1
|
Gözüküçük D, İleri BA, Başkan SK, Öztarhan E, Güller D, Önal H, Öztarhan K. Evaluation of cardiac autonomic dysfunctions in children with type 1 diabetes mellitus. BMC Pediatr 2024; 24:229. [PMID: 38561716 PMCID: PMC10986024 DOI: 10.1186/s12887-024-04644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes, impacting the autonomic nerves that regulate the heart and blood vessels. Timely recognition and treatment of CAN are crucial in averting the onset of cardiovascular complications. Both clinically apparent autonomic neuropathy and subclinical autonomic neuropathy, particularly CAN pose a significant risk of morbidity and mortality in children with type 1 diabetes mellitus (T1DM). Notably, CAN can progress silently before manifesting clinically. In our study, we assessed patients with poor metabolic control, without symptoms, following the ISPAD 2022 guideline. The objective is is to determine which parameters we can use to diagnose CAN in the subclinical period. METHODS Our study is a cross-sectional case-control study that includes 30 children diagnosed with T1DM exhibiting poor metabolic control (average HbA1c > 8.5% for at least 1 year) according to the ISPAD 2022 Consensus Guide. These patients, who are under the care of the pediatric diabetes clinic, underwent evaluation through four noninvasive autonomic tests: echocardiography, 24-h Holter ECG for heart rate variability (HRV), cardiopulmonary exercise test, and tilt table test. RESULTS The average age of the patients was 13.73 ± 1.96 years, the average diabetes duration was 8 ± 3.66 years, and the 1-year average HbA1c value was 11.34 ± 21%. In our asymptomatic and poorly metabolically controlled patient group, we found a decrease in HRV values, the presence of postural hypotension with the tilt table test, and a decrease in ventricular diastolic functions that are consistent with the presence of CAN. Despite CAN, the systolic functions of the ventricles were preserved, and the dimensions of the cardiac chambers and cardiopulmonary exercise test were normal. CONCLUSIONS CAN is a common complication of T1DM, often associated with the patient's age and poor glycemic control. HRV, active orthostatic tests, and the evaluation of diastolic dysfunctions play significant roles in the comprehensive assessment of CAN. These diagnostic measures are valuable tools in identifying autonomic dysfunction at an early stage, allowing for timely intervention and management to mitigate the impact of cardiovascular complications associated with T1DM.
Collapse
Affiliation(s)
- Davut Gözüküçük
- Department of Medicine, Division of Pediatrics, Sağlık Bilimleri University, Kanuni Sultan Süleyman Training and Research Hospital, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
| | - Berkut A İleri
- Department of Medicine, T.C. Demiroğlu Bilim University İstanbul Florence Nightingale Hospital, İzzetpaşa Mah, Abide-I Hürriyet Cd No:166, Şişli, 34381, Istanbul, Turkey
| | - Serra Karaca Başkan
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine Training and Research Hospital, Turgut Özal Millet St., Istanbul, Fatih, Topkapı, 34093, Turkey
| | - Ece Öztarhan
- Department of Medicine, Yeditepe University, Yeditepe Faculty of Medicine Training and Research Hospital, Koşuyolu, Koşuyolu Cd. No: 168, Kadıköy, 34718, Istanbul, Turkey
| | - Dilek Güller
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Gastroenterology, T.C. Demiroğlu Bilim University, İstanbul Florence Nightingale Hospital, İzzetpaşa Mah, Abide-I Hürriyet Cd No:166, Şişli, 34381, Istanbul, Turkey
| | - Hasan Önal
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Endocrinology and Metabolism, Sağlık Bilimleri University, Başakşehir Çam ve Sakura City Hosptial, Başakşehir Mahallesi G-434 Caddesi No: 2L, Başakşehir, Istanbul, Turkey
| | - Kazım Öztarhan
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine Training and Research Hospital, Turgut Özal Millet St., Istanbul, Fatih, Topkapı, 34093, Turkey.
| |
Collapse
|
2
|
Uzunhan O, Yıldırım MB, Eser C, Öztarhan K, Çelik A. A rare cause of air-leak syndrome in a premature newborn: a case report. BMC Pediatr 2023; 23:360. [PMID: 37442972 PMCID: PMC10339639 DOI: 10.1186/s12887-023-04140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Pulmonary complications, such as airway leak syndrome, are common in preterm neonates; however, bronchial rupture is a rarely seen phenomenon. CASE PRESENTATION In this case, we present a preterm newborn who developed pneumomediastinum and pneumothorax. The pneumothorax persisted, despite placement of a thorax tube, requiring a thoracotomy to detect and treat the bronchial rupture. CONCLUSION Physicians should have a high suspicion of bronchial rupture in patients with persistent air leak syndrome, even after thorax tube placement and continuous negative pressure implementation.
