Objective To explore the value of echocardiography in patients with aortic stenosis who underwent transapical aortic valve implantation (TAAVI).Methods Fifteen high-risk patients with severe aortic stenosis were chosen in the present study,all of which received TAAVI in Fuwai Hospital Chinese Academy of Medical Sciences from June 2014 to March 2015.The left ventricular end-diastolic diameter (LVEDD),left atrial diameter (LAD),left ventricular ejection fraction (LVEF),effective orifice area (EOA),mean aortic pressure gradient (MPG),as well as artificial valve function of patients were measured at different time points (before operation,discharge,1 month and 3-6 months after operation) by echocardiography.The data were analyzed using one-way ANOVA analysis with SPSS software,and multiple comparisons were done using LSD student t test.Results The data from preoperative echocardiography indicated severe aortic stenosis in the 15 patients,with the average level of EOA as (0.55± 0.28) cm2 and MPG as (58.93± 14.96) mmHg (1 mmHg=0.133 kPa).Moderate paravalvular aortic regurgitation was observed in one patients,who was then received a second implantation.There was no significant difference between LVEDD,LAD,and LVEF when the patients were at discharge,1 month and 3-6 months after operation.The prosthetic valves were stable and conformed by echocardiography,while paravalvular leak regurgitation (1-2 mm) was observed in 7 patients.One patient died of other reasons.Compared with preoperative data,the EOA increased while MPG decreased when the patients were at discharge,1 month and 3-6 month after operation (t=6.619,7.357,6.401,all P ＜ 0.001;t=9.523,9.687,5.932,all P ＜ 0.001).Conclusion With careful patient screening and selection,TAAVI can be an effective treatment for high-risk severe aortic stenosis patients,in which echocardiography plays an important role during the surgery and follow up.

Objective To evaluate the clinical application value of epicardial transesophageal echocardiography (ETE) in cardiac surgeries. Methods Using the transesophageal multi-plane ultrasonic probe of GE company, ETE were performed for a total of 53 patients undergoing cardiac surgeries with extracorporeal circulation and heart re-beat, evaluating valvular function, left ventricular systolic function and residual shunts. Results Qualiifed ETE images were obtained in all of the 53 cases without complications of infection, bleeding and serious arrhythmia. Intraoperative regional left ventricular systolic dysfunction happened in 5 cases and was promptly handled. Residual mitral regurgitation after valvular replacement was found in one case, which was reduced by valvuloplasty. One case showed moderate tricuspid regurgitation and another two cases indicated residual shunt. All the problems in the above cases were corrected in immediate surgeries. Moreover, the pressure gradient of one hypertrophic obstructive cardiomyopathic patient fell significantly to 8 mmHg after successful myectomy (the blood flow velocity fell from 3.2 m/s to 1.4 m/s). Conclusion Epicardial transesophageal echocardiogramphic examination is easy to handle and useful in monitoring abnormalities in cardiac surgery by providing hemodynamic and anatomic information.

Objective: To assess the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on mid- to long-term left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) by real-time three-dimensional echocardiography (RT-3DE). Methods: A total of 46 HOCM patients who received 2DE and RT-3DE examination before and after (with the mean of 18.8 months) PTSMA were studied. The ratios of E/A and E/Ea were analyzed, RT-3DE was conducted to collect the images, to obtain 17-segmant volume-time curve and to calculate the parameters of rEDV, rESV, rSV and rPFR respectively. Results: The follow-up echocardiography in all 46 patients indicated that the ratio of E/Ea decreased after the operation (12.04 ± 3.29) vs (15.70 ± 5.68),P<0.001, the rSV of left ventricular anterior wall middle segment and anterior septal middle segment decreased after the operation,P<0.05, while the rPFR of anterior septal middle segment, rear septal middle segment and apical segment increased,P<0.05. Conclusion: PTSMA may improve local left ventricular diastolic function in HOCM patients, RT-3DE provides a new method and viewing angle for HOCM evaluation.

