İleri mitral darlığının koroner akım rezervine ve sol ventrikül sistolik fonksiyonuna etkisi / Severe mitral stenosis effect on coronary flow reserve and left ventricular systolic function
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Tarih
2009
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T.C. Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Mitral darlığı, gelişmemiş ve gelişmekte olan ülkelerde özellikle daha önceki dekatlarda görülen akut romatizmal ateşin takip eden rezidüel etkileri nedeniyle hala önemli mortalite ve morbidite nedeni olmaya devam etmektedir.% 99 `u romatimal olan mitral darlığının sol ventrikül sistolik fonksiyonuna etkisiz olduğu fikrinin aksine, yeni çalışmalarda saf mitral darlığında hastaların %25-30'unda sol ventrikül sistolik disfonksiyonu saptanmıştır. Bu çalışmada koroner arter hastalığı olmayan saf mitral darlığının koroner akım rezervine ve sol ventrikül sistolik fonksiyonuna etkisi araştırılmıştır.Yöntem: Çalışmaya kantitatif olarak değerlendirilip, ileri mitral darlığı saptanan 40-65 yaş arasında olan 20 hasta ( 14'ü kadın, 6' sı erkek) alındı. Hastaların ekokardiyografisi Vivid 7 (General Electric Milwaukee ) cihazı kullanılarak yapıldı. Ejeksiyon fraksiyonu (LV EF), Simpson Metodu ve M-Mode ile hesaplandı. Dijital ortamda kaydedilen görüntülerden uygun yazılım yardımıyla sol ventrikül (LV) strain ve strain rate analizleri yapıldı. Left anterior desending arter (LAD) akımları, koroner presetleri ve pulsed wave doppler ile değerlendirildi. Bazal koşullardaki ve İV dipiridamol ile oluşan hiperemik sistolik ve diastolik koroner akımlar değerlendirilerek koroner akım rezervi hesaplandı. Mitral darlığı giderildikten 7 gün sonra (Perkütan mitral balon valvüloplasti yada mitral kapak replasmanı ile), preoperatif yapıldığı gibi LV EF, LV strain, strain rate ve koroner akımlar değerlendirildi, koroner akım rezervi tekrar hesaplandı. Bulunan değerler girişim öncesi ile kıyaslandı.Sonuçlar: Mitral darlığında girişim öncesi bulgular, girişim sonrası ile kıyaslandığında; mitral kapak alanının (P=0,000<0,05), aort ve pulmoner ileri akım hızlarının, anlamlı olarak arttığı (sırasıyla P=0,007,P=0,007<0,05), LVEF'nin arttığı (P=0,001<0,05) tespit edilmiştir. Sol ventrikül; total sistolik, erken diastolik ve geç diastolik strain değerlerinin; erken ve geç diastolik strain rate değerlerinin anlamlı olarak arttığı ancak sistolik strain rate değerlerinin anlamlı olarak artmadığı tespit edilmiştir. LAD koroner akım değerlendirilmesinde ise girişim öncesi ile kıyaslandığında LAD bazal ve hiperemi sonrası , sistolik-diastolik peak akım hızlarının anlamlı olarak arttığı ancak hesaplanan koroner akım rezervinin değişmediği saptanmıştır.
Mitral stenosis secondary to acute rheumatic fever sequel has been a morbidity and mortality cause in the developed and underdeveloped countries. Rheumatic mitral stenosis was known not to be affecting left ventricular systolic function, but new studies showed that pure mitral stenosis depress left ventricular systolic function % 25- 30. In this study we investigated coronary flow reserve and left ventricular systolic function impact on pure mitral stenosis without coronary artery diseaseMaterial and methods:20 severe mitral stenosis 40-65 years old aged patients were included in our study. We performed their echocardiographic study with Vivid 7 (General Electric Milwaukee ) device. Ejection fraction ( LV EF ) were calculated with Simpson methode and M-mode. Left ventricular strain and strain rate analyses were performed on digitally recorded images with compatible software.Left anterior descending artery flows were assesed with coronary presets and pulsed wave doppler analysis.Basal and dipiridamol induced hiperemic systolic and diastolic coronary flows were digitally recorded and coronary flow reserve were calculated.we performed transthorasic echocardiography 7 days later after surgically or percutaneus mitral valvuloplasty procedures . Left ventricular EF , left ventricular strain, left ventricular systolic strain rate and coronary flows were assesed and coronary flow reserves were calculated.A measurement results were compared after the approachResults: Mitral stenosis were significiantly improved after the approach. (P=0,000<0,05). Aortic and pulmonary forward velocities were significiantly improved after the approach( P=0,007,P=0,007<0,05) and left ventricular ejection fraction improvement were determined (P=0,001<0,05). Total systolic , early diastolic and late diastolic strain measurements were significiantly increased after the approach. Early and late diastolic strain rate values were significiantly increased but sistolic strain rate values were not significiantly increased. LAD coronary flow assesment were compared before and after the approach. LAD basal and hiperemic sistolic and diastolic flow measurements were increased but coronary flow reserve measurements were not significiantly improved.
Mitral stenosis secondary to acute rheumatic fever sequel has been a morbidity and mortality cause in the developed and underdeveloped countries. Rheumatic mitral stenosis was known not to be affecting left ventricular systolic function, but new studies showed that pure mitral stenosis depress left ventricular systolic function % 25- 30. In this study we investigated coronary flow reserve and left ventricular systolic function impact on pure mitral stenosis without coronary artery diseaseMaterial and methods:20 severe mitral stenosis 40-65 years old aged patients were included in our study. We performed their echocardiographic study with Vivid 7 (General Electric Milwaukee ) device. Ejection fraction ( LV EF ) were calculated with Simpson methode and M-mode. Left ventricular strain and strain rate analyses were performed on digitally recorded images with compatible software.Left anterior descending artery flows were assesed with coronary presets and pulsed wave doppler analysis.Basal and dipiridamol induced hiperemic systolic and diastolic coronary flows were digitally recorded and coronary flow reserve were calculated.we performed transthorasic echocardiography 7 days later after surgically or percutaneus mitral valvuloplasty procedures . Left ventricular EF , left ventricular strain, left ventricular systolic strain rate and coronary flows were assesed and coronary flow reserves were calculated.A measurement results were compared after the approachResults: Mitral stenosis were significiantly improved after the approach. (P=0,000<0,05). Aortic and pulmonary forward velocities were significiantly improved after the approach( P=0,007,P=0,007<0,05) and left ventricular ejection fraction improvement were determined (P=0,001<0,05). Total systolic , early diastolic and late diastolic strain measurements were significiantly increased after the approach. Early and late diastolic strain rate values were significiantly increased but sistolic strain rate values were not significiantly increased. LAD coronary flow assesment were compared before and after the approach. LAD basal and hiperemic sistolic and diastolic flow measurements were increased but coronary flow reserve measurements were not significiantly improved.
Açıklama
Anahtar Kelimeler
Koroner akım rezervi, Mitral darlığı, Sol ventrikül strain, Sol ventrikül strain rate, Coronary flow reserve, Mitral stenosis, Left ventricular strain, Left ventricular strain rate
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Künye
Bektaş, O. (2009). İleri mitral darlığının koroner akım rezervine ve sol ventrikül sistolik fonksiyonuna etkisi / Severe mitral stenosis effect on coronary flow reserve and left ventricular systolic function. (Yayımlanmamış Tıpta Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
