Perioperative echocardiography in minimally invasive surgery for hypertrophic obstructive cardiomyopathy.

BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) is clinically symptomatic and prone to malignant arrhythmias and sudden cardiac death (SCD). Currently, an effective treatment is surgical resection of the hypertrophic ventricular septum to relieve the left ventricular outflow tract (LVOT) obstruction and mitral insufficiency. Our center performs an innovative, minimally invasive right infra-axillary thoracotomy for transaortic septal myectomy. Minimally invasive procedures rely more on perioperative transesophageal echocardiography (TEE). This study aimed to explore the use of echocardiography during the perioperative period of surgical intervention for HOCM. METHODS: Between August 2021 and April 2022, 27 patients with HOCM underwent cardiac surgery at our hospital. Minimally invasive transaortic septal resection (Morrow myectomy) was performed from the right axilla. The extent of myectomy and need for mitral valve repair were based on perioperative TEE assessment and surgical findings. The demographic parameters and clinical data of patients were recorded. The cardiopulmonary bypass time, aortic cross-clamp, and mechanical ventilation times were calculated. TEE was used to assess ventricular wall thickening and anatomical abnormalities of mitral regurgitation, assist in intravenous catheterization, and assess the postoperative gradients of the LVOT. RESULTS: Among the 27 patients with HOCM who underwent transaortic septal myectomy by minimally invasive right infra-axillary thoracotomy, 16 had LVOT obstruction, 2 had mid-LV obstruction, and 9 had both LVOT and mid-LV involvement. TEE provides information about the fine structure of the LV cavity and the etiology of the obstruction. In all cases, LVOT obstruction and mitral valve systolic anterior motion were resolved postoperatively, and the degree of mitral regurgitation was significantly reduced. CONCLUSION: Perioperative echocardiography provides valuable information regarding the complex etiology of LVOT obstruction during minimally invasive right infra-axillary thoracotomy for transaortic septal myectomy. It helps determine the extent of septal resection and assess the need for concomitant mitral valve repair.

Mitral Geometry on the Mechanism of Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy.

OBJECTIVE: The mechanism of left ventricular outflow tract obstruction (LVOTO) is complex in hypertrophic cardiomyopathy (HCM). We aimed to evaluate the impact of mitral valve geometry on LVOTO by echocardiography. MATERIALS AND METHODS: The study population comprised 177 consecutive patients with HCM. Morphological findings of left ventricular hypertrophy and LVOTO-related abnormalities were assessed by comprehensive transthoracic echocardiography. Aortomitral angle, mitral leaflet length, and coaptation height were measured and analyzed at rest. Multivariable stepwise forward logistic regression analysis was performed to identify geometric predictors of LVOTO. RESULTS: One hundred thirty-seven patients had an LVOT gradient ≥30 mm Hg. Multivariable logistic regression showed that aortomitral angle (odds ratio [OR], 0.89; 95% CI, 0.83-0.95, P < .001), coaptation height (OR, 1.96; 95% CI, 1.41-2.72, P < .001), and accessory mitral valve chordae tendineae (OR, 13.1; 95% CI, 4.32-39.95; P < .001) were independently associated with LVOTO. Receiver operating characteristic analysis showed that the area under the curve of mitral coaptation height was higher (area under the curve = 0.815) than the other 2 indicators (P < .05). CONCLUSION: Mitral coaptation height, aortomitral angle, and accessory mitral valve chordae tendineae were important predictors of SAM and LVOTO in HCM independent of septal hypertrophy.

Preliminary exploration of theory and practice training of 5G ultrasonic remote consultation in grassroot hospitals.

BACKGROUND: With the rapid development of science and technology, telemedicine diagnosis and treatment systems have gradually attracted increased attention and applications.5G ultrasound is an important branch of telemedicine, connecting grassroots hospitals at one end and provincal hospitals at the other, which provides remote guidance to grassroots doctors for ultrasound examination and image diagnosis. It is convenient for villagers obtaining diagnosis and advice from provincial ultrasound experts, saving time and economic costs, as well as benefiting from high-quality ultrasound medical resources. In this study, taishun County community grassroot hospitals were selected as the pilot study of 5G ultrasound application, to explore the effectiveness of their theory and practice, and gradually improve the remote ultrasound diagnosis and treatment standards, so as to improve their quality of grassroots hospitals and benefit grassroots people.  METHODS: This is a descriptive study. The Provincal Hospital will conduct ultrasonic theory and practice training for grassroot hospitals. The training subjects included 43 doctors in grassroots hospitals who were willing to carry out ultrasound examinations. Theories, skills training scores and trainees' questionnaires on teaching content were collected and analyzed. After passing theoretical and practical training, they will conduct ultrasound examinations in their respective communities and collect relevant cases. There are 148 cases thus far for analysis. It mainly included the type of disease, whether the patient was out-patient or inpatient, frequency of ultrasound visits in recent 5 years, and follow-up treatment measures. RESULTS: It mainly included three aspects: (1) Through theoretical and practical training, the ultrasonic diagnosis level of grassroot doctors was significantly improved. The difference in scores between the two practical trainings was statistically significant. (2) Forty-three questionnaires were sent out, feedback from trainees was very high. Most of them was very satisfied with our training. The total score of the questionnaire was 10, and 97.67% of them score more than 8. (3) In total, there were 148 remote consultation cases, including 67 males and 81 females, who were aged 21 to 101 years old (62.40 ± 15.73).mainly abdominal ultrasound, and typical cases involve fatty liver, hepatic cyst, gallbladder stone, kidney stone and so on. We analyzed case data and provided follow-up treatment recommendations. CONCLUSION: As a "visual apparatus", 5G ultrasound can be routinely carried out in grassroot hospitals, which can provide mutual benefit between doctors and patients and comprehensively promote healthy villages.

