| Objective: Endothelin-1 (ET-1) is a 21-amino acid polypeptide produced primarily by vascular endothelial cells,which was first discovered in 1988.As the most potent vasoconstrictor, ET-1 plays an important role in the regulation of vascular tension and blood stream and participates in modulation of vascular tone in systemic and pulmonary circulation.Vascular circulating load and stress load increase in patients with congenital heart defects because of abnormal blood stream channels.With the increasing of vascular pressure,cardiac atrium-ventricular load changes , cardiac function and cardiac geometry significantly transform subsequently,which stimulates the synthesization and release of ET-1,The ET-1 subsequently participates in cardiac remodeling . Thus it can be seen that there is affinitive relationship between the level of ET-1 and the change of cardiac function in congenital heart defects.Now the study of this aspect is scarce, The objective of this study is to evaluate the change of plasma ET-1 and the cardiac function before and after transcatheter closure using occluder device in different types of left-right shunt congenital heart disease and to discuss the possibility of ET-1 level as one of the index that reflecting cardiac remodeling and cardiac function of VSD ,ASD and PDA after interventional therapy.Methods: 90 patients with congenital heart disease were enrolled in this study who received interventional therapy successfully in center of Cardiovascular Disease of the First Hospital of Hebei Medical University from March 2005 to July 2005.The subjects were divided into three groups according to the results of Echocardiography:30 cases in PDA group,30 cases in ASD group and 30 cases in VSD group. Clinical baseline information were recorded in detail,which including sex ,age ,height ,weight, Echocardiography, Amplatzer occluder size and operation time. Venous blood samples were taken and stored in low temperature refrigerator.The ET-1 levels were measured before operation,6 hours,24 hours,5day and 3months after the operation.Echocardiography were performed before the procedure,5days and 3months after the procedure and Cardiac function index were recorded,such as the diameter of right atrium(RA),right ventricular (RV),left atrium(LA), left ventricle end-diastolic diameter(LVEDD),left ventricle end-systolic diam- eter(LVESD),left ventricle end-diastolic volume(LVEDV), left ventricle end-systolic volume (LVESV), left ventricular stroke volume(LVSV),left ventricular fraction shortening(LVFS) and ejection fraction(LVEF).According to intervention therapy routine, all the subjects were treated under local anaesthesia or&and general anaesthesia.Statistical analysis: SPSS 13.0 software pack was used to make statistical analysis. (1)All the measurement data was denoted by mean±standard deviation.(2) When the data was normal distribution and homoscedasticity, One-way-ANOVA was used to denote the difference among three groups or repeated-measurement-design-ANOVA was used to denote the difference among the different times and LSD was used when the difference was significant;if the data were non- homoscedasticity, One-way-ANOVA and LSD were used after logarithmic transformation. (3)All the enumeration data was compared by Chi-square( x2 ) test. (4)We tookα=0.10 as a statistical significance level of homoscedastic test,besides tookα=0.05 as the statistical significance level.Results:1 Clinical baseline characteristics of the subjects:There was significant difference about the defect size of Echocardiography, Amplatzer occluder size and operation time. There was no difference about sex ,age ,height and weight among the three groups at the 0.05 level.2 The change of plasma ET-1 level: There was significant difference about the plasma ET-1 level before transcatheter closure in three groups, The level of ET-1 were highest in PDA group and lowest in the ASD group. There were no significant changes of the plasma ET-1 level in three groups at 6h after operation. The values of plasma ET-1 decreased significantly at 24h and 5d in three groups,which reduced further 3months later. 3 The change of cardiac function:All the index of Echocardiography were compared by One-way-ANOVA. In ASD group,right atrium and right ventricle enlarged significantly.In PDA group, left atrium and left ventricle augmented remarkably.In VSD group, left ventricle magnified observably.After interventional therapy,right cardiac function improved remarkably in ASD group,but there was no change in other group,left cardiac function meliorated clearly in PDA group, there was no change in ASD group. Cardiac function improved further 3months later in three groups.3.1 The change of cardiac function in PDA group: LA,LVESD,LVEDV, LVESV, SV reduced (p<0.05) at 5d after interventional therapy, which decreased significantly at 3m, but there was no significant differences of RA,RV,LVEDD,FS and EF after operation.3.2 The change of cardiac function in VSD group: LVEDD,LVESD,LVEDV,LVESV,SV reduced(p<0.05) at 5d after interventional therapy, which decreased significantly at 3m, but there was no significant differences of RV,RA,LA,FS and EF after operation.3.3 The change of cardiac function in ASD group: RA and RV decreased significantly at 5d and 3m after the procedure(p< 0.05),LA,LVEDD,LVESD,LVEDV,LVESV and SV increased si- gnificantly(p<0.05),which improved further 3months later, There was no significant differences of FS and EF after operation. Conclusions:1 The level of ET-1 of VSD ,ASD and PDA reduce after transcatheter closure.2 Cardiac function improve remarkably after interventional therapy.3 The level of ET-1 decrease,which reflect indirectly the change of the cardiac volume load ,cardiac size and pressure of pulmonary artery.The the level of ET-1 may be one of the index of cardiac remodeling and cardiac function of PDA,ASD and VSD. |
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