The Influence Of Percutaneous Closure And Surgical Repair Of Ventricular Septal Defect On Left Ventricular Function And Systolic Synchrony Assessed By Real-time Three-dimensional Echocardiography

Background Ventricular septal defect (VSD) was one of most common congenital heart diseases,and the morbidity often occupied first. As the level of the left to right ventricle shunt, causing increased pulmonary blood flow, leading to left ventricular volume overload and left ventricular remodeling. Previously surgical repair was the main treatment of VSD, in recent years with the maturation of equipment and technology,transcatheter closure of VSD in patients with indications had become an alternative to surgical treatment. Previously reported after two procedures exist in reversed left ventricular remodeling, left ventricular function gradually improved. But the occluder and the patch as a foreign body into the heart, and the operating procedures of percutaneous closure and surgical repair, would be adversely affect the normal function and the systolic synchrony of the heart had not been reported. In this study, the recent and mid-term impact of percutaneous closure and surgical repair of VSD on left ventricular function and systolic synchrony was assessed by real-time three-dimensional echocardiography(RT-3DE), and its clinical significance was discussed.Objective To evaluate the influence of percutaneous closure and surgical repair of ventricular septal defect (VSD) on left ventricular function and systolic synchrony using RT-3DE, and comparative analysis was conducted.Methods 65 patients with perimembranous VSD were divided into transcatheter group and surgery group by different operating procedures. Using RT-3DE, the three-dimensional parameters were repeatedly measured before closure,in 3rd day and 6th month after closure. The end-diastolic volume(EDV), end-systolic volume(ESV),left ventricular ejection fraction(LVEF),left ventricular stroke volume(LVSV), left ventricular peak ejection rate(PER),left ventricular peak filling rate(PFR),the time of minimal systolic volume of 16-segmental'standard deviation(Tmsvl6-SD) and maximum difference(Tmsvl6-Dif) were recorded, still more timing-excursion parameters: average excursion(Excursion Avg),standard deviation of excursion(Excursion SD),maximum excursion(Excursion Max),and minimum excursion(Excursion Min).Two illustrations of the bull eye(IBE) were automatically formed. Thirty normal subjects were enrolled as control group.Resultsâ‘ the transcatheter group and surgical group before operation, in addition to PFR/EDV, other indicators were higher than control group(P <0.01 or P <0.05),and there was no significant difference between two operation groups (P> 0.05).â‘¡3 days after percutaneous closure, there was obvious decline in these elevated cardiac function indices. By 6 months after transcatheter closure, changes in LV volume and function caused by VSD disappeared. In the surgical group similar results can be seen. But at three days after surgical repair, LVEF, PER and PER/EDV in surgical group can be seen a significant reduction (P <0.01 or P <0.05) compared with corresponding indicators in 3rd transcatheter group. At 6 months after transcatheter closure, difference of cardiac function indexes compared with control group disappeared. Comparison of cardiac function indexes at 6 months after operation between transcatheter group and surgical group, there was no significant difference (P> 0.05). PFR/EDV,before and after two operating procedures and compared with the control group, the difference was not statistically significant (P > 0.05).â‘¢Before and after percutaneous closure and surgical repair, and compared with control group, left ventricular synchrony indexes Tmsv16-SD%,Tmsv16-Dif% ,the difference was not statistically significant(P >0.05).But in the RBBB subgroup after surgical repair, Tmsv16-SD%, Tmsv16-Dif% was significantly higher than control subjects (P <0.01) and non-RBBB patients (P <0.05).â‘£The two intuitive "the bull eye" maps showed that basal anteroseptal and basal inferoseptal segments systolic timing delayed and systolic excursion attenuated or reversed after percutaneous closure and surgical repair, we considered it caused by the impact of the occluder and the patch. The difference of timing-excursion parameter indices Excursion Avg, Excursion SD and Excursion Max between transcatheter group and surgery group was not statistically significant(P >0.05).But the difference of Excursion Min between two operation groups and control group was statistically significant(P <0.05).Conclusionâ‘ The left ventricular high load, high power state of preoperative VSD caused by the ventricular level abnormal shunt returned to normal after 6 months of transcatheter and surgery therapy. and there was no significantly difference of heart function parameters between the two groups.â‘¡The reduction of left ventricular systolic function of patients early after surgical repair was significantly higher than patients of transcatheter group. At 6 months after operation, the difference disappeared between two groups. We presumed that myocardium injury related the surgical procedure themselves was the primary cause.â‘¢Although the metal occluder and patch may cause some segments systolic abnormalities; overall left ventricular synchronicity did not be significantly affected. But there was left ventricular dyssynchrony in the patients of RBBB subgroup after surgical repair. It is worth the long-term follow-up and research.