Myocardial strain analysis by 4D-speckle tracking echocardiography for prediction of coronary artery disease severity in patients with stable angina pectoris

Objective: We sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score. Methods: The present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0e19), n ¼ 117] and critical stenosis group [Gensini score 20, n ¼ 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated. Results: Out of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (r) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (r ¼ 0.433, p < 0.001). A 4D GLS value of 17 had 84.9% sensitivity and 97.4% specificity, GAS 31 (90.9% sensitivity, 78.6% specificity), GCS 17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score 20. Conclusion: The 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.

Transcatheter Mitral Valve Implantation: Implications of Interventional Technique and 3D Echocardiography for Complex Valve?in?Valve Paravalvular Leak

Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve?in?valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve?in?valve PVL are limited. We present a case of a symptomatic patient with severe valve?in?valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve?in?valve?in?valve implantation with a 29 mm Edwards? SAPIEN 3 valve via transseptal approach using three?dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve?in?valve PVL closures.echocardiography

Factors Predicting Difficulty in Insertion of Real?Time?Three?Dimensional Transesophageal Echocardiography Probe in Adult Patients Undergoing Cardiac Surgery

Background:Transesophageal echocardiography (TEE) probe insertion may be associated with many complications. Demographic factors and airway conditions such as high Mallampati scores (MMC) and Cormack-Lehane grades (MCLG) are likely to have an impact on its ease of insertion. The primary aim of this study was to identify the predictive factors for difficult real-time-three-dimensional TEE probe insertion. Methods: A total of 153 adult patients undergoing cardiac surgery were prospectively evaluated. The upper airway manipulations required for TEE probe placement were jaw thrust, reverse Sellick抯 maneuver, and laryngoscopy. All the patients who required airway manipulations were grouped under difficult TEE probe placement group. We evaluated the patients� predictive factors such as demographic characteristics and factors related to difficult intubation. Results: Out of 153 patients, 123 were males and 30 were females. Overall, 27.5% (n = 42) patients had difficulty in probe placement. About 31.7% (n = 39) males had difficulty in TEE probe placement against 13% (n = 4) females (P?value 0.045). Difficulty in TEE probe placement was found in 72.7% (n = 16) of obese patients (body mass index [BMI] > 30), compared to 18.6% (n = 17) in the patients with BMI less than 25 (P-value < 0.001). Probe insertion was significantly more difficult in the presence of MMC III and IV (50%, n = 18) compared to class I (19.2%, n = 10) (P?value 0.001) and MCLG III (73.3%, n = 22) compared to grade I (11.1%, n = 7) (P-value 0.001). Conclusion: Male gender, obesity, higher grades of MMC and MCLG were found to be the risk factors for difficult TEE probe placement in anesthetized patients.

Evaluation of right ventricular function by fully automated three-dimensional echocardiography right ventricular quantification software in patients after heart transplantation / 中华超声影像学杂志

