Short-term prognostic predictive value of deep-learning assisted quantitative myocardial contrast echocardiography in ST-elevated myocardial infarction after primary percutaneous coronary intervention / 中华超声影像学杂志

Objective:To explore the prognostic predictive value of deep neural network (DNN) assisted myocardial contrast echocardiography (MCE) quantitative analysis of ST-elevated myocardial infarction (STEMI) patients after successful percutaneous coronary intervention(PCI).Methods:A retrospective analysis was performed in 97 STEMI patients with thrombolysis in myocardial infarction-3 flow in infarct vessel after primary PCI in Renmin Hospital of Wuhan University from June to November 2021. MCE was performed within 48 h after PCI. Patients were followed up to 120 days. The adverse events were defined as cardiac death, hospitalization for congestive heart failure, reinfarction, stroke and recurrent angina. The framework consisted of the U-net and hierarchical convolutional LSTMs. The plateau myocardial contrast intensity (A), micro-bubble rate constant (β), and microvascular blood flow (MBF) for all myocardial segments were obtained by the framework, and then underwent variability analysis. Patients were divided into low MBF group and high MBF group based on MBF values, the baseline characteristics and adverse events were compared between the two groups. Other variables included biomarkers, ventricular wall motion analysis, MCE qualitative analysis, and left ventricular ejection fraction. The relationship between various variables and prognosis was investigated using Cox regression analysis. The ROC curve was plotted to evaluate the diagnostic efficacy of the models, and the diagnostic efficacy of the models was compared using the integrated discrimination improvement index (IDI).Results:The time-cost for processing all 3 810 frames from 97 patients was 377 s. 92.89% and 7.11% of the frames were evaluated by an experienced echocardiographer as "good segmentation" and "correction needed". The correlation coefficients of A, β, and MBF ranged from 0.97 to 0.99 for intra-observer and inter-observer variability. During follow-up, 20 patients met the adverse events. Multivariate Cox regression analysis showed that for each increase of 1 IU/s in MBF of the infarct-related artery territory, the risk of adverse events decreased by 6% ( HR 0.94, 95% CI =0.91-0.98). There was a 4.5-fold increased risk of adverse events in the low MBF group ( HR 5.50, 95% CI=1.55-19.49). After incorporating DNN-assisted MCE quantitative analysis into qualitative analysis, the IDI for prognostic prediction was 15% (AUC 0.86, sensitivity 0.78, specificity 0.73). Conclusions:MBF of the area supplied by infarct-related artery after STEMI-PCI is an independent protective factor for short-term prognosis. The DNN-assisted MCE quantitative analysis is an objective, efficient, and reproducible method to evaluate microvascular perfusion. Assessment of culprit-MBF after PCI in STEMI patients adds independent short-term prognostic information over qualitative analysis.It has the potential to be a valuable tool for risk stratification and clinical follow-up.

Timely utilization of transthoracic echocardiography can improve clinical outcomes after acute kidney injury in intensive care unit patients / 中华肾脏病杂志

