection criteria have been devised. Methods From 2005 to 2015, cardiac catheterization for DS was performed in 68 patients with FUHs. Of these patients, 49 had single source pulmonary blood flow from ductus arteriosus. Procedural and follow-up data were evaluated. Results The median weight of the patients was 3.6 kg (2.3–6.8 kg), and the median age was 26 days (3 days–8 months). The technical success rate of the procedure was 95% (65 of 68 patients). Mean oxygen saturation increased from 70% ± 7.6% to 87% ± 4.6% (P

When total correction is not possible in infants who have a cyanotic congenital heart disease, creation of a palliative aortopulmonary shunt is essential. A central aortopulmonary shunt is preferable, because of its technical and hemodynamic advantages. Overcirculation, thrombosis, and stenosis of the shunt are the main postoperative sequelae that necessitate urgent reintervention. Percutaneous transcatheter closure of aortopulmonary shunts can eliminate the need for reoperation and substantially decrease postoperative morbidity and mortality rates. We report our successful transcatheter closures of central aortopulmonary shunts in a 3-month-old infant and a 15-year-old girl, with use of an Amplatzer Duct Occluder II and an Amplatzer Vascular Plug I, respectively. To our knowledge, this is the first report of the transcatheter closure of central aortopulmonary shunts with these 2 devices.

Aneurysms of the ascending aorta are frequently found in patients with a bicuspid aortic valve (BAV). This study assessed the risk factors of ascending aortic aneurysms and aortic elasticity in children with BAV. The study included 66 patients with no history of transcatheter intervention or surgical procedure who had been diagnosed with isolated BAV. Echocardiographic, blood pressure, and pulse measurements were obtained for all patients. The BAVs were classified as described by Sievers et al. (J Thorac Cardiovasc Surg 133:1226–1233, 2007), and aortic elasticity parameters were calculated using various formulas. The patients were divided into groups with and without cusp fusion, aortic stenosis (AS), aortic regurgitation (AR), or mixed lesions; the groups were then compared. The mean patient age was 10.43 ± 3.91 years; 15%he patients had no AS or AR, 33% had both AS and AR, 17% had AS alone, and 35% had AR alone. The most common type of BAV was type 5, and the ascending aorta z-scores were higher in children with mixed lesions and without a cusp fusion. Aortic distensibility (AD) was significantly higher, and the stiffness index was significantly lower, in patients with an ascending aorta z-score > 4. The ascending aortic z-scores were higher in the no-fusion and mixed lesion (AS + AR) groups, especially those originating from post-stenotic dilation due to AS. The AD was increased in patients with an ascending aorta z-score > 4. Patients should thus be monitored closely for dissection risk, and preventive medical treatment should be started early in those with AS without cusp fusion.

WOS: 000429628000003 PubMed ID: 29578201 Objective: To report clinical and procedural characteristics of twelve patients who received a covered stent for the treatment of aortic coarctation and concurrent patent ductus arteriosus (PDA). Methods: A single center database was retrospectively evaluated to obtain data of patients with combined aortic coarctation and PDA. We selected patients in whom a covered stent was used for the treatment of both pathologies. The stent length was chosen so as to cover the entire length of the lesion from healthy to healthy tissue and also cover the ampulla of PDA. Results: The median age of the patients was 15 (range, 6.5-35) years. The diameter of the coarctated segment increased from a median of 8.4 (range, 2.6-10.8) mm to 16 (range, 9-24) mm (p

Results:­ The median age at the onset of symptoms was 3.5 months (birth to 4 years). Gastrointestinal symptoms were present in all and respiratory symptoms were present in 45.5% of patients, with difficulty in feeding and recurrent respiratory tract infections being the most common symptoms, respectively. All patients underwent corrective surgery successfully. No early or late death occurred. No reoperations were required during follow-ups. Symptoms involving gastrointestinal tract disappeared in all patients (100%) in mean 6.4±4.3 months, whereas respiratory symptoms disappeared in four patients (80%) in 11.4±7.2 months. Conclusion:­Today, results of surgical treatment of DAA are satisfying. Following surgery, while gastrointestinal symptoms disappeared in all patients regardless of age, complete relief of respiratory symptoms requires early intervention.

