MUHAMMET DURAL, Kamal ISGANDAROV, Gurbet Özge MERT, Necmi ATA, KADİR UĞUR MERT

Perkütan Balon Mitral Valvuloplasti Sırasında Transözofajiyal Ekokardiyografi Kılavuzluğunun İşlem Başarısı ve Komplikasyonlar Üzerine Etkisi

Semptomatik mitral darlığı (MD) hastaları perkütan yolla tedavi edilebilmektedir. Bu hastalarda perkütan mitral balon valvulaplasti (PMBV) ile MD ve semptomları giderilebilmektedir. Bu çalışmamızda ciddi MD hastalarında PMBV işlemi sırasında transözofajiyal ekokardiyografi (TEE) kılavuzluğunun işlem başarısı ve komplikasyonlar üzerine etkisini araştırmak istedik. Çalışmaya ciddi MD ile başvuran ve PMBV yapılması planlanan 45 hasta alındı. PMBV işlemi 23 hastaya TEE kılavuzluğunda (TEE(+)), 22 hastaya ise TEE kılavuzluğu olmadan (TEE(-)) gerçekleştirildi. Çalışmada her iki grubun transseptal ponksiyon (TSP) süresi, septum geçiş başarısı, kapak geçiş başarısı değerlendirildi. PMBV ile tedavi edilen tüm hastalara 24. saat ve 12. haftada transtorasik ekokardiyografi ile değerlendirildi. Çalışmaya alınan hastaların TEE(+) grubunda yaş ortalaması 47,9±11,4, TEE(-) grubunda ise 48,5±15 (p=0,88) idi. TEE(-) grubundaki olguların ortalama boyu 163,1±7,5 cm, TEE(+) grubunda ise 161,7±5,4 cm (p=0,47) olarak gözlendi. TEE(-) grubunda Wilkins skoru 8,5(7,0-10,0), TEE(+) grubunda ise 9,0(7,0-11,0) (p=0,111) olarak gözlendi. TSP süresi TEE(-) grubunda ve TEE(+) grubunda sırasıyla 25,24±5,1 dk. ve 21,86±3,8 dk (p=0,02) olarak tespit edildi. TEE(-) grubunda kapak geçiş başarısı %100 iken, TEE(+) grubunda %85,8 olarak bulundu. TEE(+) grubunda mitral kapak geçişi daha başarısızdı ancak istatistiksel anlamlı fark yoktu (p=0,072). Komplikasyonlar her iki grupta benzerdi. PBMV esnasında kullanılan TEE’nin TSP’den doğan komplikasyonlar, TSP başarısı, kapak geçiş başarısı, işlem başarısı, işlem komplikasyonları üzerine ise herhangi bir etkisinin olmamasına rağmen TSP süresini kısalttığı gösterildi. Hastalarda işlem süresini kısaltmak, radyasyon maruziyetini en aza indirmek için PBMV işlemi sırasında TEE kılavuzluğu konvansiyonel yönteme eklenebilir.

Anahtar Kelimeler:

Ciddi mitral darlığı, perkütan mitral balon valvuloplasti, transeptal ponksiyon

The Effect of Guidance of Transesophageal Echocardiography During Percutaneous Balloon Mitral Valvuloplasty on Procedural Success and Complications

Patients with mitral stenosis (MS) can be treated with percutaneous methods. In this patient population, MS and symptoms can be relieved by percutaneous mitral balloon valvuloplasty (PMBV). In our study we aimed to investigate the effect of guidance of transesophageal echocardiography (TEE) during PMBV on procedural success and complications in patients with MS. Fourty-five patients who were planning to undergo PMBV because of severe MS were included to the study. Procedure of PBMV performed in 23 patients with TEE guidance (TEE(+)) and in 22 patients without TEE guidance (TEE(-)). Transseptal puncture (TSP) duration, transseptal transition success and transmitral transition success evaluated for each group. All patients treated with PMBV were evaluated with transthorasic echocardiography after 24. h and 12 weeks. The mean age in the TEE(+) group of the study was 47,9±11,4 and 48,5±15 (p=0,88) in TEE(-) group. The mean height was 163,1±7,5 cm in TEE(-) group and 161,7±5,4 cm (p=0,47) in TEE(+) group. It was demonstrated that Wilkins score was 8.5 (7.0-10.0) in the TEE (-) group and 9.0 (7.0-11.0) in TEE (+) group (p = 0.111). TSP duration in the TEE (-) group and TEE (+) group were 25,24 ± 5,1 min. and 21.86 ± 3.8 min (p = 0.02), respectively. In the TEE (-) group, transmitral transition success was 100%, while in the TEE (+) group it was 85.8%. In TEE (+) group, transmitral transition was more unsuccessful but there was no statistically significant difference (p = 0.072). Complications were similar in both groups. It was demonstrated that TEE guidance during PMBV shortened the TSP duration despite there was no effect on complications due to TSP, TSP success, transmitral transition success, operation success, and operation complications. In PMBV procedure, TEE guidance can be added to the conventional methods to shorten the procedure time and minimize radiation exposure.

