Pelin Ayyildiz - Academia.edu (original) (raw)

Papers by Pelin Ayyildiz

Journal of Dr. Behcet Uz Children's Hospital, 2012

Hastanemiz yenidoğan yoğun bakım ünitesinde doğumsal kalp hastalığı tanısı alan yenidoğanların sı... more Hastanemiz yenidoğan yoğun bakım ünitesinde doğumsal kalp hastalığı tanısı alan yenidoğanların sıklık, risk faktörleri ve tanısal ipuçları açısından geriye dönük değerlendirilmesi. Yöntemler: Eylül 2007-Eylül 2009 tarihleri arasında yenidoğan yoğun bakım servisinde yatırılarak tedavi gören 6297 yeni doğandan 367'si ekokardiyografi yapılarak değerlendirildi. Sürekli değişkenler ile ilgili farklılıkların varlığı student t-testi ile kategorik değişkenler arasında farklılık olup olmadığı ise ki-kare testi ile araştırıldı. Bulgular: Ortalama anne yaşı 27±8 (17-42) olarak bulundu. Yüz beş hastada doğumsal kalp hastalığı bulunduğu görüldü. Hastaların %21.9'u matür, %78.1'i prematürdü. Doğumsal kalp hastalığı sıklığı sıklığı %1.6 olarak belirlendi. Ailelerin %16'sında akraba evliliği bulunuyordu. Tanı alan hastaların %61.9'unu siyanotik grup oluşturuyordu. Doğumsal kalp hastalığı tanısı alan bebeklerin %83.9'u solunum sıkıntısı nedeniyle yatmaktaydı. Doğumsal kalp hastalığı tanısı alan yenidoğanlardan en sık kardiyoloji konsültasyonu istenme nedeni %39.3 ile üfürümdü. Doğumsal kalp hastalığı tanısı alan hastalar içinde en sık saptanan kardiak defektler ventriküler septal defekt (%34.3), siyanotik doğumsal kalp hastalıkları içerisinde ise en sık büyük arterlerin komplet transpozisyonu tespit edildi. Otuz dört hasta kalp cerrahisi geçirdi. On bir hasta cerrahi öncesi, 2'si de cerrahi sonrası komplikasyonlar nedeniyle kaybedildi. En sık ölüm nedeni kalp yetmezliği ve sepsis iken en sık eşlik eden kardiyak defektin hipoplastik sol kalp olduğu tespit edildi. Sonuç: Yenidoğanların kardiyak hemodinamiği farklı olduğu için yatırılan her hastaya belirgin kardiyak semptom olmasa bile dikkatli kardiyak muayene ve ekokardiyografik değerlendirme yapılması önemlidir. Anahtar kelimeler: Doğumsal kalp hastalığı, yenidoğan, yoğun bakım, ekokardiyografik değerlendirme ABSTRACT Objective: To evaluate retrospectively relative frequencies, risk factors and diagnostic clues of congenital heart disease in newborns at our neonatal intensive care unit. Methods: In this study 367 cases who had underwent echocardiographic examination were evaluated retrospectively amongst 6297 newborns hospitalized at intensive care unit between September 2007, and September 2009. Differences between continuous variables were analyzed by Student t test. Incidence of the disease occurrence were tested for significance with the chisquared test. Results: Mean mother age was found as 27±8 (17-42) years. One hundred and five (1.6%) newborns were diagnosed as congenital heart disease. Besides, 21.9% of the newborns with congenital heart disease were mature and 78.1 of them premature. Frequency of congenital heart disease was 1.6%. Parents of 16% of the patients had a history of consanguineous marriage, and 61.9% of the diagnosed cases constituted the cyanotic group. Besides, 83.9% of the newborns diagnosed as congenital heart disease were hospitalized because of respiratory distress. Heart murmur was the main reason (39.3%) for requesting cardiology consultation in newborns diagnosed as congenital heart disease. Ventricular septal defect (34.3%) was the most common congenital heart defect. Complete transposition of the great arteries (6.6%) was the most common cyanotic disorder. In the follow-up 34 patients who underwent cardiac surgery. 11 patients passed away before cardiac surgery and 2 were lost because of postsurgical complications. While most common reasons of death were congestive heart failure and sepsis, hypoplastic left heart was the most common associated cardiac defect. Conclusion: Careful cardiac examination and echocardiographic evaluation of neonates hospitalized in intensive care unit is important due to different cardiac hemodynamics even in the absence of significant cardiac findings.

