| Background:In recent years,due to the rapid population increase,the incidence of CHD is also rising,especially in developing countries,about 8 newborns in every 1000 live births can be found with CHD.With the development and progress of medical technology,adult CHD has become one of the most common cardiovascular diseases.These patients may have no symptoms when they were young,which could be diagnosed while they visit hospital due to some symptoms like chest distress after grown up.In addition,some of these patients could tolerate the diseases until getting older because of economic factors,mild symptoms and other aspects.Elderly patients with CHD usually has untypical symptoms which may lead to misdiagnosed.And most of them often have cardiac structure and functional changes,which lead to arrhythmia,infective endocarditis,pulmonary hypertension,heart failure and other complications.Elderly patients generally hard to tolerate surgery,while interventional operation has the advantages of minimal invasive and good long-term prognosis.However,there are some controversies in the study of the effect of transcatheter closure of CHD in elderly patients.Objective:Application of echocardiography to estimate cardiac structure and heart function in elderly patients with CHD before and after transcatheter closure.Comparing with young patients with congenital heart disease,we aimed to investigate the valuable of echocardiographic parameters for evaluation and provide the evidences for interventional treatment for elderly patients with congenital heart disease value.Methods:From Novermber 2014 to February 2017,we retrospectively collected 35 patients(male 10 cases,female 25 cases,age 65.89 ± 0.89 years)with CHD in our hospital as the elderly group,meanwhile collected another 39 patients(male 14 cases,female 25 cases,age 29.62 ± 0.92 years)with CHD as the youth group.All the patients signed the informed consent before selected,and recorded the basic information(name,gender,age),vital signs(heart rate,respiration,pulse,body temperature,blood pressure),conventional biochemical indicators etc.Echocardiography was performed in all patients before interventional treatment,1 days after operation and 3 months follow-up.Echocardiography measurements includes: LVEDD,LVESD,EF,FS,LAD,PAD,RVD,RAD,PASP.The above results were collected in computer,and the database was established by SPSS20.0 software.Results:1.The general information analysis showed: There were no significant difference between two groups of patients in gender,diastolic blood pressure,LVEDD,LVESD,EF,FS,PAD,the maximum diameter of ASD,width-diameter of PDA,length-diameter of PDA,Qp/Qs,PVR.However,age,the systolic blood pressure,fasting blood glucose,TC,TG,LDL-C,LAD,RVD and RAD had statistically significant(P<0.05),the elderly group was higher than youth group;in addition,HDL-C also had significant difference(P<0.05),the elderly group were lower than young group.The constituent ratio of ASD,VSD and PDA had a significant difference between two groups(P<0.05).Dyspnea,chest discomfort,pulmonary hypertension,infective endocarditis,systemic lupus erythematosus,renal insufficiency,postoperative readmission had no significant difference.But the cardiac function of elderly group was statistically lower than that of youth group(P<0.05),and the combination incidence of elderly atrial fibrillation,coronary heart disease,hypertension and diabetes compared with young group increased significantly(P<0.05).2.Echocardiographic parameters:(1)In youth group,1)ASD: LVEDD increased significantly after 3 months than before and 1 day after surgery(P<0.05),but there were no statistically difference between preoperative and postoperative 1 day.RAD,RVD had statistically decrease after surgery than before(P<0.05),but they had no significant difference between postoperative 1 day and 3 months after surgery.PAD,EF,FS,LAD and LVESD showed no statistically difference before and after surgery.2)VSD: PAD increased significantly after 3 months than before(P<0.05),but no statistically difference between 1 day after surgery and before and after 3 months.EF and FS increased significantly 1 day after surgery than before(P<0.05),but no statistically difference but no statistically difference between 3 months after surgery and before and postoperative 1 day.LAD,LVEDD,LVESD,RAD and RVD showed no statistically significance before and after surgery.3)PDA: Compared with preoperative day,LAD had reduced significantly 1 day after surgery(P<0.05),but 3 months after surgery had no statistically difference and before and 1 day after surgery.LVEDD and PAD shrunk significantly 3 month after treatment(P<0.05),the differences between the day after surgery and other two periods were no significant difference.However,LVESD,RAD,RVD,EF,FS reduced continuously after closure surgery,but the changes of each periods showed no statistically significance.