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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.
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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.
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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.
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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.
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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.
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Objective@#To compare aortic annular diameter measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) in patients with severe aortic stenosis, and to evaluate the impact on selection of prosthetic valve type in transcatheter aortic valve implantation (TAVI).@*Methods@#Clinical data of 138 patients with severe aortic stenosis referred for TAVI between January 2014 and June 2016 in our hospital were retrospectively analyzed.The difference of aortic annular diameter measured by TTE, TEE, and MSCT were compared.TTE was performed after TAVI to evaluate the accuracy of measurement before TAVI.@*Results@#(1) Aortic annular diameter was (23.37±2.22) mm by TTE and (23.52±1.70) mm by TEE (P=0.12). Pearson correlation analysis showed that aortic annular diameter measured by TTE was correlated to that measured by TEE (r=0.87, P<0.05). (2)The long-axis diameter and the short-axis diameter measured by MSCT multiplanar reconstruction were significantly different ((27.86±2.87) mm vs. (21.91±2.53) mm, P<0.05). There was no significant difference between the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT ((24.92±2.38) mm vs. (24.84±2.25) mm, P=0.08). However, the diameter derived from the circumference ((25.35±2.34) mm) was significantly larger than the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT, and the difference were (0.43±0.62) mm and (0.51±0.62) mm respectively(both P<0.05). (3) Measurements of the aortic annulus diameter by MSCT including the mean of the long- and short-axis diameters, diameter derived from cross-sectional area, and diameter derived from the circumference were larger than the measurement by TTE and TTE (all P<0.05). (4) Implantation was successful in all patients.Moderate to severe paravalvular leakage was detected in 3 patients at 7 days post TAVI, and 1 patient developed severe prosthetic valve restenosis at 6 months post TAVI and received valve-in-valve implantation.@*Conclusions@#In severe aortic stenosis patients referred for TAVI, the aortic annular diameter derived from TTE and TEE measurements are smaller than that from MSCT.In the absence of a gold standard, selection of prosthetic valve type in TAVI procedure should rely on comprehensive considerations, which is of importance to get good clinical results for severe aortic stenosis patients underwent TAVI.
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<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>
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Humanos , Ecocardiografía Transesofágica , Válvula Mitral , Insuficiencia de la Válvula Mitral , Cirugía General , Estenosis de la Válvula Mitral , Cirugía General , Prótesis e Implantes , Implantación de Prótesis , Métodos , Estudios RetrospectivosRESUMEN
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.
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<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>
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Humanos , Angiografía , Aorta Torácica , Válvula Aórtica , Estenosis de la Válvula Aórtica , Cateterismo Cardíaco , Vasos Coronarios , Arteria Femoral , Implantación de Prótesis de Válvulas Cardíacas , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Seno Aórtico , Tomografía , Reemplazo de la Válvula Aórtica TranscatéterRESUMEN
Objective To evaluate peak left ventricular(LV) apical rotation velocity during early diastole by speckle tracking echocardiography in normal peopleand patients with myocardial hypertrophy because of hypertension. Methods Two dimensional images of left basal and apical ventricular short axis view were recorded in 20 healthy people and 20 patients with hypertension and left ventricular hypertrophy(LVH). Rotation velocity-time curves of six segments in LV apex and base were obtained using Qlab software. The peak rotation velocity in early diastole of LV apex(A-Vel) and base (B-Vel) were acquired through Excel software. Results In LVH group,A-Vel was significantly decreased(P<0. 05) while B-Vel appeared no difference (P = 0.58) compared with healthy individuals. Conclusions Peak LV apical rotation velocity in early diastole can evaluate the change of LV diastolic function in patients with hypertension and LVH.
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To evaluate the morphology of atrial septum by the live three-dimensional echocardi- ography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial sep- tum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneu- rysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%,ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with in-traoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphologi- cal features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.
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Objective To observe the expression of growth-associated protein-43(GAP-43) in the hippocampus of neonatal rats with hypoxic-ischemic brain damage (HIBD). Methods HIBD was established by the method of Rice in 48 SD rats aged 7 days and another 48 matched normal rats served as control. Immunohistochemistry and RT-PCR were respectively used to detect the expression of GAP-43 protein and mRNA in all rat hippocampus on day 8, 10, 14, 21, 28, 35 after HIBD (n=8 at each time point for each group). Results The expression of GAP-43 protein and mRNA in hippocampus was obviously increased in HIBD rats as compared with normal rats, the peak of GAP-43 protein appeared at 3rd week, and the peak of mRNA at 2nd week. Conclusion The expression of GAP-43 protein and mRNA increased in the hippocampus of rats following HIBD, which was possibly related to the recovery of injured hippocampus.
