肺动脉高压( pulmonary artery hypertension, PAH) 是右心衰竭的首要原因, 而右心衰竭又是 PAH 患者的重要致命因素, 及时而准确地对肺动脉高压患者的右心室功能做出评价, 对其病情评估、治疗决策和预后判断有重要的意义。近年来新发展的超声心动图二维应变及应变率技术、实时三维成像技术、Tei 指数及三尖瓣环收缩期位移等新技术弥补了传统超声评价右心功能的不足。本文就超声新技术在评价PAH 患者右心功能的应用做一综述。
We tried to explore the value of contrast echocardiography (CEcho) on evaluating hypertrophic cardiomyopathy (HCM) with the inferior wall hypertrophy. A total of 114 patients with HCM were investigated. All the patients received CEcho and routine echocardiography (Echo), and 45 of them received cardiac magnetic resonance (CMR) and 47 of them received Holter. The frequency and percentage of inferior wall hypertrophy were analyzed in HCM patients, as well as the structure and function. The results showed that: (1) Inferior wall hypertrophy was detected in 55 patients (48%) by Echo, while 68 patients (60%) by CEcho. (2) There was no significant difference between CMR and CEcho in the measurement of inferior wall at end-diastole and end-systole. Thickness of inferior wall by CEcho tended to be higher than CMR. However, the inferior wall thickness measured by Echo was obviously lower than that by CMR (P < 0.05) and CEcho ( P < 0.05). (3) Bland-Altman plot suggested good consistency between CEcho and CMR in measuring inferior wall thickness. 95% CI of mean differences in inferior wall thickness between CEcho and CMR were smaller in HCM patients as compared with that between Echo and CMR. Unary linear regression analysis showed good degree of fitting between CEcho and CMR. (4) Holter showed that HCM patients with inferior wall hypertrophy were likely to have higher incidence of premature ventricular complexes (PVC) ≥ 500/24 h. We demonstrate that CEcho is rather sensitive in detecting inferior wall hypertrophy. Echo may underestimate the inferior wall thickness. The risk of ventricular premature beats may increase in HCM patients with inferior hypertrophy.
Objective To explore the application value of echocardiography in the differential diagnosis of Fabry disease and hypertrophic cardiomyopathy (HCM). Methods Baseline data and echocardiographic parameters of Fabry disease patients and HCM patients admitted to the First Affiliated Hospital of Xi’an Jiaotong University between January 2022 and January 2024 were selected and compared between groups. The diagnostic ability for Fabry disease and HCM was analyzed using receiver operating characteristic curves and area under the curve (AUC). Results A total of 16 Fabry disease patients and 41 HCM patients were included. The Fabry disease group had lower age, body mass index, proportion of electrocardiogram abnormalities, and smoking history than the HCM group (P<0.05); the Fabry disease group had a longer medical history than the HCM group (P<0.05). The maximum thickness of the left ventricular myocardium and the ascending aortic diameter in the Fabry group were both smaller than those in the HCM group (P<0.05). The e-peak velocity in the Fabry group was greater than that in the HCM group (P<0.05). For the differential diagnosis of Fabry disease and HCM, the AUC for the e-peak velocity was 0.698 [95% confidence interval (0.502, 0.894), P<0.05], sensitivity was 41.7%, specificity was 100%, and Youden index was 41.7%. When the three factors were combined, both sensitivity and accuracy were significantly higher than the e-peak. The AUC was 0.773 [95% confidence interval (0.585, 0.961), P<0.05], with a sensitivity of 100% and specificity of 45.5%. There were no statistically significant differences in the 2D-speckle tracking imaging echocardiography parameters between the two groups, including global longitudinal strain of the left ventricle, strain of the apical segment, strain of the basal segment, and so on (P>0.05). Conclusion Echocardiography may have certain significance in the diagnosis of Fabry disease and HCM.
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.
