Kutay Sel

Objectives: Complete heart block (CHB) is a rare but potentially life-threatening condition in childhood. A permanent pacemaker (PM) can provide a physiologically appropriate heart rate under defined criteria. It is known that normal cardiac function plays an important role in growth, which is the main indicator of health in childhood. While a holistic health approach is increasingly emphasized, there are limited data in the literature evaluating long-term growth in pediatric patients with a PM. This study aimed to assess the impact of PM implantation on growth in children with CHB. Methods: This study included 25 pediatric patients (11 girls, 14 boys) aged 2–16 years with CHB who underwent PM implantation. Anthropometric measurements, including height, weight, and body mass index (BMI), were recorded pre-implantation and at follow-up, continuing until age 18. Z scores adjusted for age and gender were calculated and compared between baseline and final follow-up. Results: The mean follow-up duration was 7.65 ± 2.79 years. Statistically significant increases were observed in weight and BMI Z scores post-implantation ( p < 0.05). Although height Z scores also showed an upward trend, the change did not reach statistical significance. Conclusion: Permanent PM implantation in children with CHB is associated with significant improvements in weight and BMI over the long term, indicating a positive influence on overall growth. While height gains were less marked, the findings suggest that improved cardiac function post-implantation supports better growth trajectories. These results underscore the importance of timely PM implantation, with favorable growth outcomes observed over long-term follow-up in pediatric patients with CHB.

Purpose: Growth hormone (GH), which has been used for many years for various indications, has been extensively studied because of its systemic effects. One notable effect is on the cardiovascular system. Heart rate variability (HRV) is a widely used noninvasive tool for understanding environmental factors, diseases, and treatment effects, providing insights into the autonomic nervous system (ANS). This study aimed to examine the effects of childhood GH replacement treatment (GHRT) on HRV parameters and their implications for the ANS. Methods: The study included 10 pediatric patients (mean age 12.01 ± 1.38 years) evaluated for short stature and diagnosed with isolated GH deficiency (GHD). Time‐domain parameters of HRV were examined in patients with a 24 h Holter monitoring before GHRT and after six months of treatment. Results: Root mean square of the successive normal sinus R–R interval difference (RMSSD) and percentage of successive normal sinus R–R intervals longer than 50 milliseconds (pNN50), which are known to correlate with the parasympathetic nervous system, decreased significantly after 6 months of treatment compared to baseline. No significant changes were observed in the other time‐domain parameters, the standard deviation of all normal sinus R–R intervals (SDNN), and the standard deviation of the averages of R–R intervals in all 5 min segments of the recording (SDANN). Conclusion: GHRT in childhood was associated with significant reductions in vagally mediated HRV parameters, suggesting an effect on autonomic regulation during the early phase of treatment. Long‐term studies are required to determine whether these changes persist or normalize over time. This appears to be the first study to investigate the effects of GHRT on ANS function in children with GHD.

Background: Although isolated ductus arteriosus aneurysm has been reported as 0.8% in autopsy series, it has recently been reported as up to 8.8% with increased awareness. Most cases are asymptomatic and regress spontaneously. In this study, we aimed to evaluate the characteristics, clinical manifestations, and outcomes of ductus arteriosus aneurysm in neonates. Material and Methods: A total of 22 newborns with echocardiographic images recorded in the hospital registry system were identified to have a ductus arteriosus aneurysm. The demographic, clinical, and echocardiographic findings of the patients were extracted from the hospital records. Results: The mean gestational age and weight at birth of the newborns were 38 ^6/7 weeks (35 ^3/7 – 40 ^6/7 weeks) and 3203 g (2445–4080 g), respectively. The maximal length and width of the aneurysm ranged from 6 to 21 mm and 5.3 to 13 mm, respectively. In three of the patients, thrombus in the aneurysm was detected on the third day of life, leading to surgical excision of thrombus and ligation of the aneurysm in two. In the remaining 19 patients, the aneurysm regressed spontaneously and closed in an average of 5.3 days. Conclusion: With increased awareness and earlier and more frequent application of echocardiography in newborns, the diagnosis of ductus arteriosus aneurysm is being reported more frequently. The most common scenario is spontaneous regression, however, it should not be forgotten that it can lead to serious complications, as reported previously. In selected cases, surgical treatment may be an option to prevent more serious or late complications, though the indications for surgical intervention remain unclear.

Objective: The aim of this study was to assess active standing test responses in ovewrweight or obese children and to determine the factors that contribute to orthostatic abnormalities. Materials and Methods: Orthostatic responses were investigated in bothobese and overweight children. To provide an overview of the autonomic nervous system (ANS), blood pressure and heart rate measurements, laboratory parameters, and anthropometric measures were analyzed. Results: A total of 123 overweight or obese children, with a median age of 15.03 (range from 6.9 to 17.9), were included in this study. Seventy-seven patients (63%) were obese, whereas 46 (37%) were overweight. Orthostatic disturbances were observed in 78 patients (63%). In the standing test, 73 patients (59%) exhibited an abnormal response. Orthostatic hypotension (33%), orthostatic hypertension (30%), and postural orthostatic tachycardia syndrome (18%), were detected in the patients. The group that had orthostatic hypotension had a lower systolic pressure in the standing test after 10 min. The group with orthostatic hypertension had higher body mass index. Furthermore, the orthostatic group displayed significantly higher levels of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), insulin, and HbA1c. Conclusion: The results of this study signifies a connection between obesity or being overweight and ANS, . highlighting the need for evaluation of the ANS in obese or overweight children to predict the adverse consequences and to prevent occuring during childhood. Cite this article as: Donmez YN, Sel K. Cardiovascular response to active standing test in children with overweight and obesity. Turk Arch Pediatr. 2025;60(3):268-273.

