Changes In The Level Of Serum CTnI Before And After Transcatheter Closure Of Congenital Heart Disease And Its Correlative Factors

Objective: Congenital Heart Diseases(CHD) is the most common diseases in children. About 150000 children with CHD were born every year in china. Transcatheter interventional therapy with occluder devices for congenital heart diseases is safe, easy and effective. It was widely used at home and abroad. But the myocardial damage due to transcatheter interventional therapy hasn't been reported domestically. The objective of this study is to investigate the degree of myocardial damage, its risk factors and recovery process after transcatheter interventional therapy, and to evaluate the efficacy and safety of interventional therapy for congenital heart diseases. This research provides clinical guidance to improve prognosis.Methods: 90 patients, who received interventional therapy successfully in center of Cardiovascular Disease of the First Hospital of Hebei Medical University from March 2005 to July 2005, included 35 patients with ventricular septal defect (VSD), 31 patients with patent ductus arteriosus (PDA), 24 patients with atrial septal defect (ASD),were treated with the occluders successfully and Chloramines ketone was used in basic anaesthesia in while 1% lidocaine was used in local anesthesia . Clinical baseline information were recorded in detail, which including age ,height ,weight, amplatzer occluder size and operation time. The levels of cTnI were measured before,and 6 h,12 h,24 h, 5 d after intervention. Venous blood samples were taken and stored in low temperature refrigerator. Kit of CTnI was made by RECI Diagnostics GmbH in germany. The normal value of CTnI is from 0 to 0.48 ug/ml. 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) Multiple linear regression was used to analyze the correlation between the clinical baseline characteristics and myocardial damage due to transcatheter interventional therapy(test levelα1=0.05,α2=0.10) (5)We tookα=0.10 as a statistical significance level of homoscedastic test,besides tookα=0.05 as the statistical significance level.Results :1 Changes in the level of serum cTnI:All the patients had a common serum cTnI level before intervention, the peak levels of cTnI were occurred 6h(p<0.05) and all the patients had a common serum cTnI level again 5d(p>0.05) after intervention. There was significant difference of 5 groups of different time after operation(p<0.05).2 cTnI's correlative factors2.1 Clinical baseline characteristics of the subjects:There was significant difference about age , the dose of constrast agent, total time of intervention application, the purssure of pulmonary artery and the times of releasing the occluders of the group of elevated and the group of non elevated ctni levels(p<0.05) . There was no difference about BMI, sex , the defect size and the Amplatzer occluder size among the two groups at the 0.05 level.2.2 Clinical baseline characteristics of the subjects were entered into multiple linear regression model, multiple linear regression:cTnI=-0.490-0.101×age+0.068×the purssure of pulmonary artery +0.031×total time of intervention application +1.261×the times of releasing the occluders +0.026×the dose of constrast agent.3 The relation between cTnI and the type of CHD3.1 The cTnI levels of VSD were significantly greater than the other two groups 6h,12h and 24h after intervention(p<0.05) and the cTnI levels of ASD were lowest(p<0.05).3.2 The percentage increase of the cTnI level of VSD was significantly greater than the other two groups 6h after intervention(p<0.05) and the percentage increase of the cTnI level of ASD was lowest(p<0.05). 3.3 Clinical baseline characteristics of the subjects:There was significant difference about the defect size, the Amplatzer occluder size and operation time of the group of VSD,ASD and PDA (p<0.05). There was no difference about age, sex, BMI and the times of releasing the occluders among the three groups at the 0.05 level.Conclusions: 1 Catheterization to treat congenital heart diseases may result in reversible, minor myocardial damage. And it can be recovered in short-term. So it is a safe, effective and ideal method. 2 cTnI peak levels correlated with age, the purssure of pulmonary artery, total time of intervention application, the times of releasing the occluders, the dose of constrast agent, the type of disease. 3 the degree and the rate of Myocardial damage from the higher to the lower is VSD, ASD and PDA.