Echocardiographic diagnosis of aortico‐left ventricular tunnel / 中华超声影像学杂志

Objective To analyze the echocardiographic features of patients with aortico‐left ventricular tunnel ( ALV T ) and explore the value of echocardiography in the diagnosis of ALV T . Methods Echocardiographic features of 23 patients with ALV T w ho were admitted to Fuwai Hospital from July 2002 to February 2019 were reviewed and analyzed . T he accuracy of echocardiographic diagnosis of ALVT was investigated by comparing the results of echocardiographic diagnosis with intraoperative and cardiac catheterization and CT . T he diagnosis methodology was summarized . T he reasons for misdiagnosis by echocardiography were analyzed . Results Among the 23 patients with ALVT , 1 case was diagnosed through CT examination prior to the operation and died from the cardiac arrest , 1 case was diagnosed through cardiac catheterization and ventriculography , the remaining 21 patients ( 91 .3% ) received the surgical operation and were diagnosed as ALV T . Eighteen patients ( 78 .2% ) were accurately diagnosed by echocardiography . One case was misdiagnosed as aortic valve insufficiency ,one case was diagnosed as aortic bicuspid valve and regurgitation ,two cases misdiagnosed as aortic valve dysplasia and insufficiency ,and one case was misdiagnosed as aortic dissection . According to Hovaguimian classification : 8 cases ( 34 .8% ) were of type Ⅰ ,12 cases ( 52 .2% ) of type Ⅱ ,1 case ( 4 .3% ) of type Ⅲ ,and 2 cases ( 8 .7% ) of type Ⅳ . Different types of patients are treated with different surgical methods . Conclusions ALV T can be accurately diagnosed with echocardiography , but it needs to be differentiated from other aorta to left ventricular shunt or reflux diseases . The establishment of the optimal diagnosis process is helpful to avoid and reduce the missed diagnosis and misdiagnosis to the greatest extent ,and provides a reliable basis for the selection of surgical methods .

Clinical features and surgical treatment effect of patients with cardiac cavernous hemangioma / 中华心血管病杂志

Objective@#To investigate the clinical features and surgical treatment effect of patients with cardiac cavernous hemangioma.@*Methods@#Clinical data of 9 patients (5 male, aged from 4 to 53 years old) with cardiac cavernous hemangioma, who underwent surgical treatment from November 2002 to March 2015 and the diagnosis of cardiac cavernous hemangioma was confirmed by postoperative histological examination, were retrospectively analyzed. Effects of surgical treatment were analyzed.@*Results@#Four patients were asymptomatic (heart murmur presented in 3 patients during physical examination). Three patients presented with palpitation, chest distress, and short of breath. One patient presented with epigastric discomfort and another patient presented with intermittent fever for more than 10 months. ST and T wave changes of electrocardiogram were found in 2 patients, cardiac mass was detected in the right heart chamber in 5 patients by echocardiography, and no cardiac mass was detected the rest 4 patients. Cardiac masses were resected en bloc, then the adjacent tissues were repaired in 7 patients, and mass was partially resected due to the involvement with adjacent heart structure. No cardiac mass was found during operation in 1 case, impaired mitral valve structure was excised and postoperative pathologically confirmed as cardiac valve cavernous angioma on the excised mitral valve structure. No signs of recurrence or enlargement of cardiac cavernous hemangioma were found during the 11(10, 11)years follow up.@*Conclusions@#There is no specific clinical feature for patients with cardiac cavernous hemangioma. It is difficult to detect the cardiac valve cavernous angioma by echocardiography before surgery. Individualized surgical treatment is associated with good clinical outcome in this patient cohort. However, the clinical features and surgical treatment effect of patients with cardiac cavernous hemangioma still need to investigate in large sample trial.

Clinical Features in Patients With Asplenia Syndrome Combining Complex Congenital Heart Disease / 中国循环杂志