Türk kardiyoloji derneği arşivi, Jun 1, 2016

Balkan Medical Journal, Mar 9, 2023

This case series reports on four patients who presented with giant aneurysms of the atrial append... more This case series reports on four patients who presented with giant aneurysms of the atrial appendages (AA).

The anatolian journal of cardiology, 2016

Balkan Medical Journal, Mar 24, 2023

Perinatal journal, Aug 1, 2019

Fetal konotrunkal kalp anomalileri: Prenatal taramada dört oda görünümü yeterli mi? Amaç: Bu çal›... more Fetal konotrunkal kalp anomalileri: Prenatal taramada dört oda görünümü yeterli mi? Amaç: Bu çal›flmada hastanemiz perinatoloji ünitesinde konotrunkal kalp anomalisi tan›s› alan olgular›n kay›tlar› incelenerek prenatal dönemde konotrunkal kalp anomalisi tan›s›na yönlendiren faktörlerin de¤erlendirilmesi ve prenatal konotrunkal kalp anomalisi tan›s› ile ilgili fark›ndal›¤›n art›r›lmas› amaçland›. Yöntem: Ocak 2015-Aral›k 2016 tarihleri aras›nda Kanuni Sultan Süleyman E¤itim ve Araflt›rma Hastanesi Perinatoloji Ünitesinde konotrunkal kalp anomalisi tan›s› alan olgular›n yönlendirilme nedenleri, efllik eden kalp d›fl› anomali ve kromozom anomalisi varl›¤›, olgular›n perinatal sonuçlar› ve postnatal dönemde tan›-n›n do¤rulanma baflar›s› de¤erlendirildi. Bulgular: Tüm konjenital kalp anomalilerinin içinde konotrunkal kalp anomalisi s›kl›¤› %20.4 idi. Çal›flmaya dahil edilen 101 olgunun 37'sinde (%36.6) gebelik terminasyonu gerçeklefltirildi. ‹ntrauterin fetal ölüm 5 (%5) olguda gözlendi. Olgular›n %26.7'sinde kromozom anomalisi ve %34.7'sinde kalp d›fl› ek yap›sal anomali saptand›. Canl› do¤an 59 (%58.4) olgunun 52'sinde (%88.1) prenatal tan› do¤ruland›. Olgular›n yaln›zca %27.7'sinde dört oda görünümünün anormal oldu¤u saptand›. Sonuç: Dört oda görünümünün konotrunkal kalp anomalilerinde s›kl›kla normal olmas› nedeni ile bu anomalilerin prenatal tan› s›k-l›¤›n›n art›r›labilmesi için temel fetal kardiyak tarama programla-r›nda üç damar ve üç damar trakea kesitleri rutin olarak görüntülenmelidir.

Kocaeli tıp dergisi, 2019

İzole pulmoner kapak yetersizliği (IPKY) nadir görülen bir klinik durumdur ve genellikle yıllarca... more İzole pulmoner kapak yetersizliği (IPKY) nadir görülen bir klinik durumdur ve genellikle yıllarca iyi tolere edilir. IPKY'de sağ ventrikül diyastolik fonksiyonlarını değerlendirmek istedik. YÖNTEM ve GEREÇLER: Çalışma grubu, kurumumuza yönlendirilen 3 kız ve 10 erkek çocuk hastadan oluşuyordu. Hastalar 5-16 yaş arasındaydı. Bu hastalar yaş ve cinsiyete göre benzer bir grup olan 27 sağlıklı çocukla karşılaştırıldı. Tüm hastalar için ayrıntılı fizik muayene, elektrokardiyogram, ekokardiyografi ve akciğer grafisi çekildi. BULGULAR: Çalışmamızda grup (grup I) 13 IPKY hastasından oluşuyordu. Kontrol grubunda (grup II) 6-19 yaşları arasında 27 çocuk (15 kız, 12 erkek) vardı. Grup I ve II arasında pik erken diyastolik akım hızlarında (E) istatistiksel olarak anlamlı fark vardı. Gruplar arasında pik geç diyastolik akım hızı (A) ile istatistiksel olarak anlamlı fark yoktu. Grup I'de Grup II ile karşılaştırıldığında E: A oranı anlamlı olarak azdı. Grup II ile karşılaştırıldığında grup I'de izovolemik gevşeme süresi (IVRT) uzundu, ancak gruplar arasında istatistiksel olarak anlamlı fark yoktu. Gruplar arasında karşılaştırıldığında; grup I'de E hız zaman integrali (VTI E) az, A hız zaman integrali (VTI A) aynı ve VTI E / A azalmıştı. TARTIŞMA ve SONUÇ: Her ne kadar IPVR'nin iyi huylu bir lezyon olduğu kabul edilmese de bu hastalarda sağ ventrikül diyastolik disfonksiyonunun olduğunu gördük. Bu arada, klinik semptomlar ortaya çıkmadan önce aritmi ve sağ taraflı yetmezliğin belirlenmesi önemlidir.