Objective:To explore the feasibility, accuracy and reproducibility of a novel, fully automated three-dimensional echocardiography right ventricular(RV) quantification software(3D Anto RV) to evaluate the RV volume and RV ejection fraction (RVEF) using artificial intelligence in patients after heart transplantation (HT) comparing with the gold reference-cardiac magnetic resonance (CMR).Methods:Forty-six patients after HT who were scheduled for echocardiogram at their routine follow-up examinations and also agreed to undergo CMR examination within the following 24 hours in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2018 to June 2019 were prospectively included. The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV) and RVEF of HT patients were measured by CMR 3D Auto RV and conventional semi-automated three-dimensional echocardiography RV quantification software (Tomtec 4D RV function 2.0). The results of the 3D Auto RV and conventional semi-automated Tomtec were respectively compared with CMR using paired two-tailed student′s t-tests, Pearson correlation coefficients and Bland-Altman analyses. Results:The feasibility of the 3D Auto RV was 87%.The fully automated analysis realized in 27 (59%) patients by 3D Auto RV and the analysis time required only (12±1)s. The results of the remaining 19 (41%) patients needed manual adjustment and the mean analysis time in manual adjustment was also <2 min that was shorter than the conventional semi-automated three-dimensional echocardiography RV quantification software[(108±15)s vs (160±34)s, P<0.001]. For the results of RV volumes: There were good correlations between the 3D Auto RV and CMR, conventional semi-automated Tomtec and CMR for the measurements of RVEDV, RVESV and RVSV ( r=0.77-0.84, all P<0.001). In addition, compared with CMR, although there were significantly underestimated RV volumes by the 3D Auto RV and conventional semi-automated Tomtec, the negative bias was smaller in the 3D Auto RV than the conventional semi-automated Tomtec. For the results of RVEF: the corresponding RVEF derived from 3D Auto RV and CMR showed an excellent correlation and consistency ( r=0.84, P<0.001; bias=-1.1%, Limit of agreement=-8.1%-6.0%). In addition, the correlations between the manual adjustment by 3D Auto RV and the CMR ( r=0.63-0.72, all P<0.001) was lower than the correlations between the 3D Auto RV and the CMR ( r=0.76-0.82, all P<0.001) for RV volumes and RVEF.Finally, 3D Auto RV had a good reproducibility. Conclusions:The new fully 3D Auto RV quantification software underestimate RV volumes that less than the conventional semi-automated Tomtec. And the 3D Auto RV quantification software can accurately evaluate the RVEF in patients after HT with rapid analysis and higher reproducibility, which may also support the routine adoption of this method during follow-ups of HT patients in the daily clinical workflow.

Comparison of three-dimensional echocardiography and speckle tracking echocardiography in quantification and mapping of intraventricular mechanical dyssynchrony

Objectives The aim of the study is to compare two advanced methods of evaluation of left ventricular mechanical dyssynchrony (LVMD), the speckle tracking echocardiography (STE) and the three-dimensional echocardiography (3DE). Methods One hundred thirty-six subjects, with or without LV dysfunction and with or without bundle branch block (BBB), were included in this study, designed to investigate agreement between magnitude and spatial pattern of LVMD as assessed by 3DE and STE. The frequency and severity of LVMD and localization of most asynchronous segments were compared. Results Both 3DE and STE revealed progressive rise in frequency and magnitude of LVMD with increasing disease severity. Dyssynchrony was dependent on left ventricle ejection fraction rather than the QRS duration. The frequency and magnitude of dyssynchrony were maximum in patients having LV dysfunction with left BBB. Compared with STE, 3DE diagnosed LVMD more frequently in patients having LV dysfunction with narrow QRS (17.6% vs 60.3%, respectively; P < 0.001). When the two methods were compared for localization of most asynchronous segments, the results matched only in about 50% cases. Conclusions Both 3DE and STE provided consistent results with progressive rise in magnitude of LVMD, correlating with disease severity. 3DE diagnosed more patients as having LVMD in those having LV dysfunction with narrow QRS. The most delayed segment assessed by two methods matched only in about half the cases. Correlation with clinical CRT responsiveness is needed to conclude which method is more accurate in dyssynchrony mapping for targeted lead placement.

Real-time three-dimensional echocardiographic left heart parameters in healthy indian adults

Objective Cardiac chamber dimensions are race and anthropometry dependent. We determined the age and gender specific 3-Dimensional echocardiographic (3DE) reference values for dimensions and function of left ventricle (LV) and left atrium (LA) in normal Indian adults. Methods This single center prospective study enrolled 133 adult Indians free of heart disease and/or hypertensions, subjecting them to 3DE measurements of left atrial (LA) & left ventricular (LV) volumes, function and left ventricular mass (LVM). The higher limits of normal cut-offs were determined for these parameters and their dependency on age, gender and anthropometry were analyzed. Results The body surface area (BSA) corrected higher limit cut-offs were: 59.37 ml/m2 for LV end diastolic volume (59.19 ml/m2 and 59.61 ml/m2 for men and women, respectively; P = NS); 23.48 ml/m2 for LV end systolic volume (23.27 ml/m2 and 23.11 ml/m2 for men and women, P = NS). Mean LVEF was 64.79% ± 7.26 (62.99% ± 6.51 and 67.05% ± 7.58 in men and women, P = NS). Men had higher LVM than women (119.79 g±23.95 vs. 103.26 g±23.76, P < 0.001), this difference disappeared after BSA indexing. The higher limit cut-offs for normal LA volumes were 20.49 ml for minimum volume (21.18 ml and 19.46 ml for men and women, P = NS) and 39.76 ml for maximum volume (39.60 ml and 40.03 ml in men and women, P = NS). The parameters were smaller compared to western populations but the differences attenuated after BSA indexing. Conclusions The study reports normal 3DE parameters of size and function of left heart chambers in Indians.

