A Genotyped Case of Townes–Brocks Syndrome with Absent Pulmonary Valve Syndrome from Turkey

Townes–Brocks syndrome (TBS) is a rare syndrome characterized by triad of anal, ear, and thumb anomalies. Further malformations/anomalies include congenital heart diseases, foot malformations, sensorineural and/or conductive hearing impairment, genitourinary malformations, and anomalies of eye and nervous system. Definitive diagnosis for TBS is confirmed by molecular analysis for mutations in the SALL1 gene. Only one known case of TBS with absent pulmonary valve syndrome (APVS) has been previously described to our knowledge. Here, we report a newborn diagnosed with TBS with APVS and tetralogy of Fallot (TOF) who was found to carry the most common pathogenic SALL1 gene mutation c.826C > T (p.R276X), with its surgical repair and postoperative follow-up. To our knowledge, this is the first genotyped case of TBS from Turkey to date. TBS should be suspected in the presence of ear, anal, and thumb malformations in a neonate. If a patient with TBS and TOF-APVS needs preoperative ventilation within the first months of life, this implies prolonged postoperative intubation and increased risk of mortality.

Treatment of Permanent Junctional Reciprocating Tachycardia in a Preterm Neonate: Case Report

Permanent junctional reciprocating tachycardia (PJRT) is most often observed in infants and children and can lead to incessant tachycardia. PJRT is usually refractory to medical treatment. Tachycardia may infrequently occur in the fetus in which case fetal tachycardia transplacental treatment should be started immediately. Term delivery is recommended for fetuses with tachycardia in the absence of significant clinical compromise to avoid complications of preterm birth. Herein, a 36-week preterm neonate presented with PJRT. He had tachycardia in the fetal period and was treated with digoxin, amiodaron, and esmolol therapy after birth without undergoing the catheter ablation procedure.

Clinical characteristics of neonates with VACTERL association

BACKGROUND

The VACTERL association (VA) is the non-random co-occurrence of vertebral anomalies, anal atresia, cardiovascular malformations, tracheoesophageal fistula and/or esophageal atresia, renal anomalies, and/or limb anomalies, and is referred to by the first letters of its components. Studies investigating the clinical characteristics of VA patients and probing of the observed current six component types are limited, and none of them is focused on neonates. We investigated the clinical characteristics of our patients diagnosed as having VA in the newborn period.

METHODS

We retrospectively reviewed the neonates whose final diagnosis was VACTERL association. Presence of at least three components of previously reported six anomalies was accepted as VACTERL association. Sex, birthweight, gestational age, postnatal age, anomalies of the systems that are included in VA, and the other features were recorded.

RESULTS

There was a male predominance (14/11) of 28 patients; and there were three patients with ambiguous genitalia. The most common observed VACTERL component was vertebral anomalies (n= 26), followed by anal atresia (n= 19), tracheoesophageal fistula/esophageal atresia (n= 17), renal anomalies (n= 15), limb anomalies (n= 15) and cardiac anomalies (n= 14). The most frequent combination was VCTL (n= 4). Fifteen (57%) patients had non-VACTERL anomalies and the most frequent of these was ambiguous genitalia (n= 3).

CONCLUSION

VA patients may have different clinical characteristics in different populations, and clinicians may miss some component features if the patients are evaluated after the neonatal period.

Partial anomalous pulmonary venous return associated with vascular anomalies of the aorta: multidetector computed tomography findings

Partial anomalous pulmonary venous return (PAPVR) is a congenital anomaly that involves drainage of one to three pulmonary veins directly into the right heart or systemic venous system, creating a partial left-to-right shunt. This drainage is associated with cardiac abnormalities such as mitral stenosis and pulmonary stenosis, patent ductus arteriosus, and atrial septal defects. We report a case of PAPVR associated with vascular anomalies of the aorta by multidetector computed tomography in an adult female patient.

Coronary microcatheter mapping of coronary arteries during radiofrequency ablation in children

INTRODUCTION

Radiofrequency catheter ablation (RFCA) is a safe and effective treatment option for children with refractory supraventricular tachycardias. RFCA of right-sided accessory pathways (APs) continues to be challenging, resulting in lower success rates and higher recurrence rates. One of the reasons for a prolonged or failed procedure is mapping error and changes in cardiac anatomy. The right coronary artery (RCA) runs along the ventricular aspect of the right epicardial atrioventricular groove, and RCA mapping had been reported facilitating difficult right-sided AP RFCA in the pediatric population. We reported that microcatheter-assisted mapping during RFCA can improve localization of right-sided and some left-sided APs particularly in children with congenital heart disease.