To statistically study the patients with asplenia syndrome combining complex congenital heart disease (CHD) for their common cardiac malformation, frequency of occurrence and to explore the anatomical features with possible mechanism. Methods: A total of 47 patients with asplenia syndrome were analyzed including 27 male and 20 female at the age from 23 days to 32 years. The common cardiac malformation and frequency of occurrence were statistically studied. Results: ① The cardiac malformations were mainly with the following types: abnormal position of heart in 16 (34.0%) cases, a wide range of septal tissue defect in 47 (100%) cases, abnormal atrio-ventricular valve in 42 (89.4%) cases, abnormal aortic origin in 47 (100%) cases, abnormal position of 2 grate arteries in 46 (97.8%) cases, right ventricular outflow obstruction/pulmonary arterydysplasiain 45 (95.7%) cases, anomalous systemic venous drainage in 44 (91.5%) cases and anomalous pulmonary venous drainage in 28 (59.6%) cases. ② The cardiac malformations were usually involved in several positions as 1 (2.1%) patient with 4 kinds of abnormal structures, 5 (10.6%) patients with 5 kinds of abnormal structures, 13 (27.7%) patients with 6 kinds of abnormal structures, 23 (48.9%) patients with 7 kinds of abnormal structures and 7 (14.9%) patients with 8 kinds of abnormal structures. Conclusion: Asplenia syndrome combining cardiac malformation has been complex while with specificity. Laterality dysfunction might be the primarycause for series malformations.

Diagnosis of vena cava connection in patients with polysplenia syndrome by echocardiography / 中华超声影像学杂志

Objective To explore the characteristics of vena cava and pulmonary vena connection in patients with polysplenia syndrome ,and to improve the diagnosis of the polysplenia syndrome by echocardiography .Methods Forty‐five patients with polysplenia syndrome diagnosed by echocardiography were reviewed retrospectively .The characteristics and the frequency of the various types of anomalous connection of vena cava and pulmonary vena were analyzed .Results In 45 patients with polysplenia ,27 cases (60% ) had anomalous connection of superior vena cava ,anomalous inferior vena cava was found in 24 cases (53 3.% ) ,while 22 cases (48 8.% ) were diagnosed with hepatic vein anomalous drainage .Nineteen patients (42 2.% ) had anomalous pulmonary venous ,which partially anomalous venous drainage in 4 (8 9.% ) and total anomalous pulmonary venous drainage occurred in 15 patients (33 3.% ) .Conclusions Polysplenia syndrome often accompanied with anomalous vena cava and pulmonary venous drainage .Echocardiography can effectively diagnose polysplenia syndrome .

Characteristics of vena cava connection in patients with asplenia / 中华医学超声杂志（电子版）

Objective To investigate the characteristics of vena cava connection in patients with asplenia syndrome diagnosed by ultrasound. Methods From October 2009 to February 2014, 49 patients with asplenia syndrome diagnosed in Fuwai Hospital by ultrasound were included in this study. The characteristics and percentage of varied types of anomalous connection of vena cava and pulmonary vena were analyzed. Results Thirty patients (61.2%) had bilateral superior vena cavies. In these cases, right vena cava was drainage into right atrium (or the right side of the single atrium), while left superior vena cava into left atrium (or the left side of the single atrium). For hepatic vein, drainage into inferior vena cava were found in 25 patients (53.2%), into left atrium (or the left single of the single atrium) in 1 patient (2.1%), into right atrium (or the right side of the single atrium) in 3 patients (6.3%), into both right and left atrium in 5 patients (10.2%) and into the middle of the single atrium in 1 patient (2.1%). For inferior vena cava, drainage into left atrium (or left side of the single atrium) were found in18 patients (36.2%), into right atrium (or right side of the single atrium) in 24 patients (51.1%) and into the middle of the single atrium in 1patient (2%). Total anomalous pulmonary venous drainage occurred in 20 patients (40.2%) and partially anomalous pulmonary venous drainage in 8 patients (16.3%). Conclusion Asplenia syndrome is frequently accompanied with anomalous vena cava and pulmonary venous drainage.

Exploration Research of Ventricular Septal Defect Closure via Trans-jugular Approach Solely Under the Guidance of Echocardiography / 中国循环杂志

