Objective To explore after brainstem stroke patients with dysphagia by modified balloon dilation of the clinical effect of treatment and before and after the treatment in patients with pharyngeal function change by swallowing angiog -raphy digital analysis method for analysis and evaluation .Methods 60 patients with dysphagia after collection of brainstem stroke in our hospital were randomly divided into two groups .Control group (30 cases) underwent routine dysphagia rehabili-tation training in the treatment , and the observation group of 30 cases in the control group on the basis of the treatment added with balloon dilatation for treatment .Comparative analysis of pharyngeal contraction rate ( PCR) and pharyngeal contraction time between two groups before and after treatment were assessed by swallowing and digital measurement .Results There was no significant differences in PCR between two groups of patients before treatment ( P>0.05 ) .Compared with before treat-ment, the two groups of patients after treatment with different food PCR were significantly improved , and the difference was statistically significant (P<0.05).The improvement degree of the observation group was more significant than the control group (P<0.05).There was no significant difference between the two groups of patients before treatment (P>0.05).Com-pared with before treatment and after treatment in two groups of patients with different swallowing food pharyngeal contraction duration were significantly improved , and the difference is statistically significant ( P<0.05 ) and to improve the degree of the observation group compared with the control group is more significant ( P<0.05 ) .Conclusion The digital analysis technology of swallowing angiography can effectively evaluate the changes of pharyngeal function in patients with dysphagia af -ter stroke.It is worth to be further popularized .

Objective To explore the value of echocardiography on diagnosis and differential diagnosis of aortico-left ventricular tunnel(AOLVT).Methods Echocardiographic features of 9 patients with AOLVT were reviewed and analyzed.The diagnosis methodology was summarized;the reasons for missed diagnosis and misdiagnosis by echocardiography were analyzed.Results Among 9 patients with AOLVT,one was diagnosed through CT examination prior to the operation and died from the cardiac arrest.The others all received the surgical operation and were diagnosed as AOLVT.Five patients were accurately diagnosed by echocardiography prior to the operation,4 patients were misdiagnosed,in which 3 patients were diagnosed as aortic valve regurgitation,one patient was diagnosed as aortic dissecting aneurysm.The diameter of left ventricle(LV)decreased and LV ejection fraction increased distinctively for 7 operated patients(P＜0.001)in six months after operation.Only one operated patient failed to recover from the LV dysfunction and died of aortic valve perivalvular leak in two monthes.Conclusions The diagnosis of the AOLVT mainly depends on the echocardiography.By enhancing the understanding on such disease and investigating on the structure and hemodynamics will be contributive to the accurate diagnosis of echocardiography.

Objective To study the relativity of S/CO qualitative determination of hepatitis B surface antibody and quantitative assay.Methods The different concentrations of sera were determined with time-resolved fluorescence immunoassay and enzyme-linked immunosorbent assay. The standard curve was drawn and the equation was established.Results In the curve, S/CO level was positively correlative to the quantitative detection value, and the conversion equation was Y=8.911 8×e0.177 4X.The intraclass correlation coefficient of S/CO calculating level and quantitative value was 0.934.Conclusion The content of hepatitis B surface antibody can be estimated by S/CO value. It can be used in basic-level laboratories which don′t undertake the quantitative determination of HBV markers.

Objective To determine whether strain and strain rate derived from velocity vector imaging ( VVI) allowed assessment of regional and global right ventricular ( RV) dysfunction and intra‐and inter‐ventricular dyssynchrony in patients with pulmonary hypertension ( PHTN) . Methods Ninety‐nine patients were enrolled , including 35 controls and 64 PHTN patients . All participants underwent echocardiography examinations and off line strain/strain rate analysis . Bi‐ventricular regional peak systolic strain ,strain rate ,and the time‐to‐peak systolic variables were measured at the RV free wall ,inter‐ventricular septum ,and LV lateral wall in apical four chamber views . Standard deviations of the time‐to‐peak systolic strain (SD‐Ts) and strain rate (SD‐Tsr) at six RV and three left ventricular (LV) segments were calculated to define intra‐and inter‐ventricular dyssynchrony . Results Compared with the controls , segmental and global peak systolic strain and strain rate decreased in the PHTN patients . And intra‐right ventricular dyssynchrony was present in the PHTN patients [SD‐Ts:(28 ± 20)ms in controls vs (61 ± 62) ms in patients , P = 0 .003 ] . The difference between the time‐to‐peak systolic strain rate at the basal segment of RV free wall and LV lateral wall indicated earlier RV free wall contraction in PHTN patients , relativetoLVlateralwall,particularlyinthoseseverePHTNpatients[(13±13)msincontrolsvs( -49± 14) ms in patients , P < 0 .01] . Conclusions PHTN impairs RV myocardial contraction and induces to ventricular mechanical dyssynchrony .VVI could monitor RV function during the treatment of PHTN .

