Evaluationthe right heart function has vital clinical value, especially in patients after surgical repair of tetralogy of Fallot(TOF).As an important tool used to assess the structure and function of heart, echocardiography has been used to evaluatethe right heart function of TOF after the surgery. This article reviews the current research on echocardiography techniques and right heart function in patients after surgical repair of Tetralogy of Fallot．
ObjectiveTo summarize the surgical strategy on treating mitral desease patient associated with hypertrophic obstructive cadiomyopathy (HOCM). MethodsWe retrospectively analyzed the clinical data of 17 patients with HOCM underwent surgical treatment from November 2003 to May 2015 year. There were 10 males and 7 females with a mean age of 42.2±15.5 years ranging from 7-62 years. There were 16 patients underwent modified Morrow procedure and 1 patient underwent modified Konno procedure to relieve the obstruction of left ventricular outflow tract. And different surgical treatment of mitral valve disease was implemented depending on the severity of regurgitation and under monitoring of transesophageal echocardiography. About 2 weeks after the surgery, we performed transthoracic echocardiography to evaluate the effect of operation. ResultsNo hospital death occurred and the surgery obviously improved the symptom and cardiac function in all cases. After surgery, echocardiography revealed that the mean thickness of the ventricular septum statistically decreased (P < 0.0001), the systolic anterior motion disappeared, the outflow track pressure of left ventricle statistically decreased (P < 0.0001), and the peak flow rate of left ventricle statistically decreased. However, there was no statistical difference in the change of the left ventricular ejection fraction(P=0.083). Nine patients with no mitral regurgitation (MR) or mild MR only underwent the unblock of the left ventricular outflow track, the MR decreased to mild or disappeared. Four patients with moderate or severe MR underwent mitral valve repair, and the MR decrease to mild or disappear. There were no complications occurred regarding to prosthesis implantation over the 4 patients underwent mitral valve replacement for infective endocarditis or other causes. ConclusionFor the HOCM patients with mild MR, the unblock of the left ventricular outflow track alone can effectively improve the MR. For those combined with moderate or severe MR, we should choose mitral valve repair or replacement based on individual situation of patient.
Objective To introduce the application of transcatheter closure of multi-fenestrated atrial septal defect (ASD) via femoral vein under ultrasound guidance with amplatzer cribriform occluder (ACO) and atrial septal defect occluder (ASDO), as well as to assess its feasibility, effectiveness and safety. Methods The clinical data of 48 patients with fenestrated ASD occluded via femoral vein under ultrasound guidance from December 2015 to May 2018 in our hospital were retrospectively analyzed, including 17 males and 31 females, aged 10 months to 51 years, an average of 11.50±13.86 years, and weighting 6-79 (27.00±20.14) kg. Among 48 patients with fenestrated ASD, 12 patients had double-foramen and 13 atrial septal aneurysm combined with defects and 23 multi-foramen. All patients underwent transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) to complete the closure of fenestrated ASD. Ultrasound, electrocardiogram and chest X-ray were reviewed the next day after surgery to evaluate the curative effect. Results Forty-eight patients with ASD were treated with 49 occluders, due to one patient with two occluders. There were 29 ASDO (8-26 mm) and 20 ACO (18-34 mm). During the operation, TTE/TEE examination showed that 48 patients were completely occluded, 13 patients showed fine bundle shunt in the unreleased push notification rod, and 9 patients had fine bundle shunt after the release of push notification rod. Fine bundle shunt was found in 8 patients 24 hours after operation, and microshunt was found in 3 patients 1 year after operation. All the patients were followed up. The occluder position was good. The right heart was reduced in different degrees, and the X-ray showed that the pulmonary blood was reduced in different degrees. No arrhythmia was found by electrocardiogram after operation. Conclusion It is a safe and effective method to use ACO and ASDO to occlude ASD through femoral approach under ultrasound guidance.
Before transcatheter aortic valve replacement (TAVR), echocardiography is the first choice for preoperative screening of suitable patients, which can be used to observe the morphology of aortic valve, determine the cause of aortic stenosis, and evaluate the severity of aortic stenosis and other cardiac structure and function. During TAVR procedure, echocardiography is mainly used for real-time monitoring of complications and immediate postoperative evaluation. After TAVR, echocardiography can be used to evaluate the shape and function of the prosthesis valve and monitor long-term complications. This article reviews the research progress of echocardiography in TAVR for guiding clinical practice.
