Ali Yasmin Abdelrazek, Hassan Maryam Araby, El Fiky Azza Abdallah
Ain Shams University, Cairo, 11528, Egypt.
Egypt Heart J. 2019 Aug 5;71(1):1. doi: 10.1186/s43044-019-0001-7.
This is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. All patients were subjected to full history taking; general and cardiac examination; ECG; CXR; full transthoracic echocardiographic examination, including VSD number, size, and site; LV dimensions and volumes; estimated pulmonary artery pressure; right ventricular size and function; left ventricular circumferential; and radial strain imaging by 2D speckle tracking. Patients who had ventricular septal defect closed were reassessed by transthoracic echocardiography after 3 months.
The study included 15 children with VSD: 3 males and 12 females; their age ranged from 2 to 13 years; all had subaortic VSD except for 1 who had apical muscular VSD: VSD size ranged from 3 to 8 mm; PFM coil was used to close defect in all patients except for 2 patients who had an Amplatzer duct occlude I (ADOI) device, and 1 patient needed an additional vascular plug after significant hemolysis. Pre-procedurally, group A had a significantly higher LVEDD, LVESD, and LVEDV than group B. Mean circumferential strain was significantly higher (more negative) in group A than that in group B either pre- or post-procedure. Post-procedurally, there was a significant decrease in circumferential strain (less negative) and a significant increase in radial strain (more positive).
Following transcatheter VSD closure, there is a significant decrease in LV circumferential strain and a significant increase in LV radial strain, which conclude a decrease in LV volume overload with the improvement of its contractility.
这是一项病例对照研究，于2015年9月至2018年2月期间对30名儿童进行，其中15名室间隔缺损（VSD）患儿接受了VSD经导管装置封堵术（A组），另外15名年龄和性别匹配的儿童作为对照组（B组）。我们旨在通过二维斑点追踪技术评估室间隔缺损经导管封堵术前、后的左心室（LV）整体收缩功能，并与正常对照组进行比较。所有患者均进行了全面的病史采集、体格检查和心脏检查、心电图、胸部X线检查、经胸超声心动图全面检查，包括VSD的数量、大小和位置、左心室尺寸和容积、估计肺动脉压力、右心室大小和功能、左心室圆周以及二维斑点追踪的径向应变成像。室间隔缺损封堵术后的患者在3个月后通过经胸超声心动图进行重新评估。
该研究纳入了15名VSD患儿，其中男性3名，女性12名，年龄范围为2至13岁。除1名心尖肌部VSD患儿外，其余均为主动脉瓣下VSD，VSD大小范围为3至8毫米。除2名使用Amplatzer导管封堵器I（ADOI）装置的患者外，所有患者均使用PFM线圈封堵缺损，1名患者在出现明显溶血后需要额外的血管封堵器。术前，A组的左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）和左心室舒张末期容积（LVEDV）均显著高于B组。术前和术后，A组的平均圆周应变均显著高于（更负）B组。术后，圆周应变显著降低（负性减小），径向应变显著增加（正性增加）。
经导管VSD封堵术后，左心室圆周应变显著降低，左心室径向应变显著增加，这表明左心室容量超负荷减少，收缩性改善。
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