Objective: In order to avoid the radiation and contrast agent injury, and to extend the echocardiography guided percutaneous ventricular septal defects (VSD) closure, based on femoral artery approach, we assessed the efifcacy and safety of VSD closure via trans-jugular approach solely under the guidance of echocardiography. Methods: A total of 12 patients with peri-membranous VSD treated in our hospital from 2014-10 to 2015-04 were enrolled. The patients were at the age at (1.2-3.5 with the mean of 2.4 ± 0.8 ) years, the body weight at (7-15 with the mean of 11.6 ± 2.6) kg and the diameter of VSD was (3.5-6 with the mean of 4.8 ± 0.7) mm. The patients received percutaneous VSD closure via transjugular approach solely under the guidance of echocardiography. The procedural effect was evaluated by echocardiography and the follow-up study was conducted at 1, 3 and 6 month safter the procedures. Results: There were 9 patients successfully ifnished VSD closure via trans-jugular approach. 1 patient was converted to femoral artery approach because the wire could not pass through the defect of ventricular septal; 1 was converted to minimally invasive per-ventricular closure since the catheter could not pass through the defect; 1 was converted to conventional surgical repair due to the residual shunt was more than 2mm. The procedural time was (53-89 with the mean of 67.2±12.5) min, the diameter of symmetrical occluder was (6-8 with the mean of 7.0±0.9) mm. 2 patients had immediate post-operative residual shunt, all patients were recovered and discharged. No peripheral vascular injury and cardiac perforation occurred, the hospitalization time was (3-5 with the mean of 3.6 ± 0.7) days. The follow-up examination was conducted at (1-6 with the mean of 3.9 ± 2.1) months, the slight residual shunt in 2 patients disappeared at 1 month after procedure; no pericardial effusion, occluder malposition, aortic regurgitation and atria-ventricular block occurred. Conclusion: Echocardiography guided trans-jugular approach of VSD closure is safe and effective, it may particularly avoid the radiation and contrast agent injury in clinical practice.

Effect of Percutaneous Transluminal Septal Myocardial Ablation on Diastolic Dysfunction in Patients With Hypertrophic Obstructive Cardiomyopathy by Real-time Three-dimensional Echocardiography / 中国循环杂志

Objective: To assess the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on mid- to long-term left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) by real-time three-dimensional echocardiography (RT-3DE). Methods: A total of 46 HOCM patients who received 2DE and RT-3DE examination before and after (with the mean of 18.8 months) PTSMA were studied. The ratios of E/A and E/Ea were analyzed, RT-3DE was conducted to collect the images, to obtain 17-segmant volume-time curve and to calculate the parameters of rEDV, rESV, rSV and rPFR respectively. Results: The follow-up echocardiography in all 46 patients indicated that the ratio of E/Ea decreased after the operation (12.04 ± 3.29) vs (15.70 ± 5.68),P<0.001, the rSV of left ventricular anterior wall middle segment and anterior septal middle segment decreased after the operation,P<0.05, while the rPFR of anterior septal middle segment, rear septal middle segment and apical segment increased,P<0.05. Conclusion: PTSMA may improve local left ventricular diastolic function in HOCM patients, RT-3DE provides a new method and viewing angle for HOCM evaluation.

Novel use of transesophageal echocardiographic probe for intraoperative epicardial imaging in cardiac surgery / 中华医学超声杂志（电子版）

Objective To evaluate the clinical application value of epicardial transesophageal echocardiography (ETE) in cardiac surgeries. Methods Using the transesophageal multi-plane ultrasonic probe of GE company, ETE were performed for a total of 53 patients undergoing cardiac surgeries with extracorporeal circulation and heart re-beat, evaluating valvular function, left ventricular systolic function and residual shunts. Results Qualiifed ETE images were obtained in all of the 53 cases without complications of infection, bleeding and serious arrhythmia. Intraoperative regional left ventricular systolic dysfunction happened in 5 cases and was promptly handled. Residual mitral regurgitation after valvular replacement was found in one case, which was reduced by valvuloplasty. One case showed moderate tricuspid regurgitation and another two cases indicated residual shunt. All the problems in the above cases were corrected in immediate surgeries. Moreover, the pressure gradient of one hypertrophic obstructive cardiomyopathic patient fell significantly to 8 mmHg after successful myectomy (the blood flow velocity fell from 3.2 m/s to 1.4 m/s). Conclusion Epicardial transesophageal echocardiogramphic examination is easy to handle and useful in monitoring abnormalities in cardiac surgery by providing hemodynamic and anatomic information.

