Successful ductal stent implantation for initial palliation in two patients with aortic atresia and interrupted aortic arch

The coexistence of aortic valve atresia and interrupted aortic arch are an extremely rare condition. In this pathology, blood flow to the ascending aorta and coronary arteries should be provided through the ductus arteriosus or collaterals originating from the descending aorta. In rare cases where bilateral ductus arteriosus is present, they can provide circulation. Here, we report two cases in which coronary arteries and ascending aorta were supplied by one ductus arteriosus and distal systemic circulation is supplied by a second ductus arteriosus in one patient and a collateral artery in the other. Initial palliation was successfully performed by bilateral pulmonary artery banding and transcatheter ductal stent implantation in both cases.

18F-fluorodeoxyglucose positron emission tomography/CT in the diagnosis of right-sided endocarditis in children and adults with infective endocarditis

OBJECTIVE

Infectious endocarditis poses a diagnostic challenge due to its highly variable clinical presentation. To establish a definitive diagnosis, different imaging modalities are essential. In recent years, positron emission tomography/CT has gained increasing significance in diagnosing infective endocarditis; however, its application in the pediatric age group remains limited. This study encompasses patients definitively or potentially diagnosed with infectious endocarditis at our institution from 2018 to 2023.

METHODS

A total of 29 patients underwent 18F-fluorodeoxyglucose positron emission tomography/CT examinations, with 19 of them presenting with right-sided infective endocarditis.

RESULTS

Evidence consistent with infective endocarditis was observed in 18 (94.7%) of the patients. Pulmonary septic embolism was identified in 15 (78.9%) cases, and splenic involvement was noted in 12 (57.8%) cases. Transthoracic/transesophageal echocardiography failed to reveal vegetation or provided uncertain results in six patients, whereas fluorodeoxyglucose-positron emission tomography-CT exhibited involvement. Subsequently, the diagnosis of infective endocarditis was confirmed post-surgery based on the fluorodeoxyglucose-positron emission tomography-CT findings.

CONCLUSION

Our results, along with our clinical experience, demonstrate that fluorodeoxyglucose-positron emission tomography-CT is a safe and viable method for diagnosing right-sided endocarditis, which is often challenging to visualize using echocardiography.

Biventricular repair in an infant with transposition of the great arteries and straddling of the tricuspid valve

Biventricular repair is challenging in patients with transposition of the great arteries and straddling of the atrioventricular valves. Biventricular repair is the preferred option because of its anatomical and physiological advantages. However, in cases where biventricular repair carries operative risks that are too high or cases with unsuitable intracardiac anatomy, univentricular heart repair may have to be chosen. We report a five-month-old male patient with transposition of the great arteries, an inlet ventricular septal defect and anomalous coronary anatomy who had previously undergone a pulmonary banding operation and balloon atrial septostomy. Successful biventricular repair was performed while the patient had straddling of the tricuspid valve.

Radiation Dose Reduction in Congenital Heart Disease Patients During Cardiac Catheterization by a Novel Protocol

Objective:

Cardiac catheterization remains a major source of radiation exposure for patients with congenital heart disease. This study reports the magnitude of radiation with a 3.75 frame per second (fps) pulse fluoroscopy rate and compares the reduction with the previous 15 fps protocol during cardiac catheterization for pediatric and adult congenital heart disease.

Material and Methods:

All diagnostic and interventional cardiac catheterization procedures from a single tertiary center were analyzed from January 1, 2014 to December 31, 2015, one year before and after implementing lower starting pulse fluoroscopy rates. The radiation dose was quantified as air kerma dose (mGy) and dose-area product (DAP; µGy/m²). Radiation exposure was analyzed for diagnostic and interventional procedures; the diagnostic group was subdivided into cyanotic and acyanotic patients, whereas the interventional group was subdivided according to the most common indications.

Results:

A total of 786 procedures were analyzed. The median fluoroscopy times and contrast amounts did not show a statistically significant difference between both periods (487 vs. 456 seconds and 42.5 vs. 45.3 cm³). The median air kerma for all procedures showed an 88% reduction after implementing lower pulse fluoroscopy rates (340-41 mGy). The doses were reduced significantly for diagnostic and interventional angiograms from 470 mGy and 162 mGy to 40 mGy and154 mGy. Among all patient groups, the most striking decrease was observed in the diagnostic procedures we use, of which fluoroscopy is more prominent than cine angiography.

Conclusion:

We claim that novel radiation dose reduction protocols could be easily applied without increasing fluoroscopy time or losing image quality.

