Multimodal Echocardiography Technology In Evaluation Of Right Heart Function Before And After Transcatheter Closure For Adult Patients With Atrial Septal Defect

Objectives:Application of multi-modality echocardiography researches changes of right heart function of patients with atrial septal defect(ASD)closure before and after interventional therapy;To evaluate the changes in right ventricular geometry and function in patients with ASD associated with varying degrees of pulmonary hypertension and to assess the recovery of right ventricular function in patients with ASD after the transcatheter close;The correlation between the right heart function indexes measured by multimodal ultrasound and the pulmonary artery pressure measured by cardiac catheterization will be investigated for the treatment and clinical management of the disease,to provide valuable right ventricular function information and clinical reference for the treatment and clinical evaluation of diseases.Methods:A total of 73 adult patients(52 females and 21 males)who were admitted to Yan 'an Hospital Affiliated to Kunming Medical University from September 2018 to October 2019 and diagnosed with ASD were selected,with age ranging from 18 to 71 years old,with ASDs ranging from 5 to 44 mm,mean(19.78±8.84)mm.There were 57 patients had interventional occlusion therapy Interventional occlusion was indicated and successfully treated,while the remaining 16 patients underwent right heart catheterization.Patients with ASD were divided into four groups according to the PAMP,There were 25 patients in the normal pulmonary artery pressure group(PAMP<25 mmHg),22 patients in the mild pulmonary hypertension group(PAMP:26—35 mmHg),10 patients in the moderate pulmonary hypertension group(PAMP:36?50 mmHg),16 patients in the severe pulmonary hypertension group(PAMP>50 mmHg),and 30 healthy adults were selected as the control group.All the patients with ASD underwent echocardiography within 3 days before surgery,and the evaluation indexes include the diameter and area of right heart,pulmonary artery diameter,right ventricle free wall thickness,and the three-dimensional volume of the right heart;right ventricular systolic function parameters:TAPSE,S',FAC,Tei index,IVA,3D RV EF,RVLS septum,RVLS Free wall.Right ventricular diastolic function parameters:E,A,E/A,e',a',e'/a',IVRT,E/e'.There are 28 patients of the 57 patients who were checked through multimodal echocardiography in postoperative 1 month,3 months,6 months,and 12 months,and the measurement content is the same as above.Results:When pulmonary artery pressure in ASD patients was in the normal range,RVOT prox,RVOT Distal,PA,RVBD,RVMD,RVLD,RA long and short diameter,RAA,3D EDV,3D ESV,and the late diastolic tricuspid flow velocity(A),3D RV EF,RVLS septum,RVLS Free wall Larger than the control group(P<0.05).In ASD patients with mild pulmonary hypertension,the RVOT Distal and PA inner diameter were further increased,and the early diastolic tricuspid flow velocity(E),the late diastolic tricuspid annulus velocity(a')was higher than that in the control group.3D RV EF,RVLS septum,RVLS Free wall were lower than those of patients with normal pulmonary artery pressure(P<0.05).For ASD patients with moderate pulmonary hypertension,RVFT began to thicken compared with the control group and the group of normal pulmonary artery pressure.TAPSE,RVLS Free wall,and the e'/a' further decreased,and E,A,E/e' further increased(P<0.05).For ASD patients with severe pulmonary hypertension,RVOT Distal,PA,RVBD,RVMD,RA long and short diameter,RAA,LA length diameter,RAA/LAA,RVFT,3D EDV,3D ESV,a' increase evidently,all of the systolic function parameters and e' were reduced.The E and A were decreased compared with that in the group with moderate pulmonary hypertension,and the right ventricular diastolic function had significantly decreased.RVOT Distal,PA,RVBD,RVMD,RA short diameter,RAA,LA long diameter,RAA/LAA,RVFT,3D EDV,3D ESV,TAPSE,S',FAC,Tei index,IVA,3D RV EF,RVLS septum,RVLS Free wall,e',a' and IVRT were all correlated with PAMP(P<0.05).After closure 1,3,6 and 12 months,there were significant decreases in RVOT prox,RVOT Distal,PA,RVBD,RVMD,RVLD,RA Long Diameter,RA Short Diameter,RAA,RAA/LAA,3D EDV,3D ESV,TAPSE,Tei index,RVLS septum,RVLS Free wall,3D RV EF,E,A,e',and E/e' a(P<0.05).There was an increased in LA length diameter at 1,3,6 and 12 months after closure.There was significantly decreased in RVFT at 3 months and 12 months after closure.There was decreased compared with 1 month after closure in E at postoperative 3 months,6 months,and 12 months.Conclusions:With the increase of pulmonary artery pressure in ASD patients,the right heart chamber will continue to expand,and the expansion of the right ventricular annular direction is more obvious than the expansion of the long axis.multimodal echocardiography technique can evaluate the right heart morphology and function more comprehensively than a single method,and the Right Ventricle Longitudinal Strain of the right ventricular free wall is the most sensitive index to evaluate the right ventricular systolic function in patients with ASD with different degrees of pulmonary hypertension.One month after closure,the right heart size of ASD patients decreased significantly and became stable.Reconstruction of the right ventricular myocardium needs more than 3 months to recover.The right ventricular systolic function returned to normal in 1 month after closure.Some patients had impaired diastolic function before the closure of defect,which reversed to normal within more than 6-12 months after closure.