Echocardiographic evaluation of supracardiac anomalous pulmonary venous connection in children: comparison with multilayer spiral CT.

Objective To explore the clinical value of transthoracic echocardiography (TTE) in the differentiation of Supracardiac Anomalous Pulmonary Venous Connection (SAPVC) in children. Materials and methods A total of 118 children with concurrent TTE and CT databases of cases diagnosed with SAPVCs were included. We analyzed the consistency between the two for the ability to diagnose the classification of SAPVC, drainage sites, ectopic pulmonary veins and the segments of superior vena cava (SVC). Results The consistency between TTE and CT in diagnosing the existence of SAPVC and the classification were 88.1% (95% CI: 80.9-93.4%) and 91.0% (95% CI: 84.1-95.6%), respectively. The error rate of partial type diagnosed by TTE was significantly higher than that of total and mixed type (20.5% vs. 2.8%, P = 0.003). The consistency between TTE and CT to determine drainage sites was 91.9% (95% CI: 85.2-96.2%). TTE had a significantly higher error rate in determining pulmonary vein drainage to the SVC than in those draining into the left innominate vein (17.5 vs. 2.5%, P = 0.007). The consistency of TTE and CT in judging the number of veins was 87.4% (95% CI: 79.7-92.9%). The error rate in determining the presence of 2 and 5 ectopic pulmonary veins was significantly higher than those of 1 and 4 veins (P < 0.05). Conclusion TTE for diagnosing partial SAPVC and identifying the drainage site of SVC has a high error rate of misdiagnosis and missed diagnosis. The extra attention should be given to these factors in clinical practice to improve the accuracy of TTE in diagnosing SAPVC.

Application research of three-dimensional transesophageal echocardiography in predicting prosthetic valve size for transcatheter aortic valve implantation.

Background: Transcatheter aortic valve implantation (TAVI) is an alternative method to treat patients with severe aortic valve disease. Accurate measurement of the aortic valve annulus and selection of the appropriate artificial valve are critical to the success of TAVI. Multilayer spiral computed tomography (MSCT) is recommended as the "gold standard" for assessing the aortic valve annulus before TAVI. However, MSCT scanning may not be possible for patients with iodine allergy, renal failure, or pregnancy. The purpose of this study is to evaluate the aortic valve annulus by three-dimensional transesophageal echocardiography (3D-TEE) and compare the results with MSCT, exploring the feasibility of 3D-TEE to guide the selection of artificial valve implantation in TAVI. Methods: We retrospectively analyzed 74 patients who successfully underwent TAVI in our hospital. Before the operation, 3D-TEE and MSCT were used to measure the maximum diameter, minimum diameter, area-derived diameter, and perimeter-derived diameter of the aortic valve annulus, and the results were analyzed for consistency. To predict the valve size based on 3D-TEE and the MSCT area-derived diameter, we compared the differences between the predicted valve size and the actual implanted valve size, and analyzed the differences between 3D-TEE and MSCT for guiding the selection of the prosthetic valve size. Results: There was no significant difference between 3D-TEE and MSCT in the measurement of the maximum diameter, minimum diameter, area, and perimeter of the aortic annulus and their derived diameter (P>0.05). The intraclass correlation coefficients for the maximum diameter, minimum diameter, area-derived diameter, and perimeter-derived diameter of the aortic annulus were 0.89, 0.83, 0.84, and 0.92, respectively. There was no statistical difference in the accuracy of both methods, 3D-TEE and MSCT, in predicting different prosthetic valve sizes for TAVI (P>0.05). Conclusions: 3D-TEE and MSCT have good agreement for measuring the values of various parameters of the aortic annulus. The accuracy of both methods was similar for predicting the aortic prosthetic valve size. 3D-TEE may provide guidance for selecting the prosthetic valve size for TAVI.