Parvovirus Infection in a Child Presenting with Erythema Multiforme and Vasculitis after a Yellow Jacket Bee Sting

Parvovirus B19 has a wide spectrum of clinical manifestations. Erythema multiforme and vasculitis are rarely reported with parvovirus B19 infections. Reactions to insect stings can range from local swelling to life-threatening systemic reactions. There have been rare reports of unusual reactions, such as vasculitis, occurring in a temporal relationship with insect stings. We report an 8-year-old patient having Parvovirus B-19-related erythema multiforme and vasculitis after a yellow jacket bee sting.

Effect of aortic arch surgery in newborns' cerebral and gastrointestinal hemodynamics: evaluation by Doppler ultrasonography

AIM

In this study, we investigated changes in newborns' cerebral and intestinal blood flow who had undergone aortic arch surgery.

METHOD

This study was carried out prospectively as a preliminary study in patients younger than 30 days at the time of aortic arch reconstruction between 1 August and 1 December, 2019. Cerebral and gastrointestinal hemodynamics were evaluated with Doppler USG before and 7 days after the operation. The middle cerebral artery (MCA) and celiac artery (CA) were used as measurement sites. Patients' peak systolic velocity (PSV), mean systolic velocity (MV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were evaluated.

RESULTS

A total of 16 patients enrolled in the study. The patients' median weight was 3.2 kg (2.7-4.5 kg), and age was 21 days (7-30 days). Six of them were female. Seven of the patients who underwent arcus reconstruction had an additional ventricular septal defect. The preoperative Doppler USG values of patients' were as follows: for MCA, the mean PSV was 37 ± 12 cm/s, EDV 12 ± 5 cm/s, MV 22 ± 19 cm/s, RI 0.70 ± 0.03, PI 1.24 ± 0.23, and for CA mean PSV was 67 ± 32 cm/s, EDV 29 ± 14 cm/s, MV 24 ± 9 cm/s, RI 0.79 ± 0.27, and PI 1.63 ± 0.89. Doppler USG values of patients' at the postoperative seventh day were as follows: for the MCA, mean PSV 41 ± 13 cm/s, EDV 13 ± 4 cm/s, MV 25 ± 10 cm/s, RI 0.64 ± 0.05, PI 1.23 ± 0.20, and for the CA mean PSV 70.5 ± 34 cm/s, EDV 32 ± 16 cm/s, MV 26 ± 8 cm/s, RI 0.75 ± 0.1, and PI 1.60 ± 0.38. There was a significant decrease in RI of both MCA and CA on the postoperative 7th day compared to the preoperative period (p < 0.05).

CONCLUSION

In newborns, there are significant changes in cerebral and intestinal blood flows after aortic arch surgery. RI decreased significantly, especially in the CA and MCA.

Rhythm disturbances and treatment strategies in children with congenitally corrected transposition of the great arteries

BACKGROUND

We aimed to evaluate rhythm abnormalities in cases of congenitally corrected transposition of the great arteries (ccTGA) and associated treatment strategies.

PATIENTS AND METHODS

This retrospective cohort study included 65 pediatric patients with ccTGA who were admitted to the clinic between 2009 and 2017. The patients were divided into two groups, and surgical data, Holter electrocardiographic (ECG) recordings, ECG recordings, electrophysiological data, and device implantation data on the two groups were compared.

RESULTS

Group I (n = 53, 82%) consisted of patients with significant associated lesions, and Group II (n = 12, 18%) consisted of those with minor or no associated lesions (isolated ccTGA). Rhythm abnormalities were diagnosed in 22 (34%) of the patients based on initial ECG findings and Holter ECG recordings. Eleven (17%) of these patients had atrioventricular (AV) block of different degrees, and the other 11 (17%) had supraventricular arrhythmia (SVA). The median follow-up was 49 months (range, 9-89 months), and the rhythm remained normal in 26 (42%) of the patients. Three patients died on follow-up. Of 40 patients with normal initial findings, nine required pacemaker implantation due to complete heart block, and SVA developed in seven patients on follow-up. No ventricular tachycardia was seen initially or on follow-up. Ablation was performed in four patients. During the follow-up period, pacemakers were implanted in 12 (23%) of patients in Group I and 4 (33%) of patients in Group II due to complete heart block. Cardiac resynchronization therapy (CRT) was performed in four patients due to systemic ventricular dysfunction. Notably, all four of these patients had a pacemaker implanted postoperatively.

Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months

OBJECTIVE

This clinical study aimed to assess the efficacies of mineral trioxide aggregate (MTA) and calcium hydroxide [Ca(OH)₂] in the treatment of deep carious lesions by the direct complete caries removal technique.

