Image characteristics of woven coronary artery on intravascular ultrasound and optical coherence tomography / 中华超声影像学杂志

Objective:To investigate the image characteristics of woven coronary artery (WCA)on intravascular ultrasound(IVUS) and optical coherence tomography(OCT).Methods:Thirty-seven patients suspected of WCA on coronary angiography were enrolled from Teaching Hospital of Chengdu University of Traditional Chinese Medcine, Zhengzhou Cardiovascular Disease Hospital and Zhongshan Hospital of Fudan University from January 2013 to July 2020. The intraluminal imaging features of WCA were analyzed using IVUS and OCT.Results:Of the 37 patients admitted at the cardiology service, 9 patients had WCA. All the patients underwent coronary angiography, IVUS and OCT, of which 6 lesions were located on the right coronary artery, 2 lesions were located on the left anterior descending artery and 1 patient had WCA on the circumflex artery. The mean length of WCA lesions was 2.2 cm(ranged from 1.2 cm to 4.5 cm). The angiographic appearance of WCA was numerous small tortious channels origined form the main lumen. The channels appeared to be " doughnut" like pattern and they merged to normal artery again after the anomalous segment. Flow limitation was rare unless there was coronary atherosclerosis. OCT and IVUS showed multiple spiral channels in the anomalous segment, which were independent of each other and each channels had a relatively complete three-layers vascular structure.Conclusions:With typical image characteristics, IVUS and OCT are able to screen out WCA and guide the treatment decision making.

Study of the clinical value of medical history and clinical manifestation-based protocol for the diagnosis of spontaneous coronary artery dissection using intravascular ultrasound / 中华超声影像学杂志

Objective To investigate the feasibility and clinical value of medical history and clinical manifestation-based protocol(MHCMP) for the diagnosis of spontaneous coronary artery dissection(SCAD)using intravascular ultrasound (IVUS).Methods Based on the MHCMP designed in our centre,intraoperative sequential analysis was performed in patients with acute coronary syndrom and clinical tip of SCAD,SCAD and its classification were defined according to the result of IVUS.Results Of the 37 patients admitted with ACS at the Cardiology Service,29 patients had SCAD as the cause(78.4 ％).All the patients underwent coronary angiography and IVUS,of which 9 patiens were type I (24.3 ％),15 patients were type Ⅱ (40.5％) and 5 patients were type Ⅲ (13.5％).The left anterior descending artery was the most frequently affected (16 patients),followed by the the right coronary artery (7 patients),while 5 patients had dissection of the circumflex artery and 1 patient had dissection of the left main coronary artery.Type I (evident arterial wall stain):this was the pathognomonic angiographic appearance of SCAD with contrast dye staining of the arterial wall with multiple radiolucent lumens.Type Ⅱ (diffuse stenosis of varying severity):this angiographic appearance was not well appreciated and was often missed or misdiagnosed.SCAD commonly involved the mid to distal segments of coronary arteries,and could be so extensive that it reached the distal tip.There was an appreciable (often subtle) abrupt change in arterial caliber,with demarcation from normal diameter to diffuse narrowing.This diffuse and usually smooth narrowing could vary in severity from inconspicuous mild stenosis to complete occlusion.Type Ⅲ (mimic atherosclerosis):this appearance was the most challenging to differentiate from atherosclerosis and most likely to be misdiagnosed,while IVUS was helpful for the differential diagnosis.Conclusions MHCMP is able to screen out all kinds of SCAD and guide the treatment decisions making.

Curative Effect Observation on Yixin Tongmai Decoction in Prevention and Treatment of Restenosis after Coronary Stenting of Diabetes Mellitus Complicated with Coronary Heart Disease Cases / 世界科学技术-中医药现代化

This study was aimed to evaluate the efficacy and safety of Y ixin Tongmai Decoction in prevention and treatment of diabetes mellitus complicated with coronary heart disease ( CHD ) after coronary stenting restenosis . Sixty cases were randomly divided into the conventional western medicine treatment plus Y ixin Tongmai Decoction group ( treatment group ) and conventional treatment of western medicine group ( control group ) . Observation was given on the in-stent restenosis before treatment and one-year after treatment . And the traditional Chinese medicine ( TCM ) Syndrome Scale , changes of single symptom in TCM syndrome , effect of Y ixin Tongmai Decoction on blood glucose and other adverse reactions were also observed before and one-year after treatment . The results showed that in the curative effect evaluation , the restenosis rate of treatment group was 6 . 90%, and the restenosis rate of control group was 17 . 24%. There was significant difference be-tween two groups ( P < 0 . 05 ) . According to the standard of TCM syndrome curative effect , the total effective-ness in the treatment group was 86 . 21%, and that of the control group was 31 . 03%. And there was signifi-cant difference between two groups ( P < 0 . 05 ) . In the safety evaluation , there were no obvious abnormalities during safety detection in the clinical study of two groups. There was no influence on blood sugar levels. And no drug related adverse reactions occurred . It was concluded that Y ixin Tongmai Decoction can reduce coro-nary stent restenosis rate in diabetes complicated with CHD (chest pain) with the syndrome of qi deficiency and blood stasis , phlegm-turbid stasis . It can significantly improve the TCM syndrome and single symptom of patients with good safety .