Mechanism by which salt stress induces physiological responses and regulates tanshinone synthesis.

Salvia miltiorrhiza is a traditional Chinese herbal medicine with tanshinone as one of the main bioactive components and has antitumor, antibacterial, anti-inflammatory properties, as well as other physiological functions. Tanshinone, as a secondary metabolite, is synthesized under salt stress or other environmental stresses. Oxidative stress is an important physiological response of plants to salt stress. Transcription factors (TFs) are believed to play regulatory roles in this process, and AP2/ERF TFs have significant effects on defense against the adversity of plants. However, investigations on the regulation of AP2/ERF TFs in tanshinone synthesis under salt stress are limited. In this research, the tanshinone content, related gene expression and activities of enzymes, and the markers of oxidative stress were determined. The results showed that SmAP1, SmAP2 and SmERF2 were AP2/ERF TFs with AP conserved sequences, whose relative expression levels increased and were positively correlated with the contents of tanshinone I (T-I), tanshinone IIA (T-IIA) and cryptotanshinone (CT) in the roots of Salvia miltiorrhiza. The content of malondialdehyde (MDA) and the activities of superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) increased in the roots of Salvia miltiorrhiza. The expression levels of genes encoding enzymes and the activities of key enzymes in the tanshinone biosynthesis pathway increased accordingly. The results showed that AP2/ERF TFs could positively regulate the biosynthesis of tanshinone in the roots of Salvia miltiorrhiza under salt stress.

Pulmonary arteriovenous fistula diagnosed by transthoracic contrast echocardiography: A case report.

We report the case of a 38-year-old woman who was admitted due to right limb numbness. A right-to-left shunt (RLS) was detected by transthoracic contrast echocardiography (cTTE), and microbubbles appeared in the left heart seven cardiac cycles after opacification of the right heart, suggesting pulmonary arteriovenous fistula. This was supported by computed tomography angiography. She underwent thoracoscopic partial right lower pneumonectomy and recovered after surgery. At 1 year follow-up, she had no relapse of stroke or cerebral infarction. This case shows the typical signs of pulmonary arteriovenous fistula on contrast-enhanced trans-thoracic echocardiography, which allowed an accurate and rapid diagnosis.

Diagnosis and treatment of infective endocarditis in pregnancy: a case report.

BACKGROUND: Pregnancy with infective endocarditis (IE) is rare, but the fetal and maternal mortality rates of these pregnancies are very high, making IE a serious threat to the safety of pregnant women and their fetuses. Therefore, for pregnant women with recurrent fever, a detailed medical history and physical examination should be performed, echocardiography and blood culture should be carried out as soon as possible, multidisciplinary consultation should be implemented, and a diagnosis and treatment plan should be formulated right away, as this is key to saving the lives of mothers and infants. CASE INTRODUCTION: A 30-year-old pregnant Chinese woman had IE at 26 weeks of gestation. After close monitoring and care until 31 weeks of gestation, she underwent a successful delivery, cardiac surgery, repair of the patent ductus arteriosus (PDA), mitral valvuloplasty (MVP) and removal of the vegetations. The operation was successful, and further follow-up evaluation showed no abnormality. CONCLUSION: For the diagnosis and treatment of IE in pregnancy, it is of great importance to implement an individualized diagnosis and treatment plan in combination with close monitoring by echocardiography and to select the right time for cardiac surgery and termination of pregnancy.

Mammography and ultrasound effective features in differentiating basal-like and normal-like subtypes of triple negative breast cancer.

The aim of our study was to find effective features of mammography and ultrasound in differentiating Basal-like breast cancer (BBC) and Normal-like breast cancer (NBC), two subtypes of triple negative breast cancer (TNBC). From January 2014 to March 2017, we retrospectively reviewed 91 patients who were pathologically confirmed as TNBC. According to immunohistochemical cytokeratin 5/6 (CK5/6) and Epidermal Growth Factor Receptor (EGFR), TNBCs were classified into BBCs group and NBCs group. Both CK5/6 and EGFR were negative defined to be NBC, whereas if any of CK5/6 or EGFR was positive then defined as BBC. BBCs group concluded 65 (71.4%) cases and NBCs group concluded26 (28.6%) cases. Ultrasound images and mammograms were reevaluated by breast imaging experts according to the breast imaging reporting and data system (BI-RADS) 4th edition. On mammography, masses margins had significant differences between BBCs group and NBCs group (P = 0.024). Most BBCs margins exhibited microlobulated (30/64, 46.9%) or spiculated (25/64, 39.0%), whereas most NBCs margins exhibited microlobulated (17/23, 73.9%). On ultrasound, BBCs were more frequently to present as larger than 20mm lesions (52/65, 80.0%) and more likely to have angular or spiculated margins (35/65, 53.8%), additionally, compared with NBCs, BBCs were less likely to have calcification (1/65, 1.5%). Other mammography and ultrasound features showed no significant differences between the two groups. In conclusion, we have found some effective features of mammography and ultrasound that could be helpful in differentiating BBC and NBC, which will provide some useful references for clinical diagnosis and treatment.