Murat SARGIN, Uğur FİLİZCAN, Aykut Serap AKA, Hakkı AYDOĞAN, Ergin EREN, Şebnem CETEMEN, Celalettin KARATEPE, Süheyla KESER, Onur GÖKSEL, Zeliha ALICIKUŞ, Gökçen ORHAN

Mekanik aortik kapak protez çapı ile sol ventrikül hipertrofisinin gerilemesi arasındaki ilişki

Amaç: Aort stenozlu hastalarda aort kapak replasmanından sonra sol ventrikül hipertrofisinde gerileme gözlenir. Çalışmamızda protez kapak çapları ile sol ventrikül hipertrofisinin gerilemesi arasındaki ilişkiyi araştırdık. Materyal ve Metod: Ciddi aort darlığı nedeniyle aort kapak replasmanı uygulanan 18 hastanın 2'sine 19 mm, 7 hastaya 21 mm, 8 hastaya 23 mm, 1 hastaya 25 mm standard biliflet aortik prostetik kapak takıldı. Ameliyat öncesi (3 ± 1 gün) ve ameliyattan 6 ay sonra transtorasik ekokardiyografik ölçümler yapıldı. Kullanılan protez kapak çapları ile postoperatif 6 ayda sol ventrikül kitle indeksindeki gerileme arasındaki ilişki araştırıldı. Bulgular: Postoperatif 6. ay ekokardiyografik kontrollerinde sol ventrikül kitlesi tüm gruplarda azalmış olarak saptandı. Bu azalma 25 nolu kapakta (p < 0.001) ve 23 nolu kapaklarda anlamlı (p < 0.01) düzeyde iken 19 nolu kapaklarda önemsiz düzeyde idi. Çalışmamızda 19 ve 21 nolu kapakların kendi aralarında az bir gradiyent farkı varken bu kapaklarla daha büyük çaplı kapaklar arasında önemli gradiyent farklarının olduğu gözlendi. Sonuç: Takılan küçük çaplı kapakların reziduel gradiyentlerinin daha fazla olması nedeni ile sol ventrikül kitlesindeki azalmaya katkılarının daha az olduğunu saptadık.

The relationship between mechanical aortic valve diameter and regression of left ventricular hypertrophy

Background: Valve replacement in aortic stenosis results in regression of left ventricular hypertrphy. The aim of this study was to define the relation between the diameters of prosthetic valves and the regression in left ventricular hypertrophy. Methods: The echocardiographic findings, preoperatively and sixth months postoperatively, of 18 patients who underwent aortic valve replacement (in 2 patients 19 mm, in 7 patients 21 mm, in 8 patients 23 mm, in 1 patient 25 mm bileaflet aortic prosthetic valves were used) were obtained. The relation between the diameter of the prosthesis and the regression in ventricular hypertrophy was compared. Results : We found that left ventricular mass index diminished by echocardiographic controls made in postoperative sixth months after operation. These findings were significant with 25 mm (p < 0.001) and 23 mm prosthetic valves (p < 0.01), but found insignificant with 19 mm prosthetic valves. We determined that the gradient difference between the 19 and 21 sized valves were not much significant while the difference between them and the larger sized valves were higher. Conclusions: We found out that the effect of the residual gradient in small sized prosthetic valves was greater, as a result regression in left ventricular mass index was less.

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