Öykü TOSUN, Alper GÜZELTAŞ, Tunç TUNÇER, Hüsnü ALTIN FIRAT, Halil İbrahim DEMİR, Ender ÖDEMİŞ

Effects of atrial septal defect transcatheter closure on parameters of right ventricular functions

Amaç: Bu çalışmada atriyal septal defektlerin transkateter yolla kapatılmasının sistolik ve diyastolik sağ ventrikül fonksiyonları üzerindeki erken dönem etkileri araştırıldı.Ça lış ma pla nı: Transkateter kapatma için uygun olan ve başarıyla uygulanan sekundum atriyal septal defektli 46 hasta (22 erkek, 24 kız; ort. yaş 102.9±20 ay; dağılım 61-178 ay) (çalışma grubu) ve 35 sağlıklı, yaş ve vücut kütle indeksi eşleştirilmiş çocuk (17 erkek, 18 kız; ort. yaş 104.2±21 ay; dağılım 60-180 ay) (kontrol grubu) prospektif olarak değerlendirildi. Transkateter kapatma işleminden önce ve işlemden 24 saat ve bir ay sonra ekokardiyografik inceleme yapıldı ve iki grubun sonuçları karşılaştırıldı.Bul gu lar: Transkateter kapatma için 44 hastada Lifetech Ceraflex(TM), iki hastada Nit-occlud PFM kullanıldı. Kapatmadan önce, kapatmadan bir gün ve bir ay sonra çalışma grubunun ortalama triküspit anüler düzlem sistolik hareketi değerleri sırasıyla 17.5±1.9 mm, 19.1±2.6 mm ve 20.2±2.4 mm idi. Kontrol grubunun ortalama triküspit anüler düzlem sistolik hareketi değeri 20.4±2.3 mm idi. Her iki grupta kapatma işleminden bir gün ve bir ay sonra edinilen ortalama triküspit anüler düzlem sistolik hareketi değerleri arasında anlamlı farklılık yoktu (p>0.05). Kapatmadan önceki ortalama triküspit anüler düzlem sistolik hareketi değerleri işlem sonrası birinci gün ve birinci aya göre anlamlı olarak daha düşük idi. Çalışma ve kontrol grupları arasında işlemden bir ay sonraki ortalama miyokardiyal performans indeksi değerleri açısından anlamlı bir fark yoktu. (p>0.05).So nuç: Kontrol grubu ile karşılaştırıldığında, çalışma grubunda transkateter kapatma öncesi yüksek miyokardiyal performans indeksi ve düşük triküspit anüler düzlem sistolik hareketi değerleri düşük sağ ventrikül fonksiyonuna işaret etmektedir. Kapatma sonrası düşük miyokardiyal performans indeksi ve yüksek triküspit anüler düzlem sistolik hareketi değerleri atriyal septal defektlerin transkateter yolla kapatılmasının erken dönemde bile sağ ventrikül fonksiyonlarını iyileştirdiğini düşündürmektedir.

Atriyal septal defektlerin transkateter yolla kapatılmasının sağ ventrikül fonksiyonel parametreleri üzerine etkileri

Background: This study aims to investigate the early period effects of transcatheter closure of atrial septal defects on systolic and diastolic right ventricular functions.Methods: Forty-six patients with secundum atrial septal defects (22 males, 24 females; mean age 102.9±20 months; range 61 to 178 months) (study group) who were suitable for and who underwent successful transcatheter closure and 35 healthy, age and body mass index-matched children (17 males, 18 females; mean age 104.2±21 months; range 60 to 180 months) (control group) were evaluated prospectively. Echocardiographic examination was performed before and 24 hours and one month after the transcatheter closure procedure and results of the two groups were compared.Results: For transcatheter closure, Lifetech Ceraflex(TM) was used in 44 patients and Nit-occlud PFM was used in two patients. Mean tricuspid valve annular plane systolic excursion values of study group before and one day and one month after the closure were 17.5±1.9 mm, 19.1±2.6 mm, and 20.2±2.4 mm, respectively. Mean tricuspid valve annular plane systolic excursion value of control group was 20.4±2.3 mm. In both groups, there was no significant difference between the mean tricuspid valve annular plane systolic excursion values obtained one day and one month after the closure (p>0.05). Mean tricuspid valve annular plane systolic excursion values before the closure were significantly lower than those of the first day and first month after the procedure. There was no significant difference in the mean myocardial performance index values between the study and control groups one month after the procedure. (p>0.05).Conclusion: Compared to control group, high myocardial performance index and low tricuspid valve annular plane systolic excursion values in study group before transcatheter closure indicate low right ventricular function. Low myocardial performance index and high tricuspid valve annular plane systolic excursion values after closure suggest that transcatheter closure of atrial septal defects improve right ventricular functions even in early period.

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