We reported a 65-year-old female who was admitted to our institute with "recurrent subxiphoid pain accompanied by dyspnea for more than 10 days". Electrocardiogram examination suggested acute extensive anterior ST segment elevation myocardial infarction. Preoperative transthoracic echocardiography suggested ventricular septal rupture. The patient was planned for the repair of ventricular septal rupture with cardiopulmonary bypass. The formation of left ventricular aneurysm was diagnosed by intraoperative transesophageal echocardiography (TEE). The surgeon decided to abdopt the modified incision of left ventricular approach guided by TEE, which greatly improved the prognosis of the patient. The surgery duration was 197 min, aortic cross-clamping time was 56 min, cardiopulmonary bypass time was 69 min, and the patient was safely admitted to ICU after the surgery. Extubation was performed on the first day postoperatively, and the intra-aortic balloon pump support was retreated on the second day postoperatively. Postoperative echocardiography showed that no obvious residual shunt was observed after ventricular septal repairment and ventricular aneurysm resection. The patient was discharged on the 12th day after the surgery. Additionally, the mental condition was good and daily activities were not limited within 6 months postoperatively.
Objective To investigate the correlation between the left atrial hydrodynamic change and atrial fibrillation (AF) in the patients with rheumatic mitral stenosis. Methods According to cardiac rhythm before operation, 49 patients with rheumatic mitral stenosis accompanying chronic AF were divided into two groups,group A: AF, 25 cases; group B: sinus rhythm, 24 cases. Control group : 29 healthy volunteers were examined. By using echocardiography, left atrial hydrodynamics were tested, and repeated 6-8 months after the operation. Results Left atrial stress (LAS), left atriala area (LAA) and left atrial volume(LAV) in group A after operation was much lower than before operation, LAS after operation in group B was also lower than before operation(Plt;0.01). Before operation, LAS in group A was significantly lower than that in group B, LAA and LAVwere larger. After operation, LAA and LAV in group A were significantly larger than those in group B(Plt;0.01). LAS, LAA and LAV in group A and group B before and after operation were higher than those in control group. Conclusion Left atrial hydrodynamic enviroment in patients with mitral stenosis has not reached normal even after valve replacement, LAS may be an important factor of causing AF.
Objective To analyze the midterm outcome of patients with congenital aortic stenosis undergoing percutaneous balloon aortic valvuloplasty (PBAV) by single echocardiographic guidance. Methods The clinical data of 12 patients with congenital aortic stenosis who underwent PBAV by single echocardiographic guidance at Fuwai Hospital from January 2016 to November 2017 were retrospectively analyzed. There were 7 males and 5 females with an average age of 18.27±15.30 years. The preoperative peak pressure gradient was 61.8–110.0 (80.30±24.50) mm Hg, and 50% of patients had aortic regurgitation. Results All patients successfully underwent PBAV. Aortic annulus diameter was 18.65±3.17 mm and balloon diameter was 17.62±3.77 mm, with balloon diameter to annulus diameter ratio of 0.92±0.07. The peak transaortic gradient was 16-51 (36.72±12.33) mm Hg immediately after procedure, which was significantly different from the preoperation (P=0.000). During the follow-up period, the peak transaortic gradient was 21-58 (37.06±13.52) mm Hg, and there was no significant difference between the follow-up and immediate postoperation (P=0.310). Immediately after procedure and during follow-up, 58% of patients had aortic regurgitation, which was not statistically different from the preoperation (P=0.682). Conclusion Systematic use of Doppler echocardiographic guidance for PBAV is feasible, and that it is associated with a high success rate and a very low complication rate.
ObjectiveTo evaluate the ultrasonic pre locating internal jugular venous cannulation in infants, comparison with the external landmark technique.MethodsSixty two infants scheduled for cardiac surgery were randomized prospectively into two groups. In the anatomic landmarks group( n =30), the patient’s internal jugular vein(IJV) were cannulated by using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks. In the ultrasonic pre locating group ( n =32), an two dimensional ultrasound scanner image made for locating the puncture site of vessels was used with an operative probe of HP SONOS 4500 system. The number of attempts, success rate, and incidence of complications were compared for two groups.ResultsThe success rate was 100% vs 80% in the ultrasonic pre locating group vs anatomic landmarks group, with a 3.1% vs 26 7% incidence of carotid artery punctures and the number of attempts 1.57±1.04 vs 2.55±1.76. All differences were statistically significant ( P lt;0.05,0.05,0.01). Conclusion Ultrasonographic pre-localization of the IJV is superior to the anatomic landmarks technique in terms of overall success , and decreases incidence of carotid artery puncture.