Collapse
Affiliation(s)
- Ozan Uzunhan
- Department of Neonatology, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | | | - Can Eser
- Department of Pediatrics, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Kazım Öztarhan
- Department of Pediatric Cardiology, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Alaettin Çelik
- Department of Pediatric Surgery, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| |
Collapse
|
3
|
Polat AB, Ertürk M, Uzunhan O, Karademir N, Öztarhan K. 27 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital. J Cardiothorac Surg 2023; 18:38. [PMID: 36653817 PMCID: PMC9850550 DOI: 10.1186/s13019-023-02148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Fontan operation has improved the survival of children born with congenital heart disease with single ventricle physiology. The most widely adopted variations of the Fontan procedure are the extracardiac conduit, the lateral tunnel ve the intra/extracardiac conduit with fenestration. Despite advances in the treatment and prevention of early and late complications that may develop after Fontan surgery, morbidity still remains an important problem. METHODS 304 patients who underwent Fontan surgery in our center between 1995 and 2022 were included in our study. The complications that developed in patients who underwent primary Fontan or lateral tunnel surgery and extracardiac conduit Fontan application were compared. RESULTS Classic Fontan surgery and lateral tunnel surgery were performed in 26 of the patients, and extracardiac Fontan surgery was performed in 278 patients. 218 of 304 cases were patients with single ventricular pathology. 86 cases were patients with two ventricular morphologies but complex cardiac pathology. Fenestration was performed in only 6 patients, other patients did not require fenestration. The mean follow-up period of our patients was 12 years (3 months-27 years). When the complications between Fontan procedures were compared in our study, it was found that the length of hospital stay and mortality were statistically significantly reduced in patients who underwent extracardiac Fontan surgery. There was no significant difference in terms of complications that can be seen after Fontan surgery and the length of stay in the intensive care unit. CONCLUSION Fontan complex is a palliative surgery for children with complex heart disease. Palliative surgical operations aimed at the preparation of the Fontan circulation lead to the preparation of the pulmonary vascular bed and the preservation of ventricular function. The techniques applied in Fontan surgery affect the early and long-term complications and the survival of the patients. In our study, when we examined the patients who extracardiac conduit Fontan procedure for the non-cardiac route, we found that mortality and morbidity were minimal.
Collapse
Affiliation(s)
- Ahmet Bülent Polat
- grid.414934.f0000 0004 0644 9503Department of Cardiovascular Surgery, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Murat Ertürk
- grid.414934.f0000 0004 0644 9503Department of Cardiovascular Surgery, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Ozan Uzunhan
- grid.414934.f0000 0004 0644 9503Department of Newborn, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Nur Karademir
- grid.414934.f0000 0004 0644 9503Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| | - Kazım Öztarhan
- grid.414934.f0000 0004 0644 9503Department of Pediatric Cardiology, Florence Nightingale Hospital, T.C. Demiroglu Bilim University, İzzetpaşa Mah, Abide-I Hürriyet Cad, No:166, Sisli, 34394 Istanbul, Turkey
| |
Collapse
|
4
|
Öztarhan K, Kaptaç T, Karkucak M, Öztarhan E, Gedikbaşı A. Jacobsen syndrome: a case report and clinical features of a rare genetic syndrome. Perinat J 2022. [DOI: 10.2399/prn.22.0303006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Jacobsen syndrome is an infrequent contiguous gene syndrome that involves the deletion of the long arm of chromosome 11. It is mostly accompanied by intellectual disability and other abnormalities. The majority of the patients are hospitalized or lost within the first two years of life. Case(s): We report a case of a fetus at 21 weeks of gestation with Jacobsen syndrome who presented with a conotruncal cardiac defect. Amniocentesis was performed, and karyotype analysis revealed that there was a de novo deletion of chromosome 11. The family decided to terminate the pregnancy. Conclusion: Prenatal diagnosis of Jacobsen syndrome is not always possible, since the characteristic ultrasound findings vary greatly between patients. Additionally, existing symptoms and signs may not always be found with imaging techniques. However, if present, certain ultrasonographic findings should lead clinicians to consider the syndrome. The study aims to present a rare case of Jacobsen syndrome, inform the clinicians, and guide on this syndrome and its possible outcomes.