Objective: To evaluate the intro-operative transesophageal echocardiography (TEE) for extended septal myectomy in patients with obstructive hypertrophic cardiomyophathy (HCM).
Methods: A total of 56 obstructive HCM patients with extended septal myectomy in our hospital from 2012-01 to 2012-12 were retrospectively studied. The results of pre-operative transthoracic echocardiography, intro-operative TEE and post-operative transthoracic echocardiography were analyzed and compared.
Results: There were 36 male and 20 female patients with the average age of (46.1 ± 11.3) years. The pre-operative width of inter ventricular septal was (26.1 ± 6.9) mm, left ventricular outlfow tract (LVOT) pressure gradient was (87.5 ± 12.5) mmHg. All patients received successful operation, no in-hospital death, no TEE related complication. The removed ventricular septal thickness was at (10.7 ± 2.1) mm, length at (39.1±5.5) mm. Compared with pre-operative transthoracic echocardiography, TEE indicated the immediate drop of post-operative LVOT peak velocity (4.57 ± 0.99)m/s vs (1.68±0.46)m/s and LVOT peak gradient (87.5 ± 34.4) vs (11.3 ± 7.0) mmHg, both P<0.001;signiifcant reduce of mitral regurgitation (MR) and mitral valve systotic onterior motion, both P<0.001. TEE showed that intra-operative LVOT peak velocity (r=0.63) and LVOT peak gradient (r=0.48) well related to post-operative transthoracic echocardiography. Post-operative TEE found that 2 patients had ventricular septal defect and 1 received surgical repair.
Conclusion: TEE is safe for extended septal myectomy in obstructive HCM patients. It may pre-operatively identify the cause and degree of MR, evaluate the post-operative improvement of LVOT obstruction and MR. Meanwhile, TEE may ifnd the surgical complication for in time correction in relevant patients.

Objective To evaluate the value of echocardiography in transcatheter closure of ruptured sinus of Valsalva aneurysm(TC-RSVA).Methods TC-RSVA was attempted in 11 patients.The location,shape,size of defects and its relationship with the neighbor structures were revealed before the procedure.Then the deployment of occluder was monitored during the procedure,and the effectiveness was observed in the follow-up.Results Eleven patients were diagnosed as the isolated RSVA by echocardiography.The size of defects was 2 - 13 mm estimated by echo.The procedures were successful in all patients.Usually the Amplatzer duct occluders were chosen to be 1 to 5 mm larger than the size of defects.Three patients had mild residual shunt during the procedure,which all dispeared in the first month of follow-up,but one of them demonstrated recurrent mild residual shunt in the 32nd month of follow-up.There was no aggravating aortic regurgitation in the follow-up.Conclusions TC-RSVA is relatively safe and effective.Observation of long-term effectiveness is still necessary.Echocardiagraphy plays an important role in TC-RSVA.

Objective To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients.Methods A total of 60 patients with HCM and left ventri cular outflow tract gradient (LVOTG) ＜ 50 mm Hg (1 mm Hg =0.133 kPa) at rest were enrolled consecutively,and LVOTG at rest and exercise were measured by echocardiography.Of 51 patients with gradients ＜ 30 mm Hg at rest,26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg,25 were non LVOTO with exercise peak value LVOTG ＜ 30 mm Hg,and 9 were resting obstruction with LVOTG 30-49 mm Hg.The morphological characteristics of different types of obstruction were analyzed.Results Patients with latent LVOTO were more likely to have SAM(73.1％ vs 8.0％),narrow of LVOT(46.2％ vs 4.0％),higher resting gradients [(16.9 ±7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values ＜ 0.05).The distribution of septal hypertrophy were different in the two groups (P ＜ 0.05).Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431,95 ％ CI 2.323-291.112,P =0.002) at rest and distribution of septal hypertrophy (OR 0.011,95％ CI 0.001-0.179,P =0.008).Conclusions Approximately half of patients with nonobstructive HCM at rest have latent LVOTO.SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.

Objective To evaluate the left ventricular segmental and global systolic myocardial function of the hypertrophic obstructive cardiomyopathy (HOCM) before and after transcoronary ablation of septal hypertrophy (TASH).Methods Twenty-six consecutive patients with HOCM were analysed by two-dimensional speckle tracking imaging (STI) before and after TASH.The left ventricular global and segmental systolic longitudinal strains and circumferential strain were measured.Results In the HOCM patients,the global and segmental longitudinal strains were lower than the healthy population before TASH.One week after TASH,a significant reduction of left ventricular outflow tract (LVOT) gradients occurred (P ＜ 0.001).The global and the alcohol-treated septal segmental longitudinal strains also decreased significantly[(-12.5±1.7)％ vs (-13.6± 1.6)％,P＜0.01;(-11.2±2.8)％ vs (-12.6±3.1)％,P ＜ 0.001].During 1 year follow-up after TASH,the mean NYHA function class improved after TASH (P ＜ 0.001) and the left ventricular outflow tract (LVOT) gradients and septal thickness decreased (P ＜0.001).The left ventricular global longitudinal systolic strain was increased [(-14.7 ± 2.0) ％ vs (-13.6 ±1.6) ％,P ＜0.01],and this was correlated with the decrease of the LVOT gradients (r =0.579,P ＜0.01).The alcohol-treated septal segments showed unchanged average longitudinal strain over time,while in the anterolateral and the anterior segments,the average longitudinal systolic strain increased (P ＜0.05).The basal and medial segments also showed increased average longitudinal systolic stain.However,the left ventricular circumferential strain had no changes after TASH.Conclusions TASH can significantly decrease the LVOT gradients and improve NYHA functional class with the increase of the left ventricular global and segmental longitudinal systolic function.

