| Objective:To investigate the clinical value of right ventricular function and vascular endothelial function in patients with atrial septal defect（ASD）complicated with pulmonary hypertension（PAH）before and after occlusion combined with changes in FMD.Methods:71 patients undergoing ASD occlusion were selected and divided into groups according to different degrees of pulmonary artery pressure measured by cardiac catheters:In addition,30 healthy volunteers were selected as the control group,and 25 ASD patients with pulmonary hypertension were reviewed 3 and 6 months after occlusion.Conventional echocardiographic parameters of right ventricle,right ventricular septum,free wall and global strain（SLS,FWLS,GLS-RV）and flow-mediated vascular endothelial relaxation（FMD）were measured.Results:1.Preoperative FMD and echocardiography parameters:RVEDV and RVESV increased gradually,and the differences among the three groups were statistically significant（P<0.001）.There was no significant difference between the ASD group and the ASD group combined with PAH（P>0.05）.RVSV increased gradually,and there was statistically significant difference between the control group and the ASD group combined with PAH（P<0.05）,but there was no significant difference between the control group and the ASD group alone or the ASD group combined with PAH group（P>0.05）.FMD,RVEF and RVFAC%decreased,and the differences among the three groups were statistically significant（P<0.001）.There were no significant differences in FMD between the control group and the ASD group（P>0.05）,and no significant differences in RVEF and FAC between the ASD group and the ASD group with PAH（P>0.05）.FWLAS-B,FWLS-M,FWLS-AP,SLS-AP,SLS-B,SLS-M and GLS-RV decreased gradually,and the differences among the three groups were statistically significant（P<0.05）.There was no significant difference between ASD group and ASD group combined with PAH（P>0,05）.TAPSE gradually decreased and Tei index gradually increased,and the differences among the three groups were statistically significant（P<0.001）.There was no significant difference between the ASD group and the ASD group combined with PAH（P>0.05）.The peak systolic velocity Fs’ of the free wall of the right ventricle decreased,and there was no significant difference among the three groups（P>0.05）.The peak systolic velocity Ss’of right ventricular septum decreased,but the difference was statistically sionificant only between the control group and the ASD combined with PAH group（P<0.05）.The peak values of Fe ’and Se’ in the early diastolic period of the free wall of the right ventricle and the ventricular septum decreased gradually,and the differences among the three groups were statistically significant（P<0.05）,but there were no significant differences between the control group and the ASD group or the ASD group and the ASD group with PAH（P>0.05）.The peak values of Fa ’and Sa’ in the late diastolic period of the free wall of the right ventricle and septal increased gradually,and the differences among the three groups were statistically significant（P<0.05）,while there was no significant difference between the ASD group and the ASD group combined with PAH（P>0.05）.2.Postoperative FMD and echocardiography parameters:Postoperative RVEDV,RVESV and RVSV decreased,and the difference between the three groups was statistically significant（P<0.001）,but there was no significant difference between the three groups 3 and 6 months after surgery（P>0.05）.Postoperative RVEF and FAC.increased gradually,and the difference between the three groups was statistically significant（P<0.001）,but there was no significant difference in RVEF 3 and 6 months after surgery（P>0.05）.FMD increased gradually after operation,and the difference between the three groups was statistically significant（P<0.05）,but there was no significant difference between the three and six months after plugging（P>0.05）.Tei index decreased gradually after operation,and the difference between the three groups was statistically significant（P<0.001）,but there was no significant difference between the three and six months after operation（P>0.05）.TAPSE decreased gradually after surgery,but the difference was statistically significant only 6 months after surgery（P<0.05）.Postoperative right ventricular septum,free wall and global strain（SLS,FWLS,GLS-RV）gradually increased,FWLS-M,SLS-AP,SLS-M 6 months after surgery compared with the preoperative difference was statistically significant（P<0.05）.There was no significant difference between 3 months after surgery and 3 and 6 months after surgery（P>0.05）.GIS-RV increased gradually after operation,and the difference between the three groups was statistically significant（P<0.05）.After operation,Fs’ and Ss’ of the free wall of the right ventricle and the peak velocity of septal systole decreased,Fe ’and Se’ of the peak velocity of early diastolic increased,Sa ’of the peak velocity of late septal diastolic decreased,but the difference was not statistically significant（P>0.05）.Fa’ of the peak velocity of free wall late diastolic decreased before and after sealing.There was statistically significant difference between 6 months after surgery and before surgery（P<0.05）,but there was no statistically significant difference between 3 months after surgery and before surgeiy and 3 and 6 months after surgery（P>0.05）.3.FMD was negatively correlated with pulmonary artery pressure,RVEDV,RVESV（r=-0.331,-0.405,all P=0.000）,and positively correlated with RVEF（r=0.406,P=0.000）. |
