To Assessment The Long-term Efficacy Of Interventional Treatment Of Atrial Septal Defect Patients With Moderate And Severe Pulmonary Hypertension

[Objective] To evaluate the long-term efficacy of transcatheter closure atrial septal defect (ASD) in patients with severe artery pulmonary hypertension.To evaluate the accuracy and reliability of transthoracic Doppler echocardiography (TDE) in assessment pulmonary artery systolic pressure (PASP).[Methods]The study is divided into two steps. Step1:To select34patients with congenital heart disease who was accepted interventional treatment in the First Affiliated Hospital of Kunming Medical University hospital from November2012to April2013.These patients were performed TDE1-7days before surgery.During interventional treatment pulmonary artery systolic pressure was measured again. The date from both methods were performed correlation analysis.Step2:To retrospective analysis clinical symptoms, clinical symptoms, cardiac function, pulmonary artery pressure and cardiac structure (right atrial, right ventricular diameter)62ASD patients with severe pulmonary hypertension(45-75mmHg) who accepted transcatheter closure ASD.During April2006to April2013in the First Affiliated Hospital of Kunming Medical University hospital.The follow-up time was6-60months.[Result] Step1:The measurement of PASP by TDE and right heart catheterization was20-67mmHg and22-69mmHg respectively, corresponding to the average of (44±23) and (46±24) mm Hg. There was a highly correlated between the measurement of PASP by TDE and right heart catheterization (r=0.7664, P<0.001). Through the analysis of Bland-Altman, the TDE and right heart catheterization was respectively measured PASP with a95%limit of agreement ranging from16.4to15.4mmHg and only3cases were beyond the limits of agreement ranging.Overestimation and underestimation of PASP over10mmHg by TDE occurred in5.9%and11.8%respectively, corresponding to the average degree of (6.5±5) mm Hg and (8.3±8) mm Hg. The magnitude of pressure overestimation and underestimation was insignificant (P=0.25). Through the analysis of Dichotomy variable,the measurement of PASP>=35mmHg and PASP>45mm Hg by TDE calculated the Youden index and occurred in0.58and0.68. The significance of the Youden index value absolute was closer to1, diagnostic accuracy was better. The result shows that the measurement of PASP by TDE is important and effective method of non-invasive examination.Step2:62ASD patients with pulmonary artery pressure (45-75mmHg,mean pulmonary artery pressure59.24±15mm Hg) were successfully closure and non-residual shunting. The following up time was6-60months (the average33±27months). There was non-residual shunting, thrombus, vegetation, acute and chronic heart failure clinical manifestations. The group of Moderate pulmonary hypertension (45mm Hg<PASP<=55mmHg),PAH returned to normal about6months and right atrial and ventricular diameter was recovery about6months to1year. The group of severe pulmonary hypertension (PASP>55mmHg),PAH, right atrial and right ventricular diameter were recovery about1year.[Conclusion]1.There was a highly correlated between the measurement of PASP by TDE and right heart catheterization.TDE can be used as diagnosis of pulmonary arterial hypertension and non-invasive method in the main, but can not completely replace the right heart catheterization.2.Estimation of right atrial pressure by right atrial diameter size then estimation of the pulmonary artery systolic pressure was an effective method.3. ASD patients with Moderate pulmonary hypertension (45mm Hg<PASP<=55mmHg) after interventional treatment whose pulmonary artery pressure, right atrial and right ventricular diameter were recovery time about6months to1year. It is recommended that clinical observation about1year.4.ASD patients with severe pulmonary hypertension (pulmonary artery pressure>55mmHg) after interventional treatment whose pulmonary artery pressure, right atrial and right ventricular diameter were recovery time about1year. It is recommended that clinical observation greater than1year.5.Transcatheter closure of atrial septal defect patients with moderate-severe pulmonary hypertension,that is safe,effective and fine of long-term efficacy.