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Objective:To investigate the safety and efficacy of echocardiography-guided trans-right-ventricular percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in a healthy sheep model, and to observe the pathological changes of myocardium in ablation area one year later.Methods:Twelve sheep were divided into PIMSRA group ( n=6) and sham group ( n=6). In PIMSRA group, a radiofrequency (RF) electrode was inserted to the interventricular septum (IVS) with maximum power of 80 Watts for 5 minutes. In the sham group, RF electrode tip was positioned in IVS segment but without the RF power delivery. Electrocardiogram (ECG), echocardiography, myocardial contrast echocardiography(MCE) were performed to assess the efficacy of PIMSRA at postoperative immediately, 2-week, 1-month, 2-month, 3-month, 6-month and 12-month during the follow-up. The following parameters were recorded, including the thickness of ablation area, the systolic wall thickening rate and amplitude of movement of the ablated region, left ventricular outflow tract pressure gradient (LVOT PG), and left ventricular ejection fraction (LVEF), mitral valve early diastolic peak velocity(E), late diastolic peak velocity(A) and the E/A ratio, peak velocity of early diastolic mitral annular motion(E′), peak velocity of late diastolic mitral annular motion(A′), and the E′/A′ ratio.For both groups, the myocardial biomarkers of troponin I, myoglobin and isoenzymes of creatine kinase were tested before the ablation and 3 h after the ablation, and again after 2 weeks. Tissue pathology examinations were performed at the end of study. Results:None of the animals in both groups was observed to have pericardial tamponade during perioperative period.Immediately after the procedure, septal hypokinesis was seen in all PIMSRA group animals, the systolic wall thickening rate and amplitude of movement of the ablated region were significantly decreased ( P<0.001), which was sustained until 12 months.In Sham group, there were no significant differences in the wall thickening rate and amplitude of movement of the operated region(all P>0.05).The thickness of the ablation area in the PIMSRA group was significantly increased immediately after the procedure( P<0.001), decreased to baseline level at 1-week ( P=0.931), and significantly increased at 3-month ( P<0.001).In the Sham group, the IVS thickness was significantly increased immediately after the procedure( P=0.005), decreased to baseline level at 1-week ( P=0.027), then has no further significant changes.There were no significant differences in LVEF, E/A, E′/A′ between PIMSRA and Sham group(all P>0.05).MCE showed the thickness of the ablation area was significantly decreased in the PIMSRA group 12 months after the operation.In both groups, troponin I increased significantly 3 h after the operation(all P<0.005), which decreased to baseline level 2 weeks later(all P>0.05). ECG showed that all the sheep had normal sinus rhythm. Pathological examinations revealed the tissue in the ablation area was fibrotic, having clear boundary with the surrounding normal tissue and no carbonization was observed 1 year later. Conclusions:Echocardiography-guided trans-right-ventricular PIMSRA produced precisely ablated myocardial tissues, reduced the IVS thickness significantly, preserved the global left ventricular function. All the sheep had normal sinus rhythm and without pericardial tamponade in 1 year follow-ups. Echocardiography-guided trans-right-ventricular PIMSRA is a safe and effective minimally invasive treatment for septal reduction therapy.
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Objective@#To assess the bi-ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy (HOCM) after modified Morrow surgery by three-dimensional speckle tracking echocardiography (3D-STE).@*Methods@#Twenty-eight patients with HOCM who underwent modified Morrow surgery from August 2013 to September 2016 in Xijing Hospital were consecutively included in this study. Routine and full-volume echocardiographic images were collected before and after surgery, 3D-STE echocardiographic data were analyzed by TomTec software to calculate left and right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), as well as the longitudinal strain(LS), circumferential strain(CS), radial strain(RS) of the 16 segments of left ventricle. The left atrial maximum volume(LAVmax), left atrial minimum volume (LAVmin), left atrial stroke volume(LASV), left atrial ejection fraction(LAEF) were obtained, as well as right ventricular longitudinal strain of septum [RVLS(S)], right ventricular longitudinal strain of free wall[RVLS(FW)], tricuspid annular planesystolic excursion(TAPSE), right ventricular fractional area change(RVFAC).@*Results@#Compared with baseline, the IVS thickness were significantly reduced, LVOT pressure gradient were significantly decreased, LVOT diameter were increased significantly (all P<0.05). The LS in the basal part of anterior and lateral wall were increased significantly (all P<0.05). The CS in basal and middle part of lateral wall were increased significantly (all P<0.05). The RS in basal part of anterior, lateral and posterior wall, as well as in the middle part of anterior and lateral wall were increased significantly( all P<0.05). The LAVmax, LAVmin and LASV were decreased, and the LAEF was increased(all P<0.05). The RVLS(FW) and the TAPSE were increased significantly( all P<0.05).@*Conclusions@#After modified Morrow surgery in HOCM patients, the morphological remodeling of left ventricle, left atrium and right ventricle are improved, accompanied by the improvement of the function. 3D-STE is valuable in evaluating the efficacy of modified Morrow surgery in HOCM patients.
