Right-to-left shunt detection via synchronized contrast transcranial Doppler combined with contrast transthoracic echocardiography:A preliminary study

BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast transcranial Doppler(cTCD)and contrast transthoracic echocardiography(cTTE)may yield false-negative results.Further,the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE,presents conflicting recommendations on their exclusive use,and highlights inefficiencies associated with nonsynchronous testing.AIM To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.METHODS We prospectively enrolled four patients with cryptogenic stroke(n=1),migraine(n=2),and unexplained dizziness(n=1)who underwent synchronized cTCD combined with cTTE.The participants were monitored and followed-up for 24 months.RESULTS cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines,whereas cTCD revealed only small RLSs.Moderate and large RLS were confirmed on combined cTTE and cTCD.After excluding other causes,both patients underwent PFO occlusion.At 21-and 24-month follow-up examinations,neither stroke nor migraine had recurred.cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines;however,simultaneous cTCD detected a large RLS.These patients did not undergo interventional occlusion,and dizziness and headache recurred at the 17-and 24-month follow-up examin-ations.CONCLUSION Using cTTE or cTCD may underestimate RLS,impairing risk assessments.Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.

Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography （RT-MCE） combined with two-dimensional strain echocardiography was assessed. Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months after coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu- dinal strain three months after bypass surgery was significantly higher than that before operation [（-15.78±5.91）% vs （-10.45±8.31）%, P〈0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [（-10.33±6.53）% vs （-9.41±6.09）%, P〉0.05]. It was concluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of regional systolic function. The combination of myocardial perfusion with two-dimensional strain echocardiography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

Abdominal aortic aneurysm screening during transthoracic echocardiography:Cardiologist and vascular medicine specialist interpretation

AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS: Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the ab-dominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis ofinterobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION: The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min.

Congenital Heart Diseases Diagnosed on Transthoracic Echocardiography: Perspectives from the University of Maiduguri Teaching Hospital, Nigeria

In a retrospective study of 1224 transthoracic echocardiograms performed between January 2011 and December 2013, we evaluated the spectrum of congenital heart disease (CHD) diagnosed at a tertiary referral centre in Maiduguri, north-eastern Nigeria. Diagnosis of CHD was made in 88 (8.3%) subjects, comprising 23 (26.1%) adults and 65 (73.9%) aged less than 18 years. Forty six (52.3%) of those with CHD were females, while 42 (47.7%) were males. The frequencies of the CHD in decreasing order were: ventricular septal defect 23 (26.1%), tetralogy of Fallot (TOF) 14 (15.9%) and atrial septal defect (ASD) and atrioventricular septal defect (AVSD) were 11 (12.5%) each. One of the patients with AVSD had Ellis Van Creveldt syndrome. Six (6.8%) cases of patent ductus arteriosus (PDA) were diagnosed in those younger than 18 years, while all the 5 (5.7%) cases of Ebstein’s anomaly were diagnosed in adults. There were 6 (6.8%) cases of Eisenmenger syndrome involving three cases of AVSD, one case of ASD and two cases of Ebstein’s anomaly. Timely definitive cares for these patients are still lacking in Nigeria and many areas of sub-Saharan Africa. We recommend sensitization of all relevant clinicians to actively look for congenital heart defects. Pulse oximetry and postnatal echocardiographic new-born screening which were previously validated should be implemented at secondary and tertiary levels, and efforts should be made towards providing the needed care for patients with CHD.

Study on linage Acquisition of Transthoracic Echocardiography in Mechanically Ventilated ICU Patients