Echocardiographic evaluation of aorta to right atrial fistula secondary to ruptured sinus of valsalva aneurysm

We present the case of a 37 year old male who presented with new onset dyspnea, tachycardia, palpitations, and chest tightness. His initial work up demonstrated a dilated pulmonary artery with reflux of contrast dye in to the IVC. Transthoracic echocardiogram identified a “windsock” appearance indicating Sinus of Valsalva aneurysm (SVA) and severe aortic regurgitation. As a result, the patient was taken for emergent surgery where the windsock tissue was surgically repaired with bovine pericardial patch. This case illuminates the uncommon occurrence of SVA and the ability to recognize these findings on multiple imaging modalities including transthoracic, transesophageal two and three dimensional echocardiography as well as direct surgical field visualization.

Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex

Objectives To investigate the role of three-dimensional echocardiography (3DE) in evaluation of left ventricular mechanical dyssynchrony (LVMD) in heart failure (HF) patients with narrow QRS. Methods 143 subjects (70 with HF and narrow QRS, 23 with HF and LBBB and 50 controls) were subjected to 3DE, evaluating global and regional dyssynchrony using systolic dyssynchrony index, maximum segmental dyssynchrony and opposite segment dyssynchrony. Spatial distribution of LVMD was studied in each patient using 3DE derived regional time volume curves. Extent of LVMD in HF patients with narrow QRS was compared to those with left bundle branch block (LBBB). Results Frequency of LVMD was similar in HF patients with narrow QRS or LBBB (55.7% vs. 47.8%, p = NS). There was no difference in the severity of LVMD between these two groups (10.7 ± 6.7% vs. 12.1 ± 7.4%, p = NS). Both HF groups had significantly more dyssynchrony than controls. A scattered pattern of distribution of asynchronous segments was seen in narrow QRS patients; 33.96% of them had their earliest contracting segment, instead of delayed segment, located in areas conventionally targeted for LV pacing i.e. anterolateral, inferolateral or inferior segments. Conclusions 3DE confirmed significant dyssynchrony in > 50% HF patients with narrow QRS as demonstrated by other imaging methods. 3D distribution patterns of asynchronous segments indicate possibility of left ventricular mechanics related reasons responsible for lack of CRT responsiveness, an observation that generates hypothesis on possible reasons of CRT non-responsiveness.

Evaluation of real-time three-dimensional echocardiography on short term curative effect of emergency percutaneous coronary intervention in patients with left ventricular aneurysm / 重庆医学