METHODS

This technique was used in seven patients with a mean age of 15.3+/-1.6 years and a mean weight of 52.6+/-6.5 kg. Five patients (71%) had manifest preexcitation on surface electrocardiogram, and two patients had a concealed AP. In two of them, there were single ventricle anatomies. In the other two patients, venous access problem to the heart and enormous cardiac hypertrophy were the major problems. In the remaining three patients with normal cardiac anatomy, RCA mapping was used because a standard procedure was not successful. Previous RFCA ablation was not successful in two patients. Either a 150-cm eight-electrode pair (2-6-2 mm, 2.5 French) or a four-electrode pair (2-6-2 mm, 2.3 French) microcatheter (2.3 French octapolar microcatheter) was used.

RESULTS

Average time of the multielectrode RCA mapping was 42+/-14.5 min. All eight (100%) APs were successfully ablated. No complications occurred.

CONCLUSIONS

Microcatheter-assisted coronary artery mapping during RFCA is a useful adjunctive mapping technique in children with difficult to map right-sided APs and patients with APs who has complex cardiovascular anomalies.

The Association of HLA Class I and II Antigens in Teenagers with Caries Experience

OBJECTIVE

There have been reports of a relationship between human histocompatibility antigen types and increased incidence of dental caries. The association between specific patterns of HLA genetic inheritance is not clear and not well studied. The aim of the study was to investigate the relationship between MHC alleles and DMFT index in 65 teenagers.

MATERIALS AND METHODS

Sixty-five teenagers were recruited from the students of elementary school of the university campus and the patients of the Ataturk University Dental School hospital. Low-resolution typing for the HLA-A, B, C and HLA-DR/DQ were performed by PCR-SSP method using SSP HLA class I generic DNA Typing Tray.

RESULTS

The results showed that HLA-DRB1*04 and -DRB1*07 frequencies were significantly higher (30.4% and 26.08% respectively) in DMFT≥1 group as compared with DMFT:0 group (10.5% and 5.26%), (p:0.168, OR:3.719; p:0.117, OR:6.353). Although frequencies of HLA-A*2, -B*27 and -B*51 alleles were increased in DMFT≥1 group, they were not statically important. HLA-DRB1*11 were found to be more common in DMFT: 0 groups.

CONCLUSIONS

The pathogens involve in caries induce immune systems and response via the given HLA alleles could be important.

Congenital cardiac malformations in neonates with apparently isolated gastrointestinal malformations

BACKGROUND

The association of congenital cardiac malformations (CCM) with malformations of the gastrointestinal tract/abdominal wall is known. Nevertheless, the data presently available are derived from patient populations that include some special conditions known to be associated with a high rate of CCM. The aim of the present study was therefore to determine the incidence of cardiac malformations among neonates with apparently isolated malformations of the gastrointestinal tract/abdominal wall.

METHODS

A total of 201 neonates with apparently isolated gastrointestinal malformations were screened on echocardiography.

RESULT

Thirty-six (17.9%) of the neonates were diagnosed as having a CCM. When the four most frequent gastrointestinal malformations were evaluated, a CCM was diagnosed in 11/69 (15.9%) with anal atresia, in 9/38 (23.7%) with tracheoesophageal fistula/esophageal atresia, in 2/25 (8%) with diaphragmatic hernia and in 5/17 (29.4%) with intestinal atresia. In 11 of 36 patients (30.6%) with CCM, the cardiac problems were hemodynamically significant, requiring anti-congestive and/or surgical treatment.

CONCLUSION

A significant number of neonates with apparently isolated gastrointestinal malformations had CCM. Because almost all patients with malformations of the gastrointestinal tract/abdominal wall require early surgical intervention, they should be evaluated on echocardiography to investigate CCM at the earliest opportunity.

A case of Bonneau syndrome associated with multiple renal cortical cysts

We describe a 2-month-old girl with congenital anomalies including facial anomalies, complex cardiac anomalies, polysyndactyly, dysgenesis of distal extremities and bilateral multiple renal cysts. The proband was the child of first-cousin parents. Clinical synopsis in Bonneau syndrome (OMIM: 263630) is polysyndactyly and cardiac malformation. In addition, liver anomalies were reported in two patients. We discuss polysyndactyly and cardiac malformation with bilateral multiple renal cysts, a combination not reported previously.

