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Öğe The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect(Springer, 2008) Yavuz, Taner; Nişli, Kemal; Öner, Naci; Dindar, Aygun; Aydoğan, Ümrah; Ömeroğlu, Rukiye Eker; Ertuğrul, TürkanIntroduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases in children. P-wave dispersion has been reported to be associated with non-homogeneous propagation of sinus impulses. The heterogeneity of atrial conduction time may predispose the atria to arrhythmias. The aim of this study was to determine the impact of surgical repair on P-wave indices in children with isolated secundum ASD. Methods: Children with isolated secundum ASD undergoing surgical repair (n=50; mean age, 7.0 +/- 3.0 years) and healthy controls (n=51; mean age, 7.6 +/- 2.7 years) were compared. Maximum P-wave duration (Pmax), shortest duration (Pmin) and P-wave dispersion (Pd) were measured using 12-lead surface electrocardiography. Results: Mean Pmax was found to be significantly higher in children with ASD compared with controls (95.2 +/- 10.8 vs 84.1 +/- 9.2 msec; P < 0.001), and Pd before surgery was significantly higher compared with controls (47.4 +/- 12.0 vs 38.8 +/- 9.7 msec; P < 0.001). Both P-wave indices were significantly decreased within the first year after surgical closure - the values decreased to those comparable to healthy controls (Pmax, 86.2 +/- 9.7 msec; Pd, 39.8 +/- 10.7 msec; P > 0.05). Conclusion: Surgical closure of ASD in children decreases Pmax and P-wave conduction time. We speculate that earlier closure of the defect may play an important role in avoiding permanent changes in the atrial myocardium and atrial fibrillation in adulthood.Öğe Long term follow-up results of 139 Turkish children and adolescents with rheumatic heart disease(Springer, 2008) Yavuz, Taner; Nişli, Kemal; Öner, Naci; Dindar, Aygun; Aydoğan, Ümrah; Ömeroğlu, Rukiye Eker; Ertuğrul, TürkanWe aimed to evaluate the predictors of the severity of chronic rheumatic valvar disease. The long term follow-up records of 139 patients with chronic rheumatic carditis were reviewed. Children were followed-up on an outpatient basis for a period ranging from 1-16 years (5.0 +/- 3.7 years). Mitral regurgitation either isolated (51%, n=71) or combined with aortic regurgitation (AR) (49%, n = 68) was observed in all cases of the initial attack of rheumatic carditis. AR at initial attack of the rheumatic carditis was found to be affected by gender (AR was more associated with males, p = 0.032), combined mitral and aortic regurgitation (CMAR), and presence of MR at initial attack (p = 0.000 and p = 0.012, respectively) with univariate analysis. The effect of CMAR on AR at initial attack was also significant by multivariate analysis (p = 0.000). CMAR, MR, and AR at initial attack had significant effects on CMAR at final evaluation (p = 0.000, p = 0.020, and p = 0.000, respectively) in univariate analysis. Multivariate analysis revealed the significant effects of CMAR and MR at initial attack on CMAR at final evaluation (p = 0.000 and p = 0.005, respectively). Univariate analysis showed that MR and AR at initial attack, and CMAR at final evaluation, had significant effects on MR at final evaluation (p = 0.000, p = 0.029, and p = 0.000, respectively). MR at initial attack and CMAR at final evaluation had significant effects on MR at final evaluation with multivariate analysis (p = 0.001 and p = 0.003, respectively). AR at final evaluation was affected by CMAR and AR at initial attack (p = 0.000 and p = 0.000, respectively), and CMAR and MR at final evaluation (p = 0.000 and p = 0.000, respectively) with both univariate and multivariate analysis. Mitral valve prolapsus was more common in patients with a longer duration (37.5%, 6 out of 16) than those with a shorter duration (11%, 14 out of 123) and the difference was significant (p = 0.020). In conclusion, the initial severity of valve involvement and the presence of CMAR at initial attack were found to be the best predictors for the severity of chronic rheumatic valvar disease in this study.