The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study

KORKMAZ, Şule; ARAT, Nurcan; Altay, Hakan; İLKAY, Erdoğan

The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study

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

Hakan ALTAY, (Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye)

Şule KORKMAZ, (Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye)

Erdoğan İLKAY (Mesa Hastanesi, Ankara, Türkiye)

Türk Kardiyoloji Derneği Arşivi

1 0

Yıl: 2008 Cilt: 36 Sayı: 4 Sayfa Aralığı: 223 - 230 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study

Öz:

Amaç: Romatizmal mitral darlığı (MD) olan hastalarda başlangıç pulmoner arter basıncının (PAB) perkütan mitral balon valvüloplasti (PMBV) sonrası sağ ventrikül fonksiyonlarına etkisi değerlendirildi. Ça lış ma pla nı: Çalışmaya romatizmal MD nedeniyle PMBV uygulanan 56 hasta (15 erkek, 41 kadın; ort. yaş 35) alındı. Hastalar PMBV öncesinde ekokardiyografi ile ölçülen bazal ortanca sistolik pulmoner arter basıncına göre iki grupta (PAP ≥40 mmHg, n=33; PAP <40 mmHg, n=23) değerlendirildi. Sağ ventrikül fonksiyonları pulse wave doku Doppler ekokardiyografi ve Tei indeksi ile değerlendirildi. Tüm ölçümler PMBV’den 48 saat ve üç ay sonra tekrarlandı. Bul gu lar: İşlem öncesinde iki grupta benzer olan triküspid lateral annulusun tepe sistolik (S) hızı, pulmoner arter hipertansiyonu (PAH) olan grupta ilk 48 saatte hafif artış gösterdi, üçüncü ayda ise başlangıç değerinin gerisine düştü; PAH olmayan grupta ise ilk 48 saatte anlamlı artış göstererek bu düzeyini üçüncü aya kadar korudu. Tepe geç diyastolik (A) hızlar PAH olmayan grupta tüm ölçümlerde anlamlı derecede yüksek bulundu. Erken/geç diyastolik hız oranı PAH’li grupta başlangıçta ve 48. saatte anlamlı derecede yüksek iken, üçüncü ayda bu fark kayboldu. İzovolümik relaksasyon zamanı PAH’li grupta başlangıçta ve 48. saatte daha yüksek iken, son değerlendirmede sadece bu grupta başlangıç değerinin gerisine düştü. İzovolümik kontraksiyon zamanı, üçüncü aya kadar her iki grupta da anlamlı olmayan artış gösterdi. Sadece PAH’li grupta olmak üzere, üçüncü aya kadar E dalgası deselerasyon zamanında anlamlı, kontraksiyon zamanında hafif artış görüldü. Başlangıçta PAH’li grupta anlamlı derecede yüksek (p=0.004) olan Tei indeksindeki değişimler gruplarda anlamlı farklılık göstermedi. So nuç: Bulgularımız, romatizmal MD’li hastalarda PMBV’nin PAH gelişiminden önce uygulanması halinde, sağ ventrikül longitudinal fonksiyonlarında daha fazla düzelme sağlayabileceğini göstermektedir.

Anahtar Kelime: Hemodinamikler Pulmoner arter Kan akım hızı Mitral kapak Tedavi sonucu Ventriküler fonksiyon, sağ Ekokardiyografi, doppler, pulzasyonlu Romatizmal kalp hastalığı Mitral kapak darlığı Pulsatil akım Balon dilatasyonu Diyastol

Konular: Kalp ve Kalp Damar Sistemi

Romatizmal mitral darlığı olan hastalarda bazal pulmoner arter basıncının perkütan mitral balon valvüloplasti sonrası sağ ventrikül fonksiyonlarına etkisi: Doku Doppler görüntüleme çalışması

Öz:

