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Objective:To explore the application of microvascular flow imaging (MVFI) combined with high-frequency ultrasonography in children with haemophilic arthropathy A (HAA).Methods:Retrospective study.A total of 82 children diagnosed with HAA in the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2020 were recruited.The elbow, knee and ankle joints of each child were examined by high-frequency ultrasonography.The numbers of thickened synovial joints were recorded.Blood flow signals of the thickening of synovial joints was checked by the MVFI and power Doppler ultrasound (PDUS), respectively.Color flow signals were graded by the semi-quantitative scoring systems.The chi- square test and independent multi-group ordinal multi-category rank-sum test were used to compare the differences of MVFI and PDUS in the display of thickened synovial blood flow. Results:A total of 254 joints were involved in 82 children with HAA, including synovial hypertrophy in 188 joints, hydrops articuli in 146 joints, fibrotic septa in 66 joints, cartilage damage in 63 joints, haemosider indeposition in 45 joints, bone erosion in 25 joints, osteophytes in 15 joints and bone remodeling in 8 joints.Grade Ⅱ synovial thickened joints were the most common.The proportion of blood flow signals detected by PDUS in thickened synovial membranes was significantly higher than that detected MVFI (52.66% vs.70.21%, χ2=12.225, P<0.05). Numbers of grade 0 and Ⅰ joints with thickened synovial membranes detected by MVFI were less than those of PDUS, while the opposite result was obtained in detecting grade Ⅱ and Ⅲ joints ( H=21.158, P<0.05). Compared with PDUS, MVFI more sensitively visualized the blood flow of the thickened synovial membrane. Conclusions:MVFI can more prominently detect the thickened synovial blood flow in children with HAA.A combined application of MVFI and high-frequency ultrasonography contributes to the evaluation of children with HAA.
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Objective:To predict the risk of systolic anterior motion (SAM) after mitral valvuloplasty(MVP) by intraoperative transesophageal echocardiography (TEE) and its diagnostic value.Methods:From August 2016 to May 2020, 215 patients with mitral valve degeneration underwent MVP, including 182 patients without SAM (non-SAM group), and 33 patients with SAM (SAM group). TEE examination was performed immediately after operation to determine whether SAM phenomenon was relieved. According to the physiological basis of SAM, before cardiopulmonary bypass (CPB) and immediately after CPB, the parameters of SAM group and non-SAM group were measured and compared, including left atrial dimension(LAD), left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular ejection fraction(LVEF), basal septal diameter(basal-IVDd), left ventricular posterior wall thickness(LVPW), left ventricular outflow tract diameter(LVOTD), left ventricular outflow tract maximum velocity(LVOT-Vmax), left ventricular outflow tract pressure gradient(LVOTG), mitral valve maximum velocity(MV-Vmax), mitral valve mean pressure gradient(MVG-mean), mitral regurgitation area(MR-area), bulging subaortic septum, anterior leaflet length, posterior leaflet length, ratio between the lengths of the anterior and posterior leaflets, coaptation-septum distance(c-sept), nnular diameter of mitral valve, aorto-mitral angle (AMA) to screen the independent risk factors of SAM after MVP.Results:① Compared with the non-SAM group, LVEDd, LVESD, ratio between the length of the anterior and posterior leaflets, c-sep and AMA decreased in SAM group (all P<0.05), while basal-IVDd, LVEF, posterior leaflet length and bulging subaortic septum increased in SAM group (all P<0.05). ②Compared with that before the "edge to edge" technique, LVOT-Vmax decreased from (4.31±2.26)m/s to (2.55±1.39)m/s, LVOTG decreased from (43.58±10.89)mmHg to (23.36±12.76)mmHg, MVG-mean increased from (0.46±0.33)mmHg to (2.27±0.43)mmHg, and MR-area increased from (3.52±0.79)cm 2 to (0.96±0.57)cm 2 (all P<0.05). ③Multivariate logistic regression analysis showed that independent risk factors of SAM were LVEDd<45.430 mm ( OR=0.267, 95% CI=0.084-0.847), basal-IVDd>14.870 mm ( OR=12.049, 95% CI=1.619-89.661), length ratio of anterior and posterior leaflets of mitral valve>1.371 ( OR=0.159, 95% CI=0.045-0.562), angle of bulging angulated subaortic septum>62.330°( OR=18.246, 95% CI=2.824-117.896), c-sept<23.965 mm( OR=0.177, 95% CI=0.05-0.628), and AMA<123.730°( OR=0.197, 95% CI=0.098-0.396). Conclusions:Intraoperative TEE can evaluate the risk factors of SAM before MVP, and find the SAM phenomenon after MVP in time, which is helpful for surgeons to prevent and correct SAM after MVP and avoid secondary operation.
