This study aimed to evaluate usefulness of real-time three-dimensional (four-dimensional) and three-dimensional speckle-tracking echocardiography in detecting cardiac involvement identified by cardiac magnetic resonance imaging in children with Duchenne muscular dystrophy. This cross-sectional study included 18 boys with a median age of 11.9 years (10.5–13.2 years). Left ventricular ejection fraction, global and regional myocardial strains were assessed using real-time three-dimensional echocardiography and three-dimensional speckle-tracking echocardiography as well as magnetic resonance imaging. Late gadolinium enhancement was evaluated by cardiac magnetic resonance imaging. Moderately positive correlations were found for ejection fraction (r = 0.669, p = 0.003), global longitudinal strain (r = 0.618, p = 0.008), global circumferential strain (r = 0.513, p = 0.035), and global radial strain (r = 0.605, p = 0.01) measured by three-dimensional speckle-tracking echocardiography and cardiac magnetic resonance imaging. In addition, longitudinal and circumferential strain values measured by three-dimensional speckle-tracking echocardiography showed correlations with cardiac magnetic resonance imaging in the same segment and/or adjacent segments in 13 of 16 regions , with correlation coefficients between 0.487 and 0.776 (p < 0.05). Radial strain values demostrated correlations in 25 regions, with correlation coefficients between 0.487 and 0.690 (p < 0.05). Real-time three-dimensional echocardiography and three-dimensional speckle-tracking echocardiography provided valuable information about left ventricular function as well as global and regional myocardial strain compared with magnetic resonance imaging in our patients with Duchenne muscular dystrophy. Further studies including larger patient populations and a broader range of disease severity are needed to confirm these findings.

AIM:Subclinical myocardial dysfunction may occur early in children and adolescents with type 1 diabetes mellitus (T1DM), despite preserved conventional cardiac function. However, the effect of insulin delivery modality on myocardial mechanics remains unclear. This study aimed to compare conventional echocardiographic and three-dimensional speckle-tracking echocardiographic (3D-STE) findings between pediatric patients receiving insulin pump therapy (IPT) and those receiving multiple daily insulin injections therapy (MDIIT). MATERIAL AND METHODS:In this cross-sectional study, 56 children and adolescents with T1DM receiving either IPT (n = 27) or MDIIT (n = 29) were enrolled. All participants underwent conventional echocardiography, tissue-Doppler imaging, three-dimensional echocardiography, and 3D-STE. Global and regional strain parameters derived from 3D-STE were analyzed and compared between treatment groups. RESULTS:The two groups were comparable with respect to age, sex, anthropometric characteristics, and glycated hemoglobin levels (all p > 0.05). Diabetes duration and treatment duration were significantly longer in the MDIIT group (p = 0.022 and p < 0.001, respectively). No significant differences were observed in left ventricular ejection fraction, indexed ventricular volumes, or global strain parameters (longitudinal, circumferential, and radial strain) (all p > 0.05). Several regional strain parameters differed between groups, with more favorable anteroseptal circumferential and radial strain values observed in patients receiving IPT (all p < 0.05). The E'/A' ratio was higher in the IPT group (p = 0.021). CONCLUSION:Children and adolescents with T1DM receiving IPT and MDIIT demonstrated comparable conventional echocardiographic and global 3D-STE findings. However, differences in several regional strain indices suggest the presence of subtle myocardial abnormalities in patients receiving MDIIT despite preserved global ventricular function. Further prospective studies are warranted to clarify the clinical significance of these findings.

