ObjectiveTo evaluate myocardial segmental motion function in left ventricular of patients with rheumatic mitral stenosis by using the technology of real-time three-dimensional echocardiography (RT-3DE).
MethodsWe retrospectively analyzed the clinical data of 14 patients with rheumatic mitral stenosis between October and November 2014 in our hospital as a trial group. There were 4 males and 10 females with a mean age of 50.9±9.0 years ranging from 34 to 64 years. We chose 11 healthy individuals as a control group. There were 7 males and 4 females with a mean age of 49.5±9.7 years ranging from 32 to 67 years. Both the two groups were subjected to myocardial performance evaluation using two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT-3DE) to examine the left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), longitudinal strain, circumferential strain, area strain, and lateral strain of each left ventricular myocardial segments. Result RT-3DE detected that the trial group had significantly lower values of LVEF, LVEDV and LVESV than those of the control group (P < 0.05). RT-3DE also revealed that the trial group had a significantly weaker longitudinal strain than the control group (P < 0.05).
ConclusionRT-3DE is an accurate technology for assessing myocardial motion and function in patients with rheumatic mitral valve disease.
ObjectiveTo explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD).MethodsWe retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation.ResultsAll 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05).ConclusionTTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.
Abstract： Right ventricular dysfunction or right heart failure is a complex clinical syndrome and often leads to a poor prognosis and high mortality. In order to detect right ventricular dysfunction at an early stage, provide a therapy guidance and evaluate treatment outcomes， right ventricular function evaluation has aroused more and more concern in clinical physicians. With the advantages of being non-invasive， accuracy and repetitiveness， echocardiography is used extensively in the assessment of heart function. In this review， we focus on how to use echocardiography to evaluate right ventricular function easily, efficiently， accurately and sensitively， and provide a good foundation for its further clinical application.
ObjectiveTo explore the echocardiography characteristics of aortic valve disease (AVD) among different ethnic groups in Xinjiang.MethodsThe data of a large sample (n=130 358) of different ethnic groups in Xinjiang based on the results of echocardiography were analyzed between January 2011 and December 2016, and the echocardiography characteristics of AVD among the Han nationality and different ethnic minorities in Xinjiang were summarized.ResultsThe study recruited 130 358 patients, involving Han nationality (58.49%) and 33 ethnic minorities. The ethnic minorities included the Uygur (27.42%), Kazak (7.47%), Hui nationality (3.48%) and other minorities (3.13%). Apart from Uygur, Kazak and Hui nationality, no description was given due to the small sample sizes of other minorities (3.13%). In the total study population, the prevalence of aortic valve stenosis (AS) was 0.44%, and the prevalence of severe AS was 0.10%; the prevalence of aortic valve regurgitation (AR) was 0.37%, and the prevalence of severe AR was 0.02%; the prevalence of aortic valve calcification (AVC) was 6.51%, and the highest AVC prevalence existed in ≥75 years old age group (24.45%); the prevalence of bicuspid aortic valve (BAV) was 0.54%, and the highest BAV prevalence existed in 18-44 years old age group (0.86%). Among different ethnic groups, the Uygur had the highest prevalence in terms of AS (0.60%), AR (0.63%) and BAV (0.88%), while the Han had the lowest prevalence in terms of AS (0.37%) and AR (0.24%), but the highest AVC prevalence existed in the Han nationality (7.83%). The etiology of AVD showed that the degenerative valve changes was the main cause of AS with the largest proportion of 61.97%. While the aorta root diseases (35.97%) and BAV (22.87%) were the main etiology of AR.ConclusionsIn Xinjiang the overall prevalence of AVD is low. In the elderly population, the Uygur, Kazak and Hui nationality have the higher AS prevalence than the Han nationality does. Different ethnic groups have different AVD characteristics based on the echocardiography. In the Uygur group, AVD presents the younger age of onset; the prevalence of BAV is the highest in the Uygur population, while the lowest in the Hui nationality.
Objective
To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance.
Methods
We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram.
Results
All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 yearsvs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kgvs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mmvs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mmvs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuanvs.25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up.
Conclusion
Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.
Objective
To systematically review whether the prevalence of left ventricular diastolic dysfunction was higher in systemic sclerosis (SSc) patients.