Application of the real-time three-dimensional transesophageal echocardiography in the quantification of aortic anuulus diameter in patients with aortic stenosis / 中华超声影像学杂志

Objective To investigate the application of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in quantification of the aortic anuulus diameter in patients with severe aortic stenosis.Methods RT-3D TEE image of aortic root was get perioperatively in 65 patients with sever aortic valve stenosis during the surgery procedure.The aortic annulus was reconstructed in the quantitative analysis software to generate the parameters of 3-dimensional area based aortic anuulus diameter(3D-AAAD) and 3-dimensional circumference based aortic anuulus diameter(3D-C-AAD).The parameters was compared with intraoperative aortic anuulus diameter(IO-AAD),which was get by the standard cylindrical valve sizer.Results The three dimensional form of the aortic annulus was related to the number of the valves.The value of 3D-C AAD and 3D-A-AAD were (22.4 ± 2.1) mm,(23.4 ± 1.9) mm,no significant difference could be detected between them and the IO-AAD (P ＜ 0.05).The 3D-C-AAD had a better agreements with IO-AAD than 3D-A-AAD.Conclusions RT-3D TEE can reconstruct the three dimensional sharp of aortic anuulus,and can be used as quantitative tools to calculate its diameter.

Application of real-time three-dimensional transesphaogeal echocardiography in quantitation of tricuspid valve annulus diameter / 中华超声影像学杂志

Objective To verify the feasibility and accuracy in the measurement of tricuspid valve annulus diameter(TVD) in the right ventricular outflow tract view.Methods Seventy five patients under the valve replacement surgery for the left heart valve lesions were divided into mild,moderate and severe group according to the severity of the regurgitation.The TVD was get on the apical four-chamber heart viewpreoperatively by transthoracic echocardiography(TTE),noted as TTE-TVD,meanwhile it was also get by the transesophageal echocardiography on the four-chamber view (TEE-TVD),right ventricular inflow (RVIT-TVD) and outflow tract view(RVOT-TVD).The changes of tricuspid regurgitation severtity was observed preoperatively.And the morphology of tricuspid annulus were observed using both real-time three dimensional transesophageal echocardiography (RT-3D TEE) and the quantitative software.Results Comparison in the groups:no statistically significant difference (P ＞0.05) was found between TTE-TVD,TEE-TVD and RVIT-TVD;while the RVOT-TVD was significant greater than that in the same group from other views (P ＜ 0.05).Comparison between the groups:no significant difference was found between mild and moderate regurgitation group on the same view.There was a significant difference of the TVD between the severe regurgitation group and the former two groups on each view(P ＜0.05).The severity of tricuspid regurgitation in intraoperative anesthesia was reduced.The saddle tricuspid ring evolved into the narrow planar structure on the RT-3D TEE.For the expansion of the annulus,it departure from the tricuspid septal leaflet.Conclusions TVD measured on the right ventricular outflow tract view reflect the maximum expansion of the tricuspid valve annulus diameter,and can effectively guide the decision-making choices of the surgeon.

Evaluating the left ventricular global systolic function of patients with diabetes mellitus by the real-time three-plane speckle tracking imaging / 生物医学工程学杂志

Our study was aimed to evaluate the left ventricular (LV) global longitudinal systolic function of patients with diabetes mellitus (DM) using real-time three-plane speckle tracking imaging (RT-3P STI). The case group was the patients of type 2 DM with normal LV ejection fraction (EF). Then according to glycated hemoglobin (HbAlc) control level, the case group was divided into two groups, including DM1 (HbAlc<7%, n=31) and DM2 (HbAlc >or=7%, n= 37); 63 matched volunteers were chosen as control group. Conventional measurements of the LV size and function were performed. We then applied the automatic function imaging to analyze the global longitudinal systolic peak strain (GLPS) of the three apical views online, including the GLPS of apical four chamber view (GLPS-A4C), the GLPS of apical two chamber view (GLPS-A2C), the GLPS of apical long axis view (GLPS-LAX), and then generating the average GLPS (GLPS-Avg). The experimental results showed that there was no statistical difference in clinical baseline characteristics among the three groups (P>0.05). However, there were statistical differences in the ventricular wall thickness and the LV mass index of the DM1 and DM2 groups compared with that of the control (P<0. 05). No significant differences were found in LV diameters, volumes, LVEF among the three studied groups (P>0. 05). We also found significant differences in GLPS-LAX, GLPS-A2C, GLPS-Avg when we compared DM2 group with those of the DM1 group or the control (P<0. 05). We found a statistical difference in GLPS-A4C only when we compared the DM2 group with the control(P<0. 05), and no statistical difference in the strains of the three views between DM1 group and control (P>0. 05). RT-3P STI could not only accurately be used to evaluate the LV global longitudinal systolic function, but could also reflect the reduction of sub-clilical systolic function in DM patients with poor blood glucose control in the early stage.