Keywords:

Severe mitral stenosis percutaneous balloon mitral valvulplasty, transseptal puncture, echocardiography,

PDF

___

KAYNAKLAR
1. Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010;85:483500.
2. Onat A, Keleş İ, Çetinkaya A, Başar Ö, Yıldırım B, Erer B, et al. Prevalence of coronary mortality and morbidity in the Turkish adult risk factor study: 10-year follow-up suggests coronary “Epidemic”. Türk Kardiyol Dern Arş 2001;29:8-19.
3. Inoue K, Owaki T, Nakamura T, et al. Clinicalapplication of transvenous mitral commissurotomy by a new balloon catheter. J ThoracCardiovascSurg 1984; 87:394.
4. Kronzon I, Tunick PA, Schwinger ME, et al. Transesophageal echocardiography duringpercutaneous mitral valvuloplasty. J AmSocEchocardiogr 1989; 2:380.
5. Quinones MA, Otto CM, Stoddard M, et al. Recom- mendations for quanti cation of Doppler echocardiog- raphy: a report from the Doppler Quanti cation Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002;15:167-184.
6. Şenol Y, Özdemir İ. Kalp kapağı hastalıklarında cerrahi endikasyonlar.PTT Tıp Dergisi 1999;21; 108-115.
7. Guidelines on the management of valvular heart disease (version 2012)
8. Inoue K, Feldman T. Percutaneoustransvenous mitral commissurotomy using the Inoue balloon catheter. CathetCardiovascDiagn 1993; 28:119.
9. Kultursay H. Suggestions on how to do / InterventionalCardiology / Practical tips for transseptal cardiac catheterization. ArchTurkSocCardiol 2012; 40:102-105
10. Iung B, Vahanian A: Rheumatic mitral valve disease. Otto CM Bonow RO Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed 2013 Saunders Philadelphia 255-277
11. Shavelle DM: Evaluation of valvular heart disease by cardiac catheterization and angiography. Otto CM Bonow RO Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed 2009 Saunders Philadelphia 85-100
12. Tuzcu EM, Kapadia SR: Long-term efficacy of percutaneous mitral commissurotomy for recurrent mitral stenosis. Heart. 99:1307 2013
13. Lau KW, Hung JS. A simple balloon-sizing method in Inoue-balloon percutaneous transvenous mitral commissurotomy. Cathet Cardiovasc Diagn 1994; 33(2): 120–129; discussion 130–131.
14. Tastan A, Ozturk A, Senarslan Ö, Ozel E, Uyar S, Ozcan E, Kozan Ö. Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty:which is preferable? Cardiovasc J Afr 2016; 27:DOI: 10. 5830/CVJA
15. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC.Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465-71.
16. Karaçağlar E, Atar i, Özin B . Transseptal puncture. Journal of Turkish Arrythmia, Pacemaker and Electrophysiology. Volüme 9, issue 2, June 2011.
17. Cheng-Wen Chiang, MD, FCCP; Lung-An Hsu, MD; Po-Hsien Chu, MD, FCCP;Wan-Jing Ho, MD; Hung-Shun Lo, MD; and Chao-Chien Chang. Feasibility of Simplifying Balloon Mitral Valvuloplasty by Obviating Left-Sided Cardiac Catheterization Using On-line Guidance With Transesophageal Echocardiography* MD CHEST 2003; 123:1957–1963
18. Afzal S, Veulemans V, Balzer J, Rassaf T, Hellhammer K, Polzin A, Kelm M, Zeus T Safety and efﬁcacy of transseptal puncture guided by real-time fusion of echocardiography and ﬂuoroscopy. Neth Heart J (2017) DOI 10.1007/s12471-016-0937-0
19. Kultursay H . Practical tips for transseptal cardiac catheterization. Arch Turk Soc Cardiol 2012;40(1):102-105 doi: 10.5543/tkda.2012.01931
20. Radinovic A, Mazzone P, Landoni G,Agricola E, Regazzoli D, Bella PD. Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography. Ann Card Anaesth 2016;19:589-93.
21. Yıldız A , Kaya H, Ertaş F, Polat N, Aydın M,Yüksel M, Soydinç S, Çaylı M , Ülgen M.S., Toprak N. Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience. 41 (4): 695-699 Dicle Medical Journal doi: 10.5798/diclemedj.0921.2014.04.0502
22. Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002;105:1465-71.
23. Seyfollah Abdi1 Negar salehi, Babak Ghodsi, Hossein Ali Basiri, Mahmoud Momtahen, Ata Firouzi, Hamid Reza Sanati, Farshad Shakerian, Mohsen Maadani, Homan Bakhshandeh, Soheila Chamanian, Mitra Chitsazan,Anoushiravan Vakili-Zarch. Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis. Clinical Medicine Insights: Cardiology 2012:6 35–39.