OBJECTIVE:Congenital heart defects occur in approximately 50% of children with Down syndrome and they contribute considerably to morbidity and mortality. The aim of this study is to investigate the prevalence, classification, and survival of congenital heart defects in Down syndrome.MATERIALS AND METHODS:About 1731 Down syndrome patients who underwent echocardiography between 1986 and 2022 were evaluated. The median follow-up duration was 8.7 years (range 1-35.8 years). Congenital heart defect was grouped as cyanotic and acyanotic.RESULTS:Among the 1731 patients, 52.1% had congenital heart defects. Congenital heart defect was significantly more common in females than males. The most common cardiac defect was ventricular septal defect (35%), followed by atrial septal defect (31.8%), atrioventricular septal defect (23.4%), tetralogy of Fallot (5%), and patent ductus arteriosus (3.6%). In the follow-up, 43.2% of atrial septal defect, 17.8% of ventricular septal defect, and a total of 20% of congenital heart defects were closed spontaneously. About 34.4% of congenital heart defect was corrected by cardiac surgery/intervention. Five-year survival rate was 97.4% in patients without congenital heart defects, whereas it was 95.6% in mild congenital heart defects and 86.1% in moderate to severe congenital heart defects. There was no relationship between consanguinity, parental age, maternal disease, folic acid supplementation before/during pregnancy, gestational age, birth weight, and congenital heart defects. Neuromotor development was similar in patients with and without congenital heart defects.CONCLUSION:We demonstrated that almost half of the patients had congenital heart defects; ventricular septal defect was the most common congenital heart defect type. This study is valuable in terms of the largest single-center study describing the classification, prognostic factors, and survival of Down syndrome patients with congenital heart defect from Turkey.

AbstractAim:This study aimed to evaluate the role of real-time three-dimensional (known as four-dimensional) echocardiography and three-dimensional speckle-tracking echocardiography for the early detection of left ventricular systolic dysfunction in asymptomatic children with type 1 diabetes mellitus.Materials and method:This cross-sectional study included 38 patients (mean age 15.4 ± 2.9, 42.1% male) and 38 age, gender, and body measurements matched healthy children. Each patient underwent an interview about medical history, a detailed clinical examination, blood laboratory tests, conventional echocardiography, and tissue Doppler imaging. Left ventricular ejection fraction; global longitudinal, circumferential, radial strain; twist; and torsion were measured by real-time three-dimensional and speckle-tracking echocardiography.Results:Conventional echocardiography and tissue Doppler imaging showed normal left ventricular systolic function in the patients. Although left ventricular ejection fraction (61.6 ± 1.4%, 61.8 ± 1.1%, p = 0.386), global longitudinal [−26.6 (−27.7 to −26.1)%, −26.2 (−27.7 to −24.9)%, p = 0.224], and radial strain [44.4 (42.4–45.9)%, 43.9 (41–46.1)%, p = 0.513] were similar to the controls, circumferential strain (−27.3 ± 1.3%, −28.0 ± 1.6%, p = 0.048) and twist (9.5 ± 2.3°, 11.4 ± 3.0°, p = 0.003) were decreased in the patients compared with controls.Conclusion:We found that even in children with asymptomatic type 1 diabetes mellitus with normal left ventricular ejection fraction, circumferential function was impaired and rotation pattern was changed. This novel echocardiographic method might be an important tool for detecting left ventricular systolic dysfunction in type 1 diabetes mellitus children before it becomes overt on conventional echocardiography and tissue Doppler imaging.

AIM:Beta-thalassemia major requires regular blood transfusions throughout life, which in turn leads to iron accumulation in the body. While cardiac T2* MRI is the gold standard in determining cardiac iron accumulation, it is not always feasible, which has led to the search for new biomarkers. Herein, the value of growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide in predicting cardiac iron accumulation is investigated in asymptomatic children with beta-thalassemia major.MATERIALS AND METHOD:Forty-one patients aged 11-21 years and 41 age-, gender-, body mass index-matched healthy controls were included. Serum growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide levels were compared between the patients and controls. Additionally, the relations of these biomarkers with cardiac and liver T2 * MRI were investigated in the patients.RESULTS:In the patients, growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide levels were higher than healthy controls (p < 0.001, p = 0.025, p < 0.001, respectively). There were no significant correlations of growth differentiation factor-15 and N-terminal pro-B-type natriuretic peptide levels with both cardiac and liver T2 * MRI measurements. While there was no significant correlation of serum galectin-3 with cardiac T2 * MRI measurements, a negative correlation was found with liver T2 * MRI measurements (p = 0.040, rho = -0.325).CONCLUSION:All three biomarkers investigated in this study failed to predict myocardial iron accumulation in asymptomatic children with beta-thalassemia major. However, a weak relation between serum galectin-3 level and hepatic iron accumulation was demonstrated.