Methods
The Cochrane Library, PubMed, EMbase, CBM, CNKI and WanFang Data databases were electronically searched to collect the studies about comparing echocardiographic parameters in SSc patients and controls from January 1990 to June 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.
Results
A total of 22 studies involving 1 146 patients were included. The results of meta-analysis showed that: compared to controls, patients with SSc had prolonged left isovolumetric relaxation time (MD=10.40, 95%CI 4.04 to 16.77, P=0.001), higher trans-mitral A-wave velocity (MD=0.11, 95%CI 0.07 to 0.15, P<0.000 01), prolonged mitral deceleration time (MD=8.04, 95%CI 2.66 to 13.42,P=0.003), larger mean left atrial dimension (MD=1.43, 95%CI 0.11 to 2.76, P=0.03), higher estimated pulmonary artery pressure (MD=11.35, 95%CI 6.08 to 16.6, P<0.001), higher E/E’ ratio (MD=2.08, 95%CI 0.19 to 3.96,P=0.03) and lower trans-mitral E-wave velocity (MD=–0.03, 95%CI –0.05 to –0.01, P=0.000 3), mitral E/A ratio (MD=–0.24, 95%CI –0.32 to –0.15, P<0.000 01) and trans-mitral E’-wave velocity (MD=–1.52, 95%CI –2.44 to –0.60,P=0.001). There were no differences in left ventricular ejection fraction, isovolumetric end-systolic dimension, septal end-diastolic thickness and posterior wall end-diastolic thickness, trans-mitral A’-wave velocity, E’/A’ ratio.
Conclusion
SSc patients are more likely to have echocardiographic parameters of LVDD. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To systematically evaluate the safety and efficacy of percutaneous closure of atrial septal defect (ASD) guided by echocardiography alone versus fluoroscopy. Methods The databases of PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI from January 2000 to October 2021 were searched by computer for relevant research literature. Two reviewers independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Results A total of 19 cohort studies and 1 randomized controlled study were collected, including 2 825 patients. The Newcastle-Ottawa Scale score for cohort studies was≥7 points. Meta-analysis showed that there was no statistical difference in the operative success rate (RR=1.01, 95%CI 1.00 to 1.02, P=0.17), incidence of occluder displacement/shedding (RR=0.77, 95%CI 0.26 to 2.27, P=0.63), incidence of arrhythmia (RR=0.50, 95%CI 0.21 to 1.14, P=0.10), incidence of pericardial effusion (RR=0.98, 95%CI 0.32 to 2.98, P=0.97), operative time (MD=–0.23, 95%CI –7.56 to 7.10, P=0.95) or cost (SMD=–0.39, 95%CI –1.09 to 0.30, P=0.27) between the two groups. The echocardiography group reduced the incidence of total postoperative complications (RR=0.42, 95%CI 0.30 to 0.60, P<0.001) and residual shunt (RR=0.70, 95%CI 0.50 to 0.98, P=0.04), and shortened length of hospital stay (MD=–0.43, 95%CI –0.77 to 0.09, P=0.01). Conclusion Compared with traditional fluoroscopy-guided percutaneous closure of ASD, echocardiography guidance alone is equivalent in terms of operative success rate, major postoperative complications, operative time and total cost, but it reduces the incidence of total postoperative complications and residual shunt, and has a shorter length of hospital stay.
【摘要】 目的 評價經食管超聲心動圖(TEE) 監測房間隔缺損封堵術的臨床價值。 方法 手術前應用經胸超聲心動圖(TTE)及TEE篩選符合條件的100例單純房間隔缺損(ASD)患者行封堵術;手術中TEE監測整個封堵過程和引導封堵傘的放置;手術后評價封堵效果、殘余分流或并發癥等。 結果 100例患者均應用TTE和TEE確診,導引和監測成功閉合房間隔缺損。技術成功96例,成功率96%;4例失敗,失敗率4%。手術后復查無1例殘余分流,3例胸腔積液。經胸超聲心動圖與TEE診斷結果完全一致率40%,TEE診斷對手術前TTE診斷做出補充或修正診斷的有60例(60%)。結論 TEE對選擇適合行封堵術者、選擇封堵器大小、指導封堵器的釋放、以及療效評價均具有重要的作用。【Abstract】 Objective To evaluation the clinical role of transesophageal echocardiography (TEE) for atrial septal defect (ASD) blockade operation. Method The 100 patients with ASD were selected on transthoracic echocardiography (TTE) and TEE. During operation, TEE was applied to monitor the procedure of occlusion, to guide the occluder cites, to evaluate the effects and to make sure if there were peripheral residual shunts around the occlusion and other complications. Results All of the patients were exactly diagnosed by TTE and TEE，guiding and evaluating the successful closed ASD. The successful rate of occlusion was 96%，the failure rate was 4%. The review after surgery showed that, there were no residual review, pleural effusion in three patients. The concordance rate of TTE and TEE diagnosis result is 40%. TEE diagnosis amend the preoperative TTE diagnosis in 60 patients (60%). Conclusions TEE plays an important role in select inpatients，determining the size of the occluder，correctly before occlusion operation, guiding the placement of the occluder in operation and evaluating the effect after operation.
