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Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair, and evaluate the value of real-time three-dimensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation of valveplasty ring. A 4-0 Goretex sutures was used for reconstruction of artificial chordae. Realtime three-dimensional transesophageal echocardiography was performed in all the patients during the preoperative, intraoperatire, and postoperative periods. The length of the chordae tendineae under the A1 section of the anterior leaflet and the P1 section of the posterior leaflet were measured and considered the normal length of chordae tendineae by real-time three-dimensional transesophageal echocardiography preoperatively. These pre-determined normal chordal lengths helped intraoperatively to approximate the length of the artificial chordae used and postoperatively to gauge the success of the procedures. The same values were used again postoperatively to gauge the success of intervention. Full flexible valveplasty rings were used in all the patients.Results There was no operative death. The mean cardiopulmonary bypass (CPB) and aortic cross clamp time were ( 142. 0 ±31.2 ) min and (98.0 ± 22.5 ) min, respectively. One patient' s intraoperative echocardiography upon termination of CPB showed persistent severe mitral regurgitation and was converted to mitral valve replacement. This patient was not included in the study group. The mean number of artificial chordae per patient was (2.0 ± 1.5 ) , range from 1 to 3. The mean preoperatively measured normal chordal length was ( 21.0 ± 2.5 ) mm, and the mean postoperative artificial chordal length was ( 20.0 ± 2.2 )mm. The difference was not significant. The follow-up interval was from 3 to 30 months and the follow-up rate was 98%. During the follow-up period, there was no late death. Trace mitral regurgitation (MR) was detected in 15 patients, mild and moderate MR were detected in 1 for each. No severe MR was detected. The freedom from reoperation was 100% during follow-up.There were no documented artificial chordae ruptures. Conclusion Conclusion Artificial chordal replacement with Gore-tex suture in mitral valve repair in this group of patients with mitral valve prolapse appears to have satisfactory early and mid-term results. Real-time three-dimensional transesophageal echocardiography plays a critical role in this technique. Real-time threedimensional transesophageal echocardiography can exactly predict the length of artificial chordae, which is helpful to improve the outcomes of mitral valve repair. However, longer term follow-up and larger series are required to validate our findings.
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BACKGROUND: Tissue Doppler echocardiography (TDE) has been proved to evaluate general and local function of heart but less reported on adriamycin-induced cardiomyopathy following bone marrow stromal cell (BMS) transplantation.OBJECTIVE: To evaluate myocardial function of an adriamycin-induced cardiomyopathy rabbit model following BMS transplantation using TDE.DESIGN, TIME AND SETTING: A randomized animal control study was performed at Laboratory of Ultrasound, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from September 2002 to December 2003.MATERIALS: A total of 28 male adult Japanese rabbits weighing (2.0+0.2) kg were used in this study. Adriamycin was used to induce cardiomyopathy model in 20 rabbits.METHODS: Twenty-eight male Japanese rabbits were randomly divided into three groups: cell transplantation group (n=10),PBS group (n=10), and sham operation group (n=8). BMSs were isolated from cell transplantation group at the 8th day. On the 12th week, cells were labeled with 4, 6-diamidino-2-phenylindole (DAPI), and then epicardial directly injected into the myocardium of the same rabbits in thoracotomy surgery. Non-cell only culture fluid PBS was injected in PBS group. Sham operation group underwent thoracotomy surgery with the same volume of saline injection.MAIN OUTCOME MEASURES: Left ventricular function was assessed by conventional and tissue Doppler echocardiography before and 4 weeks after surgery. Histological examination including apotisis study and DAPI fluorescent were assessed after sacrificed.from (4.0+1.1) cm/s to (5.3+1.2) cm/s (P ＜ 0.05) around the inject site, but the improvement of global myocardial function was not found by conventional echocardiography. In PBS and sham operation group there were no differences in global and myocardium at 4 weeks after transplantation. Histological findings showed that the injury of the myocardium around the injection site was relieved with less apoptosis.
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Objective To evaluate left atrial function serial change after circumferential pulmonary vein ablation(CPVA)for paroxysmal atrial fibrillation using tissue Doppler echocardiography.Methods One hundred and eight patients with paroxysmal atrial fibrillation underwent CPVA guided by CARTO.Tissue Doppler imaging and conventional echocardiography were underwent 48 h before CPVA,48 h,1 month,3 month and 6 month after CPVA.Results One hundred and six patients with paroxysmal atrial fibrillation finished CPVA successfully.Compared tO 48 h pre-CPVA,left atrial diameter and volume decreased 48 h,1 month,3 month,6 month after CPVA,significant change were found at 3 month,6 month after CPVA(P＜0.05).Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD).left ventricular ejection fraction(LVEF),mitral flow E revealed no significant change(P＞0.05).Mitral flow A decreased significantly 48 h after CPVA(P＜0.05),restored significantly after 3 month.Tissue Doppler parameter S'and E'revealed no significant change(P＞0.05)through the period,A'decreased significantly 48 h after CPVA(P＜0.05),restored significantlv after 1 month.Conclusions Left atrial diameter and volume decreased after CPVA.Left atrial active contraction function decreased shortly after CPVA(LA stunning),and restored progressively.