Objective To use real-time three-dimensional echocardiography(RT-3DE) to compare the cardiac function related indicators between before operation and at postoperative 2 months in the patients with left ventricular aneurysm(LVA) undergoing emergency percutaneous coronary intervention(PCI),and to assess the PCI short term effect.Methods RT-3DE was applied to observe the left ventricular end-diastolic volume(LVEDV),end systolic volume(LVESV),cardiac output(CO),end-diastolic volume index(EDVI),end systolic volume index (ESVI),cardiac index (CI),left ventricular ejection fraction (LVEF) and left ventricular spherical index(SPI) before operation and at postoperative 2 months in 31 cases of acute anterior myocardial infarction(AAMI) complicating LVA.The patients were divided into the functional LVA group(A),anatomical LVA group (B) and complicating thrombus LVA group(C).The cardiac function parameters in various groups conducted the intra-group and inter group comparisons.Results Compared with before operation,LVEF at postoperative 2 months in the group A was increased and SPI was decreased(P＜0.05);CO,CI and LVEF before operation and at postoperative 2 months in the group B were increased and SPI was decreased(P＜0.05);SPI at postoperative 2 months in the group C was decreased(P＜0.05);EF and SPI before operation and at postoperative 2 months had no statistical difference among 3 groups(P＞0.05).SPI before operation and at postoperative 2 months was negatively correlated with LVEF and positively correlated with EDV,ESV,EDVI,ESVI,CO and CI.Conclusion The left ventricular morphology and overall systolic function at 2 months after PCI in the patients with functional and anatomical LVA are improved,but the curative effect in the patients with complicating thrombus LVA is unobvious.

Insuficiencia mitral funcional auricular. Estudio ecocardiográfico tridimensional / Atrial functional mitral regurgitation. Three-dimensional echocardiographic study

Resumen Introducción y objetivos: La fibrilación auricular puede producir remodelado de la aurícula izquierda e inducir insuficiencia mitral funcional. El objetivo de este estudio es establecer qué características del anillo mitral están relacionadas con la regurgitación mitral funcional auricular. Método: Restrospectivamente se reclutaron 29 pacientes en fibrilación auricular persistente y 36 en ritmo sinusal. Las características del anillo mitral mediante ecocardiografía transesofágica tridimensional fueron analizadas en ambos grupos. Los parámetros ecocardiográficos 2D y 3D fueron correlacionados con el orificio regurgitante efectivo. Resultados: Los pacientes con fibrilación auricular presentaron mayor volumen de aurícula izquierda, diámetro anteroposterior al final de la diástole y disminución de su porcentaje de cambio (p: 0.015, 0.019 y < 0.001 respectivamente). En el análisis de regresión multivariante el índice de elipticidad (ˇ: −0.756, p: 0.004) y el ratio altura/diámetro anterolateral posteromedial (ˇ: −0.704, p: 0.003) fueron parámetros independientes correlacionados con el orificio regurgitante efectivo (R2: 0.699, p: 0.019) en pacientes con fibrilación auricular. Conclusiones: La fibrilación auricular produce cambios en el tamaño y dinámica del diámetro anteroposterior, lo que provoca un anillo mitral circular. Los mayores determinantes de la insuficiencia mitral funcional auricular en el grupo de fibrilación auricular resultaron el índice de elipticidad y el ratio altura/diámetro anterolateral-posteromedial.

Abstract Introduction and objectives: Atrial fibrillation can lead to left atrium remodelling and induce functional mitral regurgitation. The aim of this study is to establish those features of the mitral annulus that are related to atrial functional mitral regurgitation. Methods: A total of 29 patients with persistent atrial fibrillation and 36 controls in sinus rhythm were retrospectively enrolled. The characteristics of the mitral annulus were analysed by three-dimensional transoesophageal echocardiography in both groups. The 2D and 3D echocardiographic parameters were correlated with the effective regurgitant orifice. Results: Patients with atrial fibrillation had a larger left atrium volume, anteroposterior diameter at end-diastole, and lower percentage of change in this diameter (P = .015, P = .019 and P < .001, respectively). In the multiple regression analysis, the ellipticity index (ˇ: −0.756, P = .004) and height-anterolateral-posteromedial diameter ratio (ˇ: −0704, P = .003) were independent parameters that correlated with the effective regurgitant orifice (R2: 0.699, P = .019) in patients with atrial fibrillation. Conclusions: Atrial fibrillation leads to atrial dilation and alterations in the size and dynamics of the anteroposterior diameter, producing a circular mitral annulus. The independent determining factors of atrial functional mitral regurgitation in the atrial fibrillation group were the ellipticity index and the height-anterolateral-posteromedial diameter ratio.

