Comparison Of The Left Ventricular Function Before And After Transcatheter Occlusion Of Atrial Septal Defect In Adult Patients With Small Left Ventricle

Objectives:To explore the left ventricular function before and after transcatheter occlusion of Atrial Septal defect in adult patients with small left ventricle.Methods:Selected 54 ASD cases associated with small left ventricle which had been successfully implemented the closure,as the research object from January 2015 to June 2015.22 cases of 54 ASD patients whose left ventricular end-diastolic diameter,LVEDd<40mm were included into group A(small left ventricle group);32 cases of 54 ASD patients whose left ventricular end-diastolic diameter,LVEDd≥40mm were included into group B(normal left ventricle group).Each case was measured the diameter of ASD through echocrdiography,systolic pulmonary artery pressure(s PAP)and diastolic pulmonary artery pressure(d PAP)for calculating the mean pulmonary artery pressure(m PAP)by right heart catheterization;measured the each cavity diameter of hear at pre-operation,24 hours postoperatively,the first,the third,the sixth month after Amplatz closure,tricuspid annual plane systolic excursion(TAPSE)at pre-operation,the first,the third,the sixth month after Amplatz closure,NT-Pro BNP at pre-operation,the first day,the third day postoperatively,the first,the third,the sixth month after Amplatz closure.SPSS 13.0 statistical software was used to analysis,such as age,echocardiography index,NT-Pro BNP count indicators,using t test,such as gender rate compared with chi-square test,P < 0.05 for the difference was statistically significant.Based on multiple factors Logistic regression analysis to screen the adult small independent clinical characteristics of the left ventricle in patients with ASD,P <0.05 for statistical significance.Results: 1.General informationThe age,constitute proportion of male and female,systolic pulmonary artery pressure,mean pulmonary artery pressure,The body surface area(BSA),the size of ASD and the size of the Closure model number of group A are no difficult with group B.they indicated that the baseline having no obvious difference between two groups.2.The variation of NT-Pro BNP The mean value of NT-Pro BNP,in group A was higher than in group B at pre-operation(A=154.2±91.8,B=94.0±87.8,p=0.013).the value had increasing from the fist day to the third day both in group A and B after operation,but they were no stastical significance,the value of p respectively was 0.86 and 0.59.Then the value had declining from the fist month to the sixth month both in group A and B during the following dtime,but the value of NT-Pro BNP in group A was still higher than group B,the value of p respectively was 0.01 and 0.01.At the same time the value of NT-Pro BNP in group A still higher than the rang of normal value,though the value in group B come back th rang of normal value(A=152.5±99.4,B=71.8±51.8,p<0.01).The result showed that adult ASD patients with left ventricular had abnormal cardiac function compared with the normal size left ventricular group.3.The variation of right function(TAPSE)The mean value of TAPSE in group A was higher than in group B at preoperation that the difference between in group A and B was significant(A=25.4±2.5,B=27.0±2.7,p=0.020).The difference of TAPSE indicated that the right ventricular systolic function between in group A was worse that than in group B.The value had declining from the first month to the third month both in group A and B during the following dtime,but they had no statistical significant(P>0.05).But the value in the sixth month in group A still higher than the group B(A=23.1±1.7,B=22.1±1.3,p=0.032)in the sixth month,which showed that the right ventricular systolic function restored slowly.4.The variation of the left ventricular function.The analysis of the proportion of the “E/A<1” pre-operation and the fist,the third and the sixth month after Amplatz closure showed that the difference between group A and B was significant,which the proportion in group A was respectively 81.8%,72.7%,50%,31.8% and in group B was 21.9%,15.6%,18.7%,9.4%.The value of χ2 and p respectively were 19.007,P<0.001;17.887,P<0.001;5.902,P<0.015;4.352,P<0.037.Meanwhile the analysis of the proportion of the “8 < E/EM < 15” pre-operation and the fist,the third and the sixth month after Amplatz closure showed that the difference between group A and B was significant only in preparation(n=54,χ2=8.061,P<0.005).The consequences indicated that the left ventricular diastolic function in group A was worse than that in group B.Meanwhile,the left ventricular diastolic function recovered slowly.Preoperative and postoperative using Simpson method measuring LVEF compared the two groups and each group had no obvious difference in contrast,p > 0.05.5.The variation of Cavity interior diameter T Found that preoperative left atrial diameter(LA)in group A than B group,but no statistical difference(P > 0.05),the LA the fist day postoperative was lower than the LA preoperative(P < 0.05),and no longer changes;LA preoperative and postoperative in group B were no significant changes.That adult patients with left ventricular ASD preoperative left atrial diameter is relatively increased,may be related to decrease left ventricular diastolic function and left atrial pressure increased.The mean value of left ventricular end-diastolic diameter(LV)in group A was smaller than in group B at pre-operation(A=37.9±1.3,B=44.4±3.3,p=0.000).The significance was obvious from pre-operation to post-operation both in group A and B.The tendency both was increasing that the increasing tendency in group A happened in first 24 hours post-operation as which in group B happened near a month post-opreation.But the value in the first,the third sixth month in group A still smaller than the group B.The consequences showed that the LV restored slowly.Found that the right atrial left-right diameter(RAL),he right atrial anteroposterior diameter(RAA)and the right ventricular end-diastolic diameter(RV)in group A was bigger than in group B before the operation(p<0.05).Each observation point RAL and RAA between two groups were no significant differences(P > 0.05).The RV lessened obviously in 24 hours postoperatively(A=27.1±2.8,B=25.4±5.1,p=0.023).But the value in the sixth month in group A still bigger than the group B(A=21.1±2.5,B=18.9±2.0,p=0.000).The consequences showed that the RV restored slowly.6.Multi-factor logistics regression analysis preperation The results of multi-factor analysis showed that enlargement and E/Em values increase were independent clinical characteristics for ASD patients with small left ventricular.Conclusion: 1.The patients with small left ventricular had a poorer left ventricle diastolic function than normal left ventricular group pre-operation;At the same time,the left heart diastolic function recovery time in small left ventricular group extended.2..Preoperative enlargemental right ventricular,high E/Em values may be the correlative risk factors of left heart diastolic function recovery slow.