Koşuyolu heart journal, Apr 1, 2019

Introduction: Ebstein's anomaly (EA) is a congenital malformation of the tricuspid valve. In the ... more Introduction: Ebstein's anomaly (EA) is a congenital malformation of the tricuspid valve. In the present study, the aim was to examine the relationship between the Great Ormond Street Score (GOSE) index and P-wave characteristics in patients with EA. Patients and Methods: Unoperated patients with EA were evaluated retrospectively. Echocardiographic GOSE indices were calculated for each patient. The P-wave characteristics on the 12-channel electrocardiography (ECG) were also evaluated simultaneously. Results: There were EA 24 cases in the study. The median age was 12 months (range, 1 day-8 years). The median P-wave dispersion was 18 msn (range, 8-36 msn), median P-max duration was 86 msn (range, 58-104 msn), median P-min duration was 62 ms (range, 18-88 msn), and median P amplitude was 2.7 mm (range, 1.2-5 mm). Atrial arrhythmia was detected in eight cases. In the arrhythmia group, the P dispersion and P-max duration were significantly higher than in the non-arrhythmic group (p< 0.05). The median GOSE index was measured as 0.62 (range, 0.2-1.3). The GOSE index grade was detected as Grade 1 in 8 cases, Grade 2 in 12 cases, and Grade 3 in 4 cases. When the patients' GOSE index and P-wave characteristics were evaluated, a positive correlation was found between the P-max (r= 0.5, p= 0.02) and P amplitude (r= 0.780, p= 0.001). There was no significant correlation between the P dispersion and P-min durations (p> 0.05). Conclusion: In EA cases, the GOSE index can be estimated, especially by evaluating the P-wave maximum duration and amplitude. Thus, clinicians may have an idea about the prognosis of cases with EA by evaluating the P-wave changes in ECG and especially the development of supraventricular arrhythmia.

Turkish Journal of Thoracic and Cardiovascular Surgery, Apr 11, 2016

Bu çalışmada çift girişli sol ventrikül-ventriküloarteriyel diskordans tanılı fonksiyonel tek ven... more Bu çalışmada çift girişli sol ventrikül-ventriküloarteriyel diskordans tanılı fonksiyonel tek ventriküllü olgular değerlendirildi. Ça lış m a pla nı: Ocak 2010-Ekim 2014 tarihleri arasında çift girişli sol ventrikül-ventriküloarteriyel diskordanslı toplam 34 hasta (17 erkek, 17 kadın; ort. yaş 2.64 ay; dağılım 1 gün-24 yıl) retrospektif olarak incelendi. Hastaların demografik özellikleri, ekokardiyografik ve hemodinamik ölçümleri, yapılan invazif, cerrahi işlemler ve sonuçları gözden geçirildi. Bul gu lar: Hastaların 24'ünde pulmoner hipertansiyon olup, bunların sekizinde arkusta tıkanıklık vardı. Sekizinde pulmoner darlık ve ikisinde pulmoner atrezi mevcuttu. Hiçbir hastada ekokardiyografi ile değerlendirildiği üzere, çıkım yolu tıkanıklığı saptanmadı. Yirmi beş hastaya cerrahi yapıldı. Bu hastaların 14'üne pulmoner arter bant işlemi ve bunların dördüne ek olarak arkus rekonstrüksiyonu gerçekleştirildi. Altı hastaya iki yönlü kavopulmoner anastomoz, dört hastaya aortopulmoner şant ve bir hastaya Norwood tipi cerrahi yapıldı. Medyan takip süresi 9.96 ay (dağılım 0.24-53.88 ay) idi. Takip sırasında 12 hastaya iki yönlü kavopulmoner anastomoz yapıldı. İlk palyasyon olarak arkus rekonstrüksiyonu ile birlikte veya tek başına pulmoner arter bant yapılan ve iki yönlü kavopulmoner şant dönemine gelen hiçbir hastada çıkım yolunda sistemik darlık gelişmedi. So nuç: Çalışma bulgularımıza göre, çift girişli sol ventrikül ventriküloarteriyel diskordanslı hastalarda birincil tedavi stratejisi büyük farklılıklar göstermekle birlikte, pulmoner kan akımı sınırlı olan hastalara aortopulmoner şant veya duktal stent uygulanabilirken, pulmoner kan akımı sınırlı olmayan hastalara arkus rekonstrüksiyonu ile beraber veya tek başına pulmoner arter bandı uygulanabilir. Bulboventriküler foramen restriksiyonu olan hastalara ise ilk olarak Norwood tipi cerrahi uygulanabilir. Anah tar söz cük ler: Çocukluk çağı; çift girişli ventrikül; ventriküloarteriyel diskordans.

