Mitral kapak prolapsuslu çocuk hastalarda mitral yetersizlik gelişimi ve seyrinin değerlendirilmesi
Evaluation of the development and course of mitral regurgitation in children with mitral valve prolapse
Yazar: TAHİR ÇAĞLAR
Danışman: PROF. DR. MEHMET KERVANCIOĞLU
Gaziantep Üniversitesi / Tıp Fakültesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı / Çocuk Kardiyolojisi Bilim Dalı
Derece: Tıpta Uzmanlık, 2022
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases
Dizin: Mitral kapak = Mitral valve ; Mitral kapak prolapsusu = Mitral valve prolapse ; Mitral kapak yetmezliği = Mitral valve insufficiency ; Çocuk hastalıkları = Child diseases ; Çocuklar = Children

Özet:
Mitral kapak prolapsusu (MVP) mitral kapaktaki fibromiksömatöz değişikliklerin
sonucu olarak, bir veya her iki lifletin sistol sırasında mitral kapak anulusundan sol
atriyuma bombeleşmesi ile meydana gelen bir kapak patolojisidir. Genel
popülasyonda MVP'nin ekokardiyografik olarak görülme sıklığı %2 ile %3
arasındadır. MVP'li hastalarda sıklıkla mitral yetersizlik (MY) eşlik edebilir. Bu
çalışmada iki boyutlu ekokardiyografi ile MVP tanısıyla takipli hastaların, geriye
dönük taranarak, mitral yetersizlik gelişimi ve seyrinin değerlendirilmesi, MVP'ye
eşlik eden ek kardiyak ve ekstrakardiyak patoloji sıklığının değerlendirilmesi
amaçlanmıştır.
Gaziantep Üniversitesi Tıp Fakültesi Çocuk Kardiyolojisi Bilim Dalı'nda 2011-2021
yılları arasında mitral kapak prolapsusu tanısıyla takip edilmiş 202 hasta çalışmamıza
dahil edilmiştir. Tüm hastaların yaşı, cinsiyeti, eşlik eden ek kardiyak ve
ekstrakardiyak bulguların sıklığı, dosyalarındaki ekokardiyografi raporları taranarak
değerlendirilmiş, verilerin analizinde SPSS 25 yazılımından yararlanılmıştır.
MVP'li 202 çocuk hastanın 7 ay-17 yaş arasında tanı aldığı ve hastaların başvuru yaş
ortalamasının 8.73±3,81 olduğu bulundu. Hastaların %94.1'inde MY saptandı.
Hastaların %74.2'sinin kız ve %25.8'inin erkek olduğu tespit edildi. MY gelişme
sıklığı açısından kız ve erkekler arasındaki fark anlamlı bulunmadı. Hastaların
takibinde %32.6'sında MY derecesinin azaldığı, %23.7'sinde artış olduğu ve
%43.5'inin MY derecesinde fark olmadığı tespit edildi. Hastaların %21'inde hafif,
%79'unda belirgin MVP olduğu belirlendi. En sık başvuru, üfürüm nedeni ile
yapılmış olup, sırasıyla; geçirilmiş akut romatizmal ateş öyküsü, Marfan sendromu,
çarpıntı, eklem ağrısı, ateş, sırt ağrısı, göğüs ağrısı, pektus excavatum diğer sık
başvuru nedenlerini oluşturmaktadır. MVP'ye eşlik eden ek kardiyak hastalıklar
sırasıyla en sık ASD, daha sonra TVP, PFO ve VSD olarak bulunmuştur.
Transkateter yolla ASD'si kapatılan MVP'li hastalarda MY seyrinde anlamlı farklılık
bulunmadı. Hastaların EF düzeyi ile MY derecesi arasında da anlamlı ilişki olmadığı

Abstract:
Mitral valve prolapse (MVP) is a valve pathology characterized by the cambering of
one or both leaflets from the mitral valve annulus to the left atrium during systole as
a result of fibromyxomatous changes in the mitral valve. The echocardiographic
incidence of MVP in the general population is between 2% and 3%. Mitral
regurgitation (MR) may often accompany patients with MVP In this context, the
objective of this study is to evaluate the development and course of mitral
regurgitation and to evaluate the frequency of additional cardiac and extracardiac
pathological findings accompanying MVP by retrospectively scanning the patients
followed up with the diagnosis of MVP based on two-dimensional echocardiography.
The study sample consisted of 202 patients who were followed up with the diagnosis
of MVP in Gaziantep University Faculty of Medicine, Department of Pediatric
Cardiology, between 2011 and 2021. The age and gender information, frequency of
additional cardiac and extracardiac pathological findings accompanying MVP and
echocardiography reports available in their files were retrospectively scanned and
evaluated. The resulting data were analyzed using the SPSS 25.00 software package.
The patients included in the study sample at diagnosis were between 7 months and
17 years old. The mean age of the patients at the time of admission to the hospital
due to MVP was 8.73±3.81 years. MR was detected in 94.1% of the patients. It was
determined that 74.2% of the patients were girls, and 25.8% were boys. There was no
significant difference between boys and girls in terms of the incidence of MR. In the
follow-up of the patients, it was determined that the severity of MR decreased by
32.6%, increased by 23.7%, and did not change in43.5% of the patients.
Additionally, it was determined that 21% and 79% of the patients had mild and acute
MVP, respectively. The most common reason for admission was murmur, followed
by a history of acute rheumatic fever, Marfan syndrome, palpitations, arthralgia,
fever, back pain, chest pain, and pectus excavatum, respectively. On the other hand,
the most common additional cardiac disease accompanying MVP was ASD (atrial
septal defect), followed by TVP, patent foramen ovale (PFO), and ventricular septal
defect (VSD), respectively. The course of MR in MVP patients whose ASD was
closed via transcatheter was not significantly different from other MVP patients.
There was also no significant relationship between patients' ejection fraction (EF)
levels and MR severity. Extracardiac pathologies accompanying patients with MVP,
in order of frequency, were determined as Marfan syndrome, mucopolysaccharidosis,
diabetes mellitus, Down syndrome, Niemann-Pick disease, pectus excavatum, and
growth retardation.
The mean age of MVP patients at admission was 8.73±3.81 years. There were three
times more girls than boys with MVP in the study sample. MVP was accompanied
by MR in 94.1% of the patients. The severity of MR did not change significantly
between admission and follow-up. The most common reason for admission was
murmur and chest pain, and the most common accompanying additional cardiac
findings were ASD and TVP. There was no significant relationship between MR
severity and EF level. The most common accompanying extracardiac pathology was
found to be the Marfan syndrome. The study's findings indicate that early diagnosis
and follow-up of MVP are crucial.
Keywords: Mitral valve prolapse, Mitral regurgitation, echocardiography