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@#Objective To 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). Methods We 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. Results All 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). Conclusion TTE 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.
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Objective To analyze the echocardiographic features of patients with aortico‐left ventricular tunnel ( ALV T ) and explore the value of echocardiography in the diagnosis of ALV T . Methods Echocardiographic features of 23 patients with ALV T w ho were admitted to Fuwai Hospital from July 2002 to February 2019 were reviewed and analyzed . T he accuracy of echocardiographic diagnosis of ALVT was investigated by comparing the results of echocardiographic diagnosis with intraoperative and cardiac catheterization and CT . T he diagnosis methodology was summarized . T he reasons for misdiagnosis by echocardiography were analyzed . Results Among the 23 patients with ALVT , 1 case was diagnosed through CT examination prior to the operation and died from the cardiac arrest , 1 case was diagnosed through cardiac catheterization and ventriculography , the remaining 21 patients ( 91 .3% ) received the surgical operation and were diagnosed as ALV T . Eighteen patients ( 78 .2% ) were accurately diagnosed by echocardiography . One case was misdiagnosed as aortic valve insufficiency ,one case was diagnosed as aortic bicuspid valve and regurgitation ,two cases misdiagnosed as aortic valve dysplasia and insufficiency ,and one case was misdiagnosed as aortic dissection . According to Hovaguimian classification : 8 cases ( 34 .8% ) were of type Ⅰ ,12 cases ( 52 .2% ) of type Ⅱ ,1 case ( 4 .3% ) of type Ⅲ ,and 2 cases ( 8 .7% ) of type Ⅳ . Different types of patients are treated with different surgical methods . Conclusions ALV T can be accurately diagnosed with echocardiography , but it needs to be differentiated from other aorta to left ventricular shunt or reflux diseases . The establishment of the optimal diagnosis process is helpful to avoid and reduce the missed diagnosis and misdiagnosis to the greatest extent ,and provides a reliable basis for the selection of surgical methods .
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Objective: To explore the prevalence and risk factors of mitral regurgitation (MR) in the population ≥35 years in China in order to provide prevention reference for high risk crowd. Methods: The residents ≥35 years were taken by a stratified multistage sampling method. General information of crowd was collected by predesigned questionnaire and physical examination including life style, disease history, body weight and height. Echocardiography was conducted, fasting blood glucose and blood lipid levels were measured. Results: A total of 28814 subjects were enrolled. The overall MR detection rate was 18.4%, the detection rate in male and female were both 18.4%. The detection rates of moderate and severe MR were 0.3% in the paticipants at (35-50) years, 0.9% at (51-64) years and 2.2% at ≥65 years. MR prevalence showed an increasing trend with aging. Multivariate Logistic regression analysis indicated that age, systolic blood pressure, urban and rural, district, left atrial front and back diameter, left ventricular end diastolic front and back diameter, left ventricular ejection fraction, stroke, atrial fibrillation and heart failure were the risk factors for MR occurrence. Conclusion: MR detection rate was rather high in China. Specific prevention action should be taken for those with theabove risk factors.
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Objective: To evaluate the clinical value of echocardiography in aortic valvuloplasty (AVP) in the low-age pediatric patients with congenital aortic valve stenosis. Methods: We retrospectively studied 39 low-age (at median of 23 months) patients with congenital aortic valve stenosis who received aortic valve repair in our hospital for their echocardiography information, and statistically analyzed the main indicator changes by 4 time points as pre-operation and 1 week, 1-3 months, 6-12 months after the operation respectively. Results: In our study, the bicuspid to tricuspid valve ratio was approximately at 5.5/1 and 2 patients died during peri-operative period. Compared with pre-operative time point, Doppler aortic valve peak velocity (Vmax ) and the mean aortic transvalvular pressure gradient (MPG) were reduced accordingly, for Vmax: (4.30 ± 0.73) m/s vs (2.65 ± 0.78) m/s, (2.93 ± 0.63) m/s, (3.01 ± 0.83) m/s,P<0.01, for MPG: (45.78 ± 15.19) mmHg vs (18.24 ± 10.08) mmHg, (21.01 ± 10.08) mmHg, (22.31 ± 13.41) mmHg. Compared with pre-operative time point, left ventricular ejection fractions (LVEF) were similar in 3 post-operative time points. Compared with 1 week post operative time point, left ventricular end-diastolic anteroposterior diameter (LVEDD) was increased at 6-12 months post-operative time point, the relative wall thickness (RWT) was decreased, bothP<0.05, and aorta valve regurgitation (AR) was increasedP<0.01. Pearson correlation analysis showed that aortic annulus (AA) inner diameter was positively related to LVEDD (r= 0.648,P<0.01), negatively related to Vmax (r= -0.205,P<0.05) and RWT was positively related to Vmax (r= 0.196,P<0.05). There were 6 patients with pre-operatively decreased LVEF, 1 of them died and the rest 5 with elevated LVEF at 6-12 months post-operative period,P<0.05. Conclusion: Echocardiograghy could be used as the ifrst choice of imaging method for diagnosing congenital aortic valve stenosis, it has the important role for in-operative monitoring and post-operative evaluation of AVP in relevant patients.
