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    Brucella Infection Associated with Complete Atrioventricular Block
    (Galenos Publ House, 2016) Bilici, Meki; Demir, Fikri; Yilmazer, Murat Muhtar; Bozkurt, Fatma; Tuzcu, Volkan
    Background: The clinical spectrum of Brucella infection is quite diverse and characterized by multi-system involvement. Patients present with myocarditis, endocarditis, or pericarditis. Infective endocarditis is the most common cardiovascular complication in patients with brucellosis. Although conduction abnormalities are seen in cases with endocarditis, they are reported very rarely in the setting of cardiac Brucella infection. Case Report: An eight and a half-year-old male patient was referred to our clinic due to inadequate response to cotrimaxazole plus streptomycin treatment at the 15th day of admission. Although local hospital records on the patient showed a heart rate of 80 bpm, we determined a heart rate of 46 bpm. The electrocardiogram showed complete atrioventricular (AV) block. The average heart rate was determined as 48 bpm with 24-hour Holter electrocardiogram (ECG) monitoring. The echocardiographic examination showed normal-sized heart chambers and the absence of valvular involvement. An agglutination test for brucellosis was found to be positive with a titer of 1/320. High fever, arthralgia, and splenomegaly regressed following doxycycline plus rifampicin therapy, but there was no improvement in the AV block. A permanent pacemaker was implanted because of the detection of an average heart rate of 48 bpm. Conclusion: Because cardiac failure and rhythm abnormalities are reported in the course of Brucella infection and may be associated with significant outcomes, cases with brucellosis should be evaluated carefully in terms of cardiac involvement. This report aims to draw attention to complete AV block as an extremely rare complication of Brucella infection.
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    Complications of cardiac catheterization in pediatric patients: a single center experience
    (Turkish J Pediatrics, 2012) Yilmazer, Murat Muhtar; Ustyol, Ala; Guven, Baris; Oner, Taliha; Demirpence, Savas; Doksoz, Onder; Mese, Timur
    We analyzed 519 catheterization procedures performed over a period of two years retrospectively. Several risk factors related to the patient or catheterization were analyzed. The incidence of complications was 6.2%. The most common major and minor complications were arterial thrombosis that required intervention and transient arrhythmias, respectively. The incidence of complications during interventional studies was higher (9.7%) when compared to that in diagnostic procedures (5.4%). The independent risk of any complication was greatest up to 1 year of age (p=0.02). The risks of a major complication (p=0.003) and development of arterial thrombosis (p=0.02) were significantly greater in patients <1 year of age by univariate analysis. The risks of pediatric cardiac catheterization continue to decline. The complication rates associated with interventional catheterization were significantly higher than with diagnostic catheterization in this study. Younger age, particularly <1 year of age, is the strongest predictor of development of any complication.
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    Evaluation of left atrial functions in children with chronic renal failure
    (Turkish Soc Cardiology, 2014) Demirpence, Savas; Guven, Baris; Mese, Timur; Serdaroglu, Erkin; Yilmazer, Murat Muhtar; Firuzan, Esin; Tavli, Vedide
    Objective: One-quarter of deaths in children with chronic renal failure is due to cardiovascular complications. Conventional echocardiographic methods are insufficient for evaluating systolic functions in children with chronic renal failure. The aim of the present study was to investigate cardiac functions in children with chronic renal failure by evaluating left atrial volume and functions. Methods: The present cross-sectional observational study included 44 children undergoing dialysis, 16 children with chronic renal failure but not yet on dialysis, and 20 healthy control subjects. Transthoracic echocardiography was performed for all children. Variables regarding to left ventricle and atrium (left atrial systolic force, left atrial systolic force index, left atrial volume, left ventricular mass index, and relative wall thickness) were measured using two-dimensional and M-mode echocardiography. Results: Left atrial systolic force index was negatively correlated with systolic blood pressure and left ventricular mass (p=0.01, r=0.266 and p=0.02, r=0.347, respectively). However, it was positively correlated with both early and late diastolic mitral inflow velocity (r=0.518, p=0.001 and r=0.828, p=0.001, respectively). There were no significant difference among the groups in terms of left atrial systolic force index and left atrial volume. However, left atrial systolic force index was higher in children with chronic renal failure but not yet on dialysis. Conclusion: Left atrial systolic force was negatively correlated with systolic blood pressure and left ventricular mass. These findings suggested that evaluating left atrial systolic force and left atrial volume were useful to determine diastolic dysfunction and the necessity of dialysis in patient with chronic renal failure.