Morphological Features of Complex Congenital Cardiovascular Anomalies in Fetuses: as Evaluated by Cast Models / 华中科技大学学报（医学）（英德文版）

Accurate prenatal diagnosis of complex congenital cardiovascular anomalies,vascular ones in particular,is still challenging.A fetal cardiovascular cast model can provide a copy of the cardiac chambers and great vessels with normal or pathological structures.This study was aimed to demonstrate three-dimensional anatomy of complex congenital cardiovascular anomalies in fetuses by means of corrosion casting.Twenty fetuses with prenatal-ultrasound-diagnosed complex cardiovascular anomalies were enrolled in this study (19 to 35 gestational weeks).Fetal cardiovascular cast models were made by a corrosion casting technique.The specimens were injected with casting material via the umbilical vein,and then immersed in strong acid after casting fluid was solidified,to disclose the geometries of cardiovascular cavities.Nineteen cast models were successfully made from 20 specimens.The casts distinctly showed the morphological malformations and spatial relationship between cardiac chambers and great vessels.One hundred and eleven abnormalities were revealed by casting in the 19 specimens,including 34 abnormalities located in the cardiac chambers (3,4 and 27 anomalies in the atria,atrioventricular valves and ventricles,respectively),and 77 in the great vessels (28,20,24 and 5 anomalies in the aorta and its branches,the pulmonary artery,the ductus arteriosus and the major veins,respectively).Corrosion casting can display three-dimensional anatomy of fetal complex cardiovascular anomalies.This improves our understanding of related pathomorphology and prenatal diagnosis.

Current status and prospective of echocardiography in evaluating right ventricular lead Induced tricuspid regurgitation / 医学研究生学报

The Lead-Induced Tricuspid Regurgitation(LITR)is defined as new-onset or progressive tricuspid regurgitation ( TR) due to endocardial leads .As a complication of pacemaker , LITR has not been fully recognized neither clinically or echocardio-graphically for a long time .Conventional two-dimensional echocardiography has some inherent limitations in identifying tricuspid valve morphology and diagnosing the LITR .Recently, three-dimensional echocardiography has been developed for assessing anatomical rela -tionship between the lead and the tricuspid leaflets , which is a promising modality to explore the mechanism of LITR .A better under-standing of LITR could help optimize the preventative and treatment strategies .

Evaluation of Left Atrial Reservoir Function in Patients with Noncompaction Cardiomyopathy by Using Real-time Three-dimensional Echocardiography / 中国医科大学学报

Objective To assess left atrial reservoir function based on left atrial filling volume,the left atrial expansion index and left atrial ejection fraction (LAEF) were measured in patients with left ventricular non-compaction cardiomyopathy (LVNC),using real-time three-dimensional echocardiography (RT3DE),to determine the value for LVNC diagnosis.Methods The study included 20 patients diagnosed with LVNC,including 3 patients,aged 4-16 years;8 patients,aged 17-35 years;9 patients,aged 36-55 years;and 20 healthy age-matched control subjects.All patients underwent two-dimensional echocardiography and RT3DE.Results Two-dimensional echocardiography showed no differences between groups (P ＞ 0.05).RT3DE analysis showed that the average left atrial filling volume/BSA,left atrial expansion index,and LAEF were significantly higher in the LVNC group.Conclusion LVNC is associated with increased left atrial reservoir function.RT3DE shows promise for the diagnosis of LVNC.

Horseshoe-like Shaped Atrial Septal Defects Confirmed on Three-Dimensional Transesophageal Echocardiography

No abstract available.

Tricuspid annulus: A spatial and temporal analysis.

Background: Traditional two‑dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single‑frame measurements of the septolateral (S‑L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real‑time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R‑wave‑gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end‑ and mid‑systole, end‑ and mid‑diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral‑anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end‑systole (P < 0.001), mid‑diastole (P = 0.014), and mid‑systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S‑L) that is routinely measured with 2D TEE.

Dynamic changes in the ischemic mitral annulus: Implications for ring sizing.