Role of cardiac magnetic resonance on predicting outcome in patients with hypertrophic obstructive cardiomyopathy undergoing percutaneous transluminal septal myocardial ablation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the predictive value of cardiac magnetic resonance (CMR) on outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing percutaneous transluminal septal myocardial ablation (PTSMA).</p><p><b>METHODS</b>A total of 38 consecutive HOCM patients underwent CMR imaging before PTSMA in Fuwai hospital From March 2010 to September 2012 were included in this retrospective study. The efficacy was defined as >30 mmHg (1 mmHg = 0.133 kPa) reduction of echocardiography derived left ventricular outflow tract gradient (LVOTG) at 6 months post operation. The relationship between CMR imaging derived parameters and effect of PTSMA was analyzed. Receiver operating curve (ROC) was applied to assess the predicting effectiveness of related CMR parameters.</p><p><b>RESULTS</b>The effective rate of PTSMA was 65.8% (25/38). The thickness of basal anterior wall (r = 0.505, P = 0.001), basal anteroseptal wall (0.500, P = 0.001) and the sum of the two segments (r = 0.656, P < 0.001) was positively correlated to the post-procedure reduction of LVOTG. The area under the ROC curve of the thickness of basal anterior wall, basal anteroseptal wall and the sum of the two segments was 0.806, 0.675 and 0.834, respectively. The sensitivity was 84.6% and specificity was 84.0% to predict the efficacy of PTSMA using the sum of left ventricular basal anterior wall and basal anteroseptal wall thickness 49.6 mm as cut-off value.</p><p><b>CONCLUSIONS</b>LVOTG reduction post PTSMA positively correlates to pre-procedure left ventricular basal anterior wall, basal anteroseptal wall and the total thickness of these two segments in patients with HOCM. The total thickness of these two segments is a superior parameter for predicting efficacy of PTSMA in HOCM patients.</p>

Application of Echocardiography for Occluding the Multiple Seconded Atrial Septal Defects in Relevant Patients / 中国循环杂志

Objective: To evaluate the effect of echocardiography for occluding the multiple seconded atria1 septal defects ( MASD) in relevant patients. Methods: A total of 42 MASD patients were selected by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The transcatheter closure was monitored by TTE and X-ray, the effect of treatment was evaluated by TTE, ECG and chest X-ray at 24 hours and 1, 3, 6 months after the procedure. There were 38 patients with 2 defects, 3 with many central small defects and 1 with 3 defects. The patients included 17 male and 25 female with the mean age of (32.6 ± 13.4) years. Results: The size and distance of the defects were measured with 4 cardiac chambers cross sectional study. The mean diameter of bigger defect from up to down was (9-27) mm, with the mean of (20.7 ± 6.1) mm, from front to back was (8-23) mm, with the mean of (16.9 ± 5.7) mm;the mean diameter of small defect from up to down was (3-12) mm, with the mean of (6.8 ± 3.6) mm. The length of the defect interva1 was (4-18) mm, with the mean of (7.9 ± 2.6) mm. There were 4 patients with 2 defect interval at 8.7 mm who received 2 occluders without post-operative lfow shunt. The rest 38 patients received 1 Amplatzer occluder which was (14-36) mm with the mean of (25.1 ± 6.4) mm which was (6.9 ± 1.7) mm larger than echocardiographic prediction. The success rate of implantation was 100%. There were 17 (40.5%) patients with post-operative lfow shunt. The patients were followed-up for (6-36) months, with the mean of 18.7 months, there were 11 (26.2%) patients with small amount of lfow shunt at 3 months after the operation. Conclusion: Echocardiography is important for choosing the type and size of occluder devices, in-operative monitoring and post-operative effect evaluation for treating the ASD patients.

Assessment of transcatheter closure of coronary artery fistula by transthoracic echocardiography / 中华超声影像学杂志

Objective To investigate the efficacy of transcatheter closure of coronary artery fistula (CAF) by transthoracic echocardiography(TTE) and the role of TTE in this therapy. Methods CAF were occluded with transcatheter closure techniques in 17 patients. TTE was performed before and after the treatments. The key points were retrospectively analyzed including: the sites of CAF, the position and diameter of CAF,the shape and position of the devices after the intervention,the residual shunt,and cardiac chamber size. Results Before the therapy,TTE made definite diagnosis of CAF. All patients had lesions in single coronary artery, and the diameter of CAF was 2-14 (6.4 ± 3.5)mm. All patients underwent transcatheter closure successfully. TTE revealed the shunts disappear 1-4 days after the occlusion. During a follow-up period of 1- 29 (11.7± 7.9)months,no residual shunts, no complications, and normal size of thecardiac chambers were recognized by TTE. Conclusions The transcatheter closure of CAF has emerged as a less invasive, safe and effective strategy. Echocardiography has important role in primary screening of patients and the follow-up after the treatments.

