Objective To investigate the feasibility and clinical application of real-time threedimensional transesophageal echocardiography(RT3D-TEE). Methods Fifty-nine patients with various heart diseases were examined or monitored by RT3D-TEE.Among them,20 patients with different kinds of arrhythmias,24 patients with valvular heart diseases, 12 patients with congenital heart diseases,2 patients with aortic dissection, 1 with unexplained pulmonary hypertension. Results RT3D-TEE was performed successfully in all the patients with good image quality and the normal tissues as well as diseased cardiac structures were distinctly displayed.Conclusions RT3D-TEE is a safe and reliable new technique which can be applied in the patients with poor acoustic window and may be a powerful tool in the intraoperative monitoring.RT3D-TEE is also an important supplement to real time three dimensional transthoracic echocardiography and makes it possible for the first time to monitor the cardiac operation with RT3D-TEE without interrupting the operation procedure.

Objective    To analyze the assessment and maintenance of 125 donor hearts from brain death donation and explore the use of marginal donor hearts. Methods    A retrospective analysis was conducted on the evaluation, maintenance, operation and follow-up results of 125 donor hearts from April 2016 to August 2019. There were 98 males and 27 females at age of 6-50 (36.0±2.4) years. Results    Twelve donor hearts were discarded due to unqualified evaluation after heart harvest. 113 patients of heart transplantation were performed with a double lumen venous anastomosis manner. The mean time of cold ischemia was 220.1±6.7 min. Four patients died within 30 days after operation. Postoperative right ventricular assist circulation was performed in 4 patients, intra-aortic balloon counterattack (IABP) in 12 patients and extracorporeal membrane oxygenation (ECMO) in 12 patients. Marginal donors included 15 hepatitis B antigen positive donor hearts, 2 tricuspid regurgitation, 1 mitral regurgitation, 5 coronary calcification, 4 myocardial stunning and 2 severe weight mismatch. The results of follow-up (2 years) after marginal donor heart transplantation were satisfactory. Conclusion    Improving the assessment and maintenance of donor hearts can improve the utilization rate of the heart, and the marginal donor heart transplantation needs long-term follow-up.

Objective To analyze the short- and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body (IVFB) via double valve replacement (Commando procedure) or aortic valve replacement and mitral valve repair (Hemi-Commando procedure). Methods The patients who underwent Commando or Hemi-Commando procedure between September 2014 and September 2022 in Guangdong Provincial People’s Hospital were collected. The perioperative and follow-up data were reviewed and analyzed for the assessment of short- and mid-term outcomes. Results Eleven patients received Commando procedure (a Commando group), including 4 males and 7 females with a median age of 61 (33, 68) years; 7 patients received Hemi-Commando procedure (a Hemi-Commando group), including 5 males and 2 females with a median age of 50 (36, 58) years. Two patients died in the postoperative 30 days (1 patient in the Commando group and 2 patients in the Hemi-commando group). Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death. Fifteen patients were discharged and followed up for 13 (6, 42) months, with a survival rate of 100%. The rates of free from recurrent endocarditis or re-operation were both 100%. Conclusion Commando and Hemi-Commando procedures are effective strategies for IVFB reconstruction, and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.