To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.
Echocardiography, Doppler/instrumentation ; Echocardiography, Doppler/*methods ; Heart Ventricles/*ultrasonography ; Myocardial Contraction/*physiology ; Sinoatrial Node/physiology ; Tachycardia/physiopathology ; Tachycardia/ultrasonography

The paper presents a novel fetal heart rate (FHR) detecting system which is a fuzzy counter using the auto-correlation and fuzzy mathematic algorithm. This system is able to deal with the increase and decrease phenomena of FHR, caused by the various interference and noises. It has a higher detection level than ever and a better robust system based on the DSP.
Algorithms ; Echocardiography, Doppler ; instrumentation ; Equipment Design ; Fetal Monitoring ; instrumentation ; Fuzzy Logic ; Heart Rate, Fetal

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.
Animals ; Dogs ; Echocardiography, Doppler ; instrumentation ; methods ; Heart Ventricles ; diagnostic imaging ; Myocardial Contraction ; physiology ; Sinoatrial Node ; physiology ; Tachycardia ; diagnostic imaging ; physiopathology

Transcatheter aortic valve implantation and transcatheter mitral valve repair (MitraClip) procedures have been performed worldwide. In this paper, we review the use of two-dimensional and three-dimensional transesophageal echo for guiding transcatheter aortic valve replacement and mitral valve repair.
Aged ; Aged, 80 and over ; Aortic Valve Stenosis/*therapy/*ultrasonography ; Balloon Valvuloplasty ; Bioprosthesis ; *Cardiac Catheterization/adverse effects/instrumentation ; *Echocardiography ; Echocardiography, Doppler, Color ; Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects/instrumentation/*methods ; Humans ; Mitral Valve Insufficiency/*therapy/*ultrasonography ; Predictive Value of Tests ; Prosthesis Design ; Severity of Illness Index ; Surgical Instruments ; Ultrasonography, Interventional/*methods

No abstract available.
Aged ; *Cardiac Catheterization/instrumentation ; Computed Tomography Angiography ; Coronary Angiography/methods ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial/diagnostic imaging/*therapy ; Humans ; Septal Occluder Device ; Treatment Outcome

OBJECTIVETo evaluate the indications, methodology and results of the transcatheter closure of patent ductus arteriosus (PDA) with the new Amplatzer Duct Occluder II (ADO-II).

METHODTotally 51 patients underwent transcatheter closure of PDA with the new ADO-II. The devices were delivered by 4F or 5F sheath through arterial or venous side respectively. The descending aorta angiography and transthoracic echocardiography was performed to evaluate the device position, residual shunt and complications caused by the device during and after implantation.

RESULTForty-nine patients had successful transcatheter closure of the PDA without significant residual shunts and artery obstruction during the short-term follow-up. One patient received the ADO-II dislodgment and first generation ADO re-implantation for the obvious descending aortal obstruction caused by ADO-II. Another patient had the ADO-II dislodgment and left pulmonary artery shaping surgery, because the ADO-II implantation led to obstruction of the left pulmonary artery. Both the obstructions in these two patients were ameliorated afterwards.

CONCLUSIONThe transcatheter closure using the ADO-II is safe and effective for the non-window type PDA with a small size.

Adolescent ; Aortography ; Cardiac Catheterization ; instrumentation ; methods ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; diagnostic imaging ; surgery ; Echocardiography, Doppler ; methods ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Prosthesis Design ; Pulmonary Embolism ; epidemiology ; etiology ; surgery ; Reoperation ; Septal Occluder Device ; Treatment Outcome

OBJECTIVETo assess agreement between the ultrasonic cardiac output monitor (USCOM) and conventional echocardiography (ECHO) in the measurement of cardiac output in newborn infants, investigate the accuracy and clinical utility of the USCOM in healthy neonates. To explore a more convenient, faster, more accurate hemodynamic monitoring method, for improving the outcome of the critically ill neonates.

METHODFrom October 1(st), 2011 to March 31(st), 2012, a total of 49 infants were included, 20 were term infants, 29 were preterm infants. Cardiac outputs were measured by both ultrasonic cardiac output monitor and echocardiography in all the infants, 60 times measurements were done in both the term infants the preterm infants. The cardiac output of the left and right ventricles, heart rate, diameter and velocity time integral of the aortic valve and pulmonary artery valve of each infant were recorded. The consistency of two methods was analyzed as described by Bland-Altman.

RESULTTerm the term infant group includea 20 term infants, 11 were male and 9 were female, the mean gestational age were (38.1 ± 0.56) weeks, mean age were (2 ± 1) days, mean weight were (3.2 ± 0.29) kg, mean Apgar score were 10. The mean left ventricular output measured by Echo was (242.3 ± 38.9) ml/(kg·min), measured by USCOM was (211.7 ± 38.5) ml/(kg·min); The mean right ventricular output measured by ECHO was (318.9 ± 47.0) ml/(kg·min), measured by USCOM was (340.7 ± 76) ml/(kg·min). Agreement between Echo and USCOM for left ventricular output (LVO) was (bias, ± limits of agreement, mean % error): (30.6 ± 51.1) ml/(kg·min), 21%, and for right ventricular output (RVO): (-21.8 ± 105) ml/(kg·min), 33.2%. The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than that estimated by ultrasonic cardiac output monitor (P < 0.001). The velocity time integral of the pulmonary artery valve measured by ultrasonic cardiac output monitor were significantly larger than measured by conventional echocardiography (P < 0.001). The heart rate, velocity time integral of the aortic valve measured by two methods had no significant differences (P > 0.05). The preterm neonates group included 29 preterm infants, 18 were male and 11 were female, the mean gestational age were (32.6 ± 2.8) weeks, mean age were (2 ± 1) days, mean weight were (1.88 ± 0.57) kg. All the infants were diagnosis as preterm infant, low birth weight. The mean left ventricular output measured by ECHO was (259.8 ± 70) ml/(kg·min), measured by USCOM was (235.6 ± 61.8) ml/(kg·min), the mean right ventricular output measured by ECHO was (318.9 ± 47.0) ml/(kg·min), measured by USCOM was (340.7 ± 76) ml/(kg·min). Agreement between Echo and USCOM for left ventricular output (LVO) was (bias, ± limits of agreement, mean % error): (24.1 ± 71.2) ml/(kg·min), 27.4%, and for right ventricular output (RVO): (-29.5 ± 192.9) ml/(kg·min), 51.8%. The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than estimated by ultrasonic cardiac output monitor (P < 0.001). The velocity time integral of the pulmonary artery valve measured by USCOM were significantly larger than that measured by conventional echocardiography (P < 0.001). The heart rate, velocity time integral of the aortic valve measured by two methods had no significant differences (P > 0.05).

