Evaluation Of The Right Ventricular Function Of Patients In Atrial Septal Defect With Pulmonary Hypertension By 2D Speckle Tracking Imaging After Transcatheter Closure

Background and ObjectivesAtrial septal defect(ASD) is a common congenital heart disease, taking up 10%-30% of congenital heart disease. Any harm or damage to atrial septum will cause the direct delivery and blood flow between the left and right atrium. Such disease is called atrial septal defect.ASD includes four types, namely, ostium primum ASD, ostium secundum ASD, sinus venosus ASD and coronary sinus ASD. For grown-ups,25% of the foramen ovale is not closed up, and due to its small amount of divided flow, it has little clinical significance.Ostium secundum ASD is common, taking up about 70%.30% of the untreated adults will have pulmonary hypertention, which leads to right heart failure,Whether symptoms appear depends on the patient’s ability of endurance. The current examination technologies such as echocardiography can make a precise diagnosis to ASD. Timely diagnosis and treatment can prevent the deterioration of heart function and elongate life span.So accurate preoperative evaluation ASD in ventricular function especially right ventricular function to choose the operation time is especially important.and postoperative right heart function changes on the prognostic also to have the important meaning.Since the successful application of interventional therapy on the treatment of ostium secundum ASD in 1967 and its clinical application by Amplatzer in 1997, it has gained in acceptance for its more reasonable structure, reliable function, being handy to place, stable to fix, and easy to recycle, replace and reinstalled, and expanding the pertaining symptoms of interventional therapy. Coupled with the application of new material and advanced monitoring equipment (such as the application of TEE), transcatheter occlusion has gradually become one of the main treatment methods of ostium secundum ASD. The structural change of the right ventricular before and after transcatheter occlusion includes change of structure, systolic function and diastolic function. The way of evaluating transcatheter occlusion of ASD through echocardiography includes Two dimensional echocardiography, spectra and color Doppler echocardiography, Tissure Doppler Imaging(TDI), velocity vector imaging(VVI) and Two Dimensional Speckle Tracking Imaging(2DSTI). Because of right ventricular geometry form complex,and the right ventricle muscle trabecular more developed, affect the accuracy of the endocardial painted.So two-dimensional ultrasound examination of the accuracy of the determination of right ventricular function is poor,and Angle between acoustic beam direction and the room wall motion direction influenced TDI and VVI, and therefore could not accurately evaluate right ventricular function.2DSTI is a new technology based on strain and strain rate imaging, a new tool for quantifying regional ventricular function. It tracks the spots on the two dimensional echocardiography to get the organizing speed, strain and strain rate of myocardium to analyze its movement. Furthermore, it can overcome the limitation of TDI technology of angle dependence, so it has more advantages than TDI.2DSTI provides clinical treatment with a brand new, unharmful and effective method of evaluating the myocardium function of the whole and all parts. Research shows that after transcatheter occlusion, the function of heart of the patient changes, but the comparison of right ventricular function has been rarely reported. This paper uses STI to analyze the 2 D strain parameters of right ventricular free wall of atrial septal defect patients with pulmonary hypertension before and after transcatheter closure, and discusses the application value of Two Dimensional Speckle Tracking Imaging (2DSTI) to evaluate the change of right ventricular function on atrial septal defect patients with pulmonary hypertension before and after transcatheter closure so as to come up with a brand new harmless, fast,precise and objective method to evaluate the function of right ventricular. Materials and methodsTake 50 ostium secundum ASD patients successfully treated with transcatheter occlusion in ZhengzhouUniversity People’s Hospital(Henan Provincial People’s Hospital) during December,2010 to September,2011 as examples.22 are men,28 are women, aged between 16 to 49, with an average age of 31.1±8.26. The defect diameter is 1.0-3.2(1.9±0.6)cm. These 50 patients have Pulmonary hypertention of different degrees.19 patients have light Pulmonary hypertention,24 mediate, and 7 severe. Light:35-49mmHg; Mediate:50-69mmHg; Severe:≧70mmHg. None of them has pulmonary stenosis, right ventricular outflow tract stenosis, organic disease of tricuspid value, severe tricuspid regurgitation, or obvious outflow to the left from right ventricular pulmonary disease. All of them have sinus rhythm, no inborn heart disease and ectopic cardiac rhythm. In the randomly selected 41 healthy people with no abnormal findings in physical examination and other auxiliary examinations,14 are male,27 are female, aged between 18-45, with an average age of 31.6±8.34. Use S5-1 probe of Philips iE33 color Doppler ultrasonic instrument, frequency 1-5MHZ. ASD patients are examined by Doppler echocardiography 3 days before and one week and three months after operation. Make sure the subjects were taken left lateral position, and be connected electrocardiography. Collect and store cardiac apical four-chamber view imagings of three cardiac cycles. Then, imagings were transferred to Qlab7.1 work station for offline strain analysis. Record Peak systolic strain(￡), Peak systolic strain rate(SRs), early diastolic strain rate (SRe)and late diastolic strain rate(SRa) were measured in basal, mid apical and segment of right ventricular free wall.Results1. It was shown that the￡、SRs、SRe and SRa in basal,mid and apical segment of right ventricular free wall in patients group were significantly lower than that in the control subject.(P<0.05)2. In patients group, a week after transcatheter closure,￡、SRs、SRe and SRa increased in basal, mid and apical segment of right ventricular free wall(P<0.05), after three months than a week more step went to increase (P<0.05); While,a week after transcatheter closure, RAED, RVED and PASP decreased(P<0.05), after three months than a week more step went down(P<0.05)3. With higher level of Pulmonary hypertention, the￡、SRs、SRe and SRa in basal,mid and apical segment of right ventricular free wall in patients group declines sharply.4. PASP has a good relativity with the￡and SRs of apical segment of right ventricular free wall. (r=-0.851,P<0.01,r=-0.592, P<0.05)Conclusion1. Patients of ASD with Pulmonary hypertention have different level of functional decline in right ventricular.2. Functional decline in right ventricular gets severer with higher degree of Pulmonary hypertention.3. A short period after transcatheter closure, the function of the right ventricular of ASD patients is improved.4. Pulmonary hypertention is the key factor to influence the contraction function of right ventricular of the ASD patients.5. Two Dimensional Speckle Tracking Imaging(2DSTI) can evaluate the change of function and form of the right ventricular after ASD operation precisely and objectively.