| Background:Atrial septal defect (ASD) is one kind of the most frequent congenital heart disease. Echocardiography is the most important diagnostic method. Although 2-Dimensional echocardiography (2DE) has high accuracy in displaying directly its anatomic structure, but is influenced by acoustic window. Accurate assessment of cardiac function is very important for clinic diagnosis. Although there are a few of articles about cardiac function pre- and post-operation in ASD, but there is always dispute. Recent real-time three-dimensional echocardiography (RT-3DE) becomes an effective method in evaluating cardiac morphology and function, providing more three-dimensional anatomic information than 2DE. Some researchers evaluated the volume of left ventricle (LV) and right ventricle (RV) using RT-3DE, and found that the values measured by RT-3DE correlates well with that by MRI, indicating that RT-3DE is a perfect technique in evaluating ventricular volume and function in dynamic and real-time condition.Tei index is a novel index to detect global cardiac function. The usage of conventional Tei index (C-Tei) derived from Doppler technique is limited because of poor sampling clarity. Tissue Doppler imaging (TDI) was introduced to calculate Tei-index (TDI-Tei) in 1990s, and soon was applied to clinical owing to its clear sampling. It is considered that TDI-Tei index is more sensitive and accurate than C-Tei in evaluating RV function and is a perspective method for cardiac function.ObjectiveTo evaluate RV morphology and systolic function of ASD before operation and at different time point after operation with RT-3DE, to evaluate RV global function with TDI-Tei and C-Tei index; then evaluate the feasibility of RT-3DE and TDI-Tei index for evaluating LV and RV function. To evaluate RA function with AQ. MethodsThirty patients with ASD receiving surgery treatment (surgery group, mean age 12±10 years) and thirty receiving transcatheter closure treatment (occlusion group, mean age 14±12 years) during October 2006 to July 2007 were enrolled in evaluation. Ten of them received MRI evaluation.Philips iE33 with probe S5-1 and probe X3-1 was used to obtain 2-dimensional dynamic images and 3-dimensional full volume images. The images then were imported to QLAB5.2 workstation. RV volume of end-diastole (EDV) and end-systole (ESV) and systolic function (ejection fraction, EF) were analyzed with QLAB5.2 3DQ Advance software. TDI-PW images in mitral annulus and tricuspid annulus were used for measurement of time interval"a'"and"b'", blood flow frequency spectrum of mitral orifice and tricuspid orifice for time interval"a", LV outflow tract and RV outflow tract for"b"respectively. Then TDI-Tei index and C-Tei index were calculated.Cardiac MRI images were obtained in ten cases of ASD before operation with 1.5T Infinit Twin Speed MR instrument (GE Corporation).After routine three-plane location scanning, apical four and two chamber's view were obtained, then short axis views were located vertical to interventricular septum. Consecutive multiple plannar short axis images were obtained with Fiesta Cine series. With the help of postprosessing software package, outline the endocardium border of RV, RVEDV, RVESV and EF were calculated respectively and used as control standard of RT-3DE.Results:1.The mean RVEDV, RVESV, RVEF, LVEDV, LVESV and LVEF measured by RT-3DE had no statistic difference, compared with that by MRI in 10 preoperative ASD patients, with coefficient correlation was 0.994, 0.974, 0.948, respectively (all P=0.000).2.Compared with pre-operation, RVEDV, RVESV decreased significantly at 7d post-op, and decreased further at 3mon post-op, in both surgery and occlusion group (all P<0.05).3.TDI-Tei correlated well with C-Tei and RVEF, in both surgery and occlusion group, before and at 7d and 3mon after operation (all P=0.000). But TDI-Tei is more sensitive than C-Tei in displaying change of RV function in both surgery and occlusion group.4. RV functional change: 1) Surgery group: Compared with preoperation, T-Tei increased and RVEF decreased markedly at 7d post-op (P<0.05), while T-Tei decreased and RVEF increased markedly (P<0.05), nearly to normal at 3mon post-op, indicating that systoic function and global function decreased at 7d and improved at 3mon post-op.2) Occlusion group: Compared with preoperation, T-Tei decreased markedly at 7d post-op, and RVEF increased markedly at 3mon post-op (P<0.05), indicating global function improved at 7d and systoic function improved at 3mon post-op.5. RA functional change:All RA functional parameters had no differences between surgery group and occlusion group(P>0.05).EDV, ESV, EREV and RAV decreased significantly at 7d and 3mon post-op, in both surgery and occlusion group (all P<0.05). There was no statistic difference between 7d and 3mon post-op.1) Compared with preoperation, AE increased significantly at 7d post-op, AEF decreased significantly at 3mon post-op in surgery group (P<0.05), while AEF decreased significantly at 3mon post-op (P<0.05) in occlusion group. Indicating that AE and AEF was not change with the same tendency.2) Compared with preoperation, REF increased significantly at 3mon post-op in surgery group (P<0.05) and RE has no statistic difference between pre-operstion and 7d and 3mon post-op (P>0.05). Both RE and REF showed no statistic difference between pre-operstion and 7d and 3mon post-op in occlusion group (P>0.05).3) RE/AE increased gradually and there was statistic difference between pre-operstion and 7d and 3mon post-op in surgery group (P<0.05). In occlusion group, RE/AE decreased significantly at 7d, compared with preoperation (P<0.05), and then increased at 3mon post-op (P<0.05). There was no statistic difference between pre-operstion and 3mon post-op in occlusion group (P>0.05).Conclusions:Part 1:RT-3DE provide RV volumes and ejection fraction highly relative to that by MRI, indicate that RT-3DE can accurately quantify RV volumes and systolic function. Part 2: RV morphology and function1. RV high loading condition was released at 7d and released further at 3mon post-op, omdocating that RV morphology was ragain fast and last long in both surgery and occlusion group.2. TDI-Tei index can make estimation more sensitive and accurate than C-Tei index to RV global function of ASD.3. RV function decreases in early stage after surgery and recover gradually at 3mon post-op. Whlie RV global and systolic function improve in early stage and recover to normal at 3mon after transcatheter closure. RV function recovers more early in occlusure group than in surgery group.Part 3:RA function1. Resevior function: Before operation, RA enlarged to enchance its resevior function. After operation, RA resevior function recovers fast to normal because of its volume decreasing in both surgery group and occlusure group.2. Bump function: Before operation, RA enchances its bump function because of functional compensation. After operation, AEF decreases gradually to normal condition and AE changed not markedly in surgery group. While in occlusure group, AE decreases gradually to normal condition and AEF changes not markedly. So, the change of AE and AEF is discordant.3. Passageway function: RE/AE increases gragually after surgery, indicating that RA passageway function improves in surgery group. While in occlusure group, RE/AE does not improve markedly after operation, may be because that RE/AE does not decrease obviously before operation owing to its smaller atrial septal defect. |
PDF Full Text Request