WOS: 000334902700011 Background: This study aims to evaluate patients diagnosed with Scimitar syndrome. Methods: Twelve patients (8 girls, 4 boys; mean age: 4.0 +/- 4.8 years; range 1 month to 16 years) with a mean weight of 16.7 +/- 21.8 kg who were diagnosed with Scimitar syndrome in our clinic between January 2003 and December 2011 were included. Clinical findings of the patients, physical examination, telecardiography, echocardiography, cardiac catheterization, and surgical findings and follow-up data were retrospectively reviewed. Results: Of 12 patients, five (42%) were considered with infantile type and seven (58%) with child/adult type Scimitar syndrome. All patients of infantile type presented with tachypnea and cardiac failure findings, while one patient with child/adult type had a history of recurrent lower respiratory tract infection. Additional cardiac defects were atrial septal defect in seven, coarctation in one, patent ductus arteriosus in two, and ventricular septal defect with pulmonary atresia in one patient. Bilateral Scimitary syndrome was present in one patient. All infantile type patients had severe pulmonary hypertension, while only one of the child/adult type patients had mild pulmonary hypertension. Six of nine patients with aortopulmonary collateral artery underwent transcatheter closure of the artery. Surgery was performed in 10 patients (83%). One patient with infantile type in the early postoperative period and another patient with bilateral Scimitar syndrome who was not operated during follow-up died due to pulmonary infection. Conclusion: Scimitar syndrome is a rare syndrome which may present with different clinical presentations. Patients with child/adult type disease are often asymptomatic, however, may present with recurrent pulmonary infections. Although aortopulmonary collateral occlusion may provide symptomatic relief, surgery is indicated in patients with obstructed Scimitar vein and additional cardiac anomalies, in particular.

AimThe present study aims to define the lowest effective prostaglandin E1 dose in patients with inadequacy of pulmonary blood flow and/or intracardiac blood mixing and those with inadequate systemic blood flow.MethodsPatients with inadequacy of both pulmonary blood flow and/or blood mixing (Group 1) and those with inadequate systemic blood flow (Group 2) were retrospectively evaluated in two separate groups with regard to the prostaglandin E1 starting dose given in the referring facility, the lowest and the highest dose administered in our centre, treatment duration, adverse effects, and administered treatment.ResultsNo difference between the groups could be detected with respect to sex or birth weight (p=0.95 and 0.42, respectively). Group 1 and Group 2 were statistically similar in aspect of prostaglandin treatment duration (9.73±0.81 days versus 11.6±1.05 days, p=0.064). When compared with Group 2, the initial, maintenance and lowest efficient doses of prostaglandin E1 treatment were significantly lower and the titrated dose of prostaglandin E1 was significantly higher in Group 1 (p=0.001 for each).ConclusionOur findings indicate that the infusion of prostaglandin at a very low dose (0.003–0.005 mcg/kg/minute) is sufficient to maintain the patency of the ductus arteriosus. A higher dose of prostaglandin E1 may be necessary in patients with inadequate systemic blood flow.

1Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey 2Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey 3Department of Infectious Diseases, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

Background We sought to investigate the safety, efficacy, and follow-up results of percutaneous patent ductus arteriosus (PDA) closure using the novel Cardi-O-Fix duct occluder (CDO), a device similar to but less expensive than the Amplatzer duct occluder (ADO). We also aimed to compare these two devices in terms of results. Methods Between March 2005 and May 2012, 167 patients diagnosed with moderate-to-large PDA underwent transcatheter closure. ADO was used in 56 (33.5%) patients with a mean age of 8.1 ± 11.9 years (3.6 months–56 years), whereas CDO was used in 111 (66.5%) patients with a mean age of 12.6 ± 14.6 years (4.8 months–63 years). Results The narrowest PDA diameter, the used device diameter, procedure time, fluoroscopy time, and residual shunt rates were similar between the two groups. Procedural success rate was 100% in both groups. Although the residual shunt rate was higher in the CDO group immediately after the procedure, the difference was not statistically significant (12.6 vs. 8.9%; P = 0.3). There was no statistically significant difference between groups at discharge and during follow-up. No deaths occurred in any of the groups, and there were no differences in complication rates during the short- and mid-term follow-up periods (CDO 7/111 vs. ADO 5/56; P = 0.5 π). Conclusion The CDO can be used for PDA closure because of its safety, effectiveness, and simplicity in use. It is available in bigger sizes and can be used in patients with large defects. According to our short- and mid-term findings, the results it yields are similar to those of the ADO; thus, it may be the preferred choice owing to its low cost and large size variability. © 2013 Wiley Periodicals, Inc.

