Tam düzeltme operasyonu yapılmış olan fallot tetralojili olgularda aritmi komplikasyonunun preoperatif ve postoperatif EKG parametreleri ile değerlendirilmesi
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Tarih
2019
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Ege Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
AMAÇ: Bu çalışmada, opere Fallot tetralojili olgularda EKG bulgularının ve bu bulguların komplikasyonlarla ilişkisinin araştırılması amaçlanmıştır. GEREÇ VE YÖNTEM: Ege Üniversitesi Hastanesi'nde Ocak 2006 – Aralık 2014 arasında tam düzeltme operasyonu yapılan Fallot tetralojili 0-18 yaş arasındaki olgular kaydedildi. Bu olguların arşiv dosyalarında kayıtlı veriler retrospektif olarak incelendi. Operasyon raporu, postoperatif ekokardiyografi raporu, kataterizasyon bilgileri, önceki palyatif operasyon bilgileri, preoperatif ve postoperatif elektrokardiyografi ve Holter elektrokardiyogram sonuçları gibi çalışmaya yön verecek bilgileri eksik olanlar çalışma dışı bırakıldı. Bu kriterlere göre dışlandıktan sonra 38 olgu çalışmaya alındı. Olgular telefon numaraları ile arandı ve çağırıldı. Bilgilendirilmiş Olgu Onam Formu eşliğinde ailelerine bilgi verildi. Onam alındıktan sonra demografik ve klinik verileri kaydedildi, EKO verileri, EKG parametreleri kaydedildi. Veriler SPSS 18.0 programıyla analiz edildi. BULGULAR: Çalışmaya alınan olguların ortanca yaşı 9'du (aralık: 4-21) ve 15'i kız, 23'ü erkekti. Tam düzeltme operasyonu öncesinde 16 olguda palyatif modifiye Blalock-Taussing (MBT) şant uygulanmıştı. Düzeltme operasyonunda RVOT genişletilmesi 13 olguda greft, 3 olguda perikardiyal yama, 22 olguda transanuler yamayla yapılmıştı. 3 olguda EKO'da pulmoner gradient <15 mmHg, 28 olguda 15-29 mmHg (hafif), 6 olguda 30-49 mmHg (orta) ve 1 olguda 50 mmHg (ağır) olarak ölçülmüştü. >50 mmHg gradientli hasta saptanmadı. Ayrıca 12 olguda orta, 1 olguda ağır pulmoner yetmezlik (PY) saptandı. Orta-ağır PY saptanan 13 olgunun 5'inde aynı zamanda PS gradientinin ≥30 mmHg olduğu gözlendi. Operasyon tipleri ile PS ya da PY gelişimi arasında ilişki saptanmadı. Tüm olgularda postoperatif dönemde QRS süresinde artış saptandı. QRS süreleri preoperatif dönemde %15,8 olguda >120 msn iken, operasyon sonrası 1. yılda 28,9%, 2. yılda 39,5%, 3. yılda ise 55,3% oranında saptandı. Özellikle postoperatif 3. yılda PY derecesi ile QRS süresi artışı arasında pozitif korelasyon saptandı (p=0,03). QRS süresindeki değişimin operasyon tipi ve PS derecesi ile korelasyonu saptanmadı (p>0,05). PR sürelerinin hastaların tümünde izlemde arttığı gözlenirken operasyon tipi, PS ve PY ile aralarında korelasyon saptanmadı (p>0,05). P dispersiyonu normal sınırlarda (<40 msn) bulundu ancak postoperatif dönemde gruplar arasında anlamlı değişiklik saptanmadı. QRS aksının preoperatif ve postoperatif karşılaştırılmasında PY orta-ağır olan olgularda postoperatif dönemde sol aksa kaydığı, PS ≥30 mmHg olan olgularda ise sağ aksın sebat ettiği görüldü. QTc süresi tüm olgularda artarken diğer bulgularla ve aritmi gelişimi ile korelasyonu saptanmadı. Postoperatif dönemde QTd düzenli bir azalma ya da artış göstermedi; operasyon tipleri ve diğer bulgularla korelasyonu saptanmadı. Postoperatif 3.yılda 31 olguda (%81,57) RBBB, 6 olguda (%15,7) inkomplet sağ dal bloğu ve 1 olguda (%2,6) 1. derece AV blok saptandı. Holter elektrokardiyografide 1 olguda VEV (normal ritmin %5'inden az) ve 1 olguda aralıklı ektopik ritm görüldü. SONUÇ: Çalışmamızda postoperatif PS ve PY gelişim oranları ve QRS artışıyla korelasyonları diğer çalışmalarla benzer şekilde bulunmuştur. QRS süresi >180 msn olan hasta saptanmadı. Ayrıca aritmi gelişimi ve QT dispersiyonunun yapılan diğer çalışmalara göre daha düşük çıkmasının, hasta sayısının ve izlem süresinin diğer çalışmalara görece yetersiz olmasından kaynaklandığını düşünmekteyiz. Postoperatif komplikasyon ve EKG bulgularının; daha çok sayıda hastanın daha uzun süre izlendiği çalışmalarla değerlendirilmesi gerekliliği aklımızda bulundurulmalıdır.