Günümüzde insanlık hiç beklemediği bir durumla karşılaştı. Her şey istediğimiz şekilde gitmese de en azından bugün gelinen süreç kadar birdenbire hayatımızın hızını kesen, yavaşlatan bir olgu ile karşılaşmamıştık. Küresel bir tehdit haline dönüşen ve dünyayı kasıp kavuran küresel salgından (Covid19) bahsediyoruz. Covid-19 salgını tüm dünyayı etkileyen küresel bir tehdittir. Covid-19’dan önce dünya yine birtakım küresel tehditlerle mücadele ediyordu. Ancak hiçbiri Covid-19 kadar insanlığı etkilemedi. Bu küresel salgın günümüz insanı için tek yönlü bir etkiye sahip değildi. Covid-19 dünyayı pek çok yönden etkilemiştir. Covid-19’un toplum üzerinde fizyolojik, psikolojik, sosyolojik, ekonomik ve siyasal etkilerinin var olduğu görülmektedir. Covid-19 nedeniyle insanlar, sağlığını, işini ve yakınlarını kaybetme endişesini yaşamışlardır. Covid-19 nedeniyle dışarı çıkma yasakları ve karantina süreçleri insanları çok yormuştur. Bu gibi durumlar insanlarda anksiyeteye, strese, kaygıya ve depresyona yol açmıştır. Bütün bunlar insanın mutsuz olmasına neden olmuştur. Bu çalışma, var olan ve hâlâ devam etmekte olan bu olguyu yani koronavirüs salgını karşısında değişen hayatımızı konu etmeyi amaçlar. Çalışma bu fenomene uyum sağlamayıp sağlayamama durumunu tartışma konusu olarak ele almaktadır. Bu konuyu ele alırken de eudaimonist/mutlulukçu etik düşüncesi temel alınmıştır. Çalışma salgınla birlikte yaşamayı ve buna bağlı olarak mutlu olmanın imkânı olup olmadığını sorgulamayı hedeflemektedir. Sonuç olarak küresel salgının geçici bir durum olduğu düşünülürse mutlu olmak mümkündür.

AIM:This study aimed to evaluate the role of real-time three-dimensional (four-dimensional) and speckle tracking echocardiography for early detection of left ventricular systolic dysfunction and also for the relationship between myocardial deformation parameters and myocardial iron load which is measured by cardiac magnetic resonance relaxation time T2* values in asymptomatic children with beta-thalassemia major.MATERIAL AND METHODS:This multicenter cross-sectional study included 40 patients (mean age 15.4 ± 2.9, 42.1% male) and 40 healthy children whose age, gender, and body mass index-matched with patients. Each participant underwent conventional echocardiography and tissue Doppler imaging. Left ventricular ejection fraction; global longitudinal, circumferential, radial strains; twist; and torsion were measured by real-time three-dimensional and speckle tracking echocardiography. Cardiac magnetic resonance imaging T2* was measured in patients.RESULTS:Left ventricular global longitudinal, circumferential, and radial strains were decreased despite preserved global ventricular function in patients compared to healthy children (p = p = .029, p = p &lt; .001, p = .003, respectively). There were no statistically significant differences between patients with T2* ≥ 20 ms and patients with T2* &lt; 20 ms for all echocardiographic parameters. Also, there were no significant correlations between all echocardiographic parameters and T2* values in all patients, those with T2* ≥ 20 ms, and T2* &lt; 20 ms.CONCLUSION:We found that even in asymptomatic children with beta-thalassemia major, left ventricular longitudinal, circumferential and, radial functions were impaired by real-time three-dimensional (four-dimensional) and speckle tracking echocardiography. This novel echocardiographic method might be an important tool for detecting subclinical left ventricular systolic dysfunction irrespective of T2* values.