WOS: 000418417300006 Background: In this study, we aimed to evaluate accompanying cardiac pathologies in patients with left atrial isomerism and report the follow-up results. Methods: A total of 72 patients (25 males, 47 females; mean age 44.6 +/- 65.8 months; range 0 day to 255 months) with left atrial isomerism in two congenital heart diseases centers were retrospectively analyzed between July 2002 and December 2016. Clinical, radiological, electrocardiographic, echocardiographic, and angiocardiographic findings of the patients, surgical and transcatheter procedures, and postoperative follow-up data were recorded. Results: The mean follow-up was 108 +/- 49.5 (range 12 to 173) months. Of 72 patients, four did not require surgery, while a permanent pacemaker was implanted in two patients. Of 68 patients who needed surgery, 17 were the candidates of biventricular correction, while the remaining 51 patients were the candidates of univentricular correction. The Kawashima procedure was performed in 29 patients. The pulmonary antegrade flow was left open in seven of these patients. In four patients, hepatic veins were incorporated into the Fontan circulation at the same session. In six patients, hepatic veins were directed to the pulmonary artery due to progressive cyanosis during follow-up using extracardiac conduit. Three patients died after surgery. Mortality or progressive cyanosis was not observed in any patients in whom the hepatic veins were incorporated into the Fontan circulation at the same or in another session, or in the patients in whom the antegrade flow was left open. Conclusion: The overall prognosis is excellent in patients with biventricular physiology. However, tissue oxygenation tends to fall in patients undergoing Kawashima procedure. Therefore, incorporation of the hepatic veins into the pulmonary circulation at the same session, or leaving the antegrade flow open in suitable cases seems to be a safe approach in patients undergoing Kawashima procedure.

Background: In this study, we aimed to evaluate accompanying cardiac pathologies in patients with left atrial isomerism and report the follow-up results. Methods: A total of 72 patients (25 males, 47 females; mean age 44.6 +/- 65.8 months; range 0 day to 255 months) with left atrial isomerism in two congenital heart diseases centers were retrospectively analyzed between July 2002 and December 2016. Clinical, radiological, electrocardiographic, echocardiographic, and angiocardiographic findings of the patients, surgical and transcatheter procedures, and postoperative follow-up data were recorded. Results: The mean follow-up was 108 +/- 49.5 (range 12 to 173) months. Of 72 patients, four did not require surgery, while a permanent pacemaker was implanted in two patients. Of 68 patients who needed surgery, 17 were the candidates of biventricular correction, while the remaining 51 patients were the candidates of univentricular correction. The Kawashima procedure was performed in 29 patients. The pulmonary antegrade flow was left open in seven of these patients. In four patients, hepatic veins were incorporated into the Fontan circulation at the same session. In six patients, hepatic veins were directed to the pulmonary artery due to progressive cyanosis during follow-up using extracardiac conduit. Three patients died after surgery. Mortality or progressive cyanosis was not observed in any patients in whom the hepatic veins were incorporated into the Fontan circulation at the same or in another session, or in the patients in whom the antegrade flow was left open. Conclusion: The overall prognosis is excellent in patients with biventricular physiology. However, tissue oxygenation tends to fall in patients undergoing Kawashima procedure. Therefore, incorporation of the hepatic veins into the pulmonary circulation at the same session, or leaving the antegrade flow open in suitable cases seems to be a safe approach in patients undergoing Kawashima procedure., Amaç: Bu çalışmada sol atriyal izomerik hastalarında eşlik eden kardiyak patolojiler değerlendirildi ve takip sonuçları sunuldu. Ça¬lış¬ma pla¬nı: Temmuz 2002 - Aralık 2016 tarihleri arasında iki doğumsal kalp hastalıkları merkezinde sol atriyal izomerizmli toplam 72 hasta (25 erkek, 47 kız; ort. yaş 44.6±65.8 ay; dağılım 0 gün - 255 ay) retrospektif olarak incelendi. Olguların klinik, radyolojik, elektrokardiyografik, ekokardiyografik ve anjiyokardiyografik bulguları, cerrahi ve transkateter işlemler ve ameliyat sonrası takip verileri kaydedildi. Bulgular: Ortalama takip süresi 108±49.5 (dağılım 12-173) ay idi. Yetmiş iki hastanın dördüne cerrahi gerekmez iken, iki hastaya kalıcı kalp pili takıldı. Cerrahi gereken 68 hastanın 17’si iki ventrikül tamiri adayı iken, geriye kalan 51 hasta tek ventrikül tamiri adayıydı. Yirmi dokuz hastaya Kawashima işlemi uygulandı. Bu hastaların yedisinde pulmoner antegrad akım açık bırakıldı. Dört hastada hepatik venler aynı seansta Fontan dolaşımına dahil edildi. Altı hastada takip sırasında ilerleyici siyanoz nedeniyle hepatik venler, ekstrakardiyak kondüit yardımıyla, pulmoner artere yö550nlendirildi. Cerrahi sonrasında üç hasta kaybedildi. Hepatik venlerin aynı seansta ya da ikinci bir seansta Fontan dolaşımına dahil edildiği hastalar veya antegrad pulmoner akımın açık bırakıldığı hastalarda mortalite veya ilerleyici siyanoz gözlenmedi. So¬nuç: İki ventrikül fizyolojisine sahip hastaların genel prognozu mükemmeldir. Ancak, Kawashima işlemi yapılan hastalarda doku oksijenizasyonu düşme eğilimindedir. Bu nedenle, Kawashima işlemi yapılan hastalarda, aynı seansta hepatik venlerin dolaşıma dahil edilmesi veya uygun olgularda antegrad akımın açık bırakılması güvenli bir yaklaşım olarak görünmektedir.

