Real Time Three-dementional Echocardiography Combined With Cardiac Catheterization Technique For The Evaluation Of Atrial Septal Defect Closure Study On Right Cardiac Function Before And After Treatment

Research background:In recent years, atrial septal defect (ASD) closure has become a kind of importantmethod for rectification and treatment of ASD, but the comprehensive research on itsinfluence of right heart function is rare. Since the complexity, the special structure andfunction characteristics of the right ventricular structure, which leads to lacking of theaccurate evaluation method for a long term. Before2005, American society ofechocardiography（ASE）published guideline also was mainly aimed at the evaluation of leftventricular function, the research of right heart function was still in the preliminary stage. Inthe next few years, however, with the knowledge of right heart function,2010Europe andAmerica four societies of echocardiography published the new guideline cited a large numberof literature of recent years, many of which were aimed at the right ventricle. The guidelineconfirmed the echocardiography imaging diagnosis method of evaluation right heart can bewidely used in clinical conventional application. This thesis was using real-timethree-dimensional echocardiography (RT-3DE) combined with cardiac catheterizationtechniques to evaluate ASD closure before and after treatment of the change of the right heartfunction, and to further explore RT-3DE in evaluation of right heart function value ofclinical application.Purpose:1．Using the real-time three-dimensional echocardiogranhy (RT-3DE) to researchchanges of right heart function of patients with atrial septal defect closure before and aftertreatment; 2．Through cardiac catheterization technique to evaluate pulmonary artery pressurechanges of patients with atrial septal defect closure before and after treatment;3．Basing on pressure measure standard for cardiac catheterization, evaluating theechocardiography pulmonary artery pressure measurement accuracy.Methods:1．Selected33patients diagnosed ostium secundum ASD in our department ofcardiology from2010January to2011September. The male9, female24, age8~65yearold, average (35.52+15.24), including29patients with varying degrees of pulmonaryarterial hypertension (PASP≥30mmHg), closuring by preoperative TTE and/or TEEmeasurement of ASD maximum diameter of5.1~34.2mm, average (19.81+8.55) mm, andin the echocardiogranhy monitoring of successfully implanted the ASD occluder. All of thepatients were checked through transthoracic two-dimensional echocardiography andreal-time three-dimensional echocardiography (RT-3D-TEE) in preoperative, postoperative1weeks, and the evaluation indexes include the right ventricular end diastolic diameter(RVEDd), right ventricular end-diastolic volume (RVEDV), right ventricularend-systolic volume (RVESV), two-dimensional right ventricular area change fraction(RV-FAC),3D right ventricular ejection fraction (3D-RVEF), right ventricular Tei index,right ventricular systolic pressure (RVSP), pulmonary artery systolic pressure（SPAP）,diastolic pressure(PADP) and mean pressure(MPAP) and so on. The images were filed toanalysis, and all patients would undergo regular follow-up and review after1months,3months,6months.2．All patients were measured the right ventricle, right atrium, pulmonary arterypressure by cardiac catheter before and after Atrial septa defect closuring operation, and themeasurement indexes were as "gold standard" for evaluation of right ventricular systolicpressure，pulmonary artery systolic pressure, diastolic pressure and mean pressure.3．All values were represented by means±standard deviation. before and after operationright heart function compared with matching t test, the relationship between two variablesusing the straight-line related and regression analysis, P <0.05for the difference isstatistically significant, income datas were for statistical analysis by use of statisticalsoftware SPSS17.0. Results:Atrial septal defect (ASD) patients in interventional therapy of postoperative1weeks,1months,3months and6months, the right ventricular end diastolic diameter (RVEDd),right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume(RVESV) decreased obviously (P <0.01), right ventricular Tei index decreased significantly(P <0.01); two dimensional right ventricular fractional area change (RVFAC) andthree-dimensional right ventricular ejection fraction (3D-RVEF) in the patients afterclosure of a preoperative decreased significantly (P <0.01), but after3months declineslowed, six months after surgery to new balance; the right ventricular systolic pressure，pulmonary artery systolic pressure, diastolic pressure and mean pressure of ASD patientsafter transcatheter closure were significantly reduced than that before operation (P <0.01);echocardiography estimation of right ventricular pressure and the corresponding right heartcatheterization manometry value comparative analysis results were highly correlated (r=0.879,0.827,0.854,0.872,0.916,0.865,0.924,0.816).Conclusion:1．Patients with ASD have varying degrees dysfunction of right heart, ASD patients’right heart function can be improved in different degree after interventional therapy;2．Right ventricular pressure estimated by echocardiography and the corresponding rightheart catheterization manometry values were highly correlated;3．Real-time three-dimensional echocardiography (RT-3DE) evaluation of the rightheart function were convenient, noninvasive, easily repeatable, sensitive, accurate andadvanced, the comprehensive evaluation can achieved accurately from the right heartfunction.