Collapse
|
5
|
Çiçek M, Kılıç Z, Mercen Y, Karaoğlan E, Öztarhan K. A Rare Cause of Facial Paralysis in Children: A Case of Ramsay Hunt Syndrome. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0040-1719052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractPeripheral facial paralysis in children can have many causes including trauma, otitis media, head and neck tumors, congenital anomalies, viral infections, as well as metabolic and genetic factors. One cause of peripheral facial paralysis is Ramsay Hunt syndrome (RHS), which is also known as herpes zoster oticus, affecting the seventh and eighth cranial nerves. It is characterized by inner ear dysfunction, periauricular pain, and peripheral facial paralysis accompanied by the presence of an erythematous vesicular rash around the ear pinna and outer ear canal or in the oral mucosa. RHS is very rare in children when compared with its prevalence in adults. A 13-year-old male with no prior medical history applied to the pediatric emergency department after having first developed a vesicular rash on the left ear pinna and pain around the left ear, which was followed 1 day later by the development of ipsilateral facial asymmetry. The patient was hospitalized and simultaneously started on 2 mg/kg/d methylprednisolone for 10 days (followed by a 15-day taper), 100 mg/kg/d intravenous ceftriaxone twice per day (stopped on day 10), 30 mg/kg/d intravenous acyclovir three times per day (stopped on day 21), ciprofloxacin ear drops, tobramycin eye drops, ointment, and artificial tear drops with eye patching. However, only a minimal improvement was observed in the patient's peripheral facial paralysis by day 21. When compared with the prevalence in adults, RHS is very rare in children, which is why reports of pediatric RHS are limited in the literature. Therefore, additional studies are needed to provide information about the pathophysiology, diagnosis, and treatment of pediatric RHS.
Collapse
Affiliation(s)
- Muharrem Çiçek
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Kılıç
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Yezdanşer Mercen
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Emel Karaoğlan
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Kazım Öztarhan
- Department of Pediatric Cardiology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Odaman Al I, Bayram C, Ersoy G, Öztarhan K, Güzeltaş A, Kasar T, Uysalol E, Koç B, Ayçiçek A, Özdemir N. A Rare Late Complication of Port Catheter Implantation: Embolization of the Catheter. Turk J Haematol 2018; 35:142-143. [PMID: 28443819 PMCID: PMC5972342 DOI: 10.4274/tjh.2017.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Işık Odaman Al
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Cengiz Bayram
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Gizem Ersoy
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Kazım Öztarhan
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Cardiology, İstanbul, Turkey
| | - Alper Güzeltaş
- University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Clinic Pediatric Cardiology, İstanbul, Turkey
| | - Taner Kasar
- University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Clinic Pediatric Cardiology, İstanbul, Turkey
| | - Ezgi Uysalol
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Başak Koç
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Ali Ayçiçek
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Nihal Özdemir
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| |
Collapse
|
7
|
