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Objective: To assess the application value of CT scanning in percutaneous pulmonary valve implantation (PPVI). Methods: A total of 19 patients with severe pulmonary regurgitation planed to receive PPVI in our hospital from 2014-05 to 2016-07 were studied. CT scan and transthoracic echocardiography (TTE) were conducted to collect the data of pulmonary root anatomy and to compare the difference of pulmonary annulus size measured by CT and TTE. The accuracy of pre-operative measurement was evaluated by the follow-up study at (1-26) months after the operation. Results: In all 19 patients, the mean anatomic measurements by CT were as follows: diameter of pulmonary annulus (24.3±3.5) mm, diameter of pulmonary sinotubular junction (25.4±4.0) mm, diameter at distal of main pulmonary artery (27.5±4.8) mm, diameter of right ventricular outflow tract (36.8±7.3) mm, length of main pulmonary artery (45.5±7.0) mm, diameter of left pulmonary artery (17.9±1.5) mm and diameter of right pulmonary artery (18.5±3.6) mm. The diameter of pulmonary annulus measured by CT was larger than TTE, P<0.05. During (1-26) months follow-up period, no patients suffered from stent fracture or translocation, peri-pulmonary valve regurgitation, obvious pulmonary regurgitation or coronary stenosis; 1 patient had increased flow rate at right pulmonary artery opening by stent blocking and 2 patients had residue mild stenosis of pulmonary valve. Conclusion: Pulmonary annulus size measured by CT and TTE was different; CT may precisely assess the morphology of pulmonary root with adjacent area which is important for pre-operative evaluation in PPVI patients.
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Objective: To explore the imaging and clinical features of Behcet's disease with coronary artery involvement in order to improve the diagnosis and treatment in clinical practice. Methods: A total of 6 Behcet's disease patients with coronary involvement diagnosed and treated in our hospital from 1999-08 to 2016-11 were analyzed. Coronary angiography (CAG) and coronary CTA were performed for diagnosis. There were 5 cases received CAG and 5 cases received CTA examinations. Results: All 6 patients had the first clinical visit by sudden pericardial tapenade, myocardial infarction or cardiac shock. For diagnosis: the imaging presentation included coronary stenosis, occlusion and pseudo aneurysm formation. 3 patients had anterior descending artery involvement, 1 had the far-end of left circumflex involvement and 2 had the middle segment of right coronary involvement; all patients were combining large amount of pericardial effusion. For treatment: there were 3 patients with aneurysm received conservative treatment (1 case had open thoracic exploration), 1/3 lost contact and 2 having long-term normal life; 3 patients received coronary stent implantation without optimal effect. Conclusion: The patients of Behcet's disease with coronary involvement may easily form pseudo aneurysm; CAG/CTA has been helpful for diagnosis. Clear pre-operative diagnosis of etiology is important for treatment.
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Objective: To explore the short and mid-term efficacy of device closure of patent foramen ovale (PFO) for treating the patients with PFO combining cryptogenic stroke (CS) and transient ischemic attack (TIA). Methods: A total of 56 PFO patients with CS and TIA receiving device closure in our hospital from 2009-05 to 2015-12 were retrospectively studied. Transthoracic echocardiography (TTE), electrocardiogram (ECG), chest X-ray were examined at 24h, 1 month, 3 and 6 months after theoperation; telephone visit was conducted every 6 months thereafter. Results: There were 54/56 PFO patients combining CS and 2 combining TIA; 53 (94.6%)patients received PFO occluder from Starway medical technology. Aspirin was used for 6 months after the operation. The patients were followed-up for the average of (34.67±23.24) months. No body suffered from post-operative stroke and TIA; no residual shunt was observed. Conclusion: The short and mid-term efficacy of device closure has been satisfactory for treating the patients with PFO combining CS and TIA; its overall clinical value should be further investigated in large population and long-term study.