OBJECTIVE: In this study, we aimed to investigate the ECG findings in patients with operated Tetralogy of Fallot and to investigate the relationship between these findings and complications. MATERIAL AND METHODS: Between January 2006 and December 2014, the patients who underwent complete correction operation between 0-18 years of age with Tetralogy of Fallot at Ege University Hospital were recorded. The data of these cases in the archive files were analyzed retrospectively. The subjects in which their cases without operation report, postoperative echocardiography report, catheterization information, previous palliative operative information, preoperative and postoperative electrocardiography and Holter electrocardiogram record results were excluded from the study. 38 subjects were included in the list. The subjects’ parents were informed about study with informed consent form and by the researcher. First, demographic and clinical data were recorded, after that echocardiographic data and ECG parameters were recorded for each case. Data were analyzed with SPSS v18.0 programme. RESULTS: The median age of the subjects was 9 years (range: 4-21). 15 were female and 23 were male. Palliative modified Blalock-Taussing (MBT) shunt was applied in 16 subjects before total correction operation. RVOT widening was performed in 13 subjects with graft, 3 with pericardial patch and 22 with transanular patch. 3 subjects had <15mmHg pulmonary gradient, 28 subjects had 15-29 mmHg (mild), 6 subjects had 30-49mmHg (moderate) and 1 subject had 50 mmHg (severe) pulmonary stenosis (PS). No patient with > 50 mmHg gradient was detected. In addition, 12 patients had moderate and 1 patient had severe pulmonary insufficiency (PI). 5 of 13 patients with moderate-severe PI were also observed to have a PS gradient ≥ 30mmHg. No relationship was found between the operation types and PS or PI development. Postoperative QRS duration was increased in all cases. QRS periods were > 120 ms in 15.8% of patients in the preoperative period, 28.9% at postoperative first year, 39.5% at postoperative 2nd year and 55.3% at postoperative 3rd year. A positive correlation was found between the degree of PI and QRS duration, especially in the postoperative 3rd year (p=0.03). There was no correlation between prolongation of QRS and the degree of PS (p> 0.05). While PR was observed to be increased in all patients, there was no correlation between operation type, PS and PI degrees (p> 0.05). P dispersion was found to be within normal limits (<40 msec) but there was no significant difference between the groups in the postoperative period. In the preoperative and postoperative comparisons of the QRS axis was shifted to the left in the postoperative period in subjects with moderate or severe PI and the right axis persisted in patients with PS ≥30 mmHg. QTc duration was increased in all cases, but no correlation was found with other findings and arrhythmia. QTd did not show a steady decrease or increase in the postoperative period; and had no correlation with the operation types and other findings. At postoperative 3rd year, 31 patients (81.57%) had RBBB, 6 patients (15.7%) had incomplete right bundle branch block and 1 patient (2.6%) had first degree AV block. Holter electrocardiography showed VEP in 1 patient (less than 5% of normal rhythm duration) and intermittent ectopic rhythm in 1 patient. CONCLUSION: In our study, the correlations between postoperative PS and PI rates and prolongation of QRS were found to be similar to other studies. No patient had a QRS duration >180 msec detected. In addition, we think that arrhythmia incidence and QT dispersion are lower than the other studies because of inadequate number of patients and shorter follow-up period compared to other studies. It should be kept in mind that more patients should be evaluated for longer periods of time to define postoperative complications and ECG findings after major cardiovascular interventions.
