An Observation Of Hemodynamics, Cardiac Chamber Size And Left Ventricular Systolic Function In Patinets With Ventricular Septal Defect Before And After Occlusion By Echocardiography

Objective To evaluate the changes of hemodynamics, cardiac chamber size and left ventricular systolic function in patients with VSD before and after occlusion in short and middle term using transthoracic echocardiography (Transthoracic echocardiography).Methods40patients with VSD hospitaled in First Affiliated Hospital and cardiovascular Research Institute of Guangxi Medical University were involved in the present study during July2010and October2011. TTE and RT-3DE were performed on patients before occlusion and after three days, three months and six months of occlusion. Left atrial end-systolic diameter was measured using two-dimensional. Right ventricular end-diastolic diameter, left ventricular end-systolic and end-diastolic diameter were evaluate via long axis view. Right atrial end-systolic diameter, right ventricular end-diastolic diameter were measured via apical four-chamber view. The mitral E wave peak velocity (Em) and A wave peak velocity (Am) were measured by spectral doppler. The main pulmonary artery diameter was evaluated via aorta short axis view. Pulmonary artery orifice peak flow velocity (Vmax) and mean blood flow velocity (Vmean) were determined by doppler spectrum. Left ventricular outflow maximum velocity was measured via apical five-chamber view. Real-time three-dimensional echocardiography (RT-3DE) was adopted to measure left ventricular end-diastolic volume (LVEDV) via apical four-chamber view. Left ventricular ejection fraction (LVEF) was automatically calculated by the instrument.All data obtained after occlusion were compared with pre-operation using paired t test, the difference was statistically significant when P<0.05.Results (1) Hemodynamic changes:abnormal shunt disappeared after transcatheter closure of ventricular. After three days, three months and6months of occlusion, the mitral Em, Am, the pulmonary valve orifice Vmax and Vmean were significantly decreased. The difference was statistically significant (P <0.05).(2) Left ventricular cardiac chamber size changes:(A) Left atrial end-systolic diameter was reduced compared with pre-operation (P<0.05). After3days,3months and6months of occlusion, the diameter was further reduced (P <0.01). Left ventricular end-diastolic diameter was reduced after3days of occlusion (P<0.05) compared with pre-operation, but left ventricular end-systolic diameter was not different compared with pre-operation (P>0.05). After3months and6months of occlusion, the left ventricular end-diastolic diameter was further decreased and the left ventricular end-systolic diameter were also reduced (P<0.05).(B) The right heart:There was no difference in right atrial end-systolic diameter obtained at different time points after occlusion (P>0.05). Right ventricular end-diastolic diameter were reduced after3days,3months and6months of occlusion (P<0.05). Pulmonary artery:the diameter of pulmonary artery was decreased after3days,3months and6months of occlusion (P<0.05).(3) Changes in left ventricular volume and left ventricular function:After three days, three months and six months of occlusion, EF was significantly reduced (P<0.05). Compared with pre-operation, left ventricular end-diastolic volume was reduced (P<0.05) after3days,3months and6months of occlusion. The left ventricular end-systolic volume showed no significant changes after three days of occlusion, but was reduced after three months and six months of occlusion (P<0.05).Conclusions It is very helpful to assess the effect of occlusion on patients with VSD by transthoracic echocardiography. The occlusion performed in patients with VSD changed the original abnormal hemodynamic state. Thus, the original increasing compensatory volume in heart chamber was corrected. While improving the shape and configuration of abnormal heart chamber, the left ventricular systolic function was restored. It is feasible and accurate to measure heart volume and cardiac function in patients with VSD by RT-3DE.