METHODS AND MATERIALS

A total of 100 permanent molar/premolar teeth were capped with either Ca(OH)₂ (n=49) or MTA (n=51) and restored with composite resin in 73 patients. Periapical radiographs were acquired prior to the treatment as well as at six, 12, and 24 months posttreatment. Two calibrated examiners performed the clinical and radiographic assessment of the periapical pathology and pulpal symptoms. Intergroup comparisons of the observed values were performed using the Fisher exact test. Significance was predetermined at α = 0.05.

RESULTS

The recall rates were 100% at six and 12 months posttreatment and 98.6% at 24 months posttreatment. Four teeth capped with Ca(OH)₂ (two each at six and 12 months posttreatment) and two capped with MTA (one each at 12 and 24 months posttreatment) received endodontic emergency treatment because of symptoms of irreversible pulpitis, which were clinically and/or radiographically established. There were no significant differences in pulp vitality between the two pulp-capping agents at six, 12, or 24 months posttreatment (p=0.238, p=0.606, and p=0.427, respectively).

CONCLUSIONS

Both pulp-capping materials were found to be clinically acceptable at 24 months posttreatment.

Prenatal diagnosis of left coronary artery to right ventricle fistula

Prenatal diagnosis of a congenital coronary artery fistula between the left coronary artery and the right ventricle was established at 28 weeks of gestation. Hydrops fetalis developed during follow-up and the baby died on the first day after delivery. It is rare for coronary artery fistulas to become symptomatic during fetal life.

Relationships between left heart chamber dilatation on echocardiography and left-to-right ventricle shunting quantified by cardiac catheterization in children with ventricular septal defects

Left atrium and/or left ventricle dilatation on echocardiography is considered to be an indication for closure of ventricular septal defects (VSD). No study has addressed the accuracy of using dilated left heart chambers when defining significant left-to-right shunting quantified by cardiac catheterization in isolated small or moderate VSDs. In this study, the relation between dilated left heart chambers, measured by echocardiography, and left-to-right ventricle shunting, quantified by cardiac catheterization, was evaluated in patients with isolated VSD. The medical records of all patients with isolated VSD who had undergone catheterization from 1996 to 2010 were examined retrospectively. Normative data for left heart chambers adjusted for body weight (BW) and body surface area (BSA) were used. The pulmonary-to-systemic flow ratio (Qp:Qs) was calculated by an oximetry technique. A total of 115 patients (mean age 7.3 ± 5 years) fulfilled the inclusion criteria. There was a statistically significant difference in terms of Qp:Qs between the patient groups with normal and dilated left heart chambers, when adjusted for BW and BSA (p = 0.001 and p = 0.002, respectively). But the relationships between Qp:Qs and left heart chamber sizes on echocardiography were not strong enough to be useful for making surgical decisions, as left heart chamber dilatation was not significantly associated with Qp:Qs ≥ 2 (p = 0.349 when adjusted for BW, p = 0.107 when adjusted for BSA). Left heart chamber dilatation was significantly associated with Qp:Qs ≥ 1.5 only when it was adjusted for BSA (for BW p = 0.022, for BSA p = 0.006). As a result, left heart chamber dilatation measured by echocardiography does not show significant left-to-right ventricle shunting, as quantified by catheterization. We still advocate that catheter angiography should be undertaken when left heart chambers are dilated in echocardiography in order to make decisions about closing small- to moderate-sized VSD.

Coming from behind to win--a qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services.

A case with quadriparetic cerebral palsy and cyanosis: congenital methemoglobinemia

The recessive form of congenital methemoglobinemia, caused by a defect of nicotinamide adenine dinucleotide-cytb5 reductase enzyme (cytb5r), is a rare disorder clinically presenting with cyanosis. Two different forms of recessive congenital methemoglobinemia have been described: In type I, cyanosis is the only major symptom and enzyme deficiency is restricted to erythrocytes. In type II, observed in 10-15% of all patients, enzyme deficiency occurs in the entire body and cyanosis is associated with severe, progressive neurologic impairment. This report presents a 10-year-old female with recessive congenital methemoglobinemia type II. She was admitted with quadriparetic cerebral palsy, mental retardation, convulsions, swallowing difficulty, and cyanosis. Etiology of cyanosis was not clarified exactly but was readily but erroneously attributed to uncontrolled, repetitive convulsions and aspiration of excessive oral secretions. Her methemoglobin level was measured as 51%, and a diagnosis of congenital methemoglobinemia was established. Oral ascorbic acid 500 mg/day was initiated. She responded well to therapy. Interestingly, neurologic deficits improved after ascorbic acid treatment. In conclusion, cyanosis and repetitive convulsions associated with neurologic deficits may be explained by congenital methemoglobinemia, a potentially treatable condition.

