Evaluation of Atrial Septal Defect Using Real-time Three-dimensional Echocardiography:Comparison with Surgical Findings

The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography （RT3DE） was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery （r=0.77, P〈0.001）. The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.

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.

Evaluation of Right Ventricular Volume and Systolic Function by Real-time Three-dimensional Echocardiography

The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV “Full volume” images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpson's rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P<0.25—0.0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P<0.001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0.986, P<0.001; r=0.93, P<0.001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RV's complex shape, apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.

Left Ventricular Systolic Strain of the Cardiac Allograft Evaluated with Three-dimensional Speckle Tracking Echocardiography

Three-dimensional speckle tracking echocardiography was employed to evaluate the changes of left ventricular systolic strain in 23 heart transplant recipients at 1 st, 3rd, 6th and 12th month after heart transplantation, and 23 healthy subjects served as controls. The three-dimensional full-volume echocardiographic images of left ventricle were recorded and then were analyzed using EchoPAC software. The strain curves and peak systolic strain values for each segment and overall left ventricular wall were obtained. Left ventricular global peak longitudinal strain （GPSL）, global peak radial strain （GPSR）, global peak circumferential strain （GPSC） and global peak area strain （GPSA） were measured and then statistically analyzed. There were no significant differences in left ventricular ejection fraction （LVEF） and cardiac output （CO） between heart transplant recipients and controls. The GPSL in heart transplant recipients at 1st month after surgery was significantly lower than that in controls, but close to the normal value at 3rd month after surgery and later. The GPSC, GPSA and GPSR were significantly lower in heart transplant recipients at 1 st, 3rd, 6th and 12th month after surgery than those in controls. It is suggested that three-dimensional speckle tracking echocardiography can be used for monitoring changes of left ventricular systolic strains and evaluating left ventricular systolic function in cardiac allograft.

Surgical Resection of Mitral Valve Papillary Fibroelastoma: A Robot-Assisted, Minimally Invasive Approach with Three-Dimensional Transesophageal Echocardiography Imaging

Papillary fibroelastomas (PFEs) are benign tumors of the endocardium that most frequently affect cardiac valves and typically present with embolic symptoms such as stroke or transient ischemic attack (TIA). Surgical excision is usually recommended for left-sided tumors and is associated with excellent long-term outcomes. The use of a robot-assisted, minimally invasive surgical approach for management of mitral valve disease is growing, and has been associated with shorter hospital stays and improved early quality of life. Three-dimensional (3D) transesophageal echocardiography (TEE) offers several advantages in the assessment of mitral valve disease and cardiac tumors, including the ability to precisely locate the site of attachment of the mass and the spatial relationships to surrounding structures. These factors are particularly important when planning a surgical approach. We report two cases of mitral valve PFEs which were successfully removed using a robot-assisted, minimally invasive surgical approach with 3D TEE imaging. This approach to treatment of PFEs is an attractive alternative to the traditional approach involving median sternotomy.

A 3-dimensional transoesophageal echocardiography perspective of mitral valve abscess

An 85-year-old female with history of dementia presented with concern for severe sepsis and was found to have methicillin sensitive staphylococcus aureus bacteremia complicated by atrial fibrillation.For further workup,a transoesophageal echocardiography(TOE)was obtained.The study revealed a large echogenic density with multiple echolucent areas within the finding.There was evidence of blood flow in these echolucent areas based on color flow imaging.This mass was intermittently protruding into the left ventricle causing a function mitral stenosis.The collective findings on echocardiography,in context of bacteremia,were highly suggestive of mitral valve abscess(Figure 1).

Assessment of Atrial Septum Morphology by Live Three-dimensional Echocardiography

To evaluate the morphology of atrial septum by the live three-dimensional echocardiography （L3DE） and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect （ASD）, including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings （r=0.90）. It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.

Real-time Three-dimensional Echocardiography in Assessment of Congenital Double Orifice Mitral Valve

The application of real-time three-dimensional echocardiography （RT 3DE） in the diagnosis of double orifice mitral valve （DOMV） was explored. Five cases of DOMV were examined by using 2-dimensional echocardiography （2DE） and RT 3DE. The spatial morphology of malformed mitral valve and its change in hemodynamics were observed. DOMV associated with partial atrioventricular septal defect was found in 3 cases （in which 2 cases had cleft mitral valve） and isolated DOMV in 2 cases; and moderate to severe mitral regurgitation was detected in 3 cases, and mild mitral regurgitation in 1, and no regurgitation in 1 case; 1 case had complicated rhumatic heart disease. Three cases were preoperatively discovered by 2DE, while 2 missed （1 case was discovered postoperatively）. Four cases were diagnosed by RT 3DE preoperatively, and 1 case was diagnosed postoperatively （not examined by RT 3DE preoperatively）. It was suggested that RT 3DE is a reliable technique in the diagnosis of DOMV; it permitted comprehensive and noninvasive assessment of mitral valve and may supplement 2D TTE in the assessment of DOMV.