Pulmonary arteriovenous malformation (PAVM) is a rare cause of cyanosis in newborn. A 12-day-old male newborn (2.8 kg) was referred to our hospital with the complaints of cyanosis and respiratory distress. On two-dimensional echocardiography, the right pulmonary artery (PA) appeared larger than left PA and the left atrium, left ventricle were dilated. The right heart chambers were in normal limits. A color flow Doppler echocardiogram revealed a turbulent flow due to a PAVM originating from medium branch of right PA, and continuous wave Doppler showed continuous flow pattern. Agitated saline injection resulted in the delayed appearance of the contrast in the left-side chambers three to four heart cycles after appearance in the right-side chambers; the study was considered positive and indicative of an intrapulmonary shunt. Selective angiography of the right PA confirmed the diagnosis of a large solitary PAVM in the right middle lobe with a feeding artery. Amplatzer vascular plug I, which is designed to close abnormal vascular structures, was chosen to close the PAVM. The deployment of device performed safely and the oxygen saturation of baby increased to 95% immediately after deployment. Heart failure and respiratory distress also resolved after the procedure.

The closure of a secundum atrial septal defect through the jugular vein in a child with interrupted inferior vena cava with azygos continuation by steerable delivery catheter is described in the present report. The steerable catheter can be used to correct the perpendicular position of the device over the margins of the defect, and is particularly useful in cases of large defects.

The purpose of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by transthoracic echocardiography (TTE). Since 2004, ASD closure was performed successfully in total 337 patients. Transthoracic echocardiography guidance was used in 206 patients (61.1%) (group 1). Closure was guided by transesophageal echocardiography under general anesthesia in patients with poor transthoracic acoustic windows, defects with aneurysmatic septum and/or multiple defects in 131 patients (38.9%) (group 2). The median age (9 vs. 16 years, P < 0.001), mean defect diameter (14.9 ± 4 vs. 17.2 ± 5 mm, P < 0.001), ratio of complex atrial septal defect (14 vs. 34%, P = 0.01), the median balloon stretch dimensions (21 vs. 18.7 mm, P = 0.003) and the median device diameters (22 vs. 19 mm, P < 0.001) were significantly greater in group 2 compared to group 1. Both the median procedure time and the median fluoroscopy time was significantly shorter in group 1 (60 vs. 75; and 13 vs. 16.5 min; P < 0.0001 and P < 0.0001, respectively). The incidence of residual shunt did not differ significantly in two groups during follow up. Transthoracic echocardiography guidance during transcatheter ASD closure is safe and effective in children and in many adults. Even complex ASDs could be closed with TTE in patients with good acoustic windows. Performing the procedure under TTE guidance significantly reduces procedure time and also provides increased patient's comfort.