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Objective: To evaluate the changes of left and right ventricular function in patients after percutaneous pulmonary valve implantation (PPVI). Methods: A total of 8 patients with successful PPVI in our hospital from 2014-05-27 to 2015-03-25 were studied. The patients received pre-operative evaluation including clinical symptoms, plasma BNP levels, ECG, chest X-ray, echocardiography, CT and MRI examinations. Post-operative follow-up study was conducted at 6 months after PPVI to compare the ventricular functional changes. Results: The average age in 8 patients was 14-42 (25.4±8.1) years including 7 with tetralogy of Fallot correction and 1 with pulmonary stenosis plasty for 24 years. Echocardiography found that 3 patients with mid to large pulmonary regurgitation and 5 with large regurgitation. Compared with pre-operation, at 6 months after PPIV, all patients had decreased right ventricular end-diastolic diameter (RVEDD) as (44.0±4.8) mm vs (33.6±7.1) mm, right ventricular end-diastolic volume index (RVEDVI) (150.1±25.7) ml/m2 vs (111.4±39.1) ml/m2, RVESVI (107.8±21.5) ml/m2 vs (80.7±22.2) ml/m2 and right ventricular cardiac output (RV-CO) (6.8±1.3) L/min vs (4.9±0.8) L/min, but right ventricular ejection fraction (RVEF) was similar (40.5±6.2) % vs (39.5±9.9) %, P>0.05; while increased LVEDD (42.9±4.4) mm vs (46.1±3.0) mm, P0.05. Conclusion: PPVI may decrease right ventricular preload, improve its reverse remodeling and maintain systolic function at normal level in relevant patients; while the impacts on left ventricular function and geometry should be further studied.
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Objective To assess the feasibility and efficacy of Amplatzer duct occluder Ⅱ (ADOⅡ) in occlusion of aortopulmonary collateral arteries. Methods Seven patients,6 males and 1 female, with aortopulmonary collateral circulation diagnosed previously by cardiac Computed Tomograpy or cardioangiography from Mar 2014 to Apr 2015 were enrolled. All of them were treated with ADO Ⅱ. Results The age of the patients ranged between 5 - 71 months old and weight 4. 2 - 22. 0 kg. Successful hybrid approach was achieved in 6 of 7 patients. One patient failed the occlusion because of severe hypoxemia and mild-moderate residual shunt after catheter intervention. Total 15 aortopulmonary collateral vessels were embolized by 7 ADO-Ⅱ, 22 non-detachable coils ( Cook corp. ) and 2 detachable micro-coils ( Boston Scientific corp. ). Complete embolization was achieved in 2 patients,4 patients had mild residual shunt and 1 patient had mild-moderate residual shunt after the embolisation. No interventional complications recorded. Conclusions ADO Ⅱ has high controllability and suitable for application through small delivery catheter for minimally-invasive procedures to the vessels. It is a preferable alternative in treating pediatric patients with large and tortuous aortopulmonary collateral arteries.