Objective This study aimed to determine which parameters in transthoracic echocardiography(TTE)are more likely to be affected when applied in a critical care setting with mechanical ventilation.Methods Ninety mechanically ventilated ICU patients were enrolled into the study group.The control group consisted of 90 patients who underwent interventional therapy.All patients had bedside TTE for parametric measurements including the right ventricular size,septal kinetics and left ventricular ejection fraction(LVEF)by eyeballing(visual assessment),the tricuspid annular plane systolic excursion(TAPSE),mitral annular plane systolic excursion(MAPSE)by M-mode sonography,the right ventricular outflow tract velocity-time integral(RVOT VTI)and left ventricular outflow tract velocity-time integral(LVOT VTI)by pulse-Doppler,the right ventricular fraction of area change(FAC)and left ventricular ejection fraction(LVEF Simpson)by endocardium tracing.We compared the differences in the frequency of optimal image acquisition in assessments of these parameters between the two groups,as well as the differences in acquisition rates of parameter measurements in ventilated ICU patients.Results There were significantly fewer patients in the study group than in the control group who had optimal images acquisitions for parameter assessments with M-mode method,pulse Doppler method and endocardiumtracing method(P<0.05);no significant difference was obsered in the number of patients with optimal images for RV eyeballing and LVEF eyeballing between the two groups.In the study group,significantly fewer optimal images were acquired for FAC than forTAPSE(22.2%vs、72.2%,χ2=45.139,P<0.001)and RVOT VTI(22.2%vs.71.1%,χ2=43.214,P<0.001);there were also fewer optimal images acquired for LVEF Simpson than for MAPSE(37.8%ys.84.4%,χ2=41.236,P<0.001)and LVOT VTI(37.8%vs.85.6%,/=43.455,P<0.001).Conclusions Images acquisition of optimal TTE images tend to be difRcult in mechanically ventilated ICU patients,but eyeballing method for functional evaluation could be an alternative method.For quantitative parameters measurements,M-mode based longitudinal function evaluation and pulse Doppler-based VTI were superior to the endocardium-tracing based parameter assessments.

Focus assessed transthoracic echocardiography (FATE) to diagnose pleural effusions causing haemodynamic compromise

The clinical assessment of patients with respiratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the evaluation of acutely unstable patients. This case series describes the use of the Focus Assessed Transthoracic Echocardiography (FATE) protocol to diagnose unsuspected pleural collections of fluid and how drainage significantly contributes to the haemodynamic improvement seen in these patients.

Transthoracic echocardiography assists appropriate pulmonary artery catheter placement: An observational study

AIM: To investigate the utility of transthoracic echocardiography in confirming appropriate pulmonary artery catheter(PAC) placement. METHODS: Three commonly used transthoracic echocardiography(TTE) views were used to confirm PAC position in 103 patients undergoing elective cardiac surgery- the parasternal short axis right ventricular inflow-outflow view; the subcostal short axis right ventricular inflow-outflow view; and the parasternal short axis ascending aortic view. All PACs were inserted by the managing anesthesiologist under pressure waveform guidance alone, who was blinded to all sonographic information. A sonographer blinded to all pressure waveform information confirmed visualisation of an "empty" PA before PAC insertion, and visualisation of the PAC balloon in the main PA(MPA) or right PA(RPA) after attempts at placement were complete. Agreement, sensitivity and specificity of TTE in confirming appropriate PAC placement was compared against pressure waveformguidance as the "gold standard". The successful view used was compared against patients' anthropomorphic indices, presence of lung hyperinflation, and insertion of PAC during positive pressure ventilation. Agreement between TTE and pressure waveform guidance was analysed using Cohen's Kappa statistic. The relative proportion of total RPA seen by subcostal vs parasternal TTE views was also compared with a further 20 patients' computed tomography(CT) pulmonary angiograms(CTPA), to determine efficacy in detection of distal RPA PAC placement. RESULTS: Appropriate positioning of the PAC balloon, and its to-and-fro movement consistent with a nonwedged state, within the MPA or RPA was confirmed by TTE in 98 of the 103 patients [sensitivity 95%(95%CI: 89%-98%)], and absence of the PAC balloon before insertion correctly established in 100 patients [specificity 97%(92%-99%)]. This was in very good agreement with pressure waveform guidance [Cohen's Kappa 0.92,(0.87-0.98)]. The subcostal view was the best view to visualise the PAC tip when it was placed in the right pulmonary artery(OR 70, P < 0.0001), was more successful in patients with COAD(OR 9.5, P = 0.001), and visualized 61%(vs 44% by parasternal views, P < 0.001) of mean RPA lengths compared with CTPA; however the parasternal views were more successful in patients with higher body mass indexs(OR 0.78 for success with subcostal views, P < 0.001). There was a trend towards insertion during intermittent positive pressure ventilation favoring visualisation by subcostal views(OR 3.9, P = 0.08). The subcostal view visualized a greater length of the RPA than parasternal views(3.9 cm vs 2.9 cm, P < 0.0001). PACs were more often placed in the MPA than RPA(80 vs 18 patients). Three patient's pulmonary arteries were not visible by any TTE view; in a further 2 patients, despite preinsertion visualisation of their pulmonary arteries, the PAC balloon was not visible by any view with TTE where correct placement by pressure waveform was unequivocal.