CONCLUSIONAgreement between USCOM and conventional ECHO in the LVO measurement is acceptable, both in the term group and the preterm group. LVO measurement measured by USCOM is recommended. The accuracy and clinical utility of the USCOM in neonates is acceptable. USCOM is a convenient, fast and accurate hemodynamic monitoring method in neonates. While the agreement between USCOM and conventional ECHO in the RVO measurement is poor, especially in the preterm group, the results of the RVO cannot be considered interchangeable in the two methods.

Cardiac Output ; Echocardiography, Doppler ; instrumentation ; methods ; Female ; Heart Rate ; physiology ; Hemodynamics ; physiology ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Male ; Monitoring, Physiologic ; methods ; Reproducibility of Results ; Sensitivity and Specificity ; Ventricular Function ; physiology

OBJECTIVE: To discuss the suitable types of ventricular septal defects for asymmetric occluders, and elucidate the critical role of echocardiography in choosing occluders, guiding successful occlusion and avoiding injury during operation. METHODS: We retrospectively studied 179 patients with ventricular septal defects who received minimal-invasive surgical device closure with asymmetric occluder. We analyzed the types, size and morphology of ventricular septal defects suitable for asymmetric occluders. The therapeutic efficiency was evaluated by follow-ups. RESULTS: Out of the 179 successful cases treated with asymmetric occluders, 86.59% had perimembranous ventricular septal defects, and double-committed sub-arterial ventricular septal defects accounted for 13.41%. In general, the size of occluders to be selected was the maximum diameter of the defects plus 2-3 mm. Follow-ups showed that occluders were placed and fixed properly. No severe residual shunt, valve regurgitation or heart block were discovered. CONCLUSION Application of asymmetric occluders expands the range of indications for occlusion via small chest incision. Accurate echocardiography helps to improve the safety and successful rate of the surgery.
Adolescent ; Child ; Child, Preschool ; Echocardiography, Doppler, Color ; Female ; Heart Septal Defects, Ventricular ; diagnostic imaging ; surgery ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Retrospective Studies ; Septal Occluder Device

A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.
Aged ; Cardiac Surgical Procedures ; methods ; Cardiology ; instrumentation ; methods ; Catheters ; Echocardiography ; methods ; Equipment and Supplies ; Female ; Heart Ventricles ; physiopathology ; Humans ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; surgery ; Pulmonary Disease, Chronic Obstructive ; complications ; Risk ; Ultrasonography, Doppler ; methods ; Ventricular Dysfunction, Left ; surgery

OBJECTIVETo document the five-year follow-up results of transcatheter Amplatzer duct occluder (ADO) occlusion of patent ductus arteriosus (PDA) in children and to assess the safety and effectiveness of this method for PDA closure.

METHODSA retrospective cohort study was completed in patients with PDA underwent transcatheter closure by the ADO in Guangdong Cardiovascular Institute from April 1998 to December 2003.

RESULTSTranscatheter closure of PDA with ADO was attempted in 250 children patients. The median age was 5.3 years and median weight was 15.1 kg. The PDAs were from 1.8 mm to 11.0 mm (median 4.2 mm) in the narrowest diameter, of which 52 were larger than 5 mm (20.0%). All PDAs were occluded with 4 approximately 14 mm ADO through 6F (n = 205) or 7F (n = 45) sheaths. Devices were successfully implanted in 245 patients (98.0%). The Qp/Qs decreased from 1.90 +/- 0.60 to 1.03 +/- 0.21 (P < 0.05). All shapes of the PDA could be closed. Late complication occurred in five patients, including hemolysis in three patients and the los of the pulse of femoral artery in two patients. Follow-up after device implantation was accomplished in 205 patients (82.0%). The incidence of residual shunt at follow-up periods of 1 d, 1 m, 6 m, 12 m, 24 m, 36 m, 48m and 60 m after device occlusion was 9.2%, 2.8%, 1.2%, 0.8%, 0, 0, 0 and 0, respectively. Five patients (2.0%) required re-intervention to treat residual shunt with or without hemolysis. Event-free rates were 98.0% at one year and five years.

CONCLUSIONThis long-term follow-up result confirmed the safety and effectiveness of ADO closure of PDAs in children.

Adolescent ; Balloon Occlusion ; adverse effects ; instrumentation ; methods ; Cardiac Catheterization ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; diagnostic imaging ; therapy ; Echocardiography, Doppler, Color ; Embolization, Therapeutic ; adverse effects ; methods ; Female ; Follow-Up Studies ; Hemolysis ; Humans ; Infant ; Male ; Radiography, Interventional ; Retrospective Studies ; Time Factors ; Treatment Outcome