Cardiac Remodeling Following Occlusion Of ASD By Domestic Amplatzer Occluder In Adult Females

Objective: To observe the effect of transcatheter closure by domestic Amplatzeroccluder for adult female ASD patients with cardiac morphological andelectrophysiological remodeling, simultaneous analysis of factors that might affect thecardiac remodeling after transcatheter closure.Method: select2010January to2012December in our hospital with a diagnosisof secundum atrial septal defect and successful transcatheter closure of adult femaleASD patients as the research object, after admission were proved by clinical,biochemical, ECG, X-ray and transthoracic ultrasound heartbeat graph examination,not with other organic heart disease, hypertension, congenital malformation complex,renal dysfunction and diabetes patients, included46cases. On preoperative,postoperative day3, after1months,3months,6months,12leads ECG andtransthoracic echocardiography, right heart catheterization of the pulmonary arterialpressure test.Results:1、For adult female ASD patients,6months after the closure ofelectrocardiogram manifestations tended to be normal, Pd, QTd in3days wassignificantly reduced, heart rate, P-R interval, duration of QRS, P Ⅱ amplitude andRV1+SV5were decreased3months after transcatheter closure.2、Within6monthsafter closure, the RA, RV, PA were reduced in diameter, LV diameter increased(P<0.05), the change after3days was the most obvious (to account for changes in6months of53.3%, respectively,55.2%,47.8%,33%), LA in diameter had nosignificant change.3、Pulmonary artery systolic pressure decreased right after thetranscatheter closure(P<0.05), the decrease is more significant in the group ofpulmonary artery hypertension；compared with the normal pressure group, the groupof pulmonary artery hypertension had larger ASD and RVd diameter； the rate ofchange was positively correlated with the Square of ASD diamete (R0.713, p<0.01). 4、After6months of the closure,16people were still not back to normal heart shape,compared with the recovery group, ASD diameter, preoperative pulmonary arterysystolic pressure, Pd, RVd, RAd were different. Among all the factors, the RVd beforeclosure has the biggest effect (multivariate analysis, P=0.034),ROC curve (area=0.842P=0.001)show that RVd≥29.8mm before closure was71.4%sensitive and74.7%specific in residual cardiac anomaly6months after transcatheter closure.Conclusion:1、 For adult female ASD patients,Morphology andelectrophysiology remodeling after transcatheter closure is an early as well as apersistent event during6months after operation.2、The decrease of pulmonary arterysystolic pressure is more significant in the group of pulmonary arteryhypertension,the change rate of pulmonary artery systolic pressure during thetranscatheter closure was correlated with ASD area.3、 The diameter of RVd beforeclosure can calculate the recovery of of cardiac morphology6months afterocclusion.