ObjectiveTo explore the echocardiography characteristics of aortic valve disease (AVD) among different ethnic groups in Xinjiang.MethodsThe data of a large sample (n=130 358) of different ethnic groups in Xinjiang based on the results of echocardiography were analyzed between January 2011 and December 2016, and the echocardiography characteristics of AVD among the Han nationality and different ethnic minorities in Xinjiang were summarized.ResultsThe study recruited 130 358 patients, involving Han nationality (58.49%) and 33 ethnic minorities. The ethnic minorities included the Uygur (27.42%), Kazak (7.47%), Hui nationality (3.48%) and other minorities (3.13%). Apart from Uygur, Kazak and Hui nationality, no description was given due to the small sample sizes of other minorities (3.13%). In the total study population, the prevalence of aortic valve stenosis (AS) was 0.44%, and the prevalence of severe AS was 0.10%; the prevalence of aortic valve regurgitation (AR) was 0.37%, and the prevalence of severe AR was 0.02%; the prevalence of aortic valve calcification (AVC) was 6.51%, and the highest AVC prevalence existed in ≥75 years old age group (24.45%); the prevalence of bicuspid aortic valve (BAV) was 0.54%, and the highest BAV prevalence existed in 18-44 years old age group (0.86%). Among different ethnic groups, the Uygur had the highest prevalence in terms of AS (0.60%), AR (0.63%) and BAV (0.88%), while the Han had the lowest prevalence in terms of AS (0.37%) and AR (0.24%), but the highest AVC prevalence existed in the Han nationality (7.83%). The etiology of AVD showed that the degenerative valve changes was the main cause of AS with the largest proportion of 61.97%. While the aorta root diseases (35.97%) and BAV (22.87%) were the main etiology of AR.ConclusionsIn Xinjiang the overall prevalence of AVD is low. In the elderly population, the Uygur, Kazak and Hui nationality have the higher AS prevalence than the Han nationality does. Different ethnic groups have different AVD characteristics based on the echocardiography. In the Uygur group, AVD presents the younger age of onset; the prevalence of BAV is the highest in the Uygur population, while the lowest in the Hui nationality.
Objective To systematically review whether the prevalence of left ventricular diastolic dysfunction was higher in systemic sclerosis (SSc) patients. Methods The Cochrane Library, PubMed, EMbase, CBM, CNKI and WanFang Data databases were electronically searched to collect the studies about comparing echocardiographic parameters in SSc patients and controls from January 1990 to June 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 22 studies involving 1 146 patients were included. The results of meta-analysis showed that: compared to controls, patients with SSc had prolonged left isovolumetric relaxation time (MD=10.40, 95%CI 4.04 to 16.77, P=0.001), higher trans-mitral A-wave velocity (MD=0.11, 95%CI 0.07 to 0.15, P<0.000 01), prolonged mitral deceleration time (MD=8.04, 95%CI 2.66 to 13.42,P=0.003), larger mean left atrial dimension (MD=1.43, 95%CI 0.11 to 2.76, P=0.03), higher estimated pulmonary artery pressure (MD=11.35, 95%CI 6.08 to 16.6, P<0.001), higher E/E’ ratio (MD=2.08, 95%CI 0.19 to 3.96,P=0.03) and lower trans-mitral E-wave velocity (MD=–0.03, 95%CI –0.05 to –0.01, P=0.000 3), mitral E/A ratio (MD=–0.24, 95%CI –0.32 to –0.15, P<0.000 01) and trans-mitral E’-wave velocity (MD=–1.52, 95%CI –2.44 to –0.60,P=0.001). There were no differences in left ventricular ejection fraction, isovolumetric end-systolic dimension, septal end-diastolic thickness and posterior wall end-diastolic thickness, trans-mitral A’-wave velocity, E’/A’ ratio. Conclusion SSc patients are more likely to have echocardiographic parameters of LVDD. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo analyze the efficacy and safety of percutaneous balloon pulmonary valvuloplasty (PBPV) for pulmonary valve stenosis guided by ultrasound.MethodsFrom March 2016 to July 2019, 32 patients with pulmonary valve stenosis were treated in our hospital. There were 19 males and 13 females with an average age of 1-12 (6.2±3.1) years and weight of 7-45 (22.7±9.2) kg. The clinical efficacy of PBPV guided by transthoracic echocardiography (TTE) was evaluated.ResultsThe transvalvular pressure gradient (PG) of the patients before PBPV was 65.4±11.9 mm Hg. All patients successfully received PBPV under TTE guidance. The PG was 19.7±4.0 mm Hg immediately after operation, which was significantly decreased (P<0.001). All patients survived without any serious complications. The PG values at 3 months, 6 months and 12 months after operation were 18.4±4.0 mm Hg, 16.4±3.9 mm Hg, 15.2±3.3 mm Hg, respectively, which were significantly lower than that before the operation (P<0.001).ConclusionPBPV guided by echocardiography is safe and effective in the treatment of pulmonary valve stenosis with low complications rate.
