The Morphology And Functional Evalution In Ventricular Septal Defect With Right Ventricular Outflow Tract Stenosis Characterized By Ultrasonic Cardiogram

Objective To observation the image anatomy variation characteristics of patients with ventricular septal defect(VSD) with right ventricular outflow tract stenosis (RVOTS) by Using echocardiography combined with tissue and pulsed Doppler method, to analyze the method in diagnosis and the improvement of postoperative heart function in VSD+RVOTS.To discusses the finiteness and improve possible of the method, and guide ultrasound in diagnosis of VSD+RVOTS and postoperative heart function evaluation.Methods From June of2011to June of2012, We selected45patients who had diagnosed with VSD+RVOTS underwent echocardiography in the Cardiovascular Department of First Hospital of Lanzhou University. All patients underwent echocardiography examination1week and3months after operation, Measurement Indicators include:the position and morphology of VSD+RVOTS; VSD diameter; Cross outflow stenosis differential pressure, flow velocity, the narrow orifice diameter and right ventricular free wall thickness; using tissue and pulsed Doppler to detect Tei index of the right ventricle for All patients. Surgical exploration in VSD+RVOTS place and morphological structure. Result1、Image anatomy characteristics Preoperative echocardiography examination see that right ventricle hypertrophy than the normal (12.02±3.07mm vs3.5±1.1mm, P<0.01); blood flow through the RVOT were obvious speed up (6.8±1.12m/s), RVOT inside diameter is7.1±1.14mm, according to cross outflow stenosis differential pressure degree, they were divided into10cases of mild (56±17.03mmHg),18cases of medium (82±6.32mmHg) and14cases of severe (117±21.36mmHg). VSD include perimembranous VSD(n=25,56%), subarterial VSD(n=12,26%),intracristal VSD (n=8,18%), the mean diameter was8.09±2.16mm.RVOTS belongs to the infundibular entrance type in20cases, tubular stenosis in13cases, infundibular outlet stenosis in10cases, right ventricular wall partial endocardial fibrous hyperplasia in2cases.After operation1week and3months, the echocardiography examination shows that the right ventricle hypertrophy, blood flow through the RVOT, RVOT inside diameter had statistical significance than before operation.2. Function index Preoperative, the right ventricular Tei index (tissue Doppler Tei index was0.66±0.10, pulse Doppler Tei index was0.69±0.07) was significantly higher than normal(0.37±0.09,0.26±0.08)(P <0.05). The Tei index with RVOTS stenosis severity increased, mild stenosis (0.46±0.05,0.54±0.06), moderate (0.59±0.03,0.64±0.03), severe (0.71±0.06,0.75±0.05).3months of postoperative, the Tei index (0.32±0.14,0.30±0.09) compared with the preoperative, postoperative1weeks was significantly reduced (P<0.05).3. The misdiagnosis rate42cases were diagnosed VSD+RVOTS by echocardiography before surgery. But the correct diagnosis were40cases that confirmed by operation,2cases were VSD, the misdiagnosis rate was12%.Conclusion Echocardiography combined with tissue and pulse doppler method can fully reflect the VSD+RVOTS image anatomy changes and effectively evaluate the right heart function changes preoperative. The higher diagnosis rate suggests the method can be effectively applied in VSD+RVOTS preoperative diagnosis and postoperative function evaluation.