The treatment for proximal aortic arch hypoplasia in paediatric patients is still controversial. While some authors favours direct tissue anastomosis, others state that patch augmentation may also be a good alternative. The aim of this study is to compare the results of arch reconstructions using bovine pericardium with the direct anastomosis technique.

Paediatric patients who underwent arch reconstruction via median sternotomy between 2019 and 2023 were evaluated. Patients were divided into two groups according to the repair method of arch reconstructions: direct native tissue anastomosis and bovine pericardial patch augmentation. Using perioperative data, the relationship between the surgical method and postoperative morbidity, in-hospital mortality, and the risks for early reintervention was investigated.

Between August 2019 and August 2023, 38 paediatric patients underwent arch reconstruction. The average age and weight of the patients were 40 days (15–157.5 days, interquartile) and 3.78 kg (3.2–6.0 kg, interquartile range), respectively. While completely native tissue anastomosis was applied in 18 of the patients (47.4%), bovine pericardial patch was used in arch reconstruction in 20 patients (52.6%). Cross-clamp time was found to be significantly longer in patients using bovine patches (p = .016). No difference was detected between the two surgical methods in terms of postoperative mortality and morbidity factors (p > .05). There was no significant difference between the two surgical procedures in terms of reintervention in the early period after discharge (p = .177).

Although early results of both reconstruction techniques may be promising, their reliability needs to be evaluated in detail with large-scale prospective studies.

Ebstein’s anomaly represents 40% of congenital tricuspid valve abnormalities. Studies about paediatric Ebstein’s anomaly patients are limited.

To evaluate clinical characteristics, treatment (medical/arrhythmia ablation/surgical) results, and outcome of Ebstein’s anomaly patients, and to determine factors affecting arrhythmia presence and mortality.

Clinical data, echocardiography, treatment results, and outcomes of patients followed in our centre between 2000 and 2017 were retrospectively evaluated.

A total of 79 patients (61 children, median diagnosis age: 1.5 years [1 day–24 years]) were included. Eight patients (10.1%) were deceased during the study period. Common associated anomalies were atrial septal defect/patent foramen ovale (56.9%), mitral regurgitation (25.3%), pulmonary stenosis/atresia (17.7%), and ventricular septal defect (16.5%). Genetic diseases/congenital anomalies were present in 5/3.8%. Tricuspid regurgitation was present in 75.9%, and severe in 50%. Arrhythmias were detected in 30.4%, and accessory pathway-mediated re-entrant tachycardia was the most common (67%). Wolff-Parkinson-White syndrome was present in 12.7%. Twenty-one ablation procedures (radiofrequency ablation [85.7%]/cryoablation [14.3%]) were performed in 16 patients (median age: 13.3 years [4.9–17]). Acute success/recurrence rates: 87.5/25%. Surgery was performed in 31.6% (median age: 6.5 years [4 days–29 years]), 7.6% were operated during the first month, and 12.6% during the first year. Second surgery was required in 28%. Perioperative mortality rate was 12%, and median mortality age was 25 days (1 day–17 years). Median follow-up period was 5.3 years (1 day–32 years). Older diagnosis age (p = 0.005) and mild-moderate mitral regurgitation (p = 0.036) were associated with arrhythmias. Younger age at diagnosis (p = 0.012), younger age at first surgery (p = 0.004), surgery before age three years (p = 0.037), and presence of pulmonary atresia (p = 0.000014) were associated with mortality. Gender, diagnosis age, congenital anomalies/genetic disorders, tricuspid regurgitation, arrhythmias, and surgery history did not have an independent effect on survival.

In children and young adults presenting with Ebstein’s anomaly, younger age at presentation and at surgery, surgery before age three years, pulmonary atresia were associated with death. Ablation procedures can be successfully performed but recurrence rate is still high.

This study assesses the operational challenges and clinical outcomes encountered by a university-based Emergency Medical Team (EMT) during the medical search and rescue (mSAR) response to the February 2023 earthquakes in Kahramanmaraş, Turkey.

In this observational study, data were retrospectively collected from 42 individuals who received mSAR services post-earthquake. The challenges were categorized as environmental, logistical, or medical, with detailed documentation of rescue times, patient demographics, injury types, and medical interventions.

