Publication: Arteriyel "Switch" yapılan hastalarda sol ventrikül fonksiyonları ve Doppler "Tissue Imaging" yöntemi ile duvar hareketlerinin değerlendirilmesi
Abstract
Büyük damarların transpozisyonunda anatomik bir düzeltme sağlayan arteriyel "switch" operasyonu sonrasında sol ventrikül fonksiyonları ve koroner arterlerin taşınmasına bağlı miyokard hareketlerinde gelişebilecek bozukluklar halen araştırılmaktadır. Doppler "tissue imaging" yöntemi ile hareket eden dokulardaki hızların ölçülmesi ve miyokard kontraktilitesinin değerlendirilmesi mümkün olmaktadır.Çalışmamızda yaşları 3-65 ay arasında değişen 21 arteriyel "switch" operasyonu geçirmiş çocukta ve yaşları 7 -58 ay arasında değişen 16 normal çocukta iki boyutlu, m-mode, Doppler ve renkli Doppler ekokardiyografi ile sol ventrikül büyüklüğü ve fonksiyonları değerlendirildi ve Doppler "Tissue Imaging" yöntemi ile sistolik ejeksiyon fazında interventriküler septum ve sol ventrikül arka duvarında mid-miyokardiyal hız ölçümleri yapıldı. Sol ventrikül hacmi hastalarda ortalama 43.82 ± 12.2 ml ile kontrol grubundaki ortalama 37.72(7.66 ml değerine göre daha yüksekti ( p<0.05). Sol ventrikül kitlesi de hasta ve kontrol gruplarında sırası ile 81.55±17.94g ve 59.49(13.94g bulundu ve ikisi arasındaki fark da istatistiksel olarak anlamlı idi ( p<0.0005). Sol ventrikül kitlesi iki aşamalı operasyon geçiren hastalarda belirgin olarak fazla idi. Arteriyel "switch" operasyonu geçiren hastalarda kısalma fraksiyonu genel olarak normal sınırlar içinde olmakla birlikte hastalarda ortalama %33.71±4.17 ile kontrol grubundaki % 39.66±5.14 değerine göre daha düşüktü (p < 0.005). Ejeksiyon fraksiyonu ve kalp hızına göre düzeltilmiş çevresel kısalma fraksiyonu da arteriyel "switch" yapılan hastalarda daha düşüktü. CW Doppler ile aort akım trasesinden elde edilen akselerasyon zamanı, ejeksiyon zamanı , ortalama akselerasyon ve akselerasyon zamanı/ejeksiyon zamanı parametrelerinin normal çocuklardan farklılık göstermediği tesbit edildi. Hastaların 12'sinde hafif, 3'ünde orta derecede neo-aortik kapak yetersizliği tespit edildi. Orta derecede yetersizlik görülen hastaların tümü iki aşamalı operasyon geçirmişti. Doppler Tissue Imaging yöntemi ile 10 hastada sistol sırasında interventriküler septumun ters yönde hareket ettiği, sol ventrikül arka duvar hızının normal çocuklardan daha yüksek olduğu gösterildi. Sonuç olarak, arteriyel "switch" operasyonlarından sonra klinik sonuçların yüz güldürücü olmasına karşın ventrikül fonksiyonları ve duvar hareketlerinde normal çocuklara göre bazı farklılıklar olabileceği, Doppler "Tissue Imaging" yönteminin bu hasta grubunda miyokard fonksiyonlarının değerlendirilmesinde yararlı olabileceği düşünüldü.
Although arterial switch operation has become the first choice of treatment in patients with transposition of great arteries, left ventricular function and myocardial wall motion abnormalities due to the transportation of coronary arteries are still under investigation. Doppler tissue imaging can be used for evaluation of myocardial wall motion and contractility in various disease states. We investigated left ventricular size and function by using two dimensional, M-mode, Doppler and color Doppler echocardiography and measured the mid-myocardial velocity of interventricular septum and left ventricular posterior wall during systolic ejection phase by Doppler tissue imaging in 21 patients, between 3 and 65 months, who had gone to arterial switch operation and in 16 normal children between 7 and 58 months. Left ventricular volume was larger in patients (43.82±12.2 ml) than the normal children (37.72±7.76 ml) (p<0.05). Left ventricular mass was 81.5±17.2 g and 59.5±13.49 g in patients and normal children, respectively and the difference was significant (p<0.0005). This difference was more striking in patients who had two-stage operation. Left ventricular shortening fraction was within the normal range in most of the patients, and the mean value being 33.7±4.1% which was less than the control group (39±5%) (p<0.005). Ejection fraction and left ventricular circumferential shortening were also less than the control group. Acceleration time, ejection time, mean acceleration, acceleration time/ejection time ratio measured from the aortic Doppler flow were not different in patients and normal children. Twelve patients had mild and three had moderate neo-aortic valve regurgitation and all the patients with moderate regurgitation had two-stage operation. Interventricular septal motion was found to be paradoxical in 10 of the patients by Doppler tissue imaging and the velocity of the posterior wall was greater than the normal children.In conclusion, although the clinical results of arterial switch operations are promising, there may be some differences of left ventricular function and myocardial motion compared to normal children. Doppler tissue imaging is beneficial in this group of patients for detection of myocardial wall motion abnormalities.
Although arterial switch operation has become the first choice of treatment in patients with transposition of great arteries, left ventricular function and myocardial wall motion abnormalities due to the transportation of coronary arteries are still under investigation. Doppler tissue imaging can be used for evaluation of myocardial wall motion and contractility in various disease states. We investigated left ventricular size and function by using two dimensional, M-mode, Doppler and color Doppler echocardiography and measured the mid-myocardial velocity of interventricular septum and left ventricular posterior wall during systolic ejection phase by Doppler tissue imaging in 21 patients, between 3 and 65 months, who had gone to arterial switch operation and in 16 normal children between 7 and 58 months. Left ventricular volume was larger in patients (43.82±12.2 ml) than the normal children (37.72±7.76 ml) (p<0.05). Left ventricular mass was 81.5±17.2 g and 59.5±13.49 g in patients and normal children, respectively and the difference was significant (p<0.0005). This difference was more striking in patients who had two-stage operation. Left ventricular shortening fraction was within the normal range in most of the patients, and the mean value being 33.7±4.1% which was less than the control group (39±5%) (p<0.005). Ejection fraction and left ventricular circumferential shortening were also less than the control group. Acceleration time, ejection time, mean acceleration, acceleration time/ejection time ratio measured from the aortic Doppler flow were not different in patients and normal children. Twelve patients had mild and three had moderate neo-aortic valve regurgitation and all the patients with moderate regurgitation had two-stage operation. Interventricular septal motion was found to be paradoxical in 10 of the patients by Doppler tissue imaging and the velocity of the posterior wall was greater than the normal children.In conclusion, although the clinical results of arterial switch operations are promising, there may be some differences of left ventricular function and myocardial motion compared to normal children. Doppler tissue imaging is beneficial in this group of patients for detection of myocardial wall motion abnormalities.