(2)In elderly group,1)ASD: RAD,RVD and PAD were statistically decreased after operation,compared with preoperative period(P<0.05).And the change of RVD between one day after surgery and 3 months later also had significant difference,but the difference of RAD and PAD between this two period showed no statistically significance.LVEDD and LVESD increased after operation,but they had no significant difference.After treatment,LAD,EF,FS was lower than that before,they had no statistically significance yet.2)PDA: 3 months after interventional treatment,RAD,RVD decreased significantly(P<0.05).Besides,RVD value of one day after surgery also statistically lower than preoperative period(P<0.05),but no significant difference between postoperative periods.Nevertheless,Rad had decreased in one day after surgery,but the results showed no statistically significance.After transcathater closure,LVEDD,LVESD,PAD,EF,FS was lower than that before,they had no statistically significance among each periods.Compared with preoperative day,LAD was lower after surgery,but it increased 3 months after surgery than the postoperative 1 day,the changes of which showed no statistically difference.(3)In ASD patients,?RAD and ?RVD 3 months after operation has statistical differences between youth and elderly group(P<0.05),?RAD elderly group larger than youth group,?RVD youth group larger than elderly group,1 day after operation had no significant difference between two groups;?LVEDD,?LVESD,?LAD,?PAD,?EF and ?FS 1 day and 3 month after operation had not statistically significant between each group.(4)In PDA patients,?LVEDD 1 days after operation had significant difference(P<0.05),youth group larger than elderly group,there was no significant difference between two group 3 months after operation;?LVESD,?LAD,?PAD,?RAD,?RVD,?EF and ?FS 1 day and 3 month after operation had not statistically significant between each group.3.Echocardiographic follow-up evaluation:(1)PASP evaluation: the detection number of youth group was less than that of the elderly group,both of them decreased with the increase of follow-up time,and there was no statistical difference between the two groups.The PASP of the young group decreased significantly 1 days after operation(P<0.05),and there was no significant difference between 1 day and 3 months after the operation.There was no statistical difference between before and after the operation in the elderly group.1 day after operation,the PASP of the youth group was significantly lower than that of the elderly group(P<0.05),and there was no statistical difference between the two groups before and 3 months after the operation.All patients had no residual shunt during the follow-up period.(2)preoperative evaluation: 1)youth group,LVEDD,LVESD mild to moderate PH and severe PH decreased significantly than non PH(P<0.05),no significant differences between severe PH and mild to moderate PH;RAD,RVD severe PH and mild to moderate PH were significantly increased than non PH(P<0.05),no significant differences between mild to moderate PH,severe PH and non PH;PAD severe PH increased significantly than mild to moderate PH and non PH(P<0.05),no significant difference between mild to moderate PH and non PH;LAD,EF and FS have no significant differences between each group.2)in elderly group,LVEDD,severe PH was significantly reduced than non PH(P<0.05),mild to moderate PH had no significant difference with severe PH and non PH;RAD,RVD severe PH increased significantly than mild to moderate PH and non PH(P<0.05),mild to moderate PH has no statistically diference with severe PH and non PH;there was no significant difference in LAD,LVESD,EF,FS between each group.3)in non PH group,RAD and RVD in elderly group was significantly enlarged compared with youth group(P<0.05),there was no significant difference in LAD,LVEDD,LVESD,PAD,EF and FS;in mild to moderate PH group,LAD in elderly group were significantly higher than the young group(P<0.05),but there was no significant difference in LVEDD,LVESD,RAD,RVD,PAD,EF and FS;in severe PH group,there was no significant difference in LAD,LVEDD,LVESD,RAD,RVD,PAD,EF and FS between youth and elderly patients.