OBJECTIVE:Transcatheter secundum type atrial septal defect closure is an alternative to surgical closure in many cases when conditions are appropriate. In this study, the demographic data and follow-up results of patients with secundum atrial septal defect undergoing transcatheter closure were discussed.MATERIALS AND METHODS:Data of patients who underwent transcatheter closure of secundum atrial septal defect between 2004 and 2017 were investigated retrospectively. Gender, age at intervention, defect size, procedure duration, fluoroscopy time, periprocedural complications, residual shunt existence, and early and mid-term follow-up results were collected.RESULTS:A total of 179 patients [41% males; 10% adults, median age: 8.1 years (1.3-58.6); weight: 28 kg (11-90)] were admitted to catheterization for atrial septal defect closure and their median atrial septal defect size was 13 mm (6-30); 74 (41%) patients had a large atrial septal defect (≥12 mm). Suitable defects for closure were observed in 165 of 179 patients. The procedural success rate was 95.7%. No death was observed; however, minor complications occurred in 3 patients during the procedure (1.6%). The rate of residual shunt after 1 year was 1.3%, and all shunts were mild. After a median follow-up of 2.8 years (range, 6 months to 13.6 years), delayed major complications such as death, cardiac erosion, and infective endocarditis were not experienced. The delayed minor complication was supraventricular extrasystole in 1 patient.CONCLUSION:Transcatheter atrial septal defect closure is safe in children and adults with a minimal rate of periprocedural and delayed complications. It has a favorable early and mid-term outcome in our study, especially with no death or major complications.

AbstractAim:The left and right ventricular dysfunction are important clinical course indicators in patients with repaired tetralogy of Fallot. This study aimed to evaluate ventricular volumes, functions, and myocardial deformation in children with repaired tetralogy of Fallot by real-time three-dimensional (four-dimensional) echocardiography and compared with healthy children. It also aimed to investigate the relationships between ventricular volumes, functions, and myocardial deformation parameters in the patients.Materials and methods:In this cross-sectional study, 35 patients (mean age 15.1 ± 2.8 years, 54% male) and 35 healthy controls of similar age, gender, and body measurements underwent echocardiography. End-diastolic volume index, end-systolic volume index, and ejection fractions of both ventricles; global longitudinal, circumferential, radial strain, twist, and torsion of the left ventricle; the longitudinal strain of the right ventricle free wall and septum were measured.Results:Left ventricular ejection fraction, global circumferential and radial strain, twist and torsion were significantly lower in patients compared with controls. Left ventricular ejection fraction correlated with global circumferential (r = −0.446, p < 0.001) and radial strain (r = −0.433, p < 0.001) in the patients. Right ventricular volumes were significantly higher, and ejection fraction was significantly lower in patients compared with controls. All right ventricular parameters correlated with each other in the patients.Conclusion:Left ventricular contraction pattern was changed, circumferential and radial fibres were most affected in the patients. Right ventricular dilatation and dysfunction were detected, and right ventricular ejection fraction correlated well with strain measurements of the right ventricle.

