Publications by authors named "Emine Azak"

16 Publications

  • Page 1 of 1

Premature cardiac beats in children with structurally normal heart: Autonomic dysregulation.

Pediatr Int 2021 Jun 22. Epub 2021 Jun 22.

Department of Pediatric Cardiology, Yıldırım Beyazıt University, Faculty of Medicine, Ankara City Hospital. Üniversiteler Mahallesi, 1604. Cadde No:9, Çankaya/Ankara, Turkey.

Background: Premature ventricular contractions and supraventricular contractions are common rhythm disorders requiring comprehensive analyses in children. The aim of the study was to evaluate the heart rate variability (HRV) in premature ventricular contractions (PVCs) and supraventricular contractions (PSVCs) with children.

Methods: The study compared the characteristics of HRV among 175 children with PVCs and 160 children with PSVCs who underwent 24 hours Holter monitoring, and 101 healthy children.

Results: Significant differences were found between SDNN, SDANN, rMSSD and pNN50 values of the patient and control groups. The PVCs group had a significantly lower HF and higher LF/HF ratio and the PSVCs group had a significantly higher LF and higher LF/HF ratio, compared to the control group. No significant correlation existed between frequency and SDNN index, rMSSD and pNN50 values of the PVCs group. The ROC analysis showed a significantly changed LF/HF ratio when premature contractions exceeded 60 beats per hour in children with PVCs.

Conclusions: This study indicated an increased sympathetic tone and a significantly decreased vagal tone in children with PVCs and PSVCs. HRV can be used increasingly as a non-invasive method in the follow-up of children with premature cardiac contractions.
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http://dx.doi.org/10.1111/ped.14893DOI Listing
June 2021

A rare association of left pulmonary artery sling with Scimitar syndrome: Recurrent wheezing and respiratory distress in a pediatric patient.

Turk Gogus Kalp Damar Cerrahisi Derg 2021 Jan 13;29(1):105-109. Epub 2021 Jan 13.

Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Congenital anomalies of the heart and great vessels may lead to localized recurrent pulmonary infections through different mechanisms. Pulmonary artery sling (left pulmonary artery originating from the right pulmonary artery) and Scimitar syndrome are rare causes of wheezing in infants. An 18-month-old female infant with left pulmonary artery sling, Scimitar syndrome, and an anomalous connection of left pulmonary veins to the left atrium was admitted to our clinic. She successfully underwent transcatheter embolization using the Vascular Plug-II on the anomalous systemic arterial supply and repair of pulmonary arterial sling and Scimitar anomaly via a median sternotomy. In conclusion, diagnosis of left pulmonary arterial sling accompanied by abnormalities can be missed in some cases using echocardiography. It may be necessary to conduct more advanced imaging methods before deciding the treatment method to be performed in these patients.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2021.20227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970084PMC
January 2021

A case of infective endocarditis due to Herbaspirillum Huttiense in a pediatric oncology patient.

J Infect Dev Ctries 2020 11 30;14(11):1349-1351. Epub 2020 Nov 30.

Department of Pediatric Heamatology and Oncology, Ankara City Hospital, Ankara, Turkey.

Infective endocarditis (IE) is an infection of the endocardium and/or heart valves that involves thrombus formation (vegetation). This condition might damage the endocardial tissue and/or valves. An indwelling central venous catheter is a major risk factor for bacteremia at-risked pediatric populations such as premature infants; children with cancer and/or connective tissue disorders. Herbaspirillum huttiense is a Gram-negative opportunistic bacillus that may cause bacteremia and pneumonia rarely in this fragile population. Herein we report the very first case of bacteremia and IE in a pediatric oncology patient caused by H. huttiense.
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http://dx.doi.org/10.3855/jidc.13001DOI Listing
November 2020

Acute myocarditis following varicella zoster infection in an immunocompetent adolescent: An uncommon complication.

Arch Argent Pediatr 2020 06;118(3):e284-e287

Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ziraat Mah, Ankara, Turkey.