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The volume-time curve change in patients with normal left ventricular (LV) diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography (RT3DE). LV diastolic dysfunction was defined by E'0.05). It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.
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Diastole/physiology , Echocardiography, Three-Dimensional/methods , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Function, Left/physiologyABSTRACT
The volume-time curve change in patients with normal left ventricular (LV) diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography (RT3DE). LV diastolic dysfunction was defined by E'＜A' in pulse-wave tissue Doppler for inter-ventricular septal (IVS) of mitral annulus. In 24 patients with LV diastolic dysfunction, including 12 patients with delayed relaxation (delayed relaxation group) and 12 patients with pseudo-normal function (pseudo-normal group) and 24 normal volunteers (control group), data of full-volume image were acquired by real-time three-dimensional echocardiography and subjected to volume-time curve analysis. EDV (end-diastolic volume), ESV (end-systolic volume), LVEF (left ventricular ejection fraction), PER (peak ejection rate), PFR (peak filling rate) from RT3DE were examined in the three groups. Compared to the control group, PFR (diastolic filling index of RT3DE) was significantly reduced in the delayed relaxation group and pseudo-normal group (P＜0.05). There were no significant differences in EDV, ESV, LVEF, PER (P＞0.05). It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.
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AIM: To evaluate myocardial relaxation function changes in an adriamycin-induced cardiomyopathy model using the transmitral flow velocity to mitral annular velocity ratio (E/E'), a strong positive relationship with left ventricular filling pressure and a good indicator for evaluating left ventricular diastolic relaxation abnormality. METHODS: Twenty-eight Japanese rabbits were divided into two groups. Adriamycin was administered at cardiomyopathy model. 8 rabbits served as controls receiving the same amount of saline once a week for a total of 8 weeks. Conventional and tissue Doppler echocardiography (TDE) were performed at baseline, 4th, 6th,8th, 10th and 12th week. RESULTS: In the adriamycin-treated group, LV chamber diameter significantly increased, while ejection fraction and fraction shortening significantly decreased in 10th and 12th week (P ＜0.05). The significant changes were firstly found in 10th week. Mitral annulus systolic peak velocity (S') by TDE significantly decreased in 8th, 10th and 12th week ( P ＜0.05). The significant changes were firstly found in 8th week. The ratio of E/E' significantly increased in 6th,8th, 10th and 12th week (P ＜ 0.05). The significant changes were firstly found in 6th week. In the control group, no significant changes were found in all parameter by tissue Doppler conventional echocardiography (P ＞0.05). CONCLUSION: Myocardial function is reduced in adriamycin-induced rabbit model of dilated cardiomyopathy. The relaxation parameter (E/E') by TDE changes is earlier than contraction indices S' by TDE and conventional echocardiography in adriamycin-induced cardiomyopathy rabbits, which provides a new sensitive and reliable method to evaluate LV relaxation function.
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Objective To improve the understanding of cardiac valve involvement in Behcet's disease (BD).Methods The echocardiographic manifestations of 13 patients with BD were analysed and the results of 5 patients were compared with those of operation.Results Cardiac valve involvement wasn't rare.In the study,cardiac valve involvement was observed in 26% (13/50) of patients with BD.The principal manifestations of cardiac valve involvement were valve prolapse,perforation,split and regurgitation.Four (80%) patients had repeated operation.Conclusion Echocardiography provides the important information of valvular morphology and function in BD.
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Objective To evaluate the unusual echocardiographic manifestation and its clinical value in the patients with constrictive pericarditis (CP). Methods To analyse the echocardiographic manifestation of CP in 187 patients retrospectively, especially left ventricular ejection fraction (LVEF) and variation with respiration (VER) in mitral E velocity. Results Most of the patients with CP expressed the common echocardiographic features of CP. But some unusual echocardiographic signs were revealed. (1)LVEF
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0.05 ). After once injection both observers considered the number of clearly recognized endocardial border segments increased significantly. The number evaluated by observers A increased from 2.68 ? 0.95 to 5.99 ? 0.10 while from 2.82 ? 1.03 to 5.99 ? 0.11 by observers B( P 0.05 ). The average contrast enhancement rate of LV endocardial border was 99.7 %. Perfluoropropane-albumin microsphere injection had no significant effection on vital signs such as blood prssure, heart rate and respiration. Electrocardiogram didn′t change markedly and the variance of the laboratory findings like blood and urine routine examination, hepatic and renal function was in normal range. Only one case( 0.33 %) had slight side-effects who suffered from mild nausea and diarrhea, which suggested the clinical safety of this contrast agent. Conclusions Perfluoropropane-albumin microsphere injection could enhance the resolution of LV endocardial borders and make the judgement of regional myocardial movement easier. It has little side-effects and will be appropriate for clinical use.
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Objective To investigate the characteristics and the diagnostic value of the tissue strain imaging in constrictive pericarditis(CP).Methods Twenty-six patients and thirty controls underwent comprehensive echocardiography with apical four chamber tissue Doppler imaging and strain imaging.Peak strain of the middle segments of the inter-ventricle septum and left ventricular lateral wall was recorded.The peak strain difference and strain ratio between the two segments were calculated.Results In patients with CP peak strain of the left ventricle lateral wall was significantly lower than that of the septum[(-5.60?3.46)% vs(-14.14?4.11)%,P