Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography

tutun, ufuk; Aksöyek, Ayşen; BUDAK, Baran; ULUS, A. Tulga; ERBAŞ, Sakine; ARAT, Nurcan; KÖSE, Serdal Kenan; KATIRCIOĞLU, S. Fehmi; SEREN, Mustafa; BOZBOĞA, Seher; PARLAR, A. İhsan

Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography

A. Tulga ULUS, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

Ufuk TÜTÜN, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

Baran BUDAK, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

Sakine ERBAŞ, (Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara, Türkiye)

Nurcan ARAT, (Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara, Türkiye)

Seher BOZBOĞA, (Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara, Türkiye)

Serdal Kenan KÖSE, (Ankara Üniversitesi, Tıp Fakültesi, Bioistatistik Anabilim Dalı, Ankara, Türkiye)

Mustafa SEREN, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

A. İhsan PARLAR, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

Ayşen AKSÖYEK, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

S. Fehmi KATIRCIOĞLU, (Sağlık Bakanlığı, Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara, Türkiye)

Diğer Yazarlar

Anadolu Kardiyoloji Dergisi

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Yıl: 2007 Cilt: 7 Sayı: 4 Sayfa Aralığı: 397 - 403 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography

Öz:

Amaç: Bu longitüdinal çalışmada, mitral kapak replasmanı yapılan hastalarda prostetik kapak çaplarının kardiyak strese cevabı ve cerrahiyi takiben kapak çapının iyileşme-yeniden yapılanma üzerine etkilerinin araştırılması planlanmıştır.Yöntemler: Mitral kapak replasmanı yapılan 39 hasta, mekanik kapak çapının postoperatif kardiyak yeniden yapılanma üzerine etkisinin araştırılması amacı ile ventrikül çapları, sistolik fonksiyonları ve kardiyak kitle indeksleri açısından karşılaştırılmıştır. Hastalar protez kapak çapına göre 3 gruba ayrılmıştır. Grup 1- kapak çapı 29 numaranın altı hastaları (n=11), Grup 2- 29 numara olan hastaları (n=11) ve Grup 3- kapak çapı 29 numaranın üstünde olan hastaları içermektedir (n=17). İstatistiksel analiz için Ki-kare ve ANOVA testleri kullanılmıştır.Bulgular: Sadece Grup 1’deki hastalarda sol ventrikül kitle indeksi ve diyastol sonu çapında istatistiksel açıdan anlamlı azalma tespit edilmiştir (138.3±29.7 gm/2 ile 86.6±15.6 g/m2 ve 5.1±0.5 cm ile 4.4±0.4 cm, p<0.05). Grup 3’deki hastalar da sol ventrikül ejeksiyon fraksiyonu cerrahiyi takiben gerilemiştir (64.0±5.6% ile 55.9±6.5%, p<0.05). Dobutamin stres ekokardiyografi sırasında, mitral protez kapak maksimum ve ortalama gradiyentleri ve pulmoner arter basınçları önemli miktarda artmıştır. Maksimum gradiyent Grup 1’de 14.2±4.6’dan 20.7±7.5 mmHg’ya (p<0.05), Grup 2’de 11.6±4.7’dan 16.2±6.8 mmHg’ya (p<0.05) ve Grup 3’de 10.6±3.1’dan 20.8±12.7 mmHg’ya (p<0.05) yükselmiştir. İzovolümik relaksasyon zamanı dobutamin infüzyonunu takiben tüm gruplarda azalmıştır, ancak bu azalma 3. grupta anlamlı değildir. Sonuç: Büyük çaplı kalp kapak protezi taşıyan grupta mitral kapak replasmanını takiben sol ventrikül sistolik fonksiyonlarında bozulma görülmektedir. Sadece küçük çaplı protez ile replasman yapılan grupta kardiyak kitle indeksinde azalma saptanmış ve sistolik fonksiyonlar korunmuştur. Cerrahiden sonra yapılan ekokardiyografi ile tespit edilen kitle indeks ve sistolik-diyastolik fonksiyon değişiklikleri, kullanılan kapak çaplarının kardiyak yeniden yapılanma üzerine etkilerinin olabileceği yönde olmuştur.

Anahtar Kelime: Kardiyotonik ajanlar Kalp kapağı protezleri Mitral kapak yetmezliği Ventriküler yeniden yapılandırma Mitral kapak Kalp kapağı protezi implantasyonu Dobutamin Ekokardiyografi, stres Strok volümü Ventriküler fonksiyon, sol

Konular: Kalp ve Kalp Damar Sistemi

Mitral kapak replasmanı yapılan hastalarda dobutamin stres ekokardiyografi ile hemodinamik değişikliklerin değerlendirilmesi

Öz:

