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Objective:To investigate the safety and efficacy of echocardiography-guided trans-right-ventricular percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in a healthy sheep model, and to observe the pathological changes of myocardium in ablation area one year later.Methods:Twelve sheep were divided into PIMSRA group ( n=6) and sham group ( n=6). In PIMSRA group, a radiofrequency (RF) electrode was inserted to the interventricular septum (IVS) with maximum power of 80 Watts for 5 minutes. In the sham group, RF electrode tip was positioned in IVS segment but without the RF power delivery. Electrocardiogram (ECG), echocardiography, myocardial contrast echocardiography(MCE) were performed to assess the efficacy of PIMSRA at postoperative immediately, 2-week, 1-month, 2-month, 3-month, 6-month and 12-month during the follow-up. The following parameters were recorded, including the thickness of ablation area, the systolic wall thickening rate and amplitude of movement of the ablated region, left ventricular outflow tract pressure gradient (LVOT PG), and left ventricular ejection fraction (LVEF), mitral valve early diastolic peak velocity(E), late diastolic peak velocity(A) and the E/A ratio, peak velocity of early diastolic mitral annular motion(E′), peak velocity of late diastolic mitral annular motion(A′), and the E′/A′ ratio.For both groups, the myocardial biomarkers of troponin I, myoglobin and isoenzymes of creatine kinase were tested before the ablation and 3 h after the ablation, and again after 2 weeks. Tissue pathology examinations were performed at the end of study. Results:None of the animals in both groups was observed to have pericardial tamponade during perioperative period.Immediately after the procedure, septal hypokinesis was seen in all PIMSRA group animals, the systolic wall thickening rate and amplitude of movement of the ablated region were significantly decreased ( P<0.001), which was sustained until 12 months.In Sham group, there were no significant differences in the wall thickening rate and amplitude of movement of the operated region(all P>0.05).The thickness of the ablation area in the PIMSRA group was significantly increased immediately after the procedure( P<0.001), decreased to baseline level at 1-week ( P=0.931), and significantly increased at 3-month ( P<0.001).In the Sham group, the IVS thickness was significantly increased immediately after the procedure( P=0.005), decreased to baseline level at 1-week ( P=0.027), then has no further significant changes.There were no significant differences in LVEF, E/A, E′/A′ between PIMSRA and Sham group(all P>0.05).MCE showed the thickness of the ablation area was significantly decreased in the PIMSRA group 12 months after the operation.In both groups, troponin I increased significantly 3 h after the operation(all P<0.005), which decreased to baseline level 2 weeks later(all P>0.05). ECG showed that all the sheep had normal sinus rhythm. Pathological examinations revealed the tissue in the ablation area was fibrotic, having clear boundary with the surrounding normal tissue and no carbonization was observed 1 year later. Conclusions:Echocardiography-guided trans-right-ventricular PIMSRA produced precisely ablated myocardial tissues, reduced the IVS thickness significantly, preserved the global left ventricular function. All the sheep had normal sinus rhythm and without pericardial tamponade in 1 year follow-ups. Echocardiography-guided trans-right-ventricular PIMSRA is a safe and effective minimally invasive treatment for septal reduction therapy.
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Objective To investigate the safety and long-term efficacy of a new treatment,echocardiography-guided transthoracic laser ablation of the animal interventricular septum (IVS),for obstructive hypertrophic cardiomyopathy (HOCM).Methods Ten healthy sheep were randomly divided into two groups:experimental group:sheath puncture with laser ablation (energy:3 W,1000 J),sham control group:sheath puncture only without laser ablation.Echocardiography and electrocardiogram (ECG) were recorded before operation,immediately after operation,and 1,3 and 6-month after the operation.Left ventricular systolic and diastolic function,longitudinal strain,difference of time to peak between the ablation segment and the surrounding segments were analyzed.Blood samples were collected before and one hour after the operation to examine the serological results.Results Immediately and 6 months after the operation,all animals survived with normal cardiac function.No severe complications such as cardiac tamponade or bundle branch block occurred.The Troponin I level was significantly elevated immediately after the operation(P ＜0.05).The thickness of the ablated IVS was significantly reduced 6 months after the operation compared with before the operation[(3.23 ± 1.21)mm vs (8.53 ± 0.44)mm,P ＜0.05].Mmode echocardiography showed that the amplitude of movement of the ablated region of the experimental group 6 months after the operation was significantly decreased compared with the control group (P ＜0.05).Three dimensional strain analysis showed that for the experimental group,the longitudinal strain of the ablation segment was significantly reduced and the difference of time to peak was significantly delayed,compared with the control group(P ＜0.05).Conclusions Echocardiography-guided transthoracic laser ablation of IVS is a safe,effective,and minimally invasive method.It is capable to reduce the volume of IVS without influencing the cardiac function,which makes it a potential alternative for HOCM treatment.