OBJECTIVETo investigate expression of tissue transglutaminase (tTG) protein and its role in carcinogenesis of brain tumors.

METHODStTG protein was detected by immunohistochemical method in 62 astrocytomas, 18 oligodendrogliomas, 30 benign meningiomas, 30 pituitary adenomas and 10 normal brain tissues.

RESULTS(1) In brain tumors, tTG protein expression was heterogeneous locating in tumor and endothelial cells. (2) Immunoreactivity of tTG protein was significantly different between different grades of astrocytomas. (3) Expression intensity of tTG protein in glioma was higher than that in benign brain tumors. (4) Strong expression of tTG protein in tumor cell was obtained around the necrosis foci and apoptotic cells in astrocytomas.

CONCLUSIONStTG protein expression contributed to tumor malignant progression in malignant brain tumors.

Adolescent ; Adult ; Aged ; Apoptosis ; Astrocytoma ; enzymology ; pathology ; Brain Neoplasms ; enzymology ; pathology ; Child ; Endothelial Cells ; enzymology ; Female ; GTP-Binding Proteins ; biosynthesis ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Oligodendroglioma ; enzymology ; pathology ; Transglutaminases ; biosynthesis

OBJECTIVETo evaluate high resolution MR in imaging of the anatomy and tumor invasion of the anal canal.

METHODSTwenty-three patients with low rectal cancer confirmed by pathology results were recruited as the study group and 20 patients without history of anal canal diseases were recruited as the control group. All patients received MRI examinations containing three TSE-T2WI sequences and three 3D-VIBE sequences. The distance between the tumor and the anal margin was measured in the study group. Two radiologists finished T staging of the tumor independently.

RESULTSMRI had a clear demonstration of the anatomy of the anal canal in all 20 control patients. The T staging of 23 patients of study group was T2 (n=8), T3 (n=7), and T4 (n=8), and the depth of anal canal invasion (T-DACI) was T0-DACI (n=10), T1-DACI (n=1), T2a-DACI (n=3), T2-DACI (n=3), T3-DACI (n=4) and T4-DACI (n=2). Eight patients received surgery and the consistency between pathological staging and imaging staging was 75%.

CONCLUSIONHigh resolution MRI has the capacity of demonstrating the complex anatomy of the anal canal, and can provide evidence of anal canal invasion for low rectal cancer.

Anal Canal ; pathology ; Humans ; Magnetic Resonance Imaging ; Neoplasm Staging ; Rectal Neoplasms ; pathology

Objective: To evaluate the effect of echocardiography for occluding the multiple seconded atria1 septal defects ( MASD) in relevant patients.
Methods: A total of 42 MASD patients were selected by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The transcatheter closure was monitored by TTE and X-ray, the effect of treatment was evaluated by TTE, ECG and chest X-ray at 24 hours and 1, 3, 6 months after the procedure. There were 38 patients with 2 defects, 3 with many central small defects and 1 with 3 defects. The patients included 17 male and 25 female with the mean age of (32.6 ± 13.4) years.
Results: The size and distance of the defects were measured with 4 cardiac chambers cross sectional study. The mean diameter of bigger defect from up to down was (9-27) mm, with the mean of (20.7 ± 6.1) mm, from front to back was (8-23) mm, with the mean of (16.9 ± 5.7) mm;the mean diameter of small defect from up to down was (3-12) mm, with the mean of (6.8 ± 3.6) mm. The length of the defect interva1 was (4-18) mm, with the mean of (7.9 ± 2.6) mm. There were 4 patients with 2 defect interval at 8.7 mm who received 2 occluders without post-operative lfow shunt. The rest 38 patients received 1 Amplatzer occluder which was (14-36) mm with the mean of (25.1 ± 6.4) mm which was (6.9 ± 1.7) mm larger than echocardiographic prediction. The success rate of implantation was 100%. There were 17 (40.5%) patients with post-operative lfow shunt. The patients were followed-up for (6-36) months, with the mean of 18.7 months, there were 11 (26.2%) patients with small amount of lfow shunt at 3 months after the operation.
Conclusion: Echocardiography is important for choosing the type and size of occluder devices, in-operative monitoring and post-operative effect evaluation for treating the ASD patients.