A study of location of coronary artery ostia in transcatheter aortic valve implantation procedure using three dimensional echocardiography / 中华超声影像学杂志

Objective To study the the feasibility of real-time 3D transesophageal echocardiography (RT-3D TEE) in measuring the distance between the coronary artery ostia and the aortic annulus.Methods RT-3D TEE image of aortic root was collected intraoperatively in 18 cases who were refered to our center for transcatheter aortic valve implantation.The aortic annulus was reconstructed and the height of the annulus (H) was generated.Meanwhile RT-3D TEE and MDCT was used to determine the left coronary artery ostia-aortic annulus distance (E-LAA,C-LAA) and the right coronary artery ostia-aortic annulus distance (E-RAA,C-RAA).Results The display rate of right coronary artery was 94.4％ (17/18),with the left coronary artery 88.9％ (16/18) on the RT-3D TEE imaging.The height of the annulus(H) was lower than the distance between the coronary artery ostia and the aortic annulus(P ＜0.05).No statistically significant differences was found in the parameters of the distance between the coronary artery ostia and the aortic annulus between RT-3D TEE and MDCT (P ＞0.05).Conclusions RT-3D TEE imaging can display and measure the distance between the coronary artery ostia and the aortic annulus.

Clinical reevaluation of the echocardiographic value in diagnosing the arrhythmogenic right ventricular cardiomyopathy / 中华超声影像学杂志

Objective To investigate the diagnostic value of echocardiography in arrhythmogenic right ventricular cardiomyopathy (ARVC) by summarizing and comparing the electrophysiological and the imaging features.Methods The echocardiography and MRI were performed in the 65 cases of ARVC to measure the right ventricle and the free wall,noted as TTE-RV,MRI-RV and TTE-RVFW.The velocity of tricuspid valve regurgitation (TRmax) and left ventricular ejection fraction (LVEF) were measured.The three-dimensional electric anatomical model of right ventricular was get by the Carto system,and the right ventricular area (Area-RV),the scar area (Area-Scar) was calculated.Results Twenty-seven cases (41.5 ％) was confirmed by the echocardiography,21 cases (32.3 ％) was suspiciously diagnosed,14 cases (32.3％) was miss diagnosed,and 3 cases (4.6％) was misdiagnosed.Statistically significant difference could be detected among the echocardiography confirmed groups and the other two groups for the parameters TTE-RV,MRI-RV,Area-RV,Area-Scar,and TTE-RVFW (P ＜ 0.05).Also there was a statistically significant difference of the parameters of Area-RV and Area-Scar between the suspiciously and miss diagnosed groups (P ＜0.05).Different echocardiographic findings was found in ARVC with different stages,but myocardial fibrosis and low voltage scar could be detected in all patients on the MRI imaging and and electrophysiological mapping.Conclusions The diagnosis of typical ARVC can be confirmed by echocardiography,but for the patients with early and middle stages,comprehensive evaluation should be refered to the clinical data.

Study of the location of coronary ostial in the artic valve stenosis by the real-time three-dimensional transesophageal echocardiography / 中华超声影像学杂志

Objective To study the the feasibility of real-time 3D transesophageal echocardiography (RT-3D TEE) to measure the distance between the coronary ostial and the junction of left ventricle and artery.Methods The RT-3D TEE image of the aortic root was collected intraoperative in 65 cases who were refered to our center for valve replacement.The reconstruction of the aortic annulus was done in the QLAB quantitative analysis software and the height parameter of the annulus could be generated.Meanwhile the coronary artery position was observed and the distance between the coronary ostial and the junction of left ventricle and artery was measured respectively.Results In the 65 cases,49 cases clearly showed bilateral coronary ostial,three cases only showed the left coronary ostial,six cases only showed the right coronary ostial,seven cases of both sides of the coronary ostial were unclear.The shows rate of right coronary ostial was 84.61％ (55/65),with the left coronary ostial 81.54％ (52/65).The measured value of the L-AA in systole and diastole were (15.5 ± 1.9)mm,(12.8 ± 1.5)mm,the R-AA systole and diastole measured values were (13.7 ± 1.8)mm,(12.4 ± 1.7)mm,respectively,there was significant difference between systole and diastole respectively.The aortic annulus height (H) got by 3D reconstruction of the aortic annulus was lower than ventricular-arterial junction to the coronary artery distance in both systole and diastole.Conclusions Not only can RT-3D TEE reconstruct the annulus,but also can show and measure the distance between the coronary ostial and the junction of left ventricle and artery respectively.