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Objective@#To investigate the safety and long-term efficacy of a new treatment, echocardiography-guided transthoracic laser ablation of the animal interventricular septum (IVS), for obstructive hypertrophic cardiomyopathy (HOCM).@*Methods@#Ten healthy sheep were randomly divided into two groups: experimental group: sheath puncture with laser ablation (energy: 3 W, 1000 J), sham control group: sheath puncture only without laser ablation. Echocardiography and electrocardiogram (ECG) were recorded before operation, immediately after operation, and 1, 3 and 6-month after the operation. Left ventricular systolic and diastolic function, longitudinal strain, difference of time to peak between the ablation segment and the surrounding segments were analyzed. Blood samples were collected before and one hour after the operation to examine the serological results.@*Results@#Immediately and 6 months after the operation, all animals survived with normal cardiac function. No severe complications such as cardiac tamponade or bundle branch block occurred. The Troponin I level was significantly elevated immediately after the operation(P<0.05). The thickness of the ablated IVS was significantly reduced 6 months after the operation compared with before the operation[(3.23±1.21)mm vs (8.53±0.44)mm, P<0.05]. M-mode echocardiography showed that the amplitude of movement of the ablated region of the experimental group 6 months after the operation was significantly decreased compared with the control group(P<0.05). Three dimensional strain analysis showed that for the experimental group, the longitudinal strain of the ablation segment was significantly reduced and the difference of time to peak was significantly delayed, compared with the control group(P<0.05).@*Conclusions@#Echocardiography-guided transthoracic laser ablation of IVS is a safe, effective, and minimally invasive method. It is capable to reduce the volume of IVS without influencing the cardiac function, which makes it a potential alternative for HOCM treatment.
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Objective@#To investigate the safety and efficacy of transthoracic echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).@*Methods@#Nine HOCM patients with interventricular septal thickness ≥15 mm and ≤25 mm who were treated with PIMSRA between October 2016 to March 2017 in the Hypertrophic Cardiomyopathy Center of Xijing Hospital of Air Force Military Medical University were enrolled,and the clinical data were retrospectively analyzed.Interventricular septum thickness, left ventricular outflow tract diameter and maximum gradient were measured by transthoracic echocardiography immediately after procedure, at 1 month, 3 months and 6 months after operation.Symptoms and New York Heart Association (NYHA) functional class were assessed, and provoked left ventricular outflow tract gradient and exercise time were measured after 6 months.@*Results@#The anterior interventricular septum ((21.5±2.6) mm vs. (24.7±2.7) mm, P<0.05) and posterior interventricular septum (21.1±2.5) mm vs. (22.6±3.3) mm, P<0.05) were significantly increased,left ventricular outflow tract diameter was widened ((8.2±3.4) mm vs. (4.8±2.2) mm, P<0.05), left ventricular outflow tract gradient ((26.8±19.6) mmHg (1 mmHg=0.133 kPa) vs. (83.3±32.4) mmHg, P<0.05) and mitral regurgitation (2.0±1.9) ml vs. (3.2±3.0) ml, P<0.05) were significantly decreased immediately after ablation compared with pre-operation values. Anterior interventricular septum, posterior interventricular septum and left ventricular outflow tract gradient further decreased after 1 month ((17.5±2.0) mm vs. (24.7±2.7) mm, P<0.05; (16.9±2.1) mm vs. (22.6±3.3) mm, P<0.05; (11.6±4.0) mmHg vs. (26.8±19.6) mmHg, P<0.05, respectively) compared with values immediately after ablation. Anterior interventricular septum and posterior interventricular septum decreased after 3 and 6 months ((14.8±1.7) mm and (13.4±2.0) mm vs. (17.5±2.0) mm, all