Splenectomized versus non-splenectomized patients with thalassemia major. Echocardiographic comparison.

Objective: To study the effect of splenectomy in patients with thalassemia major on the cardiovascular system through echocardiographic study.

Methods: A prospective, cross sectional study was carried out from December 2006 to December 2007. Patients from the Thalassemia Center in the Maternity and Children's Hospital, Madina, Kingdom of Saudi Arabia, were screened by means of history, physical examination, laboratory studies, and echocardiography.

Results: Fifty-seven patients were studied: 36 were non-splenectomized, while 21 were surgically splenectomized. The 2 study groups were well matched for age, gender, height, and weight. The total amount of blood given during the previous year (6577.1+/-206.9 ml versus 5390.5+/-220.2 ml, p=0.0005), and the annual transfusion index (200.9+/-11.3 versus 134.1+/-7.3, p=0.0001) were significantly lower in the splenectomized group. There was no significant difference between the 2 groups regarding laboratory studies. Left ventricular systolic function shows no difference regarding fraction shortening between the 2 groups. The mitral valve E/A ratio was significantly higher in the splenectomized group (1.6+/-0.2 versus 1.4+/-0.2, p=0.02). The pulmonary artery pressure was higher in the splenectomized group (34.2+/-9.1 versus 20.8+/-9.2 mm Hg, p=0.0001). There was a significantly higher number of patients with pulmonary hypertension in the splenectomized group (14 [66.7%] versus 6 [16.7%], p=0.0004).

Conclusion: Splenectomized patients with thalassemia major are at high risk of having impaired diastolic left ventricular function and pulmonary hypertension.