ABSTRACT
Objective To evaluate the left ventricular diastolic function of patients with normal left ventricular ejection fraction ( LVEF) by echocardiography and real‐time cardiac catheter measurement ,and improve the accuracy and reliability of echocardiographic diagnosis . Methods One hundred and twenty patients with know n or suspected coronary artery disease w ho underwent coronary angiography and left ventricular catheterization were prospectively selected from July 2017 to January 2018 in the Affiliated Hospital of Jiangsu University . According to the left ventricular end diastolic pressure ( LVEDP) real‐time measurement ,the patients were divided into groups of LVEDP ≤15 mm Hg ( 43 cases ) and LVEDP ＞ 15 mm Hg ( 77 cases) . General data were compared and the difference of echocardiographic parameters between the two groups were analyzed ,and the ROC curve of each echocardiographic parameter for diagnosing LVEDP was draw n . Results T he parameters including flow propagation velocity ( VP) ,the ratio of filling fraction of E and A ( E/A) ,early diastolic filling deceleration time ( DT ) ,the duration of mitral A ( A‐dur ,) mitral annulus velocity at the septal side ( e′sep) ,systolic pulmonary venous flow velocity ( PVs) ,diastolic pulmonary venous flow velocity ( PVd ) and PVs/PVd were used to the diagnosis of the increasing of LVEDP ,however their accuracies were low ( AUC between 0 .5～0 .7) . T he parameters including left atrial volume index ( LAVI ) , tricuspid regurgitation ( T Rmax ) ,mitral annulus velocity in lateral wall of left ventricle ( e′lat ) ,average e′,E/e′sep ,E/e′lat ,average E/e′,velocity of pulmonary vein atrial reversal ( PVa) ,pulmonary vein atrial reversal duration ( Pva‐dur) ,the difference between the duration of pulmonary venous A wave and mitral A wave( PvaD‐AD) were also used to the diagnosis of the increasing of LVEDP , but their accuracies were still poor ( AUC between 0 .7～0 .9 ) . According to the real‐time left ventricular pressure measurement and different parameters of echocardiography ,the multivariate regression equation :LVEDP＝ 0 .292 LAVI + 0 .35 PVa + 0 .04 T Rmax + 0 .075 ( PvaD‐AD ) －0 .109 PVs －6 .773 was put forward as a correction standard ,the accuracy of the diagnosis of LVEDP was significantly improved ( AUC ＝0 .922) . Conclusions T he assessment of left ventricular diastolic function needs to be performed comprehensively with multiple parameters . T he multiple regression equation can accurately evaluate left ventricular diastolic function in patients with normal LVEF .
ABSTRACT
Objective: To explore the value of TEE-guided surgical minimal invasive closure of atrial septal defects (ASD) and ventricular septal defects (VSD). Methods: Totally 58 patients with ASD and 129 patients with VSD underwent TEE-guided minimal invasive surgical closure. After small chest wall incision, under TEE monitoring, the accurate puncture point of right atrium or right ventricular wall was selected, then arterial hemostatic sheath passed through the gap. Multi-section TEE was used to confirm that the occluder position was suitable. Then the occluder was released when no significant residual shunt and valve complication was observed. Results: Minimal invasive surgical closure was successfully performed in all 58 ASD patients, with small residual shunts were found in 8 cases. Minimal invasive surgical closure of VSD was successfully performed in 114 patients but failed in 15 patients who then underwent open heart repair. Among 114 patients with successfully occluded VSD, 19 patients displayed minimal residual shunt, 2 patients displayed right ventricular outflow tract blood flow velocity increased, and the guide wire smoothly entered the gap in 1 patient after changing the right ventricular wall puncture point. Conclusion: TEE is useful for minimal invasive surgical closure of ASD and VSD, included measuring the size and position, choosing the occluder size, determing operative approach, guiding occluder released and evaluating instant therapeutic effect.