Medium-and Long-term Changes Of Cardiac Geometry Based On Z Scores After Percutaneous Interventional Closure Of The Perimembranous Ventricular Septal Defect

Objective: To explore the medium-and long-term changes of cardiac geometry based on Z scores after percutaneous interventional closure of the perimembranous ventricular septal defect(PMVSD),and to provide strong evidence for the prognosis and the safety of percutaneous interventional occlusion in children with PMVSD.Methods: Thirty three children with PMVSD were underwent percutaneous interventional occlusion in the First People’s Hospital of Jining form January 2012 to June2013.The changes of Z scores for left ventricular end-diastolic diameter(LVEDd),interventricular septal diastolic thickness(IVSd),left ventricular posterior wall thickness(LVPWd),left ventricular mass(LVM),and left ventricular volume(LVEDV),as well as left ventricular mass index(LVMI),left ventricular remodeling index(LVRI),and the ratio of left and right ventricular end-diastole diameter(LVEDd/RVEDd)at 1m,3m,6m,1y,2y,3y,4y,5y,and 6y after percutaneous interventional occlusion were retrospectively analyzed,respectively.The measuring methods of cardiac ultrasound indicators recommended jointly by the American Society of Echocardiography and the European Cardiovascular Imaging Association were referred.The average measured values of LVEDd,LVPWd,and IVSd in three cardiac cycles are used.Continuous variables data of normal distribution were expressed as ±s.One-way analysis of variance was performed at multiple follow-up points,and SNK(Student-Newman-Keuls)test was used for further paired comparison at each follow-up point.P < 0.05 means the difference is statistically significant.Results:1.Thirty three children with PMVSD were enrolled in this study,of whom 12cases(36.4%)were male and 21 cases(63.6%)female,aged from 3.0 years to 7.0 years and averaged age was(4.60 ± 1.18)years,as well as body weights and heights were(16.0± 2.5)kg and(104.4 ± 8.1)cm,respectively.Before percutaneous interventional occlusion,the Z scores of LVEDd in all PMVSD children were greater than 2,of whom 4cases whose Z scores of LVPWd and IVSd were more than 2,12 cases whose Z scores of LVPWd and ISVd less than 2,and 8 cases whose Z scores of LVPWd more than 2 and Z scores of IVSd less than 2,9 cases whose Z scores of IVSd greater than 2 and Z scores ofLVPWd less than <2.Operation time of children with PMVSD was(86.6±22.6)minutes,occluders in the operation were all supplied by Shenzhen Xianjian Equipment.Under the angiography,defect diameter of children with PMVSD was(4.2±1.6)mm,with a maximum of 8 mm and a minimum of 3 mm.Eleven cases children(33.3%)with membranous tumors were treated with the occluders of small waist and large edge,and symmetric occluders were adopted for the remaining 22cases(66.6%).Diameter of occluder is(6.4±4.2)mm,and the difference between defect diameter and occluder is(2.2±1.8)mm.2.The indicatior change of left ventricular longitudinal structure after percutaneous interventional closure.PMVSD Children’s LVEDd/RVEDd ratio and LVEDd Z scores decreased significantly(P <0.05)1 month after the operation,and separaetly tended to be stable 1 year and 2 years later.Z scores of IVSd and LVPWd had no change within 3 months after operation,and began to decrease significantly(P <0.05)6 months later,and became stable 3 years later.3.The indicator change of left ventricular hypertrophy and dilation after percutaneous interventional closure.The LVMI and LVM Z scores didn’t have any change within 1 month after operation,and began to decrease significantly(P <0.05)after3 months,and separately tended to be stable 2 and 3 years later.The LVEDV Z scores decreased significantly(P <0.05)1 month after operation and tended to be stable 2 years later.4.The indicator change of direction of left ventricular remodeling after percutaneous interventional closure.LVRI didn’t change within 3 months after operation,and began to decrease significantly(P <0.05)6 months later,and were stable 2years later.Conclusion: Percutaneous interventional occlusion is good for the reverse remodeling of cardiac geometry,and the changes tended to stabilize with follow-up.