Myocarditis is a serious complication of varicella zoster virus infection. A 15 year-old boy was admitted to the Emergency Department for chest pain, tachycardia and hypotension. An electrocardiogram showed sinus tachyicardia. Cardiac biomarkers were elevated and echocardiography revealed left ventricular apical, inferolateral, septal hypokinesis, and mitral regurgitation. Varicella zoster virus serum immunoglobulin M antibody was positive. The patient was discharged without any sequelae.
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http://dx.doi.org/10.5546/aap.2020.eng.e284DOI Listing
June 2020

[Cardiovascular findings and effects of enzyme replacement therapy in patients with mucopolysaccharidosis type VI].

Turk Kardiyol Dern Ars 2019 Oct;47(7):587-593

Department of Pediatric Nutrition and Metabolism, University of Health Sciences Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey.

Objective: The mucopolysaccharidoses (MPS) are an important group of lysosomal storage diseases. Commonly reported cardiac involvement includes mitral leaflet thickening and accompanying prolapsus, regurgitation, and rarely, stenosis. The aim of this study was to evaluate cardiac involvement in patients with MPS type VI.

Methods: The study included a total of 13 children with MPS type VI who were admitted to a single pediatric department between 2016 and 2018. Cardiac status was evaluated prospectively with clinical findings, electrocardiography, and echocardiography. The age of the patients (8 boys, 5 girls) ranged between 2 and 14 years (median: 9 years).

Results: No arrhythmia was observed in any patient. Thickening of the mitral valve with or without regurgitation and prolapsus was the most common lesion seen. Additional involvement of the aortic valve was detected in 12 (92.3%) patients, and additional involvement of the tricuspid valve in 4 (30.8%). Isolated septal hypertrophy was found in 2 patients, and congestive heart failure in another.

Conclusion: Cardiac involvement is frequent in MPS. Mitral valve deformation is the most frequent finding. An echocardiographic examination should be performed periodically even if the patient has no clinical signs of cardiac disease, and any cardiac involvement should be kept under control with medical treatment.
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http://dx.doi.org/10.5543/tkda.2019.44502DOI Listing
October 2019

The assessment of treatment outcomes in patients with acute viral myocarditis by speckle tracking and tissue Doppler methods.

Echocardiography 2019 09 26;36(9):1666-1674. Epub 2019 Aug 26.

Department of Pediatric Cardiology, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Objectives: The aim was to evaluate the role of tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), to identify myocardial dysfunction, and to evaluate myocardial segmental deformation in acute viral myocarditis.

Methods: Twenty-one patients and twelve healthy children were studied prospectively. The TDI and STE were performed before and after treatment. The myocardial velocities (S , E , and A ) and time intervals (isovolumic contraction, isovolumic relaxation, and ejection times [ET]) at interventricular septum (IVS), left, and right ventricular basal segments were examined by TDI. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and strain rate (LVGCSR), and right ventricular global longitudinal strain (RVGLS) and strain rate (RVGLSR) were examined by STE.

Results: S and E at IVS and at LV, ET at IVS, ET at RV, ET at LV were significantly lower in patients before treatment than controls. LVGLS, LVGLSR, LVGCS, LVGCSR, RVGLS, RVGLSR were significantly decreased in patients before treatment than controls. There was significant improvement for LVGLS, LVGLSR, LVGCS, LVGCSR, and RVGLS in patients after treatment. S , E , and A at LV were significantly lower in patients before treatment than in patients after treatment. In spite of improvements, S , E , and ET at IVS, LVGLS, LVGLSR, LVGCS, LVGCSR were significantly lower in patients after treatment than controls.

Conclusions: The TDI and STE were useful methods for detection of early myocardial dysfunction and evaluation of treatment outcomes in acute viral myocarditis.
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http://dx.doi.org/10.1111/echo.14449DOI Listing
September 2019

Subclinical Myocardial Dysfunction Demonstrated by Speckle Tracking Echocardiography in Children with Euthyroid Hashimoto’s Thyroiditis

J Clin Res Pediatr Endocrinol 2019 11 20;11(4):410-418. Epub 2019 Jun 20.