Aghdasi-Bornaun H, Kutluk G, Keskindemirci G, Öztarhan K, Dedeoğlu R, Yılmaz N, Tosun Ö. Evaluation of autonomic nervous system functions in frame of heart rate variability in children with inflammatory bowel disease in remission. Turk J Pediatr 2018; 60:407-414. [PMID: 30859765 DOI: 10.24953/turkjped.2018.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aghdasi-Bornaun H, Kutluk G, Keskindemirci G, Öztarhan K, Dedeoğlu R, Yılmaz N, Tosun Ö. Evaluation of autonomic nervous system functions in frame of heart rate variability in children with inflammatory bowel disease in remission. Turk J Pediatr 2018; 60: 407-414. Heart Rate Variability (HRV) is one of the reliable and noninvasive parameters to evaluate autonomic control of the cardiovascular system in patients. The aim of our study was to assess autonomic function in pediatric patients with inflammatory bowel disease (IBD) in remission using Power Spectral Analysis of HRV. Autonomic cardiovascular function was evaluated by time and frequency-domain indexes of spontaneous heart rate in 36 IBD children patients in remission phase and 36 sex and age matched healthy controls. Twenty children with Ulcerative Colitis (UC) and 16 patients with Crohn`s disease (CD) were diagnosed according to their history, physical and laboratory examination, endoscopic, histopathological and radiological findings of upper and lower gastrointestinal system. Significant decrease was observed at HRV parameters in IBD patients when compared with control group. These differences was found in some of time domain parameters (NNmean, SDNNtotal, SDNNday) and frequency domain parameters (TP, LF,VLF) (p < 0.05). Also, there was a significant higher minimum heart rate ratio (p < 0.04) in patients in comparison to the control group. In the IBD group, there was a relative tendency for parasympathetic suppression and sympathetic predominance which reflects an autonomic dysfunction. This imbalance has a circadian rhythm and it is more obvious during the day. These observations may suggest a previously unrecognized role of chronic inflammation for autonomic modulation in IBD.
Collapse
Affiliation(s)
- Helen Aghdasi-Bornaun
- Departments of Pediatric Cardiology, University of Health Sciences Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Günsel Kutluk
- Departments of Pediatric Gastroenterology Hepatology and Nutrition University of Health Sciences Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Gonca Keskindemirci
- Departments of Pediatrics, University of Health Sciences Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Kazım Öztarhan
- Departments of Pediatric Cardiology, University of Health Sciences Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Reyhan Dedeoğlu
- Department of Pediatric Cardiology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Nuh Yılmaz
- Department of Pediatric Cardiology, İstinye University Medical Faculty, Istanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Medeniyet University Medical Faculty, Istanbul, Turkey
| |
Collapse
|
8
|
Bornaun H, Öner N, Nişli K, Öztarhan K, Yavuz T, Türkoğlu Ü, Dindar A, Eker Ömeroglu R. Assessment of lipid profile and some risk factors of atherosclerosis in children whose parents had early onset coronary artery disease. ARCH ARGENT PEDIATR 2017; 115:50-54. [PMID: 28097840 DOI: 10.5546/aap.2017.eng.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/11/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND/AIM The objective of our study was to analyze the lipid profile and some risk factors of atherosclerosis such as oxidized-low density lipoprotein (ox-LDL), small dense LDL (sd LDL) in the offspring of patients with premature coronary heart disease (CHD). POPULATION AND METHODS Children whose parents had early onset CHD were matched with age and sex pairs. Study and controls were analyzed for lipid levels, apolipoproteins (Apo- A,B,E), ox-LDL, sd LDL and lipoprotein (a) [Lp(a)]. The data were evaluated with SPSS using "Student t and Mann-Whitney U" tests. RESULTS The study group children (n: 43) had higher LDL, Lp(a) and ox-LDL levels, ratios of TC/HDL, Apo-B/A, LDL/HDL and ox-LDL/HDL (p<0.05) than control group. CONCLUSION These findings suggest that dyslipidemia and increased LDL, Lp(a) and ox-LDL levels are common in the offspring of patients with early onset CHD and account largely for their familial predisposition for CHD.