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Objective To study the local morphology of post-infarction ventricular septal rupture (PI-VSR) and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification (LVO) combined with real-time three-dimensional echocardiography (RT-3DE).Methods Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected.The consistency of two-dimensional ultrasound,RT-3DE and the detection of LVO on the maximum diameter,location,number and shape of ventricular septal rupture (VSR) with the surgical results were compared.Through LVO combined with RT-3DE,the changes of left ventricular function indexes before and after surgery were compared.According to the general data and clinical data of patients,independent risk factors affecting survival and prognosis were explored.Results ①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results (all P ＞0.05).The location,number and shape of VSR detected by LVO were consistent with the surgical results (all P ＜0.05).RT-3DE had good consistency in detecting VSR location,shape and surgical results (all P ＜0.05).Among them,of LVO's detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively.LVO had a sensitivity of 0.923,specificity of 1.000,accuracy of 0.947,positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape.② LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients.The parameters of left ventricular function improved significantly(all P ＜0.05).③The independent risk factors affecting the 30 d survival rate included:gender,Killips pump function classification,and whether or not surgery was performed.Conclusions LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter,location,number and shape,which provides the basis for the selection of treatment strategy.LVO combined with RT-3DE can evaluate the changes of left ventricular function before and after surgery,which can provide reference for clinical evaluation of prognosis.
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Objective@#To study the local morphology of post-infarction ventricular septal rupture (PI-VSR) and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification (LVO) combined with real-time three-dimensional echocardiography (RT-3DE).@*Methods@#Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected. The consistency of two-dimensional ultrasound, RT-3DE and the detection of LVO on the maximum diameter, location, number and shape of ventricular septal rupture (VSR) with the surgical results were compared. Through LVO combined with RT-3DE, the changes of left ventricular function indexes before and after surgery were compared. According to the general data and clinical data of patients, independent risk factors affecting survival and prognosis were explored.@*Results@#①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results (all P>0.05). The location, number and shape of VSR detected by LVO were consistent with the surgical results (all P<0.05). RT-3DE had good consistency in detecting VSR location, shape and surgical results (all P<0.05). Among them, of LVO′s detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively. LVO had a sensitivity of 0.923, specificity of 1.000, accuracy of 0.947, positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape. ②LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients. The parameters of left ventricular function improved significantly(all P<0.05). ③The independent risk factors affecting the 30 d survival rate included: gender, Killips pump function classification, and whether or not surgery was performed.@*Conclusions@#LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter, location, number and shape, which provides the basis for the selection of treatment strategy. LVO combined with RT-3DE can evaluate the changes of left ventricular function before and after surgery, which can provide reference for clinical evaluation of prognosis.
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Objective To explore the value of color Doppler ultrasonography in diagnosis of transplant renal artery stenosis( TRAS) of children . Methods The results of ultrasound examination and clinical data of 82 kidney transplant children with suspected TRAS were retrospectively analyzed . According to the results of the CTA ,the enrolled children were divided into a stenosis group with 21 cases and a non-stenosis group with 61 cases . The differences of ultrasound hemodynamic parameters between the two groups were compared . The hemodynamic parameters and cutoff values of prediction of TRAS were determined according to the ROC curve ,and the corresponding sensitivity and specificity were calculated . Logistic regression was used to screen TRAS independent predictors . Results Compared with the non-stenosis group ,the peak systolic velocity ( PSV ) of the renal aorta ,the renal aorta PSV/interlobular artery PSV ( post PSV ratio ) and acceleration time ( AT ) of interlobular artery in the stenosis group were significantly higher ,but the PSV of the interlobular artery was lower ( all P ＜ 0 .05 ) . Differences of indicators between the two groups can be used to predict TRAS . Through the ROC curve the peak systolic velocity of the renal aorta and the interlobular artery were 218 .5 cm/s and 25 .5 cm/s ,respectively ,the post PSV ratio was 7 .2 ,and the AT of intervein arterial was 67 .5 ms ,the sensitivity and specificity were the highest ,which could be used as the ultrasound screening threshold . The PSV of the interlobular artery can be used as an independent predictor of TRAS . Conclusions Analysis of hemodyamic parameters of transplanted kidney arteries by Doppler ultrasonography might be useful in predicting TRAS in children .
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Objective To evaluate the diagnostic value of ultrasound image features combined with cesarean section scores for placenta accreta . Methods A total of 151 pregnant women in the later trimester of pregnancy underwent two-dimensional and color Doppler ultrasonography . According to the results of the operation ,they were divided into the accreta group and the non-accreta group . The number of cesarean section and placental thickness in the two groups were recorded . The ultrasound image characteristics of the placenta previa ,the placenta posterior gap disappeared ,the placental lacuna in the placenta ,the muscle layer becoming thin or disappeared after the placenta ,the anatomical region of the uterus-bladder junction line and the abundant blood flow signal behind the placenta were compared between the two groups . Logistic regression analysis was performed according to the results of single factor analysis . After assigning the characteristics of the regression model ,the ROC curve was drawn to determine the best diagnostic intercept point . Results The presence of placenta previa ,placental lacuna and placental enriched blood flow signals combined with cesarean section scores were used to diagnose placenta accreta ,the area under the ROC curve was 0 .991 ,based the best cut-off point with 4 .5 ,the corresponding diagnostic sensitivity and specificity were 91 .1% and 100% ,respectively . Conclusions Ultrasound image features combined with cesarean section history scores have a high practical value in the diagnosis of placental accreta .