Estudo da função ventricular direita na estenose mitral reumática

• Autor(a) principal: Marildes Luiza de Castro
• Data de Publicação: 2012
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://hdl.handle.net/1843/BUOS-96ZJLW
• topic: Estenose mitral; Ecocardiograma; Ventrículo direito; Strain; Contração miocárdica; Disfunção ventricular direita; Válvula mitral Doenças; Cardiopatia reumática/ultrassonografia; Coração; Ventrículos do coração; Valva mitral; Ecocardiografia tridimensional; Estenose da valva mitral

Rheumatic heart disease remains a serious health problem in developing countries and is the leading cause of acquired heart disease in young adults. Mitral stenosis is the most common valvular lesion associated to rheumatic heart disease leading to pressure elevation in left atrium, pulmonary hypertension and hence right ventricular overload. The right ventricle function plays an important role in the development of symptoms and affects the functional capacity and survival in patients with mitral stenosis. The present study evaluated right ventricle function in mitral stenosis by echocardiography using various parameters, including tissue Doppler imaging and two-dimensional strain. It is a cross-sectional study where 46 patients with moderate to severe pure mitral stenosis, in sinus rhythm, were included. Patients with other valvular lesions, heart disease or systemic diseases associated were excluded. A control group consisting of 27 healthy individuals with similar age and sex to cases was selected for comparison of echocardiographic parameters of right ventricular function. The mean age of the study population was 42.1 ± 0.6 years and 42 were female, with mean valve area of 1.2 ± 0.3 cm. Nineteen patients were in functional class I, 11 in class II and 7 in class III / IV. Only 17% presented with clinically right ventricular failure. The most commonly used drugs were diuretics and beta blockers. The diameters of the left ventricle and ejection fraction were similar between patients and controls, but the diameter and left atrial volume were greater in the patients. The values of various parameters used for echocardiographic study of right ventricular function were different in patients compared to controls, except the end-diastolic area of the right ventricle. The right ventricular two-dimensional strain was 17.5 ± 3.9% in patients and 21.8 ± 3.4% in controls (p=0.007). The right ventricle strain correlated negatively with systolic pulmonary artery pressure (r = -0.3; p= 0.038). This study demonstrated impaired right ventricle function assessed using several echocardiographic parameters in patients with mitral stenosis and no clinical evidence of right ventricular failure, determined primarily by elevation of pulmonary artery pressure.