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<p><b>OBJECTIVE</b>To investigate the feasibility of using lower iodine concentration (270 mgI/ml) contrast medium, lower X-ray tube voltage (100 kVp) and iterative reconstruction (IR) to reduce both iodine load and radiation dose but keep the image quality of coronary CT angiography (CCTA).</p><p><b>METHODS</b>A total of 80 consecutive patients with suspected coronary artery disease were prospectively assigned to one of two groups via computer central system from January to May 2013. The control group (n = 40) was scanned using dual-source CCTA protocols of 120 kV, 370 mgI/ml Iopromide and filtered back projection reconstruction with a vascular algorithm (B26f). The study group (n = 40) was scanned using 100 kV, 270 mgI/ml Iodixanol and sinogram affirmed iterative reconstruction with a vascular algorithm (I26f). Other scan parameters and contrast injection protocol were similar between the two groups. Attenuation in the ascending aorta and coronary arteries along with image noise were measured. Images were reconstructed, measured and graded, and iodine load and effective radiation dose were calculated.</p><p><b>RESULTS</b>The body mass index ((25.3 ± 3.0) kg/m² vs. (25.4 ± 3.0)kg/m², P = 0.852), image quality scores (4.70 ± 0.52 vs. 4.63 ± 0.59, P = 0.545), mean signal-to-noise ratios (22.2 ± 5.5 vs. 23.6 ± 5.8, P = 0.277), and contrast-to-noise ratios (35.6 ± 17.6 vs. 41.1 ± 17.6, P = 0.163) were similar between the control group and study group. Mean iodine loads were significantly reduced in the study group ((18.49 ± 0.75)g) compared to control group ((25.27 ± 0.94)g), P< 0.001). Mean effective radiation doses were also significantly reduced in the study group ((2.31 ± 0.73) mSv) compared to that in control group ((3.52 ± 1.16) mSv), P< 0.001).</p><p><b>CONCLUSION</b>Use of low X-ray tube voltage and iterative reconstruction allows lower iodine load and effective radiation dose application at CCTA without image quality reduction.</p>
Subject(s)
Humans , Algorithms , Aorta , Body Mass Index , Contrast Media , Coronary Angiography , Coronary Artery Disease , Feasibility Studies , Fluoroscopy , Injections, Intravenous , Iodine , Iohexol , Tomography, X-Ray Computed , Triiodobenzoic AcidsABSTRACT
Objective To assess the safety and efficacy of balloon dilation of pulmonary valve stenosis with 10 F domestic balloon catheter in children ≥ 10 kg. Methods From May 2009 to June 2014, eighty-three consecutive children with weight ≥ 10 kg and age of (4.5±2.8)(ranged from 1-12) years underwent percutaneous balloon pulmonary valvoloplasty(PBPV) with 10 F domestic balloon catheter. Indication for treatment, procedural details, catheterization data, complication rate, peak-to-peak systolic gradient across the valve and pulmonary insufficiency on echocardiography were respectively analyzed. Forty-four patients were followed up 6-44 months after procedure. Results All procedures were completed successfully. The peak-to-peak systolic gradient across the pulmonary valve decreased from (67.7±26.2) mmHg to (15.4±11.6) mmHg (P < 0.01) immediately after PBPV. Two patients developed reactive infundibular spasm after dilation. They were relieved at 6 months post PBPV. No patient had severe pulmonary insufficiency, tricuspid regurgitation or reintervetion. Conclusions PBPV with 10 F domestic balloon catheter in children with weight≥10 kg is a safe and effective method.
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Objective To explore the prognosis and management of atrial fibrillation (AF) in patients with atrial septal defect(ASD) accompanied by AF after transcatheter closure of ASD. Methods During the period from July 2010 to May 2013, a total of 24 patients with ASD accompanied by AF were admitted to authors’ hospital to receive transcatheter closure of ASD. Electrocardiogram (ECG), chest X-ray film and transthoracic echocardiography (TTE) were performed before and one day after the operation. Follow-up information was obtained through telephone or at out-patient clinic interview. Results Successful occlusion of ASD was obtained in all patients, and in no patient the AF rhythm turned to sinus rhythm after the procedure. In one patient preoperative AF turned to postoperative atrial flutter, and AF recurred in one case who had received transcatheter ablation of AF before the procedure. One female patient developed gastric bleeding during the course of orally taking warfarin, and she died of cerebral infarction at three days after ceasing the use of warfarin. Of the 24 patients, no anticoagulant drug was used in 5 (20.8%), oral administration of aspirin was given in 7 (29.2%), and oral medication of warfarin was employed only in 11 (45.8%). Conclusion The spontaneous conversion rate of AF is very low in patients with ASD complicated by AF after transcatheter closure of ASD. Postoperative medication of anticoagulation should be strictly standardized and carefully managed.
