Ahmet KARAKURT, Lokman SOYORAL, Yüksel KAYA, Nihat SÖYLEMEZ, Edip GÖNÜLLÜ, Mahmut ÖZDEMİR, Bahattin BALCI, Ahmet GÜLER, Tolga Sinan GÜVENÇ, Yemlihan CEYLAN, Nesim ALADAĞ

Atrial septal defektli hastalarda perkütan kapama öncesi ve sonrası yüzey ekg’de p dalga dispersiyonu

Amaç: Atrial septal defekt (ASD) erişkin yaş grubunda tanı konan konjenital kalp hastalıklarının en sık görülenlerin- den biridir. ASD’lerin perkütan kapatılması bu defektlerin tedavisinde önemli gelişmeler sağlamıştır. Elektrokardi- yografik bulgular ASD’lerin anatomik lokalizasyonlarına göre farklılıklar sergileyebilir. Bu çalışmanın amacı ASD’li hastalarda, perkütan kapama öncesi ve sonrası yüzey elektrokardiyografide P dalga dispersiyonu değerlerinde deği- şiklik olup olmadığını araştırmaktır. Yöntem ve Gereçler: ASD’leri perkütan yolla kapatılan 48 hastanın, perkütan kapatılma öncesi ve sonrası ikinci ay- daki maksimum p-dalgası süresi (Pmaks), minimum p-dalgası süresi (Pmin) ve P dalga dispersiyon süresi (Pdis) in- celenmiştir. Bulgular: ASD hastalarında Pmaks, Pmin ve Pdis süreleri perkütan kapama öncesi sırası ile ortalama 97,29±20,50 msn, 53,96±11,25 msn ve 43,33±21,96 msn iken; işlem sonrası 97,71±17,29 msn, 51,04±12,76 msn ve 46,67±17,05 msn idi. Kapatma öncesi Pmaks, Pmin veya Pdis değerleri kontrol grubu ile istatistiksel olarak anlamlı farklılık gös- termemiştir. Pmaks ve Pmin değerlerinin perkütan kapama işlemi sonrası ve öncesinde birbirleri ile pozitif yönde ilişkili olduğu gösterilmiştir. Perkütan kapama işlemi öncesi ile sonrasındaki Pmaks, Pmin ve Pdis değerleri karşılaştırıldığında iş- lemden iki ay sonra bakılan EKG’de Pmaks ve Pdis değerlerinde artma olurken Pmin değerinde azalma olduğu tes- pit edilmiştir, ancak bu değişiklikler istatistiksel olarak anlamlı bulunmamıştır. Sonuç: Atriyal septal defekti olan hastalarda, kapatma öncesi ölçülen P dispersiyonu kontrol grubundan farklı de- ğildir ve kapatma sonrası da anlamlı farklılık izlenmemiştir. Bu sonuç, çalışmaya dahil edilen hastaların demogra- fik veya klinik özellikleri ya da çalışma yapılan bölgenin oluşturduğu fizyolojik etkiler sebebi ortaya çıkmış olabilir.

P wave dispersion on surface ecg before and after percutaneous closure ın patients with atrial septal defect

Aim: Atrial septal defect (ASD) is one of the most frequent congenital heart diseases in adults. Treatment of these defects was revolutionized by the introduction of percutaneous closure. Regarding to anatomical side of the ASD, dif- ferent electrocardiographic changes can be observed. This study aimed to investigate whether the P-wave dispersion duration (Pdis) values on the surface electrocardiography differed before and after the percutaneous closure in ASD patients. Material and Method: Maximum and minimum P-wave durations (Pmax and Pmin), and Pdis of 48 patients, in whom atrial septal defects were closed percutaneously, were compared before and two months after the percutaneous closure. Results: The mean Pmax, Pmin and Pdis values were: 97.29±20.50 ms, 53.96±11.25 ms and 43.33±21.96 ms, re- spectively, before the percutaneous closure; and 97.71±17.29 ms, 51.04±12.76 ms and 46.67±17.05 ms, respectively, after the percutaneous closure. Neither parameter was significantly different from controls before closure. The Pmax and Pmin values which were taken after and before the closure were positively correlated. The Pmax and Pdis values increased and the Pmin value decreased two months after the percutaneous closure, but without statistical significance. Conclusion: Our findings show that P dispersipn, as measured from surface electrocardiogram, does not differ be- tween ASD patients and controls, and closure of ASD does not lead a significant difference in these parameters. These results could be explained with the demographic and clinical characteristics of our patients, or with the physiologic changes attributable to the moderately high altitude of the study location.

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