| Objective: To evaluate the changes of hemodynamic, cardiac chamber loadand systolic and diastolic function before and after atrial septal defect (ASD) and ventricular septal defect (VSD) occlusion by using transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI).Methods: TTE and TDI were performed in 126 patients with ASD and VSDsuccessfully occluded from August, 2003 to March, 2005 before occlusion and three days, three months and six months after occlusion. The spectra of tricuspid and mitral valves were recorded by placing sample volume of pulsed wave Doppler on orifice of tricuspid and mitral valves on four chamber view, and spectrum of pulmonary artery was recorded on pulmonary valve on short axis view of great artery. E peak and A peak velocities of tricuspid and mitral valves, and maximal, mean velocities and velocity-time integral of pulmonaryartery were measured from the spectra. The anterior-posterior diameters, left-right diameters and long diameters of left ventricle both in systole and diastole were respectively measured on short axis view of left ventricle in tendon cordal level and apical four chamber view. The long diameter of left ventricle in diastole and systole, the long and traverse diameters of left and right atrium in systole were measured on four chamber view. The antieror-postieror diameter of right ventricular in diastole Antieror-postieror diameter of left atrium in systole were measured on parasternal long axis view. The diameter of pulmonary artery of middle part was measured on short axis of great vessel by using two-dimensional echocardiography. The volume of left ventricular in end-systolic and end-diastolic period were also measured by using Simpson's equation with tracing endocardium on apical four chamber view. With TDI, the velocities on annular and middle positions of left and right ventricular lateral wall and ventricular septum were measured on apical four chamber view. Results:1. Involved change on third day, third month and sixth month after ASD occlusion: (1) Hemodynamic change: Left to right shunt in atrial level disappeared after occlusion. Compared with the data before occlusion, E peak and A peak velocities of tricuspid valve as well as maximal, mean velocities and velocity-time integral of pulmonary artery were significantly reduced (P<0.001) on 3 days, 3 months and 6 months after occlusion. (2) The change of chamber load: All diameters of right heart and middle part of pulmonaryartery were markedly decreased on 3 days after occlusion (P<0.05), while thediameter of left heart, especially antieror-postieror diameter and left-right diameter of left ventricle were significantly augmented on 3 days after occlusion (P<0.05). The parameters above mentioned were further graduallyrecovered on 3 months and 6 months. (3) The change of cardiac function measured by TDI: On 3 days, 3 months and 6 months after ASD occlusion significant decrease of TDI velocity were noted on following waves and positions (P<0.05): S', E' and A' peak velocities on base and middle parts of right ventricular lateral wall; S', E' and A' velocities on base part of ventricular septum; S' velocities on base and middle parts of left ventricular lateral wall. However, S' and E' velocities on middle part of ventricular septum were significantly reduced only on 3 days and 3 month (P<0.01).2. Involved change after VSD occlusion on third day, third month and sixth month: (1) Hemodynamic change: Left to right shunt in ventricular level disappeared after occlusion. Compared with the data before occlusion, E and A peak velocities of mitral valve and maximal and mean velocities, velocity-time integral of pulmonary artery were remarkably decreased (P<0.001). (2) The change of chamber load: Left-right diameter of right ventricle was significantly lessened on 3 days, 3 months and 6 months after occlusion (P<0.05). Antieror-postieror diameter of left atrium in systole , antieror-postieror diameter and left-right diameter as well as end-diastolc volume of left ventricle were significantly markedly decresed on 3 days after occlusion (P<0.05). All diameters of left atrium and left ventricle, and end-systolic volumes of left ventricle were significantly reduced on 3 and 6 months (P<0.05). (3) The change of cardiac function measured by TDI: E' velocity on middle part of left ventricular lateral wall on 3 and 6 months and A' velocity on middle part of left ventricular lateral wall on 6 months were significantly decreased(P<0.05). But, there were no significantly change on all the other wall velocity.Conclusion: TTE and TDI are simple and valuable methods for observation on the effect of ASD and VSD occlusion, which may supply useful information... |
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