Objective:To investigate the effect of usage of transthoracic echocardiography(TTE) on the prognosis of patients after acute kidney injury (AKI) in intensive care unit (ICU).Methods:The clinical data of patients with AKI in the Medical Information Mart for Intensive Care (MIMIC-Ⅲ v1.4) database was collected retrospectively, and the patients were divided into TTE group (with TTE within 24 hours of AKI diagnosis) and No-TTE group (without TTE examination or first TTE examination was more than 24 hours after AKI diagnosis). Propensity score matching (PSM) was utilized to balance the baseline variables between the two groups and Cox regression analysis was used to evaluate the independent risk factors for 28-day all-cause mortality (the primary outcome). Moreover, after PSM, the effects of TTE usage on the second outcomes (including the volumes of intravenous fluid and urine output in the first, second and third 24-hour after the diagnosis of AKI; the total number of mechanical ventilation-free days, renal replacement therapy-free days and vasopressor-free days within 28 days after ICU admission; use of diuretics after the diagnosis of AKI; reduction in serum creatinine within 48 hours after the diagnosis of AKI; and the length of ICU stay and hospital stay) were also evaluated.Results:Among 23 945 eligible AKI patients, 3 365 patients (14.1%) patients received TTE within 24 hours after the diagnosis of AKI and finally there were 3 361 patients in TTE group and No-TTE group included in this study after PSM based on the ratio of 1∶1. After PSM, all variables in the two groups were well balanced (standardized mean difference<0.1, respectively). Before and after PSM, patients in TTE group had lower 28-day all-cause mortality compared with patients in No-TTE group (10.76% vs 13.04%, χ2=13.535, P<0.001; 10.65% vs 18.80%, χ2=88.932, P<0.001), and Kaplan-Meier survival curves also revealed that patients in the TTE group had higher cumulative survival rate compared with patients in No-TTE group (Log-rank χ2=15.438, P<0.001; Log-rank χ2=75.360, P<0.001, respectively). Multivariate Cox regression analysis showed that TTE was an independent influencing factor for 28-day all-cause mortality before and after PSM ( HR=0.80, 95% CI 0.73-0.89, P<0.001; HR=0.58, 95% CI 0.51-0.65, P<0.001). And all subgroup analyses showed the similar results. Compared with patients in the No-TTE group, patients in the TTE group had higher volume of intravenous fluid on the first day and the second day after the diagnosis of AKI (both P<0.01). Patients in the TTE group had higher volume of urine output on the first day and the third day after the diagnosis of AKI (both P<0.01). The patients in the TTE group had a significantly lower duration of vasopressor-free and mechanical ventilation-free (both P<0.01). The usage of diuretic was significantly higher in the TTE group compared with that in the No-TTE group (54.1% vs 44.2%, χ2=65.609, P<0.001). With respect to serum creatinine, the reduction in serum creatinine within 48 hours after the diagnosis of AKI was higher in the TTE group than that in the No-TTE group [36.6(23.0, 97.2) μmol/L vs 30.1(14.2, 61.9) μmol/L, Z=-9.549, P<0.001]. Moreover, TTE group had shorter ICU stay than that in the No-TTE group [5.03(3.40, 8.90) d vs 5.37(3.77, 10.00) d, Z=-6.589, P<0.001]. There were no significant difference between the two groups in other secondary outcomes (all P>0.05). Conclusions:Timely TTE utilization after AKI incident is associated with better clinical outcomes for ICU patients.

Safety and short-term outcomes evaluation of transfemoral transcatheter aortic valve replacement in the treatment of pure native aortic valve regurgitation / 中华超声影像学杂志

Objective:To evaluate the safety and short-term outcomes of transfemoral transcatheter aortic valve replacement (TAVR) with domestic prostheses in patients with pure native aortic valve regurgitation (AR).Methods:A total of 16 patients with pure native AR who underwent transfemoral TAVR in the Renmin Hospital of Wuhan University from June 2019 to January 2022 were consecutively included in our study, and 24 patients with aortic stenosis (AS) who underwent transfemoral TAVR in the same period were selected as the control group. This study compared the baseline characteristics, baseline echocardiography, morphological characteristics of the aortic root, safety of the procedure and short-term outcomes between the two groups.Results:Compared with the AS group, the pure native AR group had a higher prevalence of baseline NYHA class Ⅲ or Ⅳ, a larger left ventricular end-diastolic diameter (LVEDD), a smaller relative ventricular wall thickness (RWT) (all P<0.05), a lower aortic root calcification score, and a larger sinus junction diameter, and cardiac angle (all P<0.05). During TAVR operation, the pure native AR group was treated with larger prostheses size, with a larger percentage in relation to the native annulus size and outflow tract (all P<0.05). There were 7 cases (43.8%) treated with 'valve in valve’, 2 cases (12.5%) with moderate paravalvular leak(PVL), and 2 cases (12.5%) with prostheses-migration to ascending aorta.However, no cases of death, transfer to surgery, coronary obstruction or annular rupture were observed in the pure native AR group. There were no statistical differences between the pure native AR group and AS group in device success rate (56.3% vs 62.5%, P>0.05) and 1-month all-cause mortality[0 (0/16) vs 4.2% (1/24), P>0.05]. The 6MWT, NT-proBNP, and NYHA were significantly improved at 1-month post TAVR compared with those before the procedure in the two groups (all P<0.05). Echocardiography showed significant reverse cardiac remodeling and improved left ventricular function compared with those before the procedure in the two groups. Conclusions:Transfemoral TAVR is a feasible and safe method for patients with pure native AR, and its short-term prognosis is similar to that in AS patients with well-established TAVR.