OBJECTIVE: In this study, we aimed to investigate the ECG findings in patients with operated Tetralogy of Fallot and to investigate the relationship between these findings and complications. MATERIAL AND METHODS: Between January 2006 and December 2014, the patients who underwent complete correction operation between 0-18 years of age with Tetralogy of Fallot at Ege University Hospital were recorded. The data of these cases in the archive files were analyzed retrospectively. The subjects in which their cases without operation report, postoperative echocardiography report, catheterization information, previous palliative operative information, preoperative and postoperative electrocardiography and Holter electrocardiogram record results were excluded from the study. 38 subjects were included in the list. The subjects’ parents were informed about study with informed consent form and by the researcher. First, demographic and clinical data were recorded, after that echocardiographic data and ECG parameters were recorded for each case. Data were analyzed with SPSS v18.0 programme. RESULTS: The median age of the subjects was 9 years (range: 4-21). 15 were female and 23 were male. Palliative modified Blalock-Taussing (MBT) shunt was applied in 16 subjects before total correction operation. RVOT widening was performed in 13 subjects with graft, 3 with pericardial patch and 22 with transanular patch. 3 subjects had <15mmHg pulmonary gradient, 28 subjects had 15-29 mmHg (mild), 6 subjects had 30-49mmHg (moderate) and 1 subject had 50 mmHg (severe) pulmonary stenosis (PS). No patient with > 50 mmHg gradient was detected. In addition, 12 patients had moderate and 1 patient had severe pulmonary insufficiency (PI). 5 of 13 patients with moderate-severe PI were also observed to have a PS gradient ≥ 30mmHg. No relationship was found between the operation types and PS or PI development. Postoperative QRS duration was increased in all cases. QRS periods were > 120 ms in 15.8% of patients in the preoperative period, 28.9% at postoperative first year, 39.5% at postoperative 2nd year and 55.3% at postoperative 3rd year. A positive correlation was found between the degree of PI and QRS duration, especially in the postoperative 3rd year (p=0.03). There was no correlation between prolongation of QRS and the degree of PS (p> 0.05). While PR was observed to be increased in all patients, there was no correlation between operation type, PS and PI degrees (p> 0.05). P dispersion was found to be within normal limits (<40 msec) but there was no significant difference between the groups in the postoperative period. In the preoperative and postoperative comparisons of the QRS axis was shifted to the left in the postoperative period in subjects with moderate or severe PI and the right axis persisted in patients with PS ≥30 mmHg. QTc duration was increased in all cases, but no correlation was found with other findings and arrhythmia. QTd did not show a steady decrease or increase in the postoperative period; and had no correlation with the operation types and other findings. At postoperative 3rd year, 31 patients (81.57%) had RBBB, 6 patients (15.7%) had incomplete right bundle branch block and 1 patient (2.6%) had first degree AV block. Holter electrocardiography showed VEP in 1 patient (less than 5% of normal rhythm duration) and intermittent ectopic rhythm in 1 patient. CONCLUSION: In our study, the correlations between postoperative PS and PI rates and prolongation of QRS were found to be similar to other studies. No patient had a QRS duration >180 msec detected. In addition, we think that arrhythmia incidence and QT dispersion are lower than the other studies because of inadequate number of patients and shorter follow-up period compared to other studies. It should be kept in mind that more patients should be evaluated for longer periods of time to define postoperative complications and ECG findings after major cardiovascular interventions.
Açıklama
Anahtar Kelimeler
Fallot Tetralojisi, Tam Düzeltme, QRS Uzaması, Erken Dönem İzlem, Operasyon Komplikasyonları, Aritmi, EKG, Tetralogy Of Fallot, Total Correction, Prolongation Of QRS, Early Follow-Up, Complications Of Operation, Arrhythmia, ECG
