Kosuyolu Heart J 2010;13(1)
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Effects of Mitral Balloon Valvuloplasty on Left Ventricular Systolic Functions:
Assessment with Color Tissue Doppler

Mustafa Akcakoyun1, Hekim Karapınar1, Ozlem Esen2, Ramazan Kargın1, Selcuk Pala1,
Yunus Emıroglu1, Zekeriya Kaya1, Cihan Dundar1, Akın Izgi Associate Prof1,
Cevat Kirma Associate Prof1, Ali Metin Esen Associate Prof1


1 Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital,

Department of Cardiology, Istanbul, Turkey

2 İstanbul Memorial Hospital, Department of Cardiology, Istanbul, Turkey

ABSTRACT

Objective: Left ventricular (LV) systolic functions are generally depressed in Mitral Stenosis (MS). Recovery of LV systolic functions demonstrated with 2D echocardiography in some patients by mitral balloon valvuloplasty (MBV). Systolic mitral annular velocity (S') by Tissue Doppler Imaging (TDI) predicts LV systolic function. We aimed to evaluate early effects of MBV on LV systolic function by TDI.

Methods: Forty-eight consecutive patients included to the study (39 female, 36±10 years). A full transthoracic echocardiographic study (TTE) including left ventricular ejection fraction assessment by teicholz method and mitral annular color TDI assessment was performed 24 hours before and after MBV in all patients. MBV performed by İnoue technique under guidance of TTE. Analysis of mitral lateral annular S' wave velocity was performed immediately after echocardiographic examination.

Results: MBV performed successfully in 43 patients (Group A), and severe mitral regurgitation developed in 5 patients (Group B). Mitral valve area, and S' wave velocity increased, mean and maximum mitral gradient, and left atrial diameter, and systolic pulmonary artery pressure (PAP) were reduced significantly by MBV in group A patients

(p<0.01, =0.046, <0.01, <0.01, <0.01, <0.01, respectively). But, only mitral valve area increased significantly in group B patients (p<0.01). LVEF by teicholz did not change significantly in both groups.

Conclusion: Improvements of LV systolic functions after successfull MBV can easily showed by color TDI where 2D echocardiography could not indicate.

Key Words: Mitral stenosis, mitral balloon valvuloplasty, left ventricular function, tissue Doppler Imaging

Mitral Balon Valvuloplastinin Sol Ventrikül Sistolik Fonksiyonları Üzerine Etkisinin
Renkli Doku Doppler ile Değerlendirilmesi

Effects of Mitral Balloon Valvuloplasty on Left Ventricular Systolic Functions:
Assessment with Color Tissue Doppler

Mustafa Akcakoyun1, Hekim Karapınar1, Ozlem Esen2, Ramazan Kargın1, Selcuk Pala1,
Yunus Emıroglu1, Zekeriya Kaya1, Cihan Dundar1, Akın Izgi Associate Prof1,
Cevat Kirma Associate Prof1, Ali Metin Esen Associate Prof1


1 Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital,

Department of Cardiology, Istanbul, Turkey

2 İstanbul Memorial Hospital, Department of Cardiology, Istanbul, Turkey

ÖZET

Amaç: Sol ventrikül (SV) sistolik fonksiyonları mitral darlığı hastalarında genellikle bozulmuştur. Başarılı mitral balon valvuloplasti (MBV) ile SV sistolik fonksiyonlarının bazı hastalarda düzeldiği konvansiyonel yöntemlerle tespit edilmiştir. Doku doppler (DD) ile mitral anulusdan elde edilen sistolik dalga (S')'nın SV sistolik fonksiyonu ile oluştuğu ve hızının SV fonksiyonları ile korele olduğu gösterilmiştir. Bizde MBV ile SV sistolik fonksiyonlarındaki değişimi DD ile değerlendirmeyi amaçladık.

Metod: Ardışık 48 hasta (39 kadın, 36±10 yıl) çalışmaya alındı. Tüm hastalara işlemden önceki 24 saat içinde teicholz yöntemiyle SV ejeksiyon fraksiyonu (EF) ve renkli DD ile elde edilen mitral lateral anulusu S' dalga hızı ölçümünün dahil olduğu ayrıntılı transtorasik ekokardiyografik (TTE) inceleme yapıldı. MBV İnoue tekniği ile TTE kılavuzluğunda yapıldı. TTE MBV'den 24 saat sonra tekrarlandı. Veriler paired sample t-test ile değerlendirildi.

Bulgular: MBV 43 hastada başarılı (A grubu) olurken, 5 hastada ileri mitral yetersizliği (B grubu) gelişti. Her iki gruptaki hastaların kapak alanları anlamlı olarak arttı. A grubu hastaların ortalama ve maksimum mitral gradyentleri, sol atriyum çapı, sistolik pulmoner arter basıncı azalırken, mitral kapak alanı ve mitral anuler S' dalga hızları anlamlı olarak arttı (p<0.01, <0.01, <0.01, <0.01, <0.01, =0.046, sırasıyla). B grubu hastalarda ise kapak alanı artışı dışında hiçbir değişkende anlamlı değişiklik olmadı. Her iki grubun EF'lerinde de anlamlı değişiklik olmadı.

Sonuç: Başarılı MBV ile SV fonksiyonlarında düzelmenin olduğu, konvansiyonel yöntemlerle belirgin olarak tespit edilemese de, DD ile tespit edilebilmiştir. Ancak aynı düzelme ileri MY gelişen grupta izlenmemiştir.

Anahtar Kelimeler: Mitral darlığı, mitral balon valvuloplasti, sol ventrikül fonksiyonu, doku doppler görüntüleme

ABSTRACT

Objective: Left ventricular (LV) systolic functions are generally depressed in Mitral Stenosis (MS). Recovery of LV systolic functions demonstrated with 2D echocardiography in some patients by mitral balloon valvuloplasty (MBV). Systolic mitral annular velocity (S') by Tissue Doppler Imaging (TDI) predicts LV systolic function. We aimed to evaluate early effects of MBV on LV systolic function by TDI.

Methods: Forty-eight consecutive patients included to the study (39 female, 36±10 years). A full transthoracic echocardiographic study (TTE) including left ventricular ejection fraction assessment by teicholz method and mitral annular color TDI assessment was performed 24 hours before and after MBV in all patients. MBV performed by İnoue technique under guidance of TTE. Analysis of mitral lateral annular S' wave velocity was performed immediately after echocardiographic examination.

Results: MBV performed successfully in 43 patients (Group A), and severe mitral regurgitation developed in 5 patients (Group B). Mitral valve area, and S' wave velocity increased, mean and maximum mitral gradient, and left atrial diameter, and systolic pulmonary artery pressure (PAP) were reduced significantly by MBV in group A patients

(p<0.01, =0.046, <0.01, <0.01, <0.01, <0.01, respectively). But, only mitral valve area increased significantly in group B patients (p<0.01). LVEF by teicholz did not change significantly in both groups.

Conclusion: Improvements of LV systolic functions after successfull MBV can easily showed by color TDI where 2D echocardiography could not indicate.

Key Words: Mitral stenosis, mitral balloon valvuloplasty, left ventricular function, tissue Doppler Imaging

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