Evaluation of the Effect of Sigmoid-Shaped Interventricular Septum on Left Ventricular Systolic Function in Patients with Essential Hypertension by Two-Dimensional Speckle Tracking Echocardiography

Objective: To evaluate left ventricular regional and global systolic function by measuring left ventricular longitudinal strain (LS) in hypertensive patients with sigmoid-shaped interventricular septum (SIS) by two-dimensional speckle tracking (2D-STE);in order to explore whether the sigmoid-shaped interventricular septum affects the left ventricular systolic function in patients with hypertension. Methods: Routine echocardiographic parameters were measured in 30 hypertensive patients with SIS (SIS group) and 30 hypertensive patients without SIS (non-SIS group). The left ventricular segments and global LS were measured by 2D-STE, and the two sets of parameters were compared. Results: The value of the thickness of the basal segment of the interventricular septum (IVSBT), the thickness of the middle segment of the interventricular septum (IVSMT) and the ratio of the basal segment of the ventricular septum to the middle segment of the interventricular septum (IVSBT/IVSMT) in SIS group was higher than that in non-SIS group. However, the value of left ventricular outflow tract diameter (LVOTD) in SIS group was lower than that in non-SIS group. There was a significant difference between the two groups (all P Conclusion: SIS affects left ventricular regional systolic function of patients with hypertension. 2D-STE can early evaluate left ventricular longitudinal systolic function in hypertensive patients with SIS.

Assessment of Regional Left Ventricular Myocardial Function in Rats after Acute Occlusion of Left Anterior Descending Artery by Two-dimensional Speckle Tracking Imaging

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery （LAD） by using two-dimensional speckle tracking imaging （2D-STI）. Sixty Wistar rats were randomly divided into two groups, a myocardial infarction （MI） group, in which 50 rats were subjected to LAD occlusion for 30–45 min, and a sham-operated （SHAM） group that contained 10 rats serving as control. Echo-cardiography was performed at baseline and 1, 4 and 8 week（s） after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain （PRS） and circumferential strain （PCS） were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. Left ventricular internal diameter at diastole （LVIDd） and systole （LVIDs）, fractional shortening （FS）, ejection fraction （EF） and left ventricular mass （LVM） were measured by anatomical M-model echocardiography. Infarct size was measured using triphenyl tetrazolium chloride （TTC） staining 1 week and 8 weeks after the operation. Fibrosis of left ventricu-lar myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories： infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, （1） PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation （P〈0.05） and the low levels lasted 8 weeks; （2） Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant dif-ference 1 week after the operation （P〉0.05）. However, LVIDd, LVIDs and LVM were increased sig-nificantly 4 and 8 weeks after the operation （P〈0.05）, and FS and EF were decreased substantially （P〈0.05）. Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional func-tion of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.

Left Ventricle Geometry Remolding after Heart Transplantation:A Two-dimensional Ultrasound Study

The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass （LVM）, and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation （HT）. The purpose of this study was to dy- namically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end dias- tole were measured and the relative wall thickness （RWT）, left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index （LVMI） and RWT. The HT patients were divided into three groups ac- cording to the time length after surgery： A （3 months postoperatively）, B （6 months postoperatively） and C （12 months postoperatively）. We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients （16%） in group A had concentric remodeling. Nine patients （34.62%） in group B had re- construction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients （62.5%） had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hyper- trophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hy- pertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.