Summary Aim: The aim of the study was to determine the differences between rural and urban adolescents rsquo; health and health behaviors Material and Method: The data presented in this study were a part of the Turkish data nbsp; collected for the cross sectional and international nbsp; ldquo;Health Behavior in School aged Children 2005 2006 study rdquo; which aimed to evaluate adolescents rsquo; health and health behavior around Europe and North nbsp; America Data were collected from 3884 11 to 13 years of age nbsp; 1946 males 1938 females students who attended nbsp; 180 classes of 82 primary schools in nbsp; 23 cities Statistical analyses were made by using chi square nbsp; test Results: Both female and male students who lived in rural areas were more likely to go to bed hungry more often to feel dizzy more often to eat nbsp; fruits less often to brush teeth less often to exercise less often and to use computers less often than their peers living in urban areas Besides in rural areas nbsp; male students were more likely to be violent and female students were more likely to feel unhealthy to be unsatisfied with their lives and to be injured more often than their urban peers Both female and male students who lived in urban areas were more likely to eat or drink more energy dense and low nutritional value foods and drinks than their peers living in rural areas Males who lived in urban areas were more likely to be on a diet not to be satisfied with their body and to be obese than their peers living in rural areas nbsp; Conclusions: The results of this study showed that there are several health inequities between rural and urban female and male adolescents These differences should be taken into account when prepering adolescent health promotion programs Turk Arch Ped 2010; 45: 96 104 Key words: Adolescent health health behavior rural urban differencest, Özet Amaç: Bu araştırmanın amacı Türkiye rsquo;de kentsel ve kırsal alanlarda yaşayan 11 ve 13 yaşındaki öğrencilerin sağlık durumları ve sağlıkla ilgili davranışları arasındaki farklılıkları saptamaktı Gereç ve Yöntem: Bu çalışmada gençlerin sağlık durumları ve sağlık davranışlarını saptamayı hedefleyen kesitsel tanımlayıcı ve çok uluslu ldquo;Health Behavior in School Aged Children 2006 HBSC rdquo; araştırmasının Türkiye ayağına katılan 11ve 13 yaşındaki nbsp; çocukların verilerinden yararlanıldı Bu çalışma için veri çözümlemeleri 23 ildeki 82 ilkokulun 180 dersliğinde 11 ve 13 yaşlarındaki 3884 1946 erkek 1938 kız öğrenci üzerinden yapıldı Gruplar arasındaki oran farklılıkları ki kare testi ile değerlendirildi Bulgular: Kırsal alanda yaşayan hem kızların hem de erkeklerin kentlerde yaşayan akranlarından daha sık yatağa aç girdikleri daha sık baş dönmesinden yakındıkları daha az meyve yedikleri daha nadir diş fırçaladıkları daha az egzersiz yaptıkları saptandı Kırsal alanda yaşayan öğrenciler kentlerde yaşayanlara göre daha az bilgisayar kullanıyorlardı Ayrıca kırsal alanda yaşayan erkeklerin daha sık şiddet davranışları gösterdikleri ve kızların ise kendilerini daha sağlıksız hissettikleri yaşamlarından daha az memnun oldukları ve daha sık yaralandıkları saptandı Kentlerde yaşayan nbsp; kız ve erkek öğrenciler kırsal alanda yaşayan akranlarından daha sık olarak besin değeri düşük ve enerji içeriği yüksek yiyecek ve içecekleri tükettiklerini bildirdiler Kentsel alanda yaşayan erkekler arasında diyette olma bedeninden hoşnut olmama ve şişmanlık kırsal alanda yaşayanlara göre daha sıktı Çıkarımlar: Araştırmamız ülkemizde kentsel ve kırsal alanda yaşayan 11 ve 13 yaşındaki kızlar ve erkekler arasında sağlık açısından eşitsizlikler olduğunu ve kırsal alanda yaşayan hem kızların hem de erkeklerin daha fazla risk altında olduğunu göstermektedir Ergenler için sağlığı geliştirme programları hazırlanırken yerleşim yeri nedeni ile ortaya çıkan bu farklılıkların göz önüne alınması gerektiğini düşünmekteyiz nbsp; Türk Ped Arş 2010; 45: 96 104 Anahtar sözcükler: Ergen kırsal kentsel farklılıklar sağlık sağlık davranışları