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Objective To explore the value and methods of echocardiographic application in percutaneous left atrial appendage(LAA) closure for stroke prevention in patients with nonvalvular atrial fibrillation.Methods 6 male patients with nonvalvular atrial fibrillation were enrolled for percutaneous LAA closure,the mean age was (68.7 ± 5.6) years old,the mean CHADS2 (congestive heart failure,hypertension,age≥75 years,diabetes mellitus,and prior stroke or transient ischemic attacks) score was 3.2 ± 1.0.Rheumatic valvular diseases were excluded by transthoracic eehocardiography(TTE) before closure procedure.Transesophageal echocardiography(TEE) was performed to guide the punctures of the atrial septum and then monitored the operation all through the closure procedure.Diameter of LAA orifice was measure by TEE to help choosing the closure device.Immediate results of closure and complications were inspected by TEE simultaneously.24 hours,7 days,3 months,6 months and 1 year follow-up were performed using TTE.Results All the 6 patients underwent LAA closure successfully.3 LAmbre(Lifetech Scientific,Shenzhen) devices and 3 Watchman(Boston Scientific,Natick,Massachusetts) devices were implanted respectively in the 6 patients.Mean diameter of the LAA orifice was (22.4 ± 3.3)mm,and mean size of the closure devices was (28.0 ± 2.9) mm.2 mm in width residual flow at the inferior edge of closure device existed in 1 ease.No complication was observed.Post-procedure 24 hours and 7 days post-procedure followup showed optimal results in all cases.Conclusions Implantation of both LAA closure devices can be performed with high success rates in patients with nonvalvula ratrial fibrillation,with high risk for stroke,and who either had contraindication or were not willing to accept oral antieoagulation.Echocardiography plays a core role all through the closure procedure and can make it safer and more efficient.
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Objective: To evaluate the effect of echocardiography for occluding the multiple seconded atria1 septal defects ( MASD) in relevant patients. Methods: A total of 42 MASD patients were selected by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The transcatheter closure was monitored by TTE and X-ray, the effect of treatment was evaluated by TTE, ECG and chest X-ray at 24 hours and 1, 3, 6 months after the procedure. There were 38 patients with 2 defects, 3 with many central small defects and 1 with 3 defects. The patients included 17 male and 25 female with the mean age of (32.6 ± 13.4) years. Results: The size and distance of the defects were measured with 4 cardiac chambers cross sectional study. The mean diameter of bigger defect from up to down was (9-27) mm, with the mean of (20.7 ± 6.1) mm, from front to back was (8-23) mm, with the mean of (16.9 ± 5.7) mm;the mean diameter of small defect from up to down was (3-12) mm, with the mean of (6.8 ± 3.6) mm. The length of the defect interva1 was (4-18) mm, with the mean of (7.9 ± 2.6) mm. There were 4 patients with 2 defect interval at 8.7 mm who received 2 occluders without post-operative lfow shunt. The rest 38 patients received 1 Amplatzer occluder which was (14-36) mm with the mean of (25.1 ± 6.4) mm which was (6.9 ± 1.7) mm larger than echocardiographic prediction. The success rate of implantation was 100%. There were 17 (40.5%) patients with post-operative lfow shunt. The patients were followed-up for (6-36) months, with the mean of 18.7 months, there were 11 (26.2%) patients with small amount of lfow shunt at 3 months after the operation. Conclusion: Echocardiography is important for choosing the type and size of occluder devices, in-operative monitoring and post-operative effect evaluation for treating the ASD patients.