In this mSAR study, 42 patients from 30 operations were analyzed and divided into environmental (26.2%), logistical (52.4%), and medical (21.4%) challenge groups. Median rescue times were 29 (IQR 28–30), 36.5 (IQR 33.75–77.75), and 30.5 (IQR 29.5–35.5) hours for each group, respectively (P = .002). Age distribution did not significantly differ across groups (P = .067). Hypothermia affected 18.2%, 45.5%, and 66.7% in the respective groups. Extremity injuries were most common in the medical group (88.9%). Intravenous access was highest in the medical group (88.9%), while splinting was more frequent in the medical (55.6%) and logistical (18.2%) groups. Hypothermia was most prevalent in the medical group (66.7%), followed by the logistical group (45.5%). Ambulance transport post-rescue was utilized for a minority in all groups.

The study concludes that logistical challenges, more than environmental or medical challenges, significantly prolong the duration of mSAR operations and exacerbate clinical outcomes like hypothermia, informing future enhancements in disaster response planning and execution.

The aim of this study is to investigate the frequency of fragmented QRS and its associations with clinical findings and prognosis in children diagnosed with dilated cardiomyopathy with or without left ventricular non-compaction.

This retrospective study was conducted between 2010 and 2020. Patients with dilated cardiomyopathy were classified into two groups according to the presence of left ventricular non-compaction: Dilated cardiomyopathy with left ventricular non-compaction and dilated cardiomyopathy without left ventricular non-compaction. Patients were also divided into two groups according to the presence of fragmented QRS (fragmented QRS group and non-fragmented QRS group).

Twenty-three of 44 patients (52.3%) were male. Among left ventricular non-compaction patients, the fragmented QRS group had more complex ventricular arrhythmias (p = 0.003). Patients with fragmented QRS had a significantly higher rate of major adverse cardiac events and/or cardiac death in both cardiomyopathy groups (p = 0.003 and p = 0.005). However, the rate of major adverse cardiac events and/or cardiac death was similar between dilated cardiomyopathy patients with and without left ventricular non-compaction. Multivariate logistic regression analysis showed that the presence of fragmented QRS strongly predicts major adverse cardiac events and/or cardiac death (odds ratio, 31.186; 95% confidence interval, 2.347–414.307). Although the survival rates between cardiomyopathy groups were similar, patients with fragmented QRS had a markedly lower survival rate during the follow-up period, as mean of 15 months (p = 0.001).

Our study showed that the presence of fragmented QRS may be an important ECG sign predicting an major adverse cardiac event and/or cardiac death in patients with dilated cardiomyopathy. We believe that recognising fragmented QRS could be valuable in forecasting patient prognosis and identifying high-risk patients who require additional support.

This study aimed to evaluate the cardiovascular manifestations and surveillance of multisystem inflammatory syndrome in children (MIS-C) and to determine the correlation of echocardiographic findings with cardiac magnetic resonance imaging findings.

Forty-four children diagnosed as MIS-C with cardiac involvement were enrolled in this observational descriptive study. The diagnosis of MIS-C was made according to the criteria of Centers for Disease Control and Prevention. Clinical findings, laboratory parameters, and electrocardiographic and echocardiographic findings at the time of diagnosis and during follow-up were evaluated. Cardiac magnetic resonance was performed on 28 (64%) cases. The 1-year follow-up imaging was performed in all cases with abnormal initial cardiac magnetic resonance findings.

Forty-four patients (56.8% male) with a mean age of 8.5 ± 4.8 years were enrolled in this study. There was a significant positive correlation between high-sensitivity cardiac troponin T (mean: 162 ± 444.4 pg/ml) and N-terminal pro b-type natriuretic peptide (mean: 10,054 ± 11,604 pg/ml) (p < 0.01). Number of cases with an electrocardiographic and echocardiographic abnormality was 34 (77%) and 31 (70%), respectively. Twelve cases (45%) had left ventricular systolic dysfunction and 14 (32%) cases had pericardial effusion on admission. Three cases (11%) had cardiac magnetic resonance findings that may be attributed to the presence of myocardial inflammation, and pericardial effusion was present in seven (25%) cases. Follow-up cardiac magnetic resonances of all cases were normal. Cardiac abnormalities were completely resolved in all except two cases.

Myocardial involvement can be seen during acute disease, but MIS-C generally does not lead to prominent damage during a year of surveillance. Cardiac magnetic resonance is a valuable tool to evaluate the degree of myocardial involvement in cases with MIS-C.

The aim of our study was to assess left and right ventricle systolic and diastolic functions in female adolescents with vitamin D deficiency using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotid intima media thickness and asymmetric dimethylarginine levels.

Sixty-six female adolescents were enrolled in this study. The female adolescents were divided into a vitamin D deficiency group (n: 34) and a control group (n: 32). All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulse, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness.

