Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy

Primary liver cancer and liver metastases are among the most frequent malignancies worldwide,with an increasing number of new cases and deaths every year.Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy.This synopsis outlines the first clinical practice guidelines for ultrasoundguided percutaneous microwave ablation therapy for hepatic malignancy,which was created by a joint task force of the Society of Chinese Interventional Ultrasound.The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment,as well as proposing the criteria for the treatment candidates.

QUANTITATIVE ASSESSMENT OF MYOCARDIAL PERFUSION DEFECTS WITH REAL-TIME THREE-DIMENSIONAL MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

Objective To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3DE). Methods RT3DE was performed in 21 open-chest mongrel dogs undergoing acute ligation of the left anterior descending artery (LAD, n=14) or distal branch of the left circumflex artery (LCX, n=7). A perfluorocarbon microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with Philips Sonos-7500 ultrasound system. Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. In vitro anatomic measurement of myocardial mass after removal of the animal’s heart was regarded as the control. Blinded off-line calculation of left ventricular mass and perfusion defect mass from RT3DE images were performed using an interactive aided-manual tracing technique.Results Total left ventricular (LV) myocardial mass ranged from 38.9 to 78.5 (mean±SD: 60.0±10.1) g. The mass of perfusion defect ranged from 0 to 21.4 (mean±SD: 12.0±5.0) g or 0 to 27% of total LV mass (mean±SD: 19%±6%). The RT3DE estimation of total LV mass (mean±SD: 59.8±9.9 g) strongly correlated with the anatomic measurement (r=0.98; y=2.01+0.96x). The CE-RT3DE calculation of the mass of underperfused myocardium (mean±SD: 12.3±5.3 g) also strongly correlated with the anatomic measurement (r=0.96; y=-0.10+1.04x) and when expressed as percentage of total LV mass (r=0.95; y=-0.20+1.04x). Conclusions RT3DE with myocardial contrast opacification could accurately estimate underperfused myocardial mass in dogs of acute coronary occlusion and would play an important role in quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.

Impact of Coronary Artery Anatomy in Arterial Switch Operation:In-hospital and Post-discharge Outcomes

Objective The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation(ASO)is currently controversial,and the risk factors for this operation may change in more complicated patients.This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries(TGA)and Taussig-Bing anomaly(TBA).Methods We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019.The median age at operation was 33[interquartile range(IQR):20–71]days.Median follow-up time was 7.2 years(IQR:4.0–10.3 years).Results Coronary anomalies were present in 86 patients(41.7%),with 9(4.4%)of them having a single coronary artery.Additional coronary features included intramural courses in 5(2.4%)patients,ostial stenosis in 1(0.5%)patient,and accessory coronary artery orifices in 5(2.4%)patients.There were 32(15.5%)in-hospital deaths and 8(4.6%)post-discharge deaths,yielding an overall survival of 81.3%,80.7%and 79.9%at 1,5 and 10 years,respectively.Mortality due to ASO has been drastically decreased since 2013.Patients with a single coronary artery had higher rate of in-hospital mortality,but this finding was not statistically significant.The earlier surgical era(OR:2.756)and a longer cardiopulmonary bypass time(OR:2.336)were significantly associated with in-hospital mortality,while coronary patterns were not.An intramural coronary artery(HR:10.034)and a patient age of older than 1 year at the time of ASO(HR:9.706)were independent predictors of post-discharge mortality.Conclusion ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation.However,intramural coronary artery is an independent risk factor for post-discharge mortality.Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.

Assessment of global and regional left ventricular twistand displacement in anterior myocardial infarction using2-dimensional strain imaging

The recent development of 2-dimensional strain(2D strain)imaging can provide a powerful alternative for assessing left ventricular(LV)torsion.This study was conducted to evaluate the global and regional left ventricular twist by 2D strain in patients with anterior wall myocardial infarction(AMI).A total of 55 AMI patients were divided into two groups according to their ejection fraction(EF)values(group A:LVEF≥50%;group B:LVEF<50%),and 35 normal people served as the control group.Using 2-dimensional strain software,global and regional LV rotation and displacement were obtained at two planes.Compared with the control group,patients of group A showed reduced peak LV twist of the anterior and anterior-septal wall(9.26�1.89 vs 10.74�2.67;9.71�1.71 vs 11.36�2.29,both P<0.05),but the radial displacement and global twist were maintained(P>0.05).Differently,regional and global LV twist and radial displacement in patients of group B deceased significantly,especially in the anterior and anterior-septal wall,as compared with patients in the control or group A(both P<0.05).Moreover,a strong correlation was noted between peak twist and radial displacement;the twist-displacement loop was markedly distorted in patients of group B.This study demonstrated that 2D strain has a potential ability for quantification of left ventricular global and segment twist and radial displacement in patients with coronary artery disease.