Echocardiographic predictors of 30-day survival after veno-arterial extracorporeal membrane oxygenation in refractory cardiogenic shock / 中华超声影像学杂志

Objective:To investigate the predictive value of echocardiography hemodynamic parameters on 30-day survival rate after veno-arterial extracorporeal membrane oxygenation in refractory cardiogenic shock.Methods:A total of 44 patients with refractory cardiogenic shock who passed VA-ECMO weaning trial were retrospectively analyzed from September 2014 to February 2021. According to their 30-day survival outcomes after VA-ECMO removal, these patients were divided into the survival group (32 cases) and the death group (12 cases). Baseline data and the change rate of echocardiographic parameters between the first day of VA-ECMO and the day on VA-ECMO removal were compared, and the ultrasonic indicators affecting the survival of VA-ECMO within 30 days after withdrawal were determined.Results:The change rate of left ventricular ejection fraction(ΔLVEF%), the change rate of velocity time integral of the left ventricular outflow tract(ΔLVOT-VTI%), the change rate of ΔSa% and the change rate of right ventricular fractional area change(ΔRVFAC%) were improved significantly in the survival group ( P<0.05). The correlation coefficients between ΔLVEF% and ΔLVOT-VTI%, ΔLVEF% and ΔSa%, ΔLVEF % and ΔRVFAC% were 0.885, 0.861, 0.675, respectively( P<0.001); The correlation coefficient between ΔLVOT-VTI% and ΔSa was 0.918( P<0.001). ROC curve showed that the cut off values of ΔLVEF%, ΔLVOT-VTI%, ΔSa% and ΔRVFAC% to predict 30-day survival rate were 23.6%, 20.1%, 22.8% and 23.2% respectively, the sensitivity was 89.5%, 93%, 89.5% and 74.6% respectively, specificity was 66.7%, 66.7%, 66.8% and 75% respectively, the area under ROC curve (AUC) was 0.841, 0.867, 0.841 and 0.768, respectively. Conclusions:ΔLVEF%, ΔLVOT-VTI%, ΔSa% and ΔRVFAC% are predictive indicators of VA-ECMO withdrawl in patients with refractory cardiac shock. ΔLVOT-VTI% is the most valuable indicator of predicting 30-day survival rate after VA-ECMO withdrawl. Patients who meet two or more VA-ECMO echocardiographic indicators are more likely to succeed in VA-ECMO withdrawl. The improvement of right ventricular systolic function is a prerequisite for survival after 30 days of VA-ECMO withdrawal, while LVEF is an important criterion for survival after 30 days of VA-ECMO withdrawal.

Application value of simulate left atrial appendage occlusion in dynamic fluid in vitro based on left atrial appendage three-dimensional models / 中华超声影像学杂志

Objective:To evaluate the accuracy and application value of the left atrial appendage(LAA) occlusion simulation in dynamic fluid in vitro based on left atrial appendage models. Methods:The preoperative two/three-dimensional transesophageal echocardiography(2D/3D-TEE) images of 21 patients with atrial fibrillation undergoing percutaneous LAA occlusion were retrospectively analyzed. LAA models with different materials (silicone-hydrogel LAA models, silicone LAA models and Tangoplus LAA models) were obtained by 3D printing. After simulation evaluation set models in a dynamic fluid system to simulate the occlusion operation, the type of occluder was predicted, the correlation between them and the final occluder used in the operation was analyzed.According to 2D/3D-TEE monitoring in 21 patients, the compression ratio of occluders was measured and the residual leakage around occluders was observed. With the same type occluder as in surgery, the compression ratio of occluders and residual leakage around the occluders in the three LAA models were observed and compared with intraoperative measurements, the descriptive and correlation analyses were conducted.Results:The simulation score of silicone-hydrogel LAA models was higher than those of silicone LAA models and Tangoplus LAA models. The occluder size in silicone-hydrogel LAA models was more correlated to the size used in the operation( r=0.937, P<0.001) than silicone LAA models ( r=0.918, P<0.001) and Tangoplus LAA models ( r=0.895, P<0.001). With the same size of occluder, there was no significant difference between the compression ratio of the occluder in silicone-hydrogel LAA models and intraoperative ( P=0.908). In 21 patients, 7 cases of residual leakage of occluder were observed during operation, while 4 cases were observed in silicone-hydrogel LAA, 5 cases were observed in silicone LAA models and 5 cases in Tangoplus LAA models. Conclusions:Preoperative simulation system of left atrial appendage occlusion based on silica gel-hydrogel model is helpful for preoperative decision-making, simulation exercise and post-operative evaluation of percutaneous left atrial appendage occlusion.

