Agha Hala M, Mohammed Islam S, Hassan Hassan A, Abu Seif Hassan S, Abu Farag Ibrahim M
Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt.
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Egypt.
J Saudi Heart Assoc. 2020 Apr 17;32(1):71-78. doi: 10.37616/2212-5043.1012. eCollection 2020.
To analyze the acute and short-term deformation changes of both right (RV) and left (LV) ventricular wall before and after transcatheter closure of atrial septal defect (ASD) secundum in children.
To determine the feasibility of tissue Doppler and myocardial deformation imaging for evaluating RV and LV functions in children undergoing transcatheter ASD closure.
A prospective study was performed for 32 children with hemodynamic significant ASD secundum before and 6 months after percutaneous ASD closure in the Pediatric Cardiology Division of Specialized Pediatric Hospital, Cairo University. Speckle tracking echocardiography (STE) of LV and RV global analysis (longitudinal and circumferential strain) before and after ASD transcatheter closure was performed.
The mean age of the patients was 6.01 ± 3.19 (range: 3-9) years with a female to male ratio of 1.3:1. There was an improvement in the RV and LV myocardial performance index (MPI) 6 months post-ASD closure (RVMPI = 0.46 ± 0.069 vs. 0.38 ± 0.05, < 0.0001; LVMPI = 0.49 ± 0.12 vs. 0.38 ± 0.08, < 0.0001, respectively). By 2D STE, there was a significant improvement in the RV global longitudinal strain (GLS) 6 months post-ASD closure (-20.17 ± 3.14% vs. -25.86 ± 5.02%, < 0.0001). There was a significant increase in the LV end-diastolic volume (EDV) and LV end-systolic volume (ESV) using 4D STE after device closure (LVEDV = 32.96 ± 10.99 mL vs. 44.024 ± 14.9017 mL, < 0.0001; LVESV = 15.16 ± 6.08 mL vs. 21.76 ± 8.34 mL, < 0.0001, respectively). Additionally, there was a significant improvement in the LV GLS after device occlusion (-19.17 ± 3.67% vs. -22.36 ± 4.72%, = 0.009) using 4D TomTec software. There was a significant decrease in the RVEDV (54.65 ± 10.05 mL vs. 15.73 ± 8.67 mL) and RV stroke volume (25.15 ± 6.36 vs. 20.06 ± 7.2) after device occlusion using 4D TomTec software.
By using 4D STE, the LV GLS was significantly improved; in contrast, by 2D STE, the RV volume overload decreased and the RV GLS was improved on short term after transcatheter ASD secundum closure in children.
分析儿童继发孔型房间隔缺损（ASD）经导管封堵术前、后右心室（RV）和左心室（LV）壁的急性及短期变形变化。
确定组织多普勒和心肌变形成像评估经导管ASD封堵术患儿RV和LV功能的可行性。
在开罗大学专科医院儿科心脏病科，对32例有血流动力学意义的继发孔型ASD患儿进行前瞻性研究，分别于经皮ASD封堵术前及术后6个月进行研究。对ASD经导管封堵术前、后LV和RV进行斑点追踪超声心动图（STE）整体分析（纵向和圆周应变）。
患者平均年龄为6.01±3.19（范围：3 - 9）岁，男女比例为1.3:1。ASD封堵术后6个月，RV和LV心肌性能指数（MPI）有所改善（RVMPI = 0.46±0.069 vs. 0.38±0.05，P<0.0001；LVMPI = 0.49±0.12 vs. 0.38±0.08，P<0.0001）。通过二维STE，ASD封堵术后6个月RV整体纵向应变（GLS）有显著改善（-20.17±3.14% vs. -（此处原文有误，应为-）25.86±5.02%，P<0.0001）。封堵装置后使用四维STE，LV舒张末期容积（EDV）和LV收缩末期容积（ESV）显著增加（LVEDV = 32.96±10.99 mL vs. 44.024±14.9017 mL，P<0.0001；LVESV = 15.16±6.08 mL vs. 21.76±8.34 mL，P<0.0001）。此外，使用4D TomTec软件，封堵装置后LV GLS有显著改善（-19.17±3.67% vs. -22.36±4.72%，P = 0.009）。使用4D TomTec软件，封堵装置后RVEDV（54.65±10.05 mL vs. 15.73±8.67 mL）和RV每搏输出量（25.15±6.36 vs. 20.06±7.2）显著降低。
使用四维STE，LV GLS显著改善；相比之下，通过二维STE，儿童继发孔型ASD经导管封堵术后短期内RV容量超负荷减轻，RV GLS改善。