Current characteristics on small intestinal stromal tumor-a case control study.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract. Small intestine is the second most popular location of GIST, named small intestinal stromal tumor (SIST). The cumulative incidence of malignancy of SIST is twice that of gastric GIST. However, research studies on SIST are relatively rare. METHODS: The present retrospective study included 75 patients with SIST who underwent surgery resection and postoperative pathological diagnosis and analyzed the clinical manifestations, histopathological and immunohistochemical features, advantages and disadvantages of various auxiliary examinations, the treatment and prognosis of SIST. RESULTS: The number of Patients who had gastrointestinal bleeding was significantly higher than patients who had abdominal mass. Cases in the jejunum was significantly more than that in duodenum and ileum groups. With the increase of tumor diameter, the invasion risk also gradually increased. Patients with adverse outcome had bigger tumor diameter than patients with favorable outcome. For patients with adverse outcome, the nuclear division >5/50 HPF constitution is significantly higher than patients with favorable outcome. When categorized into 3 cell types according to cell morphology, the spindle-epithelioid cell type appeared only in patients with adverse outcome. Cox regression analysis indicated that tumor diameter 5.3 cm or higher and nuclear division > 5/50 can be independent risk factors for predicting SIST postoperative adverse outcome. CONCLUSIONS: The present study analyzed the clinical statistics of SIST patients and improved the understanding of this disease and provided valid statistics for clinical diagnosis and treatment.

Transthoracic echocardiography guided percutaneous laser ablation of the interventricular septum: A successful sheep model for septal thickness reduction and one year follow-up.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease, causing breathlessness, chest pain, syncope and sudden death. One-year outcome of echo-guided transthoracic percutaneous laser ablation (TPLA) of the sheep interventricular septum was studied as a novel treatment to reduce the septal thickness. It may partially address the limitations of surgical myectomy and alcohol septal ablation in terms of trauma, safety, and efficacy. METHODS: Twelve healthy adult sheep were randomly categorized into two groups: with and without the laser application of TPLA of the interventricular septum (IVS) at the energy level of 5 W for 3 min. Echocardiography, electrocardiography (ECG), cardiac magnetic resonance (CMR), serological and pathological examinations were performed over a 12-month follow-up. RESULTS: After the laser ablation all animals survived with normal cardiac function; No severe complications or bundle branch block were noted. The septal thickness (3.11 ±â€¯1.14 vs. 8.40 ±â€¯0.45 mm, p < 0.05), regional movement of ablated IVS and longitudinal strain significantly decreased when comparing the experimental and control groups. The Troponin I level was significantly elevated after the operation, which validated immediate cardiac coagulation necrosis. On cardiac magnetic resonance (CMR) imaging, the ablated myocardium showed significant fibrosis evidenced by late gadolinium enhancement. Pathological results revealed damaged ultra-structure of the ablated myocardium and development of fibrosis. CONCLUSIONS: TPLA is a safe and effective minimally invasive method to reduce IVS thickness in the long term, making it a potential alternative for HOCM treatment.

Reduction of left ventricular longitudinal global and segmental systolic functions in patients with hypertrophic cardiomyopathy: Study of two-dimensional tissue motion annular displacement.

The early detection of abnormal left ventricular systolic functions in patients with hypertrophic cardiomyopathy (HCM) remains a challenge. The aim of this study was to identify a novel method for the assessment of left ventricular systolic function in patients with HCM. A total of 65 patients with HCM were included in this study. The patients were divided into obstructive HCM (HOCM; 16 cases) and non-obstructive HCM (NOHCM; 49 cases) groups. The healthy control group comprised 48 participants. Two-dimensional (2D) speckle-tracking technology was used to measure the left ventricular global and segmental longitudinal strains and mitral annular displacement (MADs). Compared with healthy control group, the six segmental strains and the global strain of the left ventricle (LSglobal) increased while six segmental MADs and MADglobal of the mitral annulus decreased in the HOCM and NOHCM groups (P<0.05). In addition, the six segmental MADs of the mitral annulus were significantly negatively correlated with the six segmental strains of the left ventricle (r=-0.744 to -0.647, P<0.001). MADglobal was significantly negatively correlated with LSglobal (r=-0.857, P<0.001). The tissue motion annular displacement (TMAD) at the midpoint was significantly negatively correlated with LSglobal (r=-0.871, P<0.001). The 2D TMAD technique of measuring MAD was feasible and practically approachable for rapidly evaluating the left ventricular longitudinal global and segmental systolic functions of patients with HCM.