KONJENITAL IZOLE HAFIF AORT KAPAK VE HAFIF PULMONER KAPAK DARLIGININ DOGAL SEYRI: TEK MERKEZLI BIR TAKIP ÇALISMASI

Abstract

Amaç: Hafif aort darligi (AD) ve hafif pulmoner darligin (PD) dogal seyri hakkindaki bilgilerin birçogu geçmis 35-40 yillik kardiak kateterizasyon kullanilarak yapilmis olan çalismalara dayandirilmaktadir. Bu çalismanin amaci, çocuk hastalarda izole hafif valvüler AD ve izole hafif valvüler PD’nin dogal seyrini, seri Doppler ekokardiyografik ölçümler ile ortaya koymakti. Gereç ve Yöntem: Bu çalismaya hafif AD tespit edilen 50 ve hafif PD tespit edilen 75, toplam 125 çocuk dahil edildi. Hafif AD ve PD’nin klinik seyirleri cinsiyet, ilk tani anindaki yas ve valvüler gradiyente göre karsilastirildi. Bulgular: Tani yasi ortalamasi 26,1±37,6 ay (1 gün-13 yas) idi. Çocuklarin ortalama izlem süresi 27,65±21,60 (1-120) aydi. PD grubunun final gradiyentlerinde baslangica göre belirgin azalma saptandi (19,88±11,21’e karsi 23,58±6,97 mmHg, p=0,001). AD grubunda bir yas alti hastalarda daha belirgin olmak üzere tüm hastalarin final gradiyentlerinde artis saptandi (27,74±14,12’ye karsi 22,42±6,12 mmHg, p=0,002). AD grubunda final gradiyentin ortalamasi, PD grubuna göre daha yüksekti (27,74±14,12’ye karsi 19,88±11,21 mmHg, p=0,001). PD grubunda toplamda hepsi erkek ve =1 yas olan %4 hastada orta-ileri darliga progresyon görüldü. AD grubunun %12’sinde orta-ileri darliga progresyon görüldü. Hafif AD olanlardan iki hastaya, hafif PD olanlardan ise bir hastaya girisim yapildi. Sonuç: Çalismamizda hafif PD’nin hafif AD’ye göre seyrinin daha iyi oldugu ve AD’nin progresyon gösterme riskinin daha yüksek oldugu gösterildi. Bir yas ve altindaki, özellikle erkek hafif PD olgularinda sik olmasa da progresyon saptanabileceginden dikkatli takip yapilmalidir. Hafif AD ise, hastalik her yas grubunda progresif özellik gösterebileceginden yakin takip edilmelidir.

Objective: Most of the available information on the natural history of aortic stenosis (AS) and pulmonary stenosis (PS) in children is based on studies carried out over the past 35-40 years using cardiac catheterization. This study aimed to reveal the natural history of congenital isolated mild valvular AS and PS in children using serial Doppler echocardiographic examinations. Materials and Methods: A total of 125 children, 50 with mild AS and 75 with mild PS, who underwent Doppler echocardiography were included in this study. The prognoses of mild AS and PS were compared according to age, gender, and valvular gradient at the time of initial diagnosis. Results: The mean age of patients was 26.1±37.6 months at diagnosis. The mean follow-up duration was 27.65±21.60 (1- 120) months. There was a significant decrease in the final gradient of the PS group compared to the baseline (23.58±6.97 vs. 19.88±11.21 mmHg, p=0.001). In the AS group, there was an increase in the final gradient, which was more pronounced in patients =1-year-old (22.42±6.12 vs. 27.74±14.12 mmHg, p=0.002). Four percent of patients in the PS group and 12% of patients in the AS group progressed to moderate to severe stenosis. All patients who progressed in the PS group were =1-year-old and male. Conclusion: The results showed that mild PS had a better prognosis than mild AS and that the risk of progression in AS was higher. Careful follow-up should be performed in mild PS cases =1-year-old, especially in boys, since progression may be detected, even if infrequently. Mild AS should also be followed closely, as the disease may show progressive characteristics in all age groups.