Echocardiographic study of the effect of angiotensin converting enzyme inhibitors on the left ventricular systolic function in children with rheumatic mitral regurgitation

ABSTRACT

Quantitative Echo-doppler can detect easily mitral regurgitation but flow convergence Echo method provides an alternate for the calculation of the effective regurgitant orifice area [EROA]. Angiotensin convening enzyme inhibitors [A CEI] can decrease the mitral regurgitation by peripheral vasodilatation leading to decrease of the after-load. Study of the left ventricular systolic function and quantification of mitral regurgitation by Echo- cardiographic measurements. Assesment of the effect of ACEI on these measurements. 50 patients with mitral regurgitation 35 with symptomatic regurgitation [GI] and 15 without symptoms [GII] were studied. GI patients were then subdivided into 2 subgroups according to drug intake before and after giving Captopril for one month for the symptomatic patients. The groups were studied by history, clinical examination, E.C.G., X-ray, some laboratory investigations [E.S.R.-A.S.O.T- C.R.P- and C.B.C] and mainly by two-dimension and color Doppler Echocardiography together with quantitative assessment of mitral regurgitant severity by measuring mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice area of the mitral valve with the proximal isovelocity surface area method of the flow convergence region. Our results showed that left ventricular systolic functions [Stroke volume and ejection fraction] increased after A.C.E.I. therapy in both Group1-A and Group1-B together with reduction of the left ventricular end systolic and end diastolic diameters denoting improvement in left ventricular systolic function. As regard mitral regurgitation severity- Mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice area., all were reduced significantly after A.C.E.I. therapy. A.C.E.I. in children with mitral regurgitation improve significantly left ventricular systolic functions and reduces the severity of mitral regurgitation even if patients were taking previously lanoxine