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Öğe Assessment of diastolic function in children and adolescents with beta-thalassemia major by tissue Doppler imaging(Aves, 2011) Yavuz, Taner; Nisli, Kemal; Oner, Naci; Ertugrul, Turkan; Salcioglu, Zafer; Aydogan, Gonul; Karakas, ZeynepAim: The purpose of this study was to analyze myocardial diastolic function in patients with beta-thalassemia major before development of overt cardiomyopathy using pulsed wave tissue Doppler imaging, and compare data with conventional Doppler echocardiography. Material and Method: The study included 61 beta-thalassemia major subjects (age 4 to 20 years; mean age, 10.7 +/- 4.1 years; 32 females and 29 males) with normal left ventricular function and 52 healthy control subjects, matched for age and sex. All participants underwent M-mode echocardiography and left ventricular systolic function was measured; diastolic functions of the right and left ventricul were analysed using tissue Doppler imaging and conventional Doppler echocardiography. SPSS for Windows 13.0 software programme was used for statistical analysis, and the student's t-test was used to compare data. This study was approved by the ethics committee of the Istanbul Medical Faculty. Results: Body surface area was significantly smaller in the patients than in the controls (1.0 +/- 0.2 vs. 1.2 +/- 0.3 m(2), p < 0.01). Transmitral early peak velocity and ratio were found to be significantly increased in patients compared with the controls (p < 0.01 and p=0.039, respectively). Late peak velocity of mitral valve and all Doppler velocities across the tricuspid valve did not differ between groups (p > 0.05). In patients with beta-thalassemia major, the early diastolic velocities of the myocardium at the base of the left and right ventricle, at the middle segment of the left and right ventricle, and the interventricular septum were found to be higher than controls (p < 0.05). We also found significantly higher late diastolic velocities at the base and middle segments of right ventricle, early and late diastolic velocities ratio at the base of the right ventricle and at the middle segment of the left and right ventricle, and the interventricular septum compared with controls (p < 0.05). Conclusions: These findings acquired from the young aged beta-thalassemia major patients with normal ventricular systolic function were believed to be results from high preload and hyperdynamic response to chronic anemia rather than true ventricular restriction. We suggest that long-term follow-up studies should be carried out in patients with beta-thalassemia major using tissue Doppler in order to evaluate the diagnostic accuracy of this imaging technique in diagnosis of early stages of cardiac involvement. (Turk Arch Ped 2011; 46: 26-32)Öğe Beta talasemi majorlu çocuk ve ergenlerde doku Doppler yöntemiyle diyastolik işlevlerin değerlendirilmesi(2011) Yavuz, Taner; Nişli, Kemal; Öner, Naci; Ertuğrul, Türkan; Salcıoğlu, Zafer; Aydoğan, Gönül; Karakaş, ZeynepAmaç: Bu çal›flmada belirgin kardiyomiyopati tablosu geliflmemifl beta talasemi majorlu çocuk ve ergenlerde doku Doppler yöntemi ile miyokard›n diyastolik ifllevlerini incelemek ve bu verileri geleneksel Doppler verileri ile karfl›laflt›rmak amaçland›. Gereç ve Yöntem: Sol ventrikül sistolik ifllevleri normal olan 61 beta talasemi major olgusu (4-20 yafl, ortalama: 10,7±4,1 y›l; 32 k›z, 29 erkek) ile yafl ve cinsiyet aç›s›ndan hasta grubu ile uyumlu 52 kontrol olgusu çal›flmaya al›nd›. Hasta ve kontrol grubunda M-mode ekokardiyografi, sol ventrikülün sistolik ifllevi ölçüldü; sa¤ ve sol ventrikülün diyastolik ifllevleri doku Doppler ve geleneksel Doppler tekni¤i ile de¤erlendirildi. ‹statistik analizler SPSS for Windows 13.0 program› kullan›larak yap›ld›, veriler student-t testi ile