Change Of Right Ventricular Function In Early Period After Transcatheter Closure Of Atrial Septal Defect Under The Guidance Of Echocardiography

Objective: With transthoracic echocardiography,observing the change of right atrioventricular morphology and right ventricular systolic function in early period after transcatheter closure of atrial septal defect(ASD)under the guidance of echocardiography,and comparing the application value of various indexes in evaluating right ventricular function in early period after ASD closure.Methods: Fifty-four patients underwent percutaneous ASD closure guided by echocardiography and 39 healthy controls in the same period were collected in this investigation.The clinical data of the above two groups were collected completely.Subsequently,we used transthoracic echocardiography to measure and calculate the right atrial transverse diameter(RATD),right ventricular transverse diameter(RVTD),and 6 right ventricular function indexes which including right ventricular outflow tract systolic excursion(RVOT-SE),right ventricular outflow tract fractional shortening(RVOT-FS),tricuspid annular plane systolic excursion(TAPSE),tricuspid annular peak systolic velocity(S’),right ventricular fractional area change(RVFAC),right ventricular index of myocardial performance(RIMP)of ASD(preoperative,3 days after surgery,1 month after surgery,3 months after surgery)and healthy controls.The t-test was applied to analyze the clinical data of the two groups.The ANOVA analysis contributed to the analysis of these groups(changes of the right atrioventricular morphology and right ventricular function among healthy control group,the ASD before and after interventional closure).Finally,receiver operating characteristic curve(ROC)was used to assess the credibility of the right ventricular function indexes measured by echocardiography for the evaluation of the changes of right ventricular function before and after interventional occlusion in ASD.Results: 1.Fifty-four patients successfully underwent percutaneous ASD closure.The size of the atrial septal defect was(22.46±7.09)mm measured by thoracic echocardiography preoperative.There were 32 cases with pulmonary hypertension and 22 cases with normal pulmonary artery pressure.2.The comparison of clinical data of the ASD group and the healthy control group: There were no statistical differences in gender,age,body mass index(BMI),body surface area(BSA),systolic blood pressure,diastolic blood pressure,and heart rate between the above two groups.3.The comparison of the right atrioventricular morphology and right ventricular function among healthy control group,ASD before and after intervention.(1)RATD、RVTD: The RATD and RVTD of the ASD before surgery,3 days and 1 month postoperative were all larger than the healthy control group(P<0.05).But the RATD and RVTD of postoperative ASD were smaller than preoperative ASD(P<0.05),and they nearly retracted to the level of healthy control group in 3 months after surgery(P>0.05).(2)Right ventricular function indicators: RVOT-SE,RVOT-FS: No significant difference was observed of RVOT-SE and RVOT-FS between the preoperative ASD and the healthy control group(P>0.05).However,RVOT-SE and RVOT-FS of postoperative were all lower than preoperative ASD and the healthy control group(P<0.05).There was no difference of RVOT-SE and RVOT-FS in 3 days,1 month and 3 months after surgery(P>0.05).TAPSE: The TAPSE of preoperative ASD was higher than the healthy control group(P<0.05).Within 3 months,the TAPSE of each postoperative period was lower than that of preoperative(P<0.05),and it remained at the level similar to healthy control group(P>0.05).S’: The S’ of preoperative ASD was higher than the healthy control group(P<0.05).Nevertheless,in 3 days after closure,it was lower than the healthy control group(P<0.05),and increased to the level of the healthy control group in the 1 month and the 3 months after the operation(P>0.05).RVFAC: The RVFAC of preoperative ASD were lower than the healthy control group(P<0.05),and in 3 days after operation,it was reduced further compared to preoperative ASD(P<0.05).In 1 month and 3 months after operation,they returned to the preoperative level(P>0.05),but still lower than the healthy control group(P < 0.05).RIMP: The RIMP of preoperative ASD had no difference with the healthy control group(P>0.05),and in 3 days after surgery,the RIMP of ASD was higher than that of preoperative ASD and healthy control group(P<0.05).In 1 month and 3 months after surgery,there were no difference between preoperative ASD and healthy control group(P>0.05).4.The area under the curve(AUC)of ROC of various preoperative right ventricular function indicators in ASD: Before operation,the AUCs of TAPSE,S’and RVFAC exceeded 0.7.5.The AUC of the right ventricular function indexes in the early stage after interventional closure of ASD: the AUCs of RVOT-FS,TAPSE,S’,RVFAC and RIMP were all higher than 0.7.The AUC of RVOT-SE was 0.691.Especially,S’owned the highest AUC(0.82)with a sensitivity of 94.9%.Conclusion:1.After ASD closure,the right atrioventricular morphology gradually retracted,and nearly retracted to the normal level in 3 months after surgery.2.RVOT-SE,RVOT-FS,TAPSE,S’,RVFAC and RIMP can evaluate the changes of right ventricular function of ASD,and S’ has the highest credibility and the best sensitivity.3.The right ventricular function of ASD decreased in a short time after interventional occlusion,and the right ventricular function recovered to varying degree in 3 months after surgery.S’ can predict the change of right ventricular function preferably in an early phase after surgery.RVOT-FS and RVOT-SE can predict the change of right ventricular outflow tract function,combined with other indexes simultaneously,can reflect the change of the whole right ventricular function comprehensively.