الفهرس 
ThalassemiaOnly 14 pages are availabe for public view
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Abstract
Beta-thalassemia is a major health problem in Egypt and other countries. It constitutes 39% of the total hematological patients and 84% of chronic hemolytic Anemia. Over 1000 newborns are expected to be affected with this disorder annually in Egypt (Eid, 1993).
Repeated blood transfusion is the main option in keeping those patients alive, but it has complications of increased iron burden and consequent multi-organ affection due to deposition of iron in their tissues (Mostafa, 1994).
Cardiac disorders related to biventricular failure are the most frequent cause of death in patients with beta-thalassemia major. Initial cardiac changes has been documented by conventional echocardiography without clinical, ECG or radiological manifestations(LanzKawsky, 2000).
TDE has been introduced recently as a new technique to diagnose early cardiac dysfunction through detecting wall motion abnormalities before development of heart failure.
This study was done on 20 thalassemic children 2-18 years old whose attending to pediatric clinic of Benha University Hospital and 20 healthy children age & sex matched to the studied group as control group.
The patients were subjected to history taking, clinical examination, and echocradiagraphy examination, through measuring LVEDD, LVESD, EF, FS and transmitral Doppler flow of E &A waves.
Patients have also undergone TDE for imaging of the base, middle part, and apex of the free walls of the R.V. and L.V. and the septum.
Our data show that patients with thalassaemia have both global and regional RV and LV dysfunction on the basis of abnormal tissue Doppler derived myocardial velocities. Regional wall motion abnormalities detected by TDE can be present even in patients whose conventional indices of global systolic function, such as ejection fraction are within the normal range. The regional wall motion abnormalities are related to myocardial iron overload and are likely to represent evidence of iron induced myocardial dysfunction.
Conventional M-mode techniques have failed to distinguish LV function of patients with thalassaemia and iron overload from that of normal controls when global function was examined. However more detailed analysis of digitized M-mode echocardiographic tracings has detected abnormal segmental changes in contraction and relaxation (Vogel et al., 2003).
Our study confirms and extends these observations with the novel technique of TDE, which allows the evaluation of regional ventricular function.
The magnitude of systolic myocardial velocities measured by TDE at the base of the heart reflecting global long axis function was reduced in both LV and RV, while ejection fraction was still within the normal range.
We also measured abnormal early and late diastolic myocardial velocities, and abnormal relations between e- and a-velocities.
This is in keeping with our observation that regional wall motion in patients with thalassaemia and iron overload is altered in the absence of global dysfunction.