University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey

Objective: Thyroid hormones have an important role in the regulation of the cardiovascular system. The aim of this study was to investigate the presence of subclinical myocardial dysfunction in children with euthyroid Hashimoto’s thyroiditis (eHT) without evident heart disease using tissue doppler imaging (TDI) and speckle tracking echocardiography (STE) methods.

Methods: TDI and STE were peformed in 50 children with eHT and in 35 healthy children. To assess myocardial velocities and time intervals, including peak systolic velocity (S), peak early diastolic velocity (E), peak late diastolic velocity (A), isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT) and ejection time (ET), TDI was performed at the base of the interventricular septum (IVS) and in the left and right ventricles (LV and RV, respectively). Analysis of myocardial deformation by STE including strain (S) and strain rate (SR) was performed globally in two planes, longitudinal (L) and mid-circumferential (C) in LV [LV global longitudinal strain (LVGLS), LV global longitudinal strain rate (LVGLSR), LV global circumferential strain (LVGCS), LV global circumferential strain rate (LVGCSR)] and RV [(RV global longitudinal strain (RVGLS), RV global longitudinal strain rate (RVGLSR)].

Results: Among TDI parameters, ET at LV and IVS were significantly lower, IVRT and myocardial performance index at LV and IVS were significantly higher in the eHT group compared to controls (p=0.001). There were no significant differences in S, E, A and IVCT values between patients and controls. LVGLS, LVGLSR, LVGCS and LVGCSR values were significantly lower in patients than controls (p=0.01). There was a negative correlation between thyroid antibody levels and LV global longitudinal and circumferential strain and strain rate values (TPO-Ab and Tg-Ab between LVGLS, LVGLSR, LVGCS and LVGCSR; r=-411, p<0.001; r=-541, p<0.001; r=-430, p<.0.001; r=-502, r<0.01 and r=-397, p<0.001; r=-473, p<0.001; r=-519, p<0.001; r=-421, p<0.00, respectively).

Conclusion: The results show that myocardial function in children with eHT is impaired in the absence of any clinical symptoms and that conventional echocardiography is inadequate to determine these changes.
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http://dx.doi.org/10.4274/jcrpe.galenos.2019.2018.0273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878337PMC
November 2019

Catecholamine-induced Myocarditis in a Child with Pheochromocytoma

J Clin Res Pediatr Endocrinol 2020 06 18;12(2):202-205. Epub 2019 Jun 18.

Ankara City Hospital, Children’s Hospital, Clinic of Pediatric Surgery, Ankara, Turkey

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors. The clinical presentation of pediatric PPGLs is highly variable. In cases with pheochromocytoma (PCC), excess catecholamine may stimulate myocytes and cause structural changes, leading to life-threatening complications ranging from stress cardiomyopathy (CM) to dilated CM. Herein, we report the case of catecholamine-induced myocarditis in a child with asymptomatic PCC. A 12-year-and-2-month-old male patient with a known diagnosis of type-1 neurofibromatosis was brought to the emergency department due to palpitations and vomiting. On physical examination, arterial blood pressure was 113/81 mmHg, pulse was 125/min, and body temperature was 36.5 °C. Laboratory tests showed a leucocyte count of 12.8x10 μL/L and a serum C-reactive protein level of 1.1 mg/dL (Normal range: 0-0.5). Thyroid function tests were normal, while cardiac enzymes were elevated. Electrocardiogram revealed no pathological findings other than sinus tachycardia. The patient was diagnosed with and treated for myocarditis as echocardiography revealed a left ventricular ejection fraction of 48%. Viral and bacterial agents that may cause myocarditis were excluded via serological tests and blood cultures. Blood pressure, normal at the time of admission, was elevated (140/90 mmHg) on the 5 day of hospitalization. Magnetic resonance imaging revealed a 41x46x45 mm solid adrenal mass. The diagnosis of PCC was confirmed by elevated urinary and plasma metanephrines. The patient underwent surgery. Histopathology of the excised mass was compatible with PCC. It should be kept in mind that, even if there are no signs and symptoms of catecholamine elevation, CM may be the first sign of PCC.
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http://dx.doi.org/10.4274/jcrpe.galenos.2019.2019.0045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291411PMC
June 2020

Recovery of myocardial mechanics in Kawasaki disease demonstrated by speckle tracking and tissue Doppler methods.