Feasibility study of three-dimensional printing combined with mock circulatory system to make compliant mitral valve model for hemodynamic testing in vitro based on ultrasound image data / 中华超声影像学杂志

Objective:To explore the feasibility of three-dimensional(3D) printing combined with mock circulatory system of flexible mitral valve model for hemodynamic testing in vitro based on ultrasound image data, making the transformation of 3D printing valve model from static to dynamic and from anatomical to functional, as well as assisting surgical plan for mitral valve diseases. Methods:A total of 10 subjects underwent three-dimensional transesophageal echocardiography (3D-TEE) and proved to be without mitral diseases were collected as mitral normal group from February 2017 to December 2018 in Renmin Hospital of Wuhan University, 10 mitral stenosis patients were collected as mitral stenosis group, and 10 mitral regurgitation patients were collected as mitral regurgitation group. Hemodynamic parameters of velocity (peak E), pressure gradient were obtained by two-dimensional transthoracic echocardiography in three groups, and the degree of mitral valve stenosis and regurgitation were also evaluated. Then 3D-TEE was performed to obtain the 3D volume image of mitral valve. After image post-processing and 3D modeling, the valve mold was printed with soluble material polyvinyl alcohol (PVA). The mixture of human skin silicone, silicone oil, starch and curing agent were poured into the mitral valve mold in a certain proportion to make flexible silicone mitral valve model. Then, the compliant valve model was placed in mock circulatory system (MCS), regularly opening and closing as it in vivo in the heart cycle. The hemodynamic parameters of mitral valve were measured again in vitro and the degree of stenosis and regurgitation was also evaluated respectively. Paired t test was used for statistical analysis of in vivo and in vitro measurements in two groups, and the consistency test was performed. Results:The mitral valve 3D-TEE images of all patients were successfully post-processed, mitral valve molds were printed and flexible models were made. In vitro hemodynamic tests were all completed. The opening and closing state of the valve model in vitro was similar to that in vivo. Mitral valve regurgitation was detected in mitral regurgitation group in vitro, with degree to that in vivo. There were no statistically significant differences in hemodynamic parameters measured in vivo and in vitro models (all P>0.05), with a high consistency ( r=0.76). Among the 10 patients with mitral stenosis and 10 patients with mitral regurgitation, 18 patients were evaluated as same degree as in vivo. Conclusions:3D printing of compliant mitral valve model based on ultrasound image is feasible, which reproduced hemodynamic features of mitral valve in vitro, setting foundation for further surgery simulation and clinical decision-making.

Feasibility of 3D printing of mitral valve model based on echocardiographic data / 中国医学影像技术

Objective: To explore the feasibility of using 3D transesophageal echocardiography (3D-TEE) data to generate 3D patient-specific model of mitral valve (MV) using 3D printing. Methods: A retrospective study was performed in 30 patients, including 10 cases with normal MV, 10 cases with MV stenosis and 10 cases with MV prolapse. 3D-TEE volumetric data of 30 patients were acquired and postprocessed, and then soft MV models were made through injecting silicone into the molds. Measurements of MV annulus antero-posterior diameters, anterolaterior and posteromedial diameters, perimeter, area and MV opening width obtained from 3D-TEE images and from 3D models were compared, and the absolute differences of these values were calculated. Results: 3D-TEE volumetric data were successfully postprocessed, and then 3D MV models were made in all patients. The differences of MV parameters measured from 3D models were not statistically significant with those from 3D-TEE images (all P>0.05). Only less absolute differences of MV parameters were found between 3D models and 3D-TEE images. Conclusion: 3D printing of MV models based on 3D-TEE is feasible with high conserved fidelity.

Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation / 中华超声影像学杂志

Objective@#To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).@*Methods@#A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.@*Results@#Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05).@*Conclusions@#Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.

