Buradasınız

ÇOCUKLUK ÇAĞINDAKİ MASUM ÜFÜRÜMLERDE EKOKARDİYOGRAFİK İNCELEME YAPALIM MI?

DO WE PERFORM ECHOCARDIOGRAPHY ASSESMENT FOR INNOCENT HEART MURMURS IN CHILDHOOD?

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
Aim: It is aimed to evaluate the necessity of echocardiographic asssesment for the patients in whom the innocent heart murmurs are heard after the cardiovascular system examination. Material and Methods: The files of 466 patients, ages varied between 1 day and 17 years-old, who were per¬formed echocardiographic assessment and referred to our Pediatric Cardiology Outpatient Clinic because of innocent heart murmur due to physical examination, electrocardiography and telecar-diograpy between June 2007- December 2007 were evaluated respectively. Result: Patients who have innocent heart murmurs were not detected any important cardiac patology for hemodynam¬ic physiology. Also, when the innocent heart murmurs is evaluated according to types, it is deter¬minated that the most heart murmur is the innocent pulmoner murmur (47,4%). Results: In 69% of the patients who were performed ecocardiographic assesment, minor congenital heart anomalies were establised with any hemodynamic abnormalities and also 12% of them were given infective endocarditis preventive treatment. For this reason; it is determined to be suitable that echocardio-graphic assesment for the children who are reffered to our outpatient clinic because of heart mur¬mur in physical examination despite the result of innocent heart murmur.
Abstract (Original Language): 
Amaç: Kardiyovasküler sistem muayenesi sonucu masum üfürüm ön tanısı konulan hastaların kesin tanısında ekokardiyografinin mutlaka gerekip gerekmediğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Haziran 2007 ile Aralık 2007 tarihleri arasında fakültemiz Çocuk Kardiyoloji Polikliniğine ilk kez başvuran ve yaşları 1 gün ile 17 yaş arasında değişen ve fizik muayene, elek¬trokardiyografi (EKG) ve telekardiyografi incelemeleri sonucunda masum üfürüm ön tanısı ile ekokardiyografik inceleme yapılan 466 hastanın dosyaları geriye dönük olarak incelendi. Bulgular: Masum üfürümlü hastaların hiçbirinde hemodinamik olarak önemli kardiyak patoloji tespit edilmedi. Ayrıca masum üfürümler tiplerine göre değerlendirildiğinde, masum pulmoner üfürümünün en yük¬sek oranda (%47.4) duyulduğu tespit edildi. Sonuç: Hastaların % 69'unda ekokardiyografik inceleme ile hemodinamik olarak anlamlı olmayan minör doğumsal kalp hastalıkları tespit edilmiş ve bunların %12'sinin infektif endokardit proflaksisi verilmesi gereken hastalıklar olduğu görülmüştür. Bu nedenle üfürüm duyularak polikliniğimize gönderilen hastalarda fizik muayene ile masum üfürüm düşünülse bile ekokardiyografik inceleme yapılmasının uygun olacağı sonucuna varılmıştır.

REFERENCES

References: 

KAYNAKLAR
1. Advani N, Menamen S, Wilkinson JL.The diagnosis of innocent murmurs in childhood. Cardiol Young 2000.Oct;10(4):340-2.
2. Sapin SO. Recognizing normal heart murmurs: a logic-based mnemonic. Pediatrics 1997; 99(4): 616-9.
3. Smith KM. The innocent heart murmur in children. J Pediatr Health Care 1997;11(5):207-14.
4. Pelench AN.Evaluation of the pediatric patient with cardiac murmur. Pediatr Clin North Am.1999;46(2):167-88.
5. Güven H,Bakiler A R, Kozan M, Aydınlıoglu H, Hel¬vacı M, Dorak C. Yenidoğan servislerinde konjeni-tal kalp hastalıkları. Çocuk saglıgı ve hastalıkları
dergisi 2006.49: 8-11.
6. Newburger JW, Rosenthal A, Williams RG, Fel¬lows K, Miettinen OS. Non invasive tests in the ini¬tial evaluation of heart murmurs in children. N Engl J Med 1983;308:61-4.
7. Smythe JF, Teixeira OHP, Vlad P, Demers PP, Feld¬man W. Initial evaluation of heart murmurs: Are laboratory tests necessary? Pediatrics 1990; 86:497-500.
8. Çakır M, Karaaslan S, Oran B, Başpınar O, Baysal T.Çocukluk çağındaki masum üfürümlerin tanısın¬da ekokardiyografinin yeri.Türkiye Klinikleri J Pedi¬atr 2002.11:76-82.
9. Paraskos JA. The innocent murmur. Hosp Pract
1988;23:20-9.
10. Kılıç Z, Özer R, Koçak K, Tekin N. Çocukluk çağı üfürümlerinin değerlendirilmesinde oskültasyonun önemi.Türk Kardiyoloji Derneği 1995.23(1):102-6.
11. Driscoll D, Allen HD, Atkins DL et al. Guidelines for evaluation and management of common con¬genital cardiac problems in infants, children and adolescents. Circulation 1994;90:2180-8.
12. McCrindle BW, Shaffer KM. An evalation of parental concerns and misperceptions about heart murmurs. Clin Pediatr 1995;34:25-34.
13. McCrindle BW, Shaffer KM; Kan JS, Zahka KG, Rowe SA, Kidd L. Cardial clinical sings in the dif-ferentiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996;150:169-74.
14. Du Z-D, Roguin N, Barak M. Clinical and echocar-diographic evaluation of neonates with heart mur¬murs. Acta Paediatr 1997;86.752-6.
15. Bansal M, Jain H. Cardiac murmur in neonates. In¬dian Pediatrics 2005;42:397-99.
16. Arlettaz R, Archer N,Wilkinson AR.Natural history of innocent heart murmurs in newborn babies:controlled echocardiographic study.Arch Dis Child Fetal Neonatal Ed.1998;78:166-70.
17. Ozçelik N, Atalay S, Tutar E, Ekici F.Prevalence of in-teratrial septal aneurysm in newborns and their natural course. Pediatric Cardiology. 2006;
108:207-10.
18. Azhar AS, Habib HS. Accuracy of the initial evalua¬tion of heart murmurs in neonates: do we need an echocardiogram? Pediatr Cardiol. 2006;
27:234-7.
19. Firpo C, Pellanda L, Gomes GH, Casonato S, Sturm A. Echocardiographic findings in children with "in¬nocent" murmur. Rev Assoc Med Bras 2006;
52:261-4
20. Wilson W, Taubert KA, Gewitz M, Lockhard PB, Baddour LM, Levison M, Bolger A, Cabel CH,Takahashi M,Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P Gardner T, Goff D, Duract DT; American Heart As¬sociation Rheumatic Fever, Endocarditis and Kawasaki Disease Committee; American Heart As¬sociation Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anest¬hesia; Quality of Care And Outcomes Research In¬terdisciplinary Working Group. Prevention of in¬fective endocarditis: guidelines from the American Heart Association: a guidelines from the American Heart Association Rheumatic Fever,Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Car¬diovascular Surgery and Anesthesia, and the Quality of Care and Qutcomes Research Interdis¬ciplinary Working Group.Circulation.2007 Oct 9;116(15):1736-54.
21. Geva T, Hegesh J, Frand M. Reappraisal of the approach to the child with heart murmurs: is ec-hocardiography mandatory? Int J Cardiol 1988;
19:107-13.
22. Van Oort A, Hopman J, De Boo T, Van Der Werf T, Rohmer J, Daniels O. The vibratory in¬nocent heart murmur in schoolchildren: a care-control Doppler echocardiographic study. Pediatr
Cardiol 1994;15:275-81.
23. Karaaslan S, Demirören S, Oran B, Baysal T, Bas-pinar O, Uçar C. Criteria for judging the imp¬rovement in subclinical rheumatic valvitis. Cardiol Young. 2003; 13(6): 500-5.

Thank you for copying data from http://www.arastirmax.com