İnfantil hemanjiom tanılı hastalarda propranonol tedavisi öncesi kardiyak değerlendirme

Amaç: Çalışmamızın amacı, infantile hemanjiom tanılı hastaların propronalol tedavisi öncesi kardiyak bulgularını değerlendirmek, bulgularımızı literatür verileriyle karşılaştırarak ayrıntılı kardiyak taramanın gerekliliğini tartışmaktır. Gereç ve Yöntem: Ekim 2021- Ekim 2022 tarihleri arasında, tek merkezde infantil hemanjiom tanısıyla propranolol tedavisi başlanan hastalar retrospektif olarak değerlendirildi. Tedavi öncesinde yapılan elektrokardiyografi ve ekokardiyografi sonuçlarının yanı sıra hastaların propranolol doz şeması, tedavi sırasında görülen semptomları, kalp hızı ve kan basıncını içeren fizik muayene bulguları geriye dönük olarak incelendi. Bulgular: Toplam 50 hastanın 30'u kadındı. Hastaların yaş ortalamaları 7,1±7,3 ay, kilo ortalamaları ise 7,6±3,0 kg idi. Elektrokardiyografik (EKG) değerlendirmede tedavi başlanmasına engel bir durum saptanmadı. Propranolol tedavisinin, kalp hızı ve sistolik kan basıncını istatistiksel anlamlı ölçüde azalttığı izlendi (başlangıç: 120,2±10,5 dk/89,6±17,6 mmHg; 1. hafta: 118,5±10,4 dk/88,7±17,5 mmHg; 2. hafta: 117,8±9,5 dk/88,7±17,3 mmHg; 2. ay: 116,5±9,4 dk/88,6±17,3 mmHg). Diyastolik kan basıncının ise ‘başlangıç-1. hafta’ ile ‘başlangıç- 2. ay’ karşılaştırmasında anlamlı olarak azaldığı izlendi (sırasıyla 58,9±15,6 ve 58,2±15,8 mmHg; 58,9±15,6 ve 57,9±15,5 mmHg). Sonuç: Propranolol tedavisi öncesi EKG ve hastane yatışının her hastada gerekli olmadığı yönündedir. Düşük yan etki profili göz önüne alındığında kılavuzların önerisi doğrultusunda hasta bazlı, öykü ve fizik muayenenin ön planda tutulduğu değerlendirme önerilmekte; elektrokardiyografi ve kan basıncı takibinin gerekliliği riskli hasta grubu için akılda tutulmalıdır.

Anahtar Kelimeler:

İnfantil hemanjiom, propranolol, kardiyak değerlendirme, EKG

Cardiac screening in patients with infantile hemangiomas before propranolol treatment

Purpose: The aim of this study is to evaluate the cardiac findings of patients with Infantile hemangiomas (IH) prior to propronalol treatment and to compare our findings with literature data and verify the need for detailed cardiac screening. Materials and Methods: We performed a single-center retrospective review of patients diagnosed with IH who underwent cardiac screening between October 2021 and October 2022. Charts were reviewed and symptoms, heart rate, blood pressure, electrocardiogram, and echocardiogram findings were recorded for each patient. Results: Of the 50 patients, 30 were female. The mean age and weight were 7.1±7.3 months and 7.6±3.0 kg. Electrocardiography screening did not reveal any contraindication for treatment. Propranolol significantly reduced heart rate and systolic blood pressure (baseline: 120.2±10.5 bpm/89.6±17.6 mmHg; 1st week: 118.5±10.4 bpm/88.7±17.5 mmHg; 2nd week: 117.8±9.5 bpm/88.7±17.3 mmHg; 2nd month: 116.5±9.4 bpm/88.6±17.3 mmHg). Diastolic pressure reduction was significant only between ‘baseline- 1st week and ‘baseline- 2nd month (58.9±15.6 vs 58.2±15.8 mmHg; 58.9±15.6 vs 57.9±15.5 mmHg, respectively). Conclusion: Screening electrocardiography and hospitalization for initiation of propranolol therapy is not necessary in most infants. Given the low frequency of complications, it seems medical history and physical examination are the cornerstones for safe initiation and monitoring of β-blocker treatment. Electrocardiography and BP control should be part of the pretreatment evaluation in high-risk patients.

Keywords:

Infantile hemangioma, propranolol, ECG,

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