The Evaluation Of Right Ventricular Function In Patients With Atrial Septal Defect Before And After Transcatheter Closure With Tissue Doppler Tei Index

Because the anatomic shape of right ventricular is irregular, it is absent of an ideal method to evaluate the function of the right ventricular now. Tei index is also called myocardial motion index, which is currently the only parameter index using echocardiography to evaluate the overall functions of cardiac systolic and diastolic, and Tei index is unacted on heart rate, ventricular geometry, valvular regurgitation and preload et al, which can evaluate the heart function state rapidly and accuratly. Through analysing the correlation of motion spectrum of mitral valve annulus and tricuspid annulus, tissue doppler imaging (TDI) detect the rate of the movement of mitral valve annulus and tricuspid annulus in real-time and quantificationally.Tei index can measure all the relavant time intervals in the same cardiac cycle. This study mainly discussed the use of TDI-Tei index to evaluate the right heart function of patients with ASD before and after transcatheter closure.In this study, a total of 68 patients secondary to ASD were treated in the first people’s hospital of yunnan province between July 2013 and July 2014, and we estimated pulmonary artery systolic pressure (PASP) according to the tricuspid regurgitation spectrum. We classified patients group into four groups. Group A included 12 patients without PASP(< 35 mmHg); Group B included 25 patients with mild PASP (35 to 45mmHg); Group C included 15 patients with moderate PASP (46 to 55 mmHg); Group D included 16 patients with severe PASP(>55mmHg). We also filiated 25 normal and healthy cases as control group. All of the selected objects were successfully applied transcatheter closure and had not residual shunt tested by transthoracic echocardiography. Echocardiographic tissue doppler imaging(TDI) and two-dimensional echocardiography were used to inspect all subjects, comparing the changes of right atrial diameter(RAD) at systole, right ventricular end diastolic diameter (RVD), pulmonary artery diameter(PAD) at end contraction, PASP, isovolumic relaxation time(IRT), isovolumetric contraction time(ICT) before and after surgery in patients. Besides, the relationship of all above parameters among all ASD groups before transcatheter closure with the normal control group was aslo needed to conclude.The results of this study showed that① comparing all the ASD groups with the normal control group before transcatheter closure(the changes of RAD, RVD and PAD):the RAD, RVD, PAD of the ASD group without PAH had no obvious change (P> 0.05); the RVD, PAD of the ASD group with mild PAH ASD group increased (P < 0.05 or P< 0.01); and the RAD, RVD, PAD of the ASD group with moderate and severe PAH increased (P< 0.01).② the comparing of the defect in the aperture size among all the ASD groups:comparing the ASD group with severe PAH with the ASD groups with no and mild PAH, the defect in the aperture size increased(P<0.05); comparing among other groups, the defect in the aperture size hadn’t statistically significant difference(P> 0.05).③ comparing all the ASD groups with the normal control group before transcatheter closure(the change of heart function parameters included IRT, ICT and Tei index):the ICT and Tei index of the ASD group without PAH decreased(P< 0.01); the IRT and Tei index of the ASD group with mild PAH increased (P< 0.01); the IRT and ICT index of the ASD group with moderate and severe PAH extended and the cardiac function Tei index increased(P< 0.001). ④the changes of RAD、RVD、PAD and PASP among all the ASD groups in 1,3,6 months after transcatheter closure:the ASD group without PAH before and after ranscatheter closure, RAD, RVD, PAD and PASP didn’t changed obviously; the RAD, RVD, PAD and PASP of the ASD group with mild PAH returned to normal level in postoperative in around one month; the RAD, RVD, PAD and PASP of ASD group with moderate PAH returned to normal level in postoperative in around three months; and the recovery time of RAD, RVD, PAD and PASP of ASD group with severe PAH needed more than six months returning to normal level in postoperative. ⑤the changes of Tei index among all the ASD groups in 1,3,6 months after transcatheter closure:the Tei index of the ASD group without PAH returned to normal level in postoperative in around one month; the Tei index of the ASD group with mild PAH returned to normal level in postoperative in around three months; the recovery time of Tei index of the ASD group with moderate and severe PAH returning to normal level needed more than six months in postoperative.⑥ it was known from the analysis of correlation that the correlation TDI-Tei index with age and heart rate were not obvious(r1= 0.3001, P1> 0.05; r2= 0.3887, P2> 0.05); the correlation TDI-Tei index with pulmonary artery pressure(PASP) was highly relevant (r= 0.8537, P< 0.001); the correlation TDI-Tei index with the defect in the aperture size were lowly relevant (r= 0.4081, P< 0.05).The conclusions of this study showed that① the TDI-Tei index could be used as the sensitive indicator of right heart function for early diagnosis in patients with ASD. ② tissue doppler imaging (TDI) technique could provide noninvasive test results for patients with ASD quickly, accurately and through ananlysing and comparing the Tei index tested by TDI technology before and after transcatheter closure, ultimately the important information about the changes of the function of right heart in patients with ASD would be got. ③the right heart of the ASD group without PAH was in the stage of cardiac compensatory, the TDI-Tei index and ICT decreased significantly, but IRT was not different obviously, which illustrated that the function of right heart enhanced and the enhancement of the contraction function of right heart was taken as the principal thing; the RAD, RVD and PAD of the ASD groups with PAH increased with the elevating of PASP. The TDI-Tei and IRT index of the ASD patients with mild PAH increased obviously, which illustrated the right heart was out of the stage of cardiac compensation now and the diastolic function of right heart damaged first. The TDI-Tei index, IRT and ICT of the ASD patients with moderate and severe PAH increased more apparently, the function of right heart further damaged and should be involved in blocking surgery as early as possible. ④The cardiac function TDI-Tei index of right heart had a high correlation with pulmonary artery systolic pressure, which illustrated the damaging of right heart increased with the rising of pulmonary artery systolic pressure. ⑤After transcatheter closure, the TDI-Tei index of the ASD group without PAH recovered to normal level basically for about one month; the TDI-Tei index of the ASD group with mild PAH recovered to normal level basically for three months postoperatively; and the recovery time of the TDI-Tei index of the ASD group with severe PAH needed more than six months postoperatively.