AIM:Growth differentiation factor-15 is a novel biomarker of increasing importance in cardiovascular diseases. This study aimed to evaluate the relationship between ventricular measurements assessed by cardiac magnetic resonance imaging (MRI) and serum growth differentiation factor-15 levels in children with surgically corrected tetralogy of Fallot.MATERIALS AND METHOD:Serum growth differentiation factor-15 levels were measured in 40 patients (mean age: 15.2 ± 2.9 years; 52.5% male; 87.5% NYHA I). End-diastolic volume index, end-systolic volume index, and ejection fractions of both ventricles and pulmonary regurgitation fraction were measured on cardiac MRI. The correlation between growth differentiation factor-15 levels and cardiac MRI parameters of the patients was investigated. Also, growth differentiation factor-15 levels of the patients were compared with healthy controls since reference values have not been determined in children.RESULTS:The mean growth differentiation factor-15 level was 254.9 ± 6.3 pg/ml in the patient group. There was no correlation between growth differentiation factor-15 levels and cardiac MRI parameters in patients. Also, there was no significant difference in growth differentiation factor-15 levels between the patients and control groups.CONCLUSION:The serum levels of growth differentiation factor-15 were uncorrelated with ventricular size, function, and pulmonary regurgitation fraction assessed by cardiac MRI in children with operated tetralogy of Fallot. Moreover, growth differentiation factor-15 levels were not different in these patients from healthy children.

535 Wilms tumor (WT) is the most common kidney origin tumor in children. The tumor can cause thrombosis that may progress to the renal vein, vena cava inferior (VCI), and right atrium.1,2 VCI thrombus is seen with a rate of 4-10%, and right atrium thrombus is observed with a rate of 1% among cases with Wilms tumor.3 Vena cava inferior thrombus with WT is usually asymptomatic. Venous flow continues, considering there is usually a thrombus in the lumen. Although venous flow is slow, coagulum formation is rare. Therefore these patients do not need to use anticoagulation.2,4-6 We aimed to share a patient with VCI and right atrium thrombus who regressed with neoadjuvant chemotherapy, and we did not use anticoagulants despite severe thrombus.

تُغاير سلطة الحديث الآحاد لدى أهل الرأي ما عليه المحدثون في نقاط معينة، وقد نوقشت هذه المسألة كثيراً، ويهدف هذا البحث إلى دراسة تطور منهج نقد الحديث عند الأحناف، وفيما إذا انتقلت إليه بعض مزايا منهج المحدثين، ويفترض أنه مع استقرار نظام الإسناد انتقلت بعض ملامح منهج المحدثين في التعامل مع الحديث إلى أهل الرأي، وعليه فإن هناك فرقا بين منهج الحنفية المتقدمين وبين المتأخرين في نقد الحديث وعملهم به. وقد اختار البحث مسألة الجمع بين الصلاتين في السفر لتكون أنموذجا للدراسة، إذ إنها من المسائل الخلافية بين العلماء بسبب الأحاديث المتعارضة فيها، وبسبب مخالفتها دلالة العام من الآيات. وقد اختار البحث مجموعة من الكتب المتخصصة بإيراد المسائل الحديثية على منهج أهل الرأي كمجال للدراسة، ثم تتبع ما طرأ فيها من تغيرات عبر العصور في مسألة سلطة الحديث والتأثر بمنهج المحدثين فيه، وخلص إلى إثبات الفرضية المذكورة. توقف البحث عند أسباب هذا التأثير وأرجعها إلى عدة أمور، منها استقرار علوم الحديث ونظام الإسناد، واتساع العلوم التي تخدمها كعلوم العلل والتاريخ والرجال والجرح والتعديل، وأيضا علُو شأن الحديث الصحيح واشتهار القول بأن أحاديث الصحيحين تفيد العلم أو القطع النظري، بما جعل من العدول عن العمل بهذه الأحاديث شأنا صعبا على متأخري الحنفية ومستنكَرا عليهم. يضاف إلى ذلك أنَّ الحنفية المتأخرين لم يُعنَوا كثيرا بمزيد تأصيل لحجية الخبر الآحاد والتوقف عند مراتبه التي بيَّنها المحدثون، وخصوصا التمييز بين الحديث الصحيح المروي في الصحاح وغيره في هذا السياق، واكتفوا بالتعامل معها كلها على أنها من الأحاديث الآحاد الظنية، التي لا يمكن أن تعارض القطعي المتمثل بالقرآن الكريم، والسنن المشتهرة والإجماع والقواعد الكلية. ولم يشتغلوا على بيان مذهبهم وحججه أمام نظام الإسناد. ولكن في المقابل يمكن لنا القول بأن التأثير الذي حصل بين الحنفية والمحدثين كان تأثيرا متبادلا، فكما أن الحنفية تأثروا باستقرار نظام الإسناد، فإن المحدثين أيضا تأثروا بمنهج الحنفية في تقديم رواية الراوي الفقيه على غيره عند التعارض، وفي بعض ملابسات التفرد التي ناقشها الحنفية في مسألة عموم البلوى وأمثالها.

Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by lipoatrophy affecting the face, limbs and trunk, acromegaloid features, hepatomegaly, hypertriglyceridemia, and insulin resistance. The aim of this study is to evaluate the long-term follow-up findings including gastrointestinal and cardiac manifestations of the patients with CGL1 and CGL4, caused by mutations in the AGPAT2 and CAVIN1 genes, respectively. Two patients aged 2 and 9 years with the same biallelic CAVIN1 mutation and five patients aged between 6 months and 11 years 4 months with AGPAT2 mutations have been followed up for 3-9 years. The patients were between 7 and 20 years of age at their last examination. One of the two patients with CGL4 had congenital pyloric stenosis. The other patient with CGL4 have developed recurrent duodenal perforations which have not been reported in CGL patients previously. The pathological examination of duodenal specimens revealed increased subserosal fibrous tissue and absent submucosal adipose tissue. None of the five CGL1 patients had gastrointestinal problems. Two patients with CGL4 developed hypertrophic cardiomyopathy (HCMP) and severe cardiac arrhythmia, only one patient with CGL1 had HCMP. Hyperinsulinemia was detected in one patient with CGL4 and three patients with CGL1, these three CGL1 patients also had acanthosis nigricans. Hepatic steatosis was detected in one patient with CGL4 and two patients with CGL1 by ultrasonography. In conclusion, these findings suggest that CGL4 patients should also be carefully followed up for gastrointestinal and cardiac manifestations.

Introduction Supravalvular aortic stenosis (SVAS) is the congenital stenosis of the ascending aorta, which may be discrete or diffuse. It can be seen in children with no other underlying disease, especially in syndromic cases such as Williams syndrome. Supravalvular aortic stenosis is also seen as an autosomal dominant type of familial and sporadic cases. In this study, long-term and postoperative follow-up results of patients who were followed up between 1990 and 2017 were presented. Materials and methods The study included 31 patients who were evaluated and followed with echocardiography at our institution between 1990 and 2017 with SVAS. Results Twelve of the cases were female (39%). Twenty patients were diagnosed with Williams syndrome. Thirty patients remained after exclusion of one case who was lost during cardiac catheterization, were followed for an average of 6.7 ± 5.8 years. The severity of SVAS detected in the first echocardiographic examination was very mild in 6 cases (19%), mild in 8 cases (26%), moderate in 5 cases (16%) and severe in 12 cases (39%). Six patients with severe SVAS were operated after the first echocardiographic examination. Right ventricular outflow tract stenosis was detected in the first examination in 6 cases and appeared in the third year of follow-up in one case. The mean right ventricular outflow tract obstruction gradient was 46.4 ± 18.5 mmHg on Doppler examination. According to the recent echocardiographic examination, the distribution of the degree of SVAS; Six patients (19.3%) were very mild, 5 (16%) were mild, 6 (19%) were moderate, and 12 (38.7%) were severe. SVAS progressed from very mild to mild in one patient, mild to moderate in 3 patients and moderate to severe in 3 patients. On the other hand, in 2 cases with severe SVAS were decreased during follow-up. Right ventricular outflow tract stenosis was lost in four cases and there was no change in three cases. Peripheral pulmonary stenosis (PPS) was present in 14 patients and PPS progressed in 2 patients, remained same in 7 cases and regressed in 5 cases. In the first examination, 21 of the cases had no aortic regurgitation; one patient had very mild, 5 had mild, and 5 had moderate aortic regurgitation gradually. Fourteen patients did not develop aortic regurgitation up to last examination. Conclusion SVAS is a rare cause of left ventricular outflow tract obstruction requiring echocardiographic close follow-up