The aim of the study was to determine the economical impact of juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF) in Turkey. A total of 100 patients (69 F/31 M) with JIA and 100 with FMF (68 F/32 F) who were consecutively seen in the outpatient clinic of the pediatric rheumatology department at Cerrahpasa Medical School between August 2008 and January 2009 were studied. Cost data were collected through a questionnaire filled out by the parents. The mean age (JIA: 11 +/- A 5 years; FMF:12 +/- A 4 years) and mean disease duration (JIA:5 +/- A 3 years; FMF: 4 +/- A 3 years) of the patients were similar. JIA patients were assigned to 5 subtypes (polyarticular: n = 45, oligoarticular: n = 30, systemic onset: n = 13, psoriatic: n = 6, and enthesopathy-related JIA: n = 6). Forty-nine percent of the patients with JIA were treated with anti-TNF drugs and 61% with DMARDs. All patients with FMF were using colchicine. The total annual cost of JIA (a,not sign3,994 +/- A 4,101) was considerably higher than that of FMF (a,not sign162 +/- A 77) (P < 0.001). Medication fee was the major determinant of total costs in both diseases constituting 85% in JIA and 39% in FMF. Among the subtypes of JIA, total annual costs were the highest among patients with polyarticular type (a,not sign6,045 +/- A 4,078). Medications especially anti-TNF drugs were the major contributor among all determinants of costs in JIA. The low costs of health care system and prominent changes in the health care policies for the last 5 years in Turkey might have played role in our findings.

Amaç: Bu araflt›rman›n amac› Türkiye’de okula devam etmekte olan ergenlerin fiziksel etkinlik düzeylerinin demografik etkenler, beden kitle indeksi ve baz› sa¤l›k davran›fllar› ile iliflkisini saptamakt›. Gereç ve Yöntem: Bu çal›flmada kesitsel tan›mlay›c› ve çok uluslu “Health Behavior in School Aged Children (HBSC)” araflt›rmas›n›n Türkiye aya¤›na kat›lan ve 6., 8. ve 10. s›n›fa devam eden 11, 13 ve 15 yafl›ndaki ergenlerin verilerinin bir bölümü de¤erlendirildi. Veri çözümlemeleri 26 ildeki 82 ilkokulun 180 dersli¤inde 11 ve 13 yafllar›ndaki 3884 (1946 erkek, 1938 k›z) ve 83 lisenin 88 dersli¤inde 15 yafl›ndaki 1668 (901 erkek, 767 k›z) ö¤renci üzerinden yap›ld›. ‹statistiksel de¤erlendirmede ki-kare testi, faktör analizi ve lojistik regresyon analizi kullan›ld›. Bulgular: Ö¤rencilerin %20’si haftada en az yedi gün, günde en az bir saat herhangi bir fiziksel etkinlikte bulunduklar›n› bildirdi. Çok de¤iflkenli analizde (lojistik regresyon) fiziksel etkinlik ile erkek olmak, 15 yafl›na göre 11 yafl›nda ve 13 yafl›nda olmak ve akflamlar› arkadafllar› ile evin d›fl›nda zaman geçirmek aras›nda anlaml› iliflki bulundu. Beslenme davran›fllar› hem sa¤l›kl› hem de sa¤l›ks›z yiyecekleri az tüketenler esas al›narak incelendi¤inde, di¤er üç grubun (sa¤l›kl› yiyecek tüketimi s›k+sa¤l›ks›z yiyecek tüketimi seyrek olanlar; sa¤l›ks›z yiyecek tüketimi s›k+sa¤l›kl› yiyecek tüketimi seyrek olanlar; her iki tip yiyece¤i s›k tüketenler) esas gruba göre fiziksel etkinlik düzeylerinin daha fazla oldu¤u saptand›. Çıkarımlar: Bu araflt›rman›n sonuçlar› ülkemizde yaflayan ergenlerin fiziksel etkinlik düzeylerinin yetersiz oldu¤unu, özellikle k›zlar›n fiziksel olarak etkin olmad›¤›n›, ergenlerin beslenme al›flkanl›klar›n›n ve arkadafllar› ile geçirdikleri zaman›n fiziksel etkinlik düzeyleriyle iliflkili oldu¤unu göstermesi aç›s›ndan önemlidir. Etkin sa¤l›¤› koruma ve gelifltirme programlar› özellikle k›zlara odaklamal› ve ergenlerin beslenme al›flkanl›klar›n›n üzerinde durmal›d›r. Akranlar›n ergenlerin fiziksel etkinlik düzeylerinin art›r›lmas›nda önemli rol oynayabilecekleri de unutulmamal›d›r., Aim: The aim of this study was to determine the relationships between physical activity level and demographic characteristics nbsp; body mass index nbsp; and some other health behaviors nbsp; in Turkish adolescents

