| Background: Congenital heart diseases (CHD) are the most common pediatric heart diseases. Atrial septal defect (ASD) is one of the most common congenital cardiac malformations, accounting for 10%~20% of all instances of CHD. Long-term left-to-right shunt in ASD promotes right heart dilatation and pulmonary vascular changes and functional limitation, leads to second pulmonary hypertension (PH), congestive heart failure and atrial arrhythmias over a certain age. The increasing experience allows the patients with normal pulmonary pressure to be investigated the left ventricular function. It is a concerned issue for patients with PH. The quantitative evaluation of left ventricular function and PH has a very important significant in evaluating the patient conditions, determinating therapeutic methods and assessing the curative effect and prognosis of the patients with PH.It has been proved by numerous clinical study that the worse complications in the elder patients with ASD. These progressive pathophysiologic impairments, together with aging changes, frequently produce heart functional deterioration in patients aged≥40 years. In 1997, Amplatzer invented Amplatzer Septal Occluder (ASO) which the bidiscoidal occluder was made of the alloy with nickel and titanium, percutaneous device occlusion is become to be a safe and effective therapeutic method for ASD in adult with PH. Homodynamic can be evaluated accurately by catheterization during the procedure of occlusion, which may help guide anomaly correction and estimate prospective efficacy of occlusion. Cardiac catheterization and cardiac angiography can measure the pressure of chambers heart and estimate left ventricular function, butdue to its invasiveness, its use has been restriction. Echocardiography has the advantages of non-invasiveness; it could evaluate the left ventricular function of the patients with ASD associated with PH.Objective: 1. To measure pulmonary pressure and left ventricular function by cardiac catheterization and echocardiography and to observe the correlation between the values measured; 2. To assess the left ventricular function of ASD with PH patients and to determine whether the left ventricular function and pulmonary pressure could run better after transcatheter closure by echocardiography; 3. To observe the correlation between pulmonary pressure and other indexes such as Qp/Qs,left ventricular volume etc. ; 4. Choosing indication to occlude ASD with severe PH patients in a fenestrated device.Method: There were 75 patients with ASD aged≥40 years, 15 males and 60 females, divided them two groups. (1) PH group:36 patients with ASD associated with PH, 6 males and 30 females, aged from 41 to 74 (mean age 51.7±9.3) years, ASD diameter aged from 15 to 37 (mean 22.9±8.1)mm by using transthoracic echocardiogram (TTE). Systolic pulmonary artery pressure (sPAP) 40~107 (57.8±16.0) mmHg, diastolic pulmonary artery pressure (dPAP ) 10~40(22.0±5.8)mmHg, mean pulmonary artery pressure(mPAP) 31~62(37.1±7.7)mmHg were measured by using cardiac catheterization. (2) No PH group(control group): there were 39 patients, 9 males and 30 females, aged from 40 to 63 (mean age 49.3±6.0) years, ASD diameter aged from 8 to 33(mean 20.6±6.8)mm by using TTE. The sPAP 22~38 (28.9±3.9)mmHg, dPAP3~20(10±3.8) mmHg, mPAP10~19(15.9±2.8 ) mmHg were measured by using cardiac catheterization. Before operation, left ventricular end-diastolic diamete(rLVEDD), left ventricular end-systolic diameter( LVESD) , left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular stroke volume(LVSV) and left ventricular ejection fraction(LVEF) were measured by using TTE. The sPAP obtained by echocardiography Doppler according to the tricuspid regurgitation gradient pressure of the ASD with PH patients. Cardiac catheterization was performed before interventionaltherapy, sPAP,dPAP,mPAP, Qp/Qs were measured. The left ventriculography (in right oblique 30 degree and left oblique 60 degree) was recordered and the results were processed to measure the main index of left ventricle. ASO with a diameter ranging from 18 to 42(30.8±9.1)mm were placed in PH group, 3 patients of them with severe PH required a fenestrated device. The immediate sPAP were measured 28~95(42.7±15.4) mmHg after transcatheter closure, mPAP were 24~58(30.1±6.7)mmHg. ASO with a diameter ranging from 9 to 40(27.5±7.4)mm were placed in control group. Echocardiography were made at 1 day,1, 3months after the procedure.Results: There is no significant different and well positively correlated that between sPAP, LVEDV, LVESV, LVSV, LVEF values measured by echocardiography and those measured by cardiac catheterization. The LVEDD, LVEDV, LVSV and LVEF of PH group were all smaller than those of ASD group. The immediate sPAP,mPAP decreased significant after transcatheter closure. The LVEDD, LVEDV, LVSV and LVEF increased significantly after operation 1 day, whereas LVESD,LVESV were unchanged. The LVEDD, LVEDV, LVSV and LVEF improved further 1~3months later. The study also showed that the sPAP negatively correlated with LVEDD and LVEDV, but there were no difference between the sPAP and the size of ASD and Qp/Qs. The sPAP decreased significant of the patients with severe PH, who had the indication could implant a fenestrated ASO, and left ventricular function improved at 1day, 1~3months after the procedure.Conclusion: 1. The fact that echocardiography correlated well with cardiac catheterization volume-measured left ventricular function and sPAP. Echocardiography could easily and fairly accurately measure the left ventricular function and real-time monitor it; 2. The left ventricular function lesion of the ASD patients with PH were more severe than the ASD patients, the left ventricular function improved after transcatheter closure, so interventional therapy could prevent the left ventricular function from deterioration; 3. The results that sPAP correlated negatively with LVEDD,LVEDV manifest that PH can damaged the left ventricular function, but the fact, that ASD diameter, Qp/Qs had no correlation with sPAP, showed shunted-blood is not the major factor emerging PH; 4. Transcatheter closure of ASD with severe PH can improve left ventricular function and decrease PH with a fenestrated ASO, but need to grasp the indication severely. |
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