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BACKGROUND@#MAVERIC (Mitral Valve Repair Clinical Trial) validates the safety and efficacy of the ARTO system. We here report the first two successful cases of utilizing the ARTO system in patients with symptomatic heart failure (HF) with functional mitral regurgitation (FMR) in Asia.@*METHODS@#Two patients, aged 70 and 63, had severe HF with FMR. Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50% with severe mitral regurgitation (MR) in both patients. Optimizing drug treatment could not mitigate their symptoms. Therefore, we used the ARTO system to repair the mitral valve for these patients on March 5 and 6, 2019, respectively.@*RESULTS@#Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients. MR was decreased immediately after the procedures in both patients. The 30-day and 3-month transthoracic echocardiography (TTE) revealed a moderate to severe MR in both patients, and the New York Heart Association (NYHA) scales were also partially improved.@*CONCLUSION@#The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR, and the patient selection appears to be crucial.
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BACKGROUND@#Transapical off-pump NeoChord procedure is a novel minimally invasive surgical repair of degenerative mitral regurgitation (MR). Here, we report the first four cases of NeoChord procedure in patients with mitral valve prolapse in Chinese mainland.@*METHODS@#Four patients, aged 86, 84, 80 and 60 years, with severe MR due to posterior middle scallop prolapse (P2), underwent transapical off-pump artificial chordae implantation on April 9 and 10, 2019. The procedure was performed by left mini-thoracotomy under general anaesthesia and guided by 2D and 3D dimensional transoesophageal echocardiography (TEE).@*RESULTS@#Mitral valve repair via NeoChord procedure was successfully performed with implantation of 3 artificial chordae in the first patient and 3, 2, and 3 artificial chordae in the following patients, respectively. Intraoperative TEE and pre-discharge transthoracic echocardiography (TTE) showed only mild to moderate MR of these four patients and no postoperative complications were noted. There were no changes of TTE finding between one-month follow-up and pre-discharge.@*CONCLUSION@#The successful NeoChord procedures in four Chinese indicate that the valve repair using the NeoChord system for Chinese population is feasible.
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<p><b>OBJECTIVE</b>To investigate the aortic elastic properties and its clinical significance in intracranial aneurysms (IAs).</p><p><b>METHODS</b>One hundred and seven IAs patients (57 with hypertension) and 108 healthy subjects were recruited. The internal aortic diameters in systole and diastole were measured by the M-mode echocardiography, the aortic elasticity indexes were calculated and compared.</p><p><b>RESULTS</b>The aortic distensibility (DIS) was lower and the aortic stiffness index (SI) was higher in IAs patients than those in controls (both P <0.001). DIS was lower and SI was higher in IAs patients with hypertension (IAs-HP) than those in IAs with no hypertension (P <0.001). Similar results were obtained when the aortic elasticity index were adjusted for body surface area and body mass index.</p><p><b>CONCLUSION</b>Abnormal aortic elasticity is a common finding in IAs patients and hypertension is closely related to the severity of aortic elasticity.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Aorta , Diagnostic Imaging , Case-Control Studies , Elasticity , Intracranial Aneurysm , UltrasonographyABSTRACT
<p><b>BACKGROUND</b>Tissue Doppler imaging (TDI) has provided an objective means to quantify global and regional left ventricular (LV) and right ventricular (RV) function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension (PAH).</p><p><b>METHODS</b>A total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments (RV basal lateral wall, basal septal, and LV basal lateral) on apical 4-chamber view: systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view.</p><p><b>RESULTS</b>Compared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter (RA: (4.5 +/- 1.2) cm vs (3.0 +/- 0.8) cm, P < 0.05 and RV: (4.8 +/- 1.9) cm vs (3.4 +/- 0.5) cm, P < 0.05) and reduced RV fractional area change; (35 +/- 14)% vs (56 +/- 9)%, P < 0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls (P < 0.05). Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension (r = -0.82).</p><p><b>CONCLUSIONS</b>In PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Diastole , Echocardiography, Doppler , Hypertension, Pulmonary , Systole , Ventricular Dysfunction, Right , Ventricular Function, RightABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship between right ventricular (RV) mechanical delay and RV dysfunction in patients with pulmonary hypertension (PH).</p><p><b>METHODS</b>A total of 51 patients with PH were divided into mild, moderate and high PH groups and 30 healthy volunteers served as control group. RV mechanical delay (defined as the difference in time to peak systolic annular velocity between the RV free wall and the ventricular septum) and RV fractional area change were obtained on apical four chamber view with Quantitive Tissue Velocity Imaging (QTVI).</p><p><b>RESULTS</b>RV mechanical delay increases in proportion to pulmonary pressure. RV fractional area change was similar between control and mild PH patients while significantly reduced in moderate and high PH patients compared to controls. RV mechanical delay significantly correlated to RV fractional area change in all PH groups (r = -0.79; r = -0.66; r = -0.80, all P < 0.05).</p><p><b>CONCLUSION</b>RV mechanical delay measured by QTVI can be used to evaluate RV dysfunction in patients with pulmonary hypertension.</p>