Objectives: We evaluated the effect of baseline pulmonary artery pressure (PAP) on right ventricular functions after percutaneous mitral balloon valvuloplasty (PMBV) for rheumatic mitral stenosis (MS). Study design: The study included 56 patients (15 males, 41 females; mean age 35 years) who underwent PMBV for isolated rheumatic MS. The patients were divided into two groups according to the baseline median systolic pulmonary artery pressure (PAP ≥40 mmHg, n=33; PAP <40 mmHg, n=23) measured before PMBV by echocardiography. Right ventricular function was assessed by pulse wave Doppler tissue imaging and the Tei index. Assessments were repeated 48 hours and three months after PMBV. Results: The peak systolic (S) velocity of the lateral tricuspid annulus did not differ between the two groups at baseline. In patients with pulmonary artery hypertension (PAH), it showed a slight increase at 48 hours, but fell behind the baseline at three months. In patients without PAH, it showed a significant increase at 48 hours and remained unchanged at three months. Peak late diastolic (A) velocities were significantly higher at all times in patients without PAH. Patients with PAH had a significantly higher E/A ratio both at baseline and at 48 hours; however, at three months, this difference disappeared. Patients with PAH had higher isovolumic relaxation time (IVRT) at baseline and 48 hours; however, final IVRT was lower than the baseline only in patients with PAH. Isovolumic contraction time showed a steady but insignificant increase in both groups over three months. E-wave deceleration time showed a significant increase and contraction time showed a slight increase over three months only in patients with PAH. The baseline Tei index was higher in patients with PAH (p=0.004). Changes in the Tei index over time were not significant. Conclusion: Our findings suggest that, If PMBV is performed before the development of PAH, it may be more effective in the improvement of right ventricular longitudinal functions in patients with rheumatic MS.

Anahtar Kelime: Rheumatic Heart Disease Mitral Valve Stenosis Pulsatile Flow Balloon Dilatation Diastole Hemodynamics Pulmonary Artery Blood Flow Velocity Mitral Valve Treatment Outcome Ventricular Function, Right Echocardiography, Doppler, Pulsed

Konular: Kalp ve Kalp Damar Sistemi

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

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APA	ARAT N, Altay H, KORKMAZ Ş, İLKAY E (2008). The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. , 223 - 230.
Chicago	ARAT Nurcan,Altay Hakan,KORKMAZ Şule,İLKAY Erdoğan The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. (2008): 223 - 230.
MLA	ARAT Nurcan,Altay Hakan,KORKMAZ Şule,İLKAY Erdoğan The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. , 2008, ss.223 - 230.
AMA	ARAT N,Altay H,KORKMAZ Ş,İLKAY E The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. . 2008; 223 - 230.
Vancouver	ARAT N,Altay H,KORKMAZ Ş,İLKAY E The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. . 2008; 223 - 230.
IEEE	ARAT N,Altay H,KORKMAZ Ş,İLKAY E "The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study." , ss.223 - 230, 2008.
ISNAD	ARAT, Nurcan vd. "The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study". (2008), 223-230.

APA	ARAT N, Altay H, KORKMAZ Ş, İLKAY E (2008). The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. Türk Kardiyoloji Derneği Arşivi, 36(4), 223 - 230.
Chicago	ARAT Nurcan,Altay Hakan,KORKMAZ Şule,İLKAY Erdoğan The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. Türk Kardiyoloji Derneği Arşivi 36, no.4 (2008): 223 - 230.
MLA	ARAT Nurcan,Altay Hakan,KORKMAZ Şule,İLKAY Erdoğan The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. Türk Kardiyoloji Derneği Arşivi, vol.36, no.4, 2008, ss.223 - 230.
AMA	ARAT N,Altay H,KORKMAZ Ş,İLKAY E The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. Türk Kardiyoloji Derneği Arşivi. 2008; 36(4): 223 - 230.
Vancouver	ARAT N,Altay H,KORKMAZ Ş,İLKAY E The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study. Türk Kardiyoloji Derneği Arşivi. 2008; 36(4): 223 - 230.
IEEE	ARAT N,Altay H,KORKMAZ Ş,İLKAY E "The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study." Türk Kardiyoloji Derneği Arşivi, 36, ss.223 - 230, 2008.
ISNAD	ARAT, Nurcan vd. "The effect of baseline pulmonary artery pressure on right ventricular functions after mitral balloon valvuloplasty for rheumatic mitral stenosis: A tissue Doppler imaging study". Türk Kardiyoloji Derneği Arşivi 36/4 (2008), 223-230.