We aim to assess the safety, feasibility and efficacy of the new Nit-Occlud ASD-R (NOASD-R) device. From 2014 to 2015, transcatheter closure of atrial septal defect (ASD) using the NOASD-R was performed in 30 consecutive patients. The standard deployment technique as the left upper pulmonary vein approach was used in 25 patients. Right upper pulmonary vein approach was required in five. The median age was 6 years (range 3.5–60 years), and median weight was 21.5 kg (14–79 kg). Implantation was successful in all patients. The median size of devices was 16 mm (12.0–26.0 mm). The mean device size/2D defect diameter ratio was 1.26 ± 0.09 (1.12–1.40). The mean device size/color flow diameter ratio was 1.07 ± 0.06 (range 1.0–1.22). Releasing problem was encountered in three patients. A device-related erosion on the day after the closure was observed in one patient. No further device-related complication (erosion, embolization or dislodgement of the device) was encountered in a median follow-up period of 10 months (range 2–14 months). Complete occlusion has occurred in all at follow-up. NOASD-R is a feasible and effective device for use in the transcatheter occlusion of moderate to large secundum ASDs in selected patients. The occurrence of the erosion on the right atrial roof may be due to the high localization of the device and the larger size of the right disk.

We aimed to assess early and midterm outcomes of balloon valvuloplasty (BVP) procedure in patients with critical pulmonary stenosis (CPS) and to describe the predictors of the need for additional pulmonary flow and reintervention in this subgroup of patients. From 2005 to 2014, 56 neonates were diagnosed with CPS and were included in this study. All echocardiographic, catheterization and angiographic data obtained prior to the initial BVP and at follow-up were reviewed. BVP was successful in 55 neonates (98 %). Twenty-one neonates needed pulmonary blood flow augmentation after BVP (38 %). Ductal stenting (DS) was performed in 20. The patients' mean tricuspid valve (TV) annulus diameter was 10.4 ± 2 mm, and the Z score was -1.29 ± 1 (-3.7 to 0.78). The mean pulmonary valve (PV) annulus diameter was 6 ± 0.9 mm, and the Z score was -1.74 ± 1 (-4.34 to 0.05). A transcatheter or surgical reintervention was performed in 11 patients. A TV Z score

Extra genetic material in patients with Down syndrome (DS) may affect the function of any organ system. We evaluated cardiac functions using conventional tissue Doppler and two-dimensional speckle tracking echocardiography in patients with DS in the absence of congenital and acquired heart disease in patients. A total of 115 patients with DS between 6 and 13 years of age with clinically and anatomically normal heart and 55 healthy children were included in this cross-sectional study. DS was diagnosed by a karyotype test. Patients with mosaic type were not included in this study. Systolic and diastolic functions were evaluated by echocardiography. Pulsed waved Doppler transmitral early/late inflow velocity (E/A), tissue Doppler mitral annular early/late diastolic peak velocity (Ea/Aa), transtricuspid E/A and tricuspid valve annulus Ea/Aa, pulmonary venous Doppler systolic/diastolic (S/D) wave ratio were lower in patients with Down syndrome than in the control group (P=0.04, P=0.001, P

The aim of this study was to explore the relationships between involvement in bullying behaviors and school, family, and peer factors. Health Behavior in School Age Children survey questionnaire was used. Of the students surveyed, 20% were both bully and victim, 11% were bully, and 21% were victim. Being male, poor parental support, and poor monitoring by the father were found to be risk factors for being both bully and victim. Poor academic achievement, having peers at different ages, poor quality of friendship, poor communication with parents, and not being isolated by peers were found to be risk factors for being bully. Not liking school, feeling pressured by school work, poor quality of friendship, poor monitoring by the father, close bonding with mother, and poor status of the peer group were found to be risk factors for being victim. These findings highlight the importance that bullying intervention programs should include country-specific and culture-specific influences for success.

Pulmonary arteriovenous malformation (PAVM) is a rare cause of cyanosis in newborn. A 12-day-old male newborn (2.8 kg) was referred to our hospital with the complaints of cyanosis and respiratory distress. On two-dimensional echocardiography, the right pulmonary artery (PA) appeared larger than left PA and the left atrium, left ventricle were dilated. The right heart chambers were in normal limits. A color flow Doppler echocardiogram revealed a turbulent flow due to a PAVM originating from medium branch of right PA, and continuous wave Doppler showed continuous flow pattern. Agitated saline injection resulted in the delayed appearance of the contrast in the left-side chambers three to four heart cycles after appearance in the right-side chambers; the study was considered positive and indicative of an intrapulmonary shunt. Selective angiography of the right PA confirmed the diagnosis of a large solitary PAVM in the right middle lobe with a feeding artery. Amplatzer vascular plug I, which is designed to close abnormal vascular structures, was chosen to close the PAVM. The deployment of device performed safely and the oxygen saturation of baby increased to 95% immediately after deployment. Heart failure and respiratory distress also resolved after the procedure.

