Evaluatation Of The Efficacy Of Atrial Septal Defect Occlusion In Adult Patients Diagnosed Atrial Septal Defect With Tricuspid Regurgitation Through Transthoracic Echocardiography

Objective: To evaluate the efficacy of atrial septal defect occlusion(ASDO)in adult patients(aged≥18 years)diagnosed atrial septal defect(ASD)complicated with tricuspid regurgitation(TR)through transthoracic echocardiography(TTE).To analyze the factors that influence TR in adult ASD patients and the recovery situations of TR between pre-occlusion and post occlusion.To know more about the diagnosis of ASD with TR and the clinical significance of ASDO by TTE,and help to decide the treatment program for the ASD patients.Methods: 120 cases of adult ASD patients who successfully received the ASDO in Heart Institute of the First Affiliated Hospital of Guangxi Medical University during January 2009 to November 2016 were collected.TR was retrospectively analyzed in all patients pre-occlusion and post occlusion.The subjects were divided into two groups according to the size of ASD: medium size ASD group(10mm≤ASD<30mm),large size ASD group(ASD≥30mm).In the sametime,50 cases of small size ASD(4mm≤ASD≤9mm)patients and 50 cases of normal adults were collected.The relationship between TR and the size of ASD was analyzed.Mean pulmonary arterial pressure(mPAP)of all the ASD patients by catheter in right heart was measured.According to the mean pulmonary arterial pressure(mPAP),ASD patients were divided into normal mPAP group(mPAP<25mmHg),and increased mPAP group(25mmHg≤mPAP).Also,the relationship of TR and mPAP was analyzed.Follow-up visits for medium size and large sidze ASD patients after occlusion in 6 months was performed,a summary analysis by comparing the situations of TR pre-occlusion and post occlusion was done in 1 day,3 months,6 months.Results: Factors influencing TR before occlusion in all the ASD patients:(1)The size of RA and RV,the volume of TR increase with the increasing of the side of ASD,it is statistically significant(P<0.01),the Sperman coefficients are 0.835,0.877 and 0.619;(2)There is no statistical significance(P>0.05)in the difference of TR between small size ASD group and normal adults group,but the differences are statistically significant(P < 0.01)in other groups;(3)The volume of TR in the increased mPAP group is more than that in the normal mPAP group,the difference is statistically significant(P<0.01).The follow-up situations of TR after occlusion :(1)There is an obvious statistically significance(P<0.01)in the difference of TR between pre-occlusion and in 1 day after occlusion in ASD patients;(2)There is an obvious statistically significance in the difference of TR between pre-occlusion and different time after occlusion in ASD patients(F=135.582,P<0.001),it is so as to medium size and large size ASD patients,F=70.124 and 79.743,P <0.001.For both two groups,there is an obvious recovery of TR in 1 day after occlusion.The volume of TR become stable in 3 months,there is no significant change of TR in 3 months and 6 months.(3)There is an interaction effect between the recovery condition of TR after occlusion and the size of ASD before occlusion(F=17.646,P < 0.001),which indicates that the recovery condition of TR is correlated with the size of ASD before occlusion.(4)Between the two groups,there is no in statistically significance(F=3.589,P=0.061 > 0.05)of TR after occlusion,there is no significant difference(P>0.05)of TR between the two groups in different time after occlusion.Conclusion: 1.Adult ASD patients could be accompanied with TR in different degree,the volume of TR increases with the increasing of the size of ASD.2.Change of geometry configuration of right heart system and pulmonary hypertension play an important role in the generation of FTR in adult ASD patients.Before occlusion or surgery,the examination by TTE could provide the useful message for the clinical doctors during the process of diagnosis and the treatment for adult ASD patients with TR 3.Either medium size ASD patients or large size ASD patients,the volume of TR obviously decreases after occlusion,the treatment by occlusion for large size ASD patients with TR could also get a good efficacy,the examination by TTE is important for evaluating the efficacy after occlusion.