Value of two-dimensional speckle tracking imaging in quantitative assessment of left ventricular function in patients with OSAS

Objective: To research the clinical application of two-dimensional speckle tracking imaging (2D-STI) in quantitative assessment of left ventricular function in patients with obstructive sleep apnea-hypopnea syndrome (OSAS). Method: From July 2016 to December 2018, 86 patients with OSAS were selected as OSAS group. According to sleep apnea hypopnea index (AHI), they were divided into mild OSAS group (24 cases), moderate OSAS group (29 cases) and severe OSAS group (33 cases). Another 50 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The results of routine echocardiography and left ventricular global strain parameters of the OSAS group, the control group and the OSAS patients with different severity were compared and analyzed. Result: There were no significant differences in the levels of left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd) between the two groups and OSAS patients with different severity (P>0.05). The levels of IVST, LVPW and LVMI in the OSAS group were significantly higher than those in the control group, the levels of end-diastolic interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular mass index (LVMI) in the severe OSAS group were significantly higher than those in the mild and moderate OSAS group, and the levels of IVST, LVPW and LVMI in the moderate OSAS group were significantly higher than those in the mild OSAS group, there were significant differences between groups (P<0.05). The levels of GLS, GRS and GCS in the OSAS group were significantly lower than those in the control group (P<0.05). GLS, GRS and GCS levels in the severe OSAS group were significantly lower than those in the mild OSAS group and the moderate OSAS group, while the levels of global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) in the moderate OSAS group were significantly lower than those in the mild OSAS group (P<0.05). Conclusion: The left ventricular systolic function of OSAS patients is obviously impaired. Left ventricular function in OSAS patients can be assessed timely and accurately by two-dimensional speckle tracking imaging.

The role of echocardiography and CT angiography in transcatheter aortic valve implantation patients

The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.

Research and Application of Transnasal Transesophageal Echocardiography Probe

The intubation of conventional transesophageal echocardiography（TEE） probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients＇ experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit（ICU）, resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect（ASD） patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.

Study on Three Dimensional Reconstruction of Transesophageal Echocardiographic Images

Using biplane transesophageal echocardiography and the concept of three dimensional transthoracic echocardiography,we performed three dimensional reconstruction of transesophageal images of various clinicopathologic cases,including atrial septal defect,mitral stenosis,mitral valve prolapse and pulmonary stenosis.The hardware equipments and image processing flow chart of three dimensional reconstruction of transesophageal echocardiographic images are described. Our present study indicates that three dimensional reconstruction of transesophageal echocardiographic images could display multi-regional three dimensional structures of heart and great vessels,including superior vena cava,ascending aorta,right ventricular outflow tract, pulmonary artery and left heart,with clear,visual and stereoscopic imaging.The regional structures could be displayed at different levels of stereo-anatomic-sec-tions and in different orientations of rotating stereo-images,which could provide accurate three dimensional anatomical information for cardiac stereo-morphological study and definition of spatial location and size of cardiac abnormalities.

经胸超声心动图监测引导在经皮卵圆孔未闭封堵术中的应用效果

目的 观察经胸超声心动图(TTE)监测引导在经皮卵圆孔未闭(PFO)封堵术中的应用效果。方法 回顾性分析98例PFO患者的资料,患者均行介入封堵术。依据术中引导方式的不同分成X线组(n=50)和TTE组(n=48)。比较2组封堵情况、并发症发生情况、手术指标、右向左分流(RLS)分级情况以及合并偏头痛者的头痛改善情况。结果 98例PFO均成功完成封堵,其中TTE组有2例因术中声窗欠佳,加用经食道超声引导。TTE组手术时间长于X线组,差异有统计学意义(P<0.05)。术后,2组RLS分级及偏头痛者头痛影响测验-6(HIT-6)评分低于术前,差异有统计学意义(P<0.05)。结论 单纯TTE引导的经皮PFO封堵术对PFO患者RLS、偏头痛的改善效果较好,且能规避X线对医患所造成的辐射损伤。