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Objective To observe the effects of environmental stimulation at different stages of development on postnatal rats with hypoxia-ischemic brain injury (HIBI). Methods HIBI postnatal SD rats models were established by dissecting and ligating the left common carotid artery, and after 2 h of recovery, exposing to 8% oxygen-92% nitrogen gas mixture for 2 h. The HIBI rats were randomly divided into early intervention groups, late intervention group, non-intervention group. Intervention group were kept in enriched environment before or after weaning for 20 d. Non-intervention group and control group were kept in a standard environment. Space learning and memory were tested with Morris water maze. Results The ability of space learning and memory in early intervention group was better than that in late intervention group (P
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Objective To observe the effects of early enriched environment intervention on the expression of growth-associated protein-43(GAP-43) in the hippocampus of rats with hypoxic-ischemic brain injury (HIBI). Methods After the establishment of HIBI model in SD rats by the method of Rice, the animals were divided randomly into 2 groups: the intervention group and non-intervention group. The sham-operation rats were used as control group. Enriched environment intervention had been administrated to the rats of intervention group since the 2nd day after HIBI. On the 3rd, 7th, 14th, 21st and 28th day, immunohistochemistry and RT-PCR were used to measure the expressions of GAP-43 protein and mRNA in the hippocampus of rats. Results The expression of GAP-43 protein and mRNA in the rat hippocampus were increased in the non-intervention group than in the control group(P
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Objective To observe the effects of different environment stimulation on the nestin expression in hippocampus and the ability of learning and memory of rats after hypoxic-ischemic brain damage (HIBD). Methods Rat HIBD models were established by the method of Rice in 45 SD rats, then randomly divided into three groups: standard environment stimulation group (SE), enriched environment stimulation group (EE), and impoverished environment stimulation group (IE). Another 15 rats only underwent sham-operation. Different environment intervention that was designed according to Puurunen and Bourgeon’s literatures was applied to the rats on day 2 after HIBD operation. On day 28, Morris water maze was used to evaluate the ability of learning and memory. Then the nestin expression in the hippocampus was measured by immunohistochemistry. Results The ability of learning and memory of IE group reduced and was much lower than that of sham-operation group, SE group and EE group, that of SE group was lower than that of sham-operation group and EE group, but no significant difference between sham-operation group and EE group. Immunohistochemical analysis showed that nestin expression in the hippocampus of EE group significantly increased as compared with that of other groups and that of SE group was stronger than that of sham-operation group and IE group. Conclusion The EE stimulation could increase the nestin expression in the hippocampus of neonatal rats with HIBD, enhance neuranagenesis, and improve the ability of learning and memory, while the IE stimulation could decrease the nestin expression, inhibit neuranagenesis, and impair the ability of learning and memory.
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Objective To observe the effect of early enriched environmental intervention on synaptic ultrastructure and the synaptophysin expression (p38) in hippocampal CA1 area after hypoxia-ischemic brain damage(HIBD) in neonatal rats. Methods The rat model of HIBD was made by the method of Rice in 20 Sprague-Dawley rats, and divided randomly into 2 groups: the intervention group, non-intervention group. Another 10 rats underwent sham-operation as control. From the second day after HIBD, the rats of the intervention group were kept in an enriched environment for 20 d, the rats of non-intervention group and sham-operation group were raised in standard enviroment instead. The hippocampal ultrastructure was observed with electron microscope and the p38 expression was detected immunohistochemically in all rats. Results The ultrastructure of hippocampus CA1 pyramidal neuron in the non-intervention group were distorted as compared with that in the intervention group and control group. The corrected optical densities (COD) of immunoreactive products of the hippocampal p38 were significantly decreased in non-intervention group as compared with intervention group and control group (P0.05). Conclusion Early enriched environment intervention could improve the synaptic reconstruction and reduce the ultrastructural damage induced by hypoxic-ischemia.