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Objective To evaluate two kinds of practical CT three-dimensional volumetric measurement techniques in assessing atrial septal defects (ASDs) for transcatheter device closure.Methods Retrospective assessment of 50 consecutive patients who underwent ASD closure was conducted.Cardiac CT was performed in them before planned transcatheter ASD closure and postoperative chest radiograph was performed in both posteroanterior and lateral view.Coronary CT angiography was made for the detection of coronary artery disease,and three-dimensional reconstruction of ASD was conducted for determination of the defect size in the GE-workstation.Two kinds of practical CT three-dimensional volumetric measurement techniques,one named CT virtual endoscopy assisted volumetric measurement (CTVE) and another called axial sequence assisted volumetric measurement(CTAS),were used to calculate the major axis and the minor axis of the ASD respectively.Thus,the dimensions of the Equivalent Circle were derived,with circunference and area equal to the elliptic ASD according to the formulation (D =√b4/a2 + a2-b2).The ASDs occluder (ASO) dimension was measured in the lateral chest radiograph,and this postoperative occluder-waist size (POS) value was regarded as the gold standard for the measurement of ASD.The results were compared between CTVE and CTAS,and the correlations were evaluated between them and the gold standard.Results The differences in the major dimensions (-9.05 mm,t =-6.60,P ＜ 0.05),minor dimensions (-4.86 mm,t =-4.39,P ＜ 0.05) and Equivalent circle dimensions (-7.65 mm,t =-6.40,P ＜ 0.05) of ASD between CTAS and CTVE were statistically significant.Though the CTAS cannot provide the en face views of ASDs,the Equivalent Circle dimensions measured by CTAS(22.48 ± 5.59) mm was correlated well with POS (27.07 ± 6.83)mm (Y =1.14X + 1.39,r =0.94,P ＜ 0.01),and a good correlation was found between this Equivalent Circle dimensions and ASO size (Y =1.02X + 6.84,R2 =0.78,r =0.88,P ＜ 0.05).The correlation between the Equivalent Circle dimensions measured by using CTVE (30.13 ± 9.27) mm and POS was poor (Y =0.30X + 17.94,r =0.41,P ＜ 0.01),though it can provide the en face views of ASDs.Conclusion CTVE and CTAS are two complementary techniques of assessing ASDs for transcatheter device closure.
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Objective To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement(AVR) or ascending aortic replacement.Methods Eighty-seven patients with aortic-right atrial fistula underwent CT after operation.The CT features were retrospectively analyzed.Fistula was measured according to maximum width of the shunt.Results Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them,25 patients were diagnosed as mild aorto-right atrial fistula,47 patients as moderate,and 15 patients as severe.Thirty-seven patients underwent follow-up CT.Among them,10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression,8 patients with mild aorto-right atrial fistula considered to have incomplete regression,14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition,and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up.Conclusion CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up.
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Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.
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Objective To evaluate the effectiveness of MSCT in the diagnosis of superior sinus venosus atrial septal defect.Methods The MSCT features of superior sinus venosus atrial septal defect in twenty cases were evaluated retrospectively.The following data were recorded:the size and location of sinus venosus atrial septal defect,the anatomy of pulmonary vein,including number of anomalously draining pulmonary veins and their site of drainage,and associated anomalies.Results In all patients,the superior sinus venosus atrial septal defect locates in the extraseptal wall,which normally separates the right upper pulmonary vein from superior vena cava(SVC).And anomalous connection of right upper pulmonary venous and SVC was identified in all the patients.The mean value of the defect diameter was ( 17.1±5.8) mm.Left superior vena cava was identified in 3 patients.In an elderly patient,left anterior descending branch of coronary artery presented significant stenosis.And in another elderly patient with large atrial septal defect,severe pulmonary hypertension was identified by cardiac catheterization.MSCT findings of superior sinus venosus atrial septal defect in 6 cases were finally confirmed by surgical operation.Conclusions Contrastenhanced MSCT was a useful technique for the diagnosis of superior sinus venosus atrial septal defect,which accurately displayed the anatomical characteristics of the associated malformations for preoperative evaluation.