经胸及经食管超声心动图右心声学造影诊断肺动静脉畸形的临床价值

目的探讨经胸超声心动图右心声学造影(cTTE)、经食管超声心动图右心声学造影(cTEE)诊断肺动静脉畸形(PAVM)的临床价值。方法选取我院收治的可疑PAVM患者50例,均行cTTE、cTEE观察左心腔内微泡出现时间及微泡数量,并进行半定量分级。绘制受试者工作特征(ROC)曲线分析cTTE、cTEE对PAVM的诊断效能;采用Logistic回归分析cTTE、cTEE半定量分级与PAVM发生的关系。结果50例可疑PAVM患者经胸部CT或CT肺血管造影检查确诊PAVM阳性6例(PAVM组),PAVM阴性44例(非PAVM组)。PAVM组cTTE半定量分级、cTEE半定量分级均高于非PAVM组,差异均有统计学意义(均P<0.05)。纳入患者的cTEE半定量分级高于cTTE,差异有统计学意义(P<0.05)。ROC曲线分析显示,cTTE诊断PAVM的灵敏度、特异度、曲线下面积(AUC)分别为66.7%、86.4%、0.814;cTEE诊断PAVM的灵敏度、特异度、AUC分别为83.3%、88.6%、0.890。Logistic回归分析显示,cTTE、cTEE半定量分级均与PAVM发生相关(均P<0.05),其中cTTE半定量分级>Ⅱ级患者发生PAVM的风险是≤Ⅱ级患者的12.865倍;cTEE半定量分级>Ⅱ级患者发生PAVM的风险是≤Ⅱ级患者的39.450倍。结论对于可疑PAVM患者,应用cTTE、cTEE均可进行早期筛查,且cTEE半定量分级的诊断效能优于cTTE。

经胸超声心动图联合超声造影检测冠状动脉血流储备对高血压患者冠状动脉病变的预测价值

目的 探讨经胸超声心动图联合超声造影检测冠状动脉血流储备(CFR)对高血压患者冠状动脉病变的预测价值。方法 纳入伴有左心室肥厚(LVH)的高血压患者45例作为观察组,另纳入45例单纯高血压患者作为对照组。对所有患者开展经胸超声心动图联合超声造影检查,比较两组经胸超声心动图检查结果及造影检查结果。结果 两组患者的静息舒张期峰值血流速度(PDV)比较无差异(P>0.05);观察组的负荷PDV(47.34±14.98)cm/s及CFR(1.94±0.78)低于对照组的(67.78±15.57)cm/s、(2.83±1.82)(P<0.05)。观察组灌注量(7.02±2.91)L/min、曲线峰值强度(9.46±7.62)dB、曲线斜率(1.23±1.03)dB/s低于对照组的(9.64±3.34)L/min、(16.78±8.43)dB、(1.78±1.22)dB/s,灌注阳性率71.11%高于对照组的22.22%(P<0.05)。结论 经胸超声心动图联合超声造影可实现对CFR的评估,帮助了解高血压患者的冠状动脉病变情况,为冠状动脉病变的防治提供依据。

经颅多普勒发泡试验联合经胸超声心动图声学造影在筛查卵圆孔未闭所致隐源性脑卒中的临床价值

目的探讨经颅多普勒发泡试验(c-TCD)联合经胸超声心动图声学造影(c-TTE)在筛查卵圆孔未闭(PFO)所致隐源性脑卒中(CS)的临床价值。方法169例CS患者均行c-TCD及c-TTE检查,分析c-TCD、c-TTE单独及联合对于PFO及阳性检出情况、对PFO的诊断效能及下右向左分流(RLS)分级情况的作用。结果与c-TCD比较,联合检测的静息阳性率升高(P<0.05),与c-TTE比较,联合检测的静息阳性率及Valsalva阳性率均升高(P<0.05)。联合诊断PFO的灵敏度及特异度均高于c-TCD、c-TTE单独诊断(P<0.05)。与c-TCD比较,联合检测对RLS 0级、I级的检出率降低,对RLSⅡ级、Ⅲ级的检出率升高(P<0.05),与c-TTE比较,联合检测对RLSⅢ级的检出率升高(P<0.05)。结论c-TCD联合c-TTE能够提高CS患者的PFO及PFO-RLS中大量分级的检出率,提高对PFO的诊断效能。