Background. Isolated mitral valve aneurysm is rarely reported in children. In most cases it is associated with an underlying disease such as infective endocarditis. MVA can lead to severe complications that needs surgical intervention. Case. In this report, we present a 9-year old asymptomatic male patient with anterior mitral valve aneurysm and rhythm disturbance diagnosed incidentally during pre-operative evaluation. Conclusions. Being rare in children, isolated MVA should be kept in mind in the differential diagnosis of mass lesions seen on the atrial side of the mitral valve. A 24-hour electrocardiogram may define subtle rhythm disturbances in these patients.

Amaç: Başta sistemik lupus eritematozus (SLE) ve Sjögren sendromlu (SS) olmak üzere annelerinde bağ dokusu hastalığı olan yenidoğanlarda kardiyak iletim sistemi etkilenmekte ve kalp blokları görülebilmektedir. Bu durumdan annenin dolaşımındaki anti-SS-A (Ro), anti- SS-B (La) antikorları sorumludur. Bu çalışmada hastanemizde bağ dokusu hastalığı olan annelerden doğan bebeklerin klinik özellikleri ve uzun dönem takip sonuçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Yenidoğan yoğun bakım ünitesinde Ocak 2001 ile Ocak 2016 arasında annelerinde SLE, SS veya bağ dokusu hastalığı tanısı olması nedeniyle yatırılarak izlenen hastalar geriye dönük olarak tarandı, demografik ve klinik özellikleri ile elektrokardiyografik bulguları kayıt edildi.Bulgular: Çalışmaya toplam 48 anneden 49 bebek alındı. Annelerin doğum sırasında ortalama yaşı 30,8±5,0 yıl (28-41), hastaların ortalama gestasyonel haftası 35,8±2,5 hafta (28-41), ortalama doğum ağırlığı ise 2614±680 gr (730-3810 gr) idi. On yenidoğanda (%20,4) 3. derece atrioventriküler (AV) blok, bir bebekte ise 1. derece AV blok tespit edildi. Beş hastaya yenidoğan döneminde kalıcı kalp pili takıldı, bu hastalardan ikisi yenidoğan döneminde yaşamını yitirdi. AV blok ile takip edilen bir hastaya ise 6. ayında kalp pili takıldı. Kardiyak iletim sorunu olmayan bir bebek ise prematüriteye bağlı nedenler ile yaşamını yitirdi. Yaşayan 46 bebeğin ortalama takip süresi 4,6±3,1 (1,2-10,75) yıl, bunlardan AV tam bloklu olup kalp pili takılmadan izlenen hastaların takip süresi 5,6±2 yıl idi.Sonuç: Yenidoğan döneminde görülen tam AV blok hızlı müdahale edilmesi gereken ciddi bir kardiyak problemdir. Bilinen bağ dokusu hastalığı olan anne adayları üçüncü basamak merkezlerde izlenmeli, fetüs yakın takip edilmelidir. Gereken yenidoğanlara kalp pili takılarak normal yaşamlarına dönmeleri mümkündür.

The coexistence of different mechanisms of arrhythmia and multiple accessory pathways (MAPs) leading to multiple ablation targets is rarely seen in children, and data regarding these patients in the literature are limited. Herein, we aimed to evaluate patients who required multiple ablation applications, focusing on different targets during the procedures in children, and evaluating the characteristics of coexistent arrhythmia and MAPs, and the results of these procedures in children. Ablation procedures conducted between March 2009 and December 2018 were evaluated retrospectively, and patients with MAPs and/or coexistent arrhythmia who had undergone ablation procedures were included in the study. Among the 1210 patients who underwent ablation procedures, 52 patients (26 male, 26 female) were ablated for multiple targets. Of the 456 patients with APs, 21 had MAPs (4.6%) and of the 1210 patients who underwent ablation procedures, 31 patients had coexistent arrhythmia (2.5%). The patients had a mean age of 12.24 ± 3.4 (4–18) years and mean body weight of 45.17 ± 14.12 (17–74) kg. A total of 110 APs or foci were identified as quaternary in one patient, while it was triple in four patients. The procedures were unsuccessful in six targets of six patients. Although recurrence was observed in four patients, none were ablated for MAPs. Two complications were encountered, comprising ST segment depression that developed in one patient with Wolf-Parkinson-White syndrome, atrioventricular nodal re-entry tachycardia, and a temporary atrioventricular block during atrioventricular nodal re-entrant tachycardia ablation. The overall success rate according to the pathway/foci number was 94.5% (104/110), with a recurrence rate of 4.5% (5/110), and a complication rate of 1.8% (2/110). The patient success, recurrence, and complication rates were 88.4% (46/52), 7.6% (4/52), and 3.8% (2/52), respectively. In conclusion, the incidence of multiple arrhythmogenic foci and MAPs were not as low as expected in children. A structured and stepwise approach is mandatory for the diagnosis of the different mechanisms of tachycardia, even after successful ablation procedures. The success, recurrence, and complication rates were comparable with those of patients who had a solitary arrhythmogenic focus or solitary AP.