Objective To evaluate the relationship between pattern of left ventricular dilation and functional mitral regurgitation (FMR) by echocardiography. Methods A single-center retrospective observational study was conducted on 117 patients with age of 31-77 years and left ventricular end diastolic dimension≥60 mm treated in our hospital from January 2013 through May 2016. These patients were divided into four groups by FMR degree: FMR-None/Trace (FMR-N/T group,n=33), FMR-Minor (FMR-Mi group,n=37), FMR-Moderate (FMR-Mo group,n=34) and FMR-Severe (FMR-Se group,n=13). We analyzed their basic information and echocardiographic parameters including left ventricular dimension, volume, systolic function, spherical index, regional wall motion score index, tenting height and area of mitral vavle as well as anterior/posterior angle. Results The incidences of inferior/posterior/lateral myocardial infarction and basal myocardial dyskinesia/aneurysm increased with the increase of FMR degree (FMR-N/T vs. FMR-Mi vs. FMR-Mo vs. FMR-Se: 12.1% vs. 18.9% vs. 44.1% vs. 46.2%,P=0.001 and 12.1% vs. 27.0% vs.47.1% vs. 53.8%,P=0.005, respectively). The tenting height and area of mitral valve, anterior/posterior angle, regional wall score index of the left ventricle where the papillary muscle was attached to had a positive correlation with FMR degree (P＜0.05). Conclusion There is a relationship between regional left ventricular dilation and FMR. Evaluating and improving those parameters is very important when we choose the treatment strategy of functional mitral regurgitaion.
Abstract： Right ventricular dysfunction or right heart failure is a complex clinical syndrome and often leads to a poor prognosis and high mortality. In order to detect right ventricular dysfunction at an early stage, provide a therapy guidance and evaluate treatment outcomes， right ventricular function evaluation has aroused more and more concern in clinical physicians. With the advantages of being non-invasive， accuracy and repetitiveness， echocardiography is used extensively in the assessment of heart function. In this review， we focus on how to use echocardiography to evaluate right ventricular function easily, efficiently， accurately and sensitively， and provide a good foundation for its further clinical application.
ObjectiveTo investigate the natural outcome of spontaneous closure of iatrogenic atrial septal defect (IASD) in patients with atrial fibrillation after transseptal catheterization and the influencing factors affecting its healing.MethodsA total of 122 patients who underwent percutaneous left atrial appendage occlusion in West China Hospital, Sichuan University from September 2014 to February 2018 were selected for observation and follow-up. General information of the patients was collected. Each patient underwent transthoracic echocardiography and transesophageal echocardiography before the surgery or 45 days, 3 months, 6 months and 1 year after the surgery, observing the atrioventricular size, cardiac function and atrial septal defect size. The natural outcome of IASD and influencing factors and prognosis of IASD were analyzed.ResultsThe healing rate increased gradually with the follow-up time; the median healing time was 180 days [95% confidence interval (169.5, 190.5) days]. The difference in the effect on IASD healing rate between the gender and atrial fibrillation type was not significant (P>0.05); being older than 70 years old was the influence factor for the IASD healing rate (P<0.05). There was no statistically difference in right heart size and systolic and diastolic function between the unhealed group (n=18) and the healed group (n=63) after a 1-year follow-up (P>0.05), but the left ventricular size was bigger in the unhealed group than that in the healed group (P<0.05). The follow-up time points had a significant effect on the size of the left atrium, and the left atrium in the healing group after 1 year follow-up was significantly smaller than before. There was no significant difference among the different follow-up time points and no interaction between grouping and follow-up time (P>0.05). ConclusionsWith the extension of follow-up time, the healing rate increases gradually. Larger left atrium and ventricular size and the age over 70 may be related to the healing of IASD.