Assessment Of Right Ventricular Function In Patients With Pulmonary Arterial Hypertension Secondary To Atrial Septal Defect Using Real-time Three-dimensional Echocardiography

Objective: Real-time three-dimensional echocardiography is a recently developedtechnology in the field of ultrasonic medicine, which uses a unique approach to assessventricular structure and function, without any geometric assumptions. This studyinvestigates the application of real-time three-dimensional echocardiography imagingtechnology in evaluation of right ventricular volume and right ventricular function inpatients with pulmonary arterial hypertension (PAH) secondary to atrial septal defect(ASD).Methods: Between June2011and December2011,a total of33patients withPAH secondary to ASD were treated in the General Hospital of Shenyang MilitaryRegion. We classified patient group into two groups.Group A included21patients withpulmonary artery systolic pressure(PASP)30mmHg~70mmHg;Group B included12patients with PASP30mmHg~70mmHg.PAH was defined by an estimatedPASP>30mmHg,as measured using cardiac catheterization.We also enrolled15subjects with echocardiographically normal hearts and an estimated PASP<30mmHgusing2-dimensional echocardiography (2DE).All subjects underwent RT-3DE toassess right ventricular end systolic volume (RVESV), right ventricular end diastolicvolume (RVEDV), right ventricular end systolic volume index (RVESVI) and rightventricular end diastolic volume index (RVEDVI) and right ventricular ejectionfraction (RVEF).Results:1.Parameters of right ventricular volume and right ventricular function:Compared to the control group,RVEDV、RVESV、RVEDVI、RVESVI have increasedin group A and group B(P <0.01).The group A compared to the control group, RVEDV、RVESV、RVEDVI、RVESVI have enlarged(P <0.05).Both RVEDV andRVESV were enlarge in those with group A compared to those in group B(P<0.01).RVEDVI、 RVESVI were significantly enlarged in those with group Acompared to those in group B(P <0.0001).All the parameters were enlarged in group Bcompared to those in the normal subjects((P <0.0001).No significant difference was found in RVEF between the control group andgroup A,however,RVEF in group B was significantly decreased compared with that inthe control group and group A(P <0.0001,P <0.01).2.Real-time three-dimensional right ventricular volume-time curves:Right ventricular volume-time curves is "U" shape. The amplitude of rightventricular volume-time curve showed a decreasing trend with the increase ofPAH,and the minimum of the right ventricular volume in systolic period also delayed.The differences in group B was significant.Conclusion:1.RT-3DE,which is real-time,convenient, accurate, noninvasive in assessing rightventricular function, can be used to evaluate the right ventricular volume,rightventricular ejection fraction and right ventricular volume-time curves in patients withPAH secondary to ASD.2.In patients with PAH secondary to ASD,the right ventricular volume isincreased compensatorily with the increase of pulmonary artery pressure.It issignificantly enlarged in patients with severe PAH. RVEF reduced slightly when PAHis mild to moderate.But RVEF reduced significantly,if PAH continued to increase.3.The amplitude of right ventricular volume-time curve showed a decreasingtrend with the increase of PAH,and the minimum of the right ventricular volume insystolic period also delayed. The differences in group B was significant.