The anatomical structure of fused renal pyramid and its imaging findings in ultrasound and computed tomography / 中华泌尿外科杂志

Objective@#To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney, and discuss its appearances by CT and ultrasonic examinations.@*Methods@#From June 2018 to September 2018, 108 cadaveric kidneys were proceeded for regional anatomy. The distribution and anatomical manifestations of FRP was recorded. The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP. From October 2018 to January 2019, ultrasound imaging data of 112 patients with 224 kidneys were collected, including 60 males and 52 females, age (39.0±15.1), ranging from 16 to 73 years old. The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected, including 48 males and 41 females. Age (45.4±13.6), ranging from 23 to 69 years old. The imaging findings of FRP in ultrasound and enhanced CT was summarized.@*Results@#In cadaver kidneys, the proportion of FRP in upper and lower calyces was 68.6% (74/108) and 64.8% (70/108), respectively, higher than that in middle calyces 34.3% (37/108). In the middle group, the incidence of mild fusion was 39.0% (16/41) and severe fusion was 48.8% (20/41). The incidence of fusion of two renal pyramidal structures was 90.2% (37/41). HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear, and the protection of connective tissue was lacking. In Ultrasound, the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode. In ultrasound, the incidence of FRP was 18.8% (42/224). In enhanced CT, the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase. In enhanced CT, the incidence of FRP 27.5%(49/178).@*Conclusions@#The FRP is a common structure in human kidney. The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries. Ultrasound and enhanced CT have recognition ability for FRP.

The feasibility of 3D printing aortic root model by three dimensional transesophageal echocardiography data: a preliminary study compared with CT / 中华超声影像学杂志

Objective@#To preliminary explore the feasibility of three-dimensional transesophageal echocardiography (3D-TEE) as images data source for 3D printing model by comparing the 3D-TEE with CT of the aortic root Digital Imaging and Communications in Medicine(DICOM) data into 3D printing models respectively.@*Methods@#Fifteen patients who underwent surgical aortic valve replacement in the hospital were enrolled, and the aortic root 3D-TEE and CT DICOM data were obtained in perioperative. The images were imported into Mimics software to generate digital model standard tessellation language file, and to print the aortic root models by 3D printer. The structural morphology of both 3D-TEE and CT models were qualitatively evaluated respectively. The aortic annular area, perimeter, maximal diameter and minimal diameter of the original data, digital model, model and aortic valve replacement were quantitatively evaluated, and the consistency of each parameter value were analyzed. The mean diameter of 3D-TEE and CT model were calculated. The correlation of mean diameter with the number of replacement was analyzed.@*Results@#①Both 3D-TEE and CT images data were successfully printed into 3D models, and the positive rate of aortic valve structure were 93.3% (14/15) and 80.0% (12/15) respectively. ②The measured values of the aortic annular 3D-TEE and digital model were smaller than CT, CTdigital model and replacement (P<0.05), and the measurement consistency among groups was high. ③The parameter values of 3D-TEE model were smaller than CT model (P<0.05), and the measured values were all within the consistency range. The mean diameters were highly correlated with the replacement values (r>0.95, P<0.05).@*Conclusions@#3D printing aortic root model based on 3D-TEE image data is of high feasibility.

The feasibility of 3D printing aortic root model by three dimensional transesophageal echocardiography data :a preliminary study compared with CT / 中华超声影像学杂志

Objective To preliminary explore the feasibility of three‐dimensional transesophageal echocardiography ( 3D‐T EE) as images data source for 3D printing model by comparing the 3D‐T EE with CT of the aortic root Digital Imaging and Communications in M edicine ( DICOM ) data into 3D printing models respectively . Methods Fifteen patients w ho underwent surgical aortic valve replacement in the hospital were enrolled ,and the aortic root 3D‐T EE and CT DICOM data were obtained in perioperative . T he images were imported into M imics software to generate digital model standard tessellation language file ,and to print the aortic root models by 3D printer . T he structural morphology of both 3D‐T EE and CT models were qualitatively evaluated respectively . T he aortic annular area ,perimeter ,maximal diameter and minimal diameter of the original data , digital model , model and aortic valve replacement were quantitatively evaluated ,and the consistency of each parameter value were analyzed . T he mean diameter of 3D‐T EE and CT model were calculated . T he correlation of mean diameter with the number of replacement was analyzed . Results ①Both 3D‐TEE and CT images data were successfully printed into 3D models ,and the positive rate of aortic valve structure were 93 .3% ( 14/15) and 80 .0% ( 12/15) respectively . ②T he measured values of the aortic annular 3D‐T EE and digital model were smaller than CT ,CTdigital model and replacement ( P＜0 .05) ,and the measurement consistency among groups was high . ③ T he parameter values of 3D‐T EE model were smaller than CT model ( P ＜0 .05 ) ,and the measured values were all within the consistency range . T he mean diameters were highly correlated with the replacement values ( r ＞ 0 .95 , P ＜ 0 .05 ) . Conclusions 3D printing aortic root model based on 3D‐TEE image data is of high feasibility .