The vitamin D-deficient female adolescent group had normal left and right ventricle systolic and diastolic functions and normal global systolic and diastolic myocardial performance. In the patients with vitamin D deficiency, the carotid intima-media thickness was higher than that in the controls. In the patients within the vitamin D deficiency group, vitamin D was found to be positively correlated with magnesium and negatively correlated with phosphorus and left atrial dimension.

The results of this study demonstrate that vitamin D deficiency in female adolescence is associated with normal myocardial geometry and function. Although it has been associated with normal levels of asymmetric dimethyl arginine concentration, high measured carotid intima-media thickness may reflect endothelial dysfunction.

This study aims to determine and compare the effectiveness of Drop, Cover, and Hold On versus Fetal Position in the Triangle of Life regarding reducing casualties during earthquakes and establishing a consensus among medical search and rescue experts.

In this study, the data collected from ten experienced medical search and rescue professionals were analyzed using a three-stage Delphi technique to compare Drop, Cover, and Hold On versus Fetal Position in the Triangle of Life.

At the end of the first round of Delphi, all of the experts mentioned the following factors: age, position, and surface area of the injured person. A victim’s time under rubble and the experience of search and rescue teams are two prominent factors related to search and rescue. After the earthquake simulation in the second round, mannequin damage rates were examined by opening rubble pavement and tunnels. Following the second round of ratings, a third round of questionnaires was administered. As part of this questionnaire, participants were asked to give a score from one to ten based on their level of agreement. Whether they agreed or disagreed with Fetal Position in the Triangle of Life and Drop, Cover, and Hold On using a ten-point Likert scale, and the agreement rates were measured and compared. Experts completed a comparison of the two positions in the third round.

According to this expert consensus, the Fetal Position in the Triangle of Life has the following advantages over Drop, Cover, and Hold On: reduced surface area, less crush injuries, protection of a larger body part from injury, better protection from hypothermia, and better maintenance of basal metabolism.

We aimed to discuss our unit’s experience performing left ventriculotomies on children.

Between 2000 and 2022, we identified paediatric patients who required left ventriculotomy. Relevant information was gathered retrospectively.

There were eight patients who underwent surgical procedure including left ventriculotomy. The range of weight and age was between 4.5 and 50 kg and 5 months to 17 years, respectively. Left ventriculotomy was primarily performed for the excision of cardiac masses in all but one who had pseudoaneurysm repair. There were no deaths that occurred early or late. Pre-operative and post-operative ejection fractions and fractional shortening values were comparable. There was no arrhythmia detected post-operatively.

We conclude that an apical left ventriculotomy does not compromise the function of the left ventricle, even in young infants. In selected patients, it may be used safely for surgical access to the left ventricle.

This study examined the relationship between moral distress, individual and professional values in oncology nurses.

Employing structural equation modeling, a descriptive-correlational study was conducted among 116 oncology nurses. Data were collected using the Moral Distress Scale-Revised Adult Nurses, the Nursing Professional Values Scale, and the Values Scale.

The mean moral distress frequency was evaluated as low (1.6 ± 0.7) and the intensity as moderate (1.9 ± 0.8). Both the Nursing Professional Values Scale and Values Scale subdimension mean scores were at levels evaluated as high. There was no specific value that stood out from the others. Structural equation modeling analysis showed that individual values were found to have a direct and negative significant effect on moral distress intensity (β = −0.70, p < 0.01) and frequency (β = −0.58, p <0.01) and professional values had a direct positive and significant effect on moral distress intensity (β = 0.37, p < 0.05) and frequency (β = 0.25, p < 0.05).

It is believed that more national and international studies need to be conducted to examine the relationship between the moral distress concept and values. While individual values were found to have a direct and negative significant effect on moral distress, professional values had a direct positive and significant effect on moral distress.

Violence against women (VAW) is a major public health problem and a violation of women’s human rights. The coronavirus disease 2019 (COVID-19) pandemic has worsened gender inequality, resulting in a heightened incidence of VAW. This study aims to assess the characteristics of women who admit to the emergency department (ED), both before the pandemic and during the pandemic. The secondary aim is to compare the frequencies of violence cases between periods.

By single-center, retrospective, and cross-sectional design, the periods of April 10 - December 31, 2020 and April 10 - December 31, 2019 were compared. The outcomes of the study were the daily ED admission numbers of both sexes, the prevalence of VAW cases in the ED, as well as sociodemographic and clinical variables of the women who were exposed to violence.