P<0.05; (12.9±1.9) mm and (12.3±2.4) mm vs. (16.9±2.1) mm, all P<0.05, respectively) compared with values at 1 month after ablation.There were no significantly difference in left ventricular outflow tract gradient at 3 and 6 months post procedure compared with 1 month after ablation (all P>0.05). Compared with pre-operation, provoked left ventricular outflow tract gradient decreased ((25.5±11.4) mmHg vs. (147.8±58.0) mmHg, P<0.01), and total exercise time increased ((9.3±1.6) minutes vs. (6.7±1.6) minutes, P=0.03) at 6 months after operation.The symptoms were disappeared in 5 patients. There were 2 cases with NYHA class Ⅱ and 7 cases with NYHA class Ⅲ before operation,while there were 6 patients with NYHA classⅠ and 3 patients with NYHA class Ⅱ at 6 months after operation (P<0.01).@*Conclusion@#Transthoracic echocardiography-guided PIMSRA is a safe and effective new treatment approach for patients with obstructive hypertrophic cardiomyopathy.
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Objective@#To explore the application value of protective device in microwave ablation at canine liver risk area, and the role of the device in reducing complications during ablation.@*Methods@#Six healthy mongrel dogs were randomly divided into two groups: group A, used protective devices; group B, unprotected. Conventional gray-scale ultrasound and contrast-enhanced ultrasound (CEUS) were performed before treatment to identify the ablation area (the right lobe of the liver near diaphragm, 1 cm from the surface of the liver). The two groups were treated percutaneous puncture liver microwave ablation under real time ultrasound-guided with the same ablation power (50 W) and equivalent ablation time (600 s). Liver specimens were evaluated histological examination to evaluate the necrotic area of ablation and the degree of diaphragm′s injury.@*Results@#①There was no significance difference in the ablation range between two groups[ (3.3±0.1)cm vs (3.5±0.1)cm, P=0.184]; ②The tolerance of group A was better than group B during ablation treatment; ③The mean maximum ablation diameter in group A was significantly lower than that in group B [(2.1±0.1)cm vs (5.3±0.2)cm, P=0.001]. Meanwhile the pathological results showed that the damage degree in group A was significantly lower than that in group B.@*Conclusions@#This protective device has an obvious protective effect for microwave ablation of the risk area in liver (adjacent diaphragm, hepatic envelope). Our experiment suggests that this protective can reduce the damage of adjacent organ and the complications during the ablation surgery.
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Objective To investigate the basis of ultrasound microbubble technology enhanced thermal ablation effect.Methods All 48 rabbits bearing hepatic tumors were averagely randomly divided into four groups:only laser group,sham,destruction + laser group,and blank group.The filling defect area changes of before and after treatment were observed and the differences between groups were compared.Results Pathology confirmed ablation of tumor tissue could produce coagulation necrosis for experiment group.The conventional ultrasound showed there was no significant variation in the maximum diameter and area in the pre and post treatment of experiment group and control group(P ＞0.05).There was no change for the control group.Ultrasound imaging showed an area of filling defect were:laser treatment alone group (0.83 ± 0.06) cm2,microbubbles false break combined with laser therapy group (0.65 ± 0.05) cm2,microbubbles break combined with laser therapy group (2.40 ± 0.16)cm2,blank control group (0.01 ± 0.01) cm2.The filling defect area of the treatment group,which was combined with ultrasound microbubble break technology and laser ablation was increased,there was significant variation in the each group (P ＜0.05).Conclusions Microbubble burst combined laser ablation could expand the single needle laser ablation area of rabbit VX2 liver tumor and increase the therapeutic effect.
