| ObjectivesBy summarizing and analyzing the changes of peripheral blood hypersensitive troponin T(hs-cTnT)in 134 children treated with transcatheter perimembrane ventricular septal defect(pmVSD),the influencing factors of myocardial injury after transcatheter pmVSD closure were analyzed and their clinical significance was analyzed.Research objects and methodsA total of 134 children who received pmVSD in pediatric cardiology Department,Provincial Hospital Affiliated to Shandong First Medical University from April 2020 to October 2022 were selected as the study objects.Before performing pmVSD closure,the expression level of hs-cTnT in serum was measured by electrochemiluminescence method immediately after surgery,on the third and fifth day after surgery,so as to judge the severity of myocardial injury in children.Logistic regression was used to analyze the relationship between risk factors and myocardial injury,and to analyze its clinical significance.Results1.Among the 134 children,68 were male and 66 were female,aged 3.3(2.7～4.7)years,weight 15(13～18)kg,operation duration 60(50～70)min,contrast dosage 4.4(3.4～5.0)ml/kg,radiation duration 7.43(5.1～10.31)min.The occluder release times were 1.10±0.33,the defect diameter was 3(2～4)mm,the occluder diameter was 6(5～8)mm,and the pulmonary artery pressure was 27(24～30)mmHg.2.All the children’s hs-cTnT levels were in the normal range before surgery,reaching the highest(68.0-245.5)pg/mL immediately after surgery,and the hs-cTnT level was(32.6-81.5)pg/mL on the third day after surgery,still higher than the preoperative level.The hs-cTnT levels measured on the 5th day after surgery were(9.6-25.0)pg/mL,close to the normal reference range,and the differences were statistically significant(P<0.001).3.According to the different levels of hs-cTnT increase immediately after pmVSD closure,the children were divided into two groups,group A and group B,hs-cTnT of group A≤131.9 pg/mL,with the median as the dividing point,hs-cTnT of group B>131.9 pg/mL.Univariate Logistic regression analysis showed that operation time,occluder release times,contrast agent dosage and radiation time were all influencing factors for the increase of Hs-cTnT after pmVSD transcranial closure.Statistically significant variables from univariate analysis were incorporated into the multivariate Logistic regression analysis model,and the results showed that contrast agent dosage and radiation duration were independent risk factors for hs-cTnT increase after pmVSD transccatheter closure.4.According to the comparison between hs-cTnT level and hs-cTnT level on the 3rd day after transcranial catheter occlusion of pmVSD,those with higher hs-cTnT level immediately after surgery were divided into elevated group and those with lower hs-cTnT level immediately after surgery were divided into descending group.Univariate Logistic regression analysis showed that age,BMI,diameter of occluders,amount of contrast agent and radiation duration were all influencing factors for the increase of hs-cTnT after pmVSD transcranial closure.Statistically significant variables from univariate analysis were incorporated into the multivariate Logistic regression analysis model,and the results showed that contrast agent dosage and radiation duration were independent risk factors for Hs-cTnT increase after pmVSD transccatheter closure.5.According to the hs-cTnT level on the 5th day after transcatheter closure of pmVSD,the patients were divided into normal hs-cTnT group and elevated hs-cTnT group.Univariate Logistic regression analysis showed that age,operation time,contrast agent dosage,radiation time,occlusive release times and defect diameter were the factors influencing the increase of hs-cTnT after pmVSD transcranial closure.Statistically significant variables from univariate analysis were incorporated into the multivariate Logistic regression analysis model,and the results showed that operation time and defect diameter were independent risk factors for increased hs-cTnT after pmVSD catheter closure.Conclusion1.Age,operation time,occluder release times,defect diameter,contrast agent dosage and radiation time are factors affecting myocardial injury in children treated with pmVSD.2.Operation time,occluder release times,contrast agent dosage and radiation time are independent risk factors for myocardial injury in children treated with pmVSD.3.The younger the age,the more times the occlusion device is released,the longer the operation time,especially after the operation time is more than 60 minutes,the larger the defect diameter,the larger the amount of contrast agent,the longer the radiation time,the easier it is to lead to increased hs-cTnT levels,causing myocardial damage,most of which can return to normal on the 5th postoperative day. |
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