Assessment Of Left Ventricular Hemodynamics And Systolic Function In Percutaneous Ventricular Restoration Patients With Apical Aneurysm By 2D-TTE And RT-3D-TEE

Coronary heart disease cause ventricular remodeling after myocardial infarction,Left ventricular apical aneurysm is one of the most Serious consequences,it not only cause heart failure,but also lead to increase the risk of cardiac rupture and thrombosis.For the treatment of Left ventricular apical aneurysm,the traditional method is medicine conservative treatment and partial left ventriculectomy,but medicine conservative treatment has poor efficacy on patients and partial left ventriculectomy is more difficult and with high risk of operation,in addition,some patients are intolerance of operation because advanced age or with more clinical complications.In accordance with this persent situation,Otasevic and his team provide a new treatment for patients with Left ventricular apical aneurysm in 2005 which to be called percutaneous ventricular restoration(PVR),although the feasibility and safety of PVR has been proved by a number of clinical trials,But there are also some literature shows that the implantation of the VPD device easily to cause thrombosis and heart failure and so on,so the exact curative effect after Percutaneous ventricular restoration is not yet clear.The objectives of this research is to evaluate the effec of left ventricular hemodynamics and systolic function in percutaneous ventricular restoration patients with apical aneurysm by Two-Dimensional transthoracic echocardiography(2D-TTE)and Real-time Three-Dimensional Transesophageal Echocardiography(RT-3D-TEE).The team of my tutor has successfully carried out more than 30 cases of Percutaneous ventricular restoration studies since its introduction in 2015.The research included 50 patients who diagnosed as apical aneurysm in our Hospital between January 2015 to october 2017.They are divided into 25 PVR group and 25 conservative treatment group(control group).2D-TTE combined with RT-3D-TEE were applied for all the subjects on preoperative or pretreatment,one week after operaction or one week after treatment and three month after operaction or three month after reatment to obtain Left ventricular end-diastolic diameter(LVEDD),Left ventricular end-systolic diameter(LVESD),Left ventricular end-diastolic volume(EDV),End-systolic volume(ESV),Left ventricular ejection fraction(LVEF),left ventricular fractional shortening(FS),Body surface area(BSA),Stroke volume(SV),Stroke volume index(SVI),Cardiac output(CO),Cardiac output index(CI).The Results during this reearch showed a significant increase in EF,SVI(P<0.01)and statistically difference in LVEDD,LVESD,EDV,ESV,FS,SV,CO(P<0.05)between PVR group and control group in the following three months after operaction,while there was no statistically significant difference in the following one week after operaction(P>0.05).For the PVR group there showed a significant increase in SV,significant decrease in LVEDD,EDV(P<0.01)and statistically difference in LVESD,ESV,LVEF,SVI,FS,CO,CI(P<0.05)between preoperative and in the following three months after operaction,while there was no statistically significant difference between preoperative and in the following one week after operaction(P>0.05).For the control group there showed no statistically significant difference between preoperative and in the following one week after operaction or in the following three months after operaction.Then we concluded that PVR has a definite effect of left ventricular hemodynamics and systolic function in patients with apical aneurysm in the short term,while 2D-TTE and RT-3D-TEE provides a reliable basis for clinical to evaluate the effect of PVR.The research of the subject involves the minimally invasive transcatheter cardiovascular intervention,echocardiography imaging and other multidisciplinary field with many techniques,mainly through the new technology of ultrasound technology to explore the hemodynamic changes after percutaneous ventricular restoration,To provide the optimal ultrasound evaluation index for qualitative and quantitative assessment of left ventricular function after surgery,this research will contribute to stimulate the research and development of echocardiography imaging and has significant clinical application value.