MİTRAL KAPAK KALSİYUM DÜZEYİNİN DOKU KAREKTERİZASYON YÖNTEMİ İLE DEĞERLENDİRİLMESİ

Öz

Amaç: Mitral kapak hastalığının etyolojisinde çeşitli faktörler rol oynamaktadır. Mitral kapak hastalıklarında müdahalenin zamanı klinisyen için önemli bir problemdir. Müdahale kararı verilse bile kapak yapı ve morfolojisi seçilecek yöntemi etkilemektedir. Çalışmamızda mitral kapak hastalıklarında müdahalenin şeklini belirleyen en önemli faktörlerden biri olan kapak kalsifikasyonun derecesinin değerlendirilmesinde non-invazif bir yöntem olan Integrated Backscatter’in (IBS) geçerliliğini sınadık. Materyel ve metod: Bu amaçla çalışmaya mitral kapak replasmanı endikasyonu konulan 15 kadın, 5 erkek toplam 20 hasta alındı. Operasyon öncesi bütün hastalara standart transtorasik ekokardiyografi yapıldı. IBS ölçümleri parasternal uzun eksen, apikal dört boşluk, apikal iki boşluk pencerelerinden yapıldı. Her pencerede kapakta 5 noktadan IBS ölçümü yapılarak bulunan değerlerin ortalaması alındı. Kazanç etkisinden kurtulmak için kapak IBS değerlerinin interatrial septum ve sol atrial boşluk IBS değerleri toplamlarına oranı kullanıldı. Operasyonla çıkarılan kapaklardaki kalsiyum seviyesi atomik absorbsiyon yöntemi ile çalışıldı. Bulgular: Veriler ortalama ± standart sapma olarak ifade edildi. Gruplar arası farklılıklar Kruskal-Wallis ile test edildi. IBS değerleri ile kapak kalsiyum seviyesi arasındaki ilişki korelasyon analizi ile test edildi. Koralesyon analizinde mitral kapak kalsiyum konsantrasyonu ile IBS oranı arasında anlamlı ilişki gösterildi.(r: 0.7; p<0.05). Sonuç: Çalışmamızda IBS tekniğinin mitral kapak kalsiyum içeriğini tayin edebilen non-invazif, kantitatif bir yöntem olduğu gösterildi. Bu yöntem mitral kapak hastalıklarında müdahalenin şekli ve zamanlamasında yardımcı bir parametre olabilir.

Anahtar Kelimeler

• Integrated backscatter
• mitral kapak hastalığı.
• atomik absorbsiyon
• mitral valvular disease
• atomic absorbtion

EVALUATION OF MITRAL VALVULAR TISSUE CALCIUM LEVEL WITH INTAGRETED BACKSCATTER METHOD

Abstract

Objectives: A lot of factors play role in the etiology of mitral valvular disease. Timing and type of the intervention for mitral valve disease are difficult problems for clinicians. Albeit the decision of intervention such as surgery or percutenous balloon valvotomy is given, valvular structure and morphology have been affecting the type of the intervention. We tried integrated backscatter (IBS) method which measures tissue density non-invasively in evaluating of valvular calcification degree that is one of the most important factors affecting the type of intervention in mitral valvular disease. Methods: 20 patients, 15 female and 5 male, in whom indications of mitral valve replacement were present were included. Routine transthoracic two-dimensional echocardiography was performed to all patients preoperatively. Also integrated backscatter records were taken in apical four chambers, apical two chambers and parasternal long axis views. IBS measurements were taken from five points for each leaflet and averaged. This approach was repeated in each echocardiographic window. To get rid of gain effect, total average valvular IBS value was divided by average value of interatrial septum plus left atrial cavity IBS value. Calcium level in the excised mitral valve was studied with atomic absorption spectrofotometry method. Results: All data were expressed as mean ± standard deviation. Multiple group comparison was performed with Kruskal-Wallis test. Relationship between IBS value and valvular calcium level was tested with correlation analysis. Correlation analysis showed significant relationship between calcium level and IBS ratio (r:0.7; p<0.05). Conclusions: In our study, it was documented that integrated backscatter imaging method determines non-invasively mitral valvular calcium level. This method might play a role in the timing and selection of the type of intervention in mitral valvular disease.

Keywords

• Integrated backscatter
• mitral valvular disease
• atomic absorbtion

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