Benhur Şirvan ÇETİN, Mustafa KIR, Nurettin ÜNAL, Tuncay KÜME, Nuh YILMAZ

Soldan sağa şantlı doğumsal kalp hastalıklı çocuklarda şant miktarı ile ''kardiyotrofin-1'' ilişkisi

Amaç: Çalışmamızda çocuklarda soldan sağa şantlı doğumsal kalp hastalıklarında serum kardiyotrofin-1 (CT-1) düzeyleri ile şant miktarının karşılıklı etkileşimlerini araştırmak, bu belirtecin intrakardiyak defekt tipine göre değişimlerini incelemek amaçlanmıştır. Gereç ve Yöntem: Çalışmamızda, 1 ay–13 yaşları arasında, 45 hasta ve 23 sağlıklı çocuk incelendi. Hasta grubu içinde 19 olguda atriyal septal defekt (ASD), 17 olguda ventriküler septal defekt (VSD), 6 olguda ASD ve VSD (ASD+VSD) ve 3 olguda patent duktus arteriyozus (PDA) mevcuttu. Tüm çocuklara konvansiyonel ekokardiyografi incelemesi (iki boyutlu, M-Mode, iki boyutlu Doppler ve renkli Doppler ekokardiyografileri) yapıldı. Tüm olgulardan ekokardiyografi çalışmaları ile eş zamanlı olarak plazma BNP düzeyleri kemilüminisans ve CT-1 düzeyleri de “enzyme-linked immunosorbent assay” (ELISA) yöntemleriyle ölçüldü. Bulgular: Hasta grubunda CT-1 ile şant miktarı arasında (p<0,02, r=0,35), ASD grubunda da CT-1 ile defekt çapı arasında pozitif korelasyon saptandı (p<0,05, r=0,49). Ayrıca, geniş VSD’li olgularda CT-1 düzeyi kontrole göre yüksekti (p<0,05). Soldan-sağa şant miktarı yüksek olan grupta (pulmoner kan akımı/sistemik kan akımı: Qp/Qs >2) CT-1 ile EF ve FS arasında negatif korelasyon bulundu (p<0,001, r=0,71). Sonuç: CT-1’in soldan sağa şantlı kalp hastalıkları grubunda yükselmiş olduğu bulundu. Bunun yanı sıra intrakardiyak şantı fazla, kalp yetersizliği riski yüksek olan grupta da CT-1’in şant miktarıyla korele olarak arttığı saptandı. Sonuç olarak CT-1, erişkinlerde olduğu gibi çocuklardaki kalp yetmezliğinin değerlendirilmesinde de kullanılmaya aday bir belirteçtir. Ancak, çocukluk çağında CT-1 ile kalp fonksiyonları arasındaki ilişkiyi ortaya koymak için daha fazla sayıda hastanın incelendiği prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Doğumsal kalp hastalıkları, kardiyotrofin-1, beyin natriuretik peptit

THE RELATIONSHIP BETWEEN LEFT TO RIGHT SHUNTING CONGENITAL HEART DISEASE AND CARDIOTROPHIN-1 IN CHILDREN

Objective: In our study, it was aimed to investigate the interaction of serum cardiotrophin-1 (CT-1) levels in left to right shunting congenital heart disease in children and to evaluate the change of this biomarker with intracardiac defect features.Material and Method: We investigated 45 patients and 23 healthy children between 1 months and 13 years of age in our study. In the patient group, we identified an atrial septal defect (ASD) in 19 cases, a ventricular septal defect (VSD) in 17 cases, an ASD and VSD (ASD+VSD) in 6 cases and a patent ductus arteriosus (PDA) in 3 cases. All children underwent a classical echocardiography (two-dimensional, M-Mode, two-dimensional Doppler and colour Doppler echocardiography). In all patients, plasma BNP levels were measured by chemiluminescence and CT-1 levels were estimated by enzyme-linked immunosorbent assay (ELISA) method, synchronously with echocardiographic studies. Results: A positive correlation was detected between CT-1 and the number of shunts (p<0.02, r=0.35) in patient group and between CT-1 and the defect diameter (p<0.05, r=0.49) in ASD group. Furthermore, the level of CT-1 was higher in cases with a wide VSD than in control group (p<0,05). There was a negative correlation between CT-1 and EF and SF in the group with a higher number of shunts (pulmonary blood flow / systemic blood flow: Qp / Qs> 2) (p<0.001, r=0.71). Conclusion: CT-1 has been found to increase in the group with left to right shunting heart disease. Furthermore, it was indicated that the increase in CT-1 was related to the number of shunts in the group having more intracardiac shunts and a higher risk of failure.

Keywords:

Congenital heart diseases, cardiotrophin-1, brain natriuretic peptide,

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