单纯输送鞘法经胸超声引导封堵卵圆孔未闭的临床疗效

目的探讨单纯输送鞘法行经胸超声引导下经皮卵圆孔封堵手术的临床治疗效果。方法回顾性分析2020年1月至2022年12月于我院行介入封堵手术或单纯输送鞘法经胸超声引导经皮卵圆孔封堵手术的卵圆孔未闭患者临床资料,分别设为介入封堵组(40例)和单纯输送鞘组(39例)。比较2组患者的手术时间、手术并发症发生率及手术成功率;术后超声评价封堵效果;术后随访6个月,评估患者临床症状缓解情况。结果单纯输送鞘组手术成功率(100%)高于介入封堵组(90.0%),差异有统计学意义(P<0.05)。单纯输送鞘组手术时间长于介入封堵组,差异有统计学意义(P<0.05)。介入封堵组1例患者术中出现少量心包积液;单纯输送鞘组2例患者术中出现血压降低、心率减慢,对症处理后症状消失。2组并发症发生率比较,差异无统计学意义(P>0.05)。术后6个月随访,封堵伞位置良好,无残余漏;介入封堵组28例患者头痛、头晕症状消失,8例患者症状明显缓解;单纯输送鞘组30例患者头痛、头晕症状消失,9例患者症状明显缓解。结论单纯输送鞘法经胸超声引导经皮卵圆孔封堵手术安全可行,疗效满意,手术成功率高,无辐射危害,值得临床推广。

TTE联合TEE诊断主动脉瓣二瓣畸形致二尖瓣前叶瘤1例报告及文献复习

目的:分析二尖瓣瘤(MVA)的临床表现、影像学特征、治疗措施和疗效,提高临床医师对MVA的认识。方法:收集1例主动脉瓣二瓣畸形导致二尖瓣前叶瘤形成患者的临床资料,根据其临床特点和影像学特征明确临床诊断、选择治疗方法并对疗效进行分析,同时进行相关文献复习。结果:患者,女性,68岁,因心慌气短13年,加重1个月入院。患者于13年前无诱因出现心慌气短,在当地医院诊断为“心脏瓣膜病”,1个月前上述症状加重而住院治疗。经胸二维超声心动图(TTE)显示左心室肥大,主动脉瓣呈二瓣,瓣叶增厚,回声增强,主动脉瓣前向血流速度增快,瓣口面积2.0 cm^(2);二尖瓣前叶瓣缘局部略增厚,回声略增强,呈囊性“蜂窝状”结构,与主动脉瓣反流束密切相关,反流束似进入“囊袋”。术前经食管超声心动图(TEE)显示主动脉瓣二瓣畸形,前方瓣叶舒张期脱向左心室流出道;二尖瓣前叶心房面可探及“囊袋状”结构,随心动周期囊壁形态发生改变,该“囊袋”与左心室血流相交通。超声诊断为主动脉瓣二瓣畸形-横裂式、重度关闭不全伴轻度狭窄和二尖瓣前叶瘤。术中主动脉瓣瓣环扩大,瓣叶呈明显关闭不全,将瓣叶切除,主动瓣位置换1枚23号生物瓣;经主动脉瓣口探查二尖瓣,前叶瓣体可探及“囊袋样”结构,未进行特殊处理。术后TEE显示主动瓣位生物瓣回声及活动良好,二尖瓣“囊袋状”结构仍然不变。术后10 d和术后4个月随访显示主动瓣位生物瓣回声及活动良好,二尖瓣囊性病变的性质及大小与术前比较无明显变化。结论:MVA临床罕见,TTE是目前临床诊断MVA最有价值的影像学诊断方式,特别是TTE联合TEE是最佳诊断方法,且可协助治疗及疗效评价。