During the pandemic period, number of VAW cases in the ED increased 13% and the ratio of VAW cases to all ED admissions tripled compared to the pre-pandemic period. Women exposed to VAW were more likely to be without social insurance, injured in the trunk part of their body, and having a life-threatening injury in the pandemic period. In both periods, women were attacked by an intimate partner, dominantly (42.6% and 54.1%, respectively). In addition, among all admissions of adults to the ED, women’s percentage decreased while men’s admission ratios increased during the pandemic period. Admissions to ED declined 47.7% during the COVID-19 pandemic compared to the year before.

Cases of VAW tend to increase during the pandemic, and health care settings should be well-organized to respond to survivors.

Health-care workers (HCWs) are often seen as the most reliable source of vaccine-related information for their patients; nevertheless, various studies show that HCWs experience vaccine hesitation. In this study, the aim was to determine the reasons for vaccine hesitation among HCWs working in a large public hospital and its affiliated units in Istanbul.

A descriptive method for collecting qualitative data was designed for this study. The data of the HCWs were analyzed in line with the vaccine hesitancy factors put forward by the World Health Organization (WHO).

The most important vaccine hesitancy theme that emerged was the fear and lack of confidence in the vaccines, which was expressed at a higher rate than any other theme in all HCWs. The most cited reason for fear/lack of confidence in the vaccine was the fear of its side effects. It was observed that the HCWs who reported hesitation about vaccination due to pregnancy and breastfeeding consisted of women. The second most common theme for vaccine hesitation was reported as an inconvenience in accessing the vaccines. Although HCWs have priority, they stated that their reason for vaccine hesitancy was due to heavy personal issues or workloads. The final theme was about complacency, or thinking they do not need the vaccine.

Vaccine hesitation is a challenge that can be overcome with detailed monitoring and policy-making. Although the vaccine seems to be more significant, we do not want to see vaccine hesitancy grow more than the vaccine itself.

We present our experience and outcomes with the BeGraft in the treatment of aortic coarctation in a predominantly paediatric population.

This study includes a retrospective analysis of patients who had Begraft aortic stent implantation between 2018 and 2020 from a single centre.

The BeGraft aortic stent was used in 11 patients (7 males, 4 females) with a median age of 14 (13–21) years and a median weight of 65 (46–103) kg. Coarctation was native in five patients and recurrent in six patients. Median stent diameter and length were 16 mm and 38 mm, respectively. The median peak-to-peak pressure was 30 (12–55) mmHg before the procedure and 5 (0–17) mmHg after the procedure. The stenting procedure was successful in 10 of the 11 patients. Stent migration to the abdominal aorta occurred on post-procedure day 1 in the 21-year-old patient, who had previously undergone surgical closure of the ventricular septal defect and balloon angioplasty for coarctation. After repositioning failed, the stent was safely fixed in the abdominal aorta. Strut distortion also occurred during balloon retrieval in one patient, but no aneurysm or in-stent restenosis was observed at 1-year follow-up. The patients were followed for a median of 14 (4–25) months and none required redilation.

Our initial results demonstrated that the BeGraft aortic stent effectively reduced the pressure gradient in selected native and recurrent cases. Despite advantages such as a smaller sheath and low profile, more experience and medium- to long-term results are needed.

Chronic kidney disease may lead to left ventricular dysfunction. Early detection of cardiovascular disease in children with chronic kidney disease is essential to prevent cardiovascular morbidity and mortality in early adulthood. This study aimed to document the dysfunction using methods such as two-dimensional speckle-tracking echocardiography in the early stage.

A total of 34 patients diagnosed with chronic kidney disease (mean age ± standard deviation, 10.5 ± 4.1 years) and 37 sex- and age-matched (mean age 9.8 ± 4.2 years) healthy controls were studied. The results of the two groups were compared along with those of the published studies.

The echocardiography measurements had no significant difference in the end-diastolic and end-systolic diameter values of left ventricular, ejection fraction, shortening fraction, mitral E value, mitral A value, and E/A ratio between the groups. Pulmonary artery systolic and diastolic pressure and left ventricular mass index were significantly higher in the patient group (p < 0.01). The longitudinal global strain values in the apical four-chamber, three-chamber, and two-chamber views and the total global strain values were significantly lower in the patients (p < 0.01). The circumferential global strain values in the apical, mid, basal, and total global strain were lower in the patient group, but this difference was statistically significant in the apical global and total global strain values (p < 0.05).

Speckle-tracking echocardiography might help identify subclinical left ventricular dysfunction in patients with chronic kidney disease with unremarkable conventional echocardiography.