Objective: The aim of this study was to investigate the response of heart to stress according to the size of the prosthetic valve in patients who had undergone mitral valve replacement by using dobutamine stress echocardiography (DSE) and to evaluate the relationship between the size of the prosthetic valve and cardiac recovery-remodeling process. Methods: Thirty-nine patients, who had undergone mitral valve replacement were compared in terms of left ventricular diameters, systolic functions and cardiac mass indexes in order to investigate the effect of the mechanical valve size on postoperative cardiac remodeling in this longitudinal study. They were divided into three groups according to their valve size: Group 1 (valve size<29 mm, n=11), Group 2 (valve size=29 mm, n=11) and Group 3 (valve size>29 mm, n=17). Statistical analysis was performed using Chi-square and one-way ANOVA tests to determine the statistical differences between the groups. The repeated measurements of two-way ANOVA test was used to analyze effects during long-term follow-up. Results: Only Group 1 patients achieved a significant decrease in terms of left ventricular mass index and end-diastolic diameter (138.3±29.7 g/m2 vs 86.6±15.6 g/m2 and 5.1±0.5 cm vs. 4.4±0.4 cm, p<0.05). Group 3 patients’ left ventricular ejection fraction become worse after theoperation (64.0±5.6% vs. 55.9±6.5%, p<0.05). Maximum and mean pressure gradients across the mitral prosthesis as well as pulmonary artery pressure were significantly increased in all groups during DSE. Maximum gradients increased from 14.2±4.6 to 20.7±7.5 mmHg in Group 1 (p<0.05), 11.6±4.7 to 16.2±6.8 mmHg in Group 2 (p<0.05), and 10.6±3.1 to 20.8±12.7 mmHg in Group 3 (p<0.05). Isovolumic relaxation time decreased in all groups following the dobutamine infusion, as expected, but this decline was not significant in Group 3.Conclusion: A worsening in left ventricular systolic function was observed in large- sized valve prosthesis group. Only the patients who had undergone MVR with small-sized valve prosthesis achieved a decrease in cardiac mass index and preservation of the systolic function. The echocardiographically determined differences and mass index that appeared after the operation may point out that, the effect of theoperation on cardiac remodeling can be related with the ventricular size.

Anahtar Kelime: Echocardiography, Stress Stroke Volume Ventricular Function, Left Cardiotonic Agents Heart Valve Prosthesis Mitral Valve Insufficiency Ventricular Remodeling Mitral Valve Heart Valve Prosthesis Implantation Dobutamine

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	ULUS A, tutun u, BUDAK B, ERBAŞ S, ARAT N, BOZBOĞA S, KÖSE S, SEREN M, PARLAR A, Aksöyek A, KATIRCIOĞLU S (2007). Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. , 397 - 403.
Chicago	ULUS A. Tulga,tutun ufuk,BUDAK Baran,ERBAŞ Sakine,ARAT Nurcan,BOZBOĞA Seher,KÖSE Serdal Kenan,SEREN Mustafa,PARLAR A. İhsan,Aksöyek Ayşen,KATIRCIOĞLU S. Fehmi Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. (2007): 397 - 403.
MLA	ULUS A. Tulga,tutun ufuk,BUDAK Baran,ERBAŞ Sakine,ARAT Nurcan,BOZBOĞA Seher,KÖSE Serdal Kenan,SEREN Mustafa,PARLAR A. İhsan,Aksöyek Ayşen,KATIRCIOĞLU S. Fehmi Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. , 2007, ss.397 - 403.
AMA	ULUS A,tutun u,BUDAK B,ERBAŞ S,ARAT N,BOZBOĞA S,KÖSE S,SEREN M,PARLAR A,Aksöyek A,KATIRCIOĞLU S Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. . 2007; 397 - 403.
Vancouver	ULUS A,tutun u,BUDAK B,ERBAŞ S,ARAT N,BOZBOĞA S,KÖSE S,SEREN M,PARLAR A,Aksöyek A,KATIRCIOĞLU S Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. . 2007; 397 - 403.
IEEE	ULUS A,tutun u,BUDAK B,ERBAŞ S,ARAT N,BOZBOĞA S,KÖSE S,SEREN M,PARLAR A,Aksöyek A,KATIRCIOĞLU S "Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography." , ss.397 - 403, 2007.
ISNAD	ULUS, A. Tulga vd. "Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography". (2007), 397-403.

APA	ULUS A, tutun u, BUDAK B, ERBAŞ S, ARAT N, BOZBOĞA S, KÖSE S, SEREN M, PARLAR A, Aksöyek A, KATIRCIOĞLU S (2007). Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. Anadolu Kardiyoloji Dergisi, 7(4), 397 - 403.
Chicago	ULUS A. Tulga,tutun ufuk,BUDAK Baran,ERBAŞ Sakine,ARAT Nurcan,BOZBOĞA Seher,KÖSE Serdal Kenan,SEREN Mustafa,PARLAR A. İhsan,Aksöyek Ayşen,KATIRCIOĞLU S. Fehmi Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. Anadolu Kardiyoloji Dergisi 7, no.4 (2007): 397 - 403.
MLA	ULUS A. Tulga,tutun ufuk,BUDAK Baran,ERBAŞ Sakine,ARAT Nurcan,BOZBOĞA Seher,KÖSE Serdal Kenan,SEREN Mustafa,PARLAR A. İhsan,Aksöyek Ayşen,KATIRCIOĞLU S. Fehmi Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. Anadolu Kardiyoloji Dergisi, vol.7, no.4, 2007, ss.397 - 403.
AMA	ULUS A,tutun u,BUDAK B,ERBAŞ S,ARAT N,BOZBOĞA S,KÖSE S,SEREN M,PARLAR A,Aksöyek A,KATIRCIOĞLU S Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. Anadolu Kardiyoloji Dergisi. 2007; 7(4): 397 - 403.
Vancouver	ULUS A,tutun u,BUDAK B,ERBAŞ S,ARAT N,BOZBOĞA S,KÖSE S,SEREN M,PARLAR A,Aksöyek A,KATIRCIOĞLU S Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography. Anadolu Kardiyoloji Dergisi. 2007; 7(4): 397 - 403.
IEEE	ULUS A,tutun u,BUDAK B,ERBAŞ S,ARAT N,BOZBOĞA S,KÖSE S,SEREN M,PARLAR A,Aksöyek A,KATIRCIOĞLU S "Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography." Anadolu Kardiyoloji Dergisi, 7, ss.397 - 403, 2007.
ISNAD	ULUS, A. Tulga vd. "Evaluation of hemodynamic changes in patients with mitral valve replacement using dobutamine stress echocardiography". Anadolu Kardiyoloji Dergisi 7/4 (2007), 397-403.