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.

Geometric comparison of the mitral and tricuspid valve annulus:Insights from three dimensional transesophageal echocardiography

AIM To apply real time three-dimensional transesophageal echocardiography(RT3D TEE) for quantitative and qualitative assessment of the mitral valve annulus(MVA) and tricuspid valve annulus(TVA) in the same patient.METHODS Our retrospective cohort study examined the MVA and TVA in 49 patients by RT3 D TEE. MVA and TVA shape were examined by TEE. The MVA and TVA volume data set images were acquired in the mid esophageal 4-chamber view. The MVA and TVA were acquired separately, with optimization of each for the highest frame rate and image quality. The 3D shape of the annuli was reconstructed using the Philips~? Q lab, MVQ ver. 6.0 MVA model software. The end-systolic frame was used. The parameters measured and compared were annular area, circumference, high-low distances(height), anterolateralposterolateral(ALPM), and anteroposterior(AP) axes. RESULTS A total of 49 patients(mean age 61 ± 14 years, 45% males) were studied. The ALPM and the AP axes of the MVA and TVA are not significantly different. The ALPM axis of the MVA was 37.9 ± 6.4 mm and 38.0 ± 5.6 mm for the TVA(P = 0.70). The AP axis of the MVA was 34.8 ± 5.7 mm and 34.9 ± 6.2 mm for the TVA(P = 0.90). The MVA and the TVA had similar circumference and area. The circumference of the MVA was 127.9 ± 16.8 mm and 125.92 ± 16.12 mm for the TVA(P = 0.23). The area of the MVA was 1103.7 ± 307.8 mm^2 and 1131.7 ± 302.0 mm^2 for the TVA(P = 0.41). The MVA and TVA are similar oval structures, but with significantly different heights. The ALPM/AP ratio for the MVA was 1.08 ± 0.33 and 1.09 ± 0.28 for the TVA(P < 0.001). The height for the MVA and TVA was 9.23 ± 2.11 mm and 4.37 ± 1.48 mm, respectively(P < 0.0001). CONCLUSION RT3 D TEE plays an unprecedented role in the management of valvular heart disease. The specific and exclusive shape of the MVA and TVA was revealed in our study of patients studied. Moreover, the intricate codependence of the MVA and the TVA depends on their distinctive shapes. This realization seen from our study will allow us to better understand the role valvular disease plays in disease states such as hypertrophic cardiomyopathy and pulmonary hypertension.

Clinical Application of Three－dimensional Transesophageal Echocardiography in the Diagnosis of Atrial Septal Defect

This paper reports the use of three-dimensional (3-D) transesophageal echocardiography(TEE) in the diagnosis of atrial septal defect. The results displayed that the interatrial septum had integrity in normal persons. The size,shape and position of atrial septal defects could be showed clearly and the type of the defects could be identified. The reconstructed imaging of interatrial septum on 3-D TEE was clear and stereoscopic. The technique is helpful in defining spatial location and extent of atrial septal defects.

Real-time three-dimensional myocardial contrast echocardiography in assessment of myocardial perfusion defects

Background Both real-time three-dimensional echocardi ography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C 3F 8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and righ t coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals’ hearts were used as control s. Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g [mean, (54.6±9.6) g] before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass [range, 38.9-71.1 g; mean, (55.6±9.3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36.7-68.9 g; mean, (51.3±12.5) g. Or range, 38.9-71. 1 g; mean, (53.7±12.3) g, respectively] and under-perfused mass [range, 0-21.4 g; mean, (12.0±6.9) g. Or range, 0-19.8 g; mean, (10.8±6.3) g, respectively] after th e LAD ligation (P>0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50.1-65.4 g; mean, (57.5±5.9 ) g. Or range, 51.5-65.8 g; mean, (57.3±6.4) g, respectively] and under-perfused m ass [range, 0-25.6 g; mean, (13.3±9.6) g. Or range, 0-22.7 g; mean, (12.8±8.1 ) g, respectively] after the LCX ligation (P>0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g [mean, (54.8±10.0) g] a nd there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P>0.05, r=0.99). Further, the under-perfused mass derived from RT3DE [range, 0-25.6 g; mean, (12.7±8.2) g] correlate d strongly with the in vitro measurements [range, 0-22.7 g; mean, (11.9±7.2) g] ( r=0.96). Conclusion RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects.

Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes:an experimental study

Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE) Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE On RT3DE 'full volume' imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software On 2DE imaging, the volumes were measured by the Simpson method The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values ( r =0 795-0 998) and there was a good correlation between 2DE estimates and reference values ( r =0 715-0 729) There were no significant differences between RT3DE estimates, 2DE results and reference values ( P >0 05) In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values ( r =0 765-0 988), but 2DE weakly correlated with reference values ( r =0 518-0 592) There were no differences between RT3DE and reference values ( P >0 05), but a significant difference between 2DE and reference values occurred ( P <0 05) For excised canine hearts, there was a strong correlation between RT3DE and reference values ( r =0 728-0 914), while 2DE showed a less obvious correlation ( r =0 502-0 615) Again, there were no significant differences between RT3DE and reference values ( P >0 05), but there was a significant difference between 2DE and reference values ( P <0 05) Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function For LV and RV measurements by RT3DE, 8-plane strategy is the optimum choice for accuracy and convenience

Value of left ventricular regional ejection fraction determined by real-time three-dimensional echocardiography in diagnosis of aneurysm： compared with left ventriculography

Background Regional ejection fraction （EFR） measured by real-time three-dimensional echocardiography （RT-3DE） provides a novel method for quantifying left-ventricular （LV） regional systolic function. We aimed to explore the diagnostic value of regional ejection fraction （EFR） derived from RT-3DE in detecting LV aneurysms in patients with myocardial infarction. Methods Thirty-eight patients with myocardial infarction were prospectively enrolled and underwent electrocardiography （ECG）, two-dimensional echocardiography （2-DE）, RT-3DE and left ventriculography （LVG）. Subjects with a negative EFR in at least one segment on RT-3DE were considered as having a ventricular aneurysm. We compared the sensitivity, specificity, Youden＇s index, and positive and negative predictive values of ECG, 2-DE and RT-3DE in determining LV aneurysm with detection by LVG. Results On LVG an LV aneurysm was diagnosed in 16 （42.1%） patients. The sensitivity and specificity were 62.5% and 86.4% for ECG, 81.2% and 95.4% for 2-DE, and 100.0% and 90.9% for RT-3DE in diagnosing LV aneurysm. Youden＇s indexes for ECG, 2-DE and RT-3DE were 0.49, 0.77 and 0.91, respectively. Positive and negative predictive values were 76.9% and 76.0% for ECG, 92.9% and 87.5% for 2-DE, and 88.9% and 100.0% for RT-3DE. Conclusions RT-3DE-derived EFR provides a novel, reliable index in the diagnosis of LV aneurysm and has excellent sensitivity and specificity.

Assessment of the morphology and mechanical function of the left atrial appendage by real-time three-dimensional transesophageal echocardiography

Background The left atrial appendage （LAA） is an important source of thrombus formation. We investigated the feasibility of the recently developed real-time three-dimensional transesophageal echocardiography （RT3D-TEE） method in assessment of the morphology and function of the LAA. Methods Ninety-six consecutive patients （58 males with a mean age of （43.4±12.5） years） who were referred for 2-dimensional （2D） transesophageal echocardiography （TEE） underwent additional RT3D-TEE. LAA morphology was visualized in multiple views. Orifice size, depth, volumes and ejection fraction （EF） of the LAA, were measured. Results All the patients underwent RT3D-TEE examination without complications. Ninety-two patients （95.8%） had adequate images for visualization and quantitative analysis of the LAA. The LAA exhibited great variability with respect to relative dimensions and morphology. LAA orifice area was （3.8±1.2） cm^2 with a diameter of （2.4±0.9） cm x （1.4±0.6） cm. The mean depth of the LAA was （2.9±0.7） cm. End-diastolic volume （EDV-LAA）, end-systolic volume （ESV-LAA） and EF of the LAA were （6.2±3.7） ml, （4.1±2.8） ml, and 0.35±0.16, respectively. EDV-LAA, ESV-LAA and the orifice area of the LAA in patients with atrial fibrillation （AF） were larger than those without AF, whereas the EF was smaller in the AF patients. Conclusions Defining LAA morphology and quantitative analysis of the size and function of the LAA with superior quality and resolution of images using RT3D-TEE is feasible. This technique may be an ideal tool for guidance of the LAA occlusion procedure. Determination of LAA volumes and volume-derived EF by RT3D-TEE provides new insights into the analysis of LAA function.

Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy

Background Recent advances in real-time three-dimensional echocardiography （RT3DE） offer the potential to assess the left ventricular （LV） dyssynchrony simultaneously by analyzing the 17 segments time-volume curves. The purpose of this study was to test the feasibility and accuracy of RT3DE for quantitative evaluation of left ventricular systolic synchronicity. Methods Twenty-four patients with dilated cardiomyopathy （DCM） and twenty-ftve healthy volunteers were enrolled in this study. Full volume RT3DE was performed by using Philips IE33 with X3-1 probe. The global and 17-segmental time-volume curves were obtained by the on-line Qlab software （version 4.2）. The time to minimal systolic volume in each segment （Tmsv） was taken to derive the following indexes of systolic asynchrony： Tmsv 16-SD, Tmsv 16-Dif, Tmsv 12-SD, Tmsv 12-Dif, Tmsv 6-SD and Tmsv 6-Dif, which meant the standard deviation or the maximal difference of Tmsv among the 16, 12 and 6 segments of the left ventricle respectively. The software also provided with each of the above parameters as a percentage of the cardiac cycle. Results Tmsv 16-SD, Tmsv 12-SD and Tmsv 6-SD were all significantly larger in the DCM group than those of the control group [Tmsv 16-SD： （52.9±40.6） ms vs （8.8±6.2） ms; Tmsv 12-SD： （29.5＋30.8） ms vs （6.9±4.0） ms; Tmsv 6-SD： （28.9±34.6） ms vs （7.0±4.7）ms, all P≤0.001]. Tmsv 16-Dif, Tmsv 12-Dif and Tmsv 6-Dif were also significantly larger in the DCM group. There were close negative relations between the LVEF determined by RT3DE and each of the indexes of systolic asynchrony, among which the indexes of Tmsv-16-SD% and Tmsv-16-Dif% correlated most closely （r=-0.703 and r=-0.701, respectively）. The DCM patients had significantly larger EDV and ESV, with significantly reduced LVEF compared with the healthy subjects. Conclusion RT3DE provides a simple, useful and unique approach to assess the systolic synchronicity of all the left ventricular segments simultaneously.

Live three-dimensional transesophageal echocardiography in mitral valve surgery

Background Live three-dimensional transesophageal echocardiography （live-3D-TEE） is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.Methods Twenty-four patients with mitral valve disease （mean age （47.1±11.6） years, mean weight （64.7±10.5） kg） underwent live-3D-TEE and two dimensional transesophageal echocardiography （2D-TEE） before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon＇s findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases （12.5%） preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired （4.2%） using guidance by live-3D-TEE.Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.

Three-dimensional and two-dimensional morphological features of patent foramen ovale revealed by transesophageal echocardiography

Patent foramen ovale （PFO）, a congenital cardiac lesion that persists into adulthood, has become the subject of much clinical interest. PFO has been implicated in several serious clinical syndromes, including paradoxical systemic emboli （which contribute to ischemic stroke）, myocardial infarction, and complications of pulmonary embolism. Currently, two-dimensional transesophageal echocardiography （TEE） is the standard procedure for diagnosing PFO. The diameter and contrast score have been used to size the PFO.~ None of these techniques is optimal as they are all indirect ways of measuring PFOs. Few data exist on the relation between stroke risk, anatomical characteristics, and physiological behavior. The purpose of our study therefore was to explore the clinical feasibility of sizing or displaying the morphology and physiological behavior of PFOs using three-dimensional TEE.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Assessment of Aortic Root Mechanics in Hypertensive Patients by Speckle Tracking Echocardiography

Objectives: Hypertension is a major risk factor for several cardiovascular diseases, including stroke, atherosclerosis and coronary heart disease. Remodeling of the aortic root may be expected to occur in hypertensive subjects as a result of increased stress on the aortic wall due to the repeated hemodynamic overload. Two-dimensional speckle tracking echocardiography is a promising new imaging modality. The aim of this study is to assess aortic root mechanics in relation to left ventricular mechanics in hypertensive patients by speckle tracking echocardiography. Methods: The study included 50 individuals, 30 patients with hypertension compared with 20 age and sex matched healthy volunteers as control group. For both groups, conventional echo was done and speckle tracking echocardiography of the LV including longitudinal, circumferential, radial strain, LV rotation and the longitudinal strain of the ascending aorta and aortic distensibility were measured. Results: Aortic longitudinal strain of both anterior and posterior walls, andalso LV longitudinal peak systolic strain were lower significantly in patient group, and also in the same group, the apical rotation was higher than control;aortic longitudinal strain was negatively correlated with E/E, and LV global longitudinal strain was correlated positively with septal annular E wave peak velocity and with aortic distensibility. Conclusion: Hypertension significantly lowers ascending aortic longitudinal strain and the changes are correlated significantly with LV longitudinal systolic function and with echo parameters of elevated LV filling pressure.