ObjectiveTo evaluate the impact of the "key anatomical structure detection method" and "working length marking method" on the safety and efficacy of echocardiography-guided percutaneous closure of patent ductus arteriosus (PDA). MethodsPatients who underwent echocardiography-guided percutaneous PDA closure at Fuwai Hospital, Chinese Academy of Medical Sciences, with complete clinical data, between January 2016 and December 2021, were retrospectively analyzed. Patients were divided into a study group (procedure performed using both "key anatomical structure detection method" and "working length marking method") and a control group (procedures performed without these methods). Propensity score matching (PSM) was applied for 1∶1 matching between the two groups. The primary endpoint was procedure success at 30 days after procedure. Secondary endpoints included intraoperative echocardiography localization success, major and minor complication at 6 months after procedure, and days of hospital stay. Results A total of 273 patients were included, among which 141 were in the study group and 132 in the control group. Before PSM, all patients achieved procedure success. After PSM, 77 matched pairs (154 patients) were analyzed. The study group demonstrated a significantly higher intraoperative echocardiography localization success rate (98.70% vs. 50.64%, P<0.001) and shorter hospitalization duration at (4.10±1.98) d vs. (5.01±2.16) d (P=0.007). The 6-month minor complication rate was lower in the study group (0.00% vs. 6.49%, P=0.058). All patients were successfully discharged, with no cases of device embolization, infective endocarditis, or death observed during follow-up.Conclusion "Key anatomical structure detection method" and "working length marking method" are effective echocardiography-guided adjunctive methods that enhance the safety and efficacy of PDA closure. These approaches deserve further validation in prospective multicenter studies in the future.
Objective To introduce a method of preoperative three-dimensional measurement by echocardiography to guide the surgical resection of hypertrophic obstructive cardiomyopathy (HOCM) and its long-term follow-up effect. MethodsBefore operation, each patient underwent transthoracic echocardiography to measure the length, width and thickness of diastolic ventricular septum hypertrophy on the long axis, short axis and four chamber sections, in order to establish three-dimensional measurement data of myocardial hypertrophy, and quantitatively estimate the location, depth and range of myocardium to be removed between 2014 and 2022 in our hospital. According to the quantitative data during operation, the hypertrophic myocardium of ventricular septum was resected to dredge the left ventricular outflow tract. ResultsForty-three patients were recruited, including 22 males and 21 females, aged 18-78 (49.2±5.1) years. Eighteen patietns underwent mitral valve surgery at the same time. All patients were satisfied with the relief of left ventricular outflow tract obstruction. Postoperative transesophageal echocardiography showed that the left ventricular outflow tract pressure gradient decreased significantly (94.2±28.1 mm Hg vs. 6.7±4.7 mm Hg, P<0.05). There was no ventricular septal perforation or complete atrioventricular block during the operation, and no one needed a secondary aorta-clamp for re-operation to remove hypertrophic myocardium again. Postoperative echocardiography showed that the mitral valve closed well or only had mild regurgitation, and the mitral systolic anterior motion sign basically disappeared. After 1.0-8.5 years of follow-up, the average pressure difference of left ventricular outflow tract remained below 10 mm Hg, and the clinical symptoms disappeared or improved significantly. Conclusion The quantitative prediction of the resection range of hypertrophic myocardium by three-dimensional measurement of preoperative echocardiography can accurately guide the surgical range of HOCM, avoid multiple blocking of aorta during operation, relieve left ventricular outflow tract obstruction to the greatest extent, and obtain better long-term results.