(3)postoperative evaluation: 1)youth group,1 days after operation,?RAD mild to moderate PH and severe PH decreased significantly than non PH group(P<0.05),no significant differences between severe PH and mild to moderate PH;?RVD,? PAD severe PH siginificantly decreased compared with non PH(P<0.05),mild to moderate PH had no statistically difference with severe PH and non PH;?LAD,? LVEDD,?LVESD,?EF and ?FS had no statistically significant differences between each group.3 months after operation,?LAD mild to moderate PH significantly expanded than non PH,severe PH had no significant difference with mild to moderate PH and non PH;?LVEDD severe PH significantly increased than non PH,mild to moderate PH had no statistically significant difference with severe PH and non PH;?LVESD severe PH and mild to moderate PH increased significantly than non PH(P<0.05),no significant difference between severe PH and mild to moderate PH;?RAD severe PH significantly increased than non PH and mild to moderate PH(P<0.05),mild to moderate PH had no significant difference with non PH.There was no statistical difference between each group in ?RVD,?PAD,?EF and ?FS.In addition,?RAD severe PH 3 months after operation were significantly increased than and postoperative 1 day(P<0.05),while ?LAD,?LVEDD,?LVESD,?RVD,?PAD,?EF and ?FS3 months after operation had no significant difference with postoperative 1 day.2)elderly group,1 day after operation,?RAD severe PH decreased significantly than mild to moderate PH(P<0.05),severe PH and mild to moderate PH had no statistically significant difference with non PH;?LAD,?LVEDD,?LVESD,?RVD,?PAD,?EF,?FS had no statistically significant difference between each group.3 months after operation,?LAD severe PH and mild to moderate PH significantly reduced compared with non PH(P<0.05),no significant difference between severe PH and mild to moderate PH;?LVEDD mild to moderate PH significantly reduced than non PH(P < 0.05),severe PH and mild to moderate PH and PH showed no significant difference;?LVESD severe PH significantly reduced than mild to moderate PH(P<0.05),mild to moderate PH and severe PH had no significant difference with non PH;?RAD severe PH significantly reduced than non PH and mild to moderate PH(P < 0.05),there was no significant difference between mild to moderate PH and non PH;?RVD,?PAD,?EF and ?FS had no statistically significant difference between each group.?LAD,?LVEDD,?LVESD,?RAD,?RVD,?PAD,?EF and ?FS 3 months after operation had no significant difference with postoperative 1 day.3)1 day after operation,?RAD elderly group was significantly lower than youth group in non PH patients(P<0.05),and mild to moderate PH and severe PH patients had no significant difference between two groups;?LAD,?LVEDD,?LVESD,?RAD,?RVD,?PAD,?EF,?FS had no significant difference between youth and elderly group in mild to moderate PH and severe PH patients.3 months after operation,?LAD,?LVEDD,?LVESD elderly group was significantly higher than youth group in non PH patients(P<0.05),mild to moderate PH and severe PH patients had no statistical difference between the two groups;?RAD elderly group was significantly lower than youth group in non PH and severe PH patients(P<0.05),no significant difference between two groups in mild to moderate PH patients;?RVD,?PAD,?EF and ?FS elderly group had no significant difference with youth group.Conclusion:1.Compared with young people,the elderly patients with CHD is relatively poor body function and prone to combine with cardiovascular diseases like coronary heart disease,atrial fibrillation and hypertension.2.Elderly patients with heart disease type to ASD based,accounted for the vast majority,followed by PDA,VSD rarely.3.Like young patients,elderly patients with CHD underwent transcatheter closure can effectively restore cardiac structure and function in 3 months.But the recovery of right ventricular function in elderly patients is slightly slower than youth patients.4.Interventional therapy is a safe and effective method,which can improve the cardiac structure and function in elderly patients with CHD.Besides,it could also reduce the diameter and pressure of pulmonary artery. |
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