Aralik 2017
Sirozlu çocuklarda kalp fonksiyonlarinin doku Doppler görüntüleme ile degerlendirilmesi
Valuation of cardiac functions in cirrhotic children using tissue Doppler imaging
- Ana Sayfa
- Sayılar
- Aralik 2017
- Sirozlu çocuklarda kalp fonksiyonlarinin doku Doppler görüntüleme ile degerlendirilmesi...
Inönü Üniversitesi Tip Fakültesi, Çocuk Sagligi ve Hastaliklari Anabilim Dali, 2Çocuk Kardiyolojisi Bilim Dali, 3Çocuk Gastroenterolojisi Bilim Dali, Malatya
Özet
Giris ve Amaç: Sirotik kardiyomiyopati siroz varliginda olusan kardiyakdisfonksiyon olarak tanimlanmaktadir. Pediatrik yas grubunda sirotikkardiyomiyopati ile ilgili yapilmis çok az sayida çalisma vardir. Bu çalis-mada sirozlu çocuklarda kardiyak fonksiyonlar ile pulmoner komplikasyonlari tespit etmek amaçlandi. Gereç ve Yöntem: Bu çalismada Inö-nü Üniversitesi Tip Fakültesi Çocuk Gastroenteroloji Bölümü’nde, Ekim2011-Aralik 2013 tarihleri arasinda retrospektif olarak iki yillik süreçteizlenen 52 sirozlu çocuk hasta ile yas ve cinsiyetleri benzer 30 saglikliçocuk konvansiyonel, renkli Doppler ve doku Doppler ekokardiyorafikgörüntüleme yöntemleriyle degerlendirildi. Bulgular: Çalismaya alinan52 olgunun yas ortalamasi 6.5±4.6 yil, 28’i erkek (%53,3), 24’ü kiz(%47,7) idi. Kontrol grubunun yaslarinin ortalamasi 6.88±3.04 yil, 16’sierkek (%53,3), 14’ü kiz (%46,6) olmak üzere toplam 30 idi. HastalarinM-mod degerlendirmelerinde sol ventrikül arka duvari kontrol grubundan daha kalindi (5.9±1.7 mm ve 5.1±1.8 mm, p:0.03). Renkli Dopplerle mitral kapaktan ölçülen E/A orani hasta grubunda anlamli derecededüsüktü (1.46±0.43 ve 1.61±0.46, p: 0.01). Hasta grubu daha uzunizovolümik relaksasyon süresine (48.5±12.5 ms ve 42.6±11.64 ms,p: 0.001) ve daha kisa izovolümetrik kontraksiyon süresine (43.6±9.5ms ve 48.6±11.6 ms, p: 0.001) sahipti. Hasta grubunda sol ventrikü-lün miyokard performans indeksi anlamli olarak yüksekti (0.57±0.13ve 0.50±0.67, p: 0.02). Hastalarin 8 tanesine (%15) hepatopulmonersendrom tanisi kondu. Hepatopulmoner sendromlu hastalarin ekokardiyografik degerlendirilmelerinde, hepatopulmoner sendromu olmayanhasta grubuna göre interventriküler septum diastolik kalinligi (6,9±1.2mm ve 6.4±1.8 mm, p: 0.04) ve yavaslama süresi (154.1± 35.6 ms ve140.4±39.8 ms, p: 0.03) daha fazla idi.Sonuç: Sirotik çocuklarda bastadiyastolik disfonksiyon olmak üzere kardiyak disfonksiyon vardir. hepatopulmoner sendromlu grupta bu etkilenme daha fazladir. Çalismamizdoku Doppler ekokardiyografinin, hastalik progresyonunun saptanmasive izlenmesi için yararli bir yöntem oldugunu göstermektedir.
Abstract
Background and Aims: Cirrhotic cardiomyopathy is defined as cardiac dysfunction in the presence of cirrhosis. Several studies have beenconducted on cirrhotic cardiomyopathy in cirrhotic children. The aim ofthis study was to investigate cardiac functions and pulmonary complications in children with cirrhosis. Materials and Methods: This studyincluded 52 cirrhotic pediatric patients who were followed up for 2years from October 2011 to December 2013 at Inönü University, Faculty of Medicine, Department of Pediatric Gastroenterology. In addition,30 healthy children of similar age and sex were recruited and assessedusing conventional echocardiography, color Doppler echocardiography,and tissue Doppler echocardiography. Results: Mean age of the 52patients in the study group was 6.5±4.6 years; 28 patients were males(53.3%), and 24 were females (47.7%). The mean age of the controlgroup children was 6.88±3.04 years; 16 were males (53.3%), and 14were females (46.6%). M-mode echocardiographic evaluations of thepatients showed increased left ventricular posterior wall thickness compared with that in control children (5.9±1.7 and 5.1±1.8 mm, p=0.03).The mean E/A ratio measured using colored dorsal mitral valve wassignificantly lower in the patient group than that in the control group(1.46±0.43 and 1.61±0.46, p=0.01). The patient group had longerisovolumic relaxation time (48.5±12.5 and 42.6±11.64 ms, p=0.001)and shorter isovolumetric contraction time (43.6±9.5 and 48.6±11.6ms, p=0.001) than those in the control group. The myocardial performance index of left ventricle was significantly higher in the patientgroup (0.57±0.13 and 0.50±0.67, p=0.02) than that in the controlgroup. Eight patients (15%) were diagnosed with hepatopulmonarysyndrome. Echocardiographic evaluations of patients with hepatopulmonary syndrome showed that the interventricular septum diastolicthickness (6.9±1.2 and 6.4±1.8 mm, p=0.04) and the deceleration time(154.1±35.6 and 140.4±39.8 ms, p=0.03) were greater than those inthe non- hepatopulmonary syndrome patient group. Conclusion: Cirrhotic children have cardiac dysfunction, especially diastolic dysfunction. This effect is more pronounced in patients with hepatopulmonarysyndrome. Tissue Doppler echocardiography provides a quantifiableindicator that is useful for the detection and monitoring of disease progression.
