Sol-sağ şantlı kalp hastalıklı çocukların kardiyak fonksiyonlarının klasik ekokardiyografi ve doku Doppler yöntemi ile değerlendirilmesi
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Dosyalar
Tarih
2007
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ASD, VSD ve PDA en sık görülen soldan sağa şantlı konjenital kalp hastalıklarıdır. Bu hastalıkların tedavi zamanları çocuk kalp hastalıkları uzmanlarının karar verirken tereddüt içinde kaldıkları bir konudur. Tedavi zamanını tayin etmede bazı kesin kriterler bulunsa da her hasta bu kriterlere tam olarak uymayabilmektedir. Bu tip hastalarda bir karara varabilmek için kolay elde edilebilen ve hastaya ilave zorluklar getirmeyecek bazı yeni kriterler oluşturulmalıdır. Miyokard performans indeksi hem pulse Doppler ekokardiografi ile hem de doku doppler inceleme ile ölçümü kolay bir parametredir. Çocuklarda bu konuda yapılmış yeterince çalışma bulunmamaktadır. Biz de bu çalışmamızda çocuklarda soldan sağa şantlı kalp hastalıklarının takibinde önyük artışının miyokard performans indeksi üzerine etkisini ve pulse Dopplerle MPI tayini ile pulse doku Dopplerle MPI tayininin varsa birbirlerine üstünlüklerini araştırmayı amaçladık. ASD' li 15 hasta, VSD `li 13 hasta, PDA'lı 3 hasta, ASD+VSD'li 3 hasta ve ASD+PDA'lı 1 hasta olmak üzere toplam 35 hasta ile 30 kontrol hastası çalışmaya alındı. Hasta grubu ile kontrol grubu arasında yaş, cinsiyet ve kilo açısından anlamlı bir fark saptanmadı. Hasta grubu ilaç alanlar ve almayanlar, defekti büyük olanlar ve küçük olanlar, ASD'liler ve VSD'li olanlar olarak gruplandırıldı, fizik muayene , telekardiografi ve ekokardiyografi bulguları açısından karşılaştırıldı. MPI çocuklarda da kalp yetmezliğinin iyi bir göstergesi olup klinik seyir ve prognoz için bilgi veren önemli ve belirlenmesi kolay bir parametredir. Hastaların kalp yetmezliği yönünden takibinde kalp yetmezliğinin tüm parametreleri ortaya çıkmadan erken dönemde miyokard performans indeksi (ister klasik pulse Dopplerle isterse de doku Doppler ile belirlenmiş) kullanılarak yetmezlik tanısı konulabilir ve tedaviye bu şekilde yön verilebilir. Miyokard performans indeksi tayininde pulse Doppler ekokardiografi ile doku Doppler inceleme arasında, doku Doppler incelemenin uygulanabilirliğinin biraz daha kolay olması ( tek kardiyak siklusta tayin edilebilmesi) dışında anlamlı bir fark yoktur. Çocuklarda önyük değişikliklerinde, normal kontrol grubu ile soldan sağa şantlılar arasında anlamlı farklar bulundu . Elde edilen bu bulgular ışığında çocuklarda MPI' nın önyük değişikliklerinden etkilendiği sonucuna vardık ancak bu konuda kesin yargıya varabilmek için daha geniş kapsamlı ve prospektif bir çalışma yapılmalı, mümkün olursa bu çalışma invaziv yöntemlerle genişletilerek objektif veriler elde edilmelidir.
