| Bcakground and objectivesAtrial septal defect (ASD) is one of the most common congenital heart disease inadults,about65%-70%of which for secundum atrial septal defect(S-ASD). ASDmainly causes right heart volume overload due to the existence of left to right shuntand long-term load increases, the left atrial structure and function in patients withASD can also be a corresponding change that lead to atrial muscle cell degeneration,atrial muscle fibrosis and intra-atrial hemodynamic abnormalities, affecting thetension of the left atrial wall and electrophysiology, thus atrial fibrillation isinduced.The changes of left atrial size and function is not only the risk factors ofatrial fibrillation before and after transcatheter closure, but aslo independent predictorof cardiovascular disease. Therefore, the accuracy of the evaluation of the size andfunction of left atrial have important clinical significance for evaluating of left atrialfunction.Transcatheter closure is one of the most mature and effective method fortreatment of ASD, not only small damage of atrial muscle function and rapid recovery,but aslo can reduce the incidence of atrial fibrillation after transcatheter closure. Inrecent years, tissue doppler imaging(TDI)、acoustic quantification(AQ）and real-timethree-dimensional echocardiography(RT-3DE）have been applied in the assessment of left atrial function, but these technologies are not designed in view of the left atrium.Left atrial volume tracking method(LAVT) is a new technology of evaluating thevolume and function of left atrial in recent years, which influenced less by left atrialanatomic structure. According to the principle of two-dimensional tissue tracking andsecondary pixel intensity distribution, LAVT can automatically track the informationcarried by left atrial wall frame by frame in the cardiac cycle, and systematicallycalculate left atrial volume-time curve and left atrial emptying fraction curve based onthe single plane simpson’s rule. LAVT reduce the number of pixels for tracking andsaving tracking time, produce faster calculation speed, higher accuracy and higherframe rates compared to previous research technology. The changes in right heart andleft ventricle function and form have been extensive researched, but less reports aboutthe changes of left atrial size and function. The purpose of this study was to evaluatethe the left atrial size and function of secundum atrial septal defect with pulmonaryarterial hypertension in adults after transcatheter closure (LAVT) method, andanalysis of the the correlation of left atrial function indexes and PASP.Materials and methods50S-ASD patients diagnosed and successfully treated with transcatheter closurein Henan Provincial People’s Hospital during December,2012to December,2013,ofwhich18patients with mild pulmonary hypertension,22patients with moderatepulmonary hypertension,10patients with severe pulmonary hypertension, and fiftyhealthy control subjects were enrolled in this study. Left atrial volume-time curve andleft atrial emptying fraction curve were obtained3days before transcatheter closure,3days and3months after transcather closure in S-ASD patients and healthy controlsubjects by LAVT method. LA maximal volume (LAVmax), LA presystolic volume(LAVpre), LA minimal volume (LAVmin) were recorded from left atrial volume-time curve. Body surface area (BSA) was used to revise these volume indexs(LAVImax, LAVIpre, LAVImin). The following LA emptying function parameterswere calculated: LA total emptying volume indexs, LA passive emptying volumeindexs, LA active emptying volume indexs(LAVItotal, LAVIpass, LAVIact), LA total emptying fraction, LA passive emptying fraction, LA active emptyingfraction(LAVItEF, LAVIpEF, LAVIaEF). The systolic LA filling peak (dv/dtS), earlydiastolic LA emptying peak(dv/dtE), late diastolic LA emptying peak(dv/dtA) wererecorded from left atrial emptying fraction curve.Results1. LA,RV,RA in the S-ASD group were significantly higher than those in thecontrol group(P <0.05),whereas the LVEDD, LVEDV, LVESD, LVESV, SV, LVEF, Epeak, E/A were lower(P<0.05).2. LAVImax, LAVIp, LAVImin in the S-ASD group were significantly higherthan those in the control group(P <0.05), whereas the LAVItEF, dv/dtS, LAVIaEF,dv/dtA were lower(P<0.05), but no significant differences were found in LAVItotal,LAVIpass, LAVIact, LAVIpEF, dv/dtE(P>0.05).3. Three days and three months after transcatheter closure, RA, RV, PASP weresignificantly reduced than those three days before transcatheter closure (P<0.05);three months after transcatheter closure，LA was significantly reduced than thosethree days before transcatheter closure (P<0.05);three months after transcatheterclosure，LVEDD, LVEDV, LVESD, LVESV, SV, LVEF, E peak, E/A increased thanthose three days before transcatheter closure (P<0.05).4. Three months after transcatheter closure, the LAVImax, LAVIpre, LAVIminwere reduced, LAVIaEF,dv/dtA,LAVItEF,dv/dtS significantly increased than thosethree days before transcatheter closure (all P<0.05); The LAVIpass, LAVIpEF,LAVIact, LAVItotal, dv/dtE had no significant differences before and after transcatherclosure(P>0.05).5. Left atrial reservoir function indexes:LAVItEF, dv/dtS, LAVItotal hadnegative correlation with PASP(r=-0.574,-0.834,-0.737,P<0.05),Left atrial pumpfunction indexes:LAVIaEF, LAVIact had negative correlation with PASP(r=-0.885,-0.800,P<0.05),left atrial conduit function indexes:LAVIpEF, dv/dtE,LAVIpass had no correlation with PASP(r=-0.102,-0.020,-0.006,P>0.05). Conclusion1. LAVT method is a potientially useful tool to evaluate the changes of size andfunction of left atrial in S-ASD patients with PAH in adults before and aftertranscatheter closure.2. The left atrial sizes and volume are increased, the left atrial reservoir andbooster pump functions are reduced,the left atrial conduit function is no obviouschange in S-ASD patients with PAH before transcatheter closure.3. The left atrial sizes and volume are reduced，the left atrial booster pump andreservoir function are increased,the left atrial conduit function is no obvious changein S-ASD patients after transcatheter closure.4. The indexes of left atrial booster pump function and reservoir function havenegative correlation with PASP.5. left ventricular systolic and diastolic function in S-ASD patients with PAH arereduced before transcatheter closure;left ventricular systolic and diastolic function inS-ASD patients with PAH are restored after transcatheter closure. |
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