Corresponding Author / Sorumlu Yazar: Ayşe Güler Eroğlu E-mail / E-posta: ageroglu@gmail.com ©Copyright 2019 by Turkish Pediatric Association Available online at www.turkpediatriarsivi.com ©Telif Hakkı 2019 Türk Pediatri Kurumu Dernegi Makale metnine www.turkpediatriarsivi.com web adresinden ulasılabilir. DOI: 10.14744/TurkPediatriArs.2019.03764 OPEN ACCESS This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Malnutrition may lead to cardiovascular diseases such as cardiomyopathy, heart failure, cardiac arrhythmia, and in some cases sudden death during childhood (1–4). In addition, it also has effects on many systems, mainly the immune system. Malnutrition affects cardiovascular health both in childhood and adulthood and may lead to coronary artery disease, hypertension, and diabetes mellitus.

Introduction Subaortic stenosis(SAS) accounts for 8–30% of patients with congenital left ventricular outflow tract obstructions. Allthough progressive SAS occurs in many patients, the exact etiology and factors contributing to progression remains unknown. In this study, we evaluated the natural course of SAS, associated aortic regurgitation (AR), the factors affecting the progression of SAS and AR and the outcomes of surgery during the long-term follow-up with echocardiography. Materials and Methods The study included 105 patients who were evaluated and followed with echocardiography at our institution between 1990 and 2017 with SAS, consisting of either a thin ridge or a thicker but discrete obstruction with a muscular base. Patients with incomplete medical records, abnormal ventricular function, and lesions other than AR were excluded. The last examination prior to any surgical intervention provided our final measurements. The level of narrowing of the LVOT, the distance between right coronary cusp and ridge and the anulus of the aortic valve were determined with two-dimensional echocardiography. Continuous-wave Doppler was used through an apical five-chamber view to record the maximum peak and mean systolic instantaneous gradient across the supravalvular narrowing. A multivariate analysis with Cox proportional hazards modeling was performed to adjust for the different distributions of variables between groups. The enter method was used in logistic regression analysis. Results Among 105 patients (median, 5 years at initial echocardiography), 64% were male and 36% were female. The patients were followed median 6.6 years. Aortic valve morphology was tricuspit in 95.2% and bicuspid in 4.8%. The median distance of discret membran from the right coronary cusp was 6.4 mm. The degree of SAS staid the same in 60%, progressed in 29% and 11% underwent surgery after initial echocardiography. AR did not develope in 21(20%), not deteriorate in 41(39%) and progressed in 43(41%) patients. Surgery was performed in 38(63.8%) patients. 6(5.7%) patients underwent reoperation. Conclussion We recommend careful and frequent evaluation for patients with moderate stenosis because surgery may be needed depending on the severity of stenosis and AR. Postoperatively, follow-up is required.

As an ethical theorist in the history of ethics, Immanuel Kant has attracted attention.This study aims to express that the ethics of Kant is based on the ethics of professional ethics is necessary in the professional life of a theologian.The main reason for this study is the difficulties I encountered in giving the ethics courses to the students of theology.Some of the students think that it is unnecessary to take this course.Another reason for this study is that there are more professional ethics studies in the fields of business, medical engineering, law, environment and the press.However, in the field of theology, it is seen that such studies are not much.With the help of this study it is aimed to contribute to the field.The importance of the situation arises when we consider that not only the theologians, but all the professions should comply with the principles of professional ethics.But above all, it is even more important for the theologian who has an important place in society to adhere to the ethical principles.For this reason, in the words of Kant, the individual will be able to realize the profession by taking the law from himself and if he can realize the ethical principles with a duty consciousness, many problems in the society will be prevented.The main hypothesis of the study is the claim that a professional ethic can be created from Kant ethics.The study will be developed in such an ethical effort.In this study, the ethical concepts and ethical understanding of Kant is based on a transcendental, discursive and analytic method to create a professional ethics of theology.According to the results of the study, it has been revealed that Kant's ethics and professional ethics can be formed and within this framework several professional ethical principles have been established.

