Objective To evaluate the cardiovascular risk for non-cardiac thoracic surgery （NCTS） in elderly patients with dobutamine stress echocardiography and to decrease surgical risk for NCTS in the geriatrics. Methods Dobutamine stress echocardiography was used for cardiovascular evaluation in 32 NCTS candidates aged over 65 years. Patients with positive echocardiography underwent coronary angiography. Postoperative course and all complications were carefully recorded for the study. Results No serious cardiovascular events occurred during the test except for atrial or ventricular premature contracts in 5 cases. In 2 patients （6.7%,2/30） dobutamine test was positive and coronary artery occlusion was proved by further angiography. Thoracotomy was performed in 28 cases, including 2 cases with dubious result at dobutamine test. Cardiopulmonary complications occurred in 13 patients （46.4%,13/28） after surgery. Supraventricular tachyarrhythmia was the most common complication, occurred in 8 patients （28.6%,8/28）. One of the 2 patients with dubious result at dobutamine test developed definitive angina in the 5th postoperative day. The negative predictive value of dobutamine test was 100%. Conclusion Dobutamine stress echocardiography is a safe and effective method to evaluate major cardiovascular risk of NCTS in the geriatrics. But it is not predictive of tachyarrhythmia after surgery.
ObjectiveTo evaluate myocardial segmental motion function in left ventricular of patients with rheumatic mitral stenosis by using the technology of real-time three-dimensional echocardiography (RT-3DE). MethodsWe retrospectively analyzed the clinical data of 14 patients with rheumatic mitral stenosis between October and November 2014 in our hospital as a trial group. There were 4 males and 10 females with a mean age of 50.9±9.0 years ranging from 34 to 64 years. We chose 11 healthy individuals as a control group. There were 7 males and 4 females with a mean age of 49.5±9.7 years ranging from 32 to 67 years. Both the two groups were subjected to myocardial performance evaluation using two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT-3DE) to examine the left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), longitudinal strain, circumferential strain, area strain, and lateral strain of each left ventricular myocardial segments. Result RT-3DE detected that the trial group had significantly lower values of LVEF, LVEDV and LVESV than those of the control group (P < 0.05). RT-3DE also revealed that the trial group had a significantly weaker longitudinal strain than the control group (P < 0.05). ConclusionRT-3DE is an accurate technology for assessing myocardial motion and function in patients with rheumatic mitral valve disease.
Objective To compare surgical results between real-time three dimensional echocardiography（RT-3DE） guided closure of atrial septal defect （ASD） through a right minithoracotomy and traditional surgical repair under cardiopulmonary bypass （CPB）. Methods Sixty-four patients with secundum ASD received surgical repair in the First People’s Hospital of Honghe Autonomous Prefecture from April 2009 to April 2012. According to different surgical approach, all the patients were divided into group A and B. In group A, 35 patients underwent traditional ASD repair under CPB including 20males and 15 females with their age of 12-56 （16.4±4.0） years. In group B, 29 patients received real-time RT-3DE guidedASD closure through a right minithoracotomy without CPB, including 20 males and 15 females with their age of 15-50 （18.5±0.2） years. Operation time，postoperative mechanical ventilation time，hospital stay，chest drainage，mortality，morbidity and follow-up outcomes were compared between the 2 groups. Results Operation time （110.47±35.90 minutesvs. 159.32±20.60 minutes），postoperative mechanical ventilation time （10.40±22.30 hours vs. 16.40±12.20 hours），chestdrainage （106.71±85.20 ml vs. 146.70±75.63 ml）and postoperative hospital stay （4.0±1.0 days vs. 7.0±1.0 days）ofgroup B were significantly shorter or less than those of group A. In group A, 1 patient died postoperatively and 7 patientshad postoperative complications. In group B, there was no in-hospital mortality and 3 patients had postoperative complications.Postoperative morbidity of group A was significantly higher than that of group B （20.0% vs. 10.3%，P＜0.05） . ConclusionFor ASD patients with definite surgical indications，RT-3DE guided ASD closure through a right minithoracotomy has more advantages over traditional surgical repair under CBP.
ObjectiveTo share the experience of treating special cardiac malformations by applying minimally invasive techniques.MethodsEight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge.ResultsEight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory.ConclusionThe application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.