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    Evaluation of vitamin D levels in patients with acute rheumatic fever
    (Turkish Soc Cardiology, 2017) Onan, Sertac Hanedan; Demirbilek, Huseyin; Aldudak, Bedri; Bilici, Meki; Demir, Fikri; Yilmazer, Murat Muhtar
    [Abstract Not Available]
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    An extremely rare complication associated with primary varicella zoster virus infection: Cardiac tamponade
    (Turkish Soc Cardiology, 2014) Bilici, Meki; Yilmazer, Murat Muhtar; Demir, Fikri; Caliskan, Ahmet; Bozkurt, Fatma; Guzel, Abdulmenap; Onan, Sertac Hanedan
    [Abstract Not Available]
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    Improvement in cardiac structure and functions early after transcatheter closure of secundum atrial septal defect in children and adolescents
    (Turkish J Pediatrics, 2013) Yilmazer, Murat Muhtar; Guven, Baris; Vupa-Cilengiroglu, Ozgul; Oner, Taliha; Demirpence, Savas; Mese, Timur; Tavli, Vedide
    We sought to assess the effects of transcatheter closure of atrial septal defect (ASD) on right and left ventricular form and functions, as well as atrial volumes and pulmonary venous flows. We enrolled 25 patients (mean age: 9.02) prospectively who underwent successful transcatheter closure of secundum ASD. We performed transthoracic echocardiography, including two-dimensional, pulsed wave Doppler, M-mode echocardiography, and tissue Doppler imaging before the procedure and 1 day, 1 month, 3 months and 6 months after the procedure. Serum brain natriuretic peptide (BNP) levels were measured prior to the procedure, and 1 day, 1 month, and 3 months thereafter. Mitral inflow early diastolic wave increased significantly, while isovolumetric relaxation time and deceleration time did not change during the follow-up. The E/E'was also increased significantly during follow-up. After the closure, right ventricular size and right atrial volume reduced, while left ventricular size increased significantly. There was a statistically significant improvement in left and right ventricular Tei indices. Pulmonary vein systolic velocity and the ratio of systolic to diastolic wave decreased, while atrial reversal wave (ARW) velocity increased immediately after the procedure. Although the concentration of BNP was increased on the first day after the procedure, its levels reduced and had reached the pre-procedure values at 1 month of follow-up. In the study, a significant improvement in the right and left ventricular functions was detected after transcatheter closure of secundum ASD in the short-term follow-up. In addition, we found a significant reduction in right heart sizes with corresponding global functional improvement in the right ventricle after the procedure.
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    Potential Role of Vitamin D in Pathogenesis of Acute Rheumatic Fever
    (Karger, 2016) Onan, Sertac Hanedan; Demirbilek, Huseyin; Aldudak, Bedri; Bilici, Meki; Demir, Fikri; Yilmazer, Murat Muhtar
    [Abstract Not Available]
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    Spontaneous Closure of a Symptomatic Coronary Artery Fistula Just within a Few Days of Newborn Period
    (Wiley-Blackwell, 2014) Yilmazer, Murat Muhtar; Demir, Fikri; Yolbas, Ilyas; Bilici, Meki
    We present a rare case of spontaneous closure of a fistula between the left coronary artery and the right ventricle (RV) within a few days of newborn period. A 14-day-old male newborn was referred to our clinic for investigation of tachypnea and cardiac murmur. A color flow Doppler echocardiography revealed turbulent flow of a large coronary artery fistula (CAF) between the left coronary artery and the RV. Tachypnea was regressed and repeat echocardiogram showed no CAF related to cardiac chambers after 4 days of admission. The spontaneous closure of CAF was found to be more likely in cases younger than 2 years with small-sized fistulas opening into the right-sided structures, especially into the RV. Nevertheless, the spontaneous closure is very rare in cases with significant shunt. To the best of our knowledge, this is the first case with documented spontaneous closure of CAF just within the newborn period.