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Objective:To assess the bi-ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy (HOCM) after modified Morrow surgery by three-dimensional speckle tracking echocardiography (3D-STE).Methods:Twenty-eight patients with HOCM who underwent modified Morrow surgery from August 2013 to September 2016 in Xijing Hospital were consecutively included in this study. Routine and full-volume echocardiographic images were collected before and after surgery, 3D-STE echocardiographic data were analyzed by TomTec software to calculate left and right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), as well as the longitudinal strain(LS), circumferential strain(CS), radial strain(RS) of the 16 segments of left ventricle. The left atrial maximum volume(LAVmax), left atrial minimum volume (LAVmin), left atrial stroke volume(LASV), left atrial ejection fraction(LAEF) were obtained, as well as right ventricular longitudinal strain of septum [RVLS(S)], right ventricular longitudinal strain of free wall[RVLS(FW)], tricuspid annular planesystolic excursion(TAPSE), right ventricular fractional area change(RVFAC).Results:Compared with baseline, the IVS thickness were significantly reduced, LVOT pressure gradient were significantly decreased, LVOT diameter were increased significantly (all P<0.05). The LS in the basal part of anterior and lateral wall were increased significantly (all P<0.05). The CS in basal and middle part of lateral wall were increased significantly (all P<0.05). The RS in basal part of anterior, lateral and posterior wall, as well as in the middle part of anterior and lateral wall were increased significantly( all P<0.05). The LAVmax, LAVmin and LASV were decreased, and the LAEF was increased(all P<0.05). The RVLS(FW) and the TAPSE were increased significantly( all P<0.05). Conclusions:After modified Morrow surgery in HOCM patients, the morphological remodeling of left ventricle, left atrium and right ventricle are improved, accompanied by the improvement of the function. 3D-STE is valuable in evaluating the efficacy of modified Morrow surgery in HOCM patients.
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Objective To investigate the safety and long-term efficacy of a new treatment,echocardiography-guided transthoracic laser ablation of the animal interventricular septum (IVS),for obstructive hypertrophic cardiomyopathy (HOCM).Methods Ten healthy sheep were randomly divided into two groups:experimental group:sheath puncture with laser ablation (energy:3 W,1000 J),sham control group:sheath puncture only without laser ablation.Echocardiography and electrocardiogram (ECG) were recorded before operation,immediately after operation,and 1,3 and 6-month after the operation.Left ventricular systolic and diastolic function,longitudinal strain,difference of time to peak between the ablation segment and the surrounding segments were analyzed.Blood samples were collected before and one hour after the operation to examine the serological results.Results Immediately and 6 months after the operation,all animals survived with normal cardiac function.No severe complications such as cardiac tamponade or bundle branch block occurred.The Troponin I level was significantly elevated immediately after the operation(P ＜0.05).The thickness of the ablated IVS was significantly reduced 6 months after the operation compared with before the operation[(3.23 ± 1.21)mm vs (8.53 ± 0.44)mm,P ＜0.05].Mmode echocardiography showed that the amplitude of movement of the ablated region of the experimental group 6 months after the operation was significantly decreased compared with the control group (P ＜0.05).Three dimensional strain analysis showed that for the experimental group,the longitudinal strain of the ablation segment was significantly reduced and the difference of time to peak was significantly delayed,compared with the control group(P ＜0.05).Conclusions Echocardiography-guided transthoracic laser ablation of IVS is a safe,effective,and minimally invasive method.It is capable to reduce the volume of IVS without influencing the cardiac function,which makes it a potential alternative for HOCM treatment.