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ObjectiveTo assess the value of free-breathing 3D phase sensitive inversion recovery (PSIR) turbo FLASH for demonstrating the left ventricular myocardial scar in patients with myocardial infarction.MethodsTwenty-three patients with myocardial infarction underwent 2D and 3D phase sensitive inversion recovery (PSIR) Turbo FLASH sequences 10-15 minutes after injection of dimeglumine gadopentetate.The image quality,the area,location and volume of hyperenhanced scar were independently assessed by two experienced radiologists.Student′s t test or rank sum test and Pearson linear correlation were used for the statistics.ResultsThere were no significant differences in the overall image quality (2.57 ±0.59 vs 2.39 ±0.66,Z=-0.93,P =0.35),the area (24.48 ±10.83 vs 29.00 ± 11.56,Z=-1.41,P =0.16) and location ( 16.78 ± 6.51 vs 18.87 ± 6.76,Z =- 1.17,P =0.24) of hyperenhanced scar between 2D and 3D PSIR sequences.The mean volume of hyperenhanced scar was significantly greater in 3D PSIR sequence than that in 2D PSI R sequence [(23.46 ± 10.61 ) vs (31.65 ± 13.86) cm3,t =-2.25,P =0.03].There was a good correlation in the volume of hyperenhanced scar between 2D PSIR and 3D PSIR sequences (r=0.940,P＜0.01 ;y =2.851 + 1.228x,R2 =0.883).ConclusionFree-breathing 3D PSIR Turbo FLASH is a promising new imaging technique for accurate assessment of myocardial scar.
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ObjectiveTo investigate reproducibility of cardiac MRI for assessment of cardiac morphology and ventricular function in selected normal Chinese Han population.MethodsTwo hundred and sixty-nine normal volunteers underwent cardiac MRI using a 1.5 T MR system.HASTE and steady state free precession imaging were performed with long and short axis images and cine mode through the ventricle with wireless vector cardiac gating.The images were reviewed by two independent observers.The dimensions of cardiac chambers and ventricular function including ejection fraction (EF),end diastolic volume( EDV),end systolic volume (ESV) and myocardial mass were evaluated.The data between male and female were compared by using two-tailed unpaired t test.Results Total imaging time was (15 ± 3 ) min.The anteroposterior diameter of the left atrium was( 2.87 ± 0.77 ) cm,the right atrial diameter perpendicular to the atrial septum was ( 3.61 ± 0.57 ) cm,the end diastolic diameter of the left ventricle was (4.97 ±0.52) cm,the end diastolic diameter of the right ventricle was (2.65 ± 0.48) cm.On the left ventricle,EF was(60.62 ±7.08)％,EDV was (115.37 ±26.71) ml,ESV was (46.02+15.72) ml and LV mass was ( 82.97± 24.03 ) g.On the right ventricle,EF was (47.73 ± 6.50 ) ％,EDV was ( 128.27 ± 32.16 )ml,ESV was (67.7 ± 21.07) ml and RV mass was (48.24 ± 13.42) g.There were no statistically significant differences in LVESV( P =0.144 ),LVEDV index ( P =0.714 ),LVESV index ( P =0.113 ),LVCI ( P =0.199),RVEF ( P =0.296 ) and RV mass ( P =0.093 ),and statistically significant differences in other cardiac parameters between male and female.Conclusion Cardiac MRI can provide useful information about cardiac function and morphology with a high level of reproducibility in normal Chinese Han population.
