Study On Right Ventricular Function Of The Atrial Septal Defect Patients Before And After The Neoplasty By Echocardiography

Objective: 1,To evaluate the right ventricular function of the atrial septal defect patients with pulmonary hypertension against the normals by the Tei index and other related indices which were measured by Colour Doppler Flow Imaging and Tissue Doppler Imaging;2,To analyse the improving of the right ventricular function by the change of the right ventricular Tei index and other indices of the patients after the the atrial septal defect neoplasty;3,To ananlyse the feasibility and the superiority of the right ventricular Tei index in evaluating the right ventricular function by comparison with other indices.Materials and Methods: 28 atrial septal defect patients with pulmonary hypertension coming from cardiac surgery ward at First Affiliated Hospital of Guangxi Medical University and 33 age and sex-matched control subjects were selected. All the ASD patients(10 male and 18 female, mean age 24.89±12.78 years, range 4 to 51 years) were examed before and after neoplasty and the control subjects(12 male and 21 female, mean age 26.61±11.04 years, range6 to 51 years)were examed too by transthoracic echocardiography using Philips sonos7500 and Philips IE33 imaging system (Agilent Company, USA). The tricuspid inflow velocity profile in the apical four chamber view and the pulmonary orifice outflow velocity profile in the parastemal short axis view of the aortic valve level were recorded. The interval between cessation and onset of the tricuspid inflow measured from the tricuspid inflow velocity profile with pulsed-wave Doppler echocardiography is a₁. The interval b₁ is ejection time which is measured from the right ventricular outflow Doppler signal. a₁-b₁ is the sum of right ventricular isovolumetric contraction time and isovolumetric relaxation time. The right ventricular Tei index₁ is calculated as (a₁—b₁) / b₁. In the same time the early diastolic peak flow velocity (E), late diastolic peak flow velocity (A),E/A ratio from the tricuspid inflow velocity profile with pulsed-wave Doppler echocardiography and the systolic peak flow velocity (PV)from the right ventricular outflow velocity profile with pulsed-wave Doppler echocardiography were measured and the pulmonary arterial systolic pressure from the tricuspid regurgitation velocity is calculated . Then the lateral tricuspid annular motion frequency spectrum which consists of systolic wave S_a,early diastolic wave E_a,late diastolic wave A_a in the apical four chamber view by Tissue Doppler Imaging was recorded . The interval between cessation of late diastolic wave A_a to onset of the next early diastolic wave E_a is a₂. The interval between onset to cessation of the wave S_a is b₂. a₂-b₂ is the sum of right ventricular isovolumetric contraction time and isovolumetric relaxation time. The right ventricular Tei index₂ is calculated as (a₂—b₂) / b₂.Systolic peak velocity (S_a),early diastolic peak velocity (E_a),late diastolic peak velocity (A_a) were Measured and the ratio of E_a/A_a was calculated . At last, the right ventricular diastolic diameter,right atricular systolic transverse diameter and internal diameter of main pulmonary artery were measured by two-dimensional echocardiography.All numeric data were displayed as mean±standard deviation (x|-±s) . SPSS13.0 statistical software package for Windows was used to analyze all data . Data of atrial septal defect patients before the neoplasty and control subjects were compared by Independent-Samples T Test. Data of atrial septal defect patients before and after the neoplasty were compared by Paired-Samples T Test. The correlation between right ventricular Tei index₁ and Tei index₂ and the correlation between pulmonary arterial systolic pressure and right ventricular Tei index were all analyzed by person analysis.Result: (1) The right ventricular Tei index₁,Tei index₂,the late diastolic peak flow velocity (A) of the tricuspid inflow velocity profile,the pulmonary arterial systolic peak flow velocity (PV),systolic peak velocity(S_a),early diastolic peak velocity (E_a),late diastolic peak velocity (A_a) of the lateral tricuspid annular motion in the atrial septal defect patients with pulmonary hypertension were significantly larger than those in the normal control subject(p<0.01); The early diastolic peak flow velocity (A) of the tricuspid inflow velocity profile was significantly larger than that in the normal control subject(p<0.05); the ratio of E_a/A_a was significantly smaller than that in the normal control subject(p<0.01); The contrast of E/A ratio had no statistical significance(p>0.05). (2) The right ventricular diastolic diameter, right atricular systolic transverse diameter, internal diameter of main pulmonary artery and pulmonary arterial systolic pressure in the atrial septal defect patients after the neoplasty were significantly smaller than those before the neoplasty; The right ventricular Tei index₁,Tei index₂, the early diastolic peak flow velocity (E), the late diastolic peak flow velocity (A) of the tricuspid inflow velocity profile, the pulmonary arterial systolic peak flow velocity (PV), systolic peak velocity(S_a), early diastolic peak velocity (E_a), late diastolic peak velocity (A_a) of the lateral tricuspid annular motion in the atrial septal defect patients with pulmonary hypertension after the neoplasty were significantly smaller than those before the neoplasty(p<0.01); E/A ratio and E_a/A_a ratio were significantly larger than those before the neoplasty(p<0.01 ,p<0.05). (3) The right ventricular Tei indexiwas positive correlated with Tei index₂ in both the atrial septal defect patients and the normals(p<0.01); Neither the right ventricular Tei index₁ nor the right ventricular Tei index₂ was correlated with pulmonary arterial systolic pressure(p>0.05).Conclusions: 1,The right ventricular function of the atrial septal defect patients with pulmonary hypertension has degraded in different degree. 2,The pulmonary artery pressure is cutted down and the right ventricular function is improved significantly after successful neoplasty in the atrial septal defect patients. 3,The right ventricular Tei index which is not influenced by Cardiac morphous, heart rate, preload etc is sensitive and convenient to be measured and caculated as a index used to evaluate the right ventricular global function. It is more full-scale,exact and surpass to the other indexes which are also measured from Colour Doppler Flow Imaging and Tissue Doppler Imaging .We can estimate the right ventricular function of the atrial septal defect patients with pulmonary hypertension across the board and exactly by Tei index. 4,The right ventricular Tei index measured by Tissue Doppler Imaging is also good to reflect the right ventricular globle function, and even more convenient and exact. It is improvement and useful recruitment of the right ventricular Tei index measured by Clour Doppler Flow Imaging.