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Objective@#To investigate the safety and long-term efficacy of a new treatment, echocardiography-guided transthoracic laser ablation of the animal interventricular septum (IVS), for obstructive hypertrophic cardiomyopathy (HOCM).@*Methods@#Ten healthy sheep were randomly divided into two groups: experimental group: sheath puncture with laser ablation (energy: 3 W, 1000 J), sham control group: sheath puncture only without laser ablation. Echocardiography and electrocardiogram (ECG) were recorded before operation, immediately after operation, and 1, 3 and 6-month after the operation. Left ventricular systolic and diastolic function, longitudinal strain, difference of time to peak between the ablation segment and the surrounding segments were analyzed. Blood samples were collected before and one hour after the operation to examine the serological results.@*Results@#Immediately and 6 months after the operation, all animals survived with normal cardiac function. No severe complications such as cardiac tamponade or bundle branch block occurred. The Troponin I level was significantly elevated immediately after the operation(P<0.05). The thickness of the ablated IVS was significantly reduced 6 months after the operation compared with before the operation[(3.23±1.21)mm vs (8.53±0.44)mm, P<0.05]. M-mode echocardiography showed that the amplitude of movement of the ablated region of the experimental group 6 months after the operation was significantly decreased compared with the control group(P<0.05). Three dimensional strain analysis showed that for the experimental group, the longitudinal strain of the ablation segment was significantly reduced and the difference of time to peak was significantly delayed, compared with the control group(P<0.05).@*Conclusions@#Echocardiography-guided transthoracic laser ablation of IVS is a safe, effective, and minimally invasive method. It is capable to reduce the volume of IVS without influencing the cardiac function, which makes it a potential alternative for HOCM treatment.
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Objective To evaluate left ventriclular systolic function in patients with obstructive hypertrophic cardiomyopathy (HOCM) after modified Morrow surgery using two-dimensional speckle tracking imaging (2D-STI).Methods Twenty three HOCM patients were recruited in this study.Echocardiographic data from HOCM patients during pre-operation,1-month and 3-month post-operation were analyzed by Qlab software to compare the variation in systolic function indicators 1-month and 3-month post-operation including global and 16 segmental longitudinal strain,circumferential strain and conventional echocardiographic parameters of left ventricle.Results Compared with preoperative data of HOCM patients,postoperative LVOT diameter and pressure gradient,left atrial diameter and volume index were significantly decreased(P<0.05),but there was no significant difference in left ventricular ejection fraction(P<0.05).Compared with the preoperative case,global and segmental longitudinal strain showed significant reduction after 1 week and gradually recovered after 3 months,without significant variation.The longitudinal strain of the anteroseptum reduced significantly and the longitudinal strain of the free wall increased after 3 months,however,the circumferential strain reduced significantly.The circumferential strain of basal and middle segment after 3 months had improved significantly than those of postoperative 1 week.The circumferential strain of surgical site is no obvious change and the strain of free wall was improved after 3 months.Conclusions 2D-STI can effectively evaluate global and regional systolic function of left ventricle for HOCM patients after modified Morrow surgery.
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Objective To explore the feasibility and the value of ultrasound transient elastography in the estimation of intraocular pressure.Methods Thirty-two cases of glancomatous patients' and twenty-eight healthy subjects'eyeball were examined by using ultrasound transient elastography,meanwhile using Photoshop image analysis software to quantitative analysis of blue gradation ratio of the front wall tissue of eyeball,then intraocular pressure were examined by NCT.The difference of quantitative data of blue gradation ratio of the front wall tissue of eyeball between glancomatous patients and healthy subjects were compared.The relationship of quantitative value of blue gradation ratio and intraocular pressure were established.Results The blue gradation ratio of the front wall tissue of eyeball in glancomatous patients were 0.37± 0.03,while in healthy subjects were 0.33 ± 0.02,there was a significant difference between glancomatous patients and healthy subjects (P < 0.01),and there was a linear relation between blue gradation ratio and intraocular pressure(r = 0.424,P < 0.05).Conclusions The ultrasound transient elastography can be used in estimation of intra-ocular pressure in glancomatous patients,and there is a linear relation in quantitative data between blue gradation ratio and intraocular pressure.
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Objective To determine which parameters of reverse remodeling of left ventricular could become the effective indexes in evaluating the short-term therapeutic effect of cardiac resynchronization therapy(CRT)in heart failure(HF)patients.Methods CRT was performed in 26 HF patients with dysfunctions of wall motion.Serial echocardiography was practiced at baseline,one and three months after CRT.The parameters including left atrial end-diastolic diameter(LADD),left ventrieular end-diastolic diameter(LVDD),end-diastolic volume (LVEDV),end-systolic volume(LVESV),ejection fraction(LVEF)were measured and compared before and after CRT therapy.Results At one and three months after CRT,respectively,CRT was associated with reduced LADD,LVDD,LVEDV,LVESV and improved LVEF and filling time compared with those at baseline.Moreover,all these parameters had better correlations with the activities of these patients.Conclusions LADD,LVDD,LVEDV,LVESV and LVEF could become the effective indexes in evaluating the short-term effect of CRT in HF patients.The reduced diameters and volumes of left atria and left ventricle are more sensitive parameters than the improved LVEF.