Isolated left ventricular noncompaction in children: two cases with different manifestations

Isolated noncompaction of the ventricular myocardium is an uncommon disorder characterized by an excessively prominent trabecular meshwork seen in the early period of embryogenesis. The clinical presentation of noncompaction includes a high prevalence of heart failure, thromboembolic events and arrhythmias. Echocardiography is the procedure of choice for the diagnosis of noncompaction. We report two demonstrative patients with isolated noncompaction of the left ventricular myocardium and review the available related literature.

Head-up tilt table testing with sublingual isosorbide dinitrate in the diagnosis of vasovagal syncope in children

OBJECTIVE

To evaluate the effect of sublingual administration of ISDN on the results of the head-up tilt table test (HUTT) in children and adolescents with vasovagal syncope.

MATERIALS AND METHODS

The study group consisted of 30 children, each with at least one incidence of vasovagal syncope, and the control group had 15 healthy children. The patients were tilted upright at an angle of 60° for 15 minutes. If the test was negative, sublingual ISDN was administered and the test was continued for an additional 15 minutes.

RESULTS

The sensitivity and specificity of the basal test were 30% and 100%, respectively. Although the specificity decreased somewhat (93.3%) after sublingual ISDN, the sensitivity significantly increased to 96.7%. No severe complications were observed after sublingual ISDN administration.

CONCLUSION

Our results suggested that sublingual ISDN is a useful, effective and safe agent for pharmacologic stimulation and measurement of the HUTT in children. It increased the sensitivity of the test with a slight decrease in specificity.

A giant thrombus in the right ventricle of a newborn with Down syndrome: successful treatment with rt-PA

An association between thromboembolic events and Down syndrome (DS) has been increasingly reported in the literature. It is not clear whether patients with DS have increased risk for thrombotic disorders or there is a coincidence. We present a case of giant right ventricular thrombus in a neonate with DS. Risk factors for thrombosis in the present case were neonatal sepsis and dehydration. There was no congenital heart anomaly. The patient was treated successfully using recombinant tissue plasminogen activator. Recombinant tissue plasminogen activator seems to be a safe and effective thrombolytic therapy in neonates.

Interrupted Aortic Arch Associated with Absence of Left Common Carotid Artery: Imaging with MDCT

Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as complete luminal and anatomic discontinuity between ascending and descending aorta. Although its association with various congenital heart defects has been reported, absence of left common carotid artery (CCA) in patients with IAA has not been reported previously. We report a case of IAA associated with the absence of left CCA which was clearly shown on multidetector-row spiral CT.

The Effects of Ondansetron and Granisetron on Electrocardiography in Children Receiving Chemotherapy for Acute Leukemia

5-HT3 receptor antagonists, including granisetron and ondansetron, are widely used in the prophylactic treatment of chemotherapy-induced nausea and vomiting. Although the cardiac safety of granisetron and ondansetron has been investigated in several adult studies, there is no report investigating the effects of those agents on electrocardiography (ECG) in children. The effects of intravenously infused (over 30 seconds) 0.1 mg/kg ondansetron and 40 microg/kg granisetron on ECG were assessed in 22 children receiving high-dose methotrexate therapy for acute lymphoblastic leukemia. The ECG recording was obtained at before and just after the infusion, and repeated at 1, 3, 6, and 24 hours of treatment. Granisetron administration resulted in a statistically significant decrease of mean heart rate at 1 and 3 hours, and significant prolongation of mean QT and QTc dispersions at 1 hour of infusion. In patients treated with ondansetron, no meaningful change was observed. In conclusion, intravenous granisetron but not ondansetron causes clinically asymptomatic and transient changes on ECG measurements in children receiving high-dose methotrexate therapy.

Significance of bone marrow examination in the diagnostic process of paraspinal mass in children: a case report

Spinal cord compression is a rare but serious complication of non-Hodgkin lymphoma or leukemia. Biopsy of the mass with or without laminectomy would be necessary for diagnosis in patients presenting with isolated paraspinal mass in the absence of other overt clinical symptoms or findings or laboratory abnormalities that would specifically suggest leukemia or lymphoma. The authors describe a 6-year-old girl with symptoms of spinal cord compression due to a paraspinal mass who had undergone surgical intervention; she was later shown to have acute B-cell lymphoblastic leukemia. A bone marrow aspiration should be considered in such patients to avoid unnecessary surgical intervention.

Postoperative hepatic laceration in a child with type 3 von Willebrand disease

We report an unusual postoperative complication (hepatic laceration) in a child with type 3 vWD, who has not received any prophylaxis.