Collapse
Affiliation(s)
- Helen Bornaun
- Pediatric Cardiologist in Pediatric Cardiology Clinic, Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Naci Öner
- Pediatric Cardiology Department, Yeni Yüzyıl University, Istanbul,
| | - Kemal Nişli
- Pediatric Cardiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kazım Öztarhan
- Pediatric Cardiologist in Pediatric Cardiology Clinic, Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Taner Yavuz
- Department of Pediatrics, Faculty of Medicine, Okan University, Istanbul, Turkey
| | - Ümit Türkoğlu
- Pediatric Cardiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aygün Dindar
- Pediatric Cardiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rukiye Eker Ömeroglu
- Pediatric Cardiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
9
|
Gedikbaşı A, Öztarhan K, Yıldırım G, Gül A, Asar-Canaz E, Ceylan Y. Atrioventricular and ventricular septal defects; topographical analysis and impact of associated cardiac and extracardiac findings and postpartum outcome. J Turk Ger Gynecol Assoc 2010; 11:8-15. [PMID: 24591888 PMCID: PMC3939312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 01/08/2010] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate prognosis of types of ventricular septal defects and coexistence of associated cardiac and extracardiac defects. METHODS 120 prenatal diagnosed pregnancies associated with ventricular septal pathology were retrospectively evaluated and divided into four groups, as atrioventricular septal defects, perimembranous septal defects, muscular septal defects and univentricular formation. Each group was divided further into four groups, as isolated defect, co-existing extracardiac defect, septal defect with extracardiac defect and septal defect with co-existing cardiac and extracardiac defect. Postnatal follow-up was continued at least until 8 months of life. RESULTS Median gestational age at diagnosis was 26.3 weeks, 47 cases were diagnosed before 24 weeks. After dispersion of septal defects there was a statistical significance of p=0.0089 between groups. Of 31 cases with atrioventricular septal defects, only one case survived (3.2%) and there was a high association with extracardiac defects and abnormal karyotype (p=0.002). 69 cases with perimembranous ventricular septal defects were diagnosed, and 24 cases (34.8%) survived with significance for abnormal karyotype (p=0.039). Of 18 cases born with muscular septal defects 12 cases (66.7%) stay alive. We had two cases with univentricular structure; both cases decided for termination of pregnancy. CONCLUSION The more complicated and severe the pathology, the worse the prognosis. Individualized counseling is the most important point in decision making together with families.
Collapse
Affiliation(s)
- Ali Gedikbaşı
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Kazım Öztarhan
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Pediatric Cardiology, İstanbul, Turkey
| | - Gökhan Yıldırım
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Ahmet Gül
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Emel Asar-Canaz
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Yavuz Ceylan
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| |
Collapse
|
10
|
Gedikbaşı A, Gül A, Öztarhan K, Akın MA, Sargın A, Özek S, Kavuncuoğlu S, Ceylan Y. Termination of pregnancy and reasons for delayed decisions. J Turk Ger Gynecol Assoc 2010; 11:1-7. [PMID: 24591887 PMCID: PMC3939299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 01/30/2010] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To assess the indications and distribution of cases chosen for termination of pregnancy and reasons delaying until third trimester termination. METHODS Retrospective study of cases between 2002 and 2006 in the hospital council. Cases were divided in two groups, as early termination (<23 weeks of gestation) and late termination (≥23 weeks of gestation). All pregnant women who underwent termination were classified according to related systemic pathology and chorionicity. Reasons for delaying until third trimester termination were evaluated in four groups. RESULTS During this five year period 1.449 complicated pregnancies were counseled and in 713 cases termination was offered. Of 677 cases (94.95%) with termination, 412 cases (60.09%) had early and 265 cases (39.91%) late termination. The most frequent indications were central nervous system abnormalities (51.7%), chromosomal abnormalities (11.7%), and urogenital abnormalities (8.4%). The main reason for delaying termination was failure of screening by ultrasound (65.6%). CONCLUSION Systematic screening for fetal anomalies is the main step for prevention of affected pregnancies. Information given to parents for TOP is important, but the decision for TOP is influenced by many factors.
Collapse
Affiliation(s)
- Ali Gedikbaşı
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Ahmet Gül
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Kazım Öztarhan
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Division of Pediatric Cardiology, İstanbul, Turkey
| | - Mustafa Ali Akın
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Division of Neonatology, İstanbul, Turkey
| | - Akif Sargın
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| | - Sibel Özek
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Division of Neonatology, İstanbul, Turkey
| | - Sultan Kavuncuoğlu
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Division of Neonatology, İstanbul, Turkey
| | - Yavuz Ceylan
- İstanbul Bakırköy Maternity and Children Diseases Hospital, Department of Obstetrics and Gynecology, Perinatology Unit, İstanbul, Turkey
| |
Collapse
|