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Objective To evaluate the efficacy of MRI for assessment of re-distribution of bone marrow mesenchymal stem cells injected intramyocardially in main organs (heart, liver, spleen and kidney) under different heart status (beating or arresting) in a porcine model. Methods Bone marrow-derived mesenchymal stem cells were obtained from the male swine and labeled with iron oxide during culture. Acute myocardial infarction was created in female swine, one week later, the survivors were randomly divided into 4 groups. Cardiopulmonary bypass was set up to arrest the heart, and then labeled cells (1×108) were intramyocardially injected into the border of the infracted myocardium in group 1 (n=6). The same volume of cells was grafted into the beating heart in group 2 (n=6). In group 3 and 4, saline was injected into either the arresting or beating myocardium. Three days later, re-distribution of stem cells and cardiac function were assessed by T2*WI and cine MRI, respectively. All animals were sacrificed for histology and real-time quantitative polymerase chain reaction (RT-PCR) of sex-determining region on Y-chromosome (SRY) investigation.The ANOVA and t test was used for statistics. Results The left ventricular end-diastolic volume (LVEDV) before transplantation for group 1-4 were: (56.8±5.3),(54.8±6.8),(57.4±4.3)and(56.8±2.8) ml, and after transplantation for group 1-4 were: (65.2±5.2),(63.2±3.7),(60.2±4.7)and(62.2±4.4) ml. The left ventricular end-systolic volume (LVESV) before transplantation for group 1-4 were: (33.5±7.6),(32.3±5.3),(33.5±3.6)and(32.7±4.6) ml,and after transplantation for group 1-4 were: (37.3±5.6),(36.3±6.9),(34.3±5.4)and(36.3±8.1) ml. The left ventricular EF values (LVEF) before transplantation for group 1-4 were: (42.3±7.2)%,(41.7±6.8)%,(41.8±8.6)% and(42.7±7.7)%,and after transplantation for group 1-4 were: (44.5±8.7)%,(43.1±7.4)%,(42.8±5.6)% and(43.3±8.4)%. The myocardial infarction area (MI) before transplantation for group 1-4 were: (6.5±2.1),(6.4±1.9),(6.5±2.5)and(6.4±2.6) cm2,and after transplantation for group 1-4 were: (6.4±2.3),(6.2±2.6),(6.3±2.5)and(6.4±2.8) cm2 . There were no statistical differences before and after transplantation in these 4 groups[P values of before and after transplantation for LVEDV, LVESV, LVEF,MI were >0.05 (F= 0.277, 0.066,0.066, 0.003); and >0.05 (F= 1.137,0.182,0.021,0.008),respectively]. The T2 value of the infracted myocardium in group 1 decreased more obviously than that in group 2[(-22.3 ± 2.2) vs (-17.0 ± 0.8) ms, t=-5.489, P＜0.01], while the T2 value of the spleen decreased more significantly in group 2 than that in group 1[(-7.7 ± 0.7) vs (-13.3 ± 1.1) ms,t=9.055, P＜0.01]. The T2 values of the liver and kidney were no significant differences in group 1 and 2 (liver, t=-0.532,P>0.05 and kidney, t=-0.113,P>0.05). The results of RT-PCR in group 1 and 2 showed significant differences in heart[(150±62) vs (72±4) U/L ,P<0.05, t=3.109], spleen[(131±1) vs (233±17) U/L, P＜0.01, t=- 13.286]and liver[(17±1) vs (9±5) U/L ,P<0.01,t= 3.492]. Pathological examination demonstrated that the transplanted stem cells were positive for Prussian blue staining, which had a good correlation with MRI results. Conclusion MRI can serve as a convenient and efficient imaging method to track the migration of stem cells with SPIO labeled in early stage and evaluate its early re-distribution in vivo. Injection of bone marrow mesenchymal stem cells in the arresting heart could favor retaining more cells in the myocardium.
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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 analyze the image quality of coronary arteries by dual-source computed tomography (DSCT) in children with congenital heart disease(CHD). Methods Image quality of coronary arteries were scored by two radiologists with an ordinal grading system. Score 3 or 4 was considered to be good image quality and diagnostic. Score differences among 3 groups of various baseline heart rate levels, 3 groups of various age levels and 4 coronary branches were analyzed by using ANOVA. Multiple linear regression analysis was used to test the effects of age, heart rate, tube voltage, tube current, pitch, contrast volume, contrast injection rate on the coronary image scores. Results A total of 72 consecutive patients were enrolled. 71.2% (205/288) of coronary artery branches was good enough for diagnosis. Image quality of left main coronary artery (LM, score 3.64±0.49), left anterior descending (LAD, score 2.97±0.40), right coronary artery (RCA, score of 2.82±0.70), left circumflex (LCX, score 2.76±0.73) were in a descending order (F=29.00, P<0.01). Image scores of age groups of 0--1 years old (2.80±0.65), >1--3 years old (2.81±0.74), >3--14 years old (3.58±0.52) were in an ascending order (F= 20.16,P<0.01). Image scores of heart rate groups of<100 bpm (3.54±0.56),100--150 bpm (2.86± 0.70) and >150 bpm (2.81±0.63) were in a descending order (F=16.72, P<0.01). Multiple linearregression analysis demonstrated that multiple impact factors affected image quality of LM, LAD, LCX and RCA. Age(r=0.013 ,P<0.01)and contrast volume(r=0.292, P<0.01)had positive correlation with LM score. Age(r=0.509, P<0.01) and voltage (r=0.292, P=0.011) had positive correlation with LAD score. Heart rate(r= -0.179, P<0.05) had negative correlation with LAD score. Age (r=0.063, P< 0.01) had negative correlation with LCX score. Age (r=0.486,P<0.01) and voltage (r=0.220, P<0.05) had positive correlation with RCA score. Conclusions Dual-source CT could clearly shows coronary arteries of children with CHD over the age of 3 or with heart rate less than 100 bpm. Limitations of Dual-source CT coronary angiography for CHD children included young age and fast heart rate.
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Objective To define the diagnostic criteria of cardiovascular magnetic resonance imaging in distinguishing isolated left ventricular noncompaction (LVNC) from lesser degrees of hypertrabeculation. Methods Twenty-five patients with LVNC, 39 with dilated cardiomyopathy ( DCM), 16 with aortic stenosis(AS), 15 with aortic regurgitation(AR) , 19 with hypertension (HT) and 22 normal subjects were enrolled in this study. Cardiac magnetic resonance imaging was performed to evaluate the left chamber diameter, functional parameters and noncompaction or hypertrabeculation of the left ventricle in diastole with one-way ANOVA. The left ventricle was divided into 17 segments for localizing all involved segments in this present study. Results The LVNC patients had the commonest myocardial segments involved (10±2)in all subjects. Each patient with LVNC was unexceptionally associated with apical noncompaction (17th segment) , which was seldom found in the other subjects. The lateral walls including 16th, 12th and 11th segments were the most vulnerable segments in all subjects, but nobody was found to involve the basal and mid septum including 2nd, 3rd, 8th and 9th segments. The end-diastolic NC/C (noncompaction/compaction) ratio was, on average, the greatest in patients with LVNC (3.3±0.6), compared with all other subjects(AS:1.0 ±0.3, AR:1.0 ±0.3,HT:0.8 ±0.1,healthy volunteers:0.9 ±0. 2) (F = 169. 62,P <0.05). Receiver operating characteristics analysis identified the end-diastolic NC/C ratio of>2.5 as a valuable parameter to distinguish LVNC from DCM.with values for sensitivity of 96.O%(24/25)and specificity of 94.9%(37/39),respectively.The mean number of NC/C ratio>2.5 segments in the LVNC patients was 4.0 ±2.0.while 8 of 39 patients with DCM had only one segment of NC/C ratio >2.5.Conclusions MRI is all exceUent imaging modality to diagnose LVNC and distinguish LIVNC from hypertrabeeulation.The criteria of LVNC is the NC/C ratio>2.5 in two or more than two segments of free ventricular walls associated with the left ventrieular apex involved.
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Objective To analyze the characteristics of hypertrophic cardiomyopathy (HCM) on delayed contrast-enhanced cardiac magnetic resonance imaging (CMRI). Methods All patients underwent delayed contrast-enhanced CMRI. The left ventricle was divided into 9 segments to assess the location,extent and function of the hypertrophic segments. The t test was applied for the statistics. Results Of 154 patients, delayed enhancement of hypertrophic segment was found in 95 cases and non-delayed enhancement in 59 cases. The thickness and number of hypertrophic segment in patients with delayed enhancement were larger than those with non-delayed enhancement [ (24. 8 ± 5. 5 ) mm vs (20. 4 ±3.8) mm, t = 3.82, P < 0.05; (3.3 ± 1.9) vs (2.4 ± 1.7), t = 2. 26, P < 0.05 ], and the age was younger [ (46. 0 ± 15.2) years vs (55.0 ± 11.9) years, t = - 3. 67, P <0. 05 ]. The diffuse enhancement was found in 62 patients, and confluent enhancement in 33 patients. Confluent enhancement was found in all 14 patients after the alcohol ablation procedure. Conclusion The age, thickness and number of hypertrophic segments in patients with delayed enhancement are different from those with non-delayed enhancement.
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Objective To evaluate the value of MSCT, MRI and SPECT in detecting acute myocardial ischemia in Chinese mini-swine model. Methods A total of six male mini-pigs were recruited with a mean body weight of (21.6 ± 1.2) kg. All pigs were scanned on MSCT before the ligation of distal segment of Left anterior descending artery. Then, MSCT was rescanned every 2 h from ligation till 8 h latter.MRI, SPECT and the last MSCT scan were performed within 24 h one by one. Finally pathological examination was carried out right after the pig killed. Results One pig died during operation, the other 5 finished all the examinations. The pathological staining showed the same areas of myocardial infarction in the left ventricular anterior wall with the all the imaging findings, including low perfusion region of MSCT arterial phase at 2-24 h, low perfusion region of SPECT at 24 h and low perfusion region of MRI first pass phase at 24 h. Three of 5 pigs showed enhanced edge of low perfusion region on MSCT delayed scan at 4-8 h. The mean CT values in the region with reduced first-pass perfusion were 75.9,36.4, 35. 2,37. 8,37.4,33.3 HU on MDCT image at baseline, 2-8 h after operation and within 24 h after operation, respectively,and there were statistically significant difference of CT values ( F = 12. 341, P ＜0. 01 ) between preoperative and all postoperative MSCT scan. There were no statistically significant difference (F = 2. 278, P = 0. 792)among all postoperative MSCT scan. At baseline, 2-8 h after operation and within 24 h, the average volumes of stroke volume(SV)were 21.7,11.9,10.3,11.4,12. 3,12.6 ml, respectively, while the average volume of end-systolic volume( ESV)were 15.2,23.4,25.0,24. 4,25.3,22. 8 ml,respectively. The average volume of end-diastolic volume ( EDV ) at these time point were 37. 0,35.4,35.0,35.7,37. 6,37.5 ml,respectively and the average percentage of ejection fraction (EF) were 58.9% ,33.8% ,29. 0%, 31.9%,32.6% ,33.5% ,respectively. SV(F =22. 349, P＜0.01) ,ESV (F=8. 810, P＜0.01) ,EF(F =27. 240,P ＜ 0. 01 ) were all significantly different among all postoperative MSCT scan except EDV ( F = 2. 339, P =0. 079). Infarct size, which was defined as the proportion of the area of infarction to that of the entire heart,were (39.4 ±12.6)% for MSCT,(37.2 ± 10.0)% for MRI, (35.9 ±9.6)% for TTC, respectively.There were no significant differences of infarct size between TTC and MSCT (t =0. 612, P =0. 574), TTC and MRI (t=0.820, P=0.458), MSCTand MR (t=0. 425 ,P =0. 692 ). Conclusions MSCT,MRI and SPECT were all able to be used to detect the myocardial infarction in acute myocardial ischemia model The infarct size defined on MSCT, MRI and pathology were consistent. The density of ischemic myocardium and cardiac function did not change over the time within 24 h right after infarction.