Aim Left atrioventricular (AV) valve regurgitation is the most serious residual lesion after surgical correction of atrioventricular septal defect (AVSD). Despite improvements in surgical techniques, left AV valve regurgitation continues to be the most serious problem after surgery. In this study, it was aimed to investigate the risk factors of the left AV valve regurgitation by evaluating clinical and echocardiographic findings of patients with AVSD, retrospectively. Material and methods In this study, 78 patients were enrolled. Preoperative echocardiographic findings, operation data, postoperative echocardiography findings were recorded. Results Fifteen patients (19%) were partial, 26 patients (33%) were intermediate and 37 patients (47%) were complete type. Forty-seven patients (60.3%) were female and 25 patients (32%) had Down’s syndrome. The median age at diagnosis was 6 months ranged from one day to 12 years. The median age at operation was 10 months (3–180 months) and the median weight at operation was 6.8 kg (4–49 kg). The total follow-up was a median of 103 months (28 days-268 months). In patients with partial AVSD, there was no significant difference in left AV valve regurgitation in the first, postoperative and last echocardiography (p> 0.05). In patients with intermediate and complete AVSD, left AV valve regurgitation was higher in the final echocardiography than in the first echocardiography (p = 0.007 and p = 0.01, respectively). According to the univariate analysis; age, gender, the presence of Down syndrome, operation type, annuloplasty, and pulmonary hypertension were not associated with moderate or severe left AV regurgitation after surgical repair (p> 0.05). Left AV valve regurgitation in the first echocardiographic examination was found to be the only predictor of left AV valve regurgitation in the last echocardiographic examination (p=0.001). There was only one patient who was reoperated for severe left AV valve regurgitation. Conclusion The most important postoperative problem in patients with AVSD is left AV valve regurgitation. Left AV valve regurgitation in the first echocardiographic examination was found as a potential risk factor on left AV valve regurgitation.

Yenidogan bebekler yasama gozlerini actiklari anda cok sayida agrili girisimle karsilasirlar. Yenidogan yogun bakim unitesinde yasama baslayan bebeklerde ise agrili islemlerle karsilasma durumu kacinilmazdir. Bu donemde agri etkin sekilde tedavi edilmezse bebeklerde davranissal ve norolojik sorunlar ortaya cikabilir. Bu nedenle yenidoganlarin agri durumunun degerlendirilmesi ve yenidogan bakiminda rol alan tum saglik ekibi uyelerinin agri yonetimi konusunda bilgi, beceri ve deneyim sahibi olmalari gerekli ve onemlidir. Agriya sozel yanit veremese de yenidoganlar fizyolojik, davranissal, hormonal ve metabolik degisiklikler gostererek yasadiklari agriyi ifade ederler. Bu degisikliklerin gozlenmesi ve yorumlanmasina dayanan agri skorlama yontemleri ile agrinin derecesi degerlendirilebilir. Agri yanitinin uygun agri skalasi kullanilarak degerlendirilmesi tedaviyi yonlendirir. Yenidogan bebeklerde agri tedavisinin farmakolojik ve nonfarmakolojik olmak uzere iki sekli vardir. Bu yontemler birlikte ya da tek olarak kullanilabilir. Ancak tedavide en onemli nokta agrili uyarilarin mumkun oldugunca azaltilmasi ve ortadan kaldirilmasidir. Bu makalede amac; Yenidogan bakiminda rol alan saglik ekibi uyelerinde, yenidoganlarin agri duyusunun varligi ve tedavi gereksinimleri konusunda farkindalik yaratmak, etkin agri tedavisi icin kullanilacak yontemleri guncel literatur dogrultusunda aciklamaktir.