The anatomical structure of fused renal pyramid and its imaging findings in ultrasound and computed tomography / 中华泌尿外科杂志

Objective To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney,and discuss its appearances by CT and ultrasonic examinations.Methods From June 2018 to September 2018,108 cadaveric kidneys were proceeded for regional anatomy.The distribution and anatomical manifestations of FRP was recorded.The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP.From October 2018 to January 2019,ultrasound imaging data of 112 patients with 224 kidneys were collected,including 60 males and 52 females,age (39.0 ± 15.1),ranging from 16 to 73 years old.The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected,including 48 males and 41 females.Age (45.4 ± 13.6),ranging from 23 to 69 years old.The imaging findings of FRP in ultrasound and enhanced CT was summarized.Results In cadaver kidneys,the proportion of FRP in upper and lower calyces was 68.6％ (74/108) and 64.8％ (70/108),respectively,higher than that in middle calyces 34.3％ (37/108).In the middle group,the incidence of mild fusion was 39.0％ (16/41) and severe fusion was 48.8％ (20/41).The incidence of fusion of two renal pyramidal structures was 90.2％ (37/41).HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear,and the protection of connective tissue was lacking.In Ultrasound,the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode.In ultrasound,the incidence of FRP was 18.8％ (42/224).In enhanced CT,the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase.In enhanced CT,the incidence of FRP 27.5％ (49/178).Conclusions The FRP is a common structure in human kidney.The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries.Ultrasound and enhanced CT have recognition ability for FRP.

Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation / 中华超声影像学杂志

Objective To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n =20) and no weaning group (n =8).The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.Results Age,the peak of creatine kinase-MB levels(CK-MB),cardiac troponin Ⅰ levels (cTnⅠ),and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR =0.064,95％CI:0.008-0.527,P =0.011;OR =1.004,95％CI:1.002-1.108,P =0.039;OR =3.635,95％CI:1.320-9.740,P =0.020;OR =1.075,95％CI:1.045-1.286,P =0.013).In the weaning group,compared with pre-ECMO,mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2)were significantly increased at maximum flow on the first day during ECMO (all P ＜0.05),while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P ＜0.05).The values of MAP,StO2,left ventricular ejection fraction (LVEF),velocity-time integral of left ventricular outflow tract (LVOT-VTI),velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P＜0.05).Compared with the no weaning group,MAP,StO2,LVEF,LVO-TVTI and LatSa increased significantly in the weaning group (all P ＜0.05),and the left ventricular end diastolic volume (LVEDV)decreased obviously after ECMO weaning(P ＜0.05).Conclusions Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.

The analysis of survival factors and hemodynamic assessment by echocardiography in perioperative patients with ventricular septal perforation after acute myocardial infarction / 中华超声影像学杂志