Cardiology in The Young, Aug 28, 2020

Objectives:This study aimed to evaluate the clinical features of patients with septum primum malp... more Objectives:This study aimed to evaluate the clinical features of patients with septum primum malposition, imaging tools used for diagnosis, and their effects on the surgical approach.Materials and methods:Patients diagnosed with septum primum malposition in our paediatric cardiac centre between 1 January, 2015 and 1 January, 2019 were included in the study. In all patients, the age, reason for admission, transthoracic echocardiography, cardiac multidetector CT angiography findings, and subsequent surgical data were evaluated.Results:Fifteen patients were diagnosed with septum primum malposition during the study period. The median age was 12 months (2 months–10 years). Six patients were left isomeric, and the rest were situs solitus; 80% of the patients (n = 12) had additional secundum atrial septal defect. There was cardiac pathology in 46% of the patients (n = 7) in addition to the abnormal pulmonary venous drainage, ventricular septal defect (n = 3), left ventricularhypoplasia (n = 2), cortriatriatum sinister (n = 2), double outlet right ventricle (n = 1), and atrioventricular septal defect (n = 1). There was bilateral superior caval vein in three patients, right-sided superior caval vein in 11 patients, and left-sided superior caval vein in one patient. All three patients with total abnormal pulmonary venous drainage were left atrial isomeric. There were differences between the results of transthoracic echocardiography and CT angiographies in two patients. The surgical strategy was changed in three patients after the preoperative diagnosis of septum primum malposition.Conclusion:Septum primum malposition should be kept in mind during the imaging of complex CHDs specifically during the segmental analysis of the pathologies with heterotaxy syndromes; it should be differentiated from other aetiologies of abnormal pulmonary venous drainage as accurate diagnosis would facilitate the ideal surgery in these complex pathologies requiring a detailed preoperative preparation.

The anatolian journal of cardiology, 2018

Journal of Cardiac Surgery, Sep 28, 2020

Introduction: Various valve repair techniques have been described for prevention of pulmonary ins... more Introduction: Various valve repair techniques have been described for prevention of pulmonary insufficiency (PI) during right ventricular outflow tract (RVOT) reconstruction with transannular patch. Herein, we present the early results of an alternative technique of neopulmonary valve reconstruction using right atrial appendage (RAA) tissue. Methods: Between October 2019 and December 2019, 12 patients with tetralogy of fallot (TOF) (n = 10), TOF-absent pulmonary valve (n = 1) and intact ventricular septumpulmonary atresia (n = 1) underwent RVOT reconstruction with neopulmonary valve that was created using RAA tissue. Median age and weight of patients were 9.9 months (5 months-14 years) and 9.8 kg (6.2-47), respectively. Results: No mortality or major events developed. Postoperative echocardiography revealed none/trace PI in 11 patients and mild PI in 1 patient. Median right ventricle/left ventricle ratio was 0.46 (0.35-0.65) and RVOT gradient was 20 mm Hg (0-30). Median cardiopulmonary bypass and aortic clamping times were 121 minutes (81-178) and 94 minutes (59-138), respectively. Operative times revealed statistically significant learning curve pattern in terms of cardiopulmonary bypass (r 2 = .568;

Brazilian Journal of Cardiovascular Surgery, 2019

Objective: To reveal the risk factors that can lead to a complicated course and an increased morb... more Objective: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. Methods: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). Results: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). Conclusion: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.