Sealant and composite bond strength to enamel with antibacterial/self-etching adhesives

INTRODUCTION

The enamel in pits and fissures undergoing preventive or ultraconservative resin restorations may be affected by secondary caries. An antibacterial adhesive bond may be a useful choice to prevent and reduce demineralization.

OBJECTIVES

The purpose of this study was to determine the shear bond strength of an experimental antibacterial bond, a self-etch bond, and an ormocer-based adhesive bond using an ormocer-based fissure sealant and a composite resin on intact enamel.

METHODS

Twenty-four extracted human molars were sectioned bucco-lingually to obtain two flat and sound enamel surfaces. Forty-eight specimens were randomly assigned into four groups. The groups were prepared to receive the following treatments: (1) Admira Bond + Admira Seal (n = 10); (2) ABF Bond + Admira Seal (n = 11); (3) Clearfil SE Bond + Clearfil AP-X (n = 12); and (4) ABF Bond + Clearfil AP-X (n = 11). A cylindrical mould was placed over the bonded surface, and both materials were applied according to the instructions. The teeth were thermocycled 500 cycles between 5 and 55 degrees with a dwell time of 30 s. For shear bond strength testing, the load was applied vertically to the base of the mould. The cross-head speed was 5 mm min(-1).

RESULTS

The maximum load that a specimen can withstand until failure was determined and shear bond strength was calculated by dividing the load at failure by the surface area of the mould. The results (median, minimum and maximum, respectively) for the four groups were: (1) 7.9, 4.2 and 13.6 MPa; (2) 8.6, 2.6 and 15.9 MPa; (3) 5.9, 5.3 and 8.2 MPa; and (4) 8.8, 3.0 and 19.2 MPa. Kruskal-Wallis and Mann-Whitney U-tests were performed for the statistical analysis. Groups 3 and 4 were statistically significantly different (P = 0.005; P < 0.05). There was no statistically significant difference between the sealant and composite groups for ABF (P = 0.375). Fracture sites were viewed by microscope under x 16 magnification to determine if the mode of failure was adhesive or cohesive. The results (number of adhesive failed specimens and number of cohesive failed specimens, respectively) for the four groups were: (1) 7 and 3; (2) 3 and 8; (3) 2 and 9; and (4) 8 and 3.

CONCLUSION

The ABF bond has sufficiently physical qualities to be used under fissure sealant and composite resin on uncut enamel, its antibacterial efficiency notwithstanding.

Weismann-Netter-Stuhl syndrome in two siblings

Cases of Weismann-Netter-Stuhl syndrome involving the upper extremities and affecting siblings have rarely been reported. We present the radiological findings of Weismann-Netter-Stuhl syndrome in two siblings, with upper extremity involvement in one of them.

Validity of a laser fluorescence system (DIAGNOdent) for detection of occlusal caries in third molars: an in vitro study

The aim of this study was to compare the validity of the measurements of the laser fluorescence device, KaVo DIAGNOdent, with the result of polarized light microscopy in the detection of occlusal fissure caries in extracted third molars. Ten impacted, surgically removed, and 25 extracted third molars with macroscopically intact occlusal surfaces were selected. The DIAGNOdent measurements of the occlusal test site were recorded by two observers at intervals of 2 days. The teeth were then sectioned at the specified test sites for histological examinations. Prepared specimens were evaluated under the polarized light microscopy and all images were scored with the caries classification of D1 (sound and fissure lesion in the half of the outer enamel), D2 (enamel decay) and D3 (dentin decay) level (gold standard). The kappa value for the inter-observer repeatability was calculated and the value 0.83 for the first measurements and 0.67 for the second measurement were obtained,respectively. Inter-observer correct classification percentages were 88.5 and 77.1 for the first and second measurements, respectively. The kappa value for intra-observer repeatability was 0.79 for the first observer and 0.75 for the second observer. Intra-observer correct classification percentage values were 85.7 and 82.8 for the first and second observer, respectively. Value of specificity for the detection of enamel caries at D1 level was 0.74 and sensitivity values at D2 and D3 levels were 0.66 and 1.00, respectively. The present study indicates that the DIAGNOdent provides not only almost perfect agreement but also sufficient repeatability at D1, D2, D3 levels and better specificity at D1 level as well as lower sensitivity at D2 level and excellent sensitivity at D3 level.