Echocardiography 2018 03 13;35(3):380-387. Epub 2017 Dec 13.

Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey.

Aim: To investigate myocardial deformation and function during treatment for Kawasaki disease (KD) in children.

Methods: We performed speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) in 15 children with KD and 15 healthy children during treatment for KD. STE was performed for longitudinal and circumferential strain (S) and strain rate (SR) at the left ventricle (LV) and for longitudinal S and SR at the right ventricle (RV). TDI was performed at the base of interventricular septum (IVS), LV, and RV.

Results: Among TDI parameters, E and ejection time (ET) at IVS, ET at LV and ET at RV obtained obtained before treatment were significantly lower in patients with KD compared to controls. After treatment, in spite of improvements, ET at IVS and ET at RV remained significantly lower in patients with KD compared to controls. Left ventricular global longitudinal and circumferential S and SR values obtained before treatment were significantly lower in patients with KD compared to controls. Left ventricular S and SR values were found to be increased after treatment. However, left ventricular global circumferential S value remained significantly lower in patients with KD compared to controls. There were no significant differences in right ventricular global longitudinal S and SR values between patients and controls before treatment.

Conclusion: During acute phase, patients with KD have reduced global left ventricular S and SR which may be more sensitive indicators of myocardial inflammation. This study showed gradual improvements in left ventricular myocardial function during treatment for KD.
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http://dx.doi.org/10.1111/echo.13773DOI Listing
March 2018

[A rare cause of 2:1 atrioventricular block and congestive heart failure in preterm infants: Hypocalcemia].

Turk Kardiyol Dern Ars 2017 Jan;45(1):82-84

Department of Pediatric Cardiology, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey.

Atrioventricular (AV) block in the neonatal period is a rare disorder. It is frequently associated with underlying structural congenital heart disease and maternal lupus. Presently described is premature baby who developed 2:1 AV block and congestive heart failure due to hypocalcemia. Dramatic clinical improvement was observed following treatment of intravenous 10% calcium gluconate. Therefore, it is suggested that serum calcium level of newborns with AV block and congestive heart failure be measured.
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http://dx.doi.org/10.5543/tkda.2016.82453DOI Listing
January 2017

The efficacy and safety of naproxen in acute rheumatic fever: The comparative results of 11-year experience with acetylsalicylic acid and naproxen.

Turk J Pediatr 2016 ;58(5):473-479

Ankara Children's Hematology Oncology Training and Research Hospital, Pediatric Cardiology Clinic, Ankara, Turkey.

The objective was to compare the efficacy and safety of naproxen (NXN) to acetylsalicylic acid (ASA) in the treatment of acute rheumatic fever (ARF). The data of 338 children were retrospectively analyzed. The patients were grouped according to joint and valve involvement and also drug chosen [methyl prednisolone (mPSL), ASA or NXN]. The treatment results and adverse events in each group were compared. The mean age was 10.3 years and the median follow-up was 62 months. Median time for normalization of acute phase reactants was 1 week in patients given steroids and 2 weeks in patients given ASA or NXN. ASA was replaced with NXN in 18 patients (10.2%) due to hepatic toxicity. The rate of rebound, recurrence and the prevalence of rheumatic valve disease were not different in patients given NXN, ASA or mPSL. In conclusion, NXN is a safe and effective alternative to ASA in the treatment of ARF in children.
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http://dx.doi.org/10.24953/turkjped.2016.05.003DOI Listing
September 2017

Pulmonary arterial hypertension in a child with stage-IV neuroblastoma after autologous hematopoietic stem cell transplantation and review of the literature.

Pediatr Transplant 2015 Nov 18;19(7):E185-8. Epub 2015 Aug 18.

Division of Bone Marrow Transplantation Unit, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey.

