| Objective:To observe the changes of cardiac function and heart rate variability(HRV)in children with left-to-right shunt congenital heart disease(CHD)before and after interventional therapy.Method:A total of 97 children with CHD who underwent interventional surgery in Anhui Provincial Children’s Hospital from November 2020 to November 2021 were selected as the research objects,and were divided into ASD group,PDA group and VSD group according to the disease.There were 35 cases in the ASD group,including 15 males and 20 females,age 4.0±2.0 years,weight 17.9±8.2kg,defect diameter 11.6±5.7mm.There were 30 cases in the PDA group,including 8 males and 22 females,aged2.8±1.8 years,weight 14.2±6.1kg,defect diameter 3.2±1.4mm.There were 32 patients in the VSD group,including 10 males and 22 females,aged 5.7±3.3 years,weight 23.3±12.1kg,defect diameter 6.5±3.0mm.Serum NT-pro BNP level was measured by intravenous blood collection 1 day before operation and immediately after operation.LVEF/ LVFS was recorded by TTE at 5 observation sites :1 day before operation,after anesthesia,immediately after the release of the occluder,immediately after the removal of the sheath tube and 3 days after operation.The time domain index of HRV(SDNN、SDANN、r MSSD)were recorded by 24 h dynamic electrocardiogram before operation and 3 days after operation.Comparing the time domain index of HRV and serum NT-pro BNP level before and after operation,as well as the change trend of LVEF/LVFS before,during and after operation.The above data were analyzed for statistical variability in different disease groups.Result:1、NT-proBNP(pg/ml)was 170.64±93.00/94.70±53.49,217.58±161.19/98.49±71.50 and 133.87±84.73/72.34±46.91 in the ASD、PDA and VSD groups(pre/postoperative),respectively.There were statistically significant differences between pre-operative and post-operative in three groups,and among the three groups pre-operative(P < 0.05,0.01).2、LVEF/LVFS(%)was 69.91±6.17/39.31±6.09,67.90±5.09/37.57±4.33,68.47±5.92/38.68±7.07 in ASD,PDA and VSD groups before operation,respectively,and70.58±4.59/39.13±3.53、63.47±7.9/33.93±5.10、68.59±6.05/37.69±4.94 3 days after operation,respectively;The LVEF/LVFS(%)in PDA group was not only significantly lower than that before operation,but also lower than that in ASD group(70.58±4.59/39.13±3.53)and VSD group(68.59±6.05/37.69±4.94)after operation,and the difference was statistically significant(P < 0.05,0.01).3、HRV time domain indicators pre/postoperatively in the ASD,PDA,and VSD groups were SDANN(ms): 80.11±25.98/94.06±25.27,70.62±27.72/78.69±30.3,98.47±24.05/115.38±34.51,SDNN(ms): 91.34±27.40 /109.86±28.15,81.73±30.74/85.50±33.75,116.78±29.45/133.53±40.76,r MSSD(ms): 33.06±17.99 /50.11±36.93,34.43±23.63/38.10±19.28,49.13± 29.20/66.69±42.36,PNN50(%): 4.11±3.70/8.41±7.19,4.74±3.3/5.71±4.11,9.51±5.62/12.12±6.18.Except for r MSSD in the VSD group,all other indexes in the three groups were significantly higher after surgery than before surgery.All the indexes in the VSD group were higher than those in the other two groups,and SDANN and SDNN in the ASD group were higher than those in the PDA group.All the above differences were statistically significant(P <0.05).Conclusion:1.During interventional therapy,echocardiography showed a temporary decrease in left ventricular systolic function in children with left-to-right shunt CHD,which was especially obvious in PDA children and sustained until afteroperation.However,serum NT-pro BNP suggested improved cardiac function and/or decreased myocardial cell tension in children with left-to-right shunt CHD after operation.2.After interventional therapy,the vagal tone of children with CHD is higher than that before operation,suggesting the cardiac reserve capacity may be improved. |
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