Authorea (Authorea), May 11, 2020

Background: Prolonged pleural drainage after the Fontan procedure is a common complication. Vario... more Background: Prolonged pleural drainage after the Fontan procedure is a common complication. Various protocols have been described, but there is no definitive consensus for the treatment of this complication. Materials and Methods: Our primary aim was to determine the effect of the protocol on the duration of drainage and hospital stay. Our secondary aim was to determine parameters affecting prolonged drainage after the Fontan procedure. Ninety two consecutive patients who underwent the Fontan operation retrospectively analyzed. A protocol-based postoperative management was adopted at July 2018. Patients operated before the protocol were defined as Group 1(n=48), and patients operated after the protocol were defined as Group 2(n=44). Results: The mean age was 5(IQR 4.0-6.9) years the mean body weight was 17.3 (IQR 15.1-21.8) kg.There were statistically significant differences between groups in terms of total drainage, duration of pleural drainage, prolonged drainage and, LOHS(p=0.05,p=0.04, p=0.04,p=0.04,respectively). In the multivariate analysis, the application of the protocol was observed to be the only factor for prolonged drainage (OR:2.46, 95% CI Lower-Upper:1.03-5.86,p=0.04). Conclusion: Standardization and strict application of the medical treatment within a specific protocol without being affected by doctor, nurse or patientbased factors increases the success. After the changes in our medical management strategy, along with the decrease in total drainage and duration of pleural drainage, LOHS was also reduced, of course together with a reduction in the cost.

Türk kardiyoloji derneği arşivi, 2016

Turkish Journal of Thoracic and Cardiovascular Surgery, Jan 4, 2016

Revista portuguesa de cardiologia, Aug 1, 2021

Introduction: Echocardiography (echo) is the primary non-invasive imaging modality for the assess... more Introduction: Echocardiography (echo) is the primary non-invasive imaging modality for the assessment of congenital heart disease (CHD). Computed tomography angiography (CTA) also has potential to examine the anatomy of complex heart anomalies as well as extracardiac involvement. Objectives: The aim of this study is to determine the impact of new CTA technology in the diagnosis of CHD and to compare echo and CTA in terms of diagnostic accuracy. Methods: Forty-five patients who underwent preoperative echo and CTA assessment in the intensive care unit were included in this study. The results were assessed for three main types of CHD (cardiac malformations, cardiac-major vessel connections and major vessels). The main groups were also divided into subgroups according to surgical features in order to assess them more objectively. Imaging methods were compared for diagnostic accuracy, sensitivity and specificity, while surgical findings were accepted as the gold standard. Results: Patients' median age and weight were two months (three days-eight years) and 12 kg (2.5-60 kg), respectively. In 45 operated cases, 205 subgroup malformations were assessed. Diagnostic accuracy was significantly greater in echo (echo vs. CTA: 98.4% and 96.2% [chi-square=6.4, p=0.011]). During surgery, 84 cardiac malformations (echo vs. CTA: 97.4% and 95.1% [chi-square=4.9, p=0.03]), 47 cardiac-major vessel connections (echo vs. CTA: 98.3% and 95.4% [chi-square=7.5, p=0.03]), and 74 major vessel malformations (echo vs. CTA: 96% and 98% [chi-square=1.8, p=0.48]) were confirmed.

Cardiology in The Young, Jan 27, 2021

Objectives:In recent years, cardiac resynchronization therapy (CRT) has also started to be perfor... more Objectives:In recent years, cardiac resynchronization therapy (CRT) has also started to be performed in the paediatric and CHD population. This study aimed to evaluate the efficacy of CRT in children with CHD.Patients and methods:Patients with CHD who underwent CRT treatment in our paediatric cardiology clinic between January, 2010 and January, 2020 were included in the study. Demographic findings, 12-lead electrocardiograms, echocardiograms, clinical characteristics, management strategies, and outcomes were reviewed systematically.Results:The study population consisted of 18 CHD patients who had been treated with CRT for 10 years in our institution. The median age was 11 years (2.2–18 years) and the median weight was 39 kg (10–81 kg). Systemic ventricle was left ventricle in 13 patients, right ventricle in 4 patients, and 1 patient had single-ventricle physiology. CRT implantation indications were as follows: dysfunction after permanent pacemaker in 11 patients, dysfunction after left bundle branch block in 4 patients, and systemic ventricular dysfunction in 3 patients. CRT implantation techniques were epicardial (n = 13), hybrid (n = 4), and transvenous (n = 1) methods. QRS duration significantly decreased after CRT implantation (160 versus 124 m/second, p < 0.05). Median systemic ventricle ejection fraction (EF) significantly increased after the procedure (30 versus 50%, p < 0.05). Fourteen patients (78%) were responders, two patients (11%) were superresponders, and two patients (11%) were non-responders after the CRT treatment. One patient deceased during follow-up. Median follow-up duration was 40 months (6–117 months).Conclusion:When electromechanical dyssynchrony occurs in paediatric cases with CHD and developing heart failure, patients should be evaluated in terms of CRT to improve ventricular function. Alternative CRT therapy will be beneficial in these cases that do not improve clinically despite optimal medical treatment.

Artificial Organs, Aug 1, 2017