Objective To conclude the diagnostic methodology of unroofed coronary sinus (UCS) by two-dimensional echocardiography(2DE). Methods By analyzing the echocardiographic results of 16 UCS patients who were diagnosed by 2DE and confirmed by operation, the diagnostic methodology of UCS by 2DE was summarized. Results Sixteen patients with UCS were involved in this study. Among them, 12 cases were diagnosed as complete UCS,others were partial UCS(PUCS). Twelve patients were complicated with persistence of left superior vena cava (LSVC) that was connected to left atrium (LA) through UCS. All of preoperative diagnosis conducted by 2DE were finally confirmed to be consistent with the results of operation. With the analysis of acquired echo images,key points of diagnosis were concluded as follow: 1) normal coronary sinus (CS) could not be detected in the routine 2DE views referring CS. PUCS showed partial absence of CS roof,while complete UCS displayed as total absence of CS. 2)Inter-atrial shunt would definitely be found in UCS and the opening to right atrium must be coronary sinus orifice. The shunt direction was depended on the combined cardiac malformations. 3) With the occurrence of UCS,LSVC would be in junction with LA through UCS. 4) The inter-atrial shunt resulted in cardiac morphologic and hemodynamic changes. Conclusions Better understanding of the anatomic, morphological and hemodynamic characteristics of UCS would greatly contribute to accurate diagnosis on UCS.

Objective To investigate the use of laryngeal mask airway (LMA) ProSeal for airway management during open heart surgery performed under CPB in children. Methods Seventy-six ASA Ⅱ and NYHA class Ⅰ or Ⅱ patients aged 3 months-8 yr, weighing 3.3-34.5 kg undergoing open heart surgery under CPB were randomly divided into 2 groups ( n = 38 each): tracheal intubation group (group T) and ProSeal LMA group (group P1). Tracheal tube and LMA were inserted after induction of anesthesia with 8% sevoflurane. The rate of successfultracheal intubation and LMA placement, placement time, peak airway pressure and side effects during and after surgery including hypoxemia, tachycardia, bradycardia, hypotension and hypertension, laryngesl edema, dysphagia, bucking, dyspnea and hoarseness were recorded. Results There were no significant differences in the rate of successftl tracheal intubation and LMA placement, peak airway pressure, bucking, dyspnea and hoarse voice between the two groups (P＞ 0.05). The LMA placement time was significantly shorter than tracheal intubation time and the incidence of laryngeal edema and dysphagia lower in group P than in group T ( P ＜ 0.05). Conclusion The LMA ProSeal can provide adequate ventilation during operation with less complications and can be used effectively for cardiac surgery performed under CPB in children.

3D printing technology has been used in the diagnosis and treatment of cardiovascular diseases worldwide,i.e.,preoperative assessment of complex congenital heart disease,comprehensive assessment of novel clinical techniques,management of postoperative complications,and clinical teaching and training.Chinese hospitals introduced cardiovascular 3D printing technology from 2014.Preliminary clinical application showed that 3D printing had a positive significance,howeverit was expensive and caused inevitableloss of image information.Scholars should have an open but critical mind,actively try this technology and improve it.It can be reasonably believed as a good supplement of existing imaging tools in future.

Objective To evaluate the application of echocardiography in guiding percutaneous balloon pulmonary valvuloplasty in children and to summarize the key echocardiographic planes used in the procedure Methods From February 2013 to September 201 5 38 isolated congenital pulmonary valve stenosis patients were recruited Case inclusion criteria age ≥3 years old purely congenital pulmonary valve stenosis and pulmonary transvalvular pressure gradient ≥40 mmHg Echocardiography was used to assess the severity of pulmonary valve disease and to measure pulmonary transvalvular pressure gradient before procedure Intraoperative transthoracic or transesophageal echocardiography was used to monitor the whole process of percutaneous balloon pulmonary valvuloplasty and to evaluate immediate postoperative efficacy of the procedure All patients were followed up by echocardiography after a month post-discharge Results Thrity eight cases were successfully treated by echocardiography-guided percutaneous balloon pulmonary valvuloplasty The average age of children was 7 1 ±2 5 years mean body weight was 25 3 ±7 1 kg Before the procedure pulmonary transvalvular pressure gradient was 65 9 ± 8 9 mmHg pulmonary annular diameter was 14 6±1 1 mm Immediate postoperative pulmonary transvalvular pressure gradient was 1 5 5 ± 3 4 mmHg All children survived and had no significant complications After a month pulmonary transvalvular pressure was 16 1 ± 3 3 mmHg Conclusions Echocardiography plays an important role in percutaneous balloon pulmonary valvuloplasty for children with congenital pulmonary valve stenosis As a non-x ray guided way it has advantages in preoperative screening of patients intraoperative real-time monitoring and postoperative assessment of efficacy The key sections of echocardiography for intraoperative monitoring are four-chamber and aortic short axis view.