Objective To analyze the echocardiographic characteristics of above grade 3+ mitral regurgitation (MR) patients by 3D transesophageal echocardiography (3D-TEE) in transcatheter edge-to-edge repair (TEER) and compare the intervention rate of TEER treatment in patients with different risk stratification. Methods We retrospectively analyzed the clinical data of 91 patients with above grade 3+ MR in Anzhen Hospital between June 2021 and April 2022. There were 45 males and 46 females aged 66.5±15.9 years. According to pathogenesis, the patients were divided into different anatomical groups and risk stratification groups. There were 34 patients in a simple degenerative group (simple DMR group), 28 patietns in a complex disease group (Complex group), 14 patients in a simple ventricular functional reflux group (simple VFMR group), 9 patients in a simple atrial functional reflux group (simple AFMR group), and 6 patients in a mixed functional reflux group (mixed FMR group). All patients were examined with a unified standard of transthoracic echocardiography (TTE) and 3D-TEE to compare the characteristic three-dimensional structural changes of the mitral valve in each group. According to the three partition strategy of preoperative anatomical evaluation of TEER, the risk stratification was conducted for the enrolled patients, which was divided into three regions from light to heavy: green area, yellow area, and red area. TEER treatment intervention rate of patients with different risk stratification was calculated. Results Ant leaf angle and post leaf angle were negative in the simple DMR and Complex groups, and non-planar angle, prolapse height and prolapse volume were higher than those of the other groups (P=0.000). Ant leaf angle and post leaf angle were positive in the VFMR group and the mixed FMR group. Anterior and posterior (AP) diameter of valve ring (P=0.036), tenting height and tenting volume were higher than those of other groups (P=0.000). AP diameter, tenting height and tenting volume were changed mildly in patients with simple AFMR. MR patients in red and yellow zone achieved a 28.1% TEER intervention rate.Conclusion Standardized TTE and TEE examinations are crucial for the qualitative and quantitative diagnosis of MR in the echo core-lab. 3D-TEE mitral valve parameter can help determine the exact pathogenesis of MR and to improve the interventional rate of challenging MR patients.
ObjectiveTo compare the efficacy of percutaneous closure guided by transthoracic echocardiography or angiography in the treatment of patent ductus arteriosus (PDA).MethodsLiterature databases such as CNKI, VIP, Wanfang Database, PubMed, Cochrane Library were searched for collecting published literatures on percutaneous closure for PDA guided by transthoracic echocardiography and angiography, retrieval time limit was up to April 2019. Two evaluators independently screened the literature, extracted the data and evaluated the quality according to inclusion and exclusion criteria. The collected data were analyzed by RevMan 5.3 software.ResultsEight studies were included finally, with a total sample size of 681 cases. Meta-analysis showed that there was no statistical difference in the operative success rate between the echocardiography group and the angiography group (RR=0.99, 95%CI 0.97- 1.01, P=0.40). Postoperative complications were less in the echocardiography group than those in the angiography group (RR=0.26, 95%CI 0.11-0.59, P=0.001).The operation time (P<0.000 01), amount of intraoperative radiation (P<0.000 01), exposure time (P<0.000 01), hospitalization days (P<0.000 01) and hospitalization costs (P<0.000 01) in the echocardiography group were less or shorter than those in the angiography group, and the difference was statistically different.ConclusionCompared with angiography-guided, transthoracic echocardiography-guided percutaneous closure for PDA is a safe and effective method with less trauma, lower cost, and can replace angiography as one of the guiding methods for PDA.
Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.
Abstract: Objective To introduce a new technique: transthoracic closure of perimembranous ventricular septal defect (VSD) without cardiopulmonary bypass (CPB) under transesophageal echocardiography (TEE）guidance, and summarize the clinical experiences and midterm followup results. Methods A total of 136 patients with perimembranous VSD, 3 months to 15 years averaging 1.8 years, underwent transthoracic device closure. The weight of these patients ranged from 4.0 to 26.0 kg with an average weight of 12.7 kg. The diameter of their VSD ranged from 3 to 12 mm averaging 5.1 mm. A small transthoracic incision (34 cm incision by inferior sternotomy or 23 cm transverse incision in the third intercostal space) was made and the best location for right ventricular puncture was chosen and the delivery pathway was established under TEE guidance. Proper devices were delivered and then deployed to close the defect. Patients were followed up closely with a standard protocol, arranged for echocardiography, electrocardiogram and chest Xray film. Results In all the cases, 131 cases of VSD (96.3%) were successfully closed. The procedure time was less than 90 minutes and the implanting time was 5.42 minutes (16.3±5.7 min). Symmetrical devices were implanted into 89(67.9%) of the 131 patients and the other 42 patients (32.1%) were closed with asymmetrical ones. The result of TEE soon after operation showed that 3 patients had tiny residual shunt, 4 had new trivial and mild tricuspid regurgitation (TR). However, no TR worsening, aortic regurgitation (AR), complete atrioventricular heart block, or left or right outflow tract obstruction was detected in all patients. One patient 〖CM(159mm〗with transient atrioventricular block restored to sinus rhythm after 3 days of medical treatment. Five cases (3.7%) were converted to conventional open heart repair during the operation. Followup was done to all the patients for a period ranged from 6 months to 30 months (18.3±6.6 months). Tiny residual shunt in the 3 cases mentioned above vanished during the followup period. No new TR, AR, hemolysis, thrombosis, dislocation of the devices, or outflow stenosis was detected postoperatively. The tiny incision caused less psychologic depression. Conclusion Minimally invasive transthoracic device closure of VSD without CPB is a simple, effective and safe intervention under guidance of TEE for most of perimembranous VSD patients. The short and midterm clinical outcomes are promising. Longterm followup is indispensable.
ObjectiveTo explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD).MethodsWe retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation.ResultsAll 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05).ConclusionTTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.
ObjectiveTo assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients.MethodsFrom December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year.ResultsThe mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up.ConclusionPercutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.