ASSA13-10-24 Clinical Study of the Left Ventricular Function For Atrial Septal Defect in Adult with Pulmonary Arterial Hypertension

Background To assess the left ventricular function of ASD with PAH patients and to determine whether the left ventricular function and pulmonary pressure could run better after transcatheter closure by echocardiography. Methods There were 75 patients with ASD aged ≥ 40 years, 15 males and 60 females, divided them two groups. (1) PAH group: 36 patients with ASD associated with PAH, 6 males and 30 females, aged from 41 to 74 (mean age 51.7 ± 9.3) years, ASD diameter aged from 15 to 37 (mean 22.9 ± 8.1) mm by using transthoracic echocardiogram (TTE). Systolic pulmonary artery pressure (sPAP) 40 ∼ 107 (57.8 ± 16.0) mmHg, diastolic pulmonary artery pressure (dPAP) 10 ∼ 40 (22.0 ± 5.8)mmHg, mean pulmonary artery pressure (mPAP) 31 ∼ 62 (37.1 ± 7.7) mmHg were measured by using cardiac catheterization. (2) No PAH group (control group): there were 39 patients, 9 males and 30 females, aged from 40 to 63 (mean age 49.3 ± 6.0) years, ASD diameter aged from 8 to 33 (mean 20.6 ± 6.8) mm by using TTE. The sPAP 22 ∼ 38 (28.9 ± 3.9) mmHg, dPAP3 ∼ 20(10 ± 3.8) mmHg, mPAP10 ∼ 19 (15.9 ± 2.8) mmHg were measured by using cardiac catheterization. Before operation, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular stroke volume (LVSV) and left ventricular ejection fraction (LVEF) were measured by using TTE. The sPAP obtained by echocardiograPAHy Doppler according to the tricuspid regurgitation gradient pressure of the ASD with PAH patients. Cardiac catheterization was performed before interventional therapy, sPAP, dPAP, mPAP, Qp/Qs were measured. ASO with a diameter ranging from 18 to 42 (30.8 ± 9.1) mm were placed in PAH group, 3 patients of them with severe PAH required a fenestrated device. The immediate sPAP were measured 28 ∼ 95 (42.7 ± 15.4) mmHg after transcatheter closure, mPAP were 24 ∼ 58 (30.1 ± 6.7) mmHg. ASO with a diameter ranging from 9 to 40 (27.5 ± 7.4) mm were placed in control group. Echocardiography were made at 1 day, 1 ∼ 3 months after the procedure. Results The LVEDD, LVEDV, LVSV and LVEF of PAH group were all smaller than those of no PAH group. The immediate sPAP, mPAP decreased significant after transcatheter closure. The LVEDD, LVEDV, LVSV and LVEF increased significantly after operation 1 day, whereas LVESD, LVESV were unchanged. The LVEDD, LVEDV, LVSV and LVEF improved 1 ∼ 3 months follow-up. The sPAP decreased significant of the patients with severe PAH, who had the indication could implant a fenestrated ASO, and left ventricular function improved at 1day, 1 ∼ 3 months after the procedure. Conclusions The left ventricular function lesion of the ASD patients with PAH were more severe than the ASD patients, the left ventricular function improved after transcatheter closure, so interventional therapy could prevent the left ventricular function from deterioration.