| Objective:To evaluation the clinical value of transthoracicechocardiography in guiding ventricular septal defect closure duringtranscatheter intervention.Methods: A retrospective analysis was perforomed in422patients withVSD diagnosed by transthoracic echocardiography (TTE) who underwentventricular septal defect closure in the First Affiliated Hospital of GuangxiMedical University during January2004to December2012. The size of VSD inpatients was measured by the long axis view of the left ventricle, the short axisview of the aortic root and the parasternal five-champer view in order to choosethe type and size of occluder. The left atrial end-systolic anteroposteriordiameter(LADs),the left ventricular end-diastolic anteroposterior diameter(LVEDd), the left ventricular end-systolic anteroposterior diameter (LVEDs),theleft ventricular ejection fraction (LVEF), the left ventricular fractionalshortening (LVFS),the right ventricular end-diastolic anteroposteriordiameter(RVDd), the pulmonary artery end-systolic diameter(PADs),the mitralvalve maximum former blood flow velocity(MVVmax),the aorta valve maximum former blood flow velocity(AVVmax),the tricuspid valve maximumformer blood flow velocity(TVVmax) and the pulmonary valve maximumformer blood flow velocity(PVVmax) were measure1day before occlusion and3days,1month,3months and6months after occlusion, respectively andcompare the difference among them.Results:In all patients, the size of occluder was used as the dependentvariable and the VSDmax of the long axis view of the left ventricle,the shortaxis view of the aortic root, and the parasternal five-champer view were used asthe independent variable did mulriple linear regreesion analysis.The resultshowed that VSDmax and occluder sizes were positively correlated.The occluersizes had trend of increase with the increase of the VSDmax. From the factorsinto the occluer sizes regreesion equation assodated, the parasternalfive-champer view VSDmax（t=9.722）is the first main influence factor, the shortaxis view of the aortic root VSDmax（t=7.759）is the second main factor, thelong axis view of the left ventricle VSDmax（t=3.940）is the third main influencefactor.Rgreesion equation was as follows： Y=1.339+0.484X1+0.376X2+0.198X3,R=0.928, R2=0.861, P＜0.05. Comparedto one day before occlusion,LADs, LVEDd, LVEDs and PADs weresignificantly decreased after occlusion for3days,1month,3months and6months (all P＜0.05). Yet, after occlusion for3days,1month,3months and6months, the indexes mentioned above in patients were compared between eachother, LADs, LVEDd and LVEDs showed a trend of gradually narrowing (all P＜0.05). The PADs showed a decreased a trend postoperative, but there was nosignificant difference (P＞0.05). Compared to one day before occlusion, all thepostoperative observation LVEF and LVFS were significantly decreased, butthere were no significant difference (all P＞0.05). Compared to the day before occlusion, there was an increasing tend of RVDd in VSD patients (P＜0.05),butafter1month,3months and6months there were no significant difference (all P＞0.05). Compared with the day before the VSD occluder treatment, theMVVmax and the PVVmax were decreased obviously after occlusion for3days,1month,3months and6months(all P＜0.05).After occlusion for3days,1month,3months and6months, there were no significant difference in parisecomparion of the indecators were mentioned above (all P＞0.05).Comparedwith the day before the occlusion, the AVVmax and the TVVmax weresignificantly increased after occlusion for3days,1month,3months and6months(all P＜0.05), but after occlusion for3days,1month,3months and6months,these were no significant difference in parise comparion of the indicatorsmentioned above (all P＞0.05).Conclusions:Transthoracic echocardiography was helpful in selectingsuitable patients,size and the type of occluder for VSD patients during theinterventional treatment. Moreover, transthoracic echocardiography plays animportant role in assessing the cardiac hemodynamic, structure and functionbefore and after occlusion. |
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