Objective To evaluate the accuracy of preoperative diagnosis on the anatomy of coronary artery of patients with arterial switch operation(ASO) using echocardiography, to conclude the diagnostic methods. Methods From March 2007 to March 2008,50 patients were performed ASO after the diagnosis with eehoeardiography. Prior to the operation, evaluation was conducted to all of anatomical pattern of the coronary artery,and the comparison was made to the observation in the operation. There were 23 patients with complete transposition of great artery(TGA), 20 patients with double outlet of right ventricle of abnormal great artery(DORV), 2 patients with corrected transposition of the great arteries(CTGA), 1 patients with double outlet of left ventricle of abnormal great artery (DOLV), 2 patients with TGA complicated with total anomalous pulmonary venous connection (TGA + TAPVC), 2 patients with TGA complicated with pulmonary valve stenosis(TGA + PS). Results Among 50 patents,there were 40 patients with normal coronary artery,and 10 patients with abnormal coronary arteries. Except for 2 patients failing to being successfully diagnosed due to bad condition of image,48 patients could be revealed the origin and the direction of the major coronary arteries, the visibility proportion was 96.0%. Compared to the observation in the operation,the total echocardiography accuracy for 48 patients was 95.8%. Among the 40 patients with normal coronary arteries,39 patients were diagnosed accurately except 1 patient failed to be showed clearly by echo. In the 10 patients with abnormal coronary arteries,4 patients with single abnormal coronary artery, 2 patients with 2 coronary artery originating from the same coronary sinus, 2 patients with left anterior descending coronary artery originating from right coronary artery, 2 patients with 2 coronary artery originating from two adjacent coronary sinus. One patient failed to be diagnosed by echo for the bad image,2 patients was misdiagnosed by echo, the accuracy of echo was 77.8%. Conclusions Through multi-section scanning,echocardiography can accurately diagnose anatomical pattern of coronary artery for most of ASO,thus providing comprehensive and accurate diagnosis information for ASO.

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 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 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.

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 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 evaluate the results of hybrid procedure in treating infants and children with severe pulmonary stenosis (PS) and the clinic value of echocardiography in the whole procedure.Methods Hybrid therapy was performed in 43 patients [(7.1±6.8)months,ranging 5 days to 33 months] with severe PS.The echocardiography data in the whole procedure and follow up were reviewed.Results Aided by echocardiography,the hybrid therapy was successful in 43 cases without major complication.Immediately following valvuloplasty,the gradient across pulmonary valve decreased from (92.5±21.4)mm Hg to (23.6±13.0)mm Hg (P<0.05).The growth and development of 27 patients in follow-up study was well.No restenosis was found and tricuspid regurgitation decreased differently.Conclusions Hybrid procedure is effective and safe for the treatment of infants and children with severe PS.And echocardiography play an important role in the whole procedure.

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.

Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography.
Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure.
Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation.
Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.