Two-dimension Strain And Strain Rate Evaluate The Myocardial Contraction In Tibetan Patients With Patent Ductus Arteriosus After Interventional Therapy

Objective:To evaluate the function about left and right heart ventricularmyocardial contraction in children with patent ductus arteriosus children inhigh altitude place after interventional closure by two-dimension strain andstrain rate imaging technique.To find out the extent of myocardial contractionin Tibetan children with patent ductus arteriosus and the retrieve afterinterventional therapy.Methods:84children are divided into3groups:31are Tibetan PDAchildren(11boys and20girls),33are plain area PDA children (14boys and19girls),meanwhile,20are health individual in contral group(10boys and10girls).Observe children's height, weight, blood pressure, heart rate, andTEE.More than three continuous cardiac cycles are measured by Echo PAC7.0,take photos in the phase of four chanbers from the apical of leftventricular,get the curve of systole peak strain and strain rate. Measure theLVEDd and RVEDd through the left ventricular apical four chambers.Calculate the LVEDV, RVEDV using the method of Simpson. Measure andcalcalue LVEF,RVEF, LVSV,CO, CI, LVMI and LVEDVI.We respectivelyseparate the ventricular septum,left ventricular free wall, right ventricular freewall.Each of them separated into three parts, to measure endsystoliclongitudinal strain (SL) before and after the closure which reflects the localsystolic function of left and right tissure of heart musale. Measure PASP withTEE, According the shape and size of defect in opacification, put the occluderin the3-6mm more than narrowest place. Use the SPSS16.0statistic softwarefor statistics methods.Results:1. There is no difference in the age, sex, weight, blood pressure, heart rate between Tibetan group, plain group and normal group.(P>0.05). The heightof the children in Tibetan group is the lowest(P<0.01).The diameter of PDAin Tibetan group is widder than plain group. The PASP value in Tibetan groupis higher than plain group(P<0.01).2. Afternclosure,inTibetan's group, LVEDd and LVEDV decreasedremarkably(P<0.01).,meanwhile,,LVSV,CO,CI, LVMI LVEDVI and PASPdecreased eithe(rP<0.01).There is no obvious statistic difference in LVEF andRVEF(P>0.05).3. Strain and strain rate value3.1The strain of left ventricular full wall in the Tibetan group decreasedafter the closure(P<0.01). Basal and middle ventricular septal and basal andmiddle right ventricular full wall increased(P<0.01), apical right ventricularfull wall increased(P<0.05)Apical ventricular septal increased but has nostatistic difference(P>0.05). The strain rate of left ventricular full walldecreased after the closure(P<0.01), Strain rate of interventricular septal andright ventricular full wall increased after the closure,basal right ventricular fullwall(P>0.05) middle segments(P<0.05), apical segment(P<0.01).3.2The strain of Tibetan group is higher than normal group in leftventricular full wall at pre-closure,basal left ventricular full wall(P<0.05),middle and apical left ventricular full wall(P<0.01).The strain ofseptal and righr ventricular full wall is lower than normal group beforeclosure,basal septal and apical septal(P<0.05), three segments of rightventricular full wall(P<0.01).There is no difference in left ventricular fullwall and septal between Tibetan and normal group after closure(P>0.05),butthe Tibetan group is still lower than normal group in right ventricular full wallafter closure(P<0.01).3.3There is no difference in left ventricular full wall and septal betweenTibetan and plain group before closure.(P>0.05). Strain of right ventricularfull wall in Tibetan group is lower than plain group, basal and middle segment(P<0.01), apical segment(P<0.05). There is no difference of the value ofchanges in Tibetan and plain group during closure in all of segments except middle segment of right ventricular full wall(P>0.05).Conlusion:1. Two-dimensional technique could quantitative evaluate the myocardialcontraction about PDA patients and more sensitive than the value of EF.2. The change of myocardial systole has little difference between Tibetanand plain children during interventional therapy. Left ventricular myocardialsystole function restore quickly after closure,while right ventricular not, weshould follow-up for long time.