Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Tam Düzeltme Ameliyatı Yapılan Fallot Tetralojili Hastalarda Ritim ve İletim Bozukluklarının İncelenmesi
Evaluation of Rhythm and Conduction Disturbance in Patients with Tetralogy of Fallot Who Underwent Complete Correction Operation
Hülya İNCEa, Nazlıhan GÜNALb, Pelin AYYILDIZb, Metin SUNGURb
aÇocuk Nöroloji BD,
bÇocuk Kardiyoloji BD, Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Samsun
Turkiye Klinikleri J Pediatr. 2014;23(1):1-9
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışma, tam düzeltme ameliyatı yapılmış Fallot tetralojili hastalarda ritim ve iletim bozukluklarının saptanması ve ilişkili olabilecek faktörlerin belirlenmesi amacıyla planlanmıştır. Gereç ve Yöntemler: Çalışma grubuna Fallot tetralojisi tanısıyla ameliyat edilmiş, 4-20 yaş arasında 17 kız ve 12 erkek; kontrol grubuna 5,5-20 yaş arasında 13 kız, 20 erkek alınmıştır. Çalışmaya alınan 29 hasta ve 33 sağlıklı çocuğa elektrokardiyografi (EKG), 24 saatlik Holter monitörizasyon, ekokardiyografi ve egzersiz testi yapılmıştır. Veriler sayı, yüzde ve ortalama±SS ile ifade edilmiştir. Verilerin karşılaştırılmasında ki-kare testi, Fischer'in kesin testi ve McNemar testi kullanılmıştır. Çalışma için etik kurul onayı alınmıştır (2006/188). Bulgular: Hasta grubunda; 1) EKG'de %79,3 komplet sağ dal bloğu, %3,4 ventriküler prematür kontraksiyon, %6,9 sol anterior hemiblok ile uzun QT'nin sağ dal bloğuna eşlik ettiği, 2) Holter monitörizasyonda %62 ritim bozukluğu, 3) egzersiz testinde %6,8 ventriküler ritim bozukluğu saptanmıştır. Kontrol grubunda; 1) EKG'de %6,1 inkomplet sağ dal bloğu, 2) Holter monitörizasyonda %52 ritim bozukluğu saptanmıştır, ancak egzersiz testinde anormallik bulunmamıştır. Hasta grubunda %79,3 pulmoner yetersizlik, %58,6 pulmoner stenoz, %20,7 ventriküler septum defekti saptanmış; pulmoner stenoz bulunan tüm olgularda pulmoner yetersizliğin de eşlik ettiği görülmüştür. Ritim bozukluğunun izlem süresi ve ameliyat yaşıyla ilişkili olmadığı, pulmoner stenoz ile pozitif ilişkili olduğu bulunmuştur. Pulmoner kapaktaki stenoz ve yetersizlik birlikteliğinin, Holter monitörizasyonda ritim bozukluğu oranını arttırdığı görülmüştür. Sonuç: Bu çalışmada Holter monitörizasyon ile ritim bozukluğu saptanabilme oranının EKG'den daha fazla olduğu bulunmuştur. Hasta izleminde, EKG ile birlikte özellikle Holter monitörizasyon ve egzersiz testinin de rutin uygulamada faydalı olacağı düşünülmektedir.

Anahtar Kelimeler: Fallot tetralojisi; elektrokardiyografi; elektrokardiyografi, ambulatuar; egzersiz testi; aritmiler, kardiyak
ABSTRACT
 Objective: This study aims to determine the frequency of rhythm and conduction disorders in patients with tetralogy of Fallot and who underwent complete correction operation and the factors which may be related to them. Material and Methods: The study group, which operated with the diagnosis of tetralogy of Fallot, were taken 17 girls and 12 boys whose between ages of 4-20 years; and the control group 13 girls and 20 boys whose between ages 5,5-20 years. Enrolled 29 patients and 33 healthy children were performed electrocardiography (ECG), 24-hour Holter monitoring, echocardiography and exercise testing. Data were expressed in points, mean±SD and percent. Comparison of data were used with Chi-square test, Fisher's exact test and McNemar's test. Ethics committee approval was obtained for the study (2006/188). Results: In patient groups; 1) ECG records, complete right bundle block at the rate of 79.3%, 3.4% ventricular premature contraction (VPC) and 6.9% left anterior hemiblock and long QT were found to accompany right bundle block, 2) Holter records, rhythm disturbance was found 62% cases, 3) Exercise test frequent ventricular rhythm disturbance was established in 6,8% patients. In control groups; 1) ECG records, incomplete right bundle block was found at the rate of 6.1%, 2) Holter records rhythm disturbance was found 52% cases while no such disturbance was observed on exercise test. After operation, pulmonary failure was found at the rate of 58.6%, pulmonary stenosis 58.6% and ventricular septum defect 20.7%. Pulmonary failue was also present in all cases with pulmonary stenosis. No relation was found between the duration of follow up, the age and type of operation and rhythm disturbance. A positive relation was found between residual pulmonary stenosis and rhythm disturbance. It was also seen that the coexistence of pulmonary failure with pulmonary stenosis increased the rate of the establishment of rhythm disturbances. Conclusion: It was concluded that Holter monitorisation detected rhythm disturbances a higher rate than ECG. Therefore, it is beneficial to use Holter monitorisation and exercise test in addition to ECG.

Keywords: Tetralogy of fallot; electrocardiography; electrocardiography, ambulatory; exercise test; arrhythmias, cardiac

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