The evaluation of cardiac functions of children with left to right shunt cardiac diseases by classic echocardiography and tissue Doppler echocardiography ASD, VSD and PDA are the most common congenital heart diseases with left to right shunt. The mode of the treatment of the diseases is a subject in which pediatric cardiologists hesitate. Although certain criterias exist to determine the mode of the treatment, every patient might not have this criterias. To make decision in these patients, there must be criterias which are easily achieved and do not bring additional difficulties to patients. MPI is an easily measured parameter and proved to be effective in determining heart failure in adults, can be measured both with pulse Doppler echocardiography and tissue Doppler echocardiography. There aren?t many studies performed about this subject in children . In this study, we aimed to measure the effect of increased preload on MPI and determine the effect of possible difference between pulse Doppler echocardiography and pulse tissue Doppler echocardiography on MPI in children with left to right shunt. A total of 35 patients; 15 patients with ASD, 13 patients with VSD, three patients with ASD+VSD and one patients with ASD+PDA and 30 healthy children as control group were included in the study. There was no difference between the patient and control group according to age, gender and weight. The patient group was classified into subgroups getting medical treatment or not, having large defects or small defects in ASD or VSD . These subgroups were compared with each other according to physical examination, telecardiography and echocardiograhy. MPI is a useful parameter in determining cardiac failure in children, gives essential information about clinical progression and prognosis and can be measured easily. At follow up, before the appearance of all parameters of cardiac failure, the diagnosis can be made by measuring MPI and treatment can be planned. When pulse Doppler echocardiography and pulse tissue Doppler echocardiography are compared in measuring MPI, there is no significant difference except the easier way of applying pulse tissue Doppler echocardiography than pulse Doppler echocardiography. Significant differences were found between the patient and control group according to preload changes. In the light of these findings we concluded that MPI is effected by preload changes. However , to achieve certain conclusion , a more comprising and prospective study should be performed ; and if available this study should be extended by using ınvasive methods to obtain objective results.
The evaluation of cardiac functions of children with left to right shunt cardiac diseases by classic echocardiography and tissue Doppler echocardiography ASD, VSD and PDA are the most common congenital heart diseases with left to right shunt. The mode of the treatment of the diseases is a subject in which pediatric cardiologists hesitate. Although certain criterias exist to determine the mode of the treatment, every patient might not have this criterias. To make decision in these patients, there must be criterias which are easily achieved and do not bring additional difficulties to patients. MPI is an easily measured parameter and proved to be effective in determining heart failure in adults, can be measured both with pulse Doppler echocardiography and tissue Doppler echocardiography. There aren?t many studies performed about this subject in children . In this study, we aimed to measure the effect of increased preload on MPI and determine the effect of possible difference between pulse Doppler echocardiography and pulse tissue Doppler echocardiography on MPI in children with left to right shunt. A total of 35 patients; 15 patients with ASD, 13 patients with VSD, three patients with ASD+VSD and one patients with ASD+PDA and 30 healthy children as control group were included in the study. There was no difference between the patient and control group according to age, gender and weight. The patient group was classified into subgroups getting medical treatment or not, having large defects or small defects in ASD or VSD . These subgroups were compared with each other according to physical examination, telecardiography and echocardiograhy. MPI is a useful parameter in determining cardiac failure in children, gives essential information about clinical progression and prognosis and can be measured easily. At follow up, before the appearance of all parameters of cardiac failure, the diagnosis can be made by measuring MPI and treatment can be planned. When pulse Doppler echocardiography and pulse tissue Doppler echocardiography are compared in measuring MPI, there is no significant difference except the easier way of applying pulse tissue Doppler echocardiography than pulse Doppler echocardiography. Significant differences were found between the patient and control group according to preload changes. In the light of these findings we concluded that MPI is effected by preload changes. However , to achieve certain conclusion , a more comprising and prospective study should be performed ; and if available this study should be extended by using ınvasive methods to obtain objective results.
Açıklama
Anahtar Kelimeler
Kardiyak fonksiyon, Cardiac function, Klasik ekokardiyografi, Classical echocardiography, Doku doppler yöntemi, Tissue doppler method
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Doğan, M. (2007). Sol-sağ şantlı kalp hastalıklı çocukların kardiyak fonksiyonlarının klasik ekokardiyografi ve doku Doppler yöntemi ile değerlendirilmesi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