karfl›laflt›r›ld›. Bu çal›flma ‹stanbul T›p Fakültesi Etik Komitesi’nce onayland›. Bulgular: Hasta grubunda vücut yüzey alan› (1,0±0,2 m2) kontrol grubundan (1,2±0,3 m2) daha küçük idi p<0,01). Hastalar›n trans-mitral erken ak›m zirve h›z› ve erken ak›m zirve h›z›n›n geç ak›m zirve h›z›na oran› kontrollerden anlaml› olarak yüksek saptand› (s›ras›yla p<0,01 ve p=0,039). Mitral kapak geç ak›m zirve h›z› ve tüm triküspit kapak Doppler ak›m h›zlar› gruplar aras›nda farkl›l›k göstermedi (p>0,05). Beta talasemi major hastalar›n›n miyokard erken diyastolik ak›m h›zlar› sa¤ ventrikül ve sol ventrikül bazalinde, sa¤ ventrikül, sol ventrikül ve interventrikül septumun orta segmentinde kontrolden yüksek bulundu (p<0,05). Geç diyastolik ak›m h›zlar› sa¤ ventrikül bazal ve orta segmentlerde, Erken ve geç diyastolik ak›m oran› ise sa¤ ventrikül bazal ve sa¤ ventrikül, sol ventrikül ve interventrikül orta segmentlerde kontrolden anlaml› yüksek bulundu (p<0,05). Ç›kar›mlar: Normal ventrikül sistolik ifllevleri olan genç yafltaki beta talasemi major hastalar›ndan edinilen bu bulgular, gerçek ventrikül restriksiyonundan ziyade kronik anemiye ba¤l› hiperdinamik yan›t ve yüklenmeyi düflündürmektedir. Doku Doppler ile beta talasemi major hastalar›n›n uzun süreli izlemlerini içeren çal›flmalar›n yap›lmas› ile, doku Doppler görüntülemenin bu hasta grubunda kalbin erken etkilenmesini yans›tmadaki güvenilirli¤inin de¤erlendirilebilece¤i kan›s›nday›z.Öğe Long term follow-up results of 139 Turkish children and adolescents with rheumatic heart disease(Springer, 2008) Yavuz, Taner; Nisli, Kemal; Oner, Naci; Dindar, Aygun; Aydogan, Umrah; Omeroglu, Rukiye Eker; Ertugrul, TurkanWe aimed to evaluate the predictors of the severity of chronic rheumatic valvar disease. The long term follow-up records of 139 patients with chronic rheumatic carditis were reviewed. Children were followed-up on an outpatient basis for a period ranging from 1-16 years (5.0 +/- 3.7 years). Mitral regurgitation either isolated (51%, n=71) or combined with aortic regurgitation (AR) (49%, n = 68) was observed in all cases of the initial attack of rheumatic carditis. AR at initial attack of the rheumatic carditis was found to be affected by gender (AR was more associated with males, p = 0.032), combined mitral and aortic regurgitation (CMAR), and presence of MR at initial attack (p = 0.000 and p = 0.012, respectively) with univariate analysis. The effect of CMAR on AR at initial attack was also significant by multivariate analysis (p = 0.000). CMAR, MR, and AR at initial attack had significant effects on CMAR at final evaluation (p = 0.000, p = 0.020, and p = 0.000, respectively) in univariate analysis. Multivariate analysis revealed the significant effects of CMAR and MR at initial attack on CMAR at final evaluation (p = 0.000 and p = 0.005, respectively). Univariate analysis showed that MR and AR at initial attack, and CMAR at final evaluation, had significant effects on MR at final evaluation (p = 0.000, p = 0.029, and p = 0.000, respectively). MR at initial attack and CMAR at final evaluation had significant effects on MR at final evaluation with multivariate analysis (p = 0.001 and p = 0.003, respectively). AR at final evaluation was affected by CMAR and AR at initial attack (p = 0.000 and p = 0.000, respectively), and CMAR and MR at final evaluation (p = 0.000 and p = 0.000, respectively) with both univariate and multivariate analysis. Mitral valve prolapsus was more common in patients with a longer duration (37.5%, 6 out of 16) than those with a shorter duration (11%, 14 out of 123) and the difference was significant (p = 0.020). In conclusion, the initial severity of valve involvement and the presence of CMAR at initial attack were found to be the best predictors for the severity of chronic rheumatic valvar disease in this study.