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Objective To evaluate the results of hybrid procedure in treating infants and children with severe pulmonary stenosis (PS) and the clinic value of echocardiography in the whole procedure.Methods Hybrid therapy was performed in 43 patients [(7.1±6.8)months,ranging 5 days to 33 months] with severe PS.The echocardiography data in the whole procedure and follow up were reviewed.Results Aided by echocardiography,the hybrid therapy was successful in 43 cases without major complication.Immediately following valvuloplasty,the gradient across pulmonary valve decreased from (92.5±21.4)mm Hg to (23.6±13.0)mm Hg (P<0.05).The growth and development of 27 patients in follow-up study was well.No restenosis was found and tricuspid regurgitation decreased differently.Conclusions Hybrid procedure is effective and safe for the treatment of infants and children with severe PS.And echocardiography play an important role in the whole procedure.
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Objective To evaluate the value of echocardiography in transcatheter closure of ruptured sinus of Valsalva aneurysm(TC-RSVA).Methods TC-RSVA was attempted in 11 patients.The location,shape,size of defects and its relationship with the neighbor structures were revealed before the procedure.Then the deployment of occluder was monitored during the procedure,and the effectiveness was observed in the follow-up.Results Eleven patients were diagnosed as the isolated RSVA by echocardiography.The size of defects was 2 - 13 mm estimated by echo.The procedures were successful in all patients.Usually the Amplatzer duct occluders were chosen to be 1 to 5 mm larger than the size of defects.Three patients had mild residual shunt during the procedure,which all dispeared in the first month of follow-up,but one of them demonstrated recurrent mild residual shunt in the 32nd month of follow-up.There was no aggravating aortic regurgitation in the follow-up.Conclusions TC-RSVA is relatively safe and effective.Observation of long-term effectiveness is still necessary.Echocardiagraphy plays an important role in TC-RSVA.
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Objective To investigate the efficacy of transcatheter closure of coronary artery fistula (CAF) by transthoracic echocardiography(TTE) and the role of TTE in this therapy. Methods CAF were occluded with transcatheter closure techniques in 17 patients. TTE was performed before and after the treatments. The key points were retrospectively analyzed including: the sites of CAF, the position and diameter of CAF,the shape and position of the devices after the intervention,the residual shunt,and cardiac chamber size. Results Before the therapy,TTE made definite diagnosis of CAF. All patients had lesions in single coronary artery, and the diameter of CAF was 2-14 (6.4 ± 3.5)mm. All patients underwent transcatheter closure successfully. TTE revealed the shunts disappear 1-4 days after the occlusion. During a follow-up period of 1- 29 (11.7± 7.9)months,no residual shunts, no complications, and normal size of thecardiac chambers were recognized by TTE. Conclusions The transcatheter closure of CAF has emerged as a less invasive, safe and effective strategy. Echocardiography has important role in primary screening of patients and the follow-up after the treatments.
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Objective To assess the accuracy of three-dimensional color Doppler echocardiography (3DCDE) for measuring left ventricular stroke volume (LVSV). Methods A total of 45 patients were studied to measure LVSV by 3DCDE and two-dimensional Doppler echocardiograph(2DDE). Full-volume three-dimensional echocardiography (3DE) was also performed to measure left ventricular end systolic (LVESV) ,end diastolic(LVEDV) ,and LVSV (LVEDV-LVESV), which served as a reference standard for comparison. Results Mean values of LVSV by 3DE,2DDE,3DCDE were (79. 3 ± 22. 6)ml, (74. 0 ± 20. 6) ml,(78. 7 ±22. 6)ml. respectively. Compared with LVSV by 3DE,the correlation was excellent for 3DCDE (r = 0.96), good for 2DDE ( r =0.89). Conclusions LVSV measurement by 3DCDE is reasonably accurate. This new technology may be a valuable clinical tool for assessing cardiac function.
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Objective To evaluate the effect of the percutaneous transluminal septal myocardial ablation(PTSMA)on the left ventricular function in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods All HOCM patients underwent echocardiogram measurements before and after the PTSMA procedure.The peak velocity of mitral annulus was measured at Doppler tissue pulsed wave mode.Doppler tissue imaging(DTI)was obtained at the 4- and 2-chamber apical view,and the peak systolic(Sa),early diastolic(Ea),and late diastolic(Aa)myocardial velocities of mitral annulus was measured at the long apical view.Results Compared with the velocity parameters before the PTSMA procedure,the peak Sa and Ea after the PTSMA were significantly lower while Aa was un-significantly lower.Conclusions In patients with HOCM,the diastolic and systolic function of the left ventricle decreased after the PTSMA procedure.