PH is a rare condition with high mortality rate after pediatric HSCT. As clinical presentation is non-specific and may mimic other conditions, a high degree of suspicion is required for diagnosis. Here, we present a patient with stage-IV neuroblastoma who developed PAH after autologous HSCT. After exclusion of other causes of PH, we regarded that this condition was secondary to HSCT.
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http://dx.doi.org/10.1111/petr.12576DOI Listing
November 2015

3-HMG Coenzyme A Lyase Deficiency: Macrocephaly and Left Ventricular Noncompaction with a Novel Mutation.

Indian J Pediatr 2015 Jul 25;82(7):645-8. Epub 2015 Feb 25.

Infancy Service, Ministry of Health, Ankara Children's Health and Diseases, Hematology-Oncology Hospital, Ankara, Turkey.

3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) lyase deficiency, an inborn error of ketone body synthesis and leucine degradation, is a rare autosomal recessive disease. There are a few reports demonstrating clinical and neuroradiologic findings of this condition. The authors report case of an 8-mo-old infant with HMG-CoA lyase deficiency, who presented with macrocephaly, left ventricular noncompaction, recurrent pulmonary infections, nonketotic hypoglycemia, seizure and metabolic acidosis. There was no significant difference in brain magnetic resonance imaging after leucine-restricted diet and carnitine therapy and neurologic deterioration was not observed. Left ventricular noncompaction is an interesting finding for HMG-CoA lyase deficiency which has not been reported in the literature. The genetic analysis revealed a novel homozygote deletion in exon 3 and 4 in HMGCL gene. HMG-CoA lyase deficiency should be thought in the patients with hypoketotic hypoglycemia, hyperammonemia, elevated liver function tests, noncompaction left ventricle and characteristic white matter changes and in the differential diagnosis of macrocephaly.
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http://dx.doi.org/10.1007/s12098-015-1722-6DOI Listing
July 2015

Simplified gyral pattern with cerebellar hypoplasia in Sedaghatian type spondylometaphyseal dysplasia: a clinical report and review of the literature.

Am J Med Genet A 2012 Jun 23;158A(6):1400-5. Epub 2012 Apr 23.

Faculty of Medicine, Department of Pediatrics, Neonatalogy Division, Ondokuz Mayis University, Samsun, Turkey.

We report on a patient with Sedaghatian type spondylometaphyseal dysplasia (SSMD) who presented with metaphyseal dysplasia, congenital atrioventricular block, simplified gyral pattern, hypogenesis of corpus callosum, and severe cerebellar hypoplasia. We want to emphasize that in this rare congenital lethal skeletal dysplasia with unknown etiology, central nervous system malformations might be a major component of the disorder and should be evaluated in detail to possibly uncover the underlying pathophysiology.
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http://dx.doi.org/10.1002/ajmg.a.35306DOI Listing
June 2012

Somatic growth after corrective surgery for congenital heart disease.

Turk J Pediatr 2010 Jan-Feb;52(1):58-67

Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey.

We report the somatic growth characteristics of 60 infants who underwent corrective surgery for congenital heart disease. Patients were assigned to the following groups: Group 1, cyanosis with pulmonary hypertension (PH); Group 2, cyanosis without PH; Group 3, large left-to-right shunt and PH; and Group 4, left-to-right shunt or obstructive heart lesion and no PH. Weight, length, and head circumference measurements and z scores were obtained before the operation, at 45 days, and 3, 6, and 12 months after the operation. Details about dietary intake, socioeconomic status at presentation, length of stay in the intensive care unit, hospitalization period, and perioperative events were noted. The endpoint was reaching a z score > -1 for all anthropometric measurements. At presentation, 51 patients (85%) had malnutrition. The family income, dietary intake, and presence of preoperative chronic malnutrition were interrelated and influenced the weight of the patient at all times during the postoperative follow-up (p < 0.05 for all values). The severity of the heart defect had no significant influence on the postoperative anthropometric measurements (p > 0.05). The lowest preoperative z scores for weight and height were observed in Group 3. Seven patients could not achieve the endpoint at the end of 12 months (4 in Group 3 and 3 in Group 2). Catch-up growth is attained mostly in the first year after corrective surgery. Delays in reaching z scores > -1 are observed in the chronically malnourished children. If adequate calories are provided and early corrective surgery is performed, the normal growth potential may be fulfilled.
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May 2010
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