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Objective To explore the ultrasound performance and related factors on the role of normal living rabbit's liver by laser ablation. Methods The rabbit's liver tissue were ablated by Echolaser integrated laser interventional ultrasound system, and the necrosis of the lesion and performance of pathology and anatomy were observed. Results The outline of the lesion was ellipse like. The two-dimensional US showed regular hyperecho area in the center, mild strong echo in the peripheral and mild attenuation backward. Contrast enhanced ultrasound (CEUS) showed a filling defect of contrast media in the ablated area. After dissection, the center of the lesion was slag-like carbon, the peripheral was necrosis area; HE staining showed: the center of the lesion was cavity like and dye-free,peripheral area was irregular red staining, the surrounding area was infiltrative inflammatory cells. Different power and time leaded to differences of the ablative effect and lesion size:the more power and time,the bigger of the ablative size. The ablative effect and lesion size was stable in 3 W 10 min and 5 W 6 min groups and caused the complete necrosis of the zone, there existed statistical differences among the two groups. Conclusions Laser ablation can cause fast, precise, effective and safe necrosis of the liver tissue, and the more power and time, the bigger of the ablative size.
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Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.
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Objective To study the effect of high intensity focused ultrasound(HIFU)ablation on microvessel density(MVD)and vascular endothelial growth factor(VEGF)in rabbit hepatcocellular carcinoma (HCC)models.Methods The VX2 t umor cells were planted in the hepatic left-central lobe on 30 rabbits.All animals were divided into two groups randomly:HIFU group(n=25)and control group(n=5).The MVD and the expression of VEGF in the HCC was detected by immunohistochemical SABC methods in control group and 0,1,3.7,16 d after the operation in HIFU group.Results The MVD and the expression of VEGF in the HCC tissue after HIFU treatment in the HIFU group were decreased significantly as compared with those in the control group (P＜0.01).However,there was no significant difference in MVD and the expression of VEGF in the HCC tissue after HIFU treatment in the HIFU group among the different time points(P＞0.05).Conclusions HIFU treatment can effectively destroy the micovessel,repress the neovascularization and reduce the blood supply of the HCC.
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Objective To assess the value of contrast-enhanced ultrasonography(CEUS)in evaluating the therapeutic efficacy of uterine leiomyoma treated by radiofrequency ablation(RFA)and to discuss the value of its application.Methods Forty-four patients which were diagnosed as uterine leiomyomas by ultrasonic guidance needle puncture biopsy preoperation were examined by CEUS before and one week after RFA treatment respectively,and the patho-results were got again after the surgery.Routine ultrasonography was performed in 1,3,6,12 months after the treatment to compare the volume change of uterine leiomyomas with the change of the clinical symptoms.Results After the treatment,CEUS showed that the contrast agent didn't appear in thirty-five patients'uterine leiomyomas and the nonperfusion regions matched the size of the uterine leiomyomas completely.The contrast agent enhanced on the edge of the uterine leiomyomas in nine,the patho-results confirmed that the nonperfusion regions of the contrast agent were necrosis tissues and the marginal local enhancement regions were incomplete necrosis.Three month after RFA treatment,the uterine leiomyomas began to shrink,which showed obviously in 6 months after the treatment.There were significant differences in the parameters before and after the treatment(P＜0.05).Clinical symptoms improved obviously in thirty-five patients(90%)after the treatment.Conclusions RFA is an effective minimally invasive surgery of the uterine leiomyoma.CEUS can identify the treatment range and the remaining tissues.It has significant value in guiding the supplementary treatment.
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Objective To explore the cerebrovascular reactivity of the patients with cerebral infarction by transcranial color Doppler ultrasound (TCCD) and breath holding test.Methods TCCD was used to record the color Doppler imaging and Doppler spectrum and to measure peak velocity,mean velocity of double side middle cerebral artery(MCA) in thirty two normal persons and thirty seven patients with cerebral infarction confirmed by CT or MRI.Breath holding test was performed to record the Doppler spectrum and breath holding time and to calculate breath holding index(BHI).Results ①The peak velocity of MCA of the damaged side was abnormally increased by 35.1% and decreased by 40.5% .②The BHI of the damaged side was significantly lower than that of undamaged side and that of control group (P