Left ventricular systolic and diastolic functions in children with rheumatic mitral regurgitation

Bu çalışma romatizmal mitral yetmezliği olan hastaların sol ventrikül sistolik ve diastolik fonksiyonlarını değerlendirmek ve anjiotensin konverting enzim inhibitörü olan enapril tedavisine verdikleri yanıtı değerlendirmek amacıyla planlanmıştır. Yöntem: GÜTF Çocuk Kardiyolojisi Bilim dalında romatizmal mitral yetmezliği nedeniyle digoksin tedavisi alan ve klinik olarak asemptomatik olan 20 hastanın (ört yaş:14.0 ± 0.72 y) başlangıç ve enapril tedavisinin 20.günündeki sol ventrikül sistolik ve diastolik fonksiyonları ekokardiyografık kayıtlardan retrospektif olarak değerlendirilmiştir. Sonuçlar: Enapril tedavisinin ile sol ventrikül diastolik sonu (5.68^.1.19 vs 5.52-^.1.02 cm), sol ventrikül sistol sonu çapı (3.52-^0.98 vs 3.28-^1.04 cm), sol ventriküldiastolsonu volum (161.5±63.2vs 123.9±37.5 mi), sol ventrikül sistol sonu volum (58.8±33.4 vs 41.9-^.16.1 mi), kardiak output (9.08±1.18 vs 8.07±0.87 L/min/m2) düşme saptandı. Erken dolum hızı tepe değeri (1.49-^0.41 vs 1.45±0.57 m/sn), and deselerasyon zamanı (162..3±72.6 vs 156.4±63.l sn) ve izovolemik relaksasyon zamanı (75.4-^20.2 vs 65.16 m/sn) tedavi ile azalırken; A ve E süresi ,total diastolik zamanda uzama saptandı. Yorum: Sonuçlar enalapril tedavisinin ventrikülün ön ve art yükünü etkileyerek sistolik ve diastolik fonksiyonları düzelttiğini ve mitral yetmezlikli hastalarda yararlı olabileceğini göstermiştir.

Romatizmal mitral yetmezlikli hastaların sol ventrikül sistolik ve diastolik fonksiyonları

Purpose: This study was performed to determine the left ventricular systolic and diastolic functions and assess the effects of short-term angiotensin converting inhibition by enalapril in children with rheumatic mitral régurgitation. Methods: Twelve patients (mean age: 14.0 ± 0.72 years) receiving digoxin were evaluated by echocardiography for left ventricular systolic and diastolic functions followed by enalapril treatment for 20 days. Echocardiography was -epeated at the end of the treatment. Results: Left ventricular end-diastolic dimension (5.68±1.19 vs 5.52±1.02 cm), left ventricular end-systolic dimension (3.52±0.98 vs 3.28±1.04 cm), left ventricular end-diastolic volume (161.5^63.2 vs 123.9^.37.5 ml), left ventricular end-systolic volume (58.8±33.4 vs 41.9±16.1 ml), and cardiac output (9.08±1.18 vs 8.07±0.87 L/min/m2) were reduced. Peak early fitting velocity (1.49±0.41 vs 1.45^.0.57 m/sec), and deceleration time (162.3^72.6 vs 156.4^.63.1 sec) were decreased as well as isovolumic relaxation time (75.4±20.2 vs 65.16 m/sec), and A duration, E duration and total diastolic time were prolonged. Conclusion: These data show that enalapril can normalize systolic and diastolic functions by altering loading conditions and be beneficial for children with mitral régurgitation.

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1. Konstam MA, Rousseau MF, Kronenberg MW, Udelson JE, Melin J, Stewart D, Dolan N, Edens TR, Ahn S, Kinan D. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. Circulation 1992; 86: 431-438.
2. Levine HJ, Gaasch WH. Vasoactive drugs' in chronic regurgitant lesions of the mitral and aortic valves. J Am Coll Cardiol 1996; 28: 1083-1091.
3. Tischler MD, Rowan M, LeWinter MM. Effect of enalapril therapy on left ventricular mass and volumes in asymptomatic chronic, severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 1998; 82: 242-245.
Sahn DJ, DeMaria A, Kisslo J, Weyman A.Recommendations regarding quantitation in M-mode echocardiography:Results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072-1083.
Olguntürk R,Aydın B,Tunaoğlu FS,Akalın N.Rheumatic heart disease prevalence among schoolchildren in Ankara, Turkey. Turk J Pediatr 1999;41:201-206.
Shimoyama H, Sabbah HN, Rosman H, Kono T, Alam M,Goldstein S. Effects of long-term therapy with enalapril on severity of functional mitral regurgitation in dogs with moderate heart failure. J Am Coll Cardiol 1995; 25: 768-772.
Schon HR. Hemodynamic and morphologic changes after long-term angiotensin converting enzyme inhibition in patients with chronic valvular regurgitation. J Hypertens Suppl 1994; 12: S95-S104.
Calabro R, Pisacane C, Pacielo G,Russo MG.Hemodynamic effects of a single enalapril among children with asymptomatic chronic mitral regurgitation. Am Heart J 1999; 138: 955-961.