Background: Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. Aims: To present our experience with the diagnosis and outcome of APW cases. Study Design: Retrospective cohort study. Methods: Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. Results: Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. Conclusion: In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect. Turkish Başlık: Aortopulmoner Pencereli Olguların Tanı ve Tedavi Sonuçlarının Değerlendirilmesi Anahtar Kelimeler: Aortopulmoner pencere, pulmoner hipertansiyon Arka Plan: Aortopulmoner pencere; iki ayrı semilunar kapak varlığnda asendan aorta ile pulmoner arter arasında bağlantı olmasıdır ve septal defektlerin en nadir görülen tipidir. Amaç: Bu çalışmada kliniğimizde tanı almış aortopulmoner pencereli olgularımızın tanı ve tedavi sonuçlarını değerlendirmeyi amaçladık. Çalışma Tasarımı: Retrospektif kohort çalışma Yöntemler: Haziran 2003 ile Ekim 2011 tarihleri arasında 13 olgu aortopulmoner pencere tanısı aldı. Bu olguların dosyalarından başvuru sırasındaki klinik özellikleri, ekokardiyografik ve kalp kateterizasyonu bulguları ile cerrahisonuçları geriye dönük olarak gözden geçirildi. Bulgular: Yaşları 10 gün ile 16 yaş arasında değişen 11 olguya aortopulmoner pencere tanısıyla cerrahi girişim uygulandı. 12 aylık bir olguda defekt transkateter yoldan kapatıldı. Cerrahi tamir sırasında 8 olguda yapay, 3 olguda perikardiyal yama kullanıldı. Aortopulmoner pencere tamiri sırasında 2 hastada VSD, 2 olguda da kesintili arkus aorta tamiri yapıldı. Cerrahi ya da transkateter yoldan tedavi edilmiş hiçbir olgu kaybedilmedi. Postoperatif dönemde 3 olguda önemli pulmoner hipertansiyon nedeniyle nitrik oksit ve iloprost kullanımı gerekti. İzlemde kesintili arkus aorta nedeniyle cerrahi tamir uygulanmışolguya rekoarktasyon nedeniyle balon angioplasti yapıldı. Median 40 aylık süredetakip edilen diğer olgular semptomsuz ve iyi klinik durumda izlenmektedir. Sonuç: Büyüme gelişme geriliği ve kalp yetersizliği bulguları olan infantlarda aortopulmoner pencere ayırıcı tanıda düşünülmelidir. Altı aydan küçük izole defekte sahip olgularda ekokardiyografi tanı için yeterli bir yöntemdir. Kompleks olgularda kardiyak anatominin değerlendirilmesi, altı aydan büyük olgularda operabilitenin değerlendirilmesi ve uygun olgularda defektin transkateter yoldan kapatılması için kalp kateterizasyonu gerekebilir.

WOS: 000387737700017 PubMed ID: 27826346 Background and Objectives: This study aims to compare the characteristics, effectiveness and results of transcatheter closure of atrial septal defect between children, adolescents, and adults. Subjects and Methods: In this study, 683 patients who underwent atrial septal defect closure in the last 10 years were divided into three groups: children (age 16) as group 1, group 2 and group 3, respectively. Results: The average defect size and incidence of complex atrial septal defect were higher in group 3 (p=0.0001 and 0.03 respectively). While the average size of the devic was higher in adults (22.6 +/- 6.4 mm vs. 18.5 +/- 4.9 mm; p=0.0001), the ratio of the device size/total septum was higher in both children and adolescents (Group 1 and 2). In the child and adolescent groups and patients with only complex atrial septal defect, the use of techniques, other than standard deployment, was similar in all three groups (p=0.86 and 0.41, respectively). The ratio of the residual shunt was similar in all three groups. Major complications were seen in 5 cases (4 cases with migration, and 1 case with dislocation) in group 3 and 1 case (migration) in group 1. Conclusion: Depending on the complexity of the defect and age of the patient, transcatheter closure of atrial septal defect might have certain difficulties and complications. Patients must be evaluated in detail to avoid major complications and possible problems during the procedure.