Objective:To explore the anatomic repair strategy for congenital corrected transposition of great arteries (ccTGA).Methods:At the retrospective study, from August 2004 to May 2019, all 120 consecutive ccTGA were included and all accepted anatomic repair. There were 36 cases with with left ventricular outlet obstruction(LVOTO) and cardiac malpositon [ages(4.6±2.2) years, weight(17.7±5.9)kg] underwent the one and a half ventricle repair(hemi-Mustard and bidirectional Glenn procedures combined with the Rastelli), 49 cases[ages(3.4±2.7) years, weight(17.7±11.4)kg] underwent double switch operation(Great artery swtich with Senning operation), 24 cases [ages(5.7±4.3) years, weight(19.1±8.6)kg] with LVOTO and ventricular sept defect(VSD) accepted the Rastelli with Senning operation, and 14 cases with LVOTO and remote VSD [ages(6.9±4.8) years, weight(23.0±12.9)kg] accepted the Double root transposition(DRT) with Senning operation. Follow up data were collected by telephone interviews and echo. The median follow-up time were 49 months varied from 20 to 84 months, 46 months varied from 18 to 108 months, 35 months varied from 7 to 84 months and 98 months varied from 72 to 145 months. Statistical analysis was performed with SPSS 19.0.Results:There were 6 in-hospital deaths and 2 follow-up deaths. The survival probability were(84.0±6.0)% and(84.0±6.0)% at 5 and 10 years after operation. The probability of freedom from re-intervention were(95.0±11.8)% and(89.0±11.8)% at 5 and 10 years after operation. All 6 patients need implant pacemaker for Ⅲ A-V block. Seven patients had moderate or more than moderate tricuspid regurgitation. The left ventricular(systemic ventricle) EF were 0.61±0.09, 0.63±0.08, 0.59±0.01 and 0.65±0.07 in one and a half ventricle repair group, double switch(AS group), Rastelli with Senning(RS group) and DRT with Senning(DS group) patients. There were 1 heart failure in one and a half ventricle repair group, 1 in AS group and 1 in RS group. For 36 pure ccTGA patients, compared with direct double switch patients these patients accepting double switch after pulmonary banding(PAB) had more EF(0.54±0.09 vs. 0.65±0.08, P=0.00). There were significantly less patients need re-operation in one and a half ventricle repair group compared with RS group(0 vs. 13.6%, P=0.03). Conclusion:For ccTGA/LVOTO/cardiac malpositon, the one and a half ventricle repair was ideal strategy with significant less RV-PA conduit stenosis and re-operation. For pure ccTGA patients, second staged double switch after PAB had better long-term heart function. For ccTGA/ LVOTO/ remote VSD patients DRT with Senning was ideal strategy.

Objective To explore determinants of functional tricuspid regurgitation with twodimensional (2D) and three-dimensional (3D) echocardiography,and to provide theoretical basis for surgery treatments.Methods Fifty-six subjects with left-sided valular diseases and tricuspid regurgitation underwent 2D and 3D echocardiography examinations.The tricuspid annulus diameter,the valvular tethering height and right ventricular volume and ejection fraction were measured.Results Based on the degree of tricuspid regurgitation,the patients were grouped into mild regurgitation (group 1) and moderate or more regurgitation (group 2).Comparing the two groups by t test,the tricuspid annulus diameter,the largest distance of tricuspid valvular tethering and the end-diastolic right ventricle volume had significantly enlarged in group 2 ( P ＜0.01 ).And the degrees of tricuspid regurgitation had good correlations with the annulus diameter,the valvular tethering,the right ventricular volume and pulmonary artery systolic pressure.Also,the 3D echocardiography revealed there were some valvular pathologies aggravating regurgitation.Conclusions The degree of functional tricuspid regurgitation is mainly determined by the annulus dilation and pulmonary hypertension.Further more,the 3D echocardiography can give us more details of the valves.