Hybrid procedure in treating infants and children with pulmonary stenosis under echocardiographic guidance / 中华超声影像学杂志

Objective To evaluate the results of hybrid procedure in treating infants and children with severe pulmonary stenosis (PS) and the clinic value of echocardiography in the whole procedure.Methods Hybrid therapy was performed in 43 patients [(7.1±6.8)months,ranging 5 days to 33 months] with severe PS.The echocardiography data in the whole procedure and follow up were reviewed.Results Aided by echocardiography,the hybrid therapy was successful in 43 cases without major complication.Immediately following valvuloplasty,the gradient across pulmonary valve decreased from (92.5±21.4)mm Hg to (23.6±13.0)mm Hg (P<0.05).The growth and development of 27 patients in follow-up study was well.No restenosis was found and tricuspid regurgitation decreased differently.Conclusions Hybrid procedure is effective and safe for the treatment of infants and children with severe PS.And echocardiography play an important role in the whole procedure.

Value of echocardiography in transcatheter closure of ruptured sinus of Valsalva aneurysm / 中华超声影像学杂志

Objective To evaluate the value of echocardiography in transcatheter closure of ruptured sinus of Valsalva aneurysm(TC-RSVA).Methods TC-RSVA was attempted in 11 patients.The location,shape,size of defects and its relationship with the neighbor structures were revealed before the procedure.Then the deployment of occluder was monitored during the procedure,and the effectiveness was observed in the follow-up.Results Eleven patients were diagnosed as the isolated RSVA by echocardiography.The size of defects was 2 - 13 mm estimated by echo.The procedures were successful in all patients.Usually the Amplatzer duct occluders were chosen to be 1 to 5 mm larger than the size of defects.Three patients had mild residual shunt during the procedure,which all dispeared in the first month of follow-up,but one of them demonstrated recurrent mild residual shunt in the 32nd month of follow-up.There was no aggravating aortic regurgitation in the follow-up.Conclusions TC-RSVA is relatively safe and effective.Observation of long-term effectiveness is still necessary.Echocardiagraphy plays an important role in TC-RSVA.

Measurement of left ventricular stroke volume by transthoracic three-dimensional color Doppler echocardiography / 中华超声影像学杂志

Objective To assess the accuracy of three-dimensional color Doppler echocardiography (3DCDE) for measuring left ventricular stroke volume (LVSV). Methods A total of 45 patients were studied to measure LVSV by 3DCDE and two-dimensional Doppler echocardiograph(2DDE). Full-volume three-dimensional echocardiography (3DE) was also performed to measure left ventricular end systolic (LVESV) ,end diastolic(LVEDV) ,and LVSV (LVEDV-LVESV), which served as a reference standard for comparison. Results Mean values of LVSV by 3DE,2DDE,3DCDE were (79. 3 ± 22. 6)ml, (74. 0 ± 20. 6) ml,(78. 7 ±22. 6)ml. respectively. Compared with LVSV by 3DE,the correlation was excellent for 3DCDE (r = 0.96), good for 2DDE ( r =0.89). Conclusions LVSV measurement by 3DCDE is reasonably accurate. This new technology may be a valuable clinical tool for assessing cardiac function.

Suppression of human glioblastoma in nude mice by siRNA Notch-1 gene therapy / 中国癌症杂志

Background and purpose:In recent studies, the Notch-1 gene has been found to play an important role in the development of human glioblastoma.Short interfering RNA(siRNA) was used to silence the Notch-1 gene and block its expression.The objective was to determine whether siRNA targeting Notch-1 would inhibit the formation and growth of tumors in nude mice that modeled human glioblastoma.Methods:The human glioblastoma cell line TJ905 were first cultured and transfected with Notch-1 siRNA or nonsense siRNA by OligofectamineTM.The TJ905 cells were divided into 3 groups:the Notch-1 siRNA transfected group, nonsense siRNA transfected group and the control group.Each group's cells were subcutaneously injected into 5 nude mice.The nude mice(males, 3-4 weeks old) were given subcutaneous injections of either 0.2 mL of transfected siRNA or with normal TJ905 cells suspended at a 1?107 cells/mL concentration in a DMEM medium without serum.One week later, when the tumors were palpable, they were directly injected with the Notch-1 siRNA complex, nonsense siRNA complex, or PBS every 4 days for 20 days.Tumor sizes were measured every 3 days and calculated by the formula:volume(mm3) =1/2 length?(width)2.After a 20-day follow-up period, the mice were exterminated.Immunohistochemistry was used to determine the expression of Notch-1 gene.Results:The final tumor volume was less in nude mice injected with Notch-1 siRNA(1 203?206) mm3 compared mice injected with the nonsense siRNA injection(2 241?401) mm3, P