[Cardiac function in secondary defect of interatrial septum and effects of its correction by Amplatzer occluder].

ABSTRACT

AIM: To study with impulse-wave Doppler and impulse-wave tissue Doppler investigation left and right ventricular (LV, RV) function in two age groups of patients suffering from an interatrial septum defect (ISD) before and two years after transcatheter correction. MATERIAL AND METHODS: 34 patients (20 females and 14 males) with secondary ISD aged 5 to 67 years were divided into two groups by age. Group 1 consisted of 11 patients aged under 16 years (mean age 10.4 +/- 0.9 years), group 2--of 23 patients over 16 (mean age 31.8 +/- 2.6 years). 30 controls were matched by age. LV and RV functions were assessed by Doppler index (DI) using impulse-wave Doppler and impulse-wave tissue Doppler investigation before the defect repair and 24 hours, 1, 3, 6, 12 and 24 months after it. RESULTS: Indexed stretch-diameter of the defect in group 1 was 13.1 +/- 1.7 mm/m2, in group 2--11.7 +/- 0.8 mm/m2 (p > 0.05). Size of the occluder to body surface area was larger in group 1 patients (15.2 +/- 1.7 and 14.6 +/- 0.98 mm/m2, respectively; p > 0.05). There was initial LV and RV dysfunction in patients of both the groups. After transcatheter correction of ISD, RV DI normalized after 3 months after the defect correction in group 1, in group 2--only in 24 months. By linear RV function examination, after ISD correction DI reached control level in group 1 12 months, in group 2--24 months after surgery. LV DI in both groups did not differ from that of healthy controls 24 months after surgery. Lateral wall LV linear function examination after the defect correction discovered DI change after 1 month in group 1 (a 12% decrease; p < 0.01); control values were achieved only 2 years after surgery. In patients of group 2 DI reduced only 6 months after correction (by 14.5+ACUAOw- p +ADw- 0.01) and reached control values in 24 months. Tissue Doppler investigation of the mitral valve fibrous ring on the side of the interventricular septum after the occluder implantation showed that DI significantly decreased in group 1 in 1 month (by 9%). In group 2--in 6 months by 10% (p < 0.05). In 24 months DI achieved control values in both the groups. CONCLUSION: Patients with ISD have LV and RV dysfunction. Recovery of LV and RV functional activity after transcatheter repair of the defect with Amplatzer occluder takes place later (for 12-24 months), in children recovery is faster than in adults.