To follow up and analyze patients with ventricular septal rupture( VSR) after acute myocardial infarction ( AM I) w ho underwent VSR occlusion ,screen the main risk factors of survival in perioperative patients with VSR after AM I ,and observe the postoperative cardiac function and hemodynamic changes by echocardiography . Methods Seventeen VSR patients were divided into the survival group ( 11 cases) and the death group ( 6 cases) within 30 days according to the survival time . T he changes of cardiac ultrasound parameters before and after the operation of VSR survivors were compared , and the hemodynamic recovery characteristics of VSR survivors were analyzed . Results Age ,the time to VSR occlusion ,preoperative left ventricular ejection fraction ,cardiogenic shock ,and the size of VSR were all the factors that were closely related to the 30‐day mortality of VSR with odds ratio of 0 .90 ( 95% CI 0 .73 to 1 .14 , P ＝0 .045) ,1 .89( 95% CI 1 .35 to 2 .23 , P ＝0 .003) ,0 .89( 95% CI 0 .57 to 1 .24 , P ＝0 .039) ,1 .45 ( 95% CI 1 .12 to 1 .78 , P ＝0 .027) and 11 .45( 95% CI 7 .89 to 15 .56 , P ＝0 .012) ,respectively ( all P＜0 .05 ) . Compared with the preoperative measurements , the left ventricular end‐diastolic volume and pulmonary artery systolic pressure were significantly reduced in the VSR survival group ( P ＜ 0 .05 ) . Conclusions The decrease of left ventricular end diastolic volume and pulmonary artery systolic pressure after operation indicates a better prognosis in the short period . Echocardiography is a vital tool in preoperative screening ,intraoperative monitoring and postoperative follow‐up in VSR occlusion .

Preliminary study on the application of mitral valve prolapse model made by three‐dimensional printing in mitral valvuloplasty / 中华超声影像学杂志

Objective To evaluate the feasibility and accuracy of mitral valve prolapse( M VP) model made by three‐dimensional( 3D) printing based on three‐dimensional transesophageal echocardiography ( 3D‐T EE) data and the application value for mitral valvuloplasty . Methods 3D‐T EE volumetric data of 28 patients with M VP were acquired and postprocessed ,13 patients underwent mitral valve replacement and 15 patients underwent mitral valvuloplasty . A flexible material was used to made the valve 3D model by molding . T he areas of M VP identified by models were compared with surgical findings ,the circumference and the length and thickness of anterior and posterior mitral leaflets obtained from the valve specimens and the models were compared in the mitral valve replacement group . T he diameter between anterior and posterior ,the diameter between anterolaterior and posteromedial ,annulus area ,height of prolapsed leaflet and area of prolapsed leaflet were measured from 3D models and 3D‐T EE images in mitral valvuloplasty group . Surgical simulations were performed on the 3D models of the mitral valvuloplasty group ,and the water injection test was used to evaluate the surgical results and compared with the surgical results . Results 3D‐T EE volumetric data were successfully postprocessed and made as 3D M VP models in all patients . T he consistency of M VP location based on 3D models and surgical findings was 0 .92 . T he differences between the mitral valve replacement group and mitral valvuloplasty group were not significant ( P＞ 0 .05 ) . A simulation valvuloplasty was successfully performed on the 3D model in mitral valvuloplasty group ,2 patients underwent mitral valve replacement after water injection test . T he remaining 3D models successfully simulated the operation . Conclusions The M VP model made by 3D‐T EE and 3D printing technique has high feasibility and accuracy ,w hich may be promising for the mitral valvuloplasty of M VP .

A preliminary methodology and precision study of producing 3D printing heart model by multimodel medical image fusion technology / 中华超声影像学杂志

Objective To obtain abundant anatomical information using fusion of ultrasonic valve images and CT heart images and provide new methods of image processing for 3D heart printing . Methods Cardiac examinations of three-dimensional transesophageal echocardiography ( 3D-TEE) and DICOM images of 41 patients who had atrial fibrillation without structural cardiac diseases were analyzed retrospectively and the data afterward were processed by using Mimics software . For the single-mode image group ,only the heart CT were invoked as the data sources . For the multimodel image group ,CT and ultrasound images were invoked as the data sources . Valve structures of the 3D reconstructions were graded and the circumferences ,areas and other parameters of the two groups were measured . The images of two groups were overlapped ,and the angles between the two valve planes of each heart were evaluated and analysed . Results Score of valves reconstructed by ultrasound 3D construction was higher than those by CT reconstruction . Measurements of correlated parameters between the 3D-TEE group and the CT group showed no significant statistical difference ( P ＞ 0 .05 ) , and the consistency was well . Ultrasound measurements of 3D reconstructed valves were well concordant with CT reconstructed valves by Bland-Altman analysis . Mean value and standard deviation of the angles between mitral valve annulus and aortic valve ring plane of each heart in the two group were ( 3 .15 ± 0 .88)°,( 2 .87 ± 0 .76)°,respectively . Conclusions Ultrasonic valve images can fuse precisely with CT images and it provides a better displayed morphology . This will help improving simulation quality of the 3D printed hearts .