Objectives: Contrary to the rest of the mitral annulus, inter‑trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR and specifically analyze the changes in intertrigonal distance during the cardiac cycle. Methods: Intraoperative three‑dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically analyzed using Philips Qlab® software. Results: Overall, regurgitant valves were larger in area and less dynamic than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA) during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral‑posteromedial diameters and inter‑trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs in both groups. However, inter‑trigonal distance showed the least percentage change across the cardiac cycle and its reduced dynamism was validated in both cohorts (P > 0.05). Conclusions: Annular dimensions in regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The echocardiographically identified inter‑trigonal distance does not change significantly during the cardiac cycle.

Assessment of left atrial function in patients with rheumatic mitral stenosis by real time three-dimensional echocardiography / 重庆医学

Objective To evaluate of left atrial(LA) function in patients with rheumatic mitral stenosis(MS) by real time three‐dimensional echocardiography (RT‐3DE) .Methods Thirty patients with MS and 50 healthy volunteers underwent RT‐3DE . The left atrial end‐diastolic volume (LAVmax ) ,end‐systolic volume (LAVmin ) and pre‐systolic volume (LAVpre ) were measured to calculate the total ,passive and active atrial stroke volume (TASV ,PASV ,AASV) ,left atrial expansion index (LAEI) ,left atrial to‐tal ,passive ,active ejection fraction (LAEF ,LAEFpassive ,LAEFactive ) .The volume data were corrected by body surface area (BSA) to gettheleftatrialend‐diastolicvolumeindex (LAVmaxI),end‐systolicvolumeindex(LAVminI),pre‐systolicvolumeindex(LAVpreI) and the total ,passive and active atrial stroke volume index (TASVI ,PASVI ,AASVI) .The correlations between the LA volume , stroke volume ,function indices and the mitral valve area (MVA) were analyzed .Results (1)LAVmaxI ,LAVminI and LAVpreI were significantly greater in patients with MS than the controls(all P0 .05) .(3) LAEI ,LAEF ,LAEFpassive and LAEFactive were significantly lower in patients with MS than the controls(all P0 .05) .Conclusion LA function in patients with mitral stenosis decreased .RT‐3DE can be used to evaluate LA function in patients with MS and sinus rhythm .

Double-Orifice Tricuspid Valve Visualized by Three-Dimensional Transthoracic Echocardiography

No abstract available.

Rupture of Right Sinus of Valsalva Aneurysm into Right Cardiac Chambers: The Role of Different Imaging Modalities

No abstract available.

Echocardiographic detection of free‑floating thrombus in left ventricle during coronary artery bypass grafting.

We report an incident of detection of a free‑floating thrombus in the left ventricle (LV) using intraoperative two‑dimensional (2D) and three‑dimensional (3D) transesophageal echocardiography (TEE) during proximal coronary artery bypass graft anastomosis. A 58‑year‑old man presented to us with a 6‑month history of chest pain without any history suggestive of myocardial infarction or transient ischemic attacks. His preoperative echocardiography revealed the systolic dysfunction of LV, mild hypokinesia of basal and mid‑anterior wall, and the absence of an aneurysm. He was scheduled for on‑pump coronary artery bypass surgery. On intraoperative TEE before establishing cardiopulmonary bypass (CPB), a small immobile mass was found attached to LV apical area. After completion of distal coronary artery grafting, when the aortic cross‑clamp was removed, the heart was filled partially and beating spontaneously. TEE examination using 2D mode revealed a free‑floating mass in the LV, which was suspected to be a thrombus. Additional navigation using biplane and 3D modes confirmed the presence of the thrombus and distinguished it from papillary muscles and artifact. The surgeon opened the left atrium after re‑establishing electromechanical quiescence and removed a thrombus measuring 1.5 cm × 1 cm from the LV. The LV mass in the apical region was no longer seen after discontinuation of CPB. Accurate TEE‑detection and timely removal of the thrombus averted disastrous embolic complications. Intraoperative 2D and recent biplane and 3D echocardiography modes are useful monitoring tools during the conduct of CPB.