Cerebral ischemic injury after transcatheter aortic valve replacement in patients with pure aortic regurgitation / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Considering the surgical risk stratification for patients with severe calcific aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) is a reliable alternative to surgical aortic valve replacement (SAVR) (Fan et al., 2020, 2021; Lee et al., 2021). Despite the favorable clinical benefits of TAVR, stroke remains a dreaded perioperative complication (Auffret et al., 2016; Kapadia et al., 2016; Kleiman et al., 2016; Huded et al., 2019). Ischemic overt stroke, identified in 1.4% to 4.3% of patients in TAVR clinical practice, has been associated with prolonged disability and increased mortality (Auffret et al., 2016; Kapadia et al., 2016; Levi et al., 2022). The prevalence of hyperintensity cerebral ischemic lesions detected by diffusion-weighted magnetic resonance imaging (DW-MRI) was reported to be about 80%, which is associated with impaired neurocognitive function and vascular dementia (Vermeer et al., 2003; Barber et al., 2008; Kahlert et al., 2010).

Clinical study of anesthesia management and treatment strategies for emergency transcatheter aortic valve replacement / 中华急诊医学杂志

Objective:To discuss the essentials of anesthesia management and treatment strategies for emergency transcatheter aortic valve replacement (TAVR), and to provide standardized recommendations for the development of emergency TAVR technology in China.Methods:This study retrospectively analyzed the relevant data of patients undergoing emergency TAVR surgery in the Second Affiliated Hospital of Zhejiang University School of Medicine from March 2019 to February 2021, including baseline patient characteristics, perioperative echocardiography data, prognosis and 30-day follow-up. Post-operative data were compared with pre-operative data using paired-sample test.Results:Thirteen patients, aged (75.62±9.63) years, underwent emergency TAVR surgery, and 6 of them were male. Eleven patients were New York Heart Association class Ⅳ. The preoperative Society of Thoracic Surgeons score was (20.31±15.15)%. The trans-aortic valve differential pressure was significantly reduced after surgery [(68.92±30.66)mmHg vs. (2.70±2.36)mmHg, P<0.01]. Two patients died within 30 days after surgery, one patient developed a new third degree atrioventricular block, one patient had a stroke, and 4 patients developed pulmonary infection. Conclusions:Emergency TAVR surgery is a feasible and effective rescue strategy for patients with aortic stenosis in critical condition. The establishment of anesthesia standard operation procedure process for TAVR surgery helps ensure homogenized medical behavior and good teamwork.

Transapical aortic valve implantation using J-Valve? system for high-risk patients with aortic regurgitation: mid-stage of 1 year follow-up / 中华胸心血管外科杂志

Objective:To analysis the mid-stage prognosis of transapical aortic valve implantation(TA-TAVI) using J-Valve? system for the treatment of high-risk aortic regurgitation(AR) patients.Methods:Data of 25 patients with aortic regurgitation who had underwent transapical aortic valve implantation using J-Valve? system were collected in the Second Affiliated Hospital of Medical College of ZheJiang University from September 2016 to June 2020 . Analysis and summarize their postoperative all-cause mortality, the incidence of adverse events and the improvement in cardiac function.Results:There were 25 patients, including 19 males, the age rage from 59-83 years, the average age was(72.3±27.11) years. The levels of aortic regurgitation was evaluated by transthoracic echocardiography preoperatively, showed that severe AR accounted for 88%. The New York Heart Association(NYHA) of grade 3 or above was 92%. The most common comorbidity was hypertension, accounted for 68%. Coronary heart disease and history of cardiac surgery was 5 and 3 relatively in this study. The Society of Thoracic Surgeons score before surgery was 1.511%-27.674%, the average of STS score was 4.27(2.914-6.033)%. Successful J-Valve implantation was obtained in all 25 cases, no conversion to thoracotomy. After surgery, 2 patients required permanent pacemaker implantation, 1 patient needed continuous renal replacement therapy(CRRT) due to acute kidney injury, 1 occurred moderate or above paravalvular leak. The results showed good therapeutic effects in early-stage, low incidences of adverse events. The continued improvement of cardiac function and ventricular reverse remodeling could be observed in mid-stage.Conclusion:In this study, we can summarize that high-risk patients with aortic regurgitation treated with transapical aortic valve implantation using J-Valve? system can acquire great perioperative safety and mid-stage prognosis.

Clinical practice and prognosis of emergent transcatheter aortic valve replacement / 中华急诊医学杂志

Objective:To evaluate the effectiveness and prognosis of emergent transcatheter aortic valve replacement (TAVR) and to provide standardized procedural suggestion for the development of emergent TAVR in China.Methods:From January 2020 to April 2021, 12 patients who underwent emergent or salvage TAVR in the Second Affiliated Hospital Zhejiang University School of Medicine were retrospectively enrolled from the TORCH registry (Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population, a prospective cohort study; NCT02803294). Baseline, periprocedural and 30-day follow up data were collected. Post-operative data were compared with pre-operative data using Paired-Samples test.Results:Patients’ median Society of Thoracic Surgeons score (STS score) was 15.432%. There was a significant decrease of mean gradient after emergent TAVR procedure (1.69 m/s vs. 4.90 m/s, P<0.01). During the 30-day follow up, there were 1 patient (8.3%) died and 2 patients received permanent pacemaker implantation. No disabling stroke, acute kidney injury, major vascular complication occurred during the first month after emergent TAVR. Among the survival patients, there was a significant releasing of heart failure symptoms to New York Heart Association function stage Ⅰ/Ⅱ in 81.8% patients at 30-day follow up. Left ventricular ejection fraction also improved significantly from (47.4±9.5)% to 58.8±8.0% ( P= 0.026). The mean gradient were (1.57±0.30) cm 2 and no patients had a moderate or severe paravalvular leakage. Besides, a significant decrease of pro-B-type natriuretic peptide (1 089.9 pg/mL vs. 12 215.5 pg/mL , P=0.001) and troponin T (0.020 ng/mL vs. 0.337 ng/mL, P=0.003) were found at 30 days after emergent TAVR. Conclusions:For patients with severe aortic stenosis and acute cardiac decompensated, emergent TAVR is a safe and effective rescue treatment.

Novel apical-to-femoral rail technique for horizontal aorta in transcatheter aortic valve replacement / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis regardless of its surgical risk stratification (Otto et al., 2021). Aortic angulation is usually measured as the angle between the horizontal and the aortic annulus planes based on preproced‍ural multidetector computed tomography (MDCT) (Al-Lamee et al., 2011). Extremely horizontal aorta, defined as an aortic angulation greater than 70°, is an unfavorable anatomic structure that poses particular technical challenges for TAVR. Abramowitz et al. (2016) have proved that an extremely horizontal aorta increased the risk of procedural complications, such as lower device success rates, more moderate or even severe perivalvular leakage (PVL), and the need for second valve implantation. Because of the long stent frame, inflexibility, and non-steerability, it is challenging to pass the delivery system of self-expanding valves (SEVs) through an extremely horizontal aorta. As a result, patients with an extremely horizontal aorta have always been excluded from the clinical trials of TAVR, and transfemoral (TF)-TAVR with SEV is considered as an "off-label" use of TAVR (Adams et al., 2014; Kaneko et al., 2020). Herein, we present a technically difficult case, in which a patient with an extremely horizontal aorta underwent TF-TAVR with SEV by applying a unique apical-to-femoral rail strategy.

Preliminary experience of transesophageal echocardiography guided DragonFly? system for edge-to-edge tricuspid regurgitation repair / 中华超声影像学杂志

Objective:To explore the value of transesophageal echocardiography(TEE) guidance for transcatheter DragonFly? system edge-to-edge tricuspid regurgitation (TR) repair.Methods:Five cases who were chosen in the Second Affiliated Hospital, Zhejiang University School of Medicine from December 2020 to January 2021 with surgical high-risk and severe functional TR underwent transcatheter DragonFly edge-to-edge repair with the guidance of TEE. Preoperative TEE was used to evaluate the tricuspid valve anatomy and the origin and etiology of regurgitation in detail; intra-procedure guidance of TEE was performed during the DragonFly system for tricuspid valve edge-to-edge repair intervention and after release of the DragonFly clip, the effect of surgery was assessed immediately and compared with pre-procedure TEE.Results:A total of 10 DragonFly clips were implanted in 5 patients (3 in each of patients, 2 in 1 patient, and 1 in each of patients). One of the 3 clips in 1 patient fell off unilaterally from the septal valve after release, and the other 9 clips were well positioned and fixed. Immediately post-operation assessment by TEE depicted the TR in 3 patients declined to mild and 2 to moderate. The vena contracta area by using three-dimensional color blood flow quantitative assessment was reduced[(0.93±0.26)cm 2 vs (0.20±0.11)cm 2]. No complications such as serious tricuspid valve injury, pericardial tamponade, thromboembolism occurred in the 5 patients. Conclusions:TEE plays an important role in guiding and monitoring transcatheter DragonFly system edge-to-edge TR repair during the entire procedure.

Comparison study of left ventricular reverse remodeling after transcatheter aortic valve replacement of bicuspid versus tricuspid aortic valve stenosis / 中华超声影像学杂志

Objective:To compare the left ventricular (LV) reverse remodeling after transcatheter aortic valve replacement (TAVR) between patients with bicuspid aortic valve (BAV) stenosis and tricuspid aortic valve (TAV) stenosis.Methods:The data of patients who underwent TAVR procedure from March 2013 to December 2018 in the Second Affiliated Hospital of Zhejiang University were retrospectively reviewed. The patients were divided into BAV group and TAV group according to cardiac computed tomography. Echocardiographic parameters, including aortic valve peak velocity (Vmax), mean gradient (PGmean), effective orifice area(EOA), interventricular septum diastolic thickness (IVSd), left ventricular posterior wall diastolic thickness (LVPWd), left ventricular end diastolic diameter( LVEDd), LV mass index (LVMI), ΔLVMI%, left ventricular ejection fraction( LVEF) of the two groups at baseline, 1 week, 1 month and 1 year post TAVR procedure were obtained and compared.Results:①Compared with preoperative measurements, both groups showed decreases in Vmax, PGmean and increase in EOA at 1 week, 1 month, 1 year follow-ups(all P<0.05). No significant differences were found in Vmax, PGmean, EOA, moderate/sever perivalvular leakage(PVL), moderate/sever prosthetic-patient mismatch(PPM) between BAV group and TAV group at 1 year. ②Both groups showed decreases in IVSd, LVPWd, LVEDd at 1 month, 1 year post TAVR compared with those before the procedure (all P<0.05), as well as increases in LVEF at 1 week, 1 month, 1 year (all P<0.05). Downward trends of LVMI were detected in both groups within 1 year follow-up( P<0.05). ③Compared to TAV group, BAV group showed smaller baseline LVMI( P<0.05), while there were no significant differences in ΔLVMI% post TAVR for all follow-up times of the two groups(all P>0.05). Repeated measures analysis of variance also showed no significant differences in downward trend of LVMI between the two groups after TAVR within 1 year( P>0.05). Conclusions:Left ventricular reverse remodeling can be detected in both BAV and TAV patients after TAVR, which starts from 1 week and can be lasted for 1 year post procedure. Patients with bicuspid morphology might experience similar reverse LV remodeling post TAVR versus patients with tricuspid morphology.

Initial clinical experience with transesophageal echocardiography guided NeoChord system for massive regurgitation of posterior mitral valve prolapse / 中华超声影像学杂志

Objective:To explore the evaluation of transesophageal echocardiography(TEE) in patients with massive regurgitation of posterior mitral valve prolapse undergoing transapical off-pump NeoChord repair.Methods:Eight patients from April to July 2019 in the Second Affilliated Hospital of Zhejiang Univerity with massive regurgitation of posterior mitral valve prolapse underwent NeoChord repair mitral valve morphology, prolapse position and regurgitation degree were evaluated before NeoChord implantation by TEE. Under TEE guidance, the puncture site was identificated, the position and length of artificial chordae were adjusted during implantation. NeoChord′s function and positon after implantation were observed. The complications were monitored during the operation.Results:Mitral valve repair by NeoChord system was successfully performed with implantation of 2 to 4 artificial chordaes in eight patients respectively. Intraoperative TEE and pre-discharge transthoracic echocardiography(TTE) showed moderate MR in two patients, mild to moderate MR in one patient, mild MR in the remaining five patients. Reexaminations with TTE at 1 month after operation showed moderate MR in six patients, and mild to moderate MR in two patients. And no postoperative complications were noted.Conclusions:NeoChord system is a safe, effective and feasible treatment method for patient with mitral valve prolapse, TEE plays an important role during NeoChord implantation.

Optimum compatibility of nabufine mixed with flurbiprofen for patient-controlled intravenous analgesia after gynecological laparoscopic surgery: a multicenter, randomized, controlled clinical trial / 中华麻醉学杂志

Objective To evaluate the optimum compatibility of nabufine mixed with flurbiprofen for patient-controlled intravenous analgesia (PCIA) after gynecological laparoscopic surgery.Methods A total of 210 patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologist physical status Ⅰ or Ⅱ,scheduled for gynecological laparoscopic surgery under general anesthesia,were divided into 4 groups using a random number table method:sufentanil 2.0 μg/kg+flurbiprofen axetil 2.0 mg/kg group (SF group,n =55),nalbuphine 1.5 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N1 F group,n=49),nalbuphine 2.0 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N2F group,n =55) and nalbuphine 3.0 mg/kg +flurbiprofen axetil 2.0 mg/kg group (N3F group,n=51).PCIA solution was prepared correspondingly after surgery in each group.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2.0 ml/h.Nalbuphine 5 mg or sufentanil 5 μg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ＜4 at 48 h after surgery in SF and N1 F-N3F groups.Ramsay sedation scores were recorded on admission to post-anesthesia care unit (T1),at the time of post-anesthesia care unit discharge (T2) and at 6,24 and 48 h after surgery (T3-5).The total pressing times of PCIA in 0-6 h,6-24 h and 24-48 h periods after surgery and requirement for rescue analgesics were recorded.The incidence of adverse reactions such as nausea and vomiting,drowsiness and shivering within 48 h after surgery was also recorded.Results Compared with group SF,the incidence of nausea and vomiting was significantly decreased in N1 F and N2F groups,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3 F groups,and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N1 F,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3F groups,and the incidence of nausea and vomiting and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N2F,the incidence of nausea and vomiting was significantly increased (P＜ 0.05),and no significant change was found in the requirement for rescue analgesics,total pressing times of PCIA or Ramsay sedation scores in group N3F (P＞0.05).Conclusion Nabufine 2.0 mg/kg mixed with flurbiprofen 2.0 mg/kg is the optimum compatibility when used for PCIA after gynecological laparoscopic surgery.

Effect of transcatheter aortic valve replacement using Venus-A valve for treating patients with severe aortic stenosis / 中华心血管病杂志

Objective@#To evaluate the effect of transcatheter aortic valve replacement(TAVR) using Venus-A valve for treating patients with severe aortic stenosis.@*Methods@#In this prospective study, 101 consecutive severe aortic stenosis patients with high surgical risk(Society of Thoracic Surgeon(STS) score ≥4%) or at prohibitive surgical risk were enrolled from 5 academic cardiovascular centers in China(Fuwai hospital, the second affiliated hospital of Zhejiang university school of medicine, West China hospital of Sichuan university, the first affiliated hospital of Nanjing medical university, Ruijin hospital of Shanghai Jiaotong university school of medicine) from September 2012 to January 2015, and Venus-A valves were used in TAVR for these patients. The primary endpoints were death from any cause and major stroke in 1 year. The secondary endpoints included efficacy and safety of TAVR in 1 year.@*Results@#TAVR success rate was 97.9%(98/101), and 3 patients were transferred to receive surgical AVR. There were 85 patients using 1 Venus-A valve, and 13 patients underwent valve-in-valve implantation using 2 Venus-A valves. There were 1 case(1.0%) of stroke, 2 cases(2.0%)of acute myocardial infarction, 5 cases(5.0%) of pericardial effusion, 6 cases(5.9%) of severe vascular complication, and 2 cases(2.0%) of death after 7 days of TAVR. Meanwhile, aortic pressure gradient derived from echocardiography was significantly reduced when compared with pre-procedure level(11(8, 15) mmHg (1 mmHg=0.133 kPa) vs. 59(45, 71)mmHg, P<0.01), and there was no aortic root rupture or leaflets thrombosis. Rate of NYHA functional class ≤Ⅱ improvements were observed at 6 months follow-up when compared with pre-procedure(94.4%(84/89)vs. 21.3%(21/89), P<0.01). The primary endpoint was 7.9%(8/11), and the incidence of all cause death and stroke was 5.9%(6/101) and 2.0%(2/101) respectively at 1 year after the procedure. Kaplan-Meier survival analysis showed that cumulative survival rate was 94.1% at 1 year after the procedure.@*Conclusion@#TAVR using Venus-A valve for treating patients with severe aortic stenosis is effective and safe in the early and medium term post procedure.

Evaluation of a novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for transcatheter aortic valve replacement / 中华超声影像学杂志

Objective To evaluate the accuracy of a novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for transcatheter aortic valve replacement(TAVR).Methods Four patterns(Lax,Lax-Res,Sax,Sax-Res) of 3D-TEE imaging of aortic root were gotten preoperatively in 18 patients with severe tricuspid aortic stenosis who were referred to our center for TAVR.The specialized 3D-TEE reconstruction software,eSie Valves,then automatically configured a geometric model of the aortic root from the images obtained by 3D-TEE and performed a quantitative analysis of these structures:the minimal diameter(Dmin),maximal diameter(Dmax),area and perimeter(Peri) of aortic annulus,height of the ostia of the left/right coronary artery above the aortic annulus(LOH/ROH).The echo dimensions were compared with the MDCT measurements.Results No statistically significant difference were found in above parameters between the ZOOM pattern (Sax-Res and Lax-Res) and CT measurements(all P>0.05).Lax-Res pattern measurements had good correlation with MDCT,with r valves of 0.81,0.77,0.89,0.84 for Lax-Res-Dmin,Lax-Res-Dmax,Lax-Res-Area,Lax-Res-Peri,respectively(all P<0.05).3D-TEE LOH/ROH had poor correlation with MDCT LOH/ROH (all r<0.7).Conclusions The new automatic 3D-TEE software allows modelling and quantifying the aortic annulus dimensions from 3D-TEE data in patients with tricuspid aortic valves,and Lax-Res pattern is recommended.Quantified assessment of LOH/ROH is not ideal and needs to be improved.

The value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation.</p><p><b>METHODS</b>From October 2013 to June 2014, 6 transcatheter mitral valve repair operations were performed in our hospital for symptomatic patients with severe functional mitral regurgitation (MR), transesophageal echocardiography was applied to guide the implantation of 2 pieces of MitraClip. Clinical data are retrospectively analyzed to evaluate implantation timing and approach of the 2nd piece of MitraClip, as well as the immediate effect of the interventional therapy.</p><p><b>RESULTS</b>After implantation of 1st piece of MitraClip, transesophageal echocardiography evidenced MR ≥ grade 2 with central regurgitation and immediate mitral average transvalvular pressure gradient < 3 mmHg (1 mmHg = 0.133 kPa) in these 6 patients and 2nd piece of MitraClip was implanted in these patients. After implantation of 2nd piece of MitraClip, it is observed via transesophageal echocardiography that mitral regurgitations were reduced by ≥ 2 grades for all 6 patients. For 3 patients, MR was reduced to grade 1. For the other 3 patients, MR is reduced to grade 2. Among the 3 patients whose MR was reduced to grade 2, 2 operations were stopped because immediate mitral average transvalvular pressure gradient equaled to 3 mmHg, and the rest 1 operation was stopped because MR was too diverse and not able to select proper position to implant the next MitraClip. All 6 operations are completed successfully.There were no myocardial infarction, death or complications requiring mitral valve surgery after the MitraClip procedure. There were also no MitraClip detachment, thrombus embolism, mitral valve apparatus injuries, mitral stenosis, pericardial tamponade post procedure.</p><p><b>CONCLUSIONS</b>Transesophageal echocardiography plays an important role to guide the implantation of 2 pieces of MitraClip in transcatheter mitral valve repair operation. Mitral average transvalvular pressure gradient and initial position of regurgitation after implantation of the previous MitraClip are critical determinants for decision making if the next piece of MitraClip can be implanted or not.</p>

Preliminary evaluation of transesophageal echocardiography in percutaneous edge-to-edge repair of mitral regurgitation / 中华超声影像学杂志

Objective To explore the preliminary evaluation of transesophageal echocardiography in percutaneous edge-to-edge repair of mitral regurgitation.Methods Ten consecutive patients were treated with percutaneous edge-to-edge repair of mitral regurgitation using the MitraClip system.All of them had moderate-severe (n =1) or severe (n =9) central MR and high operative risk.MitraClip implantation performed under echocardiographic and fluoroscopic guidance in general anaesthesia.Preoperative and postoperative immediate echocardiographic data were prospectively collected.Results All operations succeed with one MitraClip implanted to 5 patients and two MitraClips implanted to 5 patients.Postoperative immediate echocardiography observed MR reduction,6 cases to mild,2 cases to mild-to-moderate and 2 cases to moderate.No complications occurred in all patients,such as Clip off,pericardial effusion/tamponade,or mitral valve damage.Conclusions Echocardiography guarentees the success of MitraClip based transcatheter mitral valve repair operations with safety and effectiveness.

Value of preoperative assessment on transcatheter aortic valve implantation procedure with high-pitch dual-source computed tomography angiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the value of preoperative assessment on transcatheter aortic valve implantation (TAVI) procedure with high-pitch dual-source computed tomography angiography (CTA).</p><p><b>METHODS</b>Seventeen consecutive patients with severe symptomatic aortic stenosis underwent TAVI in our department from December 2012 to December 2013 were examined by 128-slice prospective ECG-triggered high-pitch spiral CTA and the clinical data were analyzed. Aortic annulus, sinus of Valsalva, sinotubular junction, ascending aorta and native leaflet to coronary ostium length were measured. Peripheral vascular access was evaluated. Then the patients were assessed on the suitability for TAVI procedure and prosthetic valve sizes.</p><p><b>RESULTS</b>Mean diameter of the aortic annulus was (25.7 ± 2.0) mm, perimeter mean diameter was (26.4 ± 2.0) mm, area mean diameter was (25.4 ± 1.9) mm. Mean diameter of sinus of Valsalva was (34.0 ± 3.8) mm. Mean diameter of sinotubular junction was (30.5 ± 3.2) mm. Mean diameter of ascending aorta was (37.8 ± 2.8) mm. The length from native leaflet to left coronary ostium was (14.0 ± 2.0) mm, and the length from native leaflet to right coronary ostium was (15.9 ± 3.6) mm. Mean diameter of left iliac arteries was (7.5 ± 1.4) mm. Mean diameter of right iliac arteries was (7.4 ± 1.2) mm. Mean diameter of left femoral arteries was (7.4 ± 1.2) mm. Mean diameter of right femoral arteries was (7.3 ± 1.3) mm. One patient was considered ineligible for TAVI because of large aortic annulus diameter. Three patients died prior to TAVI. Two patients refused to undergo TAVI. Eleven patients underwent TAVI, 26# prosthetic valve was implanted in 1 patient, 29# prosthetic valve implanted in 6 patients, 31# prosthetic valve implanted in 4 patients. Prosthetic valve implantation was successful in 9 patients and only mild or trace perivalvular leakage was observed in these patients. Moderate perivalvular leakage were observed in 2 patients because of the location of implantation was too low, and perivalvular leakage was significantly reduced after re-implantation with same size prosthetic valve at a higher location.</p><p><b>CONCLUSIONS</b>CTA can be used to evaluate the aortic root anatomy and vascular access, and help to choose the right size of prosthetic valve. CTA has an important practical value in preoperative screening of TAVI procedure.</p>

Efficacy of intravascular ultrasound guided rotational atherectomy for heavily calcified coronary lesions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy (RA) followed by drug eluting stent (DES) implantation in treating patients with heavily calcified coronary lesions.</p><p><b>METHODS</b>Clinical characteristics, coronary angiogram, intravascular ultrasound images, peri-procedure and follow-up data (including death , myocardial infarction and target lesion revascularization) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed. IVUS examination was carried out before RA, after RA and stent implantation to guide whether further RA or post dilatation was needed. According to the arc of calcification, the patients were divided into group A (90°-270°, 18 cases) and group B (271°-360°, 26 cases).</p><p><b>RESULTS</b>In A and B group, the arc of calcification was (195 ± 71)° in group A and (345 ± 23)° in group B (P < 0.01) , length of calcification was (34.4 ± 11.8) mm in group A and (20.0 ± 6.6) mm in group B (P < 0.05). Number of burrs used and size of largest burr used were similar between 2 groups (both P > 0.05). Acute cross sectional area gain after RA was (0.43 ± 0.32) mm in group A and (0.53 ± 0.38) mm² in group B (P > 0.05). After RA, there was significant decrease in the arc of calcification in group B compared with baseline ((324 ± 52)° vs. (345 ± 23)°, P < 0.05). The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups (all P < 0.05). The final minimal lumen area after stenting were similar between 2 groups (P > 0.05). Procedure success rate was 100% (44/44) without any major complications such as death, acute myocardial infarction and coronary perforation. During the (16.6 ± 6.3) months follow-up, there was 1 death in group A, 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.</p><p><b>CONCLUSION</b>Heavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.</p>