Romatizmal mitral yetmezlikli çocuklarda geleneksel ekokardiyografi ve doku Doppler görüntüleme ile sol ventrikül fonksiyonlarının değerlendirilmesi

Amaç: Romatizmal kardit tanısı ile izlenen mitral yetmezlikli çocuklarda sol ventrikül fonksiyonlarını geleneksel ekokardiyografi ve doku Doppler görüntü- leme yöntemiyle değerlendirip, sonuçları sağlıklı kontrol grubu ile karşılaştırmayı amaçladık. Gereç ve Yöntem: Pediatrik kardiyoloji kliniğimizde romatizmal kardit sonrası mitral yetmezlik tanısı ile izlenen 30 hasta ve 5-15 yaşları arasında 30 sağlıklı çocuk çalışmaya dahil edildi. Hasta grubu hafif-orta dereceli mitral yetmezlik ve ağır mitral yetmezlik olarak sınıflandırıldı. Tüm ekokardiyografik ölçümler ça- lışma grubunun klinik ve laboratuvar sonuçlarına kör olan uzman bir pediatrik kardiyolog tarafından yapıldı. Bulgular: Ağır mitral yetmezlikli hastalarda sol ventrikül diyastol sonu çapları kontrol grubuna göre anlamlı derecede artış gösterdi (4.62±0.82 cm, 3.92±0.39 cm; p=0.008). Yine sol ventrikül sistol sonu çaplarında ağır mitral yetmezlikli hastalarda kontrol grubuna göre anlamlı olarak artmış bulundu (2.81±0.51, 2.43±0.25, p=0.01). Ejeksiyon fraksiyonu ve fraksiyonel kısalma açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Doku Doppler görün- tüleme yöntemiyle ölçülen erken diyastolik pik miyokard hızı gruplar arasında istatistiksel olarak anlamlı farklılık göstermediği halde (p>0.05), atriyal pik sisto- lik hız, ağır mitral yetmezlikli hastalarda, hem kontrol hem de hafif-orta mitral yetmezlikli hastalara göre anlamlı derecede yüksek ölçüldü (sırasıyla p<0.001, p=0.001). Sonuç: Çalışmamızda, geleneksel ekokardiyografik ölçümlerle elde edilen sol ventrikül sistolik ve diyastolik fonksiyonları açısından kontrol grubu ile mitral yetmezlikli hasta grupları arasında istatistiksel olarak anlamlı bir farklılık bulunamamıştır. Buna rağmen mitral yetmezlikli hasta grubunda sol ventriküler fonksiyonlardaki subklinik bozulma doku Doppler görüntüleme yöntemiyle saptanmıştır.

Anahtar Kelimeler:

sol ventrikül fonksiyonları, mitral yetmezlik, doku Doppler görüntüleme

Evaluation of left ventricular functions by conventional echocardiography and tissue Doppler imaging in children with rheumatic valve disease

Aim: We aimed to evaluate left ventricular functions in children with mitral regurgitation (MR) who were followed up with the diagnosis rheumatic carditis, by using conventional echocardiography and tissue Doppler imaging (TDI) and compare the results with those of healthy control subjects. Materials and Methods: 30 patients who were followed up with the diagnosis of MR due to sequel of rheumatic carditis in our pediatric cardiology clinic and 30 healthy children aged between 5-15 years were included in the study. The patient group was categorized as mild-moderate MR (n: 20), and severe MR (n: 10). All echocardiographic and Doppler assessments were performed by a single expert pediatric cardiologist, who was blinded to the clinical and laboratory results of the study groupResults: LV end-diastolic diameters were significantly increased in patient with severe MR compared to controls (4.62 ±0.82cm, 3.92±0.39cm; p:0.008). Also LV end-systolic diameters were found significantly increased in patient with severe MR compared to controls (2.81±0.51, 2.43±0.25, p:0.01). There was no statistically significant difference between groups in terms of LV ejection fraction and fractional shortening (p>0.05). Although peak early diastolic myocardial velocity obtained with TDI did not show significantly difference between the groups (p>0.05), peak atrial systolic velocity measured from the lateral and septal annulus were significantly increased in patients with severe MR when compared with controls and patients with mild--modarete MR (p<0.001, p:0.001; respectively).Conclusion: In our study, LV systolic and diastolic functions obtained by conventional echocardiographic measurements, showed no significant difference between the controls and patients with MR. However, deterioration in subclinical LV systolic and diastolic function was detected by TDI the patient group with MR. Aim: We aimed to evaluate left ventricular functions in children with mitral regurgitation (MR) who were followed up with the diagnosis rheumatic carditis, by using conventional echocardiography and tissue Doppler imaging (TDI) and compare the results with those of healthy control subjects. Materials and Methods: 30 patients who were followed up with the diagnosis of MR due to sequel of rheumatic carditis in our pediatric cardiology clinic and 30 healthy children aged between 5-15 years were included in the study. The patient group was categorized as mild-moderate MR (n: 20), and severe MR (n: 10). All echocardiographic and Doppler assessments were performed by a single expert pediatric cardiologist, who was blinded to the clinical and laboratory results of the study groupResults: LV end-diastolic diameters were significantly increased in patient with severe MR compared to controls (4.62 ±0.82cm, 3.92±0.39cm; p:0.008). Also LV end-systolic diameters were found significantly increased in patient with severe MR compared to controls (2.81±0.51, 2.43±0.25, p:0.01). There was no statistically significant difference between groups in terms of LV ejection fraction and fractional shortening (p>0.05). Although peak early diastolic myocardial velocity obtained with TDI did not show significantly difference between the groups (p>0.05), peak atrial systolic velocity measured from the lateral and septal annulus were significantly increased in patients with severe MR when compared with controls and patients with mild--modarete MR (p<0.001, p:0.001; respectively).Conclusion: In our study, LV systolic and diastolic functions obtained by conventional echocardiographic measurements, showed no significant difference between the controls and patients with MR. However, deterioration in subclinical LV systolic and diastolic function was detected by TDI the patient group with MR.

Keywords:

Mitral regurgitation, left ventricular functions, tissue Doppler imaging,

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