CLINICAL AND EPIDEMIOLOGICAL FEATURES OF THE MITRAL VALVE PROLAPS IN CHILDREN
Autori:
Ivan Malčić, Hrvoje Kniewald, Daniel Dilber, Željka Mustapić, Sanja Dorner
Sažetak
Sažetak. U radu istražujemo učestalost i kliničko značenje prolapsa mitralne valvule u populaciji polikliničkih pacijenata pedijatrijske kardiološke ambulante od studenoga 1999. do travnja 2004. Obuhvaćen je uzorak od 1187-ero djece obaju spolova, 688 je imalo strukturalnu srčanu grešku (57,9%), a izolirani prolaps dijagnosticiran je u 5l djeteta (4,3%) s apsolutnom dominacijom ženskog spola (ž:m=7,5:1). Srednja dob kod postavljanja dijagnoze bila je 12,4±2,9 god. (raspon 6–19 god.). Djeca su bila praćena 3,1±0,9 god. (raspon 1–4 god.). U 25-ero djece (49%) nađena je pridružena insuficijencija mitralne valvule, većinom I. stupnja (80%). Tijekom praćenja nije uočena progresija insuficijencije niti druge moguće komplikacije (aritmije, tromboembolija) ni u jednog djeteta. Dolihostenomelija je nađena u 10-ero djece (19,6%), a spolne razlike nisu ¬utjecale ni na pojavu insuficijencije (p=0,464, df=2, c2 2=1,54) ni na razliku u konstituciji (p=0,766, df=4, c2 2=1,83). Tipične subjektivne tegobe imalo je 37-ero djece (72,5%), od čega 22-je ozbiljnije, pa su liječeni b-blokatorima (propranolol) (43,1%). Srednja dob djece liječene b-blokatorima (13,7±2,5 god.) statistički se razlikuje od srednje dobi neliječenih (11,5±2,9 god.), pa postoji vjerojatnost utjecaja neurohormonalnih čimbenika u uznapredovalom pubertetu na pojavu subjektivnih tegoba (p=0,006, t=–2,86). Najčešći klinički simptom je bol u prsima (95% u skupini s jače izraženim simptomima). Pod utjecajem lijeka simptomi nestaju u 82% bolesnika. Prolaps mitralne valvule je entitet povoljnoga kliničkog tijeka. Valja provoditi profilaksu infektivnog endokarditisa u skupini s mitralnom insuficijencijom, a djecu s jače izraženim tegobama valja liječiti b-blokatorima.
Summary
Summary. The study deals with the incidence and clinical significance of mitral valve prolapse in the population of outpatient pediatric cardiology patients in the time period from November 1999 to April 2004. The sample included 1187 children of both sexes, 688 of whom had a structural cardiac anomaly (57.9%), and the prolapse was diagnosed in 51 children (4.3%), largely female (f:m=7.5:1). The average age at establishing diagnosis was 12.4±2.9 years (range 6–19 years). The children were followed 3.1±0.9 years (1–4 years of age). In 25 children (49%) associated mitral valve insufficiency was found, mostly of the 1st degree (80%). During follow up, neither the progression of the insufficiency nor any other complication was observed (arrhytmia, tromboembolism) in any of the children. Dolichostenomely was found in 10 children (19.6%), and both the development of insufficiency (p=0.464, df=2, c2 2=1.54) and the difference in constitution (p=0.766, df=4, c2 2=1.83) were irrelevant of sex. Typical subjective symptoms were observed in 37 children (72,5%), 22 of whom were treated with b-blockers (propranolol) (43.1%). The average age of the patients treated with b-blockers (13.7±2.5 yr) was statistically different from the average age of untreated patients (11.5±2.9 yr), hence the probability of the influence of neurohormonal factors on the development of subjective symptoms in advanced puberty (p=0.006, t=–2.86). The most common clinical symptom is chest-pain (95% of the group with stronger symptoms). When treated, the symptoms disappear in 82% of the patients. Mitral valve prolapse is the entity of favourable clinical course. The prophylaxis of infective endocarditis should be performed in the group with mitral insufficiency, and the children with stronger symptoms should be treated with b-blockers.
