Konjenital kalp hastalıklarındaki pulmoner vasküler yatağın değerlendirilmesinde yeni bir ekokardiyografik yaklaşım: Pulmoner arter sertliği

A new echocardiographic approach in assessing pulmonary vascular bed in patients with congenital heart disease: Pulmonary artery stiffness

Bayram BAĞIRTAN, Seden ÇELİK, Tuna TEZEL, Mehmet EREN, Aydın YILDIRIM, Nevzat USLU, Şevket GÖRGÜLÜ, Orhan ÖZER, Zekeriya NURKALEM, Bahadır DAĞDEVİREN

Abstract

Objective: The state of pulmonary vascular bed in congenital heart disease is the predictor of the patients’ clinical condition, prognosis and outcome of surgical intervention.This study aims to investigate the condition of pulmonary vascular bed analysing pulmonary artery stiffness by means of Doppler echocardiography.Method: Thirty-three patients (16 females, mean age 26±15 years) with various congenital heart diseases such as atrial septal defect (20 patients), ventricular septal defect (10 patients), patent ductus arteriosus (2 patients), atrioventricular septal defect ( 1 patient) were enrolled in this study. Systemic flow (Qs), pulmonary flow (Qp), systemic vascular resistance, pulmonary vascular resistance were calculated according to Fick method by using data obtained during left and right heart catheterization. Echocardiographically, pulmonary artery stiffness (PAS) was calculated by using maximal frequency shift (MFS) and accelleration time (AcT) of the pulmonary artery flow trace. PAS (kHz/sec)= MFS/AcT.Results: Invasively, the average Qp/Qs ratio, mean pulmonary artery pressure, and pulmonary vascular resistance were found as 2.58 ± 1.25, 25±20 mmHg, and 135±217 dyn.sec.cm-5, respectively. Echocardiographically, PAS was found to be 33±17 kHz/sec. Pulmonary artery stiffness was correlated with mean pulmonary artery pressure (r=0.63; p

Özet

Konjenital kalp hastalarında pulmoner damar yatağının durumu; hastanın kliniğini, prognozunu ve cerrahi tedaviden göreceği faydayı belirler. Bu çalışma pulmoner arter sertliğini (PAS) Doppler ekokardiyografik olarak hesaplayarak pulmoner damar yatağının durumunu belirlemeyi amaçlamaktadır. Yöntem: Yirmi atriyal septal defekt, 10 ventriküler septal defekt, 2 patent duktus arteriosus ve 1 tane tam atriyoventriküler septal defektli olmak üzere toplam 33 hasta (16 bayan, ortalama yaş 26±15 yıl) çalışmaya alındı. Sağ ve sol kateterizasyonla elde edilen verilerden Fick yöntemine göre sistemik akım (Qs), pulmoner akım (Qp), sistemik damar direnci ve pulmoner damar direnci hesaplandı. Ekokardiyografik olarak pulmoner arter sertliği pulmoner akım Doppler trasesinin pik frekans kayması (PFK) ve akselerasyon zamanından (AZ) hesaplandı: PAS (kHz/sn)= PFK/AZ. Bulgular: invazif olarak elde edilen ortalama Qp/Qs 2.58±1.25, ortalama pulmoner arter basıncı 25±20 mmHg ve pulmoner damar direnci 135±217 dyn-sn.cm-5 bulundu. Ekokardiyografik PAS 33±17 kHz/sn hesaplandı. Pulmoner arter sertliği ortalama pulmoner arter basıncı (r=0.63, p