Aseessment Of The Left And Right Ventricular Systolic Function Before And After Occlusion Of Senile Atrial Septal Defect Using Three-dimensional Echocardiography

Background:Earlier treatment of Atrial septal defect (ASD) by thoracotomy operation caused trauma and there was a certain degree of high risk. Adult, especially in elderly patients, were reluctant to accept this operation. In recent years, interventional occlusion of ASD were gradually accepted by many adult and even elderly patients for its low trauma and risk. Previous scholars had applied M mode echocardiography and two-dimensional echocardiography (2DE) to bserve the change of the ventricular function after occlusion of atrial septal defect. However, there was no reports of using three-dimensional echocardiography (3DE) to evaluate left and right ventricular function after transcatheter closure of senile ASD. In our study, we researched the ventricular systolic function before and after occlusion of senile ASD by3DE.Objective:Observe the change of the left and right ventricular systolic function before and after occlusion of senile atrial septal defect using3DE.Materials and Methods:We all collected35cases of elderly patients with isolated ASD in the General Hospital of Shenyang military region from2010March to2014March, including7males,28females, aged60-75years (average64.2years old). The minimum diameter of ASD is8mm and the largest diameter is28mm, averaging18.2mm. The six edges of ASD including upper and lower edges, posterior and anterior edges, superior and inferior vena cava edges were longer than7mm.12patients had mild to moderate pulmonary hypertension with pulmonary artery systolic pressure <60mmHg and left to right shunt in atrial level.11patients had mild mitral insufficiency, 5patients with mild to moderate mitral insufficiency.12patients had mild tricuspid insufficiency,6patients with mild to moderate tricuspid insufficiency. Using the Philips iE33color Doppler echocardiography (CDE), we had five functions of M-mode echocardiography,2DE, pulsed wave Doppler(PW), continuous wave Doppler(CW) and color Doppler flow imaging(CDFI). Probe frequency was1-5MHz, equipped with another X3-1probe. We conducted2DE and3DE examination at1day,1week,1month,3months,6months after the occlusion and1day before the occlusion. At first, we used M mode echocardiography and2DE for routine inspection, measuring the indicators. We used2DE to measure diameter of ASD and shunt blood flow signal by CDFI to judge size of ASD. We applied CDFI to display flow signal of heart valve regurgitation to judge degree of the heart valvular insufficiency. We used continuous wave Doppler to determine the maximum peak velocity of tricuspid regurgitation spectrum, according to the simplified Bernoulli equation A P=4V2, estimate the pulmonary artery pressure. Finally, we replaced X3-1probe for3DE inspection. On the basis of the apical four chamber view, we measured3D data of the left and right ventricle. And used Qlab software to analyze, we acquisited the data of the left ventricular end diastolic volume, the left ventricular end systolic volume, left ventricular stroke volume and left ventricular ejection fraction (LVEDV, LVESV, LVSV and LVEF); right ventricular end diastolic volume, right ventricular end systolic volume, right ventricular stroke volume and right ventricular ejection fraction (RVEDV, RVESV, RVSV and RVEF). We compared the difference between the two groups (before and after the occlusion) by t test, p<0.05had significant difference.Results:35patients with ASD successfully received occlusion by assist of CDE. And postoperative CDE scan showed all patients had no complications. The location and morphology of occlude device were normal, no residual shunt was observed.3DE measurement showed LVEDV, LVESV and LVSV increased gradually1day after the occlusion. The values of1weeks,1month,3months and6months after operation were significantly increased compared the measured values before occlusion (p<0.01). The values of1month and1days after operation had significant difference (p<0.01). The values of6months and1month after operation had no significant difference (p>0.05). RVEDV, RVESV and RVSV are decreased gradually1day after the occlusion. The difference was significant at1week,1month,3months and6month after occlusion. The difference is significant between1day and1month (p<0.001) and has no significant difference between1month and6months (P>0.05). LVEF and RVEF had no significance after and before the closure (P>0.05).Conclusion:ASD occlusion by interventional therapy will block atrial level shunt. Volumes of ventricles changed1days after occlusion, changed significantly during the period of1day to1month and stabilized after1month. The change of LVEF and RVEF after closure is not obvious. The cardiac function measured by3DE technology had the advantages of simple procedure and rapid testing with satisfied accuracy. The3DE technology applied to evaluating the cardiac function before and after senile ASD occlusion can replace some of the invasive cardiovascular examination.