The Effect of Guidance of Transesophageal Echocardiography During Percutaneous Balloon Mitral Valvuloplasty on Procedural Success and Complications

Öz

Patients with mitral stenosis (MS) can be treated with percutaneous methods. In this patient population, MS and symptoms can be relieved by percutaneous mitral balloon valvuloplasty (PMBV).  In our study we aimed to investigate the effect of guidance of transesophageal echocardiography (TEE) during PMBV on procedural success and complications in patients with MS. Fourty-five patients who were planning to undergo PMBV because of severe MS were included to the study. Procedure of PBMV performed in 23 patients with TEE guidance (TEE(+)) and in 22 patients without TEE guidance (TEE(-)). Transseptal puncture (TSP) duration, transseptal transition success and transmitral transition success evaluated for each group. All patients treated with PMBV were evaluated with transthorasic echocardiography after 24. h and 12 weeks. The mean age in the TEE(+) group of the study was 47,9±11,4 and  48,5±15 (p=0,88) in TEE(-) group. The mean height was 163,1±7,5 cm in TEE(-) group and 161,7±5,4 cm (p=0,47) in TEE(+) group. It was demonstrated that Wilkins score was 8.5 (7.0-10.0) in the TEE (-) group and 9.0 (7.0-11.0) in TEE (+) group (p = 0.111). TSP duration in the TEE (-) group and TEE (+) group were 25,24 ± 5,1 min. and 21.86 ± 3.8 min (p = 0.02), respectively. In the TEE (-) group, transmitral transition success was 100%, while in the TEE (+) group it was 85.8%. In TEE (+) group, transmitral transition was more unsuccessful but there was no statistically significant difference (p = 0.072). Complications were similar in both groups. It was demonstrated that TEE guidance during PMBV shortened the TSP duration despite there was no effect on complications due to TSP, TSP success, transmitral transition success, operation success, and operation complications. In PMBV procedure, TEE guidance can be added to the conventional methods to shorten the procedure time and minimize radiation exposure.

Anahtar Kelimeler

• Severe mitral stenosis,percutaneous balloon mitral valvulplasty,transseptal puncture,echocardiography

Perkütan Balon Mitral Valvuloplasti Sırasında Transözofajiyal Ekokardiyografi Kılavuzluğunun İşlem Başarısı ve Komplikasyonlar Üzerine Etkisi

Öz

Semptomatik mitral darlığı (MD) hastaları perkütan yolla tedavi edilebilmektedir. Bu hastalarda perkütan mitral balon valvulaplasti (PMBV) ile MD ve semptomları giderilebilmektedir. Bu çalışmamızda ciddi MD hastalarında PMBV işlemi sırasında transözofajiyal ekokardiyografi (TEE) kılavuzluğunun işlem başarısı ve komplikasyonlar üzerine etkisini araştırmak istedik. Çalışmaya ciddi MD ile başvuran ve PMBV yapılması planlanan 45 hasta alındı. PMBV işlemi 23 hastaya TEE kılavuzluğunda (TEE(+)), 22 hastaya ise TEE kılavuzluğu olmadan (TEE(-)) gerçekleştirildi. Çalışmada her iki grubun transseptal ponksiyon (TSP) süresi, septum geçiş başarısı, kapak geçiş başarısı değerlendirildi. PMBV ile tedavi edilen tüm hastalara 24. saat ve 12. haftada transtorasik ekokardiyografi ile değerlendirildi. Çalışmaya alınan hastaların TEE(+) grubunda yaş ortalaması 47,9±11,4, TEE(-) grubunda ise 48,5±15 (p=0,88) idi. TEE(-) grubundaki olguların ortalama boyu 163,1±7,5 cm, TEE(+) grubunda ise 161,7±5,4 cm (p=0,47) olarak gözlendi. TEE(-) grubunda Wilkins skoru 8,5(7,0-10,0), TEE(+) grubunda ise 9,0(7,0-11,0) (p=0,111) olarak gözlendi. TSP süresi TEE(-) grubunda ve TEE(+) grubunda sırasıyla 25,24±5,1 dk. ve 21,86±3,8 dk (p=0,02) olarak tespit edildi. TEE(-) grubunda kapak geçiş başarısı %100 iken, TEE(+) grubunda %85,8 olarak bulundu. TEE(+) grubunda mitral kapak geçişi daha başarısızdı ancak istatistiksel anlamlı fark yoktu (p=0,072). Komplikasyonlar her iki grupta benzerdi. PBMV esnasında kullanılan TEE’nin TSP’den doğan komplikasyonlar, TSP başarısı, kapak geçiş başarısı, işlem başarısı, işlem komplikasyonları üzerine ise herhangi bir etkisinin olmamasına rağmen TSP süresini kısalttığı gösterildi. Hastalarda işlem süresini kısaltmak, radyasyon maruziyetini en aza indirmek için PBMV işlemi sırasında TEE kılavuzluğu konvansiyonel yönteme eklenebilir.

Anahtar Kelimeler